To report on vitamin D status, measured as plasma 25-hydroxyvitamin D concentration (25(OH)D), the prevalence of vitamin D insufficiency and deficiency, and to explore associations between vitamin D status and background characteristics.

Data were collected in a National Dietary Survey, Riksmaten adolescents 2016–2017. The participants completed dietary assessments and questionnaires on the web and wore accelerometers. (25(OH)D) was measured with a MS method.

Representative survey conducted in schools throughout Sweden.

Participants attended school years 5 (Y5, mean age 12. 5 years), 8 (Y8, mean age 14. 5 years) and 11 (Y11, mean age 18 years), and included 1100 participants.

Overall, there was no difference in plasma 25(OH)D between girls and boys. Vitamin D insufficiency differed between the three school years. The prevalence of insufficiency in Y5 was 32 (boys) and 48 (girls) percent, while in Y11 62 (boys) and 43 (girls) percent. The prevalence of deficiency in Y11 was 16 and 15 % in boys and girls, respectively. Being born outside of Sweden was associated with a 10-fold increased risk of being vitamin D deficient. Deficiency was also associated with longer time spent in sedentary intensity, a lower consumption of fortified dairy products and fats and oils.

Vitamin D deficiency was most common in the oldest age group and being born outside of Sweden increased the risk of being deficient. The present study will form a baseline for future follow-up studies of the implementation of a new mandatory vitamin D fortification policy in 2018.

A family of nutrient-rich food (NRF) indices was validated against the mean adequacy ratio (MAR) and their associations with obesity were tested.

Cross-sectional study. NRF indices include nutrients to encourage ranging from 6–11 (protein; fibre; vitamin A, vitamin C, vitamin E and vitamin B12; Ca; Fe; K; Mg; Zn) and two nutrients to limit (saturated fat and Na), described as NRFn.2 (where n 6–11), based on reference amount of 100 g or 100 kcal using the NRF index family of algorithms. The percentage of variation in MAR (R2) was the criteria of index performance. Logistic regression models were applied to predict the association between NRF index and obesity.

Three communities in Zhengzhou city, Henan province, China.

A total of 656 adults were recruited from Henan as the subjects.

The NRF9·2 index, based on nine beneficial nutrients and two nutrients to limit, using the algorithm based on sums and 100 kcal, had the higher R2 values (R2 = 0·232). The OR for overweight (defined by BMI) in the 4th quartile (Q4) v. the 1st quartile (Q1) of the NRF9·2 index was 0·61 (95 % CI = 0·37, 0·98) after multiple adjustments.

NRF9·2 index using the algorithm based on sums and 100 kcal gave the best predicted model for diet quality. NRF9·2 index score was associated with overweight defined by BMI, but it was not associated with central obesity. The NRF9·2 index is a valid tool to assess the overall diet quality among adults in Henan province of China.

To investigate the determinants of vegetable intake in urban socio-economically disadvantaged adolescents to inform the development of an intervention programme.

A narrative systematic review was carried out by searching five electronic databases from 2013 to 2020. The descriptors used for the search strategy were vegetable intake, adolescents, determinants and correlates. Inclusion criteria were including a sample of socio-economically disadvantaged adolescents aged 12–18 years, evaluation of the association between vegetable intake and determinants of intake, and conducted in urban settings of high-income countries. Thirteen studies met the inclusion criteria. Identified determinants of vegetable intake were reported according to the five levels of the socio-ecological model of health.

Studies included in the review were conducted in four countries: USA (n 8), Australia (n 3), Ireland (n 1) and New Zealand (n 1).

Adolescents aged 12–18 years from socio-economically disadvantaged backgrounds living in urban settings.

Thirty-nine determinants were identified. Nutrition knowledge was the only determinant consistently investigated in several independent samples which was not associated with vegetable intake in socio-economically disadvantaged adolescents. For the remaining potential determinants, it was not possible to examine the consistency of evidence as there were not enough studies investigating the same determinants. Most of the studies followed a cross-sectional design and were carried out in school settings.

There is a need for further studies on the determinants of vegetable intake in this population preferably with longitudinal designs and beyond the school setting in different countries to guide the development of successful interventions.

This study qualitatively examined dietary diversity among married women of reproductive age who engaged in two socio-economic activities to explore the dynamics of food availability, access, costs and consumption.

Qualitative in-depth interviews. The food groups in the Minimum Dietary Diversity for women were used to explore women’s dietary diversity. IDI were used to develop a roster of daily food consumption over a week. We explored food items that were considered expensive and frequency of consumption, food items that women require permission to consume and frequency of permission sought and the role of economic empowerment. Data analysis followed an inductive–deductive approach to thematic analysis.

