To provide preliminary evidence in support of using ecological momentary assessment (EMA), a real-time data capture method involving repeated assessments, to measure dietary intake in children by examining the concordance of children’s dietary reports through EMA and 24 h recall.

Children completed eight days of EMA surveys, reporting on recent dietary intake of four pre-specified food categories (‘Fruits or Vegetables’, ‘Chips or Fries’, ‘Pastries or Sweets’, ‘Soda or Energy Drinks’), and completed two 24 h recalls during the same period. Concordance of children’s reports of intake during matched two-hour time windows from EMA and 24 h dietary recall was assessed using cross-tabulation. Multilevel logistic regression examined potential person-level (i.e. sex, age, ethnicity and BMI category) predictors of concordance.

Children in Los Angeles County, USA, enrolled in the Mothers’ and Their Children’s Health (MATCH) study.

One hundred and forty-four 144 children (53 % female; mean age 9·6 (sd 0·9) years; 34·0 % overweight/obese).

Two-hour concordance varied by food category, ranging from 64·9 % for ‘Fruits/Vegetables’ to 89·9 % for ‘Soda/Energy Drinks’. In multilevel models, overweight/obese (v. lean) was associated with greater odds (OR; 95 % CI) of concordant reporting for ‘Soda/Energy Drinks’ (2·01; 1·06, 4·04) and ‘Pastries/Sweets’ (1·61; 1·03, 2·52). Odds of concordant reporting were higher for Hispanic (v. non-Hispanic) children for ‘Pastries/Sweets’ (1·55; 1·02, 2·36) and for girls (v. boys) for ‘Fruits/Vegetables’ (1·36; 1·01, 1·83).

Concordance differed by food category as well as by person-level characteristics. Future research should continue to explore use of EMA to facilitate dietary assessment in children.

To evaluate the performance of waist-to-height ratio (WHtR) in predicting cardiometabolic outcomes and compare cut-off points for Brazilian adults.

Cross-sectional study. WHtR areas under the curve (AUC) were compared with those for BMI, waist circumference (WC) and waist-to-hip ratio (WHR). The outcomes of interest were hypertension, diabetes, hypertriacylglycerolaemia and presence of at least two components of metabolic syndrome (≥2 MetS). Cut-offs for WHtR were compared and validity measures were estimated for each point.

Teaching and research institutions in six Brazilian state capitals, 2008–2010.

Women (n 5026) and men (n 4238) aged 35–54 years who participated in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) at baseline.

WHtR age-adjusted AUC ranged from 0·68 to 0·72 in men and 0·69 to 0·75 in women, with smaller AUC for hypertriacylglycerolaemia and the largest for ≥2 MetS. WHtR performed better than BMI for practically all outcomes; better than WHR for hypertension in both sexes; and displayed larger AUC than WC in predicting diabetes mellitus. It also offered better discriminatory power for ≥2 MetS in men; and was better than WC, but not WHR, in women. Optimal cut-off points of WHtR were 0·55 (women) and 0·54 (men), but they presented high false-negative rate compared with 0·50.

We recommend using WHtR (which performed similarly to, or better than, other available indices of adiposity) as an anthropometric index with good discriminatory power for cardiometabolic outcomes in Brazilian adults, indicating the already referenced limit of WHtR≥0·50.

Measurement of mean population Na and K intakes typically uses laboratory-based assays, which can add significant logistical burden and costs. A valid field-based measurement method would be a significant advance. In the current study, we used 24 h urine samples to compare estimates of Na, K and Na:K ratio based upon assays done using the field-based Horiba twin meter v. laboratory-based methods.

The performance of the Horiba twin meter was determined by comparing field-based estimates of mean Na and K against those obtained using laboratory-based methods. The reported 95 % limits of agreement of Bland–Altman plots were calculated based on a regression approach for non-uniform differences.

The 24 h urine samples were collected as part of an ongoing study being done in rural China.

One hundred and sixty-six complete 24 h urine samples were qualified for estimating 24 h urinary Na and K excretion.

Mean Na and K excretion were estimated as 170·4 and 37·4 mmol/d, respectively, using the meter-based assays; and 193·4 and 43·8 mmol/d, respectively, using the laboratory-based assays. There was excellent relative reliability (intraclass correlation coefficient) for both Na (0·986) and K (0·986). Bland–Altman plots showed moderate-to-good agreement between the two methods.

