To explore the influence of socio-economic position (SEP) on habitual dietary intake in Colombian cities.

We conducted a cross-sectional, population-based study in five Colombian cities. Dietary intake was assessed with a 157-item semi-quantitative FFQ previously developed for the Colombian population. Nutrient analysis was performed using national and international food composition tables. SEP was assessed with two indicators: a government-defined, asset-based, household-level index called socio-economic stratum (SES) and, among adults, highest educational level attained.

The five main urban centers of Colombia: Bogotá, Medellin, Barranquilla, Cali and Bucaramanga.

Probabilistic, multi-stage sample of 1865 participants (n 1491 for analyses on education).

For both sexes, increasing SES was associated with a lower consumption of energy (P-trend <0·001 in both sexes), carbohydrates (P-trend <0·001 in both sexes), Na (P-trend = 0·005 in males, <0·001 in females), SFA (P-trend <0·001 in both sexes) and among females, cholesterol (P-trend = 0·002). More educated men consumed significantly less energy and carbohydrates (P-trend = 0·036 and <0·001, respectively). Among men, intake of trans fats increased monotonically with educational level, being 21 % higher among college graduates relative to those with only elementary education (P-trend = 0·023). Among women, higher educational level was associated with higher MUFA intake (P-trend = 0·027).

SES and educational level are strong correlates of the usual diet of urban Colombians. Economically deprived and less educated segments of society display dietary habits that make them vulnerable to chronic diseases and should be the primary target of public health nutrition policies.

To examine dietary patterns changes from preconception to during pregnancy and their associations with socio-demographic and lifestyle factors.

This study used data from the Australian Longitudinal Study on Women’s Health (ALSWH), a population-based prospective cohort study. Women’s dietary patterns were assessed using Healthy Eating Index-2015 (HEI-2015) score and the four patterns were obtained from the factor analysis (Western diets, vegetable and grains, traditional vegetable and fruit patterns). Multi-variable linear regression and repeated measures mixed-effect models were used.

A national representative survey which covers all Australian citizens and permanent residents in Australia.

621 women were included from the ALSWH.

Women’s scores increased on the ‘HEI-2015’, ‘traditional vegetable’ and ‘fruit’ patterns while the ‘vegetable and grains’ decreased from preconception to during pregnancy. Women with higher education were more likely to increase their HEI-2015 score and fruit consumption from preconception to during pregnancy, respectively (β = 2·31, (95 % CI 0·02, 4·60)) and (β = 23·78, (95 % CI 4·58, 42·97)), than those with lower educational status. Single women were more likely to increase the consumption of vegetables and grains compared to married women (β = 76·08, (95 % CI 20·83, 131·32)). Women with higher income had a greater increase in the HEI-2015 score than those with lower income (β = 3·02, (95 % CI 0·21, 5·83)).

The findings indicate that there have been marked dietary changes from preconception to during pregnancy. Changes in healthy dietary patterns were influenced by education, marital status and income.

To examine associations between household food insecurity and children’s physical activity and sedentary behaviours.

Secondary analysis was conducted on the Healthy Communities Study, an observational study from 2013 to 2015. Household food insecurity was assessed by two items from the US Department of Agriculture’s 18-item US Household Food Security Survey Module. Physical activity was measured using the 7-d Physical Activity Behaviour Recall instrument. Data were analysed using multilevel statistical modelling.

A total of 130 communities in the USA.

In sum, 5138 US children aged 4–15 years.

No associations were found for the relationship between household food insecurity and child physical activity. A significant interaction between household food insecurity and child sex for sedentary behaviours was observed (P = 0·03).

Additional research capturing a more detailed assessment of children’s experiences of food insecurity in relation to physical activity is warranted. Future studies may consider adopting qualitative study designs or utilising food insecurity measures that specifically target child-level food insecurity. Subsequent research may also seek to further explore sub-group analyses by sex.

To describe the use of artificial intelligence (AI)-enabled dark nudges by leading global food and beverage companies to influence consumer behaviour.

The five most recent annual reports (ranging from 2014 to 2018 or 2015 to 2019, depending on the company) and websites from twelve of the leading companies in the global food and beverage industry were reviewed to identify uses of AI and emerging technologies to influence consumer behaviour. Uses of AI and emerging technologies were categorised according to the Typology of Interventions in Proximal Physical Micro-Environments (TIPPME) framework, a tool for categorising and describing nudge-type behaviour change interventions (which has also previously been used to describe dark nudge-type approaches used by the alcohol industry).

