To assess the intake frequency of fruit and vegetables, serving sizes, reasons for and barriers to consumption, and the potential for increasing fruit and vegetable intake.

A nationwide postal questionnaire survey was conducted in 2006 over all four seasons. The participants were stratified according to occupation and sex. The response rate for 5130 questionnaires sent out was 52·7 %.

Austria.

Austrian adults, aged 19–64 years.

Daily fruit consumption was reported by 57·1 % of the participants and daily vegetable consumption by 36·2 %. On average, 2·1 (sd 1·9) servings (250 (sd 225) g) of fruit and 1·7 (sd 1·3) servings (198 (sd 159) g) of vegetables were consumed daily. Women ate fruit and vegetables both more frequently and in greater quantities than men. Both intake frequency and the number of fruit and vegetable servings were largely independent of seasonal fluctuations. The primary reason for the consumption of both fruit and vegetables was taste. The greatest barrier to higher intake was the perception that current individual consumption was already sufficient. Price did not constitute a relevant barrier in Austria. At present, the potential for increasing fruit and vegetable intake can be estimated at two servings.

Austrian adults still consume less fruit and vegetables than recommended. Strategies to increase intake should pay more attention to the taste instead of the various health aspects.

To assess the prevalence of normal weight, overweight and obesity among 10–18-year-old Czech Republic adolescents and to assess the association between energy balance-related behaviours and overweight/obesity.

Cross-sectional data from ‘The 6th Nation-wide Anthropological Survey of Children and Adolescents 2001 Czech Republic’ have been used.

Height and weight were objectively measured. Data on adolescents’ behaviours were assessed with self-reported questionnaires. Background variables were assessed by means of a parental questionnaire. Multi-level logistic regression analyses were conducted to assess behavioural risk factors of being overweight/obese.

Data on 31 228 adolescents aged 10–18 years were included in the present study.

The highest prevalence of being overweight or obese was found among boys and younger adolescents. Boys were more physically active, watched more television (TV) and used the computer more often than did girls. Being on a diet and skipping meals were positively associated with being overweight/obese, independent of gender. In boys (10–14 years old), inverse associations with being overweight/obese were found when being more physically active. Monitoring weight showed inverse relations with being overweight/obese in 15–18-year-old girls. Watching TV more than 7 h a week was positively associated with being overweight/obese in 15–18-year-old girls, and was found to be negatively associated in boys of the same age group.

These behaviours should be targeted when preventing overweight and obesity among Czech Republic adolescents. Studies using better measures of energy balance-related behaviours are needed.

To establish the Fe status of pregnant women and their neonates in the Republic of Seychelles.

A prospective study.

Republic of Seychelles.

Pregnant women were recruited and blood samples taken at enrolment and post-delivery along with cord blood samples. Ferritin and soluble transferrin receptor (sTfR) were measured in maternal (n 220) and cord blood (n 123) samples.

Maternal Fe deficiency (ferritin < 15 ng/ml, sTfR > 28 nmol/l) was present in 6 % of subjects at enrolment and in 20 % at delivery. There was no significant decrease in maternal ferritin. A significant increase in sTfR was observed between enrolment and delivery (P < 0·001). Maternal BMI and use of Fe supplements at 28 weeks’ gestation were associated with improved maternal Fe status at delivery, whereas parity had a negative effect on sTfR and ferritin at delivery.

Fe status of pregnant Seychellois women was, on average, within normal ranges. The incidence of Fe deficiency throughout pregnancy in this population was similar to that in a Westernised population. Increased awareness of the importance of adequate Fe intake during pregnancy, particularly in multiparous women, is warranted.

To study dietary glycaemic index (GI) and glycaemic load (GL) in association with physical performance in elderly Europeans.

Cross-sectional and prospective study. Physical performance was measured using the Physical Performance Test (PPT) score on a scale from 0 to 27, where high scores indicate a better physical performance. Habitual diets were measured using diet history interviews and dietary GI and GL were estimated from table values.

Eight towns/centres from the Survey in Europe on Nutrition and the Elderly, a Concerted Action (SENECA) in 1993 and 1999.

Seven hundred and sixty-five men and women, 75–80 years old, were examined in 1993; of these, 357 (47 %) were followed up in 1999, at age 80–85 years.

