To assess the available data on the prevalence of metabolic syndrome (MS) in Latin-American countries.

Systematic review. Searches were carried out in PubMed, ISIWeb, SCielo and Redalyc, using ‘metabolic syndrome x’ and ‘prevalence’ as keywords for titles and/or abstracts. Articles selected were cross-sectional studies in Latin-American countries, whose main objective was to study MS and whose study population is described below. MS must be determined using Adult Treatment Panel III criteria. Twelve studies with these criteria were selected, one of which was multi-centric.

Latin America.

Apparently healthy subjects aged 18–65 years (including young adult, mature adult and elderly populations) of both genders.

The general prevalence (weighted mean) of MS in Latin-American countries was 24·9 (range: 18·8–43·3) %. MS was slightly more frequent in women (25·3 %) than in men (23·2 %), and the age group with the highest prevalence of MS consisted of those over 50 years of age. The most frequent components of MS were low HDL cholesterol levels (62·9 %) and abdominal obesity (45·8 %). Similar outcomes were obtained from the multi-centre study on Latin-American populations analysed.

The present review brings us closer to an understanding of the prevalence of MS in Latin-American countries. However, it is not possible to know the full scope of the problem, partly because data from some countries are not available, and because the methodological differences among the studies published up to the present limit a joint analysis of their results.

To compare the general adiposity index (BMI) with abdominal obesity indices (waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR)) in order to examine the best predictor of cardiometabolic risk factors among Hispanics living in Puerto Rico.

Secondary analysis of measurements taken from a representative sample of adults. Logistic regression models (prevalence odds ratios (POR)), partial Pearson's correlations (controlling for age and sex) and receiver-operating characteristic (ROC) curves were calculated between indices of obesity (BMI, WC, WHR and WHtR) and blood pressure, HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), total cholesterol (TC):HDL-C, TAG, fasting blood glucose, glycosylated Hb, high-sensitivity C-reactive protein (hs-CRP), fibrinogen, plasminogen activator inhibitor-1 (PAI-1) and an aggregated measure of cardiometabolic risk.

Household study conducted between 2005 and 2007 in the San Juan Metropolitan Area in Puerto Rico.

A representative sample of 858 non-institutionalized adults.

All four obesity indices significantly correlated with the cardiometabolic risk factors. WHtR had the highest POR for high TC:HDL-C, blood pressure, hs-CRP, fibrinogen and PAI-1; WC had the highest POR for low HDL-C and high LDL-C and fasting blood glucose; WHR had the highest POR for overall cardiometabolic risk, TAG and glycosylated Hb. BMI had the lowest POR for most risk factors and smallest ROC curve for overall cardiometabolic risk.

The findings of the study suggest that general adiposity and abdominal adiposity are both associated with cardiometabolic risk in this population, although WC, WHR and WHtR appear to be slightly better predictors than BMI.

To describe regional differences between eastern and western Germany with regard to food, nutrient and supplement intake in 9–12-year-old children, and analyse its association with parental education and equivalent income.

Data were obtained from the 10-year follow-up of the two prospective birth cohort studies – GINIplus and LISAplus. Data on food consumption and supplement intake were collected using an FFQ, which had been designed for the specific study population. Information on parental educational level and equivalent income was derived from questionnaires. Logistic regression modelling was used to analyse the effect of parental education, equivalent income and region on food intake, after adjusting for potential confounders.

Germany.

A total of 3435 children aged 9–12 years.

Substantial regional differences in food intake were observed between eastern and western Germany. Intakes of bread, butter, eggs, pasta, vegetables/salad and fruit showed a significant direct relationship with the level of parental education after adjusting for potential confounders, whereas intakes of margarine, meat products, pizza, desserts and soft drinks were inversely associated with parental education. Equivalent income had a weaker influence on the child's food intake.

Nutritional education programmes for school-age children should therefore account for regional differences and parental education.

To determine the number of 24 h dietary recalls required to adequately estimate nutrient intake in overweight and obese adults using the US Department of Agriculture's (USDA) automated multiple-pass method (AMPM). In addition, the study quantified sources of variation in dietary intake, such as day of the week, season, sequence of diet interviews (training effect), diet interviewer, body weight and within- and between-subject variances in the intake of selected nutrients.

