To examine the influence of health behaviours and psychological well-being on gestational weight gain using a biopsychosocial model.

A prospective cohort study of pregnant women consecutively recruited at their first antenatal care visit. A self-administered questionnaire was used to collect data on health behaviours and psychological well-being in early pregnancy. Linear regression and logistic regression were used to identify predictors of total weight gain in kilograms and weight gain outside the current Institute of Medicine recommendations, respectively.

A maternity hospital in the Republic of Ireland.

Data on 799 women were analysed.

Pre-pregnant BMI ≥30·0 kg/m2, short stature, parity >0, decreased food intake and absence of health insurance predicted lower absolute gestational weight gain, while foreign nationality, consumption of takeaway meals more than once weekly and increased food intake predicted higher absolute gestational weight gain. Overweight and obesity, foreign nationality, increased food intake and height >170 cm were risk factors for excessive weight gain, while antenatal depression was protective against excessive weight gain. Notably, physical activity measures were not related to the gestational weight gain outcomes. Pre-pregnancy overweight and increased food intake were the strongest predictors of excessive gestational weight gain.

None of the psychological well-being measures examined, with the exception of antenatal depression, was associated with any of the weight gain outcomes. The behavioural predictors of gestational weight gain were increased food intake and takeaway consumption. Public health promotions should target pre-pregnancy BMI and pregnancy-associated change in food intake.

Fast-food restaurants (FFR) are prevalent. Binge eating is common among overweight and obese women. For women prone to binge eating, neighbourhood FFR availability (i.e. the neighbourhood around one's home) may promote poor diet and overweight/obesity. The present study tested the effects of binge eating and neighbourhood FFR availability on diet (fat and total energy intake) and BMI among African American and Hispanic/Latino women.

All measures represent baseline data from the Health is Power randomized clinical trial. The numbers of FFR in participants’ neighbourhoods were counted and dichotomized (0 or ≥1 neighbourhood FFR). Participants completed measures of binge eating status and diet. Weight and height were measured and BMI calculated. 2 (binge eating status) × 2 (neighbourhood FFR availability) ANCOVA tested effects on diet and BMI while controlling for demographics.

Houston and Austin, TX, USA.

African American and Hispanic/Latino women aged 25–60 years.

Of the total sample (n 162), 48 % had 1–15 neighbourhood FFR and 29 % were binge eaters. There was an interaction effect on BMI (P = 0·05). Binge eaters with ≥1 neighbourhood FFR had higher BMI than non-binge eaters or binge eaters with no neighbourhood FFR. There were no significant interactions or neighbourhood FFR main effects on total energy or fat intake (P > 0·05). A main effect of binge eating showed that binge eaters consumed more total energy (P = 0·005) and fat (P = 0·005) than non-binge eaters.

Binge eaters represented a substantial proportion of this predominantly overweight and obese sample of African American and Hispanic/Latino women. The association between neighbourhood FFR availability and weight status is complicated by binge eating status, which is related to diet.

To assess the association of breakfast intake with Mediterranean diet adherence, physical activity levels, obesity, selected cardiovascular risk markers and Fe status.

Cross-sectional study. BMI, body fat percentage and waist circumference were assessed. Physical activity was assessed using a pedometer and diet quality was evaluated by applying the KIDMED index. Blood tests to assess blood lipids, high-sensitivity C-reactive protein, fasting glucose, serum Fe and ferritin, as well as Hb, were performed.

Primary-school children of the Troodos mountainous area in Cyprus.

Eighty-three Cypriot children (mean age 9·2 (sd 1·7) years).

Compared with breakfast skippers, regular breakfast eaters were 40 % more likely to have a KIDMED score higher by one point on average (OR=1·41; 95 % CI 1·08, 1·84) after accounting for obesity levels and other confounders. Breakfast skippers, on the other hand, were by about 14 % more likely to have a body fat percentage value higher by one unit, as well as higher values for both BMI and waist circumference. The relationship was significantly strengthened when combining body fat percentage and waist circumference into a composite variable (OR=0·20; 95 % CI 0·06, 0·69). Fasting glucose was inversely correlated to breakfast intake in descriptive analyses, whereas serum Fe was positively correlated to breakfast intake after considering age, gender and diet quality. The latter relationship disappeared, however, after considering physical activity levels.

