Rapidly transitioning societies are experiencing dramatic increases in obesity and cardio-metabolic risk; however, few prospective studies from developing countries have quantified these increases or described their joint relationships.

We collected dietary, physical activity, demographic, anthropometric and cardio-metabolic risk factor data from 376 Guatemalan young adults in 1997–98 (aged 20–29 years) and in 2002–04 (aged 25–34 years).

In total, 42 % of men and 56 % of women experienced weight gain >5 kg in 5 years. Percent body fat (%BF) and waist circumference (WC) increased by 4·2 % points and 5·5 cm among men, and 3·2 % points and 3·4 cm among women, respectively. Five-year increases in both %BF and WC were associated with lower physical activity, urban residence and shorter height among men but not among women (test for heterogeneity P < 0·05 for residence and physical activity). Changes in %BF and WC and concomitant changes in cardio-metabolic risk factors were similar for men and women. In standardised regression, change in %BF was associated with changes in TAG (β=0·19; 95 % CI 0·08, 0·30), total:HDL cholesterol (β=0·22; 95 % CI 0·12, 0·33) and systolic (β=0·22; 95 % CI 0·12, 0·33) and diastolic (β=0·18; 95 % CI 0·08, 0·28) blood pressure, but not with glucose; associations were similar for WC.

Over 5 years this relatively young population of Guatemalan adults experienced rapid increases in multiple measures of adiposity, which were associated with adverse changes in lipid and blood pressure levels.

To evaluate levels of vitamin D3 and HDL-cholesterol (HDL-C), and the ratio of HDL-C to LDL-cholesterol (LDL-C), in schoolchildren receiving vitamin-D-fortified, fat-depleted, high-Ca milk in schools.

Cross-sectional study of previously randomised schools receiving supplemental milk, compared with a matched control group.

Low-decile Year 1–6 schools in the Waikato region of New Zealand.

Year 3 children from either milk schools or control schools, consenting to blood sampling.

For eighty-nine children receiving supplementary daily milk, vitamin D3 levels were significantly higher than in eighty-three control children matched for age, sex, body composition and ethnicity (mean (sd): 49·6 (15·8) v. 43·8 (14·7) nmol/l, P = 0·011), as were HDL-C levels (mean (sd): 1·47 (0·35) v. 1·35 (0·29) mmol/l, P = 0·024) and HDL-C:LDL-C (median: 0·79 v. 0·71, P = 0·026). LDL-C levels were similar in both groups (mean (sd): 2·07 (0·55) v. 2·16 (0·60) mmol/l, P = 0·31). Of control children, 32/83 (20·2 %) of the milk group (Pearson’s χ2 = 7·00, P = 0·008). Mean 25-hydroxyvitamin D (vitamin D3) levels in the milk group were still below the lower end of the recommended normal range (60 nmol/l).

Vitamin D3 levels are low in low-decile Year 3 children in midwinter. Levels are improved with vitamin-D-fortified milk but still below the recommended range. HDL-C and HDL-C:LDL-C levels are improved in the milk-supplemented group. This supports the supply of vitamin-D-fortified, fat-reduced milk to schools.

Overweight and obesity have increased to epidemic proportions among adolescents and are associated with chronic non-communicable diseases and excess mortality in adulthood. The association of overweight/obesity with poor dietary habits has not been studied in adolescents in middle-income developing countries. The present study aimed to estimate the prevalence of overweight, obesity and high waist circumference (WC) in 15–19-year-old Jamaican adolescents and to investigate the association with fast-food and sweetened beverage consumption.

The study enrolled 1317 (598 male, 719 female) adolescents aged 15–19 years using multistage, nationally representative sampling. Age-specific prevalence calculation used internal Z-score lines connecting with the WHO adult cut-off points. Logistic regression was used to examine the association of overweight or high WC with fast-food and sweetened beverage consumption, adjusting for potential confounders.