At baseline, both dietary GI and GL were significantly inversely associated with PPT scores (P = 0·03 and P = 0·05, respectively). When adjusted for age, BMI, physical activity, self-perceived health, chronic diseases and town/centre, the strength of the associations was attenuated and became non-significant (GI, P = 0·08; GL, P = 0·92). Dietary GI/GL were not associated with PPT scores 6 years later.

Among elderly Europeans, a high glycaemic diet was associated with a low physical performance at baseline but not 6 years later. Cross-sectional associations may in part be caused by variations in age, BMI, physical activity, self-perceived health, chronic diseases and geographic location.

To explore mean food group intakes associated with central obesity anthropometry among children and adolescents enrolled in the Third National Health and Nutrition Examination Survey (NHANES III).

Cross-sectional study.

Representative sampling of the US population (1998–2002).

Subjects were 3761 children (5–11 years) and 1803 adolescents (12–16 years) with single 24 h dietary recalls and anthropometric measures of central body fat (waist circumference and sum of subscapular and suprailiac skinfold thicknesses).

Results were controlled for confounding by age, height, race/ethnicity, Tanner stage, television viewing and parental education. In younger children, there was no relationship between central adiposity and mean intakes of dairy, fruit, vegetables or grains, while a positive association with meat intake was found among boys. In adolescent boys and girls, central body fat measures were inversely associated with mean dairy and grain intakes. Adolescent boys in the highest quartile of central adiposity consumed less fruit and fewer vegetables; those in the lowest central adiposity quartile consumed less meat. Finally, adolescents who met the criteria for central obesity (waist circumference ≥85th percentile for age and sex) reported consuming significantly less total dairy (as well as milk and cheese separately), total grains (whole and refined) and total fruit and vegetables. There was no association with meat consumption. To test the stability of these findings, the final analysis was replicated in 2541 same-aged adolescents from NHANES 1999–2002; the results were very similar.

These cross-sectional analyses suggest that intakes of dairy, grains and total fruits and vegetables are inversely associated with central obesity among adolescents.

To establish BMI percentile curves that describe the contemporary BMI distribution among Chinese children, and to compare their BMI percentile curves with those in two recently developed international references: the WHO and the US Centers for Disease Control and Prevention (US CDC) growth references.

A cross-sectional national survey.

Thirty provinces, municipalities and autonomous regions in China.

Nationally representative sample of 232 140 school students aged 7–18 years.

BMI percentile curves were established using the LMS method, and were compared with the percentiles of the WHO and the US CDC references. BMI distributions and growth patterns in Chinese children were dramatically different from those in the two international reference populations. Compared with the international reference populations, younger Chinese boys (7–12 years of age) had higher values of the percentiles above the median and lower values of the percentiles below the median, suggesting that they had larger proportions of extreme BMI values in both directions. Chinese girls and older Chinese boys (15–18 years of age) had substantially lower BMI percentiles than their counterparts in the reference populations, particularly those high percentiles among older age groups.

The present study described the unique patterns of BMI curves at the national level, and these curves are useful as a reference for comparing different regions and for monitoring changes over time in Chinese children. Higher proportions of children with extreme values in both directions indicate that China is currently facing both an increasing level of obesity and a high level of undernutrition, simultaneously.

To identify lifestyle clusters in adolescents and to characterize their association with overweight and obesity.

Cross-sectional and longitudinal data of the Kiel Obesity Prevention Study.

Schools in Kiel, Germany.

Cross-sectional data of 1894 adolescents aged 14 years and 4-year longitudinal data of a subsample of 389 children aged 10 and 14 years. Self-reported data of physical activity, modes of commuting to school, media time, nutrition, alcohol consumption and smoking were used to identify lifestyle clusters with two-step cluster analysis. Obesity indices (height, weight, waist circumference and fat mass (FM)) were measured.

Three lifestyle clusters were identified: a ‘low activity and low-risk behaviour’ cluster (cluster 1: n 740, 39·1 %); a ‘high media time and high-risk behaviour’ cluster (cluster 2: n 498, 26·3 %); and a ‘high activity and medium-risk behaviour’ cluster (cluster 3: n 656, 34·6 %). Strictly speaking, none of these clusters was considered to be markedly healthy. The prevalence of overweight and obesity tended to be lower in cluster 3 (15·9 %) than in clusters 1 (20·4 %) and 2 (20·5 %; P = 0·053). Longitudinally, 4-year changes in FM were found to be lowest in cluster 2, but the 4-year incidence rate of obesity was lowest in cluster 3.