Cypriot children who take breakfast regularly exhibit a higher adherence to the Mediterranean diet and have higher serum Fe concentrations and lower BMI, waist circumference, body fat percentage and fasting glucose levels, compared with children who skip breakfast. Public health professionals, educators and parents should prioritize on actions that will motivate children to regularly eat breakfast.

Food has a considerable environmental impact. Diets with less meat and dairy reduce environmental impact but may pose nutritional challenges for children. The current modelling study investigates the impact of diets with less or no meat and dairy products on nutrient intakes.

Energy and nutrient intakes were assessed for observed consumption patterns (reference) and two replacement scenarios with data from the Dutch National Food Consumption Survey – Young Children (2005–2006). In the replacement scenarios, 30 % or 100 % of the consumed dairy and meat (in grams) was replaced by plant-derived foods with similar use.

The Netherlands.

Children (n 1279) aged 2–6 years.

Partial and full replacement of meat and dairy foods by plant-derived foods reduced SFA intake by 9 % and 26 %, respectively, while fibre intake was 8 % and 29 % higher. With partial replacement, micronutrient intakes were similar, except for lower vitamin B12 intake. After full meat and dairy replacement, mean intakes of Ca, Zn and thiamin decreased by 5–13 %, and vitamin B12 intake by 49 %, while total intake of Fe was higher but of lower bioavailability. With full replacement, the proportion of girls aged 4–6 years with intakes below recommendations was 15 % for thiamin, 10 % for vitamin B12 and 6 % for Zn.

Partial replacement of meat and dairy by plant-derived foods is beneficial for children’s health by lowering SFA intake, increasing fibre content and maintaining similar micronutrient intakes. When full replacements are made, attention is recommended to ensure adequate thiamin, vitamin B12 and Zn intakes.

The present communication reports a strategy to calculate the intake of Fe based on data available for folic acid and evaluate the programme of flour fortification in Brazil.

Cross-sectional study conducted in Brazil during 2008 and 2009. A 2d dietary record of individuals was used. The usual intake of folic acid by sex and age group was estimated using the National Cancer Institute method. The quantity of folic acid and Fe established by mandatory food fortification in Brazil was used, and based on that quantity we calculated the amount of flour consumed and the intake of Fe from fortification and Fe from food. Then, the absorption of each nutrient was calculated.

Brazilian households (n 16 764).

Individuals (men and women, n 34 003, aged 10 to 60+ years) from a Brazilian nationwide survey.

Mean intake and absorption of Fe from fortification (electrolytic Fe) was low in men and women.

The impact from the consumption of fortified products is small in relation to Fe intake in Brazil. The strategy proposed to estimate Fe intake from the fortification programme indicates that the amount of flour intake observed in Brazil does not justify the current ranges of mandatory flour fortification and the form of Fe that is mainly used (electrolytic Fe).

The objective of the present study was to describe changes in overweight and obesity prevalence and eating habits among 7·5–10·5-year-old children in Aquitaine (France) between 2004 and 2008, and to assess how the programme ‘Nutrition, Prevention and Health of children and teenagers in Aquitaine’ implemented in 2004 may have impacted these changes.

Two cross-sectional studies were conducted in two samples of children: the ‘before programme’ sample during the school year 2004/2005 and the ‘after programme’ sample during the school year 2008/2009.

Data were collected on gender, age, weight, height, area of residence (rural/urban) and socio-economic status of the school (non-low socio-economic/low socio-economic). Multivariate analyses were used to assess the effect of the regional programme intervention on the evolution of overweight and obesity prevalence and eating habits independently.

The ‘before programme’ sample included 1836 children from 163 schools during the school year 2004/2005 and the ‘after programme’ sample included 3483 children from 210 schools during the school year 2008/2009.

