To examine the utility of a shorter FFQ compared with a longer FFQ, both of which are commonly used in Australia.

Comparative study.

Community setting.

One hundred and fifty-nine men (mean 55 (sem 7) years) screened for participation in an intervention study completed both the Commonwealth Scientific and Industrial Research Organisation FFQ and the Cancer Council of Victoria FFQ. Agreement between both questionnaires was assessed according to Bland–Altman plots and limits of agreement (LOA) and ordinary least products regression to test for the presence of fixed and proportional bias.

There was good relative agreement between the methods for energy and macronutrients (Pearson’s correlation coefficients: energy r = 0·7, protein r = 0·6, fat r = 0·8, carbohydrate r = 0·7, alcohol r = 0·8; P < 0·01). Mean group-level agreement for the majority of nutrients (70 %) fell between 80 % and 110 %. According to the criteria used (maximum LOA was 50–200 % and no significant proportional bias), there was acceptable agreement between the FFQ for energy and total saturated and monounsaturated fat, but not for protein, carbohydrate and fibre. Micronutrients that did not meet the agreement criteria including calcium, iron, thiamin, niacin, riboflavin and folate. When the data were analysed according to quintiles, the majority of subjects were either in exactly the same quintile or within one quintile for most nutrients, and 1–2 % were grossly misclassified by three or four quintiles.

We conclude that there is sufficient agreement between the instruments for group-level comparisons in men, but they are not interchangeable for estimation of individual intakes.

The US Food and Drug Administration (FDA) proposes to establish standardized and mandatory criteria upon which front-of-pack (FOP) nutrition labelling must be based. The present study aimed to estimate the relative contribution of declared amounts of different nutrients to the perception of the overall ‘healthfulness’ of foods by the consumer.

Protein, fibre, vitamin A, vitamin C, calcium and iron were nutrients to encourage. Total fat, saturated fat, cholesterol, total and added sugar, and sodium were the nutrients to limit. Two content claims per nutrient used the FDA-approved language. An online consumer panel (n 320) exposed to multiple messages (n 48) rated the healthfulness of each hypothetical food product. Utility functions were constructed using conjoint analysis, based on multiple logistic regression and maximum likelihood estimation.

Consumer perception of healthfulness was most strongly driven by the declared presence of protein, fibre, calcium and vitamin C and by the declared total absence of saturated fat and sodium. For this adult panel, total and added sugar had lower utilities and contributed less to the perception of healthfulness. There were major differences between women and men.

Conjoint analysis can lead to a better understanding of how consumers process information about the full nutrition profile of a product, and is a powerful tool for the testing of nutrient content claims. Such studies can help the FDA develop science-based criteria for nutrient profiling that underlies FOP and shelf labelling.

Nutrition evaluation tools should be developed both for scientific purposes and to encourage and facilitate healthy nutritional practices. The purpose of the present study was to develop and validate a simple food-based Healthy Meal Index (HMI) reflecting the nutritional profile of individual canteen meals.

The development process included overall model selection, setting nutritional goals and defining scoring systems and thresholds. Three index components were included: (i) contents of fruit and vegetables, (ii) fat content and quality and (iii) contents of wholegrain products and potatoes. The development was built on the principles embodied by the Plate Model, but providing more specificity in some areas. The simple HMI was validated against weighed and chemically analysed food and nutrient content of a representative sample of canteen meals. The sample was split into four categories according to the total index score and compared across categories.

A total of 180 meals from fifteen worksite canteens.

Average energy density decreased significantly across categories (from 876 kJ/100 g to 537 kJ/100 g, P < 0·001). Also, the content of total and saturated fat, carbohydrate and fruit and vegetables varied across categories with higher score values being closer to dietary guidelines (P < 0·001).

The simple HMI was successful in ranking canteen meals according to their nutritional quality. The index provides a valuable tool to both researchers and food and nutrition professionals, e.g. caterers and dietitians, who wish to evaluate nutritional quality of meals in line with the recommendations for healthier eating without the use of nutrition calculation programs.

To quantify the environmental component of aetiology of overweight and obesity by examining the relationship between the degree of overweight in dogs and cats and the degree of overweight in their owners.