Explicit healthy lifestyles do not exist, but an active lifestyle reduces the incidence of obesity. In adolescents, health promotion should take into account the diversity of lifestyles and address specific lifestyle clusters.

To identify the optimal waist:height ratio (WHtR) cut-off point that discriminates cardiometabolic risk factors in Turkish adults.

Cross-sectional study. Hypertension, dyslipidaemia, diabetes, metabolic syndrome score ≥2 (presence of two or more metabolic syndrome components except for waist circumference) and at least one risk factor (diabetes, hypertension or dyslipidaemia) were categorical outcome variables. Receiver-operating characteristic (ROC) curves were prepared by plotting 1 − specificity on the x-axis and sensitivity on the y-axis. The WHtR value that had the highest Youden index was selected as the optimal cut-off point for each cardiometabolic risk factor (Youden index = sensitivity + specificity − 1).

Turkey, 2003.

Adults (1121 women and 571 men) aged 18 years and over were examined.

Analysis of ROC coordinate tables showed that the optimal cut-off value ranged between 0·55 and 0·60 and was almost equal between men and women. The sensitivities of the identified cut-offs were between 0·63 and 0·81, the specificities were between 0·42 and 0·71 and the accuracies were between 0·65 and 0·73, for men and women. The cut-off point of 0·59 was the most frequently identified value for discrimination of the studied cardiometabolic risk factors. Subjects classified as having WHtR ≥ 0·59 had significantly higher age and sociodemographic multivariable-adjusted odds ratios for cardiometabolic risk factors than subjects with WHtR < 0·59, except for diabetes in men.

We show that the optimal WHtR cut-off point to discriminate cardiometabolic risk factors is 0·59 in Turkish adults.

The present study examined the prevalence of underweight and overweight in a group of primary-school children in Zahedan, south-east Iran.

A cross-sectional study in a randomly selected population of schoolchildren.

Primary-school children in Zahedan city.

A random sample of 1079 students (boys = 500 and girls = 579). Data on child’s age, parental educational levels, body weight and height were collected.

The rate of overweight/obesity among boys and girls was 8·9 % and 10·3 %, respectively; and of underweight among boys and girls was 22·8 % and 19·9 %, respectively. Prevalence of overweight increased as the boys and girls approached adolescence and it was more prevalent among girls than boys. Prevalence of overweight was directly related to maternal education in this population.

High prevalence of underweight in young children as well as increase in the prevalence of overweight in girls and boys near adolescence are of concern. Early poor growth and subsequent rapid weight gain near to adolescent stage is related to adulthood obesity.

The present paper describes the systematic development of an FFQ to assess the intake of fatty acids and antioxidants in school-aged children. In addition, a validation study applying 24 h dietary recalls was performed.

Using the variance-based Max_r method, a list of eighty-two foods was compiled from data obtained by 3 d weighed dietary records. The foods were used to design an FFQ, the comprehensibility of which was evaluated in a feasibility study. In addition, the FFQ was validated in a subset of 101 children from the German Infant Nutritional Intervention Study (GINI PLUS) against one 24 h dietary recall.

The feasibility study attested a good acceptance of the FFQ. Mean intake of foods compared well between the FFQ and the 24 h dietary recall, although intake data generated from the FFQ tended to be higher. This difference became less apparent at the nutrient level, although the estimated average consumption of arachidonic acid and EPA using the FFQ still exceeded values recorded with the 24 h recall method by 45 % and 29 %, respectively.

On the basis of the systematic selection process of the food list, the established practicability of the FFQ and the overall plausibility of the results, the use of this FFQ is justified in future epidemiological studies.

There are few studies regarding vitamin B12 deficiency in developing countries. In Brazil, a late diagnosis of vitamin B12 deficiency progressing to severe neurological damage is common. Thus, the aim of the present study was to verify the frequency of vitamin B12 deficiency in two Brazilian populations (elderly and adult participants) and to compare different methods of vitamin B12 deficiency detection.

Five hundred participants were recruited from health centres from south-east Brazil and were separated into two groups: 60 years old or more and 30–59 years old. Vitamin B12 and folate concentrations were measured using electrochemiluminescence immunoassay (ECI) and RIA. Methylmalonic acid (MMA) was measured by LC coupled to tandem MS. Full blood counts were acquired using standard methods.

