To determine the breast-feeding pattern of four main ethnic groups (the Han, Uygur, Tibetan and Zhuang) living in rural western China.

The study utilized a cross-sectional design.

Forty-five counties in ten provinces in western China in 2005.

A sample of 11 783 children younger than 36 months old (8960 Han, 1281 Uygur, 792 Tibetan and 750 Zhuang) and their mothers were recruited using a stratified, multistage, cluster random sampling method.

The rates of exclusive breast-feeding of children at 6 months of age in the Han, Uygur, Tibetan and Zhuang ethnic groups were 11·6 %, 0·8 %, 4·4 % and 13·8 %, respectively. The rates of any breast-feeding for children at 24 months of age were 8·5 %, 25·7 %, 3·0 % and 4·3 % in the four ethnic groups, respectively. After adjusting for related factors, Zhuang children had a higher odds ratio of exclusive breast-feeding to 6 months compared with Han children, whereas Uygur and Tibetan children had lower odds ratio (Zhuang: OR=1·291; 95 % CI 1·006, 1·657; Uugur: OR=0·062; 95 % CI 0·032, 0·121; Tibetan: OR=0·323; 95 % CI 0·220, 0·475). Uygur children had a lower hazard ratio of discontinued breast-feeding compared with Han children, whereas Tibetan children had a higher hazard ratio (Uygur: HR=0·368; 95 % CI 0·333, 0·408; Tibetan: HR=1·366; 95 % CI 1·244, 1·500).

The breast-feeding pattern differed among the Han, Uygur, Tibetan and Zhuang ethnic groups. The results suggest that health education regarding the benefits of breast-feeding is needed in rural western China.

To examine the association of total animal protein intake and protein derived from different dietary sources (meat; fish and shellfish; eggs; milk products) with global and abdominal obesity among adults in Luxembourg.

Binary logistic regression analysis was used to assess the relationship between animal protein intake (as a percentage of total energy intake) and global obesity (BMI≥30·0 kg/m2) and abdominal obesity (waist circumference ≥102 cm for men and ≥88 cm for women), after controlling for potential confounders.

Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study.

The study population was derived from a national cross-sectional stratified sample of 1152 individuals aged 18–69 years, recruited between November 2007 and January 2009.

There was an independent positive association between total animal protein intake and both global (OR=1·18; 95 % CI 1·12, 1·25) and abdominal obesity (OR=1·14; 95 % CI 1·08, 1·20) after adjustment for age, gender, education, smoking, physical activity and intakes of total fat, carbohydrate, fibre, and fruit and vegetables. Protein intakes from meat, fish and shellfish were positively associated with global and abdominal obesity with further adjustment for vegetal protein and other sources of animal-derived protein (all P<0·01). Protein derived from eggs or milk products was unrelated to global or abdominal obesity.

Our findings suggest that protein derived from animal sources, in particular from meat, fish and shellfish, may be associated with increased risk of both global and abdominal obesity among presumably healthy adults in Luxembourg. These findings suggest that lower animal protein intakes may be important for maintenance of healthy body weight.

To assess the effect of the Dutch school-based education programme ‘Taste Lessons’ on children’s behavioural determinants towards tasting unfamiliar foods and eating healthy and a variety of foods.

In a quasi-experimental study design, data on behavioural determinants were collected at baseline, four weeks and six months after the intervention in both the intervention and control group. Children completed consecutively three questionnaires in which knowledge, awareness, skills, attitude, emotion, subjective norm and intention towards the two target behaviours were assessed. Teachers implemented on average a third of the programme activities. Multilevel regression analyses were conducted to compare individual changes in the determinants in the intervention group with those in the control group, corrected for children’s gender and age. Effect sizes were expressed as Cohen’s d.

Dutch elementary schools.

Forty-nine classes (1183 children, 9–12 years old) in grades 5–8 of twenty-one elementary schools.