Cross-sectional study. Main outcome measures of the owners were weight, height (stature) and BMI. Of the animals, weight and divergence from ideal weight were measured by a veterinarian.

Three veterinary clinics in Amsterdam, The Netherlands.

Dogs and cats, together with their owners, who visited the veterinary clinic. Dogs and cats had to be older than 1 year, and their owners had to be at least 21 years old. After exclusion, there remained forty-seven pairs of dogs and their owners and thirty-six pairs of cats and their owners.

We found a significant relationship between the degree of overweight of dogs and the BMI of their owners (r = 0·31). Correction for length of ownership, gender and age of the animal, and gender, age, education level and activity score of the owner did not materially affect this relationship. However, after correction for the amount of time the dog was being walked each day, this relationship disappeared. No significant relationship was found between the degree of overweight of cats and the BMI of their owners.

The degree to which dogs are overweight is, in contrast to the degree to which cats are overweight, related to the BMI of their owners.

We examined the halo effect of a 2-year weight-loss diet trial, the Dietary Intervention Randomized Controlled Trial (DIRECT), on the weight and nutritional patterns of participants' spouses.

DIRECT participants in a research centre workplace were randomly assigned to one of three diets: Low-fat, Mediterranean or Low-carbohydrate. A sample of wives of the DIRECT participants, who attended support update meetings specific to their husband's diet during the first 6 months, were followed for 2 years.

South Israel.

Seventy-four women (mean age = 51 years, mean BMI =26·6 kg/m2).

Among the wives of husbands randomised to the Low-fat, Mediterranean and Low-carbohydrate diet, self-reported weight change was respectively −1·48 kg, −2·30 kg and −4·62 kg after 6 months, and +0·39 kg, −3·00 kg and −2·30 kg after 2 years. Weight loss among wives whose husbands were in the alternative diet groups combined (Mediterranean+Low-carbohydrate) was significantly greater than among wives whose husbands were in the Low-fat group after 6 months (P = 0·031) and 2 years (P = 0·034). Overweight wives experienced more weight loss. The weight change of couples was significantly correlated (r = 0·42, P < 0·001). Across all dietary groups, wives had significant improvement in their dietary patterns in all food groups according to their husbands' diets, mainly by a larger significant decrease in carbohydrate consumption in the Low-carbohydrate group (P = 0·013 compared to Low-fat). Six-month weight change among the seventy-four DIRECT participants whose wives took part in the group support sessions was −5·2 kg, compared to −3·5 kg among the 248 DIRECT participants whose wives did not take part in these sessions (P = 0·020).

Focusing on the couple as a unit could provide a cost-effective approach to weight-loss programmes.

Larger food portion sizes lead to increased energy intake levels and might contribute to the current obesity epidemic. Only a very limited number of studies are available on the actual development of food portion sizes during past decades. The present study aims to reveal trends in portion sizes of some high-energy-dense food products during recent decades in The Netherlands.

The data were collected from manufacturers and from information found in professional journals, marketing and advertising materials, and on manufacturers’ websites.

A number of trends in food portion sizes were observed. Larger sizes have been added to the portion size portfolio. The portion sizes of a number of products have also increased since their introduction, although this did not apply to all the products included. Finally, multi-packs have been introduced and the number of products within a multi-pack has also increased.

A trend towards larger portion sizes was observed, which is relevant to the public health debate regarding the prevention of overweight and obesity. It is recommended that developments in food portion sizes continue to be monitored over the coming years, and the effects of the newly introduced portion sizes on food intake be studied.

In 1976, the Royal College of Physicians and the British Cardiac Society recommended eating less fatty red meat and more poultry instead because it was lean. However, the situation has changed since that time, with a striking increase in fat content of the standard broiler chicken. The aim of the present study was to report a snapshot of data on fat in chickens now sold to the public.

Samples were obtained randomly between 2004 and 2008 from UK supermarkets, farm shops and a football club. The amount of chicken fat was estimated by emulsification and chloroform/methanol extraction.

Food sold in supermarkets and farms in England.

Chicken samples.