Na and K intake estimations were moderately underestimated using assays based upon the Horiba twin meter. Compared with standard laboratory-based methods, the portable device was more practical and convenient.

The present communication demonstrates that even if individuals are answering a pre/post survey at random, the percentage of individuals showing improvement from the pre- to the post-survey can be surprisingly high. Some simple formulas and tables are presented that will allow analysts to quickly determine the expected percentage of individuals showing improvement if participants just answered the survey at random. This benchmark percentage, in turn, defines the appropriate null hypothesis for testing if the actual percentage observed is greater than the expected random answering percentage.

The analysis is demonstrated by testing if actual improvement in a component of the US Department of Agriculture’s (USDA) Expanded Food and Nutrition Education Program is significantly different from random answering improvement.

USA.

From 2011 to 2014, 364320 adults completed a standardized pre- and post-survey administered by the USDA.

For each year, the statement that the actual number of improvements is less than the expected number if the questions were just answered at random cannot be rejected. This does not mean that the pre-/post-test survey instrument is flawed, only that the data are being inappropriately evaluated.

Knowing the percentage of individuals showing improvement on a pre/post survey instrument when questions are randomly answered is an important benchmark number to determine in order to draw valid inferences about nutrition interventions. The results presented here should help analysts in determining this benchmark number for some common survey structures and avoid drawing faulty inferences about the effectiveness of an intervention.

Overweight and obesity in childhood are serious public health issues, both in developing and developed countries. The present study aimed to ascertain overweight and obesity prevalence rates among Togolese schoolchildren in Lomé, Togo, and their correlation with physical activity, socio-economic conditions and eating habits.

Cross-sectional survey conducted in December 2015. Overweight and obesity were defined using age- and sex-specific BMI cut-off points of the International Obesity Task Force. Physical activity, socio-economic conditions and eating habits were assessed with a standardized questionnaire. Specially trained medical students interviewed children and collected the data. After bivariate regression analyses, factors associated with overweight/obesity were identified by multivariate logistic regression. Statistical significance was two-sided P<0·05.

Lomé, Togo.

Representative sample of 634 children (288 boys, 346 girls), aged 8–17 years, who were studying in primary schools.

Overweight and obesity respectively affected 5·2 and 1·9 % of children surveyed. Watching television (>4 h) on weekends (OR; 95 % CI: 3·8; 1·2, 12·0, P=0·02) and medium dietary diversity score (3·0; 1·1, 8·1, P=0·03) were independently associated with overweight/obesity in a multivariate regression model. Eating breakfast in the school cafeteria (0·2; 0·1, 0·8, P=0·03) and eating fruits (0·4; 0·1, 0·9, P=0·03) significantly reduced the risk of overweight/obesity.

Overweight and obesity prevalence were linked with sedentary behaviour and non-optimal food diversity. Promoting physical activity and fruit consumption should be explored as interventions to reduce and prevent overweight and obesity in Lomé schoolchildren. In addition, preventive approaches in the social environment of children should be considered.

The objective of the present study was to explore whether dietary patterns (DP) are associated with nutritional status indicators among adolescent Mozambican girls.

In this population-based cross-sectional study we used the FFQ data of 547 girls aged 14–19 years from Central Mozambique to derive dietary patterns by means of principal component analysis. We used two-level linear regression models to examine the associations between the DP and anthropometric and biochemical indicators of nutritional status.

We identified three DP: ‘Urban bread and fats’, ‘Rural meat and vegetables’ and ‘Rural cassava and coconut’. The ‘Urban bread and fats’ DP was positively associated with BMI-for-age Z-score (BMIZ), mid-upper arm circumference (MUAC), triceps skinfold (P for all<0·001) and blood Hb (P=0·025). A negative association was observed between the ‘Urban bread and fats’ DP and serum folate (P<0·001). The ‘Rural meat and vegetables’ DP and the ‘Rural cassava and coconut’ DP were associated negatively with BMIZ, MUAC and triceps skinfold (P for all<0·05), but the ‘Rural meat and vegetables’ DP was associated positively with serum ferritin (P=0·007).

Urban and rural DP were associated with nutritional status indicators. In a low-resource setting, urban diets may promote body fat storage and blood Hb concentrations but compromise serum folate concentration. It is important to continue valuing the traditional, rural foods that are high in folate.

