The present study examined whether objective measures of the food environment are associated with perceptions of the food environment and whether this relationship varies by socio-economic disadvantage.

The study is a cross-sectional analysis of self-report surveys and objective environment data. Women reported their perceptions on the nutrition environment. Participants’ homes and food stores were geocoded to measure the objective community nutrition environment. Data on the average price and variety of fruit and vegetables were used to measure the objective consumer nutrition environment.

The study was conducted in Melbourne, Australia, in 2003–2004.

Data presented are from a sample of 1393 women aged 18–65 years.

Overall the match between the perceived and objective environment was poor, underscoring the limitations in using perceptions of the environment as a proxy for the objective environment. Socio-economic disadvantage had limited impact on the relationship between perceived and objective nutrition environment.

Further research is needed to understand the determinants of perceptions of the nutrition environment to enhance our understanding of the role of perceptions in nutrition choices and drivers of socio-economic inequalities in nutrition.

To evaluate the associations with chronic disease risk and mortality of the consequences of bean-free diets in Taiwanese adults with regard to gender.

A sub-sample of the National Health Interview Survey (NHIS) in 2001 agreed to physical examination in the subsequent year. This group then took part in the Taiwanese Survey of Hyperglycaemia, Hyperlipidaemia and Hypertension (TwSHHH) in 2002.

Individual records were linked to the eventual death files from 2002 to 2008.

Up to the end of 2008, a total of 2820 men and 2950 women were tracked by death registry over the 6·8 years of follow-up.

Among 38 077 person-years, an average follow-up 6·5 years, 225 all-cause deaths were identified. Generalized linear models showed beans to be favourable for metabolic syndrome (other than for fasting glucose) in men; in women, beans were favourable for waist circumference and HbA1c. Cumulative logistic regression models for the effect of a bean-free diet on metabolic syndrome scores according to the Taiwanese-modified National Cholesterol Education Program–Adult Treatment Panel III (NCEP-tw) gave adjusted odds ratios of 1·83 in men and 1·45 in women. Cox regression models for the bean-free diet showed an increased hazard ratio for all-cause mortality among women (1·98, 95 % CI 1·03, 3·81) but not men (1·28, 95 % CI 0·76, 2·16).

A bean-free diet may play a role in developing the metabolic syndrome in both genders, and is a significant predictor of all-cause mortality in Taiwanese women but not men.

To determine the association between major dietary patterns characterized by factor analysis and risk of depression and anxiety symptoms among adolescents.

Diet and symptoms of depression and anxiety were assessed in a cross-sectional survey among students attending junior high school. Dietary patterns were derived from a self-reported FFQ, which consisted of thirty-eight items. Anthropometric measurements were also performed.

Four junior high schools in Bengbu city, China.

A random sample of 5003 adolescents, 11–16 years of age (mean 13·21 years).

Three major dietary patterns were identified in the study based on factor analysis: ‘snack’, ‘animal food’ and ‘traditional’. The prevalence of depression symptoms, anxiety disorders and the coexistence of both were 11·2 % (560/5003), 14·6 % (732/5003) and 12·6 % (629/5003), respectively. After adjustment for potential confounders, adolescents in the highest tertile of snack dietary pattern scores had a higher odds for ‘pure’ psychological symptoms (‘depression without anxiety’, OR = 1·64; 95 % CI 1·30, 2·06; and ‘anxiety without depression’, OR = 1·87; 95 % CI 1·51, 2·31) compared with coexisting depression and anxiety (OR = 1·93; 95 % CI 1·54, 2·43). Similar to snacks, high consumption of animal foods was associated with a higher risk of psychological symptoms. Compared with low consumption, adolescents in the highest tertile of traditional dietary pattern scores had lower odds for ‘pure’ depression (OR = 0·38; 95 % CI 0·30, 0·49), ‘pure’ anxiety (OR = 0·85; 95 % CI 0·69, 1·04) and coexisting anxiety and depression (OR = 0·50; 95 % CI 0·39, 0·63).