Rural and peri-urban setting in Enugu State, Nigeria.

Thirty-eight married women of reproductive age across two socio-economic groupings (women who work only at home and those who worked outside their homes) were recruited in April 2019.

Economic empowerment improved women’s autonomy in food purchase and consumption. However, limited income restricted women from full autonomy in consumption decisions and access. Consumption of non-staple food items, especially flesh proteins, would benefit from women’s economic empowerment, whereas staple food items would not benefit so much. Dietary diversity is influenced by food production and purchase where factors including seasonal variation in food availability, prices, contextual factors that influence women’s autonomy and income are important determinants.

With limited income, agency and access to household financial resources coupled with norms that restrict women’s income earning, women continue to be at risk for not achieving adequate dietary diversity.

To evaluate the potential of products made out of underutilised fruits and vegetables for closing seasonal nutritional gaps among rural and urban consumers in East Africa.

The multinational analysis combines sensory testing and experimental auctions to assess consumers’ perceptions and willingness to pay (WTP) for 6 different fruit and vegetable products.

Open markets in rural and urban areas in Kenya, Tanzania and Uganda.

There were 939 male and female adults who were at least 18 years old.

Tobit models for each product show that besides sensory perception, similar socio-demographic characteristics influence consumers’ WTP for these products in all 3 countries. The products are especially liked among younger, male and urban consumers.

We conclude that there is demand and a potential market for processed fruit and vegetable products based on indigenous raw material in East Africa. The products, thus, have promising potential to improve nutrition, especially during off-season conditions when access to fresh produce is limited.

To understand the psychological antecedents or personal factors that lead to weight control behaviours that can help to develop more effective prevention strategies.

The present correlational study has a non-experimental, quantitative, cross-sectional design. A model was tested considering types of motivation (autonomous motivation, controlled motivation and amotivation) as mediators in the relationship between the Grit personality and healthy and unhealthy weight control behaviours, with self-control as a moderator in the aforementioned indirect effects.

Monterrey (Nuevo León, México).

A representative sample of 1219 adults (men = 599; women = 620) aged 18–65 years (M = 29·37, sd = 11·83).

Findings supported the mediator role of the types of motivation. Specifically, Grit showed a positive indirect effect on healthy weight control behaviours through autonomous motivation. Conversely, Grit showed a negative indirect effect on unhealthy weight control behaviours through autonomous motivation. Furthermore, findings supported the moderator role of self-control in the relationship between amotivation and healthy and unhealthy weight control behaviours.

This study provides evidence for the key role of Grit in the adoption of healthy or unhealthy control behaviours, as well as the role of autonomous motivation in the development of healthy behaviours.

Various foods are associated with or protect against type 2 diabetes mellitus (T2DM). This study was to examine the associations of foods and food patterns with the risk of T2DM in South China.

Case–control study.

The dietary patterns were identified by a principal components factor analysis. Univariable and multivariable conditional logistic regression analyses were used to analyse the associations between food groups and dietary patterns and the risk of T2DM.

A total of 384 patients with T2DM and 768 controls.

After adjustment for total energy intake, the standard intake of grains (228·3 ± 71·9 v. 238·8 ± 73·1 g/d, P = 0·025) and fruits (109 ± 90 v. 145 ± 108 g/d, P < 0·001) were lower in T2DM than in controls. Four dietary patterns were identified: (1) high light-coloured vegetables and low grains, (2) high fruits, (3) high red meat and low grains and (4) high dark-coloured vegetable. After adjustment for covariables, multivariable conditional logistic regression analyses showed significant dose-dependent inverse associations between total fruit intake, whole grains intake and the score of the high-fruit dietary pattern (all Pfor trend < 0·001) and the risk of T2DM. The adjusted OR (95 % CI) for T2DM comparing the extreme quartiles were 0·46 (0·29, 0·76) for total fruits, 0·48(0·31, 0·77) for whole grains and 0·42 (0·26, 0·68) for the high-fruit dietary pattern, respectively. Similar associations were observed for all subgroups of fruits (dark-colour and light-colour).

In South China, a diet rich in fruit and whole grains is associated with lower risk of T2DM.

Dietary guidelines on pure fruit juice differ between countries regarding the question whether pure fruit juice (without added sugars) is an acceptable substitute for fruit or should be avoided because of its comparable sugar content with that of sugar-sweetened beverages (SSB). We modelled whether substituting pure fruit juice for fruit or SSB was associated with cardiometabolic risk.

