To examine the validity of the short, last 7-day, self-administered form of the International Physical Activity Questionnaire (IPAQ).

All subjects wore an accelerometer for seven consecutive days and completed the IPAQ questionnaire on the eighth day. Criterion validity was assessed by linear regression analysis and by modified Bland–Altman analysis. Specificity and sensitivity were calculated for classifying respondents according to the physical activity guidelines of the American College of Sports Medicine/Centers for Disease Control and Prevention.

Workplaces in Uppsala, Sweden.

One hundred and eighty-five (87 males) participants, aged 20 to 69 years.

Total self-reported physical activity (PA) (MET-min day−1) was significantly correlated with average intensity of activity (counts min−1) from accelerometry (r=0.34, P<0.001). Gender, age, education and body mass index did not affect this relationship. Further, subcomponents of self-reported PA (time spent sitting, time in PA, time in moderate and vigorous activity (MVPA)) were significantly correlated with objectively measured PA (P<0.05). Self-reported time in PA was significantly different from time measured by accelerometry (mean difference: −25.9 min day−1; 95% limits of agreement: −172 to 120 min day−1; P<0.001). IPAQ identified 77% (specificity) of those who met the current PA guidelines of accumulating more than 30 min day−1 in MVPA as determined by accelerometry, whereas only 45% (sensitivity) of those not meeting the guidelines were classified correctly.

Our results indicate that the short, last 7-days version of the IPAQ has acceptable criterion validity for use in Swedish adults. However, the IPAQ instrument significantly overestimated self-reported time spent in PA. The specificity to correctly classify people achieving current PA guidelines was acceptable, whereas the sensitivity was low.

As intake of flavonoids has been associated with reduced risk of coronary heart disease but data on the relation with specific classes of flavonoids are scarce, we assessed the relation between dietary intake of specific classes of flavonoids and the risk of acute myocardial infarction (AMI) in an Italian population.

Case–control study. Dietary information was collected by interviewers on a questionnaire tested for validity and reproducibility. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were obtained by multiple logistic regression models including terms for energy and alcohol intake, as well as sociodemographic factors, tobacco and other major recognised risk factors for AMI.

Milan, Italy, between 1995 and 2003.

Cases were 760 patients, below age 79 years, with a first episode of non-fatal AMI, and controls were 682 patients admitted to hospital for acute conditions unrelated to diet.

A reduced risk of AMI was found for increasing intake of anthocyanidins (OR = 0.45, 95% CI 0.26–0.78 for the highest vs. the lowest quintile, Ptrend = 0.003) and flavonols (OR = 0.65, 95% CI 0.41–1.02, Ptrend = 0.02). A tendency towards reduced risks, although not significant, was observed for flavan-3-ols (OR = 0.73, 95% CI 0.48–1.10) and total flavonoids (OR = 0.74, 95% CI 0.49–1.14). No meaningful heterogeneity was found between the sexes. No association emerged for other flavonoids, including isoflavones, flavanones and flavones.

High intake of anthocyanidins reduced the risk of AMI even after allowance for alcohol, fruit and vegetables, supporting a real inverse association between this class of flavonoids and AMI risk.

To evaluate whether meal patterns and cooking practices in Central England and Mediterranean France conform to popular stereotypes, eating together as a household, preparation of meals, food purchasing patterns, cooking practices and eating out were investigated.

Cross-sectional studies conducted simultaneously in April 2001 using self-administered postal questionnaires.

England (Nottingham, East Midlands) and France (Montpellier, Languedoc-Roussillon).

A stratified random sample of 1000 males and 1000 females aged 18–65 years was generated from the electoral roll in each country. The final sample comprised 826 subjects in England (58% males, 42% females; mean age 44 years) and 766 subjects in France (42% males, 58% females; mean age 42 years). Analyses were conducted on samples standardised for sociodemographic differences.

The French cooked from raw ingredients most often (P < 0.001), ate together as a household more regularly (P < 0.001) and were most likely to follow a regular meal pattern of three meals a day. On the other hand, the English relied more on ready-prepared (P < 0.001) and take-away (P < 0.001) meals, as well as on energy-dense snack foods such as crisps (P < 0.001). Females in both countries reported having most responsibility for preparing meals.