The overall prevalence of overweight, obesity and high WC was approximately 15 %, 6 % and 10 %, respectively. Prevalence estimated using internal Z-scores was similar to that using the International Obesity Taskforce cut-off points. Obesity (8·0 % in females, 3·3 % in males) and high WC (16·2 % in females, 1·7 % in males) were significantly more prevalent in females when using internal Z-score cut-offs. High WC was associated with the absence of fruit consumption (P = 0·043) and overweight with high sweetened beverage consumption (P = 0·018).

Overweight occurs frequently among Jamaican 15–19-year-olds and is associated with increased consumption of sweetened beverages. High WC is more prevalent among females and is related to low consumption of fruits and vegetables. Measures to reduce the consumption of sweetened beverages and increase fruit intake may reduce the prevalence of excess body fat among adolescents.

To study how dietary patterns and physical activity vary with acculturation and with past and current exposure to socio-cultural norms of the home country among Tunisian migrants.

A retrospective cohort study was conducted using quota sampling (n 150) based on age and residence. Dietary intake was assessed using a validated FFQ. Physical activity level and dietary aspects were compared according to length of residence (acculturation), age at migration (past exposure) and social ties with the home country (current exposure).

Tunisian migrant men residing in the South of France.

Migrants who had lived in France for more than 9 years had a higher percentage contribution of meat to energy intake (P = 0·04), a higher Na intake (P = 0·04), a lower percentage contribution of sugar and sweets (P = 0·04) and a lower percentage of carbohydrates (P = 0·03) than short-term migrants. Men who migrated before 21 years of age had a higher Na intake than ‘late’ migrants (P = 0·02). Men who had distant social ties with Tunisia had a lower physical activity level (P = 0·01) whereas men who had close ties had a higher percentage of fat (P = 0·01) and a higher ratio of MUFA to SFA (P = 0·02).

Acculturation led to a convergence of some characteristics to those of the host population, while some results (meat and salt consumption) were at variance with other acculturation studies. Past and current exposure to the home country helped maintain some positive aspects of the diet. Nevertheless, present dietary changes in Tunisia could soon lessen these features.

The purpose of the present study was to evaluate the changes in the availability of the most important food components of the traditional Mediterranean diet and other food groups in five geographical areas during a 43-year period.

Ecological study with food availability data obtained from FAO food balance sheets in forty-one countries for the period 1961–1965 and 2000–2004.

Mediterranean, Northern and Central Europe, Other Mediterranean countries and Other Countries of the World were the studied areas.

The main changes since the 1960s, at an availability level, were found in European areas and in Other Mediterranean countries. The greatest changes were found in Mediterranean Europe, recording high availability of non-Mediterranean food groups (animal fats, vegetable oils, sugar and meat), whereas the availability of alcoholic beverages, including wine, and legumes decreased. Despite having lost some of its typical characteristics, Mediterranean Europe has more olive oil, vegetables, fruits and fish available than other areas. Although Northern Europe has a greater availability of non-Mediterranean foods, there has been a tendency towards a decrease in availability of some of these foods and to increase Mediterranean food such as olive oil and fruits.

The present study suggests that European countries, especially those in the Mediterranean area, have experienced a ‘westernisation’ process of food habits, and have increasingly similar patterns of food availability (mainly non-Mediterranean food groups) among them. Measures must be taken to counteract these tendencies and to avoid their possible negative consequences. It is also crucial to find ways to promote and preserve the Mediterranean diet and its lifestyle in modern societies.

To examine correlates of home usage of commercially available cooking fats in Bogotá, Colombia and to determine their fatty acid composition.

Cross-sectional survey.

Bogotá, Colombia.

A representative sample of low- and middle-income families (n 2408).

The types of fat primarily used for cooking at home were mixed vegetable oils (66 %), sunflower oil (21 %) and other oils/fats including margarine (13 %). In multivariate analysis, usage of sunflower oil as the primary cooking fat was positively related to home ownership, age of the father and health as a reason for choosing the main cooking fat, and inversely associated with the number of people per room and an index of household food insecurity. The trans fat content of sunflower oil was unexpectedly higher (mean 4·2 %, range 2·2–8·6) than that of the vegetable mixture oils (mean 3·1 %, range 1·1–6·5).

