To identify the association of individual and school environment factors with overweight among adolescents.

Cross-sectional study. Sociodemographic and behavioural information was collected using an anonymous self-administered questionnaire. Indicators on human and physical resources of the schools were based on information collected in interviews with school principals. Overweight was defined based on the BMI Z-score for age and sex recommended by WHO. Logistic regression models were used for statistical analysis.

Rio de Janeiro, Brazil.

By means of a two-stage (classrooms and students) probabilistic sampling, subjects comprised 1632 students enrolled in the last year of primary education of the municipal public school network, stratified by city region.

The mean prevalence of overweight at schools was 17·2 %, ranging from 0 % to 50 %. Adolescents more likely to be overweight were those who attended schools without knives and forks or ceramic/glass plates for students in the school refectory (prevalence odds ratio (POR) = 1·40; P = 0·04), those whose head of household had completed between 8 and 10 years of schooling (POR = 1·46; P = 0·03), those who did not live with both parents (POR = 1·24; P = 0·06) and those who had not practised physical activity outside school on at least 1 d in the 7 d before the study (POR = 1·56; P = 0·04).

Sociodemographic and behavioural variables of adolescents and school characteristics were associated with overweight, confirming individual and context effects on this health disorder. Studies such as the present one, identifying variables in context, may support actions to prevent overweight among adolescents.

To examine the effects of child-oriented dietary intervention on parental eating attitudes and dietary behaviour.

In the prospective, randomized Special Turku Coronary Risk Factor Intervention Project for Children (the STRIP study), a cohort of Finnish families took part in a nutritional intervention trial focused on the quality of their children's fat intake since the age of 8 months. Health-related and hedonic eating attitudes of the parents were measured after 10 years of dietary intervention using a validated Health and Taste Attitude Scales (HTAS) questionnaire (n 660). Parents’ eating behaviour was studied using a 1 d food record (n 491).

Finland.

Mothers and fathers (n 660) of the STRIP children.

The parents of the intervention families had a higher level of interest in healthy eating compared with control parents. The interest in natural products or hedonic eating attitudes did not differ between the groups. The parents’ general health interest was associated with low saturated fat intake, fruit and vegetable consumption, fibre intake and seeking pleasure in eating, but it was not associated with BMI. The intervention also improved the quality of dietary fat among parents with the lowest level of interest in healthy eating.

Parents’ general health interest was associated with regular dietary counselling as well as with healthier food choice behaviour. However, the dietary intervention that focused especially on the quality of the child's fat intake also enhanced specific changes in the family's fat consumption without a high level of interest in healthy eating.

To complete a description of the dietary intakes of New Zealand schoolchildren by describing afternoon and evening foods and nutrients.

Twenty-four hour dietary recall data from the 2002 Children's Nutrition Survey were analysed to describe food and nutrient intakes during the afternoon (14.00 to 16.59 hours) and evening (17.00 to 23.59 hours).

New Zealand homes and schools.

Children (n 2875) aged 5–14 years.

Most children consumed something during the afternoon (79 %) and evening (98 %). Children were less likely to consume something during non-school day afternoons; if 11–14 years of age; and when of Pacific ethnicity. Afternoon food consumers had higher daily intakes for most nutrients. Afternoon intake accounted for much of this difference. In the afternoon, children consumed fruit (26 %) and biscuits/crackers (21 %). Evening eating contributed to daily intakes of energy (40 %), fat (43 %), carbohydrate (35 %), sucrose (20 %), glucose (24 %), vitamin A (47 %), Ca (26 %) and Fe (40 %). Children aged 5–6 years consumed a lower proportion of their daily energy intake during the evening than older children. In the evening, just one-third of children consumed vegetables (45 % if including potato/kumara/taro), 19 % fruit and 17 % ate hot chips. Children were more likely to consume vegetables if they also consumed potato/kumara/taro. Twenty-three per cent of children had powdered drinks/cordials, 21 % had soft drinks and 19 % had milk.

Consuming foods/drinks in the afternoon positively influenced macronutrient distribution, increasing the carbohydrate proportion. During the evening 40 % of energy intake was consumed but less than one-half of children consumed vegetables; thus inclusion of vegetables in the evening is important, particularly in meals without potato/kumara/taro.

