To examine whether weight history and weight transitions over adult lifespan contribute to physical impairment among postmenopausal women.

BMI categories were calculated among postmenopausal women who reported their weight and height at age 18 years. Multiple-variable logistic regression was used to determine the association between BMI at age 18 years and BMI transitions over adulthood on severe physical impairment (SPI), defined as scoring <60 on the Physical Functioning subscale of the Rand thirty-six-item Short-Form Health Survey.

Participants were part of the Women’s Health Initiative Observational Study (WHI OS), where participants’ health was followed over time via questionnaires and clinical assessments.

Postmenopausal women (n 76 016; mean age 63·5 (sd 7·3) years).

Women with overweight (BMI=25·0–29·9 kg/m2) or obesity (BMI≥30·0 kg/m2) at 18 years had greater odds (OR (95 % CI)) of SPI (1·51 (1·35, 1·69) and 2·14 (1·72, 2·65), respectively) than normal-weight (BMI=18·5–24·9 kg/m2) counterparts. Transitions from normal weight to overweight/obese or to underweight (BMI<18·5 kg/m2) were associated with greater odds of SPI (1·97 (1·84, 2·11) and 1·35 (1·06, 1·71), respectively) compared with weight stability. Shifting from underweight to overweight/obese also had increased odds of SPI (1·52 (1·11, 2·09)). Overweight/obese to normal BMI transitions resulted in a reduced SPI odds (0·52 (0·39, 0·71)).

Higher weight history and transitions into higher weight classes were associated with higher likelihood of SPI, while transitioning into lower weight classes for those with overweight/obesity was protective among postmenopausal women.

To conduct the first nationwide population survey to examine the associations between changes in speed of eating and weight gain over 3 years. The study also explored whether faster eating at baseline was related to healthy-weight women becoming overweight after 3 years.

Longitudinal. At baseline, participants were randomly selected from a nationally representative sampling frame to participate in a prospective study. Women completed self-administered baseline questionnaires on demographic and health measures. Self-reported speed of eating, smoking status, physical activity, menopause status, and height and weight were collected at baseline and again 3 years later.

Nationwide study, New Zealand.

Women (n 1601) aged 40–50 years were recruited at baseline from New Zealand electoral rolls.

There was no evidence of associations between 3-year BMI adjusting for baseline BMI and either baseline speed of eating (slower and faster; P=0·524) or change in speed of eating (consistently faster eating, consistently slower eating, slower eating at baseline but not at 3 years, faster eating at baseline but not at 3 years; P=0·845). Of the 488 women with healthy BMI (18·5 to <25·0 kg/m2) at baseline, seventy-seven (15·8 %) became overweight (BMI≥25·0 kg/m2) after 3 years. Compared with those who were slower eaters at baseline, faster eating at baseline did not increase the risk of becoming overweight 3 years later (P=0·958) nor did change in speed of eating (P=0·236).

Results suggest that once women have reached mid-life, faster eating does not predict further weight gain.

To examine associations between dietary intakes of fathers and their children at child age 20 months, 3·5 years and 5 years, and to determine if fathers’ intake predicts change in children’s intake between 20 months and 3·5 and 5 years of age.

The diets of fathers and their first-born children participating in the longitudinal Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program were assessed using FFQ and three 24 h recalls, respectively.

Sixty-two pre-existing first-time parent groups were selected from fourteen local government areas within a 60 km radius of Deakin University Burwood, Victoria, Australia.

Fathers and their first-born children at 20 months (n 317), 3·5 years (n 214) and 5 years of age (n 208).

Positive associations were found between fathers’ and children’s intakes of fruit and sweet snacks at 20 months (P=0·001) and 5 years of age (P=0·012). Fathers’ intake at child age 20 months was associated with change in children’s intake for fruit, sweet snacks and sugar-sweetened beverages between child age 20 months and 3·5 years, and for sweet snacks and sugar-sweetened beverages between child age 20 months and 5 years (all P<0·05). After adjustment for maternal intake, fathers’ intake of sweet snacks remained a predictor of change in children’s sweet snack intake between 20 months and 3·5 years of age (P=0·03).

Associations between the dietary intakes of fathers and their children commence at a young age and continue through early childhood. Fathers should be included in future interventions aimed at improving children’s diets.

To examine the association between fast-food consumption, diet quality and body weight in a community sample of working adults.