Vegetable oils are the primary home cooking fats in Bogotá, Colombia. Higher socio-economic status is associated with usage of sunflower oil. Paradoxically, oblivious to the higher trans content of sunflower oil and the negligible amount of n-3 fatty acids, families commonly reported ‘health’ as a reason to choose sunflower over other oils.

To investigate associations between nutritional and non-nutritional variables and Fe status parameters, i.e. serum ferritin and soluble transferrin receptors (sTfR).

Cross-sectional design. Fe status parameters were determined on a fasting venous blood sample. Nutritional variables were assessed using a 2 d food record and non-nutritional variables by a general questionnaire. A general linear model was used to investigate associations between the variables and Fe status parameters.

Region of Ghent, Dutch-speaking part of Belgium.

Random sample of 788 women (aged 18–39 years).

Median (interquartile range) ferritin and sTfR were 26·3 (15·9, 48·9) ng/ml and 1·11 (0·95, 1·30) mg/l, respectively. BMI and alcohol intake were positively associated and tea intake was negatively associated with serum ferritin. Women who used a non-hormonal intra-uterine device, who gave blood within the past year or who had been pregnant within the past year had lower serum ferritin values than their counterparts. Significant determinants of sTfR were smoking habit and pregnancy, with higher values for non-smokers and women who had been pregnant within the past year.

The present study indicates that contraceptive use, time since last blood donation, time since last pregnancy, BMI, alcohol and tea intake are determinants of Fe stores, whereas smoking habit and time since last pregnancy are determinants of tissue Fe needs. When developing strategies to improve Fe status, special attention should be given to women who use a non-hormonal intra-uterine device, gave blood within the past year and had been pregnant within the past year.

To validate an FFQ for the assessment of dietary EPA and DHA against their relative concentrations in red blood cells (RBC).

Cross-sectional analysis of baseline data. Intakes of marine food products and EPA and DHA were estimated by FFQ on the basis of consumption of marine food products in the last month. Fatty acid composition of RBC membranes was quantified by GC.

Saint-François d’Assise Hospital, Québec, Canada.

A total of sixty-five middle-aged women who participated in a randomized clinical trial.

Spearman’s correlation coefficient between intake of EPA, DHA and EPA + DHA and their corresponding concentration in RBC was 0·46, 0·40 and 0·42, respectively (all P < 0·05). Multiple regression analysis of EPA+DHA intake and RBC EPA + DHA concentration indicated positive and significant correlations for oily fish (β = 0·44, 95 % CI 0·16, 0·72, P = 0·0027), total fish (β = 0·42, 95 % CI 0·19, 0·64, P = 0·0005) and marine food products (β = 0·42, 95 % CI 0·20, 0·64, P = 0·0003). No other marine food products significantly predicted RBC EPA + DHA concentration.

Although the present validation study was undertaken among middle-aged women with low consumption of marine food products (<3 servings/week), our FFQ provided estimates of EPA and DHA intakes that correlated fairly well with their RBC concentrations. However, the absence of correlations between EPA + DHA intakes from different marine species suggests that a minimum EPA + DHA intake is necessary to observe a relationship with RBC EPA + DHA concentrations.

To assess the nutritional status and dietary practices of 0–24-month-old children living in Brazilian Amazonia.

Cross-sectional study. Information on children’s dietary intakes was obtained from diet history data. Weight and length were measured for anthropometric evaluation. Fe status was assessed using fasting venous blood samples; Hb, serum ferritin and soluble transferrin receptor concentrations were measured.

The towns of Assis Brasil and Acrelândia in the state of Acre, north-west Brazil.

A total of sixty-nine randomly selected 0–24-month-old children.

