To implement a systematic evidence-informed process to enable Fiji and Tonga to identify the most feasible and targeted policy interventions which would have most impact on diet-related non-communicable diseases.

A multisectoral stakeholder group of policy advisers was formed in each country. They used participatory approaches to identify the problem policies and gaps contributing to an unhealthy food environment. Potential solutions to these problems were then identified, and were assessed by them for feasibility, effectiveness, cost-effectiveness and side-effects. Data were gathered on the food and policy environment to support the assessments. A shortlist of preferred policy interventions for action was then developed.

Sixty to eighty policy problems were identified in each country, affecting areas such as trade, agriculture, fisheries and pricing. Up to 100 specific potential policy solutions were then developed in each country. Assessment of the policies highlighted relevant problem areas including poor feasibility, limited effectiveness or cost-effectiveness and serious side-effects. A shortlist of twenty to twenty-three preferred new policy options for action in each country was identified.

Policy environments in these two countries were not conducive to supporting healthy eating. Substantial areas of potential action are possible, but some represent better choices. It is important for countries to consider the impact of non-health policies on diets.

In the Netherlands, a supplementation of 10 μg vitamin D is recommended for children (aged 0–4 years), given that vitamin D contributes to the development of healthy bones and deficiency during childhood is a risk factor for osteoporosis at a later age. However, only 60 % of the Dutch children receive sufficient vitamin D supplementation a day. In order to develop interventions to improve supplementation intake, it is necessary to gain insight into the behaviour of parents in giving their children vitamin D supplementation and its association with variables of the Theory of Planned Behaviour, moral and descriptive norms and habits.

A cross-sectional survey to assess present supplementation-related behaviour, knowledge, received information, intention, attitude, subjective norm, perceived behavioural control, moral norm, descriptive norm and habit.

Data obtained from a representative Internet Panel by means of electronic questionnaires.

Parents (n 270) of children aged 0–4 years.

Half of the parents (48·9 %) gave their child sufficient vitamin D supplementation. Giving the supplement at a fixed time, a positive intention and habit were significantly associated with actual behaviour. The higher age of the child, first-born status, a fixed time for taking vitamin supplementation, descriptive norm and moral obligation were significantly associated with intention.

These results indicate that because many parents do not give their children adequate vitamin D supplementation, the promotion of supplementation during the first years of life is a necessity. Effective yet simple strategies should be developed, focused on improving moral obligation, descriptive norms and habit formation.

To assess the impact of a classroom-based nutrition and health education intervention among student community volunteers in improving their knowledge on individual topics.

Prospective follow-up study. Topic-wise knowledge change among student volunteers on individual topics (twenty-one questions related to nutrition and health, eight questions related to infectious diseases and two questions related to obesity and hypertension) pertaining to nutrition and health was evaluated at baseline and after intervention, using the McNemar test.

Six different colleges affiliated to Osmania University, Andhra Pradesh, India.

Six hundred and eighty-seven student volunteers under the National Service Scheme, of both genders, average age 19 years.

A significant mean improvement of 11·36 (sd 8·49, P < 0·001) was observed in the overall nutrition and health knowledge scores of the student volunteers after the education intervention. The McNemar test showed that knowledge on individual topics related to energy, proteins, fats, adolescent phase, obesity, some lifestyle diseases and infectious diseases improved significantly (P < 0·01). No significant (P > 0·05) improvement was observed in knowledge on the nutritional content of milk and sprouted grams, hypertension, HIV/AIDS, ELISA and malaria.

Topics on which our educational intervention could not bring about significant knowledge improvement have been identified and suitable modifications can be carried out to strengthen them.

Tea has been reported to reduce cardiovascular mortality, but the underlying mechanisms are largely unknown. The aim of the current project was to investigate the effect of green tea (Japanese Sencha), black tea (Indian Assam B.O.P.) and Rooibos tea (South Africa) on angiotensin-converting enzyme (ACE) and nitric oxide (NO).