Not applicable.

Twelve leading companies in the global food and beverage industry.

Text was extracted from fifty-seven documents from eleven companies. AI-enabled dark nudges used by food and beverage companies included those that altered products and objects’ availability (e.g. social listening to inform product development), position (e.g. decision technology and facial recognition to manipulate the position of products on menu boards), functionality (e.g. decision technology to prompt further purchases based on current selections) and presentation (e.g. augmented or virtual reality to deliver engaging and immersive marketing).

Public health practitioners and policymakers must understand and engage with these technologies and tactics if they are to counter industry promotion of products harmful to health, particularly as investment by the industry in AI and other emerging technologies suggests their use will continue to grow.

To assess relationships between breast-feeding, rapid growth in the first year of life and overweight/obesity status at the age of 2 years.

As part of an observational, longitudinal study beginning in early pregnancy, multivariable logistic regressions were used to assess associations between breast-feeding duration (total and exclusive) and rapid weight gain (RWG) between birth and 1 year of age, and to determine predictors of overweight/obesity status at the age of 2 years.

Nine hospitals located in the province of Quebec, Canada.

A sample of 1599 term infants who participated in the 3D Cohort Study.

Children having RWG in the first year and those having excess weight at the age of 2 years accounted for 28 % and < 10 %, respectively. In multivariable models, children breastfed < 6 months and from 6 months to < 1 year were, respectively, 2·5 times (OR 2·45; 95 % CI 1·76, 3·41) and 1·8 times (OR 1·78; 95 % CI 1·29, 2·45) more likely to show RWG up to 1 year of age compared to children breastfed ≥ 1 year. Children exclusively breastfed < 3 months had significantly greater odds of RWG in the first year (OR 1·94; 95 % CI 1·25, 3·04) compared to children exclusively breastfed for ≥ 6 months. Associations between breast-feeding duration (total or exclusive) and excess weight at the age of 2 years were not detected. RWG in the first year was found to be the main predictor of excess weight at the age of 2 years (OR 6·98; 95 % CI 4·35, 11·47).

The potential beneficial effects of breast-feeding on rate of growth in the first year of life suggest that interventions promoting breast-feeding are relevant for obesity prevention early in life.

The purpose of this study was to determine the magnitude and determinants of urban household food insecurity in East Africa.

Systematic review and meta-analysis.

Studies conducted in East Africa.

Seventeen studies (fifteen cross-sectional and two cohort) that enrolled 156 996 households. We used the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to search electronic databases (PubMed, Cochrane Library, EMBASE, CINAHL, African Journals OnLine, Web of Science, Scopus and Google Scholar; date of last search: 10 June 2020) for studies reporting the prevalence and associated factors of urban household food insecurity.

A total of 17 studies with 156 996 households from 8 countries were used for the analysis. The pooled prevalence of urban household food insecurity in East Africa was 60·91 % (95 % CI 47·72, 74·11; I 2 = 100 %; P < 0·001) where the highest (91 %) and lowest (36·5 %) was observed in Sudan and Burundi, respectively. Household head educational status (illiterate) (AOR = 2·53; 95 % CI 2·11, 2·95, I 2 = 90 %; P < 0·01), female as household head (AOR = 1·45; 95 % CI 1·16, 1·75; I 2 = 0·0 %; P = 0·993), large family size (AOR = 1·43; 95 % CI 1·09, 1·76, I 2 = 0·0 %; P = 0·863) and poorest wealth quantile (AOR = 3·95; 95 % CI 1·93, 5·98; I 2 = 57·2 %, P = 0·053) were factors which significantly increased odds of urban household food insecurity in East Africa.

The prevalence of urban household food insecurity in East Africa remains high. Therefore, policies and intervention programmes should be designed to reduce the high burden of food insecurity among urban households considering the identified factors.

According to the WHO, anaemia is a severe public health problem when the prevalence is ≥ 40 %. In 2019, in Peru, 40·1 % of children (aged 6 to 35 months) are diagnosed as anaemic. This is a concern since, despite the efforts of the governments to reduce the prevalence, the problem has stagnated since 2011. The treatment applied to deal with anaemia is Fe supplementation. Although Fe is essential for cell function, an excess can produce adverse responses, such as gut inflammation affecting microbiota and resulting in diarrhoeic episodes.