The fat energy exceeded that of protein. There has been a loss of n-3 fatty acids. The n-6:n-3 ratio was found to be as high as 9:1, as opposed to the recommendation of about 2:1. Moreover, the TAG level in the meat and whole bird mostly exceeded the proportion of phospholipids, which should be the higher for muscle function. The n-3 fatty acid docosapentaenoic acid (DPA, 22 : 5n-3) was in excess of DHA (22 : 6n-3). Previous analyses had, as usual for birds, more DHA than DPA.

Traditional poultry and eggs were one of the few land-based sources of long-chain n-3 fatty acids, especially DHA, which is synthesized from its parent precursor in the green food chain. In view of the obesity epidemic, chickens that provide several times the fat energy compared with protein seem illogical. This type of chicken husbandry needs to be reviewed with regard to its implications for animal welfare and human nutrition.

Although recent studies have shown an inverse relationship between dairy consumption and metabolic abnormalities, we are aware of no study evaluating the association between dairy consumption and circulating levels of inflammatory markers. The current study was undertaken to assess the association between the consumption of high-fat and low-fat dairy products and circulating levels of inflammatory markers among Tehrani women aged 40–60 years.

In a cross-sectional study of 486 apparently healthy women aged 40–60 years, we assessed usual dietary intakes by means of an FFQ. Anthropometric measurements were made and fasting blood samples were taken for measuring inflammatory markers.

The reported mean (sd) daily intake of low- and high-fat dairy consumption was 85 (sd 23) and 101 (sd 29) g/d, respectively. After control for age, BMI, waist circumference and other potential confounders, low-fat dairy consumption was inversely associated with C-reactive protein (β = −0.04), IL-6 (β = −0.02) and soluble vascular cell adhesion molecule-1 (β = −0.06); with further adjustment for dietary intakes, the associations remained significant just for soluble vascular cell adhesion molecule-1 (β = −0.03). High-fat dairy intake was positively associated with log-transformed values of serum amyloid A (β = 0.08) and soluble vascular cell adhesion molecule-1 (β = 0.05), both before and after adjustment for all potential confounding variables. No overall significant associations were found between total dairy consumption and inflammation.

The current study indicates an independent relationship between high-fat as well as low-fat dairy consumption, not total dairy intake, and some markers of inflammation and endothelial dysfunction. Further studies are required to identify responsible components of dairy products and related mechanisms of action.

To investigate how socio-economic position, demographic factors, degree of integration and dietary indicators are related to BMI/waist:hip ratio (WHR) and to weight dissatisfaction and slimming among South Asians in Oslo, Norway.

Cross-sectional study consisting of a health check including anthropometric measures and two self-administered questionnaires.

Oslo, Norway.

Pakistanis and Sri Lankans (n 629), aged 30–60 years, residing in Oslo.

BMI was positively associated with female gender (P = 0·004) and Pakistani origin (P < 0·001), and inversely associated with years of education (P = 0·011) and eating more hot meals (P = 0·016). WHR was positively associated with male gender (P < 0·001), age (P < 0·001) and a dietary pattern with high-fat foods (P = 0·005), and inversely associated with degree of integration (measured by a composite index, independent of duration of residence; P = 0·017). One-third of those with normal weight and most of those obese were dissatisfied with their weight. Among these, about 40 % had attempted to slim during the past year. Dissatisfaction with weight was positively associated with education in women (P = 0·006) and with integration in men (P = 0·026), and inversely associated with physical activity (P = 0·044) in men. Women who had made slimming attempts had breakfast and other meals less frequently than others (P < 0·05).

Weight dissatisfaction exists among South Asian immigrants. More research is needed regarding bodily dissatisfaction and the relationship between perception of weight and weight-change attempts among immigrants in Norway, in order to prevent and treat both obesity and eating disorders.

To assess the nutritional quality of prepared foods available to primary-school children.

Prepared foods available in a public and private school were sampled daily for 4 weeks (a total of forty-five samples) and chemically analysed for protein, fat, carbohydrate, iron, salt and sodium. The results were compared to the nutritional standards for children aged 7–10 years.

Alfenas, south-eastern Brazil.