Seventeen healthy volunteers received a single oral dose of 400 ml green tea, black tea or Rooibos tea in a randomized, three-phase, crossover study. ACE activity and NO concentration were measured (at 0, 30, 60 and 180 min) in all phases. ACE activity was analysed by means of a commercial radioenzymatic assay. Nitrite was analysed as a marker of NO concentration. In addition, ACE genotype was determined using a PCR method.

Oral intake of a single dose of Rooibos tea significantly inhibited ACE activity after 30 min (P < 0·01) and after 60 min (P < 0·05). A significant inhibition of ACE activity was seen with green tea for the ACE II genotype 30 min after intake of the tea (P < 0·05) and for the ACE ID genotype 60 min after intake (P < 0·05). A significant inhibition of ACE activity was also seen with Rooibos tea for the ACE II genotype 60 min after intake (P < 0·05). No significant effect on NO concentration was seen.

These results suggest that green tea and Rooibos tea may have cardiovascular effects through inhibition of ACE activity.

To determine associations of diet, physical activity and television (TV) viewing time with obesity among aboriginal and non-aboriginal youth in conjunction with socio-economic variables.

Cross-sectional study of differences between aboriginal and non-aboriginal groups and associations between lifestyle and socio-economic factors with obesity were examined.

Population data from the Canadian Community Health Survey Cycle 2·2 conducted in 2004 in the ten provinces of Canada.

A total of 198 aboriginal and 4448 non-aboriginal Canadian youth aged 12–17 years.

Compared to non-aboriginal youth, physical activity participation among aboriginal youth was higher, but consumption of vegetables and dairy products was lower, and more aboriginal youth were ‘high’ TV watchers. Low income adequacy was associated with decreased odds for obesity among aboriginal youth in contrast to higher odds among non-aboriginal youth. Non-aboriginal ‘high’ TV watchers consumed more soft drinks and non-whole-grain products than did ‘low’ TV watchers. Physical activity participation did not differ between ‘high’ and ‘low’ TV watchers for both groups, and was associated with lowered odds for obesity only among aboriginal youth.

Sociodemographic and lifestyle risk factors associated with obesity differ between aboriginal and non-aboriginal youth. These findings may be useful for guiding intervention efforts.

The objective of the present study was to examine associations between exposure to nutrition information as covered in mass media and daily fruit and vegetable (FV) consumption among adolescents.

Cross-sectional nutrition survey.

Vocational schools in Vienna, Austria.

A sample of 2949 ethnically diverse adolescents with mean age 17·3 (sd 1·7) years. An FFQ was used to assess usual FV consumption. Data on mass media exposure and sociodemographic characteristics were collected by means of a self-administered questionnaire. Multiple logistic regression analyses were used to control for potentially confounding variables.

Adolescents who reported exposure to nutrition information provided by booklets, the Internet or newspaper articles were more likely to eat FV daily. For example, the OR for daily fruit consumption (ORfru) was 1·6 (P < 0·001) when exposure to the Internet was reported after adjustment for age, gender, ethnicity, BMI and salary. No such associations were found for radio, television and magazines as sources of nutrition information. A negative impact on daily FV consumption was found for exposure to radio commercials (ORfru = 0·74, P = 0·04 and ORveg = 0·67, P = 0·03). Exposure to TV commercials had a negative impact on vegetable consumption (ORveg = 0·81, P = 0·05).

Newspaper articles, the Internet and booklets as a source of nutrition information are positively associated with daily FV consumption among adolescents, whereas radio commercials have a negative impact. Dissemination of ‘healthy eating’ slogans should make use of print media and the Internet.

Although teachers are the key participants in health-promoting schools (HPS) programme delivery, it is still unknown whether teachers are appropriate health information resources and role models for students with respect to healthy diets. The present study aimed to investigate the effects of implementing HPS programmes on teachers’ nutrition knowledge and diets.

