To assess current Mediterranean dietary patterns (MDP) in the western and eastern Mediterranean, i.e. in Balearic islanders (BI) and Greek islanders (GI).

Dietary patterns were assessed using FFQ on a representative sample (n 1200) of the BI and GI (n 1324) adult population. A Mediterranean Diet Score (MDS) was calculated according to the consumption of nine MDP components: (i) with a beneficial effect on health, i.e. vegetables, fruits and nuts, cereals, legumes, fish and shellfish, MUFA:SFA ratio, and moderate alcohol consumption; and (ii) with a detrimental effect on health, i.e. meat and meat products, and milk and dairy products. Persons with consumption of beneficial components below the median (GI plus BI) received a value of 0 and those with consumption above the median a value of 1. Persons with below-median consumption of detrimental components received a value of 1 and above-median consumption a value of 0. For alcohol, a value of 1 was given to consumptions of 10–50 g/d (men) and 5–25 g/d (women). The range of the MDS was 0–9, with higher scores indicating greater adherence to the MDP.

GI showed higher adherence (mean MDS 5·12 (sd 1·42)) to the MDP than BI (mean MDS 3·32 (sd 1·23)). BI diet was characterized by a high intake of legumes, nuts, seed oils, sugar and confectionery, and non-alcoholic beverages compared with GI, whereas GI diet was richer in fruit, vegetables, potatoes, olive oil, animal products and alcoholic beverages.

The GI diet seems closer to the traditional MDP than the BI diet.

To critique current practice in, and provide recommendations for, mediating variable analyses (MVA) of nutrition and physical activity behaviour change.

Theory-based behavioural nutrition and physical activity interventions aim at changing mediating variables that are hypothesized to be responsible for changes in the outcome of interest. MVA are useful because they help to identify the most promising theoretical approaches, mediators and intervention components for behaviour change. However, the current literature suggests that MVA are often inappropriately conducted, poorly understood and inadequately presented. Main problems encountered in the published literature are explained and suggestions for overcoming weaknesses of current practice are proposed.

The use of the most appropriate, currently available methods of MVA, and a correct, comprehensive presentation and interpretation of their findings, is of paramount importance for understanding how obesity can be treated and prevented.

To examine the nutritional and functional status of community older adults in China, to identify the related factors and best predictors of elder nutrition.

A cross-sectional, descriptive correlation design was utilized. A convenience sample of 162 community older adults (aged ≥65 years) were administered three questionnaires, which were used to obtain demographic characteristics, nutritional status (Mini Nutritional Assessment, MNA) and functional status (Instrumental Activities of Daily Living, IADL).

The mean MNA score was 23·8 (sd 3·92), 36·4 % of elders were at risk of malnutrition and 8·0 % were malnourished; 61·7 % were functionally independent. Spearman’s correlation analysis indicated that age, marital status, education level, personal income, number of chronic medical conditions suffered and functional status had significant correlations with nutritional status. Stepwise multiple linear regression analysis identified that the best predictors were the number of chronic conditions suffered, age, functional status and marital status.

The study has suggested that nutritional health remains a problem among older adults in the Chinese community. A large proportion was on the borderline of malnutrition, and deficiency as well as excesses coexisted. Malnutrition is an increasing hazard especially for those suffering from more diseases, at a highly advanced age, functionally dependent and widowed.

To evaluate the relative validity of recalled intake among schoolchildren and mothers in rural Kenya.

Cross-sectional study. Mothers’ recall of both the schoolchild’s intake and her own intake on the previous day were compared with intakes that were weighed by an interviewer in the home.

Karurumo location of Embu District in Kenya.

A total of forty-two sets of grade 1 students and their mothers.

Between 08.00 and 17.00 hours, when foods were both weighed and recalled, approximately 70 % of weighed food items were recalled the next day. Under-reporting of food amounts was seen across most food categories for the recall, with added sugars, sweets and fats being most affected. The recall underestimated energy intakes by approximately 6–9 % during this period. Correlation coefficients between nutrient intakes ranged from 0·43 to 0·65, while weighted κ values ranged from 0·22 to 0·50. Higher levels of agreement were noted for nutrient densities, with correlation coefficients between 0·46 and 0·82 and weighted κ values between 0·30 and 0·73.