Despite evidence linking regular nut consumption with reduced chronic disease risk, population-level intakes remain low. Research suggests nut-promoting advice from doctors facilitates regular nut consumption. However, there is no information on current nut recommendation practices of health professionals. The aim of the present study was to examine the advice provided by health professionals regarding nut consumption.

In this cross-sectional study, participants were invited to complete a survey including questions about their nut recommendation practices.

New Zealand (NZ).

The NZ Electoral Roll was used to identify dietitians, general practitioners and practice nurses.

In total 318 dietitians, 292 general practitioners and 149 practice nurses responded. Dietitians were more likely (82·7 %) to recommend patients increase consumption of nuts than general practitioners (55·5 %) and practice nurses (63·1 %; both P<0·001). The most popular nuts recommended were almonds, Brazil nuts and walnuts, with most health professionals recommending raw nuts. The most common recommendation for frequency of consumption by dietitians and practice nurses was to eat nuts every day, while general practitioners most frequently recommended 2–4 times weekly, although not statistically significantly different between professions. Dietitians recommended a significantly greater amount of nuts (median 30 g/d) than both general practitioners and practice nurses (20 g/d; both P<0·001).

Dietitians were most likely to recommend consumption of nuts in accordance with current guidelines, but there are opportunities to improve the adoption of nut consumption recommendations for all professions. This may be a viable strategy for increasing population-level nut intakes to reduce chronic disease.

Immigrants in the USA are confronted with health disparities, including childhood obesity and obesity-related chronic diseases. We aimed to identify perceptions of childhood body weight, approaches to raising healthy children and desires for supportive programmes of Somali, Latino and Hmong (SLM) parents in the Twin Cities, Minnesota, USA.

Using community-based participatory research, ten focus groups (FG) were conducted with sixty-seven parents (n 28 Somali, three FG; n 19 Latino, four FG; n 20 Hmong, three FG) of 3–12-year-old children in their native language. Demographic information was collected.

SLM parents perceived that health is not necessarily weight-based; childhood obesity is caused by overeating, eating unhealthy foods and sedentary activities; traditional foods are generally healthy while American foods are generally unhealthy; and healthy children are inherently physically active. Parents identified their goals as feeding children so they would be healthy and happy, helping them be active and safe, and teaching them to cook traditional foods to be self-sufficient and maintain their cultural identity. Parents were challenged by children’s unhealthy food and sedentary preferences, their own uncertainties about healthy foods and behaviours, and structural factors. Parents thought interventions could help them with these challenges, including information about healthy foods, age-appropriate portion sizes, safe places to be active and strategies tailored to their cultural norms.

SLM parents are trying to raise healthy-weight children based on their understanding of children’s health, weight, diet and physical activity, while dealing with social, economic and environmental challenges and trying to maintain cultural identity and traditions.

The present study aimed to investigate disordered eating (DE) among Sami compared with non-Sami residing in northern Norway.

In a cross-sectional design, stratified by sex and ethnicity, associations were tested between DE (Eating Disturbance Scale; EDS-5) and age, education level, BMI category, anxiety and depression, physical activity and consumption of snacks.

The SAMINOR 2 Clinical Survey (2012–2014) based on the population of ten municipalities in northern Norway.

Adults aged 40–69 years; 1811 Sami (844 male, 967 female) compared with 2578 non-Sami (1180 male, 1398 female) individuals.

No overall significant ethnic difference in DE was identified, although comfort eating was reported more often by Sami individuals (P=0·01). Regardless of ethnicity and sex, symptoms of anxiety and depression were associated with DE (P<0·001). Furthermore, DE was more common at lower age and higher BMI values. Education levels were protectively associated with DE among Sami men (P=0·01). DE was associated (OR, 95% CI) with low physical activity in men in general and in non-Sami women (Sami men: 2·4, 1·4, 4·0; non-Sami men: 2·2, 1·4, 3·6; non-Sami women: 1·8, 1·2, 2·9) and so was the consumption of snacks (Sami men: 2·6, 1·3, 5·0; non-Sami men: 1·9, 1·1, 3·1; non-Sami women: 2·1, 1·3, 3·4).

There were no significant differences regarding overall DE comparing Sami with non-Sami, although Sami more often reported comfort eating. There were significant sex and ethnic differences related to DE and physical activity, snacking and education level.

The present study aimed to assess the prevalence of food neophobia in pre-school children and its association with eating habits, dietary intake and anthropometric parameters.