Adults having a BMI of ≥ 28 but <38 kg/m2 were included in the study. The USDA's AMPM was used to obtain 24 h dietary recalls every 10 d for 6 months. Dietary intake data were analysed to adequately estimate the number of 24 h recalls necessary to assess nutrient intake. Variance component estimates were made by using a mixed-model procedure.

The greater Washington, DC, metropolitan area.

Adults (34 men and 39 women) aged 35–65 years.

Overweight and obese adults completed fourteen 24 h dietary recalls. Utilizing within- and between-subject variances requires 5–10 and 12–15 d of 24 h dietary recalls in men and women, respectively, to estimate energy and macronutrient intakes in a 6-month period. Within- and between-subject variances were the major contributors to variance in nutrient intakes. Day of the week, season, sequence, diet interviewer and body weight had little impact on variance.

This information is valuable for researchers planning to conduct studies on free-living individuals that include the collection of dietary intake data.

To explore the extent to which appetite status influences portion size estimation in men under laboratory conditions and to quantify how much participants’ portion estimates differed from the recommended portion sizes defined by authoritative bodies (i.e. government and health professionals’ reference amounts).

Repeated, randomized cross-over trial with each participant attending the laboratory on four separate occasions. At each session, participants rated the number of portions of eight foods and beverages displayed in front of them. Participants rated portions twice after consuming breakfast (full conditions) and twice after an overnight fast (hungry conditions). Portion estimates were compared with reference amounts from the British and American Dietetic Associations, from the UK Food Standards Agency and from the US Food and Drug Administration.

Food skills laboratory, University of Chester, UK.

Twenty-seven non-obese men (mean age 24·9 (sd 6·5) years).

Portion size estimates for all items were significantly smaller under hungry than under full conditions (P < 0·01). Relative to reference instruments, estimates were significantly smaller for all foods except banana, irrespective of appetite status (P < 0·001).

In this data set, appetite status altered the perception of food amounts. There were large discrepancies between participants’ perception of a portion and recommendations from health professionals and government standards. Nutritional educational strategies should take into account the role of hunger along with a person's familiarity with existing portion size systems when advising on portion sizes.

To identify and describe factors associated with food shop (known as tuck shop in South Africa) and lunchbox behaviours of primary-school learners in South Africa.

Analysis of data collected in 2008 from a cross-sectional survey.

Sixteen primary schools in the Western Cape, South Africa.

A total of 717 grade 4 learners aged 10–12 years.

A 24 h recall established that 69 % of learners carried a lunchbox to school and 49 % had consumed at least one item purchased from the school food shop/vendor. Most lunchboxes contained white bread with processed meat, whereas the most frequent food shop/vendor purchase comprised chips/crisps. Learners who carried a lunchbox to school had significantly lower BMI percentiles (P = 0·002) and BMI-for-age (P = 0·034), compared with their counterparts. Moreover, they were younger, had higher standard-of-living and dietary diversity scores, consumed more meals per day, had greater self-efficacy and came from predominantly urban schools, compared with those who did not carry a lunchbox to school. Learners who ate food shop/vendor purchases had a lower standard-of-living score and higher dietary diversity and meal scores. Only 2 % of learners were underweight, whereas 19 % were stunted and 21 % were overweight/obese (BMI ≥ 25 kg/m2).

Children who carried a lunchbox to school appeared to have greater dietary diversity, consumed more regular meals, had a higher standard of living and greater nutritional self-efficacy compared with those who did not carry a lunchbox to school.

To capture a more holistic picture of eating behaviour by investigating the impact of the social living conditions and weight status of parents and daughters on food consumption frequency, the context of meals and daily portion sizes.

Cross-sectional Berlin School Children's Cohort study.

A total of sixty-nine schools in Berlin (3 400 000 inhabitants, eastern Germany) participated in the present study.