Although the recall method provides an acceptable alternative to the more labour-intensive and expensive food-weighing method, there is need to further improve its performance in this population through more accurate recall of single foods, especially fruits, as well as added sugars, fats, dairy products and meats, which are often added in small amounts to mixed dishes.

To assess whether the Bangladesh Integrated Nutrition Programme (BINP) correctly identified which pregnant women should be enrolled in the food supplementation programme, whether supplementation commenced on time and was taken on a regular basis. A second objective was to determine whether food supplementation led to enhanced pregnancy weight gain and reduction in the prevalence of low birth weight.

A one-year community-based longitudinal study.

A rural union of Bhaluka Upazila, Mymensingh, located 110 km north-west of Dhaka City, the capital of Bangladesh.

A total of 1104 normotensive, non-smoking pregnant women who attended Community Nutrition Centres were studied from first presentation at the centre until child delivery.

Pregnant women who had a BMI of <18·5 kg/m2 on first presentation should have been selected for supplementary feeding (2512 kJ (600 kcal)/d for six days per week) starting at month 4 (16 weeks) of pregnancy. However, of the 526 women who had BMI < 18·5 kg/m2, only 335 received supplementation; so the failure rate was 36·3 %. In addition, of those receiving supplementation, only 193 women (36·7 % of 526 women) commenced supplementation at the correct time, of whom thirty-two (9·6 % of 335 women) received supplementation for the correct number of days (100 % days). There were no significant differences in mean weight gain between BMI < 18·5 kg/m2 supplemented or non-supplemented groups or between the equivalent groups with BMI ≥ 18·5 kg/m2. Weight gain was inversely related to initial weight, so lighter women gained relatively more weight during their pregnancy than heavier women. The mean birth weight in the supplemented and non-supplemented groups was 2·63 kg and 2·72 kg, respectively. Mothers with BMI < 18·5 kg/m2 who were or were not supplemented had almost equal percentages of low-birth-weight babies (21 % and 22 %, respectively).

The study raises doubt about the efficiency of the BINP to correctly target food supplementation to pregnant women. It also shows that food supplementation does not lead to enhanced pregnancy weight gain nor does it provide any evidence of a reduction in prevalence of low birth weight.

To evaluate the long-term effects of the Schoolgruiten Project, a Dutch primary school-based intervention providing free fruit and vegetables (F&V). In addition, we assessed whether children’s appreciation of the project mediated these intervention effects.

Participating schoolchildren (mean age 9·9 years at baseline) and their parents completed parallel questionnaires at baseline, at 1-year and at 2-year follow-up, including questions on usual F&V intake of the child, potential behavioural determinants, their appreciation of the project and general demographics. Primary outcomes were usual F&V intakes as assessed by parent and child self-reported food frequency measures. Secondary outcome measures were taste preference, knowledge of daily recommendations, availability and accessibility for fruit intake. Multilevel linear regression analyses were used to assess differences at second follow-up adjusted for baseline values between control and intervention groups.

Reports were available for 346 intervention children (148 parents) and 425 control children (287 parents).

Both child and parent reports indicated that the intervention group had a significantly higher fruit intake at 2-year follow-up (difference, servings/d: 0·15; 95 % CI 0·004, 0·286 for child reports; 0·19; 95 % CI 0·030, 0·340 for parent reports). No significant effects on vegetable intake were observed. Significant positive intervention effects were also found for knowledge of fruit recommendations among boys. Some evidence was found for partial mediation analyses of the effects on fruit intake.

The present study indicates that the Schoolgruiten scheme was effective in increasing children’s fruit intake and that appreciation of the project partially mediated this effect.

To study the differences between children’s self-reports and parents’ reports on environmental determinants of fruit and vegetable intake among 11-year-old children in the European country with the lowest reported consumption. A second objective was to examine the observed variance in fruit and vegetable intake among the children.

A cross-sectional survey was performed in Iceland as a part of the Pro Children cross-Europe survey. Children’s usual fruit and vegetable intake and its determinants were assessed through self-reports from the children (n 963) and their parents’ reports.