The intervention group showed a higher increase in knowledge (d=0·26, P<0·01), which persisted after six months (d=0·23, P<0·05). After four weeks, the intervention group showed a higher increase in number of foods known (d=0·22, P<0·05) and tasted (d=0·21, P<0·05), subjective norm of the teacher (d=0·17, P<0·05) and intention (d=0·16, P<0·05) towards the target behaviours.

Partial implementation of Taste Lessons during one school year showed small short-term effects on increasing behavioural determinants in relation to tasting unfamiliar foods and eating healthy and a variety of foods. Full and repeated implementation of Taste Lessons in subsequent years might result in larger effects.

To investigate the relationship between poor Fe status and overweight or obesity in elderly respondents in South Africa.

Cross-sectional, observational baseline survey.

Sharpeville, South Africa.

A sample size calculation determined a representative sample of 104 randomly selected elderly (≥60 years) respondents. Measurements included weight, height, biochemical and haematological parameters. Measured BMI was used to categorise the respondents into normal weight, overweight and obese groups.

The majority of the women were overweight (28·4 %) or obese (54·6 %); 58 % of the respondents had normal Fe status, 15 % were classified as Fe depleted, 9 % as Fe deficient and 13 % as Fe-deficient anaemic. Ten per cent of the respondents had low Hb levels with no other low Fe status parameters, and were thus anaemic due to other causes. A significant correlation (r = 0·318, P < 0·001) existed between BMI and high-sensitivity C-reactive protein (hs-CRP). hs-CRP was negatively correlated to serum Fe levels (r = −0·319, P < 0·001). No significant relationships existed between BMI and Fe status parameters.

A coexistence of obesity and poor Fe status were observed in these elderly respondents. The positive relationship between hs-CRP and BMI indicated chronic inflammation in the higher BMI groups. The negative relationship between hs-CRP and serum Fe indicated that lower serum Fe levels were related to the inflammation linked with higher BMI. A relationship between obesity-related chronic, low-grade inflammation and poor Fe status has been found in adults, but the significance of the current study is that this relationship was also confirmed for elderly persons.

To investigate similarities and differences in dietary habits, nutrient intakes and health outcomes of South Asians (SA) and East and South-East Asians (ESEA) and the New Zealand European and Other (NZEO) group, and to examine differences within ‘Asian’ subgroups according to duration of residence.

Nutrient intake data from 24 h diet recalls and data from the dietary habits questionnaire, anthropometry and biochemical analyses from the cross-sectional 2008/09 Adult National Nutrition Survey in New Zealand were compared for participants categorized as SA, ESEA and NZEO.

Adults aged 15 years and older (n 2995).

New Zealand households.

SA were more likely to ‘never’ eat red meat in comparison to NZEO (P<0·001) and among females also in comparison to ESEA (P<0·05). Intakes of fats and some micronutrients (riboflavin, vitamin B6, B12, Se) were lower among SA than NZEO (P<0·05). Lower intakes of Zn and vitamin B12 were reported by SA females compared with ESEA and NZEO females (P<0·05). A higher percentage of SA were obese using ethnic-specific cut-offs, had lower indices of Fe status and reported diagnosed diabetes compared with NZEO and ESEA. Recent SA male migrants had higher intakes of β-carotene, vitamin C and Ca compared with long-term migrants (P<0·05).

The results of the present study indicate that dietary habits, nutrient intakes, blood profile and body size differ significantly between Asian subgroups. It also provides some evidence for changes in dietary intakes according to duration of residence especially for SA males.

To examine the potential associations between diet quality and multiple measures of body composition in a sample of New Zealand adolescents aged 14–18 years.

Cross-sectional survey of eleven high schools in Otago, New Zealand. Each participant completed an online FFQ and a New Zealand Diet Quality Index for Adolescents (NZDQI-A) score was calculated based on variety and adequacy of intake for five major food groups. Besides height and waist circumference measurements, body composition was assessed using segmental bio-impedance analysis. Generalized estimating equations were used to examine associations between diet quality and body composition in models adjusted for sex, age, ethnicity and socio-economic status.