One HPS programme aiming at dietary intervention (HP-D) and one HPS not aiming at dietary intervention (HP-ND) were selected, along with two non-health-promoting (NHP) schools matched for school size and urbanization level with the two HPS. All 361 teachers in the four schools were invited to participate, yielding a 78·4 % overall valid response rate. A structured, self-reported questionnaire was administered, with regression models used for statistical analysis.

Teachers in the HP-D group had a mean score of 21·1 on a range of 0–30 for nutrition knowledge, which was significantly higher than the mean scores of 18·5 in the HP-ND group and 19·1 in the NHP group (P < 0·001). Better dietary behaviours were also observed among HP-D teachers. Further, being a ‘health education’ course instructor was associated with significantly higher scores on nutrition knowledge (β = 2·6, P < 0·001) and vegetable and fruit consumption (β = 1·4, P = 0·02) in the HP-D group than in the NHP group. The HP-ND and NHP groups exhibited similar patterns of non-significant differences compared with the HP-D group.

Implementation of a coordinated HPS framework on nutrition and diet was positively correlated with schoolteachers’ nutrition knowledge and dietary intake.

Childhood obesity is increasingly being recognized as a major public health problem in the Caribbean. The objective of the present study was to evaluate the effectiveness of a short-term, school-based, multi-component education intervention on improving the knowledge, attitudes and behaviour of primary-school children towards better dietary and activity habits.

The study was a randomized, controlled, school-based nutrition education and physical activity intervention. Participating schools were randomly assigned to the intervention (IVG) and non-intervention (NIVG) groups.

All primary schools in Sangre Grande, north-east Trinidad.

Five hundred and seventy-nine pupils in their sixth year of primary-school education were enrolled from twelve schools in Sangre Grande, north-east Trinidad.

Approximately 23 % of participants had BMI ≥ 85th percentile of the Centers for Disease Control and Prevention age- and gender-specific cut-off values. In multivariate regression equations controlling for age, gender, BMI and baseline value, intervention was associated with lower intake levels of fried foods, snack foods high in fat, sugar and salt (HFSS) and sodas (P < 0·05). In similar analyses, intervention was associated with higher knowledge scores (P < 0·01). Intervention was not significantly associated with physical activity and Children’s Eating Attitude Test-26 (ChEAT26) scores after controlling for age, gender, BMI and the relevant baseline values.

The intervention was associated with lower intake levels of fried foods, HFSS foods, sodas and higher knowledge scores independent of age, gender, BMI, ethnicity and the appropriate baseline value. Finally, the intervention was not associated with changes in physical activity behaviours in multivariate analyses.

To develop policy and public health recommendations for implementation at all levels by individuals and organisations working in, or related to, the field of breast-feeding promotion in developed country settings, where breast-feeding rates remain low.

Two research phases, comprising (i) an assessment of the formal evidence base in developed country settings and (ii) a consultation with UK-based practitioners, service managers and commissioners, and representatives of service users. The evidence base included three systematic reviews and an Evidence Briefing. One hundred and ten studies evaluating an intervention in developed country settings were assessed for quality and awarded an overall quality rating. Studies with a poor quality rating were excluded. The resulting seventy studies examined twenty-five types of intervention for breast-feeding promotion. These formed the basis of the second consultation phase to develop the evidence-based interventions into recommendations for practice, which comprised (i) pilot consultation, (ii) electronic consultation, (iii) fieldwork meetings and (iv) workshops. Draft findings were synthesised for two rounds of stakeholder review conducted by the National Institute for Health and Clinical Excellence.

Twenty-five recommendations emerged within three complementary and necessary categories, i.e. public health policy, mainstream clinical practice and local interventions.

The need for national policy directives was clearly identified as a priority to address many of the barriers experienced by practitioners when trying to work across sectors, organisations and professional groups. Routine implementation of the WHO/UNICEF Baby Friendly Initiative across hospital and community services was recommended as core to breast-feeding promotion in the UK. A local mix of complementary interventions is also required.