Of these children, 40·3 % were anaemic, 63·1 % were Fe-deficient, 28·1 % had Fe-deficiency anaemia and 11·6 % were stunted. Breast-feeding was initiated by 97·1 % of mothers, followed by early feeding with complementary foods. The dietary pattern reflected a high intake of carbohydrate-rich foods and cow’s milk, with irregular intakes of fruit, vegetables and meat. All infants and 92·3 % of toddlers were at risk of inadequate Fe intakes. Fe from animal foods contributed on average 0·5 % and 14·3 % to total dietary Fe intake among infants and toddlers, respectively.

Poor nutritional status and inadequate feeding practices in this study population reinforce the importance of exclusive breast-feeding during the first 6 months of life. Greater emphasis is required to improve the bioavailability of dietary Fe during complementary feeding practices.

Childhood obesity has become a major public health problem in many countries. To explore the risk factors of overweight in infants and young children might be helpful in developing an early overweight intervention strategy.

To assess the prevalence of overweight and the relationship of parental characteristics and feeding practices to overweight in infants and young children in Beijing, China.

Data on weight and length/height were collected on 4654 children aged 1–35 months in twelve communities in Beijing from a cross-sectional study. Overweight was defined as weight-for-length/height ≥2sd above the median of the WHO reference. Two hundred and fifteen families with overweight children and 215 families with normal-weight children were interviewed using a questionnaire to obtain feeding practices.

The overall prevalence of overweight was 4·7 %. Both parental overweight and low parental education were significantly higher among overweight than normal-weight children. The total energy intake was significantly higher in overweight than in normal-weight children at 12–35 months of age. Compared with normal-weight children, significantly fewer overweight children were breast-fed for at least 4 months. Overweight children were also more likely to have been introduced to infant formula and semi-solid foods during the first 4 months.

Early prevention strategies should include feeding practices identified as putting children at risk of obesity. These include early cessation of breast-feeding and premature introduction of other foods.

To evaluate the 5-year incidence of obesity in a sample of CVD-free adults and investigate the potential effect of several sociodemographic and lifestyle habits on weight change and obesity incidence in these individuals.

Men (n 1514) and women (n 1528) (>18 years) without any clinical evidence of CVD, living in the Attica area of Greece, were enrolled in the ATTICA study from May 2001 to December 2002. The sampling was random, multistage and included information about various sociodemographic, lifestyle (diet, exercise and smoking), biochemical and clinical characteristics. In 2006, the 5-year follow-up was performed through telephone calls or personal visits. Data from the 1364 participants are analysed in the present work.

The 5-year incidence of obesity was 21·8 % in men and 11·9 % in women. The ratio of men to women revealed that more men than women developed obesity, while more women than men became overweight during the follow-up period. It was found that men were 1·6 times more likely to develop obesity compared with women; abnormal waist circumference, smoking habits and the presence of hypercholesterolaemia increased the risk for developing obesity, irrespective of age and baseline lifestyle characteristics of the participants. In the multivariate analysis, no association was detected between adherence to a Mediterranean diet and incidence of obesity in initially normal-weight individuals.

Obesity remains a serious health problem for the Greek population; the alarming rates of excess body weight continue to increase. Preventive measures should be urgently addressed, targeting particularly those with metabolic risk factors.

Health targets describe government intentions for improving population health. The present paper determines whether the targets which twelve developed countries have set for obesity match the seriousness of the public health problem.

Policy documents on general public health, obesity, nutrition and physical activity were obtained by repeated searches of government websites. Details of all relevant targets on overweight, obesity, nutrition and physical activity were extracted.

Only four of the countries studied have set targets for specific reductions in the prevalence of obesity. Two have targets that only mention reducing the prevalence of obesity and two other countries wish to halt the rise in prevalence. Two countries currently have targets which are much less ambitious than those in previous policies. No obesity targets are stated in the policies of four countries. Many of the countries studied have set detailed nutrition targets, but these seldom identify desired changes in dietary behaviour. No country has set targets for a reduction in energy intake. The physical activity targets reflect recommendations from the 1990s. Few targets are set for health knowledge or behavioural intentions which are prerequisites for desired lifestyle changes.