Data from Chinese secondary-school adolescents validated findings from adult populations. Dietary patterns should be considered as important predictors of depression and anxiety among adolescents in further studies.

School lunch programmes are one strategy to promote healthier dietary habits in children, but better evaluation tools for assessing the dietary quality of such programmes are needed. The aim of the present study was to develop and validate a simple index to assess the dietary quality of school lunches for children aged 7–13 years.

A Meal Index of dietary Quality (Meal IQ) was developed to consist of seven components (nutrients and food groups) based on dietary issues for children aged 7–13 years, which were identified in a national dietary survey. The Meal IQ was validated against calculated nutrient contents of school lunches both provided by the school and brought from home.

At eight public schools from all over Denmark, data were collected on 191 individual lunches brought from home (which is most common in Denmark) and thirty-one lunches provided as part of a school food programme. In addition thirty-two lunches provided at eighteen other public schools were included.

A total of 254 school lunches.

A higher Meal IQ score was associated with a higher overall dietary quality, including lower contents of fat, saturated fat and added sugars, higher contents of fibre, various vitamins and minerals, and more fruits, vegetables and fish.

The Meal IQ is a valid and useful evaluation tool for assessing the dietary quality of lunches provided by schools or brought to school from home.

The Nordic Nutrition Recommendations (NNR) aim at preventing diet-associated diseases such as cancer in the Nordic countries. We evaluated adherence to the NNR in relation to prostate cancer (PC) in Swedish men, including potential interaction with a genetic risk score and with lifestyle factors.

Population-based case–control study (Cancer of the Prostate in Sweden (CAPS), 2001–2002). Using data from a semi-quantitative FFQ, we created an NNR adherence score and estimated relative risks of PC by unconditional logistic regression. Individual score components were modelled separately and potential modifying effects were assessed on the multiplicative scale.

Four regions in the central and northern parts of Sweden.

Incident PC patients (n 1386) and population controls (n 940), frequency-matched on age and region.

No overall association with PC was found, possibly due to the generally high adherence to the NNR score and its narrow distribution in the study population. Among individual NNR score components, high compared with low intakes of polyunsaturated fat were associated with an increased relative risk of localized PC. No formal interaction with genetic or lifestyle factors was observed, although in stratified analysis a positive association between the NNR and PC was suggested among men with a high genetic risk score but not among men with a medium or low genetic risk score.

Our findings do not support an association between NNR adherence and PC. The suggestive interaction with the genetic risk score deserves further investigations in other study populations.

The present study aimed to characterize the dietary patterns of newlyweds married within one year and to examine the factors associated with weight changes.

A cross-sectional study was carried out in 2009.

Baoshan District, Shanghai, China.

A total of 342 pairs of newlyweds were recruited at their first visit. Weight and height were measured and food intake was measured based on an FFQ with forty-nine items. Dietary patterns were identified through factor analysis, and the factors associated with weight changes were determined by multiple regression models.

Average weight gain of the participants during marital transition was 1·9 kg (2·2 kg for men and 1·6 kg for women). Four major dietary patterns were identified: vegetable pattern, sweets and fats pattern, legume pattern and poultry, beef and mutton pattern. In multivariate analyses, the highest quintile of factor 2 (sweets and fats pattern) was significantly associated with weight gain after marriage in a comparison with the lowest quintile (β = 2·94; 95 % CI 0·75, 5·15; P = 0·01) in men. The highest quintile of factor 4 (poultry, beef and mutton pattern) was inversely associated with weight gain after marriage in a comparison with the lowest quintile (β = −1·21; 95 % CI −2·32, −0·11; P = 0·03).

Our results suggest that a pattern rich in sugar, oil and condiments may lead to greater marital weight gain in men; another pattern rich in poultry, beef and mutton may lead to less marital weight gain in both men and women.

To investigate iodine status and fish consumption of schoolchildren living in the Red Sea and White Nile regions of Sudan.

Cross-sectional study to determine urinary iodine concentration, visible goitre rate, iodine content of salt and fish consumption.