The concentration of protein, lipid, iron and sodium and the energy values of the foods at the private school were significantly higher than those at the public school. No differences were seen in the carbohydrate and salt values. The range of macronutrients was more balanced at the public school in relation to fat and protein. Foods at the private school were, in general, energy-dense. At both the public and private school, they provided the minimum energy and iron. Salt content was over twice the maximum amount, and that for sodium was over three times the amount, in both the public and private school.

Overall, foods prepared at the public school were better nutritional quality than those at the private school and those offered in public schools in some developed countries. This finding can probably be explained by the fact that a nutritionist, as required by law, was responsible for planning the menus at the public school. However, corrective action is needed to adjust for the wide variability in energy and nutrient content during weekdays and in the sodium content of prepared foods available in both the public and private school.

To examine associations between parenting styles, family structure and aspects of adolescent dietary behaviour.

Cross-sectional study.

Secondary schools in the East Midlands, UK.

Adolescents aged 12–16 years (n 328, 57 % boys) completed an FFQ assessing their consumption of fruit, vegetables, unhealthy snacks and breakfast. Adolescents provided information on parental and sibling status and completed a seventeen-item instrument measuring the general parenting style dimensions of involvement and strictness, from which four styles were derived: indulgent, neglectful, authoritarian, authoritative.

After controlling for adolescent gender and age, analysis of covariance revealed no significant interactions between parenting style and family structure variables for any of the dietary behaviours assessed. Significant main effects for family structure were observed only for breakfast consumption, with adolescents from dual-parent families (P < 0·01) and those with no brothers (P < 0·05) eating breakfast on more days per week than those from single-parent families and those with one or more brother, respectively. Significant main effects for parenting style were observed for all dietary behaviours apart from vegetable consumption. Adolescents who described their parents as authoritative ate more fruit per day, fewer unhealthy snacks per day, and ate breakfast on more days per week than those who described their parents as neglectful.

The positive associations between authoritative parenting style and adolescent dietary behaviour transcend family structure. Future research should be food-specific and assess the efficacy of strategies promoting the central attributes of an authoritative parenting style on the dietary behaviours of adolescents from a variety of family structures.

The present study is to describe, on the basis of recent Finnish population surveys, (i) the frequencies of school and worksite canteen use, (ii) the determinants of having a hot lunch during school or working hours and (iii) the associations of lunch eating patterns with food habits.

The study summarises mainly basic reports and studies concerning catering services conducted in Finland based on nationally representative population surveys.

Cross-sectional study. The most important surveys cited in this paper are the School Health Promotion Study, the Work and the Working Conditions survey, the National FINDIET 2002 Study, and the Health Behavior and Health among Finnish Adult Population survey.

School lunch is eaten by on average 70–90 % of children aged 9–18 years. Of all employees, 30 % eat at a worksite canteen daily, whereas 30 % of men and 45 % of women eat packed lunches. Nationally representative cross-sectional population surveys show that the use of catering services is associated with more healthy food habits; schoolchildren eating school meals and employees eating lunch at a worksite canteen tend to make food choices closer to nutritional recommendations as compared to those not using catering services to the same degree.

Some evidence exists that catering services in schools and worksites contribute to healthy eating habits in the population. In order to verify the positive role of catering services more scientific research with prospective and intervention design studies will be needed.

To describe fruit and vegetable (FV) feeding practices at 6 months, and to examine whether these practices predict children’s FV intake at 7 years of age.

A prospective, longitudinal design was adopted. The mothers completed self-reported questionnaires at 6 months and 7 years postpartum, containing questions about their child’s FV intake.

The study was carried out on a geographically representative population of infants born in Avon, UK, from 1991 to 1992, as part of the Avon Longitudinal Study of Parents and Children.

Information was collected from 7866 mothers of infants.

Hierarchical linear regressions were used to predict FV consumption at 7 years from the early feeding variables. Children who were given home-cooked fruit or vegetables more often at 6 months were more likely to be eating a higher proportion of FV at 7 years, than those who were given home-cooked FV less often. There was no positive difference found in consumption of FV at 7 years according to how often ready-prepared fruits or vegetables were given at 6 months. The age of introduction to home-cooked vegetables moderated the relationship between frequency of consumption at 6 months and 7 years.