Prospective cohort study.

Based on a validated FFQ at baseline, we calculated the relative contribution of pure fruit juice to total consumption of fruit and pure fruit juice (${{{\rm{pure}}\;{\rm{fruit}}\;{\rm{juice}}\;\;\left( {{\rm{g}}/{\rm{day}}} \right)} \over {{\rm{fruit}}\; + \;{\rm{pure}}\;{\rm{fruit}}\;{\rm{juice}}\;\left( {{\rm{g}}/{\rm{day}}} \right)}}$) and to total consumption of SSB and pure fruit juice (${{{\rm{pure}}\;{\rm{fruit}}\;{\rm{juice}}\;\;\left( {{\rm{g}}/{\rm{day}}} \right)} \over {{\rm{SSBs}}\; + \;{\rm{pure}}\;{\rm{fruit}}\;{\rm{juice}}\;\left( {{\rm{g}}/{\rm{day}}} \right)}}$). In multivariate analyses (Cox regression), we assessed associations with incidence of type 2 diabetes, CVD, CHD and stroke after an average follow-up of 14·6 years.

About 35 000 participants from the EPIC-NL study, aged 20–70 years at enrolment.

Substitution of pure fruit juice for SSB was associated with lower risk of all endpoints. For type 2 diabetes and CHD, for example, drinking 75–100 % (as compared with 0–<25 %) of total SSB + pure fruit juice as pure fruit juice showed hazard ratio (95 % CI) of 0·74 (95 % CI 0·64, 0·85) and 0·85 (95 % CI 0·76, 0·96), respectively. Substitution of pure fruit juice for fruit was not associated with the risk of type 2 diabetes, CVD, CHD and stroke.

Substituting pure fruit juice for SSB was associated with lower cardiometabolic risk, whereas substituting pure fruit juice for fruit was not associated with cardiometabolic risk.

Although there is growing evidence suggesting that eating patterns are important determinants of health status, comprehensive information on patterning of eating behaviours is almost lacking. The aim of this cross-sectional study was to describe eating patterns in Japan.

Information on actual eating behaviours was collected using 2-d dietary record in each season over a year (total 8 d). Eating occasions were defined as any discrete intake occasion (with a discrete start clock time and name) except for eating occasions consisting of water only, which were excluded.

Japan.

A nationwide sample of 4032 Japanese aged 1–79 years.

The mean value of eating frequency of meals (i.e. breakfast, lunch and dinner), snacks and total eating occasions was 2·94, 1·74 and 4·68 times/d, respectively. The mean clock time for the start of breakfast, lunch and dinner was 07.24, 12.29 and 19.15 h, respectively. The mean time spent consuming breakfast, lunch, dinner and snacks was 19, 25, 34 and 27 min/d, respectively. On average, variability (i.e. average of absolute difference from mean) of meal frequency was small compared with that of snack frequency and total eating frequency. Both mean variability of clock time for the start of eating (<1 h) and mean variability of time spent on meals (<10 min/d) were also small. Conversely, mean variability of time spent on snacks was large (>18 min/d).

The present findings serve as both a reference and an indication for future research on patterning of eating behaviours.

To report perspectives of participants in a food benefit programme that includes foods high in added sugar (FAS) restrictions and FAS restrictions paired with fruits and vegetables (F/V) incentives.

Randomised experimental trial in which participant perspectives were an exploratory study outcome.

Participants were randomised into one of three Supplemental Nutrition Assistance Program (SNAP)-like food benefit programme groups: (1) restriction: not allowed to buy FAS with benefits; (2) restriction paired with incentive: not allowed to buy FAS with benefits and 30 % financial incentive on eligible F/V purchased using benefits; or (3) control: same food purchasing rules as SNAP. Participants were asked questions to assess programme satisfaction.

Adults in the Minneapolis-St. Paul, MN metropolitan area, eligible for but not currently participating in SNAP who completed baseline and follow-up study measures (n 254).

Among remaining households in each group, most found the programme helpful in buying nutritious foods (88·2 %–95·7 %) and were satisfied with the programme (89·1 %–93·0 %). Sensitivity analysis results indicate that reported helpfulness and satisfaction with the programme may in some instances be lower among the restriction and the restrictions paired with incentive groups in comparison to the control group.

A food benefit programme that includes restriction on purchase of FAS or restriction paired with a financial incentive for F/V purchases may be acceptable to most SNAP-eligible households with children.