To identify consumption patterns of fruit and vegetables within a representative sample of US adults with a focus on degree of produce processing and to explore sociodemographic, lifestyle and nutritional profiles associated with these patterns.

Cross-sectional analysis. Fruit and vegetable (F&V) consumption data were collected using two non-consecutive 24 h recalls. For the purpose of the study, F&V intakes were aggregated into seven subgroups indicating degree of processing, which afterwards were used as inputs into cluster analysis.

The 2005–2006 National Health and Nutrition Examination Survey.

The sample consisted of 2444 adults aged 20–59 years.

Total average F&V intake of the adults was below the recommended level. Thereby, 20 % of the respondents consumed fruit only in the form of juice. Three F&V consumption patterns were identified: ‘low-intake F&V consumers’ (74 % of respondents), ‘consumers of healthier F&V options’ (13 %) and ‘intensive fruit juice consumers’ (13 %). These groups differed markedly in terms of their sociodemographic, lifestyle and health characteristics, such as gender, age, race/ethnicity, education, smoking, weight status, etc. Differences in nutrient profiles were also found, with the ‘consumers of healthier F&V options’ showing better nutritional quality compared with other clusters.

Only a small share of US adults combines high F&V intakes with healthier F&V options that lead to a better nutritional profile. This raises discussion about a need to deliver more specific F&V promotion messages, including advice on healthier preparation methods, especially for the specific population groups.

To examine the association of consumption of whole grains (WG) with diet quality and nutrient intake in children and adolescents.

Secondary analysis of cross-sectional data.

The 1999–2004 National Health and Nutrition Examination Survey.

Children aged 2–5 years (n 2278) and 6–12 years (n 3868) and adolescents aged 13–18 years (n 4931). The participants were divided into four WG consumption groups: ≥0 to <0·6, ≥0·6 to <1·5, ≥1·5 to <3·0 and ≥3·0 servings/d. Nutrient intake and diet quality, using the Healthy Eating Index (HEI)-2005, were determined for each group from a single 24 h dietary recall.

The mean number of servings of WG consumed was 0·45, 0·59 and 0·63 for children/adolescents at the age of 2–5, 6–12 and 13–18 years, respectively. In all groups, HEI and intakes of energy, fibre, vitamin B6, folate, magnesium, phosphorus and iron were significantly higher in those consuming ≥3·0 servings of WG/d; intakes of protein, total fat, SFA and MUFA and cholesterol levels were lower. Intakes of PUFA (6–12 years), vitamins B1 (2–5 and 13–18 years), B2 (13–18 years), A (2–5 and 13–18 years) and E (13–18 years) were higher in those groups consuming ≥3·0 servings of WG/d; intakes of added sugars (2–5 years), vitamin C (2–5 and 6–12 years), potassium and sodium (6–12 years) were lower.

Overall consumption of WG was low. Children and adolescents who consumed the most servings of WG had better diet quality and nutrient intake.

To evaluate the association between vitamin C supplementation and the incidence and progression of radiographic knee osteoarthritis (OA).

Prospective cohort study.

Clearwater Osteoarthritis Study (COS): (1988 to the present) a longitudinal study.

Male and female COS participants aged 40 years and above (n 1023). The study exposure was the participants’ self-reported history of vitamin C supplementation. The participants underwent biennial, sequential knee radiographs, which were assessed using the Kellgren–Lawrence ordinal scale to determine evidence of the study 2 outcomes: incident radiographic knee OA (RKOA) and progression of RKOA.

Individuals without baseline knee OA who self-reported vitamin C supplement usage were 11 % less likely to develop knee OA than were those individuals who self-reported no vitamin C supplement usage (risk ratio (RR) = 0·89, 95 % CI 0·85, 0·93). Among those participants with RKOA at baseline, vitamin C supplement usage did not demonstrate an association with RKOA progression (RR = 0·94, 95 % CI 0·79, 1·22).