All participants had normal blood count results and mean cell volume less than 99 fl; none of them presented folate deficiency according to the results, which were all greater than 3 ng/ml. Cobalamin levels less than 200 pmol/l were identified by one of the two or by both methods in 7·2 % of the participants aged 60 years or more and 6·4 % of the participants aged 30–59 years. MMA levels were higher in older subjects (P = 0·007) compared with younger subjects. A greater correlation of MMA v. RIA was observed than of MMA v. ECI (P = 0·0017 v. P = 0·014). MMA quantification estimated that cobalamin deficiency was present in more than 11 % of the subjects for both studied groups.

The study shows that vitamin B12 deficiency is frequent in Brazilian adults and suggests that RIA is more sensitive than ECl for measuring cobalamin levels.

Few studies have examined recent shifts in meat consumption (MC), differences among US population groups, and the influence of psychosocial–behavioural factors.

Nationally representative data collected for US adults aged ≥18 years in the 1988–1994 and 1999–2004 National Health and Nutrition Examination Survey (NHANES) and the 1994–1996 Continuing Survey of Food Intakes by Individuals (CSFII) and Diet and Health Knowledge Survey (DHKS) were used.

We found a U-shaped trend in MC, a decrease between 1988–1994 and 1994–1996, and an increase from 1994–1996 to 1999–2004. NHANES 1988–1994 and 1999–2004 indicate that MC did not change significantly, particularly for all meat, red meat, poultry and seafood. Between 1994–1996 and 1999–2004, average MC, including red meat, poultry, seafood and other meat products, increased in men. Women’s total MC decreased, mainly due to decreased red meat and other meat products, except for increased seafood. Noticeable differences existed in the changes across population groups. Black men had the largest increase in consumption of total meat, poultry and seafood; Mexican American men had the smallest increase in poultry, seafood and other meat products. In 1999–2004, ethnic differences in MC became greater in women than among women in 1994–1996. Associations between MC and energy intake changed over time. Perceived benefit of dietary quality and food label use were associated with reduced red MC.

Noticeable differences exist in the shifts in MC across population groups and surveys. MC increased in men but decreased in women in recent years.

To assess to what extent the observed dietary changes and increased use of lipid-lowering medication can explain the almost 20 % decline in serum cholesterol (referring to serum total cholesterol) level observed from 1982 to 2007 in Finland.

Predicted changes of serum cholesterol were calculated by the Keys’ equation assuming the effect of trans fatty acids to be similar to SFA and using the dietary intake data of the national dietary surveys between 1982 and 2007. The effect of medication was estimated based on the information on use of lipid-lowering medication among survey participants. The predicted serum cholesterol levels were compared with observed changes in analysed serum cholesterol levels.

Four cross-sectional population surveys, in 1982, 1992, 2002 and 2007, in the provinces of North Karelia, Northern Savo and Southwestern Finland.

A total of 2325 men and 2638 women aged 26–64 years selected randomly from the national population register for the four surveys.

Changes in dietary fat quality and cholesterol intake explain 0·70 mmol/l (65 %) of the decrease in men and 0·65 mmol/l (60 %) of the decrease in women in all subjects. Decline in dietary SFA intake is the main explanatory factor (47 % in men and 41 % in women) for the changes. The impact of lipid-lowering medication on observed cholesterol levels was found to be 16 % among men and 7 % among women.

The decrease in serum cholesterol levels in Finland can be explained mainly by dietary changes, especially changes in fat quality. The effect of lipid-lowering medication is less significant.

Low birth weight is associated with increased lifelong morbidity. Kerala has a renowned, low-cost, maternal–child health system in which is couched universal access to the Integrated Child Development Scheme (ICDS), central to which is community-based maternal–infant nutritional supplementation. We assessed whether children in this environment showed enhanced birth weight and postnatal growth and whether the evolution of early markers of CVD was attenuated in comparison to contemporaries from other states.

A part retrospective, part prospective cohort study in which children (n 286) born in 1998–2000 in Calicut were identified from Anganwadi records. They were traced at 6 years and underwent full anthropometry and blood pressure measurements at 6 and 8 years.

Mean birth weight (2·86 (sd 0·40) kg) was greater than in Indian contemporaries but consistently <−1sd below the National Center for Health Statistics reference median throughout childhood. Birth weight significantly predicted body mass (BMI) at 8 years. Lower birth weight was strongly predictive of a higher waist:hip ratio (WHR) indicative of adverse central (coelomic) fat distribution (P < 0·01). Faster weight gain in infancy was weakly predictive of a lower WHR (P = 0·59), but faster late childhood growth at 6–8 years was non-significantly predictive of adverse WHR.