Port Sudan (Red Sea) and Jabal Awliya (White Nile), Sudan.

Two hundred eighty (n 280) children aged 6–12 years (142 boys, 138 girls).

The median urinary iodine concentration in children from Port Sudan and Jabal Awliya was 553 and 160 μg/l, respectively. Goitre was detected in 17·1 % of children from Port Sudan but only in 1·4 % from Jabal Awliya, The salt samples from Port Sudan contained 150–360 mg iodine (KOI3)/kg salt, whereas those from Jabal Awliya had levels below the detection limit. Despite consuming salt devoid of iodine, children from Jabal Awliya had optimal iodine status. It is plausible that consumption of Nile fish from Jabal Awliya Reservoir, which is a good source of iodine and favoured by the locals, might have provided sufficient iodine. In contrast, children from Port Sudan were at higher risk of iodine-induced hyperthyroidism resulting from consumption of excessively iodised salt.

The findings of the study clearly demonstrated that (i) Sudan still has a problem with iodine nutrition and quality control and monitoring of salt iodisation and (ii) including fish in the diet could provide a sufficient amount of iodine for schoolchildren.

Type 2 diabetes mellitus appears to involve an interaction between susceptible genetic backgrounds and environmental factors including highly calorific diets. As it is important to identify modifiable risk factors that may help reduce the risk of type 2 diabetes mellitus, the aim of the present study was to determine the association between egg consumption and the risk of type 2 diabetes mellitus.

A specifically designed questionnaire was used to collect information on possible risk factors of type 2 diabetes mellitus. The odds ratios and 95 % confidence intervals for type 2 diabetes mellitus were calculated by conditional logistic regression.

A case–control study in a Lithuanian out-patient clinic was performed in 2001.

A total of 234 cases with a newly confirmed diagnosis of type 2 diabetes mellitus and 468 controls free of the disease.

Variables such as BMI, family history of diabetes, cigarette smoking, education, morning exercise and plasma TAG level were retained in multivariate logistic regression models as confounders because their inclusion changed the value of the odds ratio by more than 10 % in any exposure category. After adjustment for possible confounders more than twofold increased risk of type 2 diabetes mellitus was determined for individuals consuming 3–4·9 eggs/week (OR = 2·60; 95 % CI 1·34, 5·08) and threefold increased risk of the disease was determined for individuals consuming ≥5 eggs/week (OR = 3·02; 95 % CI 1·14, 7·98) compared with those eating <1 egg/week.

Our data support a possible relationship of egg consumption and increased risk of type 2 diabetes mellitus.

To explore associations of early infant feeding with (i) eating patterns in the second year of life and (ii) weight status in the fourth year of life in a prospective cohort of children in Scotland.

Growing Up in Scotland (GUS) longitudinal birth cohort study (2005–2008).

Scotland, UK.

Children aged 9–12 months (n 5217) followed through to 45–48 months.

Infant feeding was associated with eating patterns, defined by using SPSS two-step cluster analysis, in the second year of life. Children who were ever breast-fed compared with never breast-fed (adjusted OR = 1·48, 95 % CI 1·27, 1·73) were more likely to have a positive eating pattern (Cluster 2). Children who started complementary feeding at 4–5 months or 6–10 months compared with 0–3 months (adjusted OR = 1·32, 95 % CI 1·09, 1·59 or AOR = 1·50, 95 % CI 1·19, 1·89) were more likely to belong to Cluster 2. Breast-feeding was negatively associated with being overweight or obese in the fourth year of life compared with no breast-feeding (adjusted OR = 0·81, 95 % CI 0·81, 1·01). Introduction of complementary feeding at 4–5 months compared with 0–3 months was negatively associated with being overweight or obese (adjusted OR = 0·74, 95 % CI 0·57, 0·97).

Breast-feeding and introduction of complementary feeding after 4 months were associated with a positive eating pattern in the second year of life. Introduction of complementary feeding at 4–5 months compared with 0–3 months was negatively associated with being overweight or obese.