To clarify nutrient supplementation usage and primary source of information among pregnant women in China.

This cross-sectional study used information on nutrient supplementation and primary source of information collected via face-to-face interviews. Data on the usage of folic acid, Ca/vitamin D, Fe, vitamins, DHA and other dietary supplements were collected. Primary source of information was categorised as family/relatives, friends/co-workers, the Internet, books/magazines, television/radio, doctors, other people and oneself.

Maternal and Child Health Hospital in Chengdu, China.

One thousand eighty-one Chinese pregnant women aged ≥20 years with singleton pregnancies.

In all three trimesters of pregnancy, usage was highest and most stable for folic acid (81·7 %), followed by vitamins (vitamin A, B-group vitamins, vitamin C and multivitamins; 75·0 %), whereas Ca/vitamin D (51·4 %) and Fe (18·1 %) usage was low, potentially indicating a deficiency risk. All supplementation usage percentages increased with pregnancy duration (P < 0·05). Notably, approximately 10 % of the pregnant women in our study did not use any nutrient supplementation, and this was especially common in early pregnancy. More than 50 % of the women reported getting information on nutrient supplementation from family members, and about 30 % reported getting this information from doctors.

Among pregnant women in China, awareness about nutrient supplementation increases as the pregnancy progresses, but some types of nutrient supplementation (such as Ca/vitamin D and Fe) remain at low levels. It is necessary to pay more attention to the health education of pregnant women in China, and the influence of family members should be emphasised.

To study the association between organic food consumption and lifestyle, socio-demographics and dietary habits.

Cohort participants completed detailed questionnaires about organic food consumption, diet and lifestyle between 1999 and 2002. Polytomous logistic regression models were used to estimate the association between organic food consumption, and lifestyle, socio-demographics, and dietary habits.

This cross-sectional study uses data from the Danish Diet, Cancer and Health cohort.

A total of 43 209 men and women aged between 54 and 73 years were included in the study.

Overall, 15 % reported never consuming organic food, 39 % had low organic food consumption, 37 % had medium organic food consumption and 10 % had high organic food consumption. The relative risk of consuming organic food versus never consuming organic food was highest among women, persons with BMI < 25 kg/m2, persons with low alcohol intake, persons participating in sports, persons who did not smoke or were former smokers, and among persons who adhered to the Danish national dietary guidelines. Associations were more distinct with higher levels of organic food consumption.

Based on a historical cohort of Danish adults, organic food consumption was associated with a generally healthy lifestyle, more favourable socio-demographics and dietary habits. These findings have to be considered in the adjustment strategy for future studies linking organic food consumption with health outcomes.

To examine the effect of the intervention implemented in the ToyBox-study on changes observed in age- and sex-specific BMI percentile and investigate the role of perinatal factors, parental perceptions and characteristics on this change.

A multicomponent, kindergarten-based, family-involved intervention with a cluster-randomised design. A standardised protocol was used to measure children’s body weight and height. Information was also collected from parents/caregivers via the use of validated questionnaires. Linear mixed effect models with random intercept for country, socio-economic status and school were used.

Selected preschools within the provinces of Oost-Flanders and West-Flanders (Belgium), Varna (Bulgaria), Bavaria (Germany), Attica (Greece), Mazowieckie (Poland) and Zaragoza (Spain).

A sample of 6268 preschoolers aged 3·5–5·5 years (51·9 % boys).

There was no intervention effect on the change in children’s BMI percentile. However, parents’ underestimation of their children’s actual weight status, parental overweight and mothers’ pre-pregnancy overweight/obesity were found to be significantly and independently associated with increases in children’s BMI percentile in multivariate modelling.

As part of a wide public health initiative or as part of a counseling intervention programme, it is important to assist parents/caregivers to correctly perceive their own and their children’s weight status. Recognition of excessive weight by parents/caregivers can increase their readiness to change and as such facilitate higher adherence to favourable behavioural changes within the family.

Undernutrition and anaemia (the commonest micronutrient deficiency), continue to remain prevalent and persistent in sub-Saharan Africa (SSA) alongside a rising prevalence of overweight and obesity. However, there has been little research on the co-existence of all three conditions in the same household in recent years. The current study examines the co-existence and correlates of the different conditions of household burden of malnutrition in the same household across SSA.

The study involved twenty-three countries across SSA who conducted Demographic and Health Surveys between 2008 and 2017.