High schools in Otago, New Zealand.

High-school students (n 681, 56 % male, mean age 16·1 (sd 1·5) years) participating in the Otago School Students Lifestyle Survey Two.

Higher NZDQI-A scores were significantly associated with lower body fat percentage (β=−0·19; 95 % CI −0·35, −0·04; P=0·014), fat-to-lean mass ratio (β=−0·26; 95 % CI −0·46, −0·05; P=0·016) and lower fat mass index (β=−0·23; 95 % CI −0·45, −0·004; P=0·046) after multivariate adjustment. No association was found between NZDQI-A and BMI, waist circumference or waist-to-height ratio.

Diet quality, as measured by NZDQI-A, was associated only with measures of body fat, not measures of overall body size. Measures specific to body fat should be used for more accurate ascertainment of body composition in examining the diet–body composition associations in this age group.

To explore factors influencing participation and attrition in a family-led weight-management programme for obese Pacific children.

Qualitative study used bilingual in-depth interviews at exit and end of an 8-week weight-management programme.

New Zealand.

Forty-two parents/primary caregivers of obese children who were randomised in the intervention weight-management programme.

Programmatic factors that enhanced retention included: simultaneous delivery to both children and parents as participants; delivery of the programme in small group settings at local community venues; enabling trustworthy and accountable relationships; providing resources for travel to venues and regular telephone/text messaging follow-up calls reinforcing programme goals; and day and time scheduling. Suggested programme improvements included having ethnic-specific Island-language delivery and practical sessions like cooking classes and shopping expeditions at local food stores. The research found that unpredictable external life crises like extended family deaths, a change in job shift, family illnesses (both acute and those requiring chronic management) and long-term family visitations affected participation and momentum. A loss of momentum through managing life crises was often difficult to overcome for participants, leading them to drop out of the weight-management programme. Most drop-out participants preferred to defer their programme participation with hopes of re-committing to future programmes at another time.

In order for weight-management programmes to be effective, participants must be able to complete them. Identifying factors that predict participation and attrition may serve as a basis for programme improvement.

The present study examines whether rural-to-urban migrant youth consume a greater diversity of high-sugar beverages and fried snacks (HSBFS) compared with their peers who remain in rural areas. It also tests whether the association between migration and HSBFS diversity is moderated by migrant youth’s social engagement with their peers.

Participants were recruited in August and September 2011 following the completion of primary school (6th grade) and shortly before many rural youth migrate to urban areas. Participants were re-interviewed six months later. HSBFS diversity was assessed at follow-up; analyses control for baseline and follow-up characteristics.

Baseline interviews occurred in rural Southeast Haiti. Follow-up interviews of migrants occurred at urban destinations in Haiti.

The sample includes 215 youth (mean age 15·9 years; 43·3 % female; 21·9 % rural-to-urban migrants) who were interviewed at baseline and follow-up.

Rural-to-urban migrant youth consumed a greater diversity of HSBFS products at follow-up than their rural counterparts (b=0·70, P≤0·05). Moreover, we found that this relationship varied by level of peer social engagement. Youth who migrated and had a high degree of peer social engagement consumed 2·2 additional types of HSBFS products daily than their counterparts who remained in rural areas and had low peer social engagement.

Higher HSBFS diversity among migrant youth is consistent with the patterns proposed by the nutrition transition. Interactions with peers may have an important influence as migrant youth adopt new dietary preferences. Emerging dietary patterns among youth migrants have important implications for health trajectories and the development of degenerative diseases.

The National Afterschool Association (NAA) standards specify the role of summer day camps (SDC) in promoting healthy nutrition habits of the children attending, identifying foods and beverages to be provided to children and staff roles in promoting good nutrition habits. However, many SDC do not provide meals. Currently, national guidelines specifying what children are allowed to bring to such settings do not exist, nor is there a solid understanding of the current landscape surrounding healthy eating within SDC.