Cross-sectional and prospective analysis of anthropometric, survey and dietary data from adults recruited to participate in a worksite nutrition intervention. Participants self-reported frequency of fast-food consumption per week. Nutrient intakes and diet quality, using the Healthy Eating Index-2010 (HEI-2010), were computed from dietary recalls collected at baseline and 6 months.

Metropolitan medical complex, Minneapolis, MN, USA.

Two hundred adults, aged 18–60 years.

Cross-sectionally, fast-food consumption was significantly associated with higher daily total energy intake (β=72·5, P=0·005), empty calories (β=0·40, P=0·006) and BMI (β=0·73, P=0·011), and lower HEI-2010 score (β=−1·23, P=0·012), total vegetables (β=−0·14, P=0·004), whole grains (β=−0·39, P=0·005), fibre (β=−0·83, P=0·002), Mg (β=−6·99, P=0·019) and K (β=−57·5, P=0·016). Over 6 months, change in fast-food consumption was not significantly associated with changes in energy intake or BMI, but was significantly inversely associated with total intake of vegetables (β=−0·14, P=0·034).

Frequency of fast-food consumption was significantly associated with higher energy intake and poorer diet quality cross-sectionally. Six-month change in fast-food intake was small, and not significantly associated with overall diet quality or BMI.

The present study aimed to explore the associations between food away-from-home (FAFH) consumption and body weight outcomes among Chinese adults.

FAFH was defined as food prepared at restaurants and the percentage of energy from FAFH was calculated. Measured BMI and waist circumference (WC) were used as body weight outcomes. Quantile regression models for BMI and WC were performed separately by gender.

Information on demographic, socio-economic, diet and health parameters at individual, household and community levels was collected in twelve provinces of China.

A cross-sectional sample of 7738 non-pregnant individuals aged 18–60 years from the China Health and Nutrition Survey 2011 was analysed.

For males, quantile regression models showed that percentage of energy from FAFH was associated with an increase in BMI of 0·01, 0·01, 0·01, 0·02, 0·02 and 0·03 kg/m2 at the 5th, 25th, 50th, 75th, 90th and 95th quantile, and an increase in WC of 0·04, 0·06, 0·06, 0·04, 0·06, 0·05 and 0·07 cm at the 5th, 10th, 25th, 50th, 75th, 90th and 95th quantile. For females, percentage of energy from FAFH was associated with 0·01, 0·01, 0·01 and 0·02 kg/m2 increase in BMI at the 10th, 25th, 90th and 95th quantile, and with 0·05, 0·04, 0·03 and 0·03 cm increase in WC at the 5th, 10th, 25th and 75th quantile.

Our findings suggest that FAFH consumption is relatively more important for BMI and WC among males rather than females in China. Public health initiatives are needed to encourage Chinese adults to make healthy food choices when eating out.

The present study investigated whether food package information is legible in a real purchase context; more specifically, it examined the level of legibility of non-mandatory, mandatory and nutritional information as well as the influence of age on legibility. This is an important issue, especially for older consumers who are usually advised to pay attention to their diet.

An in-store study was conducted in a French hypermarket. Descriptive statistics were used to measure the overall level of legibility and then ANOVA tests were carried out to examine the influence of age on the legibility of information. Complementary results included the influence of level of education.

Participants were asked to read information on four food packages when they were food shopping.

The sample included 196 consumers aged 18–82 years.

An asymmetry was observed between the extremely high level of legibility of non-mandatory information and the low level of legibility of mandatory and nutritional information provided on food packages. Elderly respondents performed significantly worse than their younger counterparts. An interaction effect was found between age and level of education on the legibility of mandatory information.

Legibility of mandatory information is clearly unsatisfactory. There appears to be a hierarchy between significant, but non-mandatory, company information and important mandatory and nutritional information. The first type of information is promoted on food packages whereas the last two are all but concealed to older and less educated consumers.

To investigate the prospective associations between dietary patterns in childhood and CVD risk in adolescence.

Prospective cohort study. Exposures were dietary patterns at age 7, 10 and 13 years derived by cluster analysis. Outcomes were physiological and biochemical cardiovascular risk markers.

Avon Longitudinal Study of Parents and Children (ALSPAC), UK.

Children (n 2311, 44.1 % male) with complete data available.