A total of 1519 girls aged 11–14 years were selected. Bi- and multivariate analyses were performed to examine the impact of age, migration background, socio-economic status (SES), parental education, family situation and the weight status of parents and daughters on three different eating behaviour scores according to nutritional recommendations.

For the three dependent eating behaviour variables, different patterns of influencing factors emerged. Multivariate regression (model 1) revealed that low and middle SES, two-parent migration background and older age were significant risk factors. Meal context was also significantly influenced by living with a single parent. Similar results were obtained for the daily portion size scores and maternal overweight status was the most influential. Model 2 succeeded in showing that, within the composite variable of family SES, mothers’ level of education was the dominant component.

SES as a whole, and especially the component of mothers’ level of education and two-parent migration background, was the strongest risk factor for an unfavourable eating pattern among adolescent girls. The results clearly indicated preventive potential. Using three different measures of eating behaviour simultaneously provided an in-depth understanding of general patterns and potential risk factors.

To examine socio-economic differences in weight-control behaviours (WCB) and barriers to weight control.

A cross-sectional study.

Data were obtained by means of a postal questionnaire.

A total of 1013 men and women aged 45–60 years residing in Brisbane, Australia (69·8 % response rate).

Binary and multinomial logistic regression analyses were performed, adjusted for age, gender and BMI. Socio-economically disadvantaged groups were less likely to engage in weight control (OR for lowest income quartile = 0·60, 95 % CI 0·39, 0·94); among those who engaged in weight control, the disadvantaged group had a likelihood of 0·52 (95 % CI 0·30, 0·90) of adopting exercise strategies, including moderate (OR = 0·56, 95 % CI 0·33, 0·96) and vigorous (OR = 0·47, 95 % CI 0·25, 0·89) physical activities, compared with their more-advantaged counterparts. However, lower socio-economic groups were more likely to decrease their sitting time to control their weight compared with their advantaged counterparts (OR for secondary school or lower education = 1·78, 95 % CI 1·11, 2·84). They were also more likely to believe that losing weight was expensive, not of high priority, required a lot of cooking skills and involved eating differently from others in the household.

Marked socio-economic inequalities existed with regard to engaging in WCB, the type of weight-control strategies used and the perceived barriers to weight control; these differences are consistent with socio-economic gradients in weight status. These factors may need to be included in health promotion strategies that address socio-economic inequalities in weight status, as well as inequalities in weight-related health outcomes.

To examine the associations between lifestyle factors and active commuting to school in Spanish adolescents.

Cross-sectional study. Lifestyle factors (overall/extracurricular physical activity, television viewing, reading as a hobby, sleep duration, breakfast/fruit intake, smoking and alcohol intake) as well as mode and duration of commuting to school were self-reported. Active commuters were defined as those adolescents who walked or cycled to school.

Secondary schools in Madrid, Spain.

Adolescents (n 2029) aged 13 to 17 years.

Similar percentages of adolescent boys (57·6 %) and girls (56·1 %) were classified as active commuters to school (P = 0·491). The analysis showed that only adequate sleep duration (OR = 1·35, 95 % CI 1·11, 1·66; P = 0·003) and breakfast consumption (OR = 0·66, 95 % CI 0·49, 0·87; P = 0·004) were independently associated with active commuting to school.

Only those behaviours that occur immediately before commuting to school (sleep and breakfast) are associated with active commuting in Spanish adolescents.

To identify the dietary, lifestyle and socio-economic factors associated with the intake of whole grains (WG) in Norway, Sweden and Denmark.

A cross-sectional study.

Subsample of the Scandinavian cohort ‘HELGA’ consisting of three prospective cohorts: The Norwegian Women and Cancer Study; The Northern Sweden Health and Disease Study; and the Danish Diet, Cancer and Health Study.

A total of 8702 men and women aged 30–65 years. Dietary data are from one 24 h dietary recall and data on socio-economic status and lifestyle factors including anthropometric values are from the baseline collection of data.

Vegetables, fruits, dairy products, fish and shellfish, coffee, tea and margarine were directly associated with the intake of WG, whereas red meat, white bread, alcohol and cakes and biscuits were inversely associated. Smoking and BMI were consistently inversely associated with the intake of WG. Furthermore, length of education was directly associated with the intake of WG among women.