Some of the study's findings confirm popular stereotypes of French and English food cultures, as the importance of the convivial aspects of eating, as well as more traditional practices such as cooking meals from basic ingredients, structured mealtimes and less between-meal snacking, remain more prominent within the French population. This may contribute to the differences in prevalence of obesity seen between the two countries.

To explore how time spent watching television (TV) is associated with the dietary behaviours of New Zealand children and young adolescents.

Secondary data analysis of a nationally representative, cross-sectional survey.

In homes or schools of New Zealand school students.

In total, 3275 children aged 5 to 14 years.

The odds of being overweight or obese increased with duration of TV viewing for children and adolescents when controlling for age, sex, ethnicity, socio-economic status and physical activity. Children and adolescents who watched the most TV were significantly more likely to be higher consumers of foods most commonly advertised on TV: soft drinks and fruit drinks, some sweets and snacks, and some fast foods. Both children and adolescents watching two or more hours of TV a day were more than twice as likely to drink soft drinks five times a week or more (P = 0.03 and P = 0.04, respectively), eat hamburgers at least once a week (both P = 0.02), and eat French fries at least once a week (both P < 0.01).

These findings suggest that longer duration of TV watching (thus, more frequent exposure to advertising) influences the frequency of consumption of soft drinks, some sweets and snacks, and some fast foods among children and young adolescents. Efforts to curtail the amount of time children spend watching TV may result in better dietary habits and weight control for children and adolescents. Future studies examining the impact of advertising on children's diets through interventions and international comparisons of legislation would provide more definitive evidence of the role of advertising in child and adolescent obesity.

The International Physical Activity Questionnaire (IPAQ) was developed to measure health-related physical activity (PA) in populations. The short version of the IPAQ has been tested extensively and is now used in many international studies. The present study aimed to explore the validity characteristics of the long-version IPAQ.

Forty-six voluntary healthy male and female subjects (age, mean±standard deviation: 40.7±10.3 years) participated in the study. PA indicators derived from the long, self-administered IPAQ were compared with data from an activity monitor and a PA log book for concurrent validity, and with aerobic fitness, body mass index (BMI) and percentage body fat for construct validity.

Strong positive relationships were observed between the activity monitor data and the IPAQ data for total PA (ρ = 0.55, P < 0.001) and vigorous PA (ρ = 0.71, P < 0.001), but a weaker relationship for moderate PA (ρ = 0.21, P = 0.051). Calculated MET-h day−1 from the PA log book was significantly correlated with MET-h day−1 from the IPAQ (ρ = 0.67, P < 0.001). A weak correlation was observed between IPAQ data for total PA and both aerobic fitness (ρ = 0.21, P = 0.051) and BMI (ρ = 0.25, P = 0.009). No significant correlation was observed between percentage body fat and IPAQ variables. Bland–Altman analysis suggested that the inability of activity monitors to detect certain types of activities might introduce a source of error in criterion validation studies.

The long, self-administered IPAQ questionnaire has acceptable validity when assessing levels and patterns of PA in healthy adults.

To describe parental concerns about their child's weight, to determine the proportion of parents taking preventive action to avoid obesity in their children and the predictors of taking preventive action, and to describe the strategies adopted by parents.

A cross-sectional survey was conducted. Children's heights and weights were measured, and parents completed a questionnaire that included measures of their own weight status, perceptions of their child's weight, concerns about their child's current weight and future weight as an adolescent and adult, and the strategies used to prevent obesity.

The study was conducted in Melbourne, Australia.

A total of 291 families of children aged 5–6 years and 919 families of children aged 10–12 years participated.

Eighty-nine per cent of parents of overweight 5–6-year-olds and 63% of parents of overweight 10–12-year-olds were unaware their child was overweight. Seventy-one per cent of parents of overweight 5–6-year-olds and 43% of parents of overweight 10–12-year-olds were not concerned about their child's current weight. Although 31% of parents of 5–6-year-olds and 43% of parents of 10–12-year-olds were taking action to prevent unhealthy weight gain in their children, less-educated parents were less likely to do so.