The analytical sample includes 145 020 households with valid data on the nutritional status of women and children pairs (i.e. women of reproductive age; 15–49 years and children under 5 years).

Logistic regression analyses were used to determine household correlates of household burden of malnutrition.

Anaemia was the most common form of household burden of malnutrition, affecting about seven out of ten households. Double and triple burden of malnutrition, though less common, was also found to be present in 8 and 5 % of the households, respectively. The age of the household head, location of the household, access to improved toilet facilities and household wealth status were found to be associated with various conditions of household burden of malnutrition.

The findings of the current study reveal that both double and triple burden of malnutrition is of public health concern in SSA, thus nutrition and health interventions in SSA must not be skewed towards addressing undernutrition only but also address overweight/obesity and anaemia.

To evaluate the association of Composite Dietary Antioxidant Index (CDAI) and Dietary Inflammatory Index (DII) with the prevalence of high-grade cervical intraepithelial neoplasia (CIN).

A cross-sectional study was conducted on women with abnormal Papanicolaou test, who underwent high-risk human papillomavirus (HPV) screening and histological test through colposcopy. Dietary data were collected using a FFQ and used to assess both CDAI and DII.

Women were recruited from 2012 to 2015 at the Cervical Cancer Screening Unit of the ‘Azienda Sanitaria Provinciale’ of Catania (Italy).

The study included 539 women with a mean age of 40·2 years, who were classified as cases (n 127 with CIN2 or more severe lesions) and controls (n 412 with normal cervical epithelium or CIN1).

Although we observed a lower proportion of HPV-positive women among those with higher CDAI (P < 0·001), the index was not associated with the diagnosis of CIN2 or more severe lesions. By contrast, women with medium or high DII showed higher odds to be diagnosed with CIN2 or more severe lesions than those with low DII (OR = 2·15; 95 % CI 1·11, 4·17; P = 0·024 and OR = 3·14; 95 % CI 1·50, 6·56; P = 0·002, respectively), after adjusting for age, HPV status, educational level, BMI, smoking status, parity, use of oral contraceptives and supplements.

Our findings suggested that a pro-inflammatory diet might be associated with an increased risk of CIN2 and more severe lesions. However, further prospective studies should be encouraged to support this evidence.

The purpose of the current study was to examine the validity of an FFQ utilised in the Food Retail: Evaluating Strategies for a Healthy Austin (FRESH Austin) study, designed to evaluate changes in the consumption of fruits and vegetables (FV) in diverse low-income communities in Austin, TX.

The FRESH Austin FFQ was validated against three 24-h dietary recalls (24hDR). All dietary assessments were administered (in-person or by telephone) by trained investigators.

Recruitment was conducted at sites within the geographic areas targeted in the FRESH Austin recruitment. People at a community health clinic, a local health centre and a YMCA within the intervention area were approached by trained and certified data collectors, and invited to participate.

Among fifty-six participants, 83 % were female, 46 % were non-White, 24 % had income < $25 K/year and 30 % spoke only/mostly Spanish at home.

The FFQ and average of three 24hDR produce similar estimates of average total servings/d across FV (6·68 and 6·40 servings/d, respectively). Correlations produced measures from 0·01 for ‘Potatoes’ and 0·59 for ‘Other Vegetables’. Mean absolute percentage errors values were small for all FV, suggesting the variance of the error estimates was also small. Bland–Altman plots indicate acceptable levels of agreement between the two methods.

These outcomes indicate that the FRESH FFQ is a valid instrument for assessing FV consumption. The validation of the FRESH Austin FFQ provides important insights for evaluating community-based efforts to increase FV consumption in diverse populations.

To investigate the magnitude and distribution of concurrent overweight/obesity and anaemia among adult women, adolescent girls and children living in low- and middle-income countries (LMIC).

We selected the most recent Demographic and Health Surveys with anthropometric and Hb level measures. Prevalence estimates and 95 % CI of concurrent overweight/obesity and anaemia were calculated for every country, overall and stratified by household wealth quintile, education level, area of residence and sex (for children only). Regional and overall pooled prevalences were estimated using a random-effects model. We measured gaps, expressed in percentage points, to display inequalities in the distribution of the double burden of malnutrition (DBM).

Nationally representative surveys from fifty-two LMIC.

Adult women (n 825 769) aged 20–49 years, adolescent girls (n 192 631) aged 15–19 years and children (n 391 963) aged 6–59 months.