Children reported lower availability and accessibility of fruits at home than did their parents, while the reports of children and parents for vegetables were more in agreement. A larger proportion of the observed variance in children’s fruit and vegetable intake could be explained by the child’s perception than by the parent’s perception of determinants. The strongest determinants for fruit and vegetable intake according to the children’s reports were availability at home, modelling, demanding family rule and knowledge of recommendations. The strongest modelling determinant for fruit was the father’s fruit intake while for vegetables it was eating vegetables together with the family.

Eleven-year-old children should be asked themselves what determines their fruit and vegetable intake. However, children reported determinants in the physical and social environment, of which the parents are a part, as an important determinant for their intake. Interventions aiming to increase fruit and vegetable intake among children must therefore target the parents.

Zn deficiency may be widespread in Asian countries such as South Korea. However, dietary habits have changed in response to rapid economic growth and globalization. Zn nutrition in South Koreans has therefore been assessed during a period (1969–1998) of unprecedented economic growth.

Cross-sectional food consumption data from the Korean National Nutrition Survey Reports (KNNSR) of South Korea at four separate time points (1969, 1978, 1988 and 1998) were used to calculate Zn, Ca and phytate intakes using various food composition tables, databases and literature values. Nutrient values in local foods were cited from their analysed values.

Average Zn intake was 5·8, 4·8 and 5·3 mg/d for 1969, 1978 and 1988 respectively, increasing to 7·3 mg/d in 1998 (73 % of the Korean Dietary Reference Intake). The phytate:Zn molar ratio decreased from 21 to 8 during the study period. Dietary Zn depletion due to marked decreases in cereal consumption, particularly barley which has a low Zn bioavailability, was counterbalanced by marked increases in the consumption of meat and fish, which are also Zn-rich foods. Reduced phytate consumption coincident with increased Zn intake suggests that Zn bioavailability also improved, particularly by 1998.

Although total Zn intake was not greatly affected over the initial period of economic growth in South Korea (1969–1988), Zn contributions from different food sources changed markedly and both Zn intake and potential bioavailability were improved by 1998. The study may have implications for Zn nutrition in other Asian countries currently experiencing rapid economic growth.

Physical activity is an important determinant of energy balance. However, its impact on overweight/obesity has proved difficult to measure in pre-school children and few studies have found significant associations. A set of simple questions was used to distinguish pre-school children with high and low physical activity, and the association of this classification with childhood overweight/obesity and performance in an established motor test was investigated.

Survey, cross-sectional.

Weight and height were measured in 12 556 children taking part in the obligatory school entrance health examination 2004–5 and 2005–6 in three urban and three rural Bavarian regions. Their parents were asked to answer a questionnaire with a set of questions on physical activity.

The mean age of the children evaluated was 5·78 (sd 0·43) years, 6535 (52·1 %) were boys. Physically active children were less likely to be overweight (OR = 0·786, 95 % CI 0·687, 0·898) or obese (OR = 0·655, 95 % CI 0·506, 0·849) and achieved 6·7 (95 % CI 5·8, 7·7) % more jumps per 30 s than less active children in a motor test, adjusted for a number of potentially confounding variables.

Classification of pre-school children as physically active or not, based on a small set of questions, revealed significant associations with overweight/obesity and a motor test. Once further validated, this classification might provide a valuable tool to assess the impact of physical activity on the risk of childhood overweight and obesity.

To test whether change in the frequency of fish intake at population level would affect the trends of death from CHD and how many CHD events could be prevented in Hong Kong, a population among those with the highest fish consumption and the lowest CHD mortality in the world.

Time trends analysis with data from repeated dietary surveys and death registration.

Hong Kong SAR, People’s Republic of China.

A total of 3096 men and women aged 40–69 years who participated in territory-wide surveys in 1995 or 2003 were included in the analysis of changes in dietary fish intake; all adults aged 40–69 years in Hong Kong were included in the analysis of time trends of CHD mortality.

Over the period, the frequency of fish intake increased and CHD mortality decreased significantly in the population age group of 50–69 years, while in the age group of 40–49 years little change in both fish intake and CHD mortality was observed. It was estimated that 240 CHD deaths (or 29 % of the total) were avoided among the population aged 40–69 years in 2003, as more than half of the population consumed fish every day in Hong Kong.