Most of the countries studied have either set no targets or set very modest targets for reducing the prevalence of obesity. Many countries have physical activity targets that are likely to be insufficient to prevent obesity. Governments need to reconsider targets on obesity and to develop shorter-term targets which monitor desired lifestyle changes.

To describe the meal patterns of Jena schoolchildren and their associations with children’s weight status and parental characteristics.

Cross-sectional study.

Twenty schools in Jena (∼100 000 inhabitants), south-east Germany.

A total of 2054 schoolchildren aged 7–14 years with information on BMI standard deviation score (BMI-SDS) and weight status (based on German reference values), of whom 1571 had additional information about their parents (parental education and employment status, weight status according to WHO guidelines) and meal patterns (school lunch participation rate, meal frequencies, breakfast consumption and frequency of family meals).

Weight status of the children was associated with weight status, education and employment status of the parents. Meal patterns were strongly dependent on children’s age and parental employment. As age increased, the frequency of meal consumption, participation rate in school lunches and the number of family meals decreased. Using linear regression analysis, a high inverse association between BMI-SDS and meal frequency was observed, in addition to relationships with parental weight status and paternal education.

Age-specific prevention programmes should encourage greater meal frequency. The close involvement of parents is essential in any strategy for improving children’s (families’) diets.

The present study aimed to analyse the worldwide trends of adherence to the Mediterranean diet (MD), in 1961–1965 and 2000–2003.

Data were obtained from the FAO food balance sheets in two periods: 1961–1965 and 2000–2003. In order to have a sample from across the world, forty-one countries were selected. The average of available energy for different food groups was calculated for all selected countries. These values were used to evaluate the adherence to the MD through a variation of Mediterranean Adequacy Index (MAI).

The majority of the forty-one countries in this study have tended to drift away from a Mediterranean-like dietary pattern. Mediterranean Europe and the Other Mediterranean country groups suffered a significant decrease in their MAI values. The Mediterranean European group, especially Greece, experienced the greatest decrease in MAI value.

In both periods, the Other Mediterranean countries showed the highest MAI values. In an analysis by countries, Iran had the highest increase in MAI across the time periods, and Egypt occupied the first place in the ranking in 2000–2003.

The Northern European group was the only one that registered an increase in MAI, although this was not statistically significant.

Many countries in the Mediterranean basin are drifting away from the Mediterranean dietary pattern (MDP). However, countries in Northern Europe and some other countries around the world are taking on a Mediterranean-like dietary pattern. The Other Mediterranean countries have the closest adherence to the MDP, currently and in the 1960s. Nutrition policy actions to tackle dietary westernisation and preserve the healthy prudent MDP are required.

To identify the best anthropometric index that predicts cardiometabolic risk factors.

Cross-sectional study in Turkey, in 2003.

Turkish men and women aged 18 years and over (n 1692) were examined. Body weight, height, waist and hip circumferences, blood pressure, total cholesterol, HDL cholesterol, TAG, glucose and insulin were measured. Metabolic syndrome score was calculated as the sum of modified National Cholesterol Education Program Adult Treatment Panel III criteria, excluding waist circumference. Insulin resistance was estimated by homeostasis model assessment (HOMA-IR).

BMI, waist:hip ratio (WHpR), waist:height ratio (WHtR), waist circumference (WC) and hip circumference (HC) were significantly correlated with each other. Partial correlation coefficients between systolic blood pressure, HDL cholesterol, TAG levels or HOMA-IR and BMI, WC or WHtR were similar and higher than correlation coefficients of WHpR and HC. The association of anthropometric indices with metabolic syndrome score and Framingham risk score was highest for WHtR. Areas under the receiver-operating characteristic curves showed that WHtR was the best anthropometric index that discriminated between the presence and absence of hypertension, diabetes and metabolic syndrome, whereas WHpR was better for dyslipidaemia.