A cross-sectional study design using validated measures with multiple observations was used to determine the types of foods and beverages brought to SDC programmes.

Four large-scale, community-based SDC participated in the study during summer 2011.

The types of foods and beverages brought by children (n 766) and staff (n 87), as well as any instances of staff promoting healthy eating behaviours, were examined via direct observation over 27 d. Additionally, the extent to which current foods and beverages at SDC complied with NAA standards was evaluated.

Less than half of the children brought water, 47 % brought non-100 % juices, 4 % brought soda, 4 % brought a vegetable and 20 % brought fruit. Staff foods and beverages modelled similar patterns. Promotion of healthy eating by staff was observed <1 % of the time.

Findings suggest that foods and beverages brought to SDC by children and staff do not support nutrition standards and staff do not regularly promote healthy eating habits. To assist, professional development, parent education and organizational policies are needed.

Iodine deficiency still remains a major public health concern worldwide despite global progress in its elimination. The aims of the present study were to evaluate dietary iodine status in the mother and one adult member of each family and the association between mothers’ knowledge, attitude and behaviour and the dietary iodine status of adult family members in Tehran.

In this cross-sectional study, 24 h urinary iodine and Na concentrations and the iodine content of household salt were measured. Mothers’ knowledge, attitude and behaviour were assessed using a questionnaire administered in face-to-face interviews.

Health-care centres from four distinct areas of Tehran.

Mother–adult family member pairs aged ≥19 years (n 290), enrolled through randomized cluster sampling.

In mothers and adult family members, median 24 h urinary iodine concentration was 73 (interquartile range (IQR) 36–141) µg/l and 70 (IQR 34–131) µg/l, dietary iodine intake was 143 (IQR 28–249) µg/d and 130 (IQR 26–250) µg/d and dietary salt intake was 8·0 (IQR 5·9–10·2) g/d and 7·5 (IQR 5·3–10·0) g/d, respectively. Significant correlations were observed between mothers’ attitude and behaviour and the 24 h urinary iodine concentration, dietary iodine intake and iodine content of salt of adult family members. In multiple analysis, lower quartiles of salt iodine content and salt intake and inappropriate behaviour scores in mothers increased the risk of urinary iodine concentration <100 µg/l in adult family members.

The present study showed that mothers’ behaviour, but not knowledge and attitude, was among major contributors to the suboptimal dietary iodine status observed in adult family members.

To investigate the experiences of women participating in a cooking and nutrition component of a health promotion research initiative in an Australian Aboriginal regional community.

Weekly facilitated cooking and nutrition classes were conducted during school terms over 12 months. An ethnographic action research study was conducted for the programme duration with data gathered by participant and direct observation, four yarning groups and six individual yarning sessions. The aim was to determine the ways the cooking and nutrition component facilitated lifestyle change, enabled engagement, encouraged community ownership and influenced community action.

Regional Bindjareb community in the Nyungar nation of Western Australia.

A sample of seventeen Aboriginal women aged between 18 and 60 years from the two kinships in two towns in one shire took part in the study. The recruitment and consent process was managed by community Elders and leaders.

Major themes emerged highlighting the development of participants and their recognition of the need for change: the impact of history on current nutritional health of Indigenous Australians; acknowledging shame; challenges of change around nutrition and healthy eating; the undermining effect of mistrust and limited resources; the importance of community control when developing health promotion programmes; finding life purpose through learning; and the need for planning and partnerships to achieve community determination.

Suggested principles for developing cooking and nutrition interventions are: consideration of community needs; understanding the impact of historical factors on health; understanding family and community tensions; and the engagement of long-term partnerships to develop community determination.

To analyse whether poor breakfast habits in adolescence predict the metabolic syndrome and its components in adulthood. Previous studies suggest that regular breakfast consumption improves metabolic parameters.