The time trend of CHD mortality was inversely related to the trend of fish intake. The frequency of fish intake may have a substantial impact on the population for the prevention of CHD deaths in Hong Kong.

To investigate the maternal factors associated with poor diet among disadvantaged children.

Survey of 300 mothers of 2-year-old children from areas of high deprivation in Scotland (response rate 81 %). A diet quality score was derived from reported consumption of carbohydrates, protein, fruit and vegetables, dairy products and restriction of sugary fatty foods.

Most children (85 %) were classified as having a poor quality diet (low diet quality score). Mothers’ general knowledge about healthy eating was high, but did not predict the quality of the children’s diet. Lower frequencies of food preparation and serving, such as cooking with raw ingredients, providing breakfast daily and the family eating together, were also associated with a poorer diet. Regression modelling identified five significant factors. An increased risk of a poor diet was associated with mothers being unlikely to restrict sweets (OR = 21·63, 95 % CI 2·70, 173·30) or finding it difficult to provide 2–3 portions of fruit daily (OR = 2·94, 95 % CI 1·09, 7·95). Concern that the child did not eat enough increased the risk of a poor diet (OR = 2·37, 95 % CI 1·09, 5·16). Believing a healthy diet would help the child eat more reduced the risk of having a poor diet (OR = 0·28, 95 % CI 0·11, 0·74), as did providing breakfast daily (OR = 0·22, 95 % CI 0·05, 0·99).

Interventions to improve children’s diet could promote more positive intentions about preparing and serving of foods, particularly of specific meals at which the family eats together. The benefits of these behaviours to the child (improved diet, weight control) should be emphasised.

Fish consumption has been shown to be inversely associated with CHD, which may be due to n-3 fatty acids. The n-3 fatty acids, EPA and DHA, are naturally found only in marine sources. Dietary intakes of methylmercury from certain fish have been hypothesized to increase the risk of CHD.

To investigate the relationship between 30 d fish frequency consumption (assessed by FFQ), total blood Hg concentrations and risk markers of CHD in women aged 16–49 years participating in the National Health and Nutrition Examination Survey 1999–2002.

Multiple linear regression analyses were used to test (i) the relationships between 30 d fish frequency consumption and five CHD risk markers, i.e. HDL cholesterol (HDL-C), LDL cholesterol, total cholesterol, TAG and C-reactive protein (CRP); and (ii) if total blood Hg attenuated any associations between fish consumption and CHD risk markers in non-pregnant, non-diabetic females aged 16–49 years.

Total 30 d fish frequency consumption was negatively associated with CRP (b = −0·10, 95 % CI −0·19, −0·02, P = 0·015) and positively associated with HDL-C (b = 1·40, 95 % CI 0·31, 2·50, P = 0·014). Adjustment for other risk factors did not significantly attenuate the associations. Despite the collinearity between fish and Hg, there is a protective association between fish intake and CHD risk factors.

The levels of DHA + EPA and other nutrients in fish may be adequate to offset the hypothesized risks of heart disease related to ingesting Hg from fish.

To examine the effect of the new Canadian labelling regulations on the fat composition and prices of margarines.

A survey of all margarines sold in major supermarkets in the Greater Toronto area was conducted in 2006, and results were compared with those of a similar survey conducted in 2002. Average fat composition, proportion of ‘trans fat-free’ margarines and average prices of margarines were compared. A general linear model procedure was used to compare the relationship between price and fat composition in 2002 and 2006.

Average amounts of trans fatty acids (TFA) and MUFA decreased, while average amounts of PUFA increased significantly from 2002 to 2006. The proportion of margarines with less than 0·2 g TFA/10 g serving rose significantly from 31 % in 2002 to 69 % in 2006. Margarines lower in TFA on average cost significantly more than margarines with greater amounts of these fats, and this relationship appeared stronger in 2006 relative to 2002.