Public health programmes are required to raise parental recognition of childhood overweight and of related risk behaviours, and to provide parents with practical strategies to prevent unhealthy weight gain in their children.

To assess the validity and reliability of the most recent adaptation of Block's full-diet food-frequency questionnaire (FFQ) among a sample of Canadian women.

Participants completed a self-administered FFQ (FFQ1), two unannounced 24-hour recalls (weekday and weekend) and a second FFQ (FFQ2) between October 2003 and February 2004. FFQs and recalls were analysed for 32 nutrients using Block Dietary Data Systems and the University of Minnesota's Nutrient Data System. Mean and median intakes were computed, along with crude and deattenuated Pearson correlation coefficients between FFQ1 and the average of two recalls (validity) and between FFQ1 and FFQ2 (reliability).

Ontario, Canada.

A random population-based sample (n = 166) of women aged 25 to 74 years.

One hundred and fifteen (69%) women completed FFQ1, 96 completed FFQ1 and both recalls, and 93 completed both FFQs, about 56 days apart. Mean intakes were similar for most nutrients. FFQ reliability was high, with Pearson correlation coefficients having a median of 0.75, ranging from 0.57 to 0.90 (macronutrients) and from 0.65 to 0.88 (micronutrients from supplements and food). FFQ validity was moderate to high, with deattenuated Pearson correlation coefficients having a median of 0.59, ranging from 0.11 to 0.73 (macronutrients) and from 0.50 to 0.76 (micronutrients from supplements and food). Our micronutrient correlations were similar to or higher than those of other studies that included supplements. Two correlations <0.40 were associated with fats.

The validity and reliability of this full-diet version of the Block FFQ were moderate to high, supporting its use in future studies among Canadian women.

As a qualitative problem solving method, to manage the accelerating phenomenon of overweight and obesity among children and adolescents as well as to promote the Mediterranean Diet and the diversity of the Mediterranean Food Cultures heritage, it is presented a creative interdisciplinary approach through art.

Taking into account that young generations are becoming the highest majority of the consumer population in the Southern and Eastern Mediterranean countries, it is reported the artist practice and the creative community-based interdisciplinary experience of Plexus International, a network of artists and scientists of various nationalities and disciplines.

Mediterranean Region and International.

Young Populations.

Through the Ark of the Well Being project, artists and scientists have collaborate together, promoting The 2005 Rome Call for a Common Action in the Mediterranean and raising more attention on the erosion of the cognitive capacities of young generations by hunger and malnutrition.

A creative interdisciplinary approach was developed to transmit through art Mediterranean food culture with the aim to achieve a broader nutritional well being.

To determine whether the literature filtering process, a vital initial component of a systematic literature review, could be successfully completed by nutrition professionals or non-professionals.

Using a diet–disease relationship as the guideline topic, inter-rater agreement for the title and abstract filtering processes between and among professionals and non-professionals was assessed and compared with an expert reference standard. Predetermined eligibility criteria were applied by all raters to 185 titles and 90 abstracts. Filtering decisions were initially made independently and then revised after a within-pair consensus meeting.

The raters were six dietitians (RD) and six nutrition graduate students (Grad). To assess inter-rater agreement (reliability), each group was divided into three pairs.

Weighted and unweighted kappa statistics and percentage agreement were calculated to determine the inter-rater agreement within pairs. Sensitivity and specificity estimates were determined by comparing responses with those of an expert reference standard. Overall, Grad pairs demonstrated greater inter-rater agreement than RD pairs for title filtering (P < 0.05); no differences were observed for abstract filtering. Compared with the expert reference standard, every rater and pair had false-negative responses for both title and abstract filtering.

After consensus meetings, both RDs and Grads were comparable in their agreement on title and abstract filtering, although important differences remained compared with the expert reference standard. This study provides preliminary findings on the value of utilising a non-expert pair in developing guidelines, and suggests that the literature filtering process is complex and quite subjective.

To assess tracking of energy and nutrient intakes between adolescence and young adulthood.

Longitudinal study of a random sample of adolescents (aged 15 years at baseline). The extent of tracking of dietary intakes (assessed by diet history) was investigated using weighted kappa statistics (κ).