Cross-sectional survey performed in 2012–2013. The Child Food Neophobia Scale (CFNS) adapted by Wardle, Carnell and Cooke was used to assess the level of food neophobia. Dietary intake was measured using an FFQ and dietary records from three days. Anthropometric measurements were taken to determine children’s nutritional status and BMI was computed based on Polish growth charts. Wilcoxon’s rank test and Pearson’s rank-correlation coefficient were applied to compare the level of food neophobia and frequency of consumption of food products and nutrient intakes.

Kindergartens in southern Poland located in or near Cracow.

Three hundred and twenty-five pre-school children and their parents.

Low neophobia was observed in 12·3 % and high neophobia in 10·8 % of the children examined. Children with a high level of neophobia were significantly less likely (P<0·05) to eat eggs, raw or cooked vegetables and legumes, whereas they tended to eat sweets and snacks more frequently; these foodstuffs were also eaten more often between meals. Because the neophobic children ate vegetables very rarely, their intakes of vitamin C (36 % of RDA) and thiamin (84 % of RDA) were far below the norms. No differences in anthropometric parameters according to level of food neophobia were observed.

High levels of neophobia are associated with diet variation and may enhance the risk of nutritional deficiencies in children.

The purpose of the current study was to examine associations of individual and aggregated screen-based behaviours, and total sitting time, with healthy and unhealthy dietary intakes among adolescents.

Cross-sectional study of adolescents. Participants self-reported durations of television viewing, computer use, playing electronic games (e-games), total sitting time, daily servings of fruits and vegetables, and frequency of consumption of sugar-sweetened beverages (SSB), diet beverages, fast foods and discretionary snacks. Logistic regression models were conducted to identify associations of screen-based behaviours, total screen time and total sitting time with dietary intakes.

Victoria, Australia.

Adolescents (n 939) in School Year 11 (mean age 16·8 years).

The results showed that watching television (≥2 h/d) was positively associated with consuming SSB and diet beverages each week and consuming discretionary snacks at least once daily, whereas computer use (≥2 h/d) was inversely associated with daily fruit and vegetable intake and positively associated with weekly fast-food consumption. Playing e-games (any) was inversely associated with daily vegetable intake and positively associated with weekly SSB consumption. Total screen (≥2 h/d) and sitting (h/d) times were inversely associated with daily fruit and vegetable consumption, with total screen time also positively associated with daily discretionary snack consumption and weekly consumption of SSB and fast foods.

Individual and aggregated screen-based behaviours, as well as total sitting time, are associated with a number of indicators of healthy and unhealthy dietary intake. Future research should explore whether reducing recreational screen time improves adolescents’ diets.

To investigate caregiver type as a potential moderating effect in the relationship between feeding style and weight status among Chinese pre-school children.

Cross-sectional data collected with the Caregiver’s Feeding Style Questionnaire (CFSQ), anthropometric data, childcare and sociodemographic information.

Shenyang, China.

Caregiver–child dyads (n 857).

After controlling for confounders, authoritarian feeding style was associated with a 0·30 lower BMI Z-score. Fathers as primary caregivers were related to lower BMI Z-score (β=−0·66), while grandparents as main caregivers were associated with higher BMI Z-score (β=0·66) after adjusting for covariates. Mothers buffered the relationship between authoritarian (β=0·50, 95 % CI 0·04, 0·95) or indulgent (β=−0·60, 95 % CI −1·06, −0·14) feeding styles and BMI Z-score. Grandparents strengthened the trend that indulgent feeding style was related to higher BMI Z-score (β=0·54, 95 % CI 0·01, 1·08).

The results of independent and interactive effects of specific feeding styles and caregiver types had different influences on child BMI Z-scores. Longitudinal investigations are needed to evaluate the effect of fathers’ and grandparents’ feeding on their children’s nutrition and weight status.

Obesity as well as job strain is increasing, and job strain might contribute to weight gain. The objective of the current study was to examine associations between longitudinal alterations in the components of job strain and subsequent weight gain.

The study was designed as a prospective cohort study with three questionnaire surveys enabling measurement of job-strain alterations over 6 years and subsequent measurements of weight gain after further 10 years of follow-up. ANCOVA and trend analyses were conducted. Job demands were measured as job busyness and speed, and control as amount of influence.

Employed nurses in Denmark.