The intake of WG was found to be directly associated with healthy diet, lifestyle and socio-economic factors and inversely associated with less healthy factors, suggesting that these factors are important for consideration as potential confounders when studying WG intake and disease associations.

To compare the prevalence of modifiable risk factors for cancer and other chronic diseases between adult cancer survivors and persons with no history of cancer.

Cross-sectional.

Population-based sample residing in California and Hawaii.

A total of 177 003 men and women aged 45–75 years who participated in the Multiethnic Cohort Study (MEC). Logistic regression was used to examine adherence to recommendations regarding modifiable risk factors among cancer survivors (n 16 346) when compared with cohort members with no history of cancer (n 160 657).

Cancer survivors were less likely than cohort members with no history of cancer to meet recommendations specified in the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) 2007 report (OR = 0·97; 95 % CI 0·96, 0·99). No difference between groups was seen for adherence to dietary recommendations alone (OR = 0·99; 95 % CI 0·98, 1·01). Site-specific analyses showed that results for colorectal cancer were similar to those for all cancers combined, but survivors of breast (OR = 1·04; 95 % CI 1·02, 1·07) and prostate (OR = 1·04; 95 % CI 1·01, 1·07) cancer were more likely to meet dietary recommendations. Latino survivors were less likely to adhere to WCRF/AICR recommendations than Latino controls; however, differences across ethnic groups were not significant (Pinteraction = 0·64).

The modest differences found between adult cancer survivors and persons with no history of cancer suggest that a diagnosis of cancer in itself may not be associated with improvements in health behaviours related to cancer and other chronic diseases.

To investigate genetic and lifestyle factors and their interactions on plasma homocysteine (Hcy) concentrations in the Boston Puerto Rican population.

Cross-sectional study. Plasma concentrations of Hcy, folate, vitamin B12 and pyridoxal phosphate were measured, and genetic polymorphisms were determined. Data on lifestyle factors were collected in interviews.

A population survey of health and nutritional measures.

A total of 994 Puerto Rican men and women residing in the Boston metropolitan area.

Smoking status was positively associated with plasma Hcy. Genetic polymorphisms MTHFR 677C→T, FOLH1 1561C→T, FOLH1 rs647370 and PCFT 928A→G interacted significantly with smoking for Hcy. MTHFR 1298A→C (P = 0·040) and PCFT 928A→G (P = 0·002) displayed significant interactions with alcohol intake in determining plasma Hcy. Subjects with PCFT 928GG genotype had significantly higher plasma Hcy concentrations compared with carriers of the A allele (AA+AG; P = 0·030) among non-drinking subjects. When consuming alcohol, GG subjects had lower plasma Hcy levels compared with AA+AG subjects. Physical activity interacted significantly with MTR 2756A→G in determining plasma Hcy (P for interaction = 0·002). Smoking interacted with physical activity for plasma Hcy (P for interaction = 0·023).

Smoking and drinking were associated plasma Hcy concentrations. Genetic variants involved in folate metabolism further modify the effects of lifestyle on plasma Hcy.

To evaluate the awareness and knowledge about weight status and its management.

A 1 d cross-sectional survey. Basic anthropometric assessments (weight, height, BMI and waist circumference) and a self-administered questionnaire were considered.

Nineteen Clinical Nutrition or Endocrinology and Metabolic Disorders Units or Dietetics Services in the Italian region of Lombardy.

All adults attending the ‘Obesity Day’ initiative.

A total of 914 participants (605 female and 309 male) were recruited. Although most of the participants (83·5 %) considered obesity to be a disease, 38·5 % were likely to misperceive their weight status. In particular, 38·8 % of normal-weight adults believed themselves to be overweight, whereas 71·1 % and 37·5 % of classes I and II/III obese adults classified themselves as being overweight and mildly obese, respectively. However, most of the overweight (90·2 %), mildly (96·8 %) and moderately/severely obese adults (99·1 %) recognized the need to lose weight. In all, 37·8 % of the sample underestimated the role of physical activity in weight management. Interestingly, only 17·2 % of dieters (previous or current) declared being advised by their doctor to lose weight. Multivariate models revealed that higher age, low education and higher BMI were important determinants of poor weight control and management. In addition, previous dieting appeared not to provide better knowledge, whereas the role of physical activity was recognized mainly by those practising it.