After adjustment of the model for age, residential area and socio-economic status of the area of residence, the prevalence of overweight including obesity (OR=1·05; 95 % CI 0·89, 1·23, P=0·56) and of obesity (OR=0·99; 95 % CI 0·71, 1·39, P=0·96) was found to have stabilized and eating habits had improved: intake of light afternoon meals had increased (OR=1·38; 95 % CI 1·13, 1·69, P=0·002) while snacking in the morning (OR=0·50; 95 % CI 0·45, 0·57, P<0·001) and nibbling (OR=0·81; 95 % CI 0·70, 0·93, P<0·001) had decreased.

These results encourage the promotion and implementation of regional and national interventions among children regarding their eating habits in order to stabilize or decrease the prevalence of overweight.

To examine (i) the prevalence of and associations between breast-feeding initiation and continuation by maternal diabetes status and (ii) the reasons for not initiating and/or continuing breast-feeding by maternal diabetes status.

Secondary data analyses of a population-based cross-sectional study were conducting using data from the US Centers for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring System (PRAMS), 2009–2011. Multivariable logistic regression was used to investigate the associations between breast-feeding initiation and continuation by diabetes status.

Thirty states and New York City, USA.

Mothers of recently live-born infants, selected by birth certificate sampling.

Among 72755 women, 8·8 % had gestational diabetes mellitus (GDM) and 1·7 % had pregestational diabetes mellitus (PDM). Breast-feeding initiation was similar among GDM and no diabetes mellitus (NDM) women (80·8 % v. 82·2 %, respectively, P=0·2), but continuation was lower among GDM (65·7 % v. 68·8 %, respectively, P=0·01). PDM women had lower initiation and continuation compared with NDM (78·2 %, P=0·03 and 60·4 %, P<0·01, respectively). In adjusted analyses, current smoking status was a significant effect modifier for initiation, but not for continuation.

Differences in breast-feeding initiation and continuation prevalence by maternal diabetes status may reflect differences in prenatal education, indicating the need for increased efforts among PDM women. Additionally, non-smoking women with PDM or GDM would benefit from additional breast-feeding education.

To investigate a 9-year trend of fresh fruit and vegetable availability and factors associated with the net availability change in two contrasting neighbourhoods.

Longitudinal design. Data were collected in 2003, 2009 and 2012 through in-store observations. Fresh fruit and vegetable availability was presented by weight-adjusted counts of stores having designated varieties per 10 000 population.

A low-income minority neighbourhood and an adjacent middle-income racially mixed neighbourhood in Albany, NY, USA. These neighbourhoods became sites of fresh produce interventions after baseline data were collected.

A total of 111, 128 and 146 eligible food stores in respective years.

Fresh fruit availability (two or more varieties) increased in both neighbourhoods. Inventory expansion of existing stores and the convenience store intervention contributed to the significant increase (P for trend=0·04) of fresh fruit availability in the minority neighbourhood. Although not statistically significant (P>0·05), the availability of two or more dark-coloured fresh vegetables also increased in the mixed neighbourhood, but declined slightly in the minority neighbourhood. The secular (non-intervention) fresh vegetable availability rate ratio by neighbourhood reached 3·0 in 2012 (P<0·01). The net decline of fresh vegetable availability in the minority neighbourhood was primarily attributed to inventory reduction of existing stores.

Longitudinal observations revealed narrowed neighbourhood disparities of fresh fruit availability and widened gaps of fresh vegetable availability. Inventory shifts of existing stores impacted the net availability change more profoundly than store opening or closing in the minority neighbourhood. Findings support increasing the programme capacity of the convenience store intervention to address the fresh vegetable disparity.

To describe the diet costs of adults in the National Diet and Nutrition Study (NDNS) and explore patterns in costs according to sociodemographic indicators.

Cross-sectional diet diary information was matched to a database of food prices to assign a cost to each food or non-alcoholic beverage consumed. Daily diet costs were calculated, as well as costs per 10 MJ to improve comparability across differing energy requirements. Costs were compared between categories of sociodemographic variables and health behaviours. Multivariable regression assessed the effects of each variable on diet costs after adjustment.