After adjustment for known confounders, we observed an association between being in the ‘Processed’ and ‘Packed lunch’ dietary pattern clusters at age 7 and BMI at age 17. Compared with the ‘healthy’ cluster, the OR (95 % CI) for being in the top 10 % for BMI was 1·60 (1·01, 2·55; P=0·05) for the ‘Processed’ cluster and 1·96 (1·22, 3·13; P=0·005) for the ‘Packed lunch’ cluster. However, no association was observed between BMI and dietary patterns at age 10 and 13. Longitudinal analyses showed that being in either the ‘Processed’ or ‘Packed lunch’ cluster at age 7 was associated with increased risk of being in the top 10 % for BMI regardless of subsequent cluster membership. No associations between other cardiovascular risk measures and dietary patterns were robust to adjustment for confounders.

We did not find any consistent evidence to support an association between dietary patterns in childhood and cardiovascular risk factors in adolescence, with the exception of BMI and dietary pattern at age 7 only. However, the importance of dietary intake in childhood upon health later in life requires further investigation and we would encourage the adoption of a healthy diet as early in life as possible.

Children from low-income countries consuming predominantly plant-based diets but little animal products are considered to be at risk of Fe deficiency. The present study determined the Fe status of children from resource-limited rural households.

A cross-sectional study.

Twenty six kebeles (the smallest administrative unit) from six zones of the Amhara region, Ethiopia.

Children aged 54–60 months (n 628).

Grain, roots or tubers were the main dietary components consumed by 100 % of the study participants, followed by pulses, legumes or nuts (66·6 %). Consumption of fruit and vegetables (19·3 %) and meat, poultry and fish (2·2 %) was low. Children had a mean dietary diversity score of 2·1 (sd 0·8). Most children (74·8 %, n 470) were in the lowest dietary diversity group (1–2 food groups). Rate of any morbidity in the preceding 14 d was 22·9 % (n 114). Infection or inflammation (α1-acid glycoprotein >1·2 g/l) was present in 30·2 % (n 184) of children. Children had a high rate of stunting (43·2 %). Of the total sample, 13·6 % (n 82) of children were anaemic, 9·1 % (n 57) were Fe deficient and 5·3 % (n 32) had Fe-deficiency anaemia. Fe-deficiency erythropoiesis was present in 14·2 % (n 60) of children.

Despite consuming a predominantly plant-based diet and little animal-source foods, there was a low prevalence of Fe-deficiency anaemia. This illustrates that dietary patterns can be inharmonious with Fe biochemical status; thus, Fe-related interventions require biochemical screening.

Little is known about the influences of maternal and infant correlates on maternal feeding beliefs and practices in the first 2 years of life, despite its important role in early obesogenic eating behaviours and weight gain.

Cross-sectional study using demographic data of mothers and infants obtained at 26–28 weeks of gestation, and postnatally from birth to 15 months, respectively. The Infant Feeding Questionnaire was administered at 15 months postpartum. The associations between maternal and infant characteristics with seven maternal feeding beliefs and practices subscales were evaluated using multivariate linear regression analysis.

Data obtained from the Singapore GUSTO (Growing Up in Singapore Towards healthy Outcomes) mother–offspring birth cohort.

Mothers and infants (n 1237).

Among other maternal correlates such as age, education, BMI, income and milk feeding practices, ethnicity was a consistent factor associated with six subscales, including concern about infant overeating/undereating and weight status, concern and awareness about infants’ hunger and satiety cues, social interaction during feeding and feeding an infant on schedule. Similarly, among infant correlates such as gender and birth order, infant body size gain (reflected by BMI Z-score change from 0 to 15 months) was significantly associated with all subscales except feeding an infant on schedule. Overall, maternal correlates had greater influence on all subscales compared with infant correlates except for the maternal concern about infant undereating or becoming underweight subscale.

The present study highlights that maternal feeding beliefs and practices can be influenced by both maternal correlates and infant correlates at 15 months of age.

Little is known about adolescents’ non-core food intake in the UK and the eating context in which they consume non-core foods. The present study aimed to describe types of non-core foods consumed by British adolescents in total and across different eating contexts.

A descriptive analysis, using cross-sectional data from food diaries. Non-core foods were classified based on cut-off points of fat and sugar from the Australian Guide to Healthy Eating. Eating context was defined as ‘where’ and ‘with whom’ adolescents consumed each food. Percentages of non-core energy were calculated for each food group in total and across eating contexts. A combined ranking was then created to account for each food’s contribution to non-core energy intake and its popularity of consumption (percentage of consumers).

The UK National Diet and Nutrition Survey 2008–2011.

Adolescents across the UK aged 11–18 years (n 666).