In the present prospective cohort study, we found no evidence to support a protective role of vitamin C in the progression of knee OA. However, after controlling for confounding variables, these data suggest that vitamin C supplementation may indeed be beneficial in preventing incident knee OA. Given the massive public health burden of OA, the use of a simple, widely available and inexpensive supplement to potentially reduce the impact of this disease merits further consideration.

To examine the workings of the nutrition-related scientific advisory bodies in Europe, paying particular attention to the internal and external contexts within which they operate.

Desk research based on two data collection strategies: a questionnaire completed by key informants in the field of micronutrient recommendations and a case study that focused on mandatory folic acid (FA) fortification.

Questionnaire-based data were collected across thirty-five European countries. The FA fortification case study was conducted in the UK, Norway, Denmark, Germany, Spain, Czech Republic and Hungary.

Varied bodies are responsible for setting micronutrient recommendations, each with different statutory and legal models of operation. Transparency is highest where there are standing scientific advisory committees (SAC). Where the standing SAC is created, the range of expertise and the terms of reference for the SAC are determined by the government. Where there is no dedicated SAC, the impetus for the development of micronutrient recommendations and the associated policies comes from interested specialists in the area. This is typically linked with an ad hoc selection of a problem area to consider, lack of openness and transparency in the decisions and over-reliance on international recommendations.

Even when there is consensus about the science behind micronutrient recommendations, there is a range of other influences that will affect decisions about the policy approaches to nutrition-related public health. This indicates the need to document the evidence that is drawn upon in the decisions about nutrition policy related to micronutrient intake.

Nutritional status has remained inadequate among disadvantaged mothers and small children in South Africa. Several supplementation programmes are administered through primary health clinics (PHC). The present study examined the perceptions of mothers who attend PHC and of the PHC staff on the purpose, management and eligibility of the vitamin A and nutritional supplementation components of the Nutrition Supplementation Programme (NSP).

Observational study based on anthropometry and questionnaires.

Random selection of ten urban and ten rural PHC from the Western Cape Province of South Africa.

Mothers (n 176) and their children (n 179) aged <5 years, and various PHC staff categories.

Half (56 %) of the households were classified as food insecure and about one-third of the children were malnourished, as evidenced by stunting, wasting or underweight. A majority of mothers complained about poor information related to the programmes. More than half of the children who were eligible for NSP were not included. In contrast, the staff felt that they managed both programmes well and problems with implementation were mostly attributed to clients.

In general, the mothers expressed more dissatisfaction and ignorance about the vitamin A programme and the NSP than was perceived by the staff. This apparent discrepancy might, at least in part, explain why these programmes do not work optimally.

To compare the classification of overweight, obesity and underweight using international v. national approaches in Kuwaiti adolescents.

Assessment of underweight, overweight and obesity using a national approach (based on Kuwaiti reference data for BMI-for-age) was compared with assessments obtained using three international approaches: the Cole et al. and International Obesity Task Force (IOTF) definitions of thinness and of overweight and obesity (Cole-IOTF); WHO 2007; and US Centers for Disease Control and Prevention (CDC) 2000 reference data and definitions. The degree of agreement between the different methods was assessed using the weighted κ statistic (κw).

Two randomly selected public intermediate schools in Kuwait City.

A total of 499 10–14-year-old Kuwaiti adolescents.

Prevalence of overweight and obesity using Kuwaiti reference data (36·7 %; 95 % CI 32·4, 41·1) was significantly lower than that obtained using international approaches – Cole-IOTF (44·7 %; 95 % CI 40·3, 49·2), CDC 2000 (44·9 %; 95 % CI 40·5, 49·4) and WHO 2007 (50·5 %; 95 % CI 46·0, 55·0) (P < 0·01). All three international approaches showed almost perfect agreement: IOTF v. WHO (κw = 0·82; 95 % CI 0·79, 0·85) and IOTF v. CDC (κw = 0·90; 95 % CI 0·87, 0·92). However, Kuwaiti reference data showed the lowest agreement with the three international approaches, the poorest being with WHO 2007 (κw = 0·54; 95 % CI 0·49, 0·59).

Caution should be exercised when using recently collected national reference data and definitions while assessing underweight, overweight and obesity for clinical and public health applications.