At 8 years of age, children in Calicut participating in the ICDS have greater birth weight and relative attenuation of the evolution of early CVD markers compared with children in apparently comparable states. The relative contributions of the ICDS and other factors inherent to Kerala cannot be inferred from the present study.

To examine the relative contribution for the prediction of hypertension by waist circumference (WC), waist:stature ratio (WSR) or waist:hip ratio (WHR) with that by BMI, to ascertain if WC, WSR or WHR enhances the prediction of hypertension by BMI.

Population-based, cross-sectional study. A change of ≥10 % in the prevalence ratio of BMI (PR) or the area under the receiver-operating characteristic curve (AUC) when WC, WSR or WHR was added to a model with BMI was used as the criterion for significant contribution to the prediction of hypertension by BMI. For greater contributions (≥10 %) these waist measures were considered as better predictors.

Nine provinces in China.

Chinese adults aged 18 to 65 years (n 7336) who participated in the 2004 China Health and Nutrition Survey.

The prevalence of hypertension (17 % and 23 % for women and men, respectively) was significantly related to increased BMI, WC, WSR and WHR (P for trend <0·001). Although there was a better model fit when WC, WSR or WHR was added to a model with BMI (P < 0·05; likelihood ratio test), the changes in PR and AUC were <10 % and <5 %, respectively. The sex-specific AUC for the prediction of hypertension by BMI (of 0·7–0·8) was similar to that by WC, WSR or WHR.

The waist indices do not perform better than BMI or markedly enhance the prediction of increased hypertension risk by BMI in Chinese adults.

To investigate average sodium excretion in 24 h urine as a marker for salt intake in the Slovene population.

Salt intake was determined by measuring sodium excretion in 24 h urine collected from a representative sample of geographically diverse Slovene adults.

Slovenia.

A random sample of 600 adults aged 25–65 years was generated from census data. The effective sample yield was 143 people, 42·7 % men and 57·3 % women.

Urinary sodium excretion was significantly higher in men (220·9 (sd 86·0) mmol Na/d) than in women (169·8 (sd 73·8) mmol Na/d); t test = 14·5, P < 0·001. Average salt intake was 11·3 (sd 4·9) g/d, higher in men than in women (13·0 (sd 5·1) v. 9·9 (sd 4·3) g/d, respectively). Average intakes of salt among regions were not significantly different. Salt intake increases slightly with increasing age, but there was no significant correlation between age and salt intake. Salt intake was increased with BMI (r = 0·384, P < 0·001).

Salt intake in Slovene adults, especially in men, exceeds the WHO recommended population nutrient intake goal of 5 g by more than twofold. A national programme for reducing salt intake in Slovenia needs to be implemented through systematic efforts including public education and involving the health-care sector and the food industry.

Drinking habits in children are associated with diet quality, but validated assessment tools for large-scale studies in young children are lacking. Therefore, we validated a self-completion 24 h recall questionnaire (RQ) focusing on beverage consumption with a 24 h weighed record (WR).

Thirty-five voluntary participants from the DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) Study cohort aged 7–9 years completed the RQ. The illustrated RQ required ticking the number of glasses of seven beverage categories consumed in five time intervals in the previous 24 h. As a reference, parents completed weighed records of their child’s diet. Agreement between the RQ and WR was tested by classification into consumers and non-consumers (kappa coefficients, κ), by the children’s ability to estimate the exact beverage and total volume consumed (Wilcoxon signed-rank test, Spearman rank correlation), and by ranking children according to reported beverage volumes.

The RQ and WR showed a good level of agreement for classifying participants into consumers and non-consumers of the single beverage categories (κ values between 0·78 and 0·94). Correlation coefficients for the volume of the single categories ranged between 0·81 and 0·91. The total beverage volume was overestimated in the RQ, on average, by 114 ml (P = 0·015). Agreement in ranking into tertiles by beverage volume was moderate to good for juice/soft drinks (κ = 0·44), milk (κ = 0·57) and water (κ = 0·70), but fair for the total beverage volume (κ = 0·23).

Our self-completion 24 h RQ could estimate the consumption of several beverage categories among young children at the group level, but quantification of total beverage volume was flawed.