We included a sub-sample of 6188 female nurses from the Danish Nurse Cohort, which consisted of the nurses who participated in surveys in 1993, 1999 and 2009.

A linear trend in weight gain was seen in nurses who were often busy in 1999 between those who were rarely v. sometimes v. often busy in 1993 (P=0·03), with the largest weight gain in individuals with sustained high busyness in both years. Loss of influence between 1993 and 1999 was associated with larger subsequent weight gain than sustained high influence (P=0·003) or sustained low influence (P=0·02). For speed, no associations were found.

Busyness, speed and influence differed in their relationship to subsequent weight gain. A decrease in job influence and a sustained burden of busyness were most strongly related to subsequent weight gain. Focus on job strain reduction and healthy diet is essential for public health.

Metabolic syndrome (MetS) refers to a group of risk factors that increase the risk of cardiovascular mortality and morbidity. Dietary habits are among the most important risk factors for MetS. The current study aimed at assessing the effect of dietary habits on the risk of MetS in a 10-year follow-up study in central Iran.

Cohort study.

Yazd, Iran.

Participants aged 20–74 years without any history of MetS, who were originally recruited for Yazd Healthy Heart Project (YHHP) during 2005–2006, were revisited during 2015–2016. At phase I of YHHP, demographic data, anthropometric measurements, five components of MetS, biochemical tests and dietary habits were evaluated; and the same data were collected in phase II.

A total of 1092 participants were eligible to be included in the present study. After follow-up, the 10-year cumulative incidence of MetS was 56·1 %. After adjustment for potential confounders, increased risk of MetS (hazard ratio; 95 % CI) was found in those who did not try to control their body weight (1·57; 1·06, 2·35), did not usually eat salad (1·91; 1·22, 3·00) and added salt to their food (1·57, 1·06, 2·33). These associations were stronger in men than in the total population after subgroup analysis, but were not present in women.

Dietary habits affect the risk of MetS in the Iranian population. Lifestyle interventions are needed to improve dietary habits to reduce the risk of MetS. Future studies are highly recommended to confirm our results in other populations.

To examine the relationship between parental work characteristics and diet quality among pre-school children in dual-parent households.

Cross-sectional study. Parental work characteristics were measured by the types of combined parental work schedules and work hours. The main outcome variables included meal eating habits as well as ‘health-conscious food’ and ‘unhealthy non-core food’ dietary patterns derived by using principal component analysis. Sociodemographic covariates were considered to reduce confounding and selection biases.

The Taiwan Birth Cohort Study, Taiwan.

A population-based sample of 18 046 children.

Multiple regression analyses indicated that compared with having both parents working standard schedules, having at least one parent who worked non-standard schedules was significantly associated with a lower likelihood of a child eating breakfast every day and a higher consumption of unhealthy non-core foods. If only one parent was employed and worked standard schedules, the children demonstrated greater odds of having home-prepared dinner most of the time. The mother’s working long hours was associated with lower odds of eating breakfast every day, more frequent consumption of unhealthy non-core foods and a lower frequency of healthy food consumption.

The findings raise concern that parents’ non-standard work schedules and mother’s long working hours have negative effects on diet quality of pre-school children. Policy implications include the need for a multifaceted approach to supporting working parents so as to create healthier food environments.

The present study examined the impacts of training on nutrition, hygiene and food safety designed by the Nutrition Working Group, Child Survival Collaborations and Resources Group (CORE).

Adapted from the 21d Positive Deviance/Hearth model, mothers were trained on the subjects of appropriate complementary feeding, water, sanitation and hygiene (WASH) practices, and aflatoxin contamination in food. To assess the impacts on child undernutrition, a randomised controlled trial was implemented on a sample of 179 mothers and their children (<2 years old) in two districts of Malawi, namely Mzimba and Balaka.

A 21d intensive learning-by-doing process using the positive deviance approach.

Malawian children and mothers.

Difference-in-difference panel regression analysis revealed that the impacts of the comprehensive training were positive and statistically significant on the Z-scores for wasting and underweight, where the effects increased constantly over time within the 21d time frame. As for stunting, the coefficients were not statistically significant during the 21d programme, although the level of significance started increasing in 2 weeks, indicating that stunting should also be alleviated in a slightly longer time horizon.

The study clearly suggests that comprehensive training immediately guides mothers into improved dietary and hygiene practices, and that improved practices take immediate and progressive effects in ameliorating children’s undernutrition.