There is evidence of reductions in TFA in margarines since new labelling regulations came into effect in Canada; however, TFA reductions appeared to be restricted to higher-priced margarines. Results suggest that voluntary approaches (i.e. manufacturer incentives via labelling) to reduce population intakes of TFA will yield little changes in TFA content of low-cost products and thus may have limited benefit for lower-income groups, who are at higher risk of heart disease.

To assess the adequacy of periconceptional intake of key micronutrients for perinatal health in relation to regular cereal consumption of pregnant women.

Low-income pregnant women (n 596) in Pittsburgh, Pennsylvania, USA, who enrolled in a cohort study at <20 weeks’ gestation. These women reported usual dietary intake in the three months around conception on an FFQ. Cereal consumers were women who reported consuming any dry cereal at least three times per week. High risk for nutrient inadequacy was defined as intake less than the Estimated Average Requirement.

About 31 % of the women regularly consumed cereal. After adjusting for energy intake, race/ethnicity, marital status, breakfast consumption and supplement use, cereal eaters had significantly higher intakes of folate, Fe, Zn, Ca, fibre and vitamins A, C, D and E (all P < 0·01) and were approximately two to six times more likely to have intakes in the highest third of the distribution for folate, Fe, Zn, Ca, vitamins A and D, and fibre (all P < 0·01) than cereal non-eaters. Cereal consumption was also associated with reductions of 65–90 % in the risk of nutrient inadequacies compared with non-consumption (all P < 0·01).

Encouraging cereal consumption may be a simple, safe and inexpensive nutrition intervention that could optimize periconceptional intake for successful placental and fetal development.

The study aimed to assess differences in dietary intake and growth of pre-schoolers and schoolchildren living in two limitary Greek islands; Samos, situated on the eastern border, and Corfu, situated on the western border.

Cross-sectional two-site study.

A total of 248 children aged 3–12 years from the two islands participated in the survey. Body weight and height were recorded and Z-scores were calculated. A 3 d food record was collected for each child, computer-analysed and compared with the Recommended Daily Allowances (RDA). Intakes ≤70 % of the RDA were considered inadequate.

The prevalence of overweight in participants from Samos and Corfu was 10·7 % and 6·5 % respectively, according to the Centers for Disease Control and Prevention growth charts. In Corfu, the diet comprised 52 % carbohydrate, 34 % fat and 14 % protein, all different from the composition of the Samian diet (42 % carbohydrate, 39 % fat, 19 % protein; P ≤ 0·05). Inadequacies in micronutrient intake were evident only in the diet of Samos and concerned folate and P of the pre-schoolers and biotin of the school-aged participants. The diet in Corfu was more similar to the overall Mediterranean pattern as well as that of Italian children. Growth and overweight trends in Corfu resembled the ones in Italy, whereas in Samos, similarities were identified with trends from Turkey.

Border areas at a distance from the mainland exhibit different dietary intakes compared with rest of the country; thus when designing nutrition surveys the setting should also include such limitary areas.

All previous studies on monetary diet cost have examined the relationship of monetary cost of self-reported diet to self-reported, rather than biomarker-based, estimates of dietary intake. The present cross-sectional study examined the association between monetary costs of self-reported diet and biomarker-based estimates of nutrient intake.

Monetary diet cost (Japanese yen/1000 kJ) was calculated based on dietary intake information from a self-administered, comprehensive diet history questionnaire using retail food prices. Biomarker-based estimates of nutrient intake (percentage of energy for protein and mg/1000 kJ for K and Na) were estimated based on 24 h urinary excretion and estimated energy expenditure.

A total of fifteen universities and colleges in Japan.

A total of 1046 female Japanese dietetic students aged 18–22 years.

Total monetary diet cost showed a significant positive association with biomarker-based estimates of protein, K and Na. Vegetables and fish were not only the main contributors to total monetary diet cost (16·4 % and 15·5 %, respectively) but also were relatively strongly correlated with total monetary diet cost (Pearson’s correlation coefficient: 0·70 and 0·68, respectively). Monetary cost of vegetables was significantly positively associated with all three nutrients, while that of fish showed a significant and positive association only with protein.

Total monetary cost of self-reported diet was positively associated with biomarker-based estimates of protein, K and Na intake in young Japanese women, and appeared mainly to be explained by the monetary costs of vegetables and fish.