The present study aimed to investigate the individual and family determinants of being overweight among children younger than 10 years of age.

Cross-sectional survey. Direct data on children's age, food intake, physical activity, type of transportation used and anthropometric measurements, as well as the education level of the mothers, were collected by trained interviewers.

Population-based study in the city of Santos, Brazil.

A total of 531 children under 10 years of age (302 aged <6 years, 229 aged ≥6 years), living in the city of Santos.

The overall prevalence of overweight and obesity (BMI-for-age Z-score >1) was 35·4 % for children under 6 years and 38·9 % for children aged 6–10 years. The socio-economic status of the family was associated with being overweight for both age groups. Logistic regression analysis showed that the lower the socio-economic status, the higher the likelihood of being overweight, among both younger children (OR = 7·73; P = 0·02) and older children (OR = 1·98; P = 0·04). The use of active transportation was associated with a lower likelihood of being overweight, but only among younger children (OR = 1·70; P = 0·05).

Socio-economic status seems to be an important individual-level determinant of overweight in children. Public policies should consider promoting the use of active transportation, as the results showed it to have a positive effect on reducing overweight issues. The high prevalence of overweight in younger children suggests that this age group should be a priority in health-promoting interventions.

To assess the relationship between adolescent perception of time to walk to neighbourhood food retail outlets and purchasing of sugar-sweetened beverages (SSB), fast and convenience food items, and to test for differences by urban v. suburban environment.

Cross-sectional observational study.

Twin Cities Metropolitan Area, Minnesota, USA.

Adolescents from two studies completed survey-based measures on perceptions of time to walk to food retail outlets from home, purchasing patterns of SSB and fast and convenience store items, perceptions of personal safety and pedestrian infrastructure, and demographic characteristics. Descriptive analysis, Spearman correlations and multivariate linear regression, accounting for clustering, were conducted.

There were 634 adolescents, approximately half male, predominantly white, with a middle-class background. Greater perceived time to food outlets was associated with less frequent purchasing of SSB, convenience store foods and fast-food items. Multivariate models showed that a perceived shorter walking time (i.e. 1−5 v. 31+ min) was significantly associated with more SSB purchasing. SSB purchases were also significantly associated with the number of food outlets within a 10 min walk (B = 0·05, P = 0·02).

A reduction in consumption of SSB and other energy-dense snacks is an important obesity prevention approach. An approach offering alternatives or reducing exposure in addition to education to alter purchasing habits may contribute to improving dietary habits and reducing the obesity epidemic.

To systematically review weight and cardiovascular risk reduction in blacks by diet and lifestyle changes.

Randomised and non-randomised controlled trials of diet with/without lifestyle changes with duration of intervention ≥3 months, and published between January 1990 and December 2009, were searched in electronic databases including MEDLINE, EMBASE, CINAHL and CCTR (Cochrane Controlled Trials Register). Studies were included if they reported weight/BMI changes with changes in at least one of the following: systolic and diastolic blood pressure, fasting plasma lipids and glucose, and glycated haemoglobin.

Clinical, community and church-based interventions.

Study participants were of African ancestry (blacks).

Eighteen studies met the inclusion criteria. Average mean difference in weight loss was −2·66 kg, with improvements in all outcomes except total cholesterol. No significant difference was observed in outcome measures between all studies and studies that recruited only healthy participants or patients with type 2 diabetes.

Diet and lifestyle changes result in weight loss with improvements in cardiovascular risk factors in blacks. However, more culturally tailored programmes have been suggested to motivate and encourage blacks to participate in intervention trials.

The aim of the study was to describe who ate 5 or more portions of fruit and vegetables per day (‘compliers’) in 1986–1987 and in 2000–2001.

We used data from the Dietary and Nutritional Surveys of British Adults. Each is a nationally representative dietary survey using 7 d weighed food records for men and women, aged 16–64 years, living in private households in Great Britain in 1986–1987 and in 2000–2001.

Great Britain.

Data were analysed for 2197 adults in 1986–1987 and 1724 adults in 2000–2001.

