The present paper describes a model for public health nutrition practice designed to facilitate practice improvement and provide a step-wise approach to assist with workforce development.

The bi-cycle model for public health nutrition practice has been developed based on existing cyclical models for intervention management but modified to integrate discrete capacity-building practices.

Education and practice settings.

This model will have applications for educators and practitioners.

Modifications to existing models have been informed by the authors’ observations and experiences as practitioners and educators, and reflect a conceptual framework with applications in workforce development and practice improvement. From a workforce development and educational perspective, the model is designed to reflect adult learning principles, exposing students to experiential, problem-solving and practical learning experiences that reflect the realities of work as a public health nutritionist. In doing so, it assists the development of competency beyond knowing to knowing how, showing how and doing. This progression of learning from knowledge to performance is critical to effective competency development for effective practice.

Public health nutrition practice is dynamic and varied, and models need to be adaptable and applicable to practice context to have utility. The paper serves to stimulate debate in the public health nutrition community, to encourage critical feedback about the validity, applicability and utility of this model in different practice contexts.

To determine the factors associated with sugar-sweetened soft drink consumption in adolescents from Sri Lanka.

A cross-sectional study where the data were collected by means of a self-administered questionnaire.

Government, private and international schools in the Colombo district of Sri Lanka.

Adolescents aged 17 years attending sixty-five schools.

Overall 82 % consumed sugar-sweetened soft drinks once weekly or more often, while 77 % and 48 % consumed sugar-sweetened carbonated drinks and sugar-sweetened fruit drinks once weekly or more often. Being a boy (OR = 1·44; 95 % CI 1·02, 2·03), attending a private/international school (OR = 4·12; 95 % CI 1·94, 8·75), mother's level of education (OR = 1·53; 95 % CI 1·03, 2·28) and father's occupation (middle level: OR = 2·39; 95 % CI 1·63, 3·52; upper level: OR = 2·48; 95 % CI 1·35, 4·56) were independently associated with the consumption of sugar-sweetened soft drinks.

The majority of adolescents in this sample consumed sugar-sweetened beverages once weekly or more often. It was evident that some sociodemographic factors were associated with the consumption of these drinks.

The aims of the present work were to study beverage consumption among obese women from rural communities in Mexico and to estimate daily polyphenol intake and dietary antioxidant capacity from beverages.

A cross-sectional study was used to analyse the beverage intake of 139 premenopausal obese women estimated through repeated 24 h food recalls. Total polyphenol content and antioxidant capacity were determined in eighteen beverages, representing 71 % of total beverage consumption, in order to estimate the intake of polyphenols (mg/person per d) and the dietary antioxidant capacity (μmol Trolox equivalents/person per d) from beverages.

Five rural communities located in Queretaro State, Mexico, in 2008.

A total of 139 premenopausal women identified as obese (BMI 35·0 (se 0·4) kg/m2), aged 25–45 years.

The contribution of beverages to dietary energy was 1369 kJ/d (18 % of total energy intake). Soft drinks were consumed the most (283 (se 17) ml/d), followed by coffee and fresh fruit beverages. Polyphenol intake and dietary antioxidant capacity from beverages was 180·9 (se 12·5) mg/person per d and >1000 μmol Trolox equivalents/person per d, respectively. The items that contributed most to this intake were coffee, roselle drink, peach and guava juices and infusions.

There is an urgent need to reduce the consumption of sugar-sweetened beverages among obese women from rural Mexico. Low-sugar beverages rich in polyphenols and antioxidants may be healthier options to replace sweetened drinks and increase the intake of bioactive compounds. Nutritional advice on this topic could be a viable strategy to tackle obesity in rural areas in Mexico.

To verify the impact of flour fortification on anaemia in Brazilian children. The survey also investigated the role of Fe deficiency as a cause of anaemia and estimated the bioavailability of the Fe in the children's diet. This local study was complemented by a nationwide survey of the types of Fe compounds added to flour.

Series of population-based surveys conducted in 2004 (baseline study), 2005, 2006 and 2008.

Pelotas, Rio Grande do Sul, Brazil.

Children under 6 years of age residing in the urban area of the city of Pelotas, Southern Brazil (n 507 in 2004; n 960 in 2005; n 893 in 2006; n 799 in 2008). In 2008, a sub-sample of children (n 114) provided venous blood samples to measure body Fe reserve parameters (ferritin and transferrin saturation).

We found no impact of fortification, with an increase in anaemia prevalence among children under 24 months of age. Hb levels decreased by 0·9 g/dl in this age group between 2004 and 2008 (10·9 g/dl to 10·0 g/dl; P < 0·001). Roughly 50 % of cases of anaemia were estimated to be due to Fe deficiency. Half of the mills surveyed used reduced Fe to fortify wheat flour. Total Fe intake from all foodstuffs was adequate for 88·6 % of the children, but its bioavailability was only 5 %.