The NDNS is a rolling dietary survey, recruiting a representative UK sample each year. The study features data from 2008–2010.

Adults aged 19 years or over were included. The sample consisted of 1014 participants.

The geometric mean daily diet cost was £2·89 (95 % CI £2·81, £2·96). Energy intake and daily diet cost were strongly associated. The mean energy-adjusted cost was £4·09 (95 % CI £4·01, £4·18) per 10 MJ. Energy-adjusted costs differed significantly between many subgroups, including by sex and household income. Multivariable regression found significant effects of sex, qualifications and occupation (costs per 10 MJ only), as well as equivalized household income, BMI and fruit and vegetable consumption on diet costs.

This is the first time that monetary costs have been applied to the diets of NDNS adults. The findings suggest that certain subgroups in the UK – for example those on lower incomes – consume diets of lower monetary value. Observed differences were mostly in the directions anticipated.

Between 1980 and 2008, two Pacific island nations – Nauru and the Cook Islands – experienced the fastest rates of increasing BMI in the world. Rates were over four times higher than the mean global BMI increase. The aim of the present paper is to examine why these populations have been so prone to obesity increases in recent times.

Three explanatory frames that apply to both countries are presented: (i) geographic isolation and genetic predisposition; (ii) small population and low food production capacity; and (iii) social change under colonial influence. These are compared with social changes documented by anthropologists during the colonial and post-colonial periods.

Nauru and the Cook Islands.

While islands are isolated, islanders are interconnected. Similarly, islands are small, but land use is socially determined. While obesity affects individuals, islanders are interdependent. New social values, which were rapidly propagated through institutions such as the colonial system of education and the cash economy, are today reflected in all aspects of islander life, including diet. Such historical social changes may predispose societies to obesity.

Colonial processes may have put in place the conditions for subsequent rapidly escalating obesity. Of the three frameworks discussed, social change under colonial influence is not immutable to further change in the future and could take place rapidly. In theorising obesity emergence in the Pacific islands, there is a need to incorporate the idea of obesity being a product of interdependence and interconnectedness, rather than independence and individual choice.

To describe adherence with infant feeding and complementary feeding guidelines.

Prospective study of infant feeding and complementary feeding practices were collected as part of the Cork BASELINE Birth Cohort Study.

Cork, Ireland.

Data are described for the 823 infants for whom a diary was completed.

Breast-feeding was initiated in 81 % of infants, and 34 %, 14 % and 1 % of infants were exclusively breast-fed at hospital discharge, 2 and 6 months, respectively. Stage one infant formula decreased from 71 % at 2 months to 13 % at 12 months. The majority of infants (79 %) were introduced to solids between 17 and 26 weeks and 18 % were given solid foods before 17 weeks. Mothers of infants who commenced complementary feeding prior to 17 weeks were younger (29·8 v. 31·5 years; P<0·001) and more likely to smoke (18 v. 8 %; P=0·004). The first food was usually baby rice (69 %), infant breakfast cereals (14 %) or fruit/vegetables (14 %). Meals were generally home-made (49 %), cereal-based (35 %), manufactured (10 %), dairy (3 %) and dessert-based (3 %). The median gap between the first–second, second–third, third–fourth and fourth–fifth new foods was 4, 2, 2 and 2 d, respectively.

We present the largest prospective cohort study to date on early infant feeding in Ireland. The rate of breast-feeding is low by international norms. Most mothers introduce complementary foods between 4 and 6 months with lengthy gaps between each new food/food product. There is a high prevalence of exposure to infant breakfast cereals, which are composite foods, among the first foods introduced.

Epidemiological studies suggest that green leafy vegetables, which are high in dietary nitrate, are protective against CVD such as stroke. High blood pressure (BP) is a major risk factor for stroke and inorganic nitrate has been shown to reduce BP. The objective of the present study was to test the hypothesis that diets containing high-nitrate (HN) vegetables would increase plasma nitrate and nitrite concentrations and reduce BP in healthy women.