Prospective. Breakfast habits and other lifestyle variables at age 16 years were assessed from questionnaires. Poor breakfast habits were defined as skipping breakfast or only drinking or eating something sweet. At age 43 years, the effective sample consisted of 889 participants defined as having the metabolic syndrome or not, using the International Diabetes Federation criteria. Logistic regression was used to calculate odds ratios and confidence intervals.

The Northern Swedish Cohort, a longitudinal population-based cohort with 27-year follow-up.

Adolescents (age 16 years).

Prevalence of the metabolic syndrome at age 43 years was 27·0 %. Of the participants, 9·9 % were classified with poor breakfast habits at age 16 years. Adjusted odds for the metabolic syndrome at age 43 years was OR = 1·68 (95 % CI 1·01, 2·78) for those with poor breakfast habits at age 16 years compared with breakfast eaters. Looking at the metabolic syndrome components, poor breakfast habits at age 16 years were associated with central obesity (OR = 1·71; 95 % CI 1·00, 2·92) and high fasting glucose (OR = 1·75; 95 % CI 1·01, 3·02) at age 43 years, even after multivariate adjustments.

Poor breakfast habits in adolescence predicted the metabolic syndrome in adulthood. Of the metabolic syndrome components, poor breakfast habits in adolescence predicted central obesity and high fasting glucose in adulthood. Further research is needed to fully understand the relationship between early breakfast habits and adult metabolic syndrome.

The Social Ecological Model (SEM) has been used to describe the aetiology of childhood obesity and to develop a framework for prevention. The current paper applies the SEM to data collected at multiple levels, representing different layers of the SEM, and examines the unique and relative contribution of each layer to children’s weight status.

Cross-sectional survey of randomly selected households with children living in low-income diverse communities.

A telephone survey conducted in 2009–2010 collected information on parental perceptions of their neighbourhoods, and household, parent and child demographic characteristics. Parents provided measured height and weight data for their children. Geocoded data were used to calculate proximity of a child’s residence to food and physical activity outlets.

Analysis based on 560 children whose parents participated in the survey and provided measured heights and weights.

Multiple logistic regression models were estimated to determine the joint contribution of elements within each layer of the SEM as well as the relative contribution of each layer. Layers of the SEM representing parental perceptions of their neighbourhoods, parent demographics and neighbourhood characteristics made the strongest contributions to predicting whether a child was overweight or obese. Layers of the SEM representing food and physical activity environments made smaller, but still significant, contributions to predicting children’s weight status.

The approach used herein supports using the SEM for predicting child weight status and uncovers some of the most promising domains and strategies for childhood obesity prevention that can be used for designing interventions.

To assess the relationship between the degree of severity of eating disorders (ED) and energy and nutrient intakes and nutritional risk in a mixed-sex adolescent population without clinical symptoms.

Cross-sectional study.

Data were collected in schools.

Adolescents (n 495) aged 14·2 (sd 1·0) years. The Eating Attitudes Test was used to detect adolescents at risk of ED (rED) and a structured interview based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, was used to diagnose eating disorder not otherwise specified (EDNOS). Dietary intake was quantified using the 24 h recall method over three days and the probability of inadequate intake was determined.

Females presented lower intakes of energy, macronutrients and micronutrients (Ca, Fe, Mg, K, P, Na, thiamin, vitamins E, C, B6, B12, pantothenic acid, folic acid) because the severity of their ED was greater. These lower dietary intakes led to nutritional risk (for Ca, Fe, Mg, P, vitamins A, D, B6) in more than 80 % and 60 % of females with EDNOS and rED, respectively. The multiple linear regression models showed that the rED and EDNOS groups presented a lower energy intake of 1597·4 kJ/d (381·8 kcal/d) and 3153·0 kJ/d (753·6 kcal/d), respectively. In contrast, little difference was observed in the nutritional intakes of males.