Children’s poor growth and nutrition status has serious consequences and therefore it is important to understand its contributing factors.

A community-based interventional study focusing on child feeding was conducted in a rural community in China. Data from the intervention group at baseline (1–4 months of age) and follow-up visits (12 and 18 months of age) were used in the present study (n 236). A structural equation model was generated to explore the effects of family wealth, household food safety, dietary intake, diseases and other factors on the growth and nutrition of young children.

Mother’s knowledge and behaviours on household food safety had positive effects on children’s weight-for-age Z-score (WAZ; β direct=0·03 and 0·15, respectively, at 12 months of age; β direct=0·02 and 0·08, respectively, at 18 months; P<0·05) and weight-for-length Z-score (WLZ; β direct=0·04 and 0·21, respectively, at 12 months of age; β direct=0·01 and 0·06, respectively, at 18 months; P<0·05). While mothers’ feeding behaviours and children’s dietary intake at 12 months of age were positively associated with WAZ and/or WLZ at current and later ages, children’s diseases were negatively associated with WAZ and WLZ cross-sectionally.

Caregiver’s knowledge and feeding behaviours, and children’s dietary intake and diseases, are factors influencing the WAZ and WLZ of children. Promoting feeding and health knowledge and behaviours at early stages of childhood can improve children’s physical growth at later ages.

To explore children’s responses to sponsorship of community junior sport by unhealthy food brands and investigate the utility of alternative, pro-health sponsorship options.

Between-subjects experiment, with four sponsorship conditions: A, non-food branding (control); B, unhealthy food branding; C, healthier food branding; D, obesity prevention campaign branding.

Online experiment conducted in schools. Participants were shown a junior sports pack for their favourite sport that contained merchandise with branding representing their assigned sponsorship condition. Participants viewed and rated the sports pack, completed a distractor task, then completed questions assessing brand awareness, brand attitudes and preference for food sponsors’ products.

Students in grades 1 to 3 (aged 5–10 years; n 1124) from schools in metropolitan Melbourne, Australia.

Compared with the control condition, there were no significant effects of unhealthy food branding on awareness of, attitudes towards or preference for these brands. Exposure to healthier food branding prompted a significant increase in the proportion of children aware of these brands, but did not impact attitudes towards or preference for these brands. Exposure to either healthier food branding or obesity prevention campaign branding prompted a significant reduction in the proportion of children showing a preference for unhealthy food sponsor products.

The sponsorship of children’s sport by healthier food brands may promote awareness of these brands and healthier sponsorship branding may reduce preferences for some unhealthy food products. Establishing and implementing healthy sponsor criteria in sports clubs could forge healthier sponsorship arrangements and help phase out unhealthy food and beverage sponsors.

To evaluate the nutrient quality of breads and breakfast cereals identified using the wholegrain definition of ≤10:1 carbohydrate:fibre ratio.

Following a cross-sectional study design, nutritional information was systematically gathered from food labels of breads and breakfast cereals that met the ≤10:1 carbohydrate:fibre criterion. The median nutrient content was compared with the UK Food Standards Agency’s nutrient profiling standards and the associations between carbohydrate:fibre ratio and other nutrients were analysed. Subgroup analyses were undertaken for products with and without fruit, nuts and/or seeds.

Products from four major supermarket stores in the UK.

Breads (n 162) and breakfast cereals (n 266).

Breads which met the ≤10:1 criterion typically contained medium fat, low saturated fat, low sugar and medium Na. Breakfast cereals typically contained medium fat, low saturated fat, high sugar and low Na. In both groups, as the carbohydrate:fibre ratio decreased, fat content increased (bread: P=0·029, r=−0·171; breakfast cereal: P=0·033, r=−0·131) and, in breakfast cereals, as the ratio increased, sugar content increased (P<0·0005, r=0·381). Breakfast cereals with fruit, nuts and/or seeds contained, per 100 g, more energy (P=0·002), fat, saturated fat and sugar (all P<0·0005), while seeded breads had more energy, fat and saturated fat (all P<0·0005).

Overall, breads and breakfast cereals meeting the ≤10:1 criterion have good nutritional quality, suggesting that the criterion could be useful in public health and/or food labelling. The utility of applying the ≤10:1 criterion to products containing fruit, nuts and/or seeds is less clear and requires further research.