To develop a psychometrically valid questionnaire for testing knowledge on micronutrients and to assess the relationship between knowledge and biomarkers of micronutrient status among adolescents.

Cross-sectional, institution-based, validity and reliability study.

Seven higher secondary schools were covered in the limits of Greater Hyderabad Municipal Corporation, Hyderabad, India.

Students aged 15–19 years, n 92 for the pre-test, n 108 for test–retest and n 109 for studying the relationship between knowledge and biomarkers of Fe, retinol, ascorbic acid, α-tocopherol, folic acid and vitamin B12 status.

From an item pool of 106, thirty-one items were selected based on content validity. Statistical tools to obtain a valid and reliable questionnaire among adolescent boys and girls resulted in eighteen items with a difficulty index of 0·11–0·86, discrimination index of 0·20–0·72 and validity index (point bi-serial correlation) of 0·10–0·62. Reliability as measured by Cronbach's α was 0·71 and the intra-class correlation coefficient was 0·80. A Bland–Altman plot showed good agreement between test and retest scores. The mean response score to the eighteen-item questionnaire was 5·2 (sd 2·68). The mean values of serum retinol were significantly different (P = 0·022) between groups below (24·8 (sd 6·64) μg/dl) and above (28·0 (sd 7·67) μg/dl) the 50th percentile of knowledge score. The relationship persisted after controlling for economic status as a covariate using analysis of covariance (P = 0·018). Other micronutrients did not show any significant relationship.

A valid and reliable eighteen-item knowledge questionnaire was constructed and found to have a significant positive relationship with plasma retinol status alone.

The current systematic review aimed to identify and critically appraise research on food environments in sports settings, including research into the types of food and beverages available, the extent and impact of food and beverage sponsorship and marketing, and views about food environments among key stakeholders.

A systematic review. Fourteen English-language studies (two were papers describing different facets of the same study), published between 1985 and 2011, were identified from searches of electronic databases and bibliographies of primary studies.

Most studies originated from Australia (n 10), with the remaining studies originating in the UK (n 1), New Zealand (n 1), the USA (n 1) and Canada (n 1). Data were collected from observations in stadia, websites and televised sports events, through in-depth interviews, focus groups and surveys with sports club members, parents and quick serve restaurant managers.

Literature exploring food environments in sports settings was limited and had some important methodological limitations. No studies comprehensively described foods available at clubs or stadia, and only one explored the association between food and beverage sponsorship and club incomes. Club policies focused on the impact of health promotion funding rather than the impact of sponsorship or food availability in sports settings.

Further research, including comprehensive studies of the food environment in sports settings, is required to document the availability, sponsorship and marketing of food and beverages at national, regional and club levels and to estimate how sports settings may influence children's diets.

To examine associations between the availability of residential-area food sources and dietary patterns among seniors.

Cross-sectional analyses. Individual-level data from the NuAge study on nutrition and healthy ageing were merged with geographic information system data on food store availability and area-level social composition. Two dietary patterns reflecting lower- and higher-quality diets (respectively designated ‘western’ and ‘prudent’) were identified from FFQ data. Two food source relative availability measures were calculated for a 500 m road-network buffer around participants’ homes: (i) proportion of fast-food outlets (%FFO) relative to all restaurants and (ii) proportion of stores potentially selling healthful foods (%HFS, healthful food stores) relative to all food stores. Associations between dietary patterns and food source exposure were tested in linear regression models accounting for individual (health and sociodemographic) and area-level (socio-economic and ethnicity) covariates.

Montréal metropolitan area, Canada.

Urban-dwelling older adults (n 751), aged 68 to 84 years.

%FFO was inversely associated with prudent diet (β = −0·105; P < 0·05) and this association remained statistically significant in models accounting for %HFS. %HFS was inversely associated with lower western diet scores (β = −0·124; P < 0·01). This latter association no longer reached significance once models were adjusted for area-level covariates.