The low bioavailability of the Fe compounds added to flours, combined with the poor quality of children's diets, account for the lack of impact of mandatory fortification.

To investigate the association between cooking behaviour and long-term survival among elderly Taiwanese.

Cohort study. The duration of follow-up was the interval between the date of interview and the date of death or 31 December 2008, when censored for survivors. Information used included demographics, socio-economic status, health behaviours, cooking frequencies, physical function, cognitive function, nutrition knowledge awareness, eating out habits and food and nutrient intakes. These data were linked to death records. Cox proportional-hazards models were used to evaluate cooking frequency on death from 1999 to 2008 with related covariate adjustments.

Elderly Nutrition and Health Survey in Taiwan, 1999–2000.

Nationally representative free-living elderly people aged ≥65 years (n 1888).

During a 10-year follow-up, 695 participants died. Those who cooked most frequently were younger, women, unmarried, less educated, non-drinkers of alcohol, non-smokers, without chewing difficulty, had spouse as dinner companion, normal cognition, who walked or shopped more than twice weekly, who ate less meat and more vegetables. Highly frequent cooking (>5 times/week, compared with never) predicted survival (hazard ratio (HR) = 0·47; 95 % CI, 0·36, 0·61); with adjustment for physical function, cognitive function, nutrition knowledge awareness and other covariates, HR was 0·59 (95 % CI, 0·41, 0·86). Women benefited more from cooking more frequently than did men, with decreased HR, 51 % v. 24 %, when most was compared with least. A 2-year delay in the assessment of survivorship led to similar findings.

Cooking behaviour favourably predicts survivorship. Highly frequent cooking may favour women more than men.

To assess the relationship of acculturation with physical activity and sedentary behaviours among Hispanic women in California.

Data from the 2005 California Women's Health Survey (CWHS) – a cross-sectional telephonic survey of health indicators and health-related behaviours and attitudes – were used.

Using a random-digit dialling process, data were collected monthly from January to December 2005.

A total of 1298 women aged ≥18 years in California who self-identified as Hispanic.

Of the participants included in the analysis, 49 % were adherent to physical activity recommendations (with 150 min of weekly activity signifying adherence). There was no significant association between language acculturation and moderate or vigorous physical activity after controlling for potential confounders such as smoking, age and employment status. There was also no association between duration of residence in the USA and moderate or vigorous physical activity. Language acculturation was positively associated with television (TV) viewing, with highly acculturated women reporting more hours of TV viewing compared with women with an intermediate acculturation score (P = 0·0001), and those with an intermediate score reporting more hours of TV viewing compared with those with a low score (P = 0·003). This relationship persisted after inclusion of smoking, employment status, age and education in the model.

Higher levels of language acculturation may be associated with increased sedentary behaviours because of the influence of US culture on those women who have assimilated to the culture. Acculturation is an important factor to be taken into account when designing health education interventions for the Hispanic female population.

To test whether there are differences in diet diversity between children still being partly breast-fed at 9 months and those completely weaned at the same age.

Cross-sectional study.

Cross-sectional study (SKOT cohort) in the area of Copenhagen, Denmark.

Healthy term infants (n 312) at 9 months of age (mean 9·1 (sd 0·3) months).

The infants partly breast-fed (n 168) at 9 months had significantly lower body weight (P < 0·0001), were significantly shorter (P = 0·0022) and were introduced to complementary foods significantly later (P < 0·0001) than completely weaned infants (n 141) of similar age. Furthermore, they had lower intake of energy, both in absolute amount (P < 0·0001) and per kilogram of body weight (P = 0·049). Significantly lower intakes of most energy-yielding nutrients, in absolute amounts and as energy percentages, were seen for the partly breast-fed compared with the completely weaned infants. These differences appear to be caused primarily by differences in the type and amount of milk consumed, as the energy derived from sources other than milk was similar except for fatty spread and vegetables as a side dish. Only small differences were found for absolute intakes of foods between feeding groups, although fatty spread had significantly higher intake rates and consumption (P = 0·031) among partly breast-fed compared with completely weaned infants.

At 9 months the infants partly breast-fed did not eat a less diversified diet compared with those completely weaned at the same age. Despite later introduction to complementary foods compared with the completely weaned, their intake of foods was similar and no delay in their progression towards the family foods was noted.

To evaluate the associations between sociodemographic and psychosocial characteristics and food label (FL) use in US adults.