To study the association between adherence to several a priori-defined healthy food patterns and the risk of hypertension.

Prospective, multipurpose, dynamic cohort study (recruitment permanently open). We followed up 10 800 men and women (all of them university graduates), who were initially free of hypertension, for a variable period (range 2–6 years, median 4·6 years). During follow-up, 640 participants reported a new medical diagnosis of hypertension. Baseline diet was assessed using a validated 136-item FFQ. Validated information about non-dietary potential confounders was also gathered. We calculated adherence to fifteen different hypothesis-oriented food patterns and assessed the association between each of them and incident hypertension using multivariable Cox models.

The SUN (Seguimiento Universidad de Navarra – University of Navarra Follow-up) Project, Spain.

Participants recruited to the SUN cohort before October 2005 were eligible for inclusion; after excluding those with self-reported hypertension or CVD at baseline, or with extreme total energy intake, data of 10 800 were analysed.

Higher adherence to the DASH (Dietary Approaches to Stop Hypertension) diet (range of the score: 0 to 5) was significantly associated with a lower risk for developing hypertension (P for trend = 0·02). The other food patterns showed no significant association with incident hypertension.

Our results support a long-term protection of the DASH diet against the incidence of hypertension, but we found no evidence of a similar inverse association with hypertension for any other a priori-defined healthy food pattern.

Uptake of advice for lifestyle change for obesity and diabetes prevention requires access to affordable ‘healthy’ foods (high in fibre/low in sugar and fat). The present study aimed to examine the availability and accessibility of ‘healthy’ foods in rural and urban New Zealand.

We identified and visited (‘mapped’) 1230 food outlets (473 urban, 757 rural) across the Waikato/Lakes areas (162 census areas within twelve regions) in New Zealand, where the Te Wai O Rona: Diabetes Prevention Strategy was underway. At each site, we assessed the availability of ‘healthy’ foods (e.g. wholemeal bread) and compared their cost with those of comparable ‘regular’ foods (e.g. white bread).

Healthy foods were generally more available in urban than rural areas. In both urban and rural areas, ‘healthy’ foods were more expensive than ‘regular’ foods after adjusting for the population and income level of each area. For instance, there was an increasing price difference across bread, meat, poultry, with the highest difference for sugar substitutes. The weekly family cost of a ‘healthy’ food basket (without sugar) was 29·1 % more expensive than the ‘regular’ basket ($NZ 176·72 v. $NZ 136·84). The difference between the ‘healthy’ and ‘regular’ basket was greater in urban ($NZ 49·18) than rural areas ($NZ 36·27) in adjusted analysis.

‘Healthy’ foods were more expensive than ‘regular’ choices in both urban and rural areas. Although urban areas had higher availability of ‘healthy’ foods, the cost of changing to a healthy diet in urban areas was also greater. Improvement in the food environment is needed to support people in adopting healthy food choices.

To validate questionnaire-based physical activity level (PAL) against accelerometry and a 24 h physical activity diary (24 h AD) as reference methods (Protocol 2), after validating these reference methods against the heart rate–oxygen consumption (HRVO2) method (Protocol 1).

Cross-sectional study.

Two villages in Andhra Pradesh state and Bangalore city, South India.

Ninety-four participants (fifty males, forty-four females) for Protocol 2; thirteen males for Protocol 1.

In Protocol 2, mean PAL derived from the questionnaire (1·72 (sd 0·20)) was comparable to that from the 24 h AD (1·78 (sd 0·20)) but significantly higher than the mean PAL derived from accelerometry (1·36 (sd 0·20); P < 0·001). Mean bias of PAL from the questionnaire was larger against the accelerometer (0·36) than against the 24 h AD (−0·06), but with large limits of agreement against both. Correlations of PAL from the questionnaire with that of the accelerometer (r = 0·28; P = 0·01) and the 24 h AD (r = 0·30; P = 0·006) were modest. In Protocol 1, mean PAL from the 24 h AD (1·65 (sd 0·18)) was comparable, while that from the accelerometer (1·51 (sd 0·23)) was significantly lower (P < 0·001), than mean PAL obtained from the HRVO2 method (1·69 (sd 0·21)).

The questionnaire showed acceptable validity with the reference methods in a group with a wide range of physical activity levels. The accelerometer underestimated PAL in comparison with the HRVO2 method.