WHtR was the best anthropometric index for predicting most cardiometabolic risk factors. WC and BMI ranked second for their predictive capability of cardiometabolic risk, followed by WHpR and HC.

To determine the current level of activity of Australian local governments in twenty-nine food and nutrition action areas and whether the level of activity had changed between 1995 and 2007.

A cross-sectional study utilising a postal survey was undertaken of all local governments in Australia. The same instrument and protocol were used in 1995 and 2007.

Australian local governments.

Local governments in Australia continue to be engaged in food and nutrition activities. This involvement has constricted in range in the last 12 years but higher levels of engagement are reported for several areas. The levels of involvement of local governments in the different states varied significantly, with Victoria reporting higher levels of involvement in several areas, particularly in food and nutrition activities related to community services. Local governments in New South Wales and Western Australia reported significantly lower levels of involvement in food and nutrition activities. Several factors may have contributed to these differences, including availability of resources and support, mandatory requirements by state governments, different attitudes of General Managers and staff and availability of funds for special projects.

If Australian local governments are to be recognised and supported for their involvements in food and nutrition activities, more in-depth research is required to elucidate the factors that act as barriers or facilitate their on-going involvement in this important area. Support for local governments in rural areas to become or remain engaged in food matters should receive special consideration.

To study prospectively the association of coffee intake with incident diabetes in the Puerto Rico Heart Health Program cohort, comprising 9824 middle-aged men (aged 35–79 years).

Of 9824 men, 3869 did not provide a fasting blood sample at baseline, 1095 had prevalent diabetes and 131 were not given fasting glucose tests at any subsequent study visit. Thus, the present analysis includes 4685 participants. Diabetes was ascertained at baseline and at two study visits between 1968 and 1975 using fasting glucose tests and self-reports of physician-diagnosed diabetes or use of insulin or hypoglycaemic medication. Logistic regression analysis was used to assess the association of coffee intake with risk of incident diabetes while adjusting for covariates (age, BMI, physical activity, smoking, education, alcohol intake, family history of diabetes, intakes of milk and sugar).

Five hundred and nineteen participants met the criteria for incident diabetes. Compared with those reporting intake of 1–2 servings of coffee/d, coffee abstainers were at reduced risk (OR = 0·64; 95 % CI 0·43, 0·94). Among coffee drinkers, there was a significant trend of decreasing risk by intake (P = 0·02); intake of ≥4 servings/d was associated with an odds ratio of 0·75 (95 % CI 0·58, 0·97).

Study findings support a protective effect of coffee intake on diabetes risk, while also suggesting that abstainers may be at reduced risk.

To examine the effect of community-based nutrition education intervention on calcium intake and bone mass in Vietnamese postmenopausal women.

A controlled trial was conducted in two groups as intervention and control. The intervention group was given nutrition education during 18 months to improve calcium intake, while the control subjects had the usual diet. Calcium intake and bone mass were evaluated every 6 months. Bone mass was assessed by speed of sound (SOS) at calcaneus, referred to as quantitative ultrasound measurement. Anthropometric indices and serum parathyroid hormone (PTH) were determined at baseline and at the end of intervention.

Two rural communes of Hai Duong province located in the Red River Delta in Vietnam.

A total of 140 women aged 55–65 years, who were more than 5 years postmenopausal and with low calcium intake (<400 mg/d), were recruited. After 18 months of intervention, 108 women completed the study.

Calcium intake in the intervention group had increased significantly (P < 0·01) while it had no significant changes in controls. SOS values were not changed significantly in the intervention subjects while it decreased significantly by 0·5 % in the controls (P < 0·01). The intervention led to a decrease in serum PTH by 12 % (P < 0·01). In the controls, there was an increase in serum PTH by 32 % (P < 0·001).

Nutrition education intervention was effective in improving calcium intake and retarding bone loss in the studied subjects.