Data from the 1994–1996 Continuing Survey of Food Intakes by Individuals and the Diet and Health Knowledge Survey were used. High socio-economic status (SES) was defined as >high school education and poverty–income ratio (PIR) >350 %, low SES as <high school level or PIR <130 %. Dietary intakes were assessed using 24 h recalls.

Metropolitan statistical area-central city, -suburban, and rural areas in the USA.

US adults (n 2797; 1460 men, 1337 women) aged 20–64 years.

Approximately 80 % of Americans reported using FL, including checking the nutrition panel, list of ingredients, short phrases, serving size, or health benefits. Only 26 % used all FL information. Compared with white women of higher SES, white men, black men and women with lower SES were 77–90 % less likely to use FL. Rural residents were 40 % less likely (OR = 0·60; 95 % CI 0·42, 0·86). Participants with good nutrition knowledge, perceptions and beliefs were twice as likely to check FL for nutrient content of foods (OR = 2·28; 95 % CI 1·53–3·40). Those who were unaware of diet–disease relationships were less likely to use FL (OR = 0·53; 95 % CI 0·32–0·85). Among overweight/obese Americans (BMI ≥ 25 kg/m2), those who perceived their weight ‘about right’ were 51 % less likely to use FL than those perceiving themselves as overweight.

Men, especially black men, women of low SES, rural residents and overweight Americans with inaccurate self-perception of body weight are less likely to use FL and should be targeted for increased intervention.

To (i) validate a recently proposed questionnaire tool for the simple assessment of physical activity (PA) in pre-school children by comparison with accelerometry and heart-rate recordings; and (ii) extend the tool by adding more questions to improve validity and to refine the classification from two to three categories (PA low, medium, high).

Baseline data of an intervention evaluation study.

Pre-school children.

Children were categorized as either physically active or non-active, based on their parents’ answers to the five-item questionnaire. Activity and heart rate were recorded for 6 d (Actiheart device; CamNtech, Cambridge, UK). Nightly sleeping periods were removed and mean accelerometry counts (MACT), time spent in moderate-to-vigorous intensity physical activity (MVPA) and time spent in sedentary behaviour (SB) were computed. In a second step, additional questions that improved validity were added, resulting in an extended seven-item questionnaire.

For 748 (90·4 %) of the participating children aged 2·3–6·7 years, the questionnaires were filled out sufficiently for classification. Children classified as physically active showed 9·6 % higher MACT (P < 0·0003), spent more time in MVPA and insignificantly less time in SB. Using the extended questionnaire, children with PA classified as medium (reference: low) showed 11·0 % more MACT, spent 11·8 % more time in MVPA and 4·8 % less time in SB. Children with PA classified as high showed 16·9 % more MACT, spent 20·2 % more time in MVPA and 7·2 % less time in SB.

With validated PA questionnaires for pre-school children lacking, the proposed questionnaire might be a reasonable option to include for PA assessment in epidemiological studies where more elaborate measurements are unavailable.

Since inadequate food consumption patterns during adolescence are not only linked with the occurrence of obesity in youth but also with the subsequent risk of developing diseases in adulthood, the establishment and maintenance of a healthy diet early in life is of great public health importance. Therefore, the aim of the present study was to describe and evaluate the food consumption of a well-characterized sample of European adolescents against food-based dietary guidelines for the first time.

The HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study is a cross-sectional study, whose main objective was to obtain comparable data on a variety of nutritional and health-related parameters in adolescents aged 12·5–17·5 years.

Ten cities in Europe.

The initial sample consisted of more than 3000 European adolescents. Among these, 1593 adolescents (54 % female) had sufficient and plausible dietary data on energy and food intakes from two 24 h recalls using the HELENA-DIAT software.

Food intake of adolescents in Europe is not optimal compared with the two food-based dietary guidelines, Optimized Mixed Diet and Food Guide Pyramid, examined in this study. Adolescents eat half of the recommended amount of fruit and vegetables and less than two-thirds of the recommended amount of milk (and milk products), but consume much more meat (and meat products), fats and sweets than recommended. However, median total energy intake may be estimated to be nearly in line with the recommendations.

The results urge the need to improve the dietary habits of adolescents in order to maintain health in later life.

The present study aimed to evaluate the nutritional status of pregnant women in Colombia and the associations between gestational BMI and sociodemographic and gestational characteristics.

Cross-sectional study. A secondary analysis was made of data from the 2005 Demographic and Health Survey of Colombia.

Bogotá, Colombia.

Pregnant adolescents aged 13–19 years (n 430) and pregnant women aged 20–49 years (n 1272).