The present study suggests that in Italy knowledge about weight management should be improved not only in the general population but also among health-care professionals. To confirm this finding, there is now the rationale for a nationally representative survey. New educational programmes can be designed on the basis of the information collected.

To assess the effectiveness (extent to which an intervention works in daily medical practice) of the use of phytosterol/phytostanol-enriched margarines to lower total and non-HDL cholesterol levels in users and non-users of statins.

Retrospective cohort study.

Data were obtained from questionnaires on health and food intake from a population-based longitudinal cohort linked to pharmacy-dispensing records.

The analysis included 3829 men and women (aged 31–71 years) who were examined during 1998–2002 and re-examined at 5-year follow-up during 2003–2007.

Recommended doses of margarines were consumed by only 9 % of the subjects. Serum total cholesterol decreased by respectively −0·16 (95 % CI −0·26, −0·05) mmol/l, −1·40 (95 % CI −1·51, −1·30) mmol/l and −1·64 (95 % CI −1·91, −1·37) mmol/l in subjects who started to use phytosterols/phytostanols only, statins only or a combination of both compounds at some point in time between examination and re-examination, compared with subjects who did not start using phytosterols/phytostanols or statins. Cholesterol-lowering effects of the phytosterols/phytostanols were similar in statin users and statin non-users and increased with increasing intake of enriched margarine (no intake, 0; low intake, −0·017 (95 % CI −0·16, 0·13) mmol/l; medium intake, −0·089 (95 % CI −0·22, 0·038) mmol/l; high intake, −0·32 (95 % CI −0·50, −0·14) mmol/l).

Although recommended intake levels of the enriched margarines were not reached by all persons, these data show that under customary conditions of use phytosterols/phytostanols are effective in lowering cholesterol levels in both statin users and non-users.

The present study was undertaken to learn more about parents’ (i) knowledge regarding healthy foods, factors associated with food purchasing and preparation, and current nutrition education resources, (ii) barriers to and promoters for establishing healthy eating habits for children and families, and (iii) interest in participating in nutrition interventions.

Focus group interviews were conducted with parents of low-income children from the Los Angeles Unified School District (LAUSD).

LAUSD Title 1 elementary schools where 50 % or more of students are eligible for free/reduced-price meals.

Sixty-four parents (93 % female; 84 % Hispanic/Latino) of elementary-school students.

The most common barriers to eating healthy foods were cost, difficulty in getting children to eat healthier foods and easy access to fast food. Parents had a basic knowledge about what foods are healthy and received most of their nutrition education through the media. Parents expressed a desire for nutrition classes and almost all of them said they would attend a nutrition programme at their child's school. Topic areas of interest included what to purchase, how to cook healthier foods, how to encourage their children to eat healthier and how to read food labels. Parents also requested classes that engage the whole family, especially fathers.

Parents in our study were interested in participating in nutrition education programmes. The information from these focus groups was used to design a parent nutrition education programme especially designed to respond to the needs of the LAUSD parents, the majority of whom are low-income and Hispanic/Latino.

The present qualitative study explored health perceptions, diet and the social construction of obesity and how this relates to the initiation and maintenance of a healthier diet in UK Pakistani women.

Pakistani women in Greater Manchester participated in focus group and one-to-one discussions. Semi-structured interviews employing fictional vignettes and body shape images were used to explore the participants’ beliefs and practices regarding diet, overweight/obesity and the risk of type 2 diabetes. Transcripts were analysed using phenomenological and sociological approaches.

Interviews took place either in local community and Pakistani resource centres or in private homes.

First- and second-generation women who were both active in the community and housebound. The women spoke English and/or Urdu.