Northern Ireland population survey.

Adolescents who participated in the Young Hearts Project, Northern Ireland at age 15 years, and subsequently at young adulthood aged between 20 and 25 years (n = 245 males, n = 231 females).

Despite overall increases in height and weight (both P < 0.001), increases in body mass index in males (P < 0.001) and body fatness in females (P < 0.001), median reported intakes of energy (kJ kg− 1 day− 1), carbohydrate (g day− 1) and fat (g day− 1) decreased (all P < 0.001) over time. Expressed as nutrient densities (per MJ), diets at young adulthood were overall richer in thiamin, vitamin B6, total folate (all P < 0.001), vitamin C (P < 0.01) and vitamin D (P < 0.05). Whereas the nutrient density of the males' diets decreased over time for calcium (P < 0.05) and vitamin A (P < 0.001), iron and riboflavin densities increased in the females' diet (P < 0.001). Tracking of energy (MJ day− 1) and nutrient intakes (expressed per MJ day− 1) at the individual level was only poor to fair (all κ < 0.25), indicating substantial drift of subjects between the low, medium and high classes of intake with increasing age.

These data suggest that individual dietary patterns exhibited at 15 years of age are unlikely to be predictive of dietary intakes at young adulthood.

To determine the relative validity and reproducibility of two alcohol intake frequency questionnaires (AFQ-A; AFQ-B), designed to classify subjects according to their alcohol intake level, in Bucaramanga, Colombia.

One hundred and nine randomly selected subjects, aged between 20 and 60 years, completed three 30-day semi-quantitative alcohol intake records (30-DR). The AFQs were applied three months after the last 30-DR. AFQ-A contained 53 items; AFQ-B contained five items, with the alcoholic drinks for AFQ-B selected by Max_r. The correlation and agreement between alcohol intake assessed with the AFQs and the 30-DR were obtained using Pearson's correlation coefficient (r), Lin's concordance correlation coefficient (pC), Spearman's rank correlation coefficient(rS), Bland and Altman's limits of agreement (LOA) and Cohen's weighted kappa statistic (Kw).

The reproducibility of the 30-DR was poor; rS ranged from 0.33 to 0.41. The reproducibility of the AFQs was higher, with rS between 0.50 and 0.73. The agreement(Kw) of the 30-DR and the AFQs was 0.40. The lower and upper LOA were between 56.4% and 11.0%. The AFQs and 30-DR were well correlated. Assessment of relative validity between the two methods yielded r values for alcohol between 0.52 Alcohol consumption and 0.60, which reduced to 0.20–0.29 after energy adjustment.

These AFQs may be useful to rank subjects according to their alcohol Max_r intake. The AFQ-B is easy and quick to apply, and is also highly cost-effective.

To develop a concise, simple tool for use by non-specialists to assess diet in children aged 3–7 years attending primary schools.

A 24-hour food tick list covering all aspects of the diet and with a focus on fruit and vegetable consumption was developed. This was compared against a 24-hour semi-weighed food diary obtained for the same day as the tick list.

Six primary schools with a range of socio-economic and ethnic backgrounds from a large city in the north of England (Leeds).

One hundred and eighty children returned completed packs of information; a response rate of 77% of those who were willing to take part, 48% of those approached.

On average, 2.4 items of fruit including juice (2.1 items as 5-a-day count) were eaten and 1.6 items of vegetables (excluding potato). Twenty-seven per cent and 36% of boys and 23% and 24% of girls reported not eating any fruit or vegetables, respectively, on the recording day. Correlations comparing the diary and tick list were high for both foods (range r = 0.44 to 0.89) and nutrients (range r = 0.41 to 0.68). The level of misclassification was much less than would be expected by chance. Parent and teacher evaluation of the tick list was very positive. Parents felt the tick list was easy and quick to complete.

The Child and Diet Evaluation Tool (CADET) tick list has been used successfully for rapid collection of food and nutrient information from children aged 3–7 years from diverse social and ethnic backgrounds. The tool has performed better than many food-frequency questionnaires in comparison to a food diary.