The female adolescents showed lower energy and nutrient intakes as the ED became more severe, which led to energy, vitamin and mineral deficiencies in a high percentage of females with ED. These nutritional risks could hinder adequate physical and psychological development and lead to chronic ED.

To assess the associations of body weight and body shape concerns and related behaviours with actual weight status among urban adolescent girls.

In the present cross-sectional study, a self-administered questionnaire was used to collect data on body weight and body shape concerns and related behaviours. Sociodemographic information was collected using a pre-tested schedule. Weight and height of each girl were measured to assess actual weight status.

Twin cities of Kolkata and Howrah, West Bengal, India.

A total of 1223 adolescent girls aged 14–19 years were selected from nine schools in Kolkata and Howrah in West Bengal.

Many overweight girls perceived themselves as overweight and engaged in weight-reducing activities. However, several normal-weight girls also perceived them as overweight and attempted to lose weight. Unhealthy eating practices to reduce weight were followed by both overweight and normal-weight girls and even by a few underweight girls. Multivariate binary logistic regression showed a significant association between actual weight status and use of unhealthy weight-loss measures. The likelihood of adopting unhealthy eating practices was significantly higher among overweight than normal-weight girls.

Health education programmes should be introduced at schools to promote effective weight-control practices that help dispel myths about weight loss.

The purpose of the present study was to determine whether elevated dietary Na intake could be associated with CVD mortality.

We performed a systematic review and meta-analysis of prospective studies representing the general population. The adjusted relative risks and their 95 % confidence intervals were pooled by the inverse variance method using random-effects models. Heterogeneity, publication bias, subgroup and meta-regression analyses were performed.

MEDLINE (since 1973), Embase (since 1975), the Cochrane Library (since 1976), ISI Web of Science, Google Scholar (until September 2013) and secondary referencing were searched for inclusion in the study.

Eleven prospective studies with 229 785 participants and average follow-up period of 13·37 years (range 5·5–19 years).

Higher Na intake was significantly associated with higher CVD mortality (relative risk=1·12; 95 % CI 1·06, 1·19). In the sensitivity analysis, the exclusion of studies with important relative weights did not significantly affect the results (relative risk=1·08; 95 % CI 1·01, 1·15). The meta-regression analysis showed that for every increase of 10 mmol/d in Na intake, CVD mortality increased significantly by 1 % (P=0·016). Age, hypertensive status and length of follow-up were also associated with increased CVD mortality.

Higher Na intake was associated with higher CVD mortality in the general population; this result suggests a reduction in Na intake to prevent CVD mortality from any cause.

Early childhood settings are promising avenues to intervene to improve children’s nutrition. Previous research has shown that a nutrition award scheme, Start Right – Eat Right (SRER), improves long day care centre policies, menus and eating environments. Whether this translates into improvements in children’s dietary intake is unknown. The present study aimed to determine whether SRER improves children’s food and nutrient intakes.

Pre–post cohort study.

Twenty long day care centres in metropolitan Adelaide, South Australia, Australia.

Children aged 2–4 years (n 236 at baseline, n 232 at follow-up).

Dietary intake (morning tea, lunch, afternoon tea) was assessed pre- and post-SRER implementation using the plate wastage method. Centre nutrition policies, menus and environments were evaluated as measures of intervention fidelity. Comparisons between baseline and follow-up were made using t tests.

At follow-up, 80 % of centres were fully compliant with the SRER award criteria, indicating high scheme implementation and adoption. Intake increased for all core food groups (range: 0·2–0·4 servings/d, P<0·001) except for vegetable intake. Energy intake increased and improvements in intakes of eleven out of the nineteen nutrients evaluated were observed.

SRER is effective in improving children’s food and nutrient intakes at a critical time point when dietary habits and preferences are established and can inform future public health nutrition interventions in this setting.

To examine the effects of lunches with different dietary energy densities on food preferences between genders.