To determine the association between diarrhoea and Fe supplementation in children with and without anaemia, controlling for different socio-demographic variables.

We conducted via logistic regression to obtain diarrhoea prevalence ratios (PR), adjusted by age, sex, geographic region, water and sanitation service, and rurality. The survey asked for recent episodes of diarrhoea during the last 7 d; similarly, after the consumption of Fe supplements during the last 12 months before the survey.

Peru.

The Demographic and Family Health Survey (DHS) is conducted annually at home among 14 202 children on average (2009–2019).

Fe supplementation in the last 7 d (PR = 1·09) or the last 12 months (PR = 1·19) (P < 0·0001) was associated with an increased risk of diarrhoea. The same association was observed between Fe supplementation and the presence of anaemia.

Fe supplementation is associated with diarrhoea and overuse in children should be avoided.

To examine the effect of food insecurity during college on graduation and degree attainment.

Secondary analysis of longitudinal panel data. We measured food insecurity concurrent with college enrolment using the 18-question United States Department of Agriculture Household Food Security Survey Module. Educational attainment was measured in 2015–2017 via two questions about college completion and highest degree attained. Logistic and multinomial logit models adjusted for socio-demographic characteristics were estimated.

USA

A nationally representative, balanced panel of 1574 college students in the USA in 1999–2003 with follow-up through 2015–2017 from the Panel Study of Income Dynamics.

In 1999–2003, 14·5 % of college students were food-insecure and were more likely to be older, non-White and first-generation students. In adjusted models, food insecurity was associated with lower odds of college graduation (OR 0·57, 95 % CI: 0·37, 0·88, P = 0·01) and lower likelihood of obtaining a bachelor’s degree (relative risk ratio (RRR) 0·57 95 % CI: 0·35, 0·92, P = 0·02) or graduate/professional degree (RRR 0·39, 95 % CI: 0·17, 0·86, P = 0·022). These associations were more pronounced among first-generation students. And 47·2 % of first-generation students who experienced food insecurity graduated from college; food-insecure first-generation students were less likely to graduate compared to first-generation students who were food-secure (47·2 % v. 59·3 %, P = 0·020) and non-first-generation students who were food-insecure (47·2 % v. 65·2 %, P = 0·037).

Food insecurity during college is a barrier to graduation and higher-degree attainment, particularly for first-generation students. Existing policies and programmes that help mitigate food insecurity should be expanded and more accessible to the college student population.

In response to concern over rising sugar-sweetened beverage (SSB) consumption, in April 2018, South Africa became the first Sub-Saharan African (SSA) country to implement an SSB tax. We assess changes in pricing and acquisition of beverages from local supermarkets and small stores among 18–39-year-old adults living in one township in the Western Cape, before and after tax implementation. This study is among the first evaluations of an SSB tax on the local food environment in a low-income township.

Store beverage pricing and participant surveys were cross-sectional, analysed 1 month before and 11 months after implementation of the tax (March 2018 and March 2019).

Langa, Western Cape, South Africa

Surveyed participants were residents of Langa between 18 and 39 years old (n 2693 in 2018 and n 2520 in 2019)

Prices of taxed SSB increased significantly among small shops and supermarkets between 2018 and 2019. There were non-significant decreases in prices of untaxed beverages in small shops, but prices of untaxed beverages increased in supermarkets. Across all store types, there was a 9 percentage point decrease in the probability of purchasing regular soda weekly pre/post-implementation. Reductions in purchasing were larger in small shops than supermarkets.

We found some differential impacts of the levy on pricing and acquisition of beverages by retailer type in one low-income township. As other SSA countries consider similar fiscal policies to curb soda consumption, obesity and related diseases, this work can be used to understand the implications of these policies in the retail setting.

To characterise different meal types by examining the contribution of specific meals to the total intakes and the nutritional quality of each meal.

A cross-sectional analysis was conducted based on dietary data collected using 4-d dietary record. Diet quality was assessed by the Healthy Eating Index-2015 and Nutrient-Rich Food Index 9.3.

Japan.

Adults aged 20–81 years (n 639).