The findings support the concept that exposure to FV is important in the early weaning period. The finding that consumption of ready-prepared FV was not positively associated with later FV consumption needs to be further investigated, with reference to theories of exposure, modelling and parental food choices. If vegetables are introduced later in weaning, they need to be fed frequently, to ensure adequate exposure.

In the present study we investigated consumers’ visual attention to nutrition information on food products using an indirect instrument, an eye tracker. In addition, we looked at whether people with a health motivation focus on nutrition information on food products more than people with a taste motivation.

Respondents were instructed to choose one of five cereals for either the kindergarten (health motivation) or the student cafeteria (taste motivation). The eye tracker measured their visual attention during this task. Then respondents completed a short questionnaire.

Laboratory of the ETH Zurich, Switzerland.

Videos and questionnaires from thirty-two students (seventeen males; mean age 24·91 years) were analysed.

Respondents with a health motivation viewed the nutrition information on the food products for longer and more often than respondents with a taste motivation. Health motivation also seemed to stimulate deeper processing of the nutrition information. The student cafeteria group focused primarily on the other information and did this for longer and more often than the health motivation group. Additionally, the package design affected participants’ nutrition information search.

Two factors appear to influence whether people pay attention to nutrition information on food products: their motivation and the product’s design. If the package design does not sufficiently facilitate the localization of nutrition information, health motivation can stimulate consumers to look for nutrition information so that they may make a more deliberate food choice.

To study whether service of a free school lunch has an impact on weight development and food intake among pupils at a lower secondary school, and to assess the association between self-perceived school behaviour and food intake.

A controlled intervention study involving service of a free healthy school lunch to 9th grade pupils took place over 4 months, from January to May 2007. Weight and height were measured before and after the intervention. The pupils also completed a short FFQ and a questionnaire concerning self-perceived school behaviour and the classroom environment before and after the intervention. A healthy food score was calculated using the FFQ data.

All 9th graders at three different lower secondary schools in southern Norway were invited to participate. One school was randomly selected as the intervention school.

Fifty-eight pupils (91 %) from the intervention school and ninety-two pupils (77 %) from the control schools participated.

BMI did not increase among the girls at the intervention school, but increased significantly among the boys at the intervention school and among the control school groups. The healthy food score correlated positively with the trait ‘satisfied with schoolwork’ (P < 0·001). Fifteen per cent of the variance in food score could be explained by gender and the trait ‘satisfied with schoolwork’.

Serving of a healthy free school lunch to secondary-school pupils may result in restricted weight gain. Further studies are needed to clarify the impact of school meals on overweight and academic performance.

To analyse cross-promotions targeted to children and adolescents on packaging in the supermarket.

On three occasions from 2006 to 2008, researchers purchased all foods in a large supermarket that included a cross-promotion on the package. A total of 397 products were categorized by promotional partner, food category, targeted age group, promotion type, product nutrition, and company policies on marketing to children.

The number of products with youth-oriented cross-promotions increased by 78 % during the period examined. Overall, 71 % of cross-promotions involved third-party licensed characters and 57 % appealed primarily to children under 12 years of age; however, the use of other forms of promotions increased from 5 % of the total in 2006 to 53 % in 2008, and promotions targeting pre-school and general audiences increased from 23 % to 54 % of the total. Only 18 % of products met accepted nutrition standards for foods sold to youth, and nutritional quality declined during the period examined. Food manufacturers with policies limiting marketing to children represented 65 % of all youth-oriented cross-promotions, their use of cross-promotions increased significantly, and the nutritional quality of their products did not improve. Some media companies did reduce the use of their properties on food promotions.

Overall, the supermarket environment worsened due to an increase in cross-promotions targeted to children and adolescents and a decline in the nutritional quality of these products. This analysis failed to find improvements in food marketing to youth and highlights the need to expand current industry self-regulatory pledges.

To investigate the influence of a trial lifestyle intervention on participants’ preferences for a range of exercise and diet programmes and whether these differ between successful and unsuccessful participants.