To examine the association between education level and food purchasing behaviour and the contribution of dietary knowledge to this relationship; and the association between household income and purchasing behaviour and the contribution made by subjective perceptions about the cost of healthy food.

The study was conducted in Brisbane City (Australia) in 2000. The sample was selected using a stratified two-stage cluster design. Data were collected by face-to-face interview from residents of private dwellings (n = 1003), and the response rate was 66.4%. Dietary knowledge was measured using a 20-item index that assessed general knowledge about food, nutrition, health and their interrelationships. Food-cost concern was measured using a three-item scale derived from principal components analysis (α = 0.647). Food purchasing was measured using a 16-item index that reflected a household's purchase of grocery items that were consistent (or otherwise) with dietary guideline recommendations. Associations among the variables were analysed using linear regression with adjustment for age and sex.

Significant associations were found between education, household income and food purchasing behaviour. Food shoppers with low levels of education, and those residing in low-income households, were least likely to purchase foods that were comparatively high in fibre and low in fat, salt and sugar. Socio-economic differences in dietary knowledge represented part of the pathway through which educational attainment exerts an influence on diet; and food purchasing differences by household income were related to diet in part via food-cost concern.

Our findings suggest that socio-economic differences in food purchasing behaviour may contribute to the relationship between socio-economic position and food and nutrient intakes, and, by extension, to socio-economic health inequalities for diet-related disease. Further, socio-economic differences in dietary knowledge and concerns about the cost of healthy food play an important role in these relationships and hence should form the focus of future health promotion efforts directed at reducing health inequalities and encouraging the general population to improve their diets.

To assess the consequences on body composition of increasing birth weight in Indian babies in relation to reported values in Western babies, and to assess the relationship between maternal and neonatal anthropometry and body composition.

Prospective observational study.

Bangalore City, India.

A total of 712 women were recruited at 12.5±3.1 weeks of gestation (mean±standard deviation, SD) and followed up until delivery; 14.5% were lost to follow-up. Maternal body weight, height, mid upper-arm circumference and skinfold thicknesses were measured at recruitment. Weight and body composition of the baby (skinfold thicknesses, mid upper-arm circumference, derived arm fat index and arm muscle index; AFI and AMI, respectively) were measured at birth in hospital.

The mean±SD birth weight of all newborns was 2.80±0.44 kg. Birth weight was significantly related to the triceps and subscapular skinfold thickness of the baby. In a small number of babies with large birth weight for gestational age, there was a relatively higher normalised AFI relative to AMI than for babies with lower or appropriate birth weight for gestational age. Maternal height and fat-free mass were significantly associated with the baby's length at birth.

Skinfold thicknesses in Indian babies were similar to those reported in a Western population with comparable birth weights, and the relationship of AFI to birth weight appeared to be steeper in Indian babies. Thus, measures to increase birth weight in Indian babies should take into account possible adverse consequences on body composition. There were no significant relationships between maternal anthropometry and body composition at birth on multivariate analysis, except for sum of the baby's skinfold thicknesses and maternal fat-free mass (P<0.02).

Nutrient profiling systems aim at positioning foodstuffs relative to each other according to their contribution to a balanced diet. The accuracy and performance of methodologies are still debated. We present here a critical analysis of the structure and efficiency of the current schemes.

The literature survey detected only four systems addressing the issue on an ‘across the board’ approach and with enough detail to enable analysis. The building principles of these systems were compared and their performance was estimated via their classification of a series of 125 foodstuffs on the basis of nutritional composition. These classifications were compared with one another and with an empirical classification by expert nutritionists.

All systems gave a similar overview, with fruits and vegetables ranked as the most favourable foods and fatty and sugary foods as the least favourable ones, but numerous discrepancies existed in every system, mainly related to their choice of nutrients and thresholds. The FSA scoring system seemed the most consistent approach, although it still generated some questionable rankings. Expert classification did not clearly validate any scheme, and cannot be considered as a true reference.

Nutrient profiling systems are confirmed to be powerful tools to translate nutritional information related to the whole diet into the level of individual foods. However, the performance of the existing schemes remains moderate. Alternative approaches, such as considering food categories or introducing more stringent validation steps by a panel of expert nutritionists, could be ways to reach more efficient and consensual tools.