In Montréal, the food environment is related to the diet of older adults but these links are more complex than straightforward. The absence of significant relationships between healthful food stores and prudent diets, and between fast-food outlets and western diets, deserves further investigation.

Few data exist looking at vitamin D status and bone health in school-aged boys and girls from Saudi Arabia. The present study aimed to determine the extent of poor vitamin D status in school boys and girls aged 6–18 years and to examine if there was any difference in status with age, physical activity and veiling and concomitant effects on bone.

Cross-sectional study.

Jeddah, Kingdom of Saudi Arabia.

A total of 150 boys (7–16 years) and 150 girls (6–18 years) from local schools were divided into age categories: 6–9 years (elementary school); 10–12 years (secondary school); 13–14 years (middle years); 15–18 years (high school).

Vitamin D status was significantly lower in girls than boys in all age groups (P < 0·01), with the 15–18-year-old girls having the lowest level (22·0 (sd 9·4) nmol/l) in comparison to the 15–18-year-old boys (39·3 (sd 14·0) nmol/l) and the 6–9-year-old girls (41·2 (sd 9·3) nmol/l). Parathyroid hormone status was highest in the 15–18-year-old girls in comparison to boys of the same age. A total of 64 % of 15–18-year-old girls had 25-hydroxyvitamin D (25OHD) status <25 nmol/l in comparison to 31 % in the 13–14 years age category, 26 % in the 10–12 years category and 2·5 % in the 6–9 years category. No boys had 25OHD status <25 nmol/l. Fully veiled girls had lower 25OHD status than partly veiled or unveiled girls (P < 0·05). Low 25OHD and high parathyroid hormone was associated with lower bone mass in the 6–9 years and 13–14 years age groups (P < 0·05).

These data suggest significant hypovitaminosis D in older adolescent females, which is a cause for concern given that there is currently no public health policy for vitamin D in the Kingdom of Saudi Arabia.

To identify family- and school-based correlates of specific energy balance-related behaviours (physical activity, sedentary behaviour, breakfast consumption, soft drink consumption) among 10–12-year-olds, using the EnRG framework (Environmental Research framework for weight Gain prevention).

A literature review to identify observational studies exploring at least one family- or school-based correlate of the specific behaviours, resulting in seventy-six articles.

Eighteen studies were conducted in Europe, forty-one studies in North America and seventeen studies in Australasia.

Healthy children aged 10–12 years.

Parental and maternal physical activity, doing physical activities with parents and parental logistic support were identified as the most important, positive correlates of physical activity. Parental rules was the most important correlate of sedentary behaviour and was inversely related to it. School socio-economic status was positively related to physical activity and inversely related to sedentary behaviour. The available studies suggested a positive relationship between soft drink availability at home and consumption. Soft drink availability and consumption at school were the most important school-based correlates of soft drink consumption. A permissive parenting style was related to more soft drink consumption and less breakfast consumption.

An important role has been awarded to parents, suggesting parents should be involved in obesity prevention programmes. Despite the opportunities a school can offer, little research has been done to identify school-environmental correlates of energy balance-related behaviours in this age group. Obesity prevention programmes can focus on the most important correlates to maximize the effectiveness of the programme. Future research should aim at longitudinal studies.

To identify spatial variation in the risk for metabolic complications (RMC) by means of a semi-parametric approach for multinomial data.

Cross-sectional study.

We visited 730 households selected in the first of a two-stage sample in South health district in Campinas, São Paulo, Brazil, 2006–2007.

We interviewed 651 individuals and obtained their respective anthropometric measures and geographical coordinates of their house location. They were classified according to a combination of BMI and abdominal circumference as having no risk, increased, high or very high RMC.

Gender, age and schooling were associated with RMC. Crude spatial risk for the three levels of RMC in relation to the absence of risk suggested different patterns in each level. Adjusted spatial risk for the RMC showed smaller significant areas, but the pattern remained similar to crude risk.

Spatial point analysis with a multinomial approach improves the understanding of differences in RMC found, as we could identify specific areas in which to intervene. The public health significance of these findings may lie in the additional evidence provided that spatial location and its features can influence patterns of RMC.