The gestational BMI and sociodemographic characteristics of the adolescents differed from those of the pregnant adult women. Thirty-one per cent of the adolescents were underweight for gestational age, compared with 14·5 % of the adult women. Eighteen per cent of adolescents were overweight for gestational age, in contrast to 37·3 % of adult women. The overall prevalence of anaemia was 44·7 % and the prevalence of low serum ferritin was 38·8 %. Women within the high quintiles of the wealth index (prevalence odds ratio (POR) = 0·56; 95 % CI 0·34, 0·91, P < 0·02) had lower odds of being underweight. Women who received prenatal care (POR = 2·17; 95 % CI 1·48, 3·09, P < 0·001) and were multiparous (POR = 2·10; 95 % CI 1·43, 3·15, P < 0·0 0 1) had higher odds of being overweight. Women in extended families (POR = 0·63; 95 % CI 0·50, 0·95, P < 0·025) had lower odds of being overweight.

Underweight in pregnant adolescents and overweight in adult women coexist as a double burden in Colombia. Factors associated with malnutrition among pregnant women and adolescents should be considered for future interventions in countries experiencing nutritional transition.

Little is known about current public health nutrition workforce development in Europe. The present study aimed to understand constraining and enabling factors to workforce development in seven European countries.

A qualitative study comprised of semi-structured face-to-face interviews was conducted and content analysis was used to analyse the transcribed interview data.

The study was carried out in Finland, Iceland, Ireland, Slovenia, Spain, Sweden and the UK.

Sixty key informants participated in the study.

There are constraining and enabling factors for public health nutrition workforce development. The main constraining factors relate to the lack of a supportive policy environment, fragmented organizational structures and a workforce that is not cohesive enough to implement public health nutrition strategic initiatives. Enabling factors were identified as the presence of skilled and dedicated individuals who assume roles as leaders and change agents.

There is a need to strengthen coordination between policy and implementation of programmes which may operate across the national to local spectrum. Public health organizations are advised to further define aims and objectives relevant to public health nutrition. Leaders and agents of change will play important roles in fostering intersectorial partnerships, advocating for policy change, establishing professional competencies and developing education and training programmes.

To examine the trends in BMI and adiposity among schoolchildren from Cuenca, Spain, during 2004–2010.

Two methodologically comparable surveys were carried out in 2004 and 2010.

Primary schools in Cuenca, a province in the middle of Spain.

All schoolchildren aged 8–11 years, belonging to 4th and 5th grades from twenty schools in the Province of Cuenca, were invited to participate in both cross-sectional studies. Weight, height and body fat percentage (BF%) from bioelectrical impedance were measured with standardized procedures.

The study included 550 boys and 539 girls in 2004, and 569 boys and 531 girls in 2010. In 2010, 8·1 % of children were underweight, 25·9 % overweight and 9·5 % obese. From 2004 to 2010, the prevalence of overweight rose from 21·6 % to 28·0 % (P = 0·004) and BF % increased from 22·6 % to 24·0 % (P = 0·001) among boys. No change was observed in overweight and BF % in girls, or in underweight and obesity in either sex. In boys, most of the distribution of BMI and BF % shifted to the right; in contrast, among girls no substantial change was apparent in the distribution of BMI and BF %.

From 2004 to 2010 the prevalence of overweight and adiposity has continued to increase among boys. However, the obesity epidemic may have levelled off in girls. Given that the prevalence of childhood excess weight is still very high, the current evidence-based efforts to halt the obesity epidemic in Spain should be strengthened.

There are no percentile curves for BMI, waist circumference (WC) or waist-to-height ratio (WHtR) available for Portuguese children and adolescents. The purpose of the present study was to develop age- and sex-specific BMI, WC and WHtR percentile curves for a representative sample of adolescents living in the Portuguese islands of Azores, one of the poorest regions of Europe, and to compare them with those from other countries.

Cross-sectional school-based study. Weight, height and WC were objectively measured according to standard procedures. Smoothed percentile curves were estimated using Cole's LMS method.

Azores, Portugal.

Proportionate stratified random sample of 1500 adolescents, aged 15–18 years.

Results showed some sex differences in the shape of the BMI curves: in girls, the upper percentile values tend to decrease by the age of 16 and 17 years; whereas in boys, the upper percentiles tend to be flat between 15 and 16 years and then increase until the age of 18 years. In both sexes, the upper percentile values of both WC and WHtR decreased slightly by the age of 16 years and then increased steeply. In both sexes, the Azorean values for the 50th and 90th WC percentiles were higher than those reported for adolescents from the majority of other countries.

The reference curves presented herein provide baseline data for the long-term surveillance of Azorean adolescents, as well as for national and international comparisons.