To explore whether initiatives to promote fruit and vegetables in primary schools are associated with changes in children’s diet.

Cross-sectional dietary survey. Main outcome measures were intakes of fruit, vegetables and key nutrients; and a score for initiatives promoting fruit and vegetables in school.

One hundred and twenty-nine English primary schools.

Year 2 children (aged 6–7 years, n 2530).

In schools running a gardening club, children ate more vegetables, 120 (95 % CI 111, 129) g/d, compared with those that did not, 99·3 (95 % CI 89·9, 109) g/d; and where parents were actively involved in school initiatives to promote fruit and vegetables, children’s intake of vegetables was higher, 117 (95 % CI 107, 128) g/d, compared with those where parents were not involved, 105 (95 % CI 96·2, 114) g/d. In schools that achieved a high total score (derived from five key types of initiatives to promote fruit and vegetables in school) children ate more vegetables, 123 (95 % CI 114, 132) g/d, compared with those that did not, 97·7 (95 % CI 88·7, 107) g/d.

Gardening, parental involvement and other activities promoting fruit and vegetables to children in school may be associated with increased intake of vegetables but not fruit. These effects were independent of deprivation status and ethnicity.

To assess the intake and sources of non-milk extrinsic sugars (NMES) and fat among children in Scotland in relation to socio-economic status, and to estimate the changes in diet required to achieve recommended levels of intake.

Cross-sectional survey with diet assessed by semi-quantitative FFQ.

Eighty postcode sectors across Scotland.

Children (n 1398) aged 3–17 years recruited from the Child Benefit register (76 % of those contacted).

The mean intake of NMES of 17·4 (95 % CI 17·0, 17·8) % food energy was considerably higher than the UK recommended population average of 11 % food energy. The mean intake of total fat of 32·9 (95 % CI 32·7, 33·2) % food energy met the recommended population average of no more than 35 % food energy, while the mean intake of SFA of 13·8 (95 % CI 13·7, 14·0) % food energy was above the recommended population average of no more than 11 % food energy. Despite clear socio-economic gradients in the mean daily consumption of many ‘healthy’ and ‘unhealthy’ food groups, socio-economic differences in NMES as a percentage of food energy were limited and there was no significant variation in the intake of total fat or SFA as a percentage of food energy with socio-economic status. Modelling of the data showed that removing sugar-sweetened soft drinks and increasing fruit and vegetable intake by 50 % would not restore the intake of NMES and SFA to recommended levels.

Major changes in the intake of many food groups will be required to bring the NMES and saturated fat intake in line with current dietary recommendations.

We investigated whether having a policy regarding the availability of sweetened beverages in school was associated with children’s purchase and total weekly and daily consumption of sweetened beverages.

Data were obtained from 10 719 children aged 9–13 years and 2065 elementary schools in the Early Childhood Longitudinal Study–Kindergarten cohort. Multilevel logistic regression was used to determine the magnitude and significance of relationships between the availability of different beverages and purchase of sweetened beverages at school and overall consumption of beverages.

The purchase of sweetened beverages by children in school was strongly associated with the administrative policy of sweetened beverage availability. Compared with children in schools without an administrative policy that allowed sweetened beverages, children in schools with the policy were three times more likely to be either occasional or frequent consumers of sweetened beverages.

A policy of availability of sweetened beverages makes an independent contribution to children’s purchase and consumption of sweetened beverages in the 5th grade year.

Various studies in the USA and Canada have consistently shown a positive association between length of residence of immigrants and obesity. Studies in European countries have obtained less consistent results. The present work assesses the influence of length of residence on the frequency of obesity in immigrants in the city of Madrid, Spain.

We studied a sample of 7155 persons aged 18 years and over residing in the city of Madrid, who were was surveyed between November 2004 and May 2005. Information was collected on immigrant status (country of birth), length of residence in Spain, obesity, sociodemographic characteristics and lifestyle.