Breakfast has been linked to several aspects of health, yet breakfast skipping is rampant across the globe. Studies in India have focused mostly on children. Hence the present study examined breakfast behaviour across different age and gender groups.

Cross-sectional sample, purposive sampling. Nutrient intakes of the participants derived from 24 h dietary recall and 3 d breakfast record data were compared with RDA values prescribed by the Indian Council of Medical Research using Student's t test, with P < 0·05 taken to indicate significance.

Mumbai, India.

Participants (n 1027) aged 8 years and above.

Nutritional adequacy of the breakfast meal and that of the day's diet were the main outcome measures. Eighty-one per cent of the participants had a nutritionally inadequate breakfast. Intakes of Fe and dietary fibre were notably low. Consumption of just milk or milk plus a milk food-based drink among schoolchildren (49 %) and increased breakfast skipping among adolescents (37 %) were seen.

The study identifies both irregularities and/or nutritional inadequacies with respect to the breakfast meal. Age- and gender-specific challenges in breakfast behaviour need to be addressed. Development of ‘nutrient-dense’ breakfast foods that can be prepared easily, school breakfast programmes and education on the importance of breakfast are the needs of the hour.

The aim of the present study was to explore knowledge of the UK weaning guidelines and the sources of weaning advice used by UK first-time mothers.

An online survey of UK parents; analysed using mixed methods.

Participants were recruited from a selection of parenting websites that hosted a link to the survey.

In total, 1348 UK first-time mothers were included in the analysis.

Knowledge of the guidelines was high (86 %) and associated with later weaning (P < 0·001), although 43 % of this sample weaned before 24 weeks. The majority of parents used multiple sources of information, the most influential being the health visitor (26 %), the Internet (25 %) and books (18 %). Fifty-six per cent said they received conflicting advice. Younger mothers and those of lower educational attainment were more likely to be influenced by advice from family, which was likely to be to wean earlier. Furthermore, those most influenced by their mother/grandmother were less likely to have accurate knowledge of the guidelines. In this population the Internet was used for weaning advice across all sociodemographic groups and was associated with a later weaning age, independently of sociodemographic factors (P < 0·001). Data from responses to a free-text question are used in illustration.

The study suggests that first-time mothers have a good understanding of the weaning guidelines but seek weaning information from multiple sources, much of which is conflicting. Informal sources of weaning advice appear most influential in younger mothers and those of lower educational attainment, and result in earlier weaning.

The present study evaluated the contribution of 100 % orange juice (OJ) consumption to the intakes of macronutrients and energy and its impact on body composition.

A cross-sectional study was conducted. The main exposure was OJ consumption based on two non-consecutive 24 h diet recalls. Macronutrient and energy intakes and body composition parameters were outcome measures. All statistical analyses were carried out using SAS and SUDAAN statistical software packages to allow for multistage sample designs.

The US population and its subgroups.

The US population aged ≥4 years (n 13 971) from the National Health and Nutrition Examination Survey 2003–2006, conducted by the National Center for Health Statistics.

In this US population, OJ consumers had lower BMI and healthier lifestyle behaviours (including lower alcohol consumption and smoking as well as higher exercise level) than non-consumers (P < 0·05). After adjusting for covariates, OJ consumers had higher daily intakes of carbohydrate, total sugar, total fat and energy than non-consumers (P < 0·01). However, these linear trends still remained even after OJ was removed from the food list of items consumed. Adult OJ consumers had lower BMI, waist circumference and percentage body fat than non-consumers (P < 0·01), as well as lower odds ratio for overweight and obesity (P < 0·01). These effects were not seen in children and adolescents, where there was no significant difference in BMI, waist circumference and percentage body fat in OJ consumers compared with non-consumers.

OJ consumption was associated with healthier body composition in adults; while there were no significant associations between OJ consumption and body composition in children and adolescents.