Non-core food comprised 39·5 % of total energy intake and was mostly ‘Regular soft drinks’, ‘Crisps & savoury snacks’, ‘Chips & potato products’, ‘Chocolate’ and ‘Biscuits’. Adolescents ate 57·0 % and 51·3 % of non-core food at ‘Eateries’ or with ‘Friends’, compared with 33·2 % and 32·1 % at ‘Home’ or with ‘Parents’. Persistent foods consumed across eating contexts were ‘Regular soft drinks’ and ‘Chips & potato products’.

Regular soft drinks contribute the most energy and are the most popular non-core food consumed by adolescents regardless of context, and represent a good target for interventions to reduce non-core food consumption.

Insight into the role of acculturation in dietary patterns is important to inform the development of nutrition programmes that target ethnic minority groups. Therefore, the present study aimed to investigate how the adherence to dietary patterns within an ethnic minority population in the Netherlands varies by acculturation level compared with the host population.

Cross-sectional study using data of the HELIUS study. Dietary patterns were assessed with an ethnic-specific FFQ. Acculturation was operationalized using unidimensional proxies (residence duration, age at migration and generation status) as well as on the basis of the bidimensional perspective, defined by four distinct acculturation strategies: assimilation, integration, separation and marginalization.

Amsterdam, the Netherlands.

Participants of Dutch (n 1370) and Surinamese (n 1727) origin.

Three dietary patterns were identified: (i) ‘noodle/rice dishes and white meat’ (traditional Surinamese pattern); (ii) ‘red meat, snacks and sweets’; and (iii) ‘vegetables, fruit and nuts’. Surinamese-origin respondents adhered more to the traditional Surinamese pattern than the other dietary patterns. Neither the unidimensional proxies nor the bidimensional acculturation strategies demonstrated consistent associations with dietary patterns.

The lack of consistent association between acculturation and dietary patterns in the present study indicates that dietary patterns are quite robust. Understanding the continued adherence to traditional dietary patterns when developing dietary interventions in ethnic minority groups is warranted.

To assess alcoholic beverage intake among Australian adults and its contribution to dietary energy intake.

Secondary analysis of a national dietary survey using 24 h dietary recall.

Australian National Nutrition and Physical Activity Survey (NNPAS) conducted from May 2011 to June 2012.

Adults (n 9341) aged 19 years and over.

On the day preceding the survey, 32·8% of Australian adults consumed one or more alcoholic drinks. The median contribution to total energy intake for consumers did not differ significantly between males and females (13·7% and 12·9%, respectively; P=0·10). The prevalence of consumption of alcoholic drinks on Friday, Saturday and Sunday was 38·8 (95% CI 37·1, 40·5)%, higher than the other days (28·6 (95% CI 27·5, 29·8)%). Consumers had a median daily intake of 4·0 standard drinks on the weekend compared with 3·0 standard drinks during the week (P<0·001). Beer was the most commonly consumed alcoholic beverage for men and white wine for women. The highest prevalence of alcoholic beverage intake occurred in the highest quintile of adjusted household income (42·7 (95% CI 40·4, 45·0)%) and the ‘overweight’ BMI category (40·3 (95% CI 38·5, 42·0)%). Alcoholic beverage intake among consumers was significantly different by household income quintile (median 3·84 (highest) v. 3·05 standard drinks (lowest); P<0·05) and by waist circumference category (median 4·09 standard drinks (highest)).

Alcoholic drinks contribute substantially to the dietary energy intake of Australian adults. The type and pattern of consumption of alcoholic beverage intake should be considered in the development of strategies to improve dietary intake.

To study the association of fish and fish-liver oil consumption across the lifespan with CHD later in life among Icelandic women, with special emphasis on the effects of consumption in adolescence.

Prevalence association study. Logistic regression was used to estimate odds ratios and 95 % confidence intervals of CHD according to fish or fish-liver oil exposure. Models were adjusted for age, education, concurrent diet and other known risk factors.

The study was nested within the AGES-Reykjavik Study, conducted in Reykjavik, Iceland.

Participants were 3326 women aged 66–96 years, with available information on CHD status at entry to the study and information on fish and fish-liver oil consumption during midlife and adolescence. Dietary habits were assessed retrospectively using a validated FFQ.

CHD was identified in 234 (7·9 %) women. Compared with women with no intake of fish-liver oil in adolescence or midlife, women who consumed fish-liver oil at least three times weekly in adolescence or in midlife had a decreased risk of CHD (OR=0·62; 95 % CI 0·45, 0·85 and OR=0·68; 95 % CI 0·50, 0·94, respectively). No associations were observed between fish intake (>2 portions/week v. ≤2 portions/week) in adolescence or midlife and CHD in this population with high fish intake.