The pooled prevalence of concurrent overweight/obesity and anaemia was 12·4 % (95 % CI 11·1, 13·7) among adult women, 4·5 % (95 % CI 4·0, 5·0) among adolescent girls and 3·0 % (95 % CI 2·7, 3·3) among children. Overall, the DBM followed an inverse social gradient, with a higher prevalence among the richest quintile, most educated groups and in urban areas; however, important variations exist. The largest inequality gaps were observed among adult women in Yemen by household wealth (24·0 percentage-points) and in Niger by education level (19·6 percentage-points) and area of residence (11·9 percentage-points). Differences were predominantly significant among adult women, but less among girls and children.

Context-specific, multifaceted, responses with an equity lens are needed to reduce all forms of malnutrition.

The cost of food is a key influence on diet. The majority of diet cost studies match intake data from population-based surveys to a single source of food supply prices. Our aim was to examine the methodological significance of using food supply data to price dietary intakes.

Nationally representative 24-h dietary recall data from the 2015 Canadian Community Health Survey-Nutrition (CCHS-N) was matched to the 2015 Canadian Consumer Price Index (CPI) food price list. Proportions and means of reported intakes covered by the 2015 CPI price list were used to compare reported intakes of food groups and food components of interest and concern overall and by quartile of CPI coverage.

Canada.

In total, 20 487 Canadians ages one and older.

The CPI covered on average 76·3 % of total dietary intake (g) without water. Staple food groups that were more commonly consumed had better CPI price coverage than those less commonly consumed. Yet some food groups (vegetables, additions and sweets) that were also commonly consumed by Canadians were not well covered by price data. Individuals in the poorest CPI coverage quartile reported consuming significantly greater gram weight (g), dietary fibre (g) and energy (kcal) as compared with those with the best coverage.

Differential CPI price coverage exists among food components and commonly consumed food groups; additionally dietary intake differs significantly in the population by CPI coverage. Methodological refinements are needed to better account for error when using prices from food supply data to estimate diet costs.

To assess the food environment at OsloMet, through the nutritional profile and processing level of available commercial foods and drinks, as well as to determine food-purchasing behaviours, preferences and opinions on the food environment, in order to identify whether interventions on campus need to be conducted.

Cross-sectional descriptive study.

Pilestredet and Kjeller campus of OsloMet (Norway).

To analyse the nutritional profile of products offered at all food outlets (seven canteens, three coffee shops and two vending machines) at the main campuses three criteria were applied: those proposed by the Spanish Agency for Food Safety and Nutrition, the UK nutrient profiling model and those of the Food and Drink Industry Professional Practices Committee Norway. In addition, products were classified by processing level, using the NOVA system. Food purchasing, food choice behaviours and opinions were analysed through a survey online, in which 129 subjects participated.

With regard to the first of the objectives, the combination of the above-mentioned criteria showed that 39·8 % of the products were ‘unhealthy’ and 85·9 % were ‘ultra-processed’. Regarding the second objective, the most important determinants of food choice were taste, convenience, and cost and nutrition/health value. The most common improvements suggested were lowering the cost, improving the allergen information on labelling and increasing the variety of fresh and healthy foods.

A high proportion of the products offered were considered ‘unhealthy’ and highly processed. Interventions that improve food prices, availability and information on labelling would be well-received in this community.

This study aims to investigate the association between iron body status and postpartum depression (PPD) among mothers during the postpartum period.

This is a case–control study.

Governmental primary health care centres in the Gaza Strip, Palestine.

This study involved 300 mothers a month after delivery, with one 150 mothers that were recruited in the cases group who were diagnosed with PPD based on Edinburgh Postnatal Depression Scale (EPDS) ≥ 10. The control group included 150 mothers did not have PPD (EPDS < 10). Body iron status is represented by the index of sTfR/log ferritin.

Among PPD mothers, 43·3 % had low ferritin level v. 15·3 % for controls (P < 0·001) and cases v. controls difference in mean Hb level was −0·61 (95 % CI −0·86, −0·35). The results of the multiple logistic regression reported that there is a statistically significant association between PPD and the body iron status existed, as mothers who suffered from iron deficiency (ID) were three times more likely to have PPD (ORadj 3·25; P = 0·015). Furthermore, the results of the final regression model showed that the other factors that can lead to PPD are absence of psychological guidance services (ORadj 8·54; P = 0·001), suffering from undesired feeling in the last pregnancy (ORadj 1·77; P = 0·034), in addition to having one of the mental health disorders in the last pregnancy (P = 0·001).

Body iron status might be a risk factor for postpartum depression and other possibilities of reverse causality may worsen the condition.