To examine: (i) children's food intake and adherence to both Canada's Food Guide for Healthy Eating and Dietary Reference Intakes; and (ii) the social and demographic factors related to children's food intake.

A cross-sectional study.

Data were obtained through the Quebec Longitudinal Study of Child Development 1998–2010, a representative sample (n 2103) of children born in 1998 in the province of Quebec, Canada. Information on energy, macronutrient and food consumption was derived from responses to a 24 h dietary recall interview addressed to children's mothers and day-care staff when the children were 4 years old.

A total of 1549 children aged 4 years who participated in a nutritional sub-study.

The mean daily total energy intake was 6360 kJ (1520 kcal) for girls and 6916 kJ (1653 kcal) for boys. For boys and girls alike, energy intake was comprised of approximately 54 % carbohydrates, 31 % fats and 15 % proteins. The mean number of servings consumed from each of the four essential food groups closely approached the dietary recommendations made by Canada's Food Guide for Healthy Eating; however, <2 % of the children in the present study actually met the full dietary guidelines. The dietary intake of pre-school children was associated with socio-economic and demographic factors, most notably mother's level of education, mother's immigrant status and sex of the child.

Diet-related disparities associated with socio-economic and demographic factors exist from as early as 4 years of age.

To review and synthesize existing national and state organizations’ policies related to the nutritional quality of snacks served in after-school programmes (ASP; 15.00–18.00 hours) in the USA.

Systematic review of websites and corresponding documentation describing national and state-level ASP organizations’ policies, standards, guidelines and/or recommendations for the nutritional quality of snacks served within the ASP setting.

ASP can play a critical role in a child's daily dietary intake. State and national organizations have developed policies to assist ASP in selecting nutritionally appropriate snacks, yet no widely accepted standards exist. By reviewing the extent of existing policies, recommendations for uniform policies can be made.

Policy documentation.

A total of seventeen organizations representing five unique snack policies comprised of thirteen different food items were identified. The most widely recognized snack policy, which the majority of state and national ASP organizations endorsed and upon which other snack policies were modelled, was the US Department of Agriculture reimbursement programmes. Consistently, policies endorsed serving fruits/vegetables, whole grains and milk/dairy products, and limiting foods high in fats/sugar/energy (calories). Two policies focused predominantly on total energy and macronutrient composition of snacks, a single policy suggested limits on sugar-sweetened beverages, and three endorsed serving water daily. A proposed set of general guidelines for ASP was developed based on uniformity in recommendations across policies.

The proposed set of nutritional guidelines will assist policy makers and ASP providers in selecting and serving nutritionally appropriate snacks that contribute to a child's overall healthful daily dietary intake.

Dietary habits, including dietary patterns, have been associated with the risk of chronic diseases, including cancer. The objective of the present study was to evaluate Korean dietary patterns as assessed by using an FFQ and associations of dietary patterns with lifestyle risk factors.

Dietary patterns were analysed by factor analysis using a sixteen-group FFQ. The associations between dietary patterns and lifestyle risk factors were investigated by logistic regression analysis.

The National Cancer Center in South Korea.

The study population included 11 440 participants aged ≥30 years who were recruited between 2002 and 2007.

Compared with the lowest quartile intake of each dietary pattern, current smoking was positively associated with the Western pattern (OR = 1·55 for the highest quartile, 95 % CI 1·27, 1·88; P < 0·001) and the traditional pattern (OR = 1·34, 95 % CI 1·11, 1·62; P = 0·002) in men, but was inversely associated with the healthy pattern in both genders (P < 0·001) and the traditional pattern (OR = 0·52, 95 % CI 0·36, 0·75; P = 0·001) in women. Alcohol consumption was positively associated with all patterns in both genders, while no association was observed with the healthy pattern in women. Physical activity and dietary supplement use were positively associated with all patterns in both genders, with the exception of physical activity in women, which showed an inverse association with the traditional pattern.

Dietary patterns are strongly associated with health behaviours. The possible confounding effect of other risk behaviours should be appropriately considered when conducting nutritional epidemiological studies.

To investigate the feasibility and impact of the Food-O-Meter, an Internet-based computer-tailored nutrition intervention in adolescents.