The fifty-five participants lacked the motivation to address weight gain and were unsure how to do so. There was a limited awareness of the link between weight gain and type 2 diabetes. Other barriers included the influence of Islam, culture and familial expectations on home cooking, perceptions that weight gain is inevitable (owing to ageing, childbirth or divine predestination) and the prioritisation of family concerns over individual lifestyle changes. As the findings of the present research did not correspond to existing educational and behaviour change models, a new Health Action Transition conceptual model is proposed.

Health education programmes that aim to address obesity and its associated risks in the South Asian community must take into account the complex beliefs and practices and the multiple dimensions of religion, ethnic and social identity within this population. The present study provides further insight into these factors and proposes a novel model for use in designing and implementing education interventions for British Pakistani women.

To identify Greek families in which all members were overweight or obese (XXL families) and to describe their profile with regard to their socio-economic status and their eating behaviours and practices.

A prospective cohort study.

The metropolitan area of Kavala.

We recruited children aged 11 and 12 years from twelve primary schools, and their parents, from volunteers. Auxologic measurements of the children included height and weight. A structured questionnaire pertaining to information on the socio-economic status of the family, anthropometric values and educational status of parents, dietary habits and the availability of various food products and beverages at home, as well as dietary intake, physical activity, time spent sleeping and time spent watching television, was filled in by one of the parents of each child. A total of 331 families finally participated.

In sixty-one families (18·43 %) both parents and child were either overweight or obese (XXL family), and in seven of these families all members were obese. Only twenty-eight families (8·46 %) had all members with a normal BMI. The XXL family was associated with lower educational status of both parents, whereas a higher percentage of XXL families resided in rural areas and had lower income. Skipping breakfast and spending more than 3 h in front of a screen every day were more frequently observed in XXL families. With regard to the availability of various food products and beverages at home, no significant differences were observed between XXL families and the rest of the studied families.

Greek XXL families have lower educational status and lower annual income.

To explore nutrition and food provision in pre-school nurseries in order to develop interventions to promote healthy eating in early years settings, especially across deprived communities.

An ethnographic approach was used combining participant observation with semi-structured interviews. Research participants were selected purposively using convenience sampling.

Community pre-school nurseries.

Nursery managers (n 9), cooks (n 6), staff (n 12), parents (n 12) and children at six nurseries (four private and two attached to children's centres) in Liverpool, UK.

Private nurseries had minimal access to information and guidelines. Most nurseries did not have a specific healthy eating policy but used menu planning to maintain a focus on healthy eating. No staff had training in healthy eating for children under the age of 5 years. However, enthusiasm and interest were widespread. The level and depth of communication between the nursery and parents was important. Meal times can be an important means of developing social skills and achieving Early Years Foundation Stage competencies.

Nurseries are genuinely interested in providing appropriate healthy food for under-5s but require support. This includes: improved mechanisms for effective communication between all government levels as well as with nurseries; and funded training for cooks and managers in menu planning, cost-effective food sourcing and food preparation. Interventions to support healthy eating habits in young children developed at the area level need to be counterbalanced by continued appropriate national-level public health initiatives to address socio-economic differences.

To explore nutrition and food provision in pre-school nurseries in order to develop interventions to promote healthy eating in pre-school settings.

Quantitative data were gathered using questionnaires and professional menu analysis.

In the community, at pre-school nurseries.

All 130 nurseries across Liverpool were a sent questionnaire (38 % response rate); thirty-four menus were returned for analysis (26 % response rate).

Only 21 % of respondents stated they had adequate knowledge on nutrition for pre-school children. Sixty-one per cent of cooks reported having received only a ‘little’ advice on healthy eating and this was often not specific to under-5 s nutrition. Fifty-seven per cent of nurseries did not regularly assess their menus for nutritional quality. The menu analysis revealed that all menus were deficient in energy, carbohydrate, Fe and Zn. Eighty-five per cent of nurseries had Na/salt levels which exceed guidelines.

Nurseries require support on healthy eating at policy, knowledge and training levels. This support should address concerns relating to both menu planning and ingredients used in food provision and meet current guidelines on food provision for the under-5 s.