Hypothetical scenarios that describe attributes of diet and exercise programmes were developed using an experimental design. Participants completed an online questionnaire at baseline, 16 weeks and 12 months where they chose their most preferred of three programmes in each of sixteen scenarios. Discrete choice modelling was used to identify which attributes participants emphasised at each time point.

Fifty-five individuals who exhibited symptoms of metabolic syndrome and who participated in a 16-week trial lifestyle intervention.

There was a clear shift in programme preferences from structure to flexibility over the intervention. At baseline, emphasis was on individually designed and supervised exercise, structured diets and high levels of support, with Gainers focusing almost exclusively on support and supervision. Losers tended to consider a wider range of programme attributes. After 16 weeks preferences shifted towards self-directed rather than organised/supervised exercise and support was less important (this depended on the type of participant and whether they were in the follow-up group). Cost became significant for Gainers following the end of the primary intervention.

The stated preference method could be a useful tool in identifying potential for success and specific needs. Gainers’ relinquishment of responsibility for lifestyle change to programme staff may be a factor in their failure and in their greater cost sensitivity, since they focus on external rather than internal resources.

The waist-to-height ratio (WHtR) assesses abdominal adiposity and has been proposed to be of greater value in predicting obesity-related cardiovascular health risks in children than BMI. The present study aims to develop WHtR cut-offs for overweight and obesity based on the 85th and 95th percentiles for the percentage body fat (%BF) in a cohort of children and adolescents.

Waist circumference (WC), height, triceps and subscapular skinfolds were used to calculate WHtR and %BF. Correlations between WHtR and %BF and WHtR/mid-abdominal skinfold were made. Receiver-operating characteristic (ROC) curve analysis was used to select WHtR cut-offs to define overweight and obesity. Subjects were grouped by WHtR cut-offs, and mean values for anthropometry, blood lipids and blood pressure (BP) variables were compared.

Australian primary and secondary schools.

A total of 2773 male (M) and female (F) subjects of the 1985 Australian Health and Fitness Survey, aged 8–16 years.

Correlation coefficients between WHtR and %BF were M: r = 0·73, F: r = 0·60, P < 0·01 and WHtR/mid-abdominal skinfold were M: r = 0·78, F: r = 0·65, P < 0·01. WHtR of 0·46(M) and 0·45(F) best identified subjects with ≥85th percentile for %BF and 0·48(M) and 0·47(F) identified subjects with ≥95th percentile for %BF. When comparing the highest WHtR group to the lowest, both sexes had significantly higher means for weight, WC, %BF, TG (male subjects only), systolic BP (female subjects only) and lower means for HDL cholesterol (P < 0·05).

WHtR is useful in clinical and population health as it identifies children with higher %BF at greater risk of developing weight-related CVD at an earlier age.

The prevalence of type 2 diabetes has been increasing in Finland, in parallel with a gradual increase in overweight and obesity during the past decades. The expanding prevalence of type 2 diabetes brings along complications, most importantly CVD. Therefore, it is extremely important to implement activities to prevent type 2 diabetes.

In the present paper, the clinical evidence for the prevention of type 2 diabetes is presented with the Finnish diabetes prevention study. In addition, the paper discusses the practical implementation of prevention of type 2 diabetes using three different types of prevention programmes as examples: FIN-D2D, including risk-screening and repeated consultation in primary health-care; FINNAIR, a workplace-targeted intervention project involving airline employees; and the good ageing in Lahti region (GOAL) programme, a community-based prevention programme.

FIN-D2D, the FINNAIR project and the GOAL programme have shown that screening for type 2 diabetes risk and implementing large-scale lifestyle intervention in primary health-care are feasible. However, the crucial questions still are whether it is possible to replicate the results concerning effectiveness of lifestyle intervention in primary and occupational health-care systems. Furthermore, it remains to be shown whether it is possible to achieve the same results in different health-care settings, cultures, regions and age groups, especially in adolescents and young adults among whom the increase in the incidence has been the highest. In addition, the importance of co-operation among all sections of society, citizens’ awareness of healthy lifestyles and the social inequalities in health must be emphasised because the diabetes epidemic cannot be solved only by concentrating on preventive actions carried out by health-care systems.