Fish-liver oil consumption, from early life, may reduce the risk of CHD in older women. Lifelong nutrition may be of importance in the prevention of CHD in older women.

Diabetes is a growing public health problem, and the environment in which people live and work may affect diabetes risk. The goal of the present study was to examine the association between multiple aspects of environment and diabetes risk in an employee population.

This was a retrospective cross-sectional analysis. Home environment variables were derived using employees’ zip code. Descriptive statistics were run on all individual- and zip-code-level variables, stratified by diabetes risk and worksite. A multivariable logistic regression analysis was then conducted to determine the strongest associations with diabetes risk.

Data were collected from employee health fairs in a Midwestern health system, 2009–2012.

The data set contains 25 227 unique individuals across four years of data. From this group, using an individual’s first entry into the database, 15 522 individuals had complete data for analysis.

The prevalence of high diabetes risk in this population was 2·3 %. There was significant variability in individual- and zip-code-level variables across worksites. From the multivariable analysis, living in a zip code with higher percentage of poverty and higher walk score was positively associated with high diabetes risk, while living in a zip code with higher supermarket density was associated with a reduction in high diabetes risk.

Our study underscores the important relationship between poverty, home neighbourhood environment and diabetes risk, even in a relatively healthy employed population, and suggests a role for the employer in promoting health.

To combat childhood obesity, researchers have focused on parental feeding practices that promote child health. The current study investigated how parenting style relates to twelve parental feeding practices.

Data on parenting style and parental feeding practices were obtained for a correlational study from users of Amazon’s Mechanical Turk, an online survey system.

USA.

Mothers of children aged 7–11 years (n 193).

Parenting style related differentially to eleven out of the twelve measured practices. Authoritative mothers displayed more feeding practices that promote child health and fewer practices that impede child health. Authoritarian and permissive mothers displayed more unhealthy practices than authoritative mothers, but differed from each other on the practices they employed.

Parenting style may relate to more aspects of feeding than previously realized. The inclusion of numerous healthy feeding practices along with unhealthy practices in the current study provides suggestions for the application of healthy feeding behaviours. Instruction on feeding behaviours and parenting style should be a focus of future educational programmes.

To evaluate the association between length of residence in an urban area and obesity among Peruvian rural-to-urban migrants.

Cross-sectional database analysis of the migrant group from the PERU MIGRANT Study (2007). Exposure was length of urban residence, analysed as both a continuous (10-year units) and a categorical variable. Four skinfold site measurements (biceps, triceps, subscapular and suprailiac) were used to calculate body fat percentage and obesity (body fat percentage >25% males, >33% females). We used Poisson generalized linear models to estimate adjusted prevalence ratios and 95 % confidence intervals. Multicollinearity between age and length of urban residence was assessed using conditional numbers and correlation tests.

A peri-urban shantytown in the south of Lima, Peru.

Rural-to-urban migrants (n 526) living in Lima.

Multivariable analyses showed that for each 10-year unit increase in residence in an urban area, rural-to-urban migrants had, on average, a 12 % (95 % CI 6, 18 %) higher prevalence of obesity. This association was also present when length of urban residence was analysed in categories. Sensitivity analyses, conducted with non-migrant groups, showed no evidence of an association between 10-year age units and obesity in rural (P=0·159) or urban populations (P=0·078). High correlation and a large conditional number between age and length of urban residence were found, suggesting a strong collinearity between both variables.

Longer lengths of urban residence are related to increased obesity in rural-to-urban migrant populations; therefore, interventions to prevent obesity in urban areas may benefit from targeting migrant groups.

High soft drink consumption has been linked with asthma. Anecdotal evidence links high-fructose corn syrup with asthma. The receptor of advanced glycation end products (RAGE) has emerged as a mediator of asthma. The objectives of the present study were to: (i) assess the correlation between intake of beverages containing excess free fructose (EFF beverages) and asthma in children; and (ii) epidemiologically test the mechanistic hypothesis that intake of high EFF beverages, such as apple juice or beverages sweetened with high-fructose corn syrup, is associated with increased risk of asthma. This hypothesis is based on the possible effect of increases in the in situ intestinal formation of advanced glycation end products (enFruAGE) with EFF, which may be absorbed and play a role in RAGE-mediated asthma.