Participants in the intervention condition received the computer-tailored advice at baseline and at 1 month, those in the control condition received standardised advice. Effects were evaluated at 1 month (n 621) and at 3 months (n 558) using multi-level modelling.

Secondary schools in six European cities. Adolescents accessed the intervention in the school computer room under the supervision of teachers.

Classes with students aged 12–17 years in the schools participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) cross-sectional study were randomised into intervention and control schools.

In most participating centres the intervention was feasible and generally well appreciated, especially by girls. Technical problems and lack of motivation of the teachers hindered implementation in some centres. Overweight adolescents had higher scores for reading and using the advice than normal weight adolescents. After 1 month adolescents receiving the standardised advice reported an increase in fat intake, while fat intake in the intervention condition was stable (F = 4·82, P < 0·05). After 3 months, there was a trend in the total group for an intervention effect of the tailored advice on fat intake (F = 2·80, P < 0·10). In the overweight group there was a clear positive effect (F = 5·76, P < 0·05).

The Food-O-Meter should be developed further. The results were modest but clear for percentage energy from fat, specifically in the overweight group. Adaptations based on new research are needed to enhance the reliability and effectiveness of the intervention.

To compare dietary patterns and food and macronutrient intakes among adults in three ethnic groups in rural Kenya.

In the present cross-sectional study, dietary intake was estimated in adult volunteers using two non-consecutive interactive 24 h recalls. Dietary patterns were assessed from the number of meals and snacks per day and from the food items and major food groups registered, and their contribution to energy intake (EI) was calculated. Anthropometric values were measured and sociodemographic data obtained using a questionnaire.

A cross-sectional study was conducted in the Bondo, Kitui and Transmara districts of rural Kenya. A high prevalence of food insecurity in Kenya underlines the importance of describing the dietary patterns and intakes in different Kenyan ethnic groups.

A total of 1163 (61 % women) adult Luo, Kamba and Maasai, with a mean age of 38·6 (range: 18–68) years, volunteered to participate.

Dietary patterns and food groups contributing to EI differed significantly among the ethnic groups. Mean EI ranged from 5·8 to 8·6 MJ/d among women and from 7·2 to 10·5 MJ/d among men, with carbohydrates contributing between 55·7 % and 74·2 % and fat contributing between 14·5 % and 30·2 % of total EI. Mean protein intake ranged from 0·72 to 1·3 g/kg per d, and EI:BMR ratio ranged between 1·1 and 1·6 in both sexes, and was highest among the Luo. Prevalence of underweight (BMI < 18·5 kg/m2) was 13·7 %, 20·5 % and 24·2 % in the Luo, Kamba and Maasai, respectively.

The degree of food insecurity measured as a degree of undernutrition and as dietary patterns differed considerably among the ethnic groups. The Maasai and Kamba in particular were exposed to food insecurity.

In Morocco, the association between obesity/overweight and socio-demographic and lifestyle factors is poorly understood. The present study aimed to investigate this association in a representative sample of the Moroccan population aged 18 years and above.

This is a cross-sectional study using a questionnaire including demographic, socio-economic and physical activity items. Height and weight were measured and BMI was computed. The association between obesity (BMI ≥ 30·0 kg/m2) or overweight (25·0 ≤ BMI < 29·9 kg/m2) and the other variables was analysed using multiple binomial logistic regression, separately in men and women.

The whole Moroccan territory.

A total of 2891 subjects took part in the survey (1430 men and 1461 women).

The prevalence of obesity was 20·9 % in women and 6·0 % in men (P < 0·0001). The prevalence of overweight was 32·9 % in women v. 26·8 % in men (P < 0·0001). In women, the risk of obesity and overweight increased with age, with the highest risk being in individuals aged 45–54 years (OR = 3·02, 95 % CI 2·06, 4·44) compared to individuals <35 years old. Married women were more prone to obesity and overweight (OR = 2·42, 95 % CI 1·50, 3·91) than single women. In men, the risk of obesity and overweight increased with average family income (OR = 2·62, 95 % CI 1·40, 4·87 for family income ≥5000 MAD/month compared to <2000 MAD/month) and in married persons (OR = 3·75, 95 % CI 1·78, 7·81) compared to single individuals.