Randomized crossover study. Participants were administered the following packed test meals once weekly on a specified day during six sessions: control (150 g of rice with a sautéed beef entrée containing 40 g of raw beef and 240 g of vegetables), high-meat/low-rice, low-vegetable, medium-fat/low-vegetable, high-fat and high-fat/low-vegetable meals. Subjective levels of sensory properties were assessed over time using visual analogue scales.

University of Tokushima Graduate School, Tokushima, Japan.

Sixty-five men and sixty-five women matched by age and BMI.

Men showed significantly stronger desires for salty and fatty foods after meals (P<0·05). Women showed a significantly stronger desire for sweetness from 2 h after the low-vegetable meal, and increasing fat content under high-vegetable conditions caused a significant stimulated sweetness desire in women more than in men (P<0·05). Moreover, after a high-meat/low-rice meal with 100 g of rice, sweetness desire was stronger in women (P=0·024), whereas no significant differences in sweetness desire were shown between genders after another low-energy-density control meal with 150 g of rice.

Men had significantly stronger desires for salty and fatty foods, whereas women preferred sweet food after meals. The sweetness desire in women was stimulated by increasing fat content, even with a high vegetable intake. Low rice intake in a low-energy-density diet also caused a relative stimulation of sweetness desire in women.

Body image dissatisfaction (BID) in school-age children is positively associated with weight status in cross-sectional studies; however, it is uncertain whether BID is a risk factor for the development of adiposity over time. The aim of the present study was to examine the association of BID with changes in BMI in school-age children.

Longitudinal study. At recruitment, children were asked to indicate the silhouette that most closely represented their current and desired body shapes using child-adapted Stunkard scales. Baseline BID was calculated as the difference of current minus desired body image. Height and weight were measured at recruitment and then annually for a median of 2·5 years. Sex-specific BMI-for-age curves were estimated by levels of baseline BID, using mixed-effects models with restricted cubic splines.

Public primary schools in Bogotá, Colombia.

Six hundred and twenty-nine children aged 5–12 years.

In multivariable analyses, thin boys who desired to be thinner gained an estimated 5·8 kg/m2 more BMI from age 6 to 14 years than boys without BID (P = 0·0004). Heavy boys who desired to be heavier or thinner gained significantly more BMI than boys without BID (P = 0·003 and P = 0·007, respectively). Thin girls who desired to be heavier or thinner gained significantly less BMI than girls without BID (P = 0·0008 and P = 0·05, respectively), whereas heavy girls who desired to be heavier gained an estimated 4·8 kg/m2 less BMI than girls without BID (P = 0·0006). BID was not related to BMI change in normal-weight children.

BID is associated with BMI trajectories of school-age children in a sex- and weight-specific manner.

The prevalence of childhood and adult obesity in Malta is among the highest in the world. Although increasingly recognised as a public health problem with substantial future economic implications for the national health and social care systems, understanding the context underlying the burden of obesity is necessary for the development of appropriate counter-strategies.

We conducted a contextual analysis to explore factors that may have potentially contributed to the establishment of an obesogenic environment in Malta. A search of the literature published between 1990 and 2013 was conducted in MEDLINE and EMBASE. Twenty-two full-text articles were retrieved. Additional publications were identified following recommendations by Maltese public health experts; a review of relevant websites; and thorough hand searching of back issues of the Malta Medical Journal since 1990.

Malta.

Whole population, with a focus on children.

Results are organised and presented using the ANalysis Grid for Elements Linked to Obesity (ANGELO) framework. Physical, economic, policy and socio-cultural dimensions of the Maltese obesogenic environment are explored.

Malta’s obesity rates may be the result of an obesogenic environment characterised by limited infrastructure for active living combined with an energy-dense food supply. Further research is required to identify and quantify the strength of interactions between these potential environmental drivers of obesity in order to enable appropriate countermeasures to be developed.