To evaluate the cost-effectiveness of the European community-based project ‘10 000 Steps Ghent’, an intervention that resulted in a significant decrease in sedentary time and a significant increase in step counts (896 steps/d) and self-reported walking (66 min/week).

An age- and gender-dependent Markov model, with a time horizon of 20 years and a cycle length of 1 year, estimating the development of diabetes, cardiovascular events and colorectal cancer.

All individuals started in a health state free of events. The effect of the intervention was based on published risk reductions related to increased walking time. Costs and utility decrements related to events were obtained from published literature. The impact of the uncertainty of the parameters on incremental costs and quality-adjusted life years (QALY) were assessed with one-way sensitivity analyses and a Monte Carlo analysis.

Cohort representing the population reached by the intervention (266 adults aged 25–75 years with a mean age of 48·2 (sd 13·1) years, 45·6 % men, 64·6 % highly educated, 70·0 % employed).

Implementing the community-based programme increased average QALY by 0·16 and 0·11 for men and women, respectively. The total costs decreased by approximately 576€ and 427€, respectively. Hence, for both genders the intervention programme was dominant. The sensitivity analyses did not change the conclusion of dominance.

The community-based ‘10 000 Steps Ghent’ campaign is a dominant intervention. Sensitivity analyses have proved the robustness of the results; hence implementing this intervention on a population-based level could lead to improved health outcomes and reduced costs.

Patterns of socio-economic inequalities in obesity and overweight have not been documented for Turkey. The present study aimed to describe educational and wealth-related inequalities for overweight in Turkey, taking a regional perspective.

Cross-sectional self-reported data of the World Health Survey 2002 for Turkey were used. BMI ≥ 25·00 kg/m2 was considered as overweight. Respondents were classified according to education years and a wealth score derived from the availability of household assets. Logistic regression analysis was applied to assess the relationship between overweight and socio-economic factors. Analyses were stratified by sex and region (West, Mediterranean, Middle, Black Sea and East).

Turkey.

Among the respondents 20 years and older, 3790 women and 4057 men had data on self-reported height and weight.

Age-adjusted overweight prevalence was 48·4 % for women and 46·1 % for men. For men, education was not systematically related to overweight while overweight was significantly increased among the highest wealth groups. For women, the prevalence of overweight was highest for low-educated and middle-wealth groups. The size of the inequalities in overweight showed only small regional variations. In the East, however, overweight prevalence was more related to higher socio-economic position than in the other regions.

Socio-economic inequalities for overweight in Turkey are at a similar level as in most European countries, and especially comparable to Southern Europe. The smaller inequalities in the East correspond to the low level of socio-economic development in this part of the country. Prevention of overweight should focus on lower educational groups throughout the entire country and especially on low-educated women.

To describe the UK Food Standards Agency's (FSA) salt reduction programme undertaken between 2003 and 2010 and to discuss its effectiveness.

Relevant scientific papers, campaign materials and evaluations and consultation responses to the FSA's salt reduction programme were used.

Adult salt intakes, monitored using urinary Na data collected from UK-wide surveys, indicate a statistically significant reduction in the population's average salt intake from 9·5 g/d in 2000–2001 to 8·6 g/d in 2008, which is likely to have health benefits.

Reducing salt intake will have an impact on blood pressure; an estimated 6 % of deaths from CHD in the UK can be avoided if the number of people with high blood pressure is reduced by 50 %.

Salt levels in food, monitored using commercial label data and information collected through an industry self-reporting framework, indicated that substantial reductions of up to 70 % in some foods had been achieved. The FSA's consumer campaign evaluation showed increased awareness of the benefits of reducing salt intake on health, with 43 % of adults in 2009 claiming to have made a special effort to reduce salt in their diet compared with 34 % of adults in 2004, before the campaign commenced.

The UK's salt reduction programme successfully reduced the average salt intake of the population and increased consumers’ awareness. Significant challenges remain in achieving the population average salt intake of 6 g/d recommended by the UK's Scientific Advisory Committee on Nutrition. However, the UK has demonstrated the success of its programme and this approach is now being implemented elsewhere in the world.