These results contribute to target groups in whom prevention programmes could be implemented.

To review research on consumer use and understanding of nutrition labels, as well as the impact of labelling on dietary habits.

A systematic review was conducted by searching electronic databases. Relevant articles were screened by two reviewers and included if they met inclusion criteria, including eight methodological criteria. A total of 120 articles were included in the review, including cross-sectional surveys (n 96), experimental designs (n 17), ‘natural experiments’ (n 7) and longitudinal population-based surveys (n 2).

Articles covered seven jurisdictions: USA (n 88), Europe (n 12), Canada (n 9), Australia and New Zealand (n 4), Norway (n 2), Thailand (n 1) and Trinidad (n 1).

Participants were from a wide range of age groups, socio-economic strata and geographical regions.

Nutrition labels on pre-packaged foods are among the most prominent sources of nutrition information. Nutrition labels are perceived as a highly credible source of information and many consumers use nutrition labels to guide their selection of food products. Evidence also shows a consistent link between the use of nutrition labels and healthier diets. However, the use of labels varies considerably across subgroups, with lower use among children, adolescents and older adults who are obese. Research also highlights challenges in terms of consumer understanding and appropriate use of labelling information.

Nutrition labels on pre-packaged foods are a cost-effective population-level intervention with unparalleled reach. However, to capitalize on their potential, governments will need to explore new formats and different types of information content to ensure that nutrition information is accessible and understandable.

To compare the Household Food Insecurity Access Scale (HFIAS), the US Food Security Survey Module (US FSSM) and a modified version of the US FSSM in which references to buying food were changed to references to getting food, in terms of their classification of food security levels among homeless individuals, and to determine which of these instruments was most preferred by homeless individuals.

A cross-sectional survey.

Recruitment of participants took place at seven shelters and from three drop-in programmes that serve homeless individuals in Toronto, Canada.

Fifty individuals who were ≥18 years of age, able to communicate in English and currently homeless.

The modified US FSSM assigned 20 % of participants to a lower ordinal food security category compared with the US FSSM, and only 8 % to a higher food security category. The HFIAS assigned 30 % of participants to a lower food security category compared with either the US FSSM or the modified US FSSM, and only 10–16 % of participants to a higher food security category. When asked to compare all three instruments, the majority of respondents (62 %) selected the HFIAS as the best instrument for people who are homeless.

A majority of homeless individuals selected the HFIAS as the best food security instrument for people who are homeless. Our findings suggest that the HFIAS is a more appropriate instrument than the US FSSM for measuring food security in the homeless population.

To describe dietary changes in men participating in an obesity intervention as part of the Self-Help, Exercise and Diet using Information Technology (SHED-IT) study.

An assessor-blinded randomized controlled trial comparing Internet (n 34) v. information-only groups (n 31) with 6-month follow-up. Dietary intake assessed by FFQ, reporting usual consumption of seventy-four foods and six alcoholic beverages using a 10-point frequency scale. A single portion size (PSF) factor was calculated based on photographs to indicate usual serving sizes.

The campus community of the University of Newcastle, New South Wales, Australia.

Sixty-five overweight/obese men (43 % students, 42 % non-academic general staff, 15 % academic staff; mean age 35·9 (sd 11·1) years, mean BMI 30·6 (sd 2·8) kg/m2).

The average PSF decreased significantly over time (χ2 = 20·9, df = 5, P < 0·001) with no differences between groups. While both groups reduced mean daily energy intake (GLM χ2 = 34·5, df = 3, P < 0·001), there was a trend towards a greater reduction in the Internet group (GLM χ2 = 3·3, P = 0·07). Both groups reduced percentage of energy from fat (P < 0·05), saturated fat (P < 0·001) and energy-dense/nutrient-poor items (P < 0·05), with no change in dietary fibre or alcohol (P > 0·05).

Although men reported some positive dietary changes during weight loss, they did not increase vegetable intakes nor decrease alcohol consumption, while saturated fat, fibre and Na intakes still exceeded national targets. Future interventions for men should promote specific food-based guidelines to target improvements in their diet-related risk factor profile for chronic diseases.