To identify the most common frequency of food-purchasing patterns and relate this pattern to characteristics of individuals and families.

A customer-intercept survey was conducted in the greater Houston area, Texas, USA, in 2002. The frequency of food shopping at supermarkets, convenience stores and restaurants to buy food for eating at home was assessed.

A total of 823 adults (78.5% female; mean age 37.4 years) who went to any of several grocery or convenience stores, including European, Hispanic and African Americans, and Asian/Pacific Islanders.

Major food-shopping patterns were a weekly big trip with a few small trips (34.9%), biweekly big trips with a few small trips (21.9%), no big shopping trips (15.4%), a weekly big trip without small trips (13.9%), a monthly big trip (8.3%), and biweekly big trips without small trips (6.4%). While 61.1% of participants never went to convenience stores to buy fruit and vegetables (F&V) for eating at home, 67% went to restaurants for F&V. African American families shopped for food least frequently, while Asian American families shopped for food most frequently. Educational level was negatively associated with the use of convenience stores and positively associated with takeaway from restaurants.

There is substantial variability in the frequency of food shopping. Future research on food shopping should incorporate this variable.

In order to obtain a measure of nutrient intake, a measure or estimate of the amount of food consumed is required. Weighing foods imposes a large burden on subjects, often resulting in underreporting. Tools are available to assist subjects in providing an estimate of portion size and these include food photographs. The application of these tools in improving portion size estimation by children has not been investigated systematically.

To assess the accuracy with which children are able to estimate food portion sizes using food photographs designed for use with adults, and to determine whether the accuracy of estimates is improved when age-appropriate portion size photographs are provided.

Original data from three separate studies, on the accuracy of portion size estimates by adults using food photographs, by children using adult photographs and by children using age-appropriate photographs, are analysed and compared.

One hundred and thirty-five adults aged 18 to 90 years and 210 children aged 4 to 11 years.

Children's estimates of portion sizes using age-appropriate food photographs were significantly more accurate (an underestimate of 1% on average) than estimates using photographs designed for use with adults (an overestimate of 45% on average). Accuracy of children's estimates of portion size using age-appropriate photographs was not significantly different from that of adults. Children overestimated a food's weight by 18% on average and adults underestimated by 5%.

Providing children with food photographs depicting age-appropriate portion sizes greatly increases the accuracy of portion size estimates compared with estimates using photographs designed for use with adults.

This study evaluates the contribution of energy-dense, nutrient-poor ‘extra’ foods to the diets of 16–24-month-old children from western Sydney, Australia.

An analysis of cross-sectional data collected on participants in the Childhood Asthma Prevention Study (CAPS), a randomised trial investigating the primary prevention of asthma from birth to 5 years. We collected 3-day weighed food records, calculated nutrient intakes, classified recorded foods into major food groups, and further classified foods as either ‘core’ or ‘extras’ according to the Australian Guide to Healthy Eating.

Pregnant women, whose unborn child was at risk of developing asthma because of a family history, were recruited from all six hospitals in western Sydney, Australia. Data for this study were collected in clinic visits and at participants’ homes at the 18-month assessment.

Four hundred and twenty-nine children participating in the CAPS study; 80% of the total cohort.

The mean consumption of ‘extra’ foods was ∼150 g day− 1 and contributed 25–30% of the total energy, fat, carbohydrate and sodium to the diets of the study children. ‘Extra’ foods also contributed around 20% of fibre, 10% of protein and zinc, and about 5% of calcium. Children in the highest quintile of ‘extra’ foods intake had a slightly higher but not significantly different intake of energy from those in the lowest quintile. However, significant differences were evident for the percentage of energy provided by carbohydrate and sugars (higher) and protein and saturated fat (lower). The intake of most micronutrients was also significantly lower among children in the highest quintile of consumption. The intake of ‘extra’ foods was inversely associated with the intake of core foods.

The high percentage of energy contributed by ‘extra’ foods and their negative association with nutrient density emphasise the need for dietary guidance for parents of children aged 1–2 years. These preliminary data on commonly consumed ‘extra’ foods and portion sizes may inform age-specific dietary assessment methods.