To explore associations between household food security and home gardening, use of soya and pressure cooker ownership in low-income households affected by HIV/AIDS in Aurangabad, India.

Cross-sectional pilot study which assessed household food security using the validated US Department of Agriculture's food security core-module questionnaire. Questions were added to explore household environment, education, occupation, home gardening, use of soya and pressure cooker ownership. Households with very low v. low food security were compared using logistic regression analysis, controlling for confounding by socio-economic status.

Aurangabad is an urban setting situated in a primarily agricultural dependent area. The study was carried out in 2008, at the peak of the global food crisis.

Adult caregivers of children affiliated with the Network of People Living with HIV/AIDS in Aurangabad.

All except for one of 133 households were identified as food insecure (99·2 %). Of these households, 35·6 % had to cut size or skip a meal in the past 30 d. Households that cut meal size due to cooking fuel shortages were more likely to have very low food security (OR = 4·67; 95 % CI 1·62, 13·44) compared with households having no cooking fuel shortages. Owning a pressure cooker was shown to be protective against very low food security after controlling for confounding by socio-economic status (OR = 0·27; 95 % CI 0·11, 0·64).

Only pressure cooker ownership showed a protective association with low household food security. Pressure cookers save household fuel costs. Therefore, future interventions should explore pressure cookers as a sustainable means of improving household food security.

To provide updated estimates of drinking water intake (total, tap, plain bottled) for groups aged ≥1 year in the USA and to determine whether intakes collected in 2005–2006 using the Automated Multiple-Pass Method for the 24 h recall differ from intakes collected in 2003–2004 via post-recall food-frequency type questions.

Cross-sectional, observational study.

What We Eat in America (WWEIA), the dietary intake component of the US National Health and Nutrition Examination Survey (NHANES).

Individuals aged ≥1 year in 2003–2004 (n 8249) and 2005–2006 (n 8437) with one complete 24 h recall.

The estimate for the percentage of individuals who reported total drinking water in 2005–2006 was significantly (P < 0·0000) smaller (76·9 %) than that for 2003–2004 (87·1 %), attributable to a lower percentage reporting tap water (54·1 % in 2005–2006 v. 67·0 % in 2003–2004; P = 0·0001). Estimates of mean tap water intake differed between the survey cycles for men aged ≥71 years.

Survey variables must be examined before combining or comparing data from multiple WWEIA/NHANES release cycles. For at least some age/gender groups, drinking water intake data from NHANES cycles prior to 2005–2006 should not be considered comparable to more recent data.

Assessing changes in dietary intake during the transition from adolescence to adulthood is challenging given the need for age-appropriate tools at different developmental stages. The present study investigated the comparability of intake estimates as assessed with the youth/adolescent and adult forms of Willett's FFQ.

Young adults were first asked to complete the adult FFQ as part of a larger study, Project EAT-III (Eating and Activity in Teens and Young Adults). A stratified random sample of respondents was invited to complete the youth/adolescent FFQ by mail within a 3-week period.

Participants were members of a longitudinal cohort who completed baseline surveys (including the adolescent FFQ) at schools in Minneapolis/St. Paul, Minnesota and completed Project EAT-III surveys online or by mail in 2008–2009.

There were ninety-one men and 103 women (median age = 24·6 years) who completed both forms of the FFQ.

The adolescent and adult forms did not provide comparable absolute intake estimates. However, with few exceptions, correlation coefficients between intake estimates were moderate (r = 0·4–0·6). Furthermore, the percentage of individuals classified into the same quartile rank category based on their responses to the adolescent and adult forms was ≥50 % for fibre, vitamins A and E, and servings of fruit (excluding juice), vegetables, dairy, whole grains and soft drinks.

Although responses on the adolescent and adult FFQ cannot be compared to describe changes in absolute intake over time, these tools provide comparable intake rankings and may be used together in longitudinal studies to investigate influences on diet.