Compared with the Spanish population, the odds for obesity in the immigrant population by length of residence was less than one in all groups, becoming closer to one with increasing time of residence (OR = 0·67, 0·73 and 0·81 for immigrants with less than 2, 2–4 and 5–9 years of residence in Spain, respectively), up to 10 or more years of residence, when it declined (OR = 0·69). The magnitude of this association was considerably reduced after adjusting for sociodemographic variables and for perceived health, but was not further modified after adjusting for lifestyle variables.

Length of residence of immigrants in the city of Madrid is not associated with the frequency of obesity. It is possible that the circumstances immigrants encounter after arriving in Spain do not involve an overexposure to factors favouring obesity, relative to those they bring with them.

A preliminary investigation into different eating patterns among Thai consumers who shop at fresh markets as opposed to supermarkets in Chiang Mai.

A short questionnaire adopted from a previous study was administered to the forty-four participants, who comprised supermarket users, fresh market users and people who consistently shopped at both supermarkets and fresh markets.

Participants were recruited within four fresh markets and two food courts attached to supermarkets in Chiang Mai.

Chiang Mai residents who agreed to participate in the study. Equal numbers were regular fresh market and supermarket users.

Initial results suggest an association between shopping at supermarkets and attributing bread with culinary value.

Supermarkets may be potentially significant players in the ‘nutrition transition’, providing Thais more convenient shopping at some cost to their healthy food choices.

To identify factors associated with exclusive breast-feeding and breast-feeding during the first year of life among Norwegian infants.

Data on breast-feeding practices were collected by a semi-quantitative FFQ.

In 2006–2007 about 3000 infants were invited to participate in a population-based prospective cohort study in Norway.

A total of 1490 mothers/infants participated at both 6 and 12 months of age.

Exclusive breast-feeding at 4 months was associated with parental education, parity and geographical region, while exclusive breast-feeding at 5·5 months was associated only with maternal age. At both ages, a negative association with exclusive breast-feeding was observed for maternal smoking. Breast-feeding at 6 months was associated with parental education, maternal age and marital status. Breast-feeding at 12 months was associated with maternal education, maternal age and number of children. At both ages, negative associations with breast-feeding were observed for maternal smoking and descending birth weight. At 12 months, a negative association was also observed for having day care by other than the parents.

Even though Norway has an extensive and positive breast-feeding tradition and a maternal leave system that supports the possibility to breast-feed, factors like maternal education, maternal age and maternal smoking are strongly associated with duration of exclusive breast-feeding and breast-feeding. Research to better understand the reasons for inequalities in breast-feeding is needed to facilitate the development of more effective breast-feeding promotion strategies. This again may improve compliance with recommendations and reduce inequalities in infant feeding practices.

The purpose of the present paper is to assess the relationship between food insecurity and food consumption patterns, anthropometric measures and serum micronutrient levels in rural Kilimanjaro, Tanzania.

A population-based cross-sectional study was carried out between March and May of 2005.

Rural Kilimanjaro, Tanzania.

Analysis was restricted to 1014 adults aged 15–44 years with children and complete data.

A large majority of the participants (91 %) reported some kind of food insecurity. Food insecurity was significantly associated with age, marital status and occupation. Participants reporting food insecurity were significantly less likely to frequently consume animal products, fruits and vegetables compared with participants categorized as food secure. Women categorized as experiencing individual food insecurity had a larger waist circumference than food-secure women (P = 0·026) while the mean BMI of women appeared to decline if they had a child who was food insecure (P = 0·038). There were no observed differences in serum micronutrient levels by food insecurity status.

Food insecurity is highly prevalent and associated with food consumption patterns, waist circumference and BMI of women in rural Tanzania. Further studies should apply self-report measures in assessing food insecurity to larger and more diversified populations.

To determine whether interventions tailored specifically to particular immigrant groups from developing to developed countries decrease the risk of obesity and obesity-related diseases.