In 1986–1987 12·7 % were classified as ‘compliers’ compared with 16·5 % in 2000–2001. Manual social classes, younger participants and people on benefits or outside paid employment were less likely to be ‘compliers’. Being divorced, widowed or separated was negatively related to being a ‘complier’, as was being in a household with dependant children or a lone parent with dependant children. Between 1986–1987 and 2000–2001 improvements were seen across social class groups and differences between men and women and between regions were reduced.

Only 12·7 % participants in the Dietary and Nutritional Surveys of British Adults were classified as ‘compliers’ in 1986–1987 compared with 16·5 % in 2000–2001. There have been some important changes in the distribution of ‘compliers’, but the low levels overall support the need for a reinvigorated policy drive to improve compliance with fruit and vegetable goals.

Previous work studying vegetarians has often found that they have lower blood pressure (BP). Reasons may include their lower BMI and higher intake levels of fruit and vegetables. Here we seek to extend this evidence in a geographically diverse population containing vegans, lacto-ovo vegetarians and omnivores.

Data are analysed from a calibration sub-study of the Adventist Health Study-2 (AHS-2) cohort who attended clinics and provided validated FFQ. Criteria were established for vegan, lacto-ovo vegetarian, partial vegetarian and omnivorous dietary patterns.

Clinics were conducted at churches across the USA and Canada. Dietary data were gathered by mailed questionnaire.

Five hundred white subjects representing the AHS-2 cohort.

Covariate-adjusted regression analyses demonstrated that the vegan vegetarians had lower systolic and diastolic BP (mmHg) than omnivorous Adventists (β = −6·8, P < 0·05 and β = −6·9, P < 0·001). Findings for lacto-ovo vegetarians (β = −9·1, P < 0·001 and β = −5·8, P < 0·001) were similar. The vegetarians (mainly the vegans) were also less likely to be using antihypertensive medications. Defining hypertension as systolic BP > 139 mmHg or diastolic BP > 89 mmHg or use of antihypertensive medications, the odds ratio of hypertension compared with omnivores was 0·37 (95 % CI 0·19, 0·74), 0·57 (95 % CI 0·36, 0·92) and 0·92 (95 % CI 0·50, 1·70), respectively, for vegans, lacto-ovo vegetarians and partial vegetarians. Effects were reduced after adjustment for BMI.

We conclude from this relatively large study that vegetarians, especially vegans, with otherwise diverse characteristics but stable diets, do have lower systolic and diastolic BP and less hypertension than omnivores. This is only partly due to their lower body mass.

To examine the association between eating in response to hunger and satiety signals (intuitive eating) and BMI. A second objective was to determine whether the hypothesized higher BMI in less intuitive eaters could be explained by the intake of specific foods, speed of eating or binge eating.

Cross-sectional survey. Participants were randomly selected from a nationally representative sampling frame. Eating in response to hunger and satiety signals (termed ‘intuitive eating’), self-reported height and weight, frequency of binge eating, speed of eating and usual intakes of fruits, vegetables and selected high-fat and/or high-sugar foods were measured.

Nationwide study, New Zealand.

Women (n 2500) aged 40–50 years randomly selected from New Zealand electoral rolls, including Māori rolls (66 % response rate; n 1601).

Intuitive Eating Scale (IES) scores were significantly associated with BMI in an inverse direction, after adjusting for potential confounding variables. When controlling for confounding variables, as well as potential mediators, the inverse association between intuitive eating (potential range of IES score: 21–105) and BMI was only slightly attenuated and remained statistically significant (5·1 % decrease in BMI for every 10-unit increase in intuitive eating; 95 % CI 4·2, 6·1 %; P < 0·0 0 1). The relationship between intuitive eating and BMI was partially mediated by frequency of binge eating.

Eating in response to hunger and satiety signals is strongly associated with lower BMI in mid-age women. The direction of causality needs to be investigated in longitudinal studies and randomized controlled trials.