A randomized, crossover trial, where participants received HN vegetables (HN diet) or avoided HN vegetables (Control diet) for 1 week. Before and after each intervention, resting BP and plasma nitrate and nitrite concentrations were measured.

University of Exeter, UK.

Nineteen healthy women (mean age 20 (sd 2) years; mean BMI 22·5 (sd 3·8) kg/m2).

The HN diet significantly increased plasma nitrate concentration (before HN diet: mean 24·4 (sd 5·6) µmol/l; after HN diet: mean 61·0 (sd 44·1) µmol/l, P<0·05) and plasma nitrite concentration (before HN diet: mean 98 (sd 91) nmol/l; after HN diet: mean 185 (sd 34) nmol/l, P<0·05). No significant change in plasma nitrate or nitrite concentration was observed after the Control diet. The HN diet significantly reduced resting systolic BP (before HN diet: mean 107 (sd 9) mmHg; after HN diet: mean 103 (sd 6) mmHg, P<0·05). No significant change in systolic BP was observed after the Control diet (before Control diet: mean 106 (sd 8) mmHg; after Control diet: mean 106 (sd 8) mmHg).

Consumption of HN vegetables significantly increased plasma nitrate and nitrite concentrations and reduced BP in normotensive women.

To assess whether a Smarter Lunchroom intervention based on behavioural economics and adapted for students with intellectual and developmental disabilities would increase the selection and consumption of fruits, vegetables and whole grains, and reduce the selection and consumption of refined grains.

The 3-month intervention took place at a residential school between March and June 2012. The evaluation employed a quasi-experimental, pre–post design comparing five matched days of dietary data. Selection and plate waste of foods at lunch were assessed using digital photography. Consumption was estimated from plate waste.

Massachusetts, USA.

Students (n 43) aged 11–22 years with intellectual and developmental disabilities attending a residential school.

Daily selection of whole grains increased by a mean of 0·44 servings (baseline 1·62 servings, P = 0·005) and refined grains decreased by a mean of 0·33 servings (baseline 0·82 servings, P = 0·005). The daily consumption of fruits increased by a mean of 0·18 servings (baseline 0·39 servings, P = 0·008), whole grains increased by 0·38 servings (baseline 1·44 servings, P = 0·008) and refined grains decreased by a mean of 0·31 servings (baseline 0·68 servings, P = 0·004). Total kilojoules and total gram weight of food selected and consumed were unchanged. Fruit (P = 0·04) and vegetable (P = 0·03) plate waste decreased.

A Smarter Lunchroom intervention significantly increased whole grain selection and consumption, reduced refined grain selection and consumption, increased fruit consumption, and reduced fruit and vegetable plate waste. Nudge approaches may be effective for improving the food selection and consumption habits of adolescents and young adults with intellectual and developmental disabilities.

To evaluate the association between risk perception and attendance in a diabetes prevention programme among South Asians with a high risk for diabetes.

An observational study. We measured risk perception during the baseline interview with causal beliefs, perceived susceptibility and perceived controllability. We used logistic regression to examine the relationship between risk perception and attendance. We adjusted for relevant sociodemographic factors, screening results and psychosocial factors.

The Hague, the Netherlands.

Five hundred and thirty-five Hindustani Surinamese (South Asians) aged 18–60 years from a lifestyle-versus-control intervention for the prevention of diabetes.

In total, 68·2 % attended the lifestyle or control intervention. Participants perceived lifestyle and heredity to increase the risk of diabetes and perceived increasing physical activity to decrease it. Only 44·2 % of the participants perceived themselves as susceptible to diabetes and only those who perceived a family history of diabetes as a cause of diabetes appeared to be more inclined to attend. However, after adjustment for confounding, the association was not statistically significant.

Risk perception was not significantly associated with attendance. The results suggest that increasing the risk perception alone in this South Asian population is unlikely to increase the attendance at a diabetes prevention programme.