A high prevalence of food insecurity has persisted in the USA for the past two decades. Previous studies suggest that the association between food insecurity and obesity may vary by gender and race/ethnicity. We examined whether food insecurity was associated with BMI and obesity within gender and racial/ethnic groups in a large, diverse sample of low-income adults.

A cross-sectional analysis of a large population-based health survey. We compared the distribution of BMI and obesity by food security levels within gender and racial/ethnic categories.

Data were derived from the 2003–2009 waves of the California Health Interview Survey.

The study sample included 35 747 non-elderly adults with households ≤200 % of the federal poverty level.

Among Hispanic men, very low food security was associated with a 1·0 kg/m2 higher BMI (95 % CI 0·3, 1·7 kg/m2) and a 36 % higher prevalence of obesity (95 % CI 17, 58 %) after multivariate adjustment. Among Hispanic women, very low food security was associated with a 1·1 kg/m2 higher BMI (95 % CI 0·4, 1·9 kg/m2) and a 22 % higher prevalence of obesity (95 % CI 8, 38 %). Positive associations were also observed for Asian women and multi-racial men. No significant associations were observed for non-Hispanic whites, African Americans, Asian men or multi-racial women.

Our results suggest that the association of food insecurity and obesity is limited to individuals of certain low-income, minority racial/ethnic groups. Whether targeted interventions to address food insecurity in these individuals may also decrease obesity risk deserves further investigation.

Maternal nutrition knowledge has frequently been identified as an important target for nutrition promotion interventions. The aim of the present study was to investigate whether maternal nutrition knowledge is more strongly associated with the mother's own diet or that of her child.

Cross-sectional multivariate linear regression with interactions analyses of survey data.

Socio-economically disadvantaged neighbourhoods in Victoria, Australia.

Five hundred and twenty-three mothers and their children who participated in the Resilience for Eating and Physical Activity Despite Inequality (READI) study, a cross-sectional survey study conducted in 2009 among women and their children residing in socio-economically disadvantaged neighbourhoods.

In adjusted models, for three (vegetable, chocolate/lollies and soft drink consumption) out of the seven dietary outcomes assessed, there was a significant association between maternal nutrition knowledge and maternal diet, whereas for the children's diets none of the seven outcomes were associated with maternal nutrition knowledge. Statistical comparison of regression coefficients showed no difference between the maternal nutrition knowledge–maternal diet association and the maternal nutrition knowledge–child diet association.

Promoting maternal nutrition knowledge may represent an important avenue for improving diet in mothers from socio-economically disadvantaged neighbourhoods, but more information is needed on how and when this knowledge is translated to benefits for their children's diet.

The ‘Smart Choices’ programme was an industry-driven, front-of-package (FOP) nutritional labelling system introduced in the USA in August 2009, ostensibly to help consumers select healthier options during food shopping. Its nutritional criteria were developed by members of the food industry in collaboration with nutrition and public health experts and government officials. The aim of the present study was to test the extent to which products labelled as ‘Smart Choices’ could be classified as healthy choices on the basis of the Nutrient Profile Model (NPM), a non-industry-developed, validated nutritional standard.

A total of 100 packaged products that qualified for a ‘Smart Choices’ designation were sampled from eight food and beverage categories. All products were evaluated using the NPM method.

In all, 64 % of the products deemed ‘Smart Choices’ did not meet the NPM standard for a healthy product. Within each ‘Smart Choices’ category, 0 % of condiments, 8·70 % of fats and oils, 15·63 % of cereals and 31·58 % of snacks and sweets met NPM thresholds. All sampled soups, beverages, desserts and grains deemed ‘Smart Choices’ were considered healthy according to the NPM standard.

The ‘Smart Choices’ programme is an example of industries’ attempts at self-regulation. More than 60 % of foods that received the ‘Smart Choices’ label did not meet standard nutritional criteria for a ‘healthy’ food choice, suggesting that industries’ involvement in designing labelling systems should be scrutinized. The NPM system may be a good option as the basis for establishing FOP labelling criteria, although more comparisons with other systems are needed.