We examined cross-sectional associations between beverage intake and self-reported current or history of asthma. Exposure variables were EFF beverages, including apple juice (AJ), non-diet soft drinks (ndSD) and fruit drinks (FD). Orange juice (OJ), not an EFF beverage, was included as a comparison. Rao–Scott χ2 analysis was used for prevalence differences and logistic regression for associations, adjusted for age, sex, race/ethnicity, BMI and total energy intake.

Data are from the National Health and Nutrition Examination Survey 2003–2006, a nationally representative survey.

US children (n 1961) aged 2–9 years with complete responses on the dietary frequency questionnaire.

Intakes of EFF beverages were significantly associated with asthma in 2–9-year-olds. Adjusted odds of asthma in children consuming EFF beverages ≥5 times/week was more than five times that in children consuming these beverages ≤1 time/month (OR=5·29, P=0·012). Children consuming AJ ≥5 times/week v. ≤1 time/month, adjusted for the other beverages, were more than twice as likely to have asthma (OR=2·43, P=0·035). In contrast, there was a tendency for OJ to be protective.

These results support the hypothesis that intake of high EFF beverages, including AJ and beverages sweetened with high-fructose corn syrup, is associated with asthma in children aged 2–9 years. Results support the mechanistic hypothesis that enFruAGE may be an overlooked contributor to asthma in children. Longitudinal studies are needed to provide evidence of causal association.

Fe is an essential element for erythropoiesis and Hb synthesis. High Hb levels affect the blood’s viscosity and are associated with cardiovascular dysfunction. The aim of the present study was to examine relationships of Hb and cardiometabolic abnormalities with the risk of alanine aminotransferase (ALT) elevation in adolescents.

A population-based, cross-sectional study.

National Nutrition and Health Survey in Taiwan (2010–2011, adolescents).

Healthy adolescents aged 13–18 years.

In total, 1941 adolescents (963 boys and 978 girls) were entered in the study. The mean age was 15·3 (sd 0·1) years (boys, 15·3 (sd 0·1) years; girls, 15·2 (sd 0·1) years). ALT tertile cut-off points for boys were 11 and 16 U/l, and for girls were 9 and 12 U/l. Girls without dyslipidaemia and presenting in the highest quartile (Q1) of Hb (>13·6 g/dl) were 1·89 and 3·76 times more likely to have raised serum ALT (9 and >12 U/l, respectively) than the reference (lowest quartile of Hb (Q1), <12·4 g/dl). Moreover, for those girls with dyslipidaemia, serum ALT seemed to increase with an increase in Hb levels. Specifically, girls with dyslipidaemia and Hb levels of 12·4, 13·1 and 13·6 g/dl were, respectively, 2·86, 3·53 and 5·64 times more likely to have elevated serum ALT levels (>12 U/l) than the reference (Q1 of Hb, <12·4 g/dl). The only effect found in boys was for those who had dyslipidaemia and presenting in Q4 of Hb (>15·4 g/dl), who were 7·40 times more likely to have elevated serum ALT of >16 U/l than the reference (Q1 of Hb, <14·1 g/dl).

Our findings suggest that an increased Hb level is a predictor of elevated serum ALT in adolescent girls with dyslipidaemia. Our study also highlights the importance of further research to establish cut-off points for Hb and its utility in diagnosing and preventing the onset of dyslipidaemia in adolescents.

The present study evaluated the association between energy intake, energy required and mortality in older adults.

A cohort study with a mean of 10·67 (sd 4·74) years of follow-up. Participants completed a 24 h dietary recall. Energy required per day was computed by BMR. Deaths through 2006 were identified from the National Death Index. A Cox regression was used to estimate the hazard ratios (HR) of quantiles of energy intake and energy required on all-cause and CVD mortality, adjusting for demographics, socio-economic status and co-morbidity.

The National Health and Nutrition Examination Survey (NHANES) III, 1988–1994.

A total of 4846 participants aged 60 years or above were analysed.

Within the follow-up period, there were a total of 2954 deaths (61·0 %), 51·9 % were caused by CVD. Relative to those in quartile 1 of energy intake, only quartile 4 was associated with all-cause mortality and CVD mortality with HR of 0·86 (95 % CI 0·77, 0·96, P=0·006) and 0·76 (95 % CI 0·65, 0·89, P=0·001), respectively. On the other hand, relative to those in quartile 1 of energy required, all quartiles of participants had a lower risk of all-cause mortality and CVD mortality. The interaction effects between energy intake and energy required with all-cause and CVD mortality were insignificant (P=0·70 and 0·61, respectively).

Independent of energy required, higher energy intake was associated with lower HR of both all-cause and CVD mortality in older adults.