Databases searched were MEDLINE (1966–September 2008), CINAHL (1982–September 2008) and PsychINFO (1960–September 2008), as well as Sociological Abstracts, PsychARTICLES, Science Direct, Web of Knowledge and Google Scholar. Studies were included if they were randomised control trials, ‘quasi-randomised’ trials or controlled before-and-after studies. Due to the heterogeneity of study characteristics only a narrative synthesis was undertaken, describing the target population, type and reported impact of the intervention and the effect size.

Thirteen studies met the inclusion criteria. Ten out of thirteen (77 %) studies focused on diabetes, seven (70 %) of which showed significant improvement in addressing diabetes-related behaviours and glycaemic control. The effect on diabetes was greater in culturally tailored and facilitated interventions that encompassed multiple strategies. Six out of the thirteen studies (46 %) incorporated anthropometric data, physical activity and healthy eating as ways to minimise weight gain and diabetes-related outcomes. Of the six interventions that included anthropometric data, only two (33 %) reported improvement in BMI Z-scores, total skinfold thickness or proportion of body fat. Only one in three (33 %) of the studies that included cardiovascular risk factors reported improvement in diastolic blood pressure after adjusting for baseline characteristics. All studies, except four, were of poor quality (small sample size, poor internal consistency of scale, not controlling for baseline characteristics).

Due to the small number of studies included in the present review, the findings that culturally tailored and facilitated interventions produce better outcomes than generalised interventions, and that intervention content is more important than the duration or venue, require further investigation.

The present study evaluated the association between fruit and vegetable intake and the incidence of upper respiratory tract infection (URTI) during pregnancy.

In a cohort of 1034 North American women, each subject was asked retrospectively about their fruit and vegetable intake during the six months before the pregnancy and their occurrences of URTI during the first half of pregnancy. Multivariable-adjusted hazard ratios (HR) were calculated with Cox proportional hazards models.

The adjusted HR of URTI for women in the highest quartile (median 8·54 servings/d) v. the lowest quartile (median 1·91 servings/d) of total fruit and vegetable intake was 0·74 (95 % CI 0·53, 1·05) for the 5-month follow-up period and 0·61 (95 % CI 0·39, 0·97) for the 3-month follow-up period, respectively. A dose-related reduction of URTI risk according to quartile of intake was found in the 3-month (P for trend = 0·03) but not the 5-month follow-up. No association was found between either fruit or vegetable intake alone in relation to the 5-month or the 3-month risk of URTI.

Women who consume more fruits and vegetables have a moderate reduction in risk of URTI during pregnancy, and this benefit appears to be derived from both fruits and vegetables instead of either alone.

Although the sociodemographic characteristics of food-insecure households have been well documented, there has been little examination of neighbourhood characteristics in relation to this problem. In the present study we examined the association between household food security and neighbourhood features including geographic food access and perceived neighbourhood social capital.

Cross-sectional survey and mapping of discount supermarkets and community food programmes.

Twelve high-poverty neighbourhoods in Toronto, Ontario, Canada.

Respondents from 484 low-income families who had children and who lived in rental accommodations.

Food insecurity was pervasive, affecting two-thirds of families with about a quarter categorized as severely food insecure, indicative of food deprivation. Food insecurity was associated with household factors including income and income source. However, food security did not appear to be mitigated by proximity to food retail or community food programmes, and high rates of food insecurity were observed in neighbourhoods with good geographic food access. While low perceived neighbourhood social capital was associated with higher odds of food insecurity, this effect did not persist once we accounted for household sociodemographic factors.

Our findings raise questions about the extent to which neighbourhood-level interventions to improve factors such as food access or social cohesion can mitigate problems of food insecurity that are rooted in resource constraints. In contrast, the results reinforce the importance of household-level characteristics and highlight the need for interventions to address the financial constraints that underlie problems of food insecurity.