Distribution of breast milk substitutes (BMS) after the 2006 Yogyakarta earthquake was uncontrolled and widespread. We assessed the magnitude of BMS distribution after the earthquake, its impact on feeding practices and the association between consumption of infant formula and diarrhoea among infants and young children.

One month after the earthquake, caregivers of 831 children aged 0–23 months were surveyed regarding receipt of unsolicited donations of BMS, and on recent child-feeding practices and diarrhoeal illness.

Community-level survey in an earthquake-affected district.

Primary caregivers of surveyed children.

In all, 75 % of households with an infant aged 0–5 months and 80 % of all households surveyed received donated infant formula; 76 % of all households received commercial porridge and 49 % received powdered milk. Only 32 % of 0–5-month-old infants had consumed formula before the earthquake, but 43 % had in the 24 h preceding the survey (P < 0·001). Consumption of all types of BMS was significantly higher among those who received donated commodities, regardless of age (P < 0·01). One-week diarrhoea incidence among those who received donated infant formula (25·4 %) was higher than among those who did not (11·5 %; relative risk = 2·12, 95 % CI = 1·34, 3·35). The rate of diarrhoea among those aged 12–23 months was around five times the pre-earthquake rate.

There were strong associations between receipt of BMS and changes in feeding practices, and between receipt of infant formula and diarrhoea. Uncontrolled distribution of infant formula exacerbates the risk of diarrhoea among infants and young children in emergencies.

To analyse changes in food choices, diet-related risk factors and their association during 6 months of military service.

Longitudinal cohort study in Finland, where all men are liable to military service and a clear majority of each age group completes service. Dietary intake data were collected by self-administered questionnaire before and at 6 months of service. Three dietary indices based on food frequencies were developed to characterize the diet: Sugar Index, Fibre Index and Fat Index. Thirteen diet-related risk factors were measured at the beginning and at 6 months of service.

Military environment, two geographically distinct garrisons.

Male conscripts aged 18–21 years (n 256) performing military service.

During 6 months of service, positive changes concerned more frequent use of fibre-rich foods (P = 0·011), improved body composition (BMI, waist circumference, muscle mass, fat mass and percentage body fat, P ≤ 0·003 for all), decreased systolic blood pressure and increased HDL cholesterol (P < 0·001 for both). Negative changes concerned more frequent use of sugar-rich foods and increased total cholesterol, TAG and blood glucose (P < 0·001 for all). The consumption of fibre-rich foods was inversely associated with anthropometric risk factors at baseline and with sugar-rich foods at both time points.

Despite more frequent consumption of sweet foods, military service with a unified, nutritionally planned diet, a controlled environment and high physical load has a positive effect on conscripts’ health risk factors. The negative changes in blood lipids and glucose may reflect more varied free-time eating.

We examined the distribution of diabetes and modifiable risk factors to provide data to aid diabetes prevention programmes in India.

Population-based cross-sectional survey of men and women included in India's third National Family Health Survey (NFHS-3, 2005–2006).

The sample is a multistage cluster sample with an overall response rate of 98 %. All states of India are represented in the sample (except the small Union Territories), covering more than 99 % of the country's population.

Women (n 99 574) and men (n 56 742) aged 20–49 years residing in the sample households.

Prevalence of diabetes was 1598/100 000 (95 % CI 1462, 1735) among men and 1054/100 000 (95 % CI 974, 1134) among women in India. Rural–urban and marked geographic variation were found with higher rates in south and north-eastern India. Weekly and daily fish intake contributed to a significantly higher risk of diabetes among both women and men. Risks of diabetes increased with increased BMI, age and wealth status of both women and men, but no effects of the consumption of milk/curd, vegetables, eggs, television watching, alcohol consumption or smoking were found. Daily consumption of pulse/beans or fruits was associated with a significantly reduced risk of diabetes among women, whereas non-significant inverse associations were observed in the case of men.

Prevalence was underestimated using self-reports. The wide variation in self-reported diabetes is unlikely to be due entirely to reporting biases or access to health care, and indicates that modifiable risk factors exist. Prevention of diabetes should focus on obesity and target specific socio-economic groups in India.