Diet quality was, on average, highest for dinner, followed, in order, by lunch, breakfast and snacks. Breakfast, lunch, dinner and snacks, on average, accounted for 21 %, 32 %, 40 % and 11 % of total energy intake, respectively. For many nutrients, the percentage contribution to total intake did not vary within each meal, broadly in line with that for energy: 18–24 % for breakfast, 26–35 % for lunch, 35–49 % for dinner and 4–15 % for snacks. However, intakes of many foods largely depended on one meal type. The foods mainly eaten at dinner were potatoes, pulses, total vegetables, fish, meat and alcoholic beverages (52–70 %), in contrast to noodles (58 %) at lunch and bread (71 %) and dairy products (50 %) at breakfast. The foods mainly eaten at snacks were confectioneries (79 %) and sugar-sweetened beverages (52 %). Conversely, rice and eggs were more evenly distributed across three main meals (19–41 % and 30–38 %, respectively), while fruit and non-energetic beverages were more evenly distributed across all meal types (17–30 % and 19–35 %, respectively).

These findings provide the background information on each meal type in Japanese and may help inform the development of meal-based guidelines and public health messages.

To investigate perceptions of iTaukei Fijian women and men around diet and the ability to consume a healthy diet.

Six focus groups were conducted with women and men separately. Six to ten women and men participated in each group. Discussions were recorded, transcribed, translated and thematically analysed. Themes were mapped to an intersectionality framework to aid interpretation.

Four villages in Viti Levu, Fiji.

Twenty-two women and twenty-four men.

Seven overarching themes were identified, including generational changes in food behaviour, strong-gendered beliefs around food and food provision, cultural and religious obligations around food, the impact of environmental change on the ability to consume a healthy diet, perceptions of the importance of food, food preferences and knowledge. Participants across focus groups identified that it was the ‘duty’ of women to prepare food for their families. However, some women reflected on this responsibility being unbalanced with many women now in the formal workforce. Changes between generations in food preferences and practices were highlighted, with a perception that previous generations were healthier. Power dynamics and external factors, such as environmental changes, were identified by women and men as crucial influences on their ability to eat a healthy diet.

Embedded traditional perceptions of gendered roles related to nutrition were misaligned with other societal and environmental changes. Given factors other than gender, such as broader power dynamics and environmental factors were identified as influencing diet, viewing nutrition-related issues through an intersectional lens is important to inform equitable food policy in Fiji.

We examined the trends over time and the factors associated with malnutrition among adolescent girls in Ghana.

Cross-sectional analysis from 3 nationwide Ghana Demographic and Health Surveys conducted in 2003 (n 983), 2008 (n 955) and 2014 (n 857). We used Cox proportional hazard models with sample weighting to model the prevalence ratio (PR) of malnutrition.

Countrywide, covering rural and urban areas in Ghana.

Non-pregnant adolescent girls aged 15–19 years.

Compared with 2003, thinness declined marginally (PR 0·88 (95 % CI 0·45, 1·73)) in 2008 and in 2014 (PR 0·71 (95 % CI 0·38, 1·56)). Stunting declined marginally by 19 % in 2008 (PR 0·81 (95 % CI 0·59, 1·12)), flattening out in 2014 (PR 0·81 (95 % CI 0·57, 1·17)). We found an increasing trend of overweight/obesity with the PR peaking in 2014 (PR 1·39 (95 % CI 1·02, 1·88)) compared to 2003. The anaemia prevalence remained severe without a clear trend. A low level of education of the adolescent girl was positively associated with stunting. Increasing age was positively associated with stunting but inversely associated with thinness and anaemia. Girls who ever bore a child were more likely to be anaemic compared to those who never did. A lower level of household wealth and a unit increase in household size was negatively associated with overweight/obesity. Urban dwelling girls were less likely to be stunted.

The stagnant burden of under-nutrition and rising over-nutrition emphasise the need for double-duty actions to tackle malnutrition in all its forms in Ghanaian adolescent girls.

To examine the associations of trimester-specific maternal prenatal carbohydrate (CHO) intake with offspring adiposity and metabolic health during peripuberty.

Prospective cohort study in which maternal dietary intake was collected via validated FFQ during each trimester. Offspring adiposity and metabolic biomarkers were evaluated at age 8–14 years. We used multivariable linear regression to examine associations between total energy-adjusted maternal CHO intake and offspring BMI z-score, skinfold thickness and metabolic syndrome risk z-score calculated as the average of waist circumference, fasting glucose, fasting C-peptide, TAG:HDL and systolic blood pressure + diastolic blood pressure/2.

Mexico City, Mexico

237 mother–child pairs in the Early Life Exposure in Mexico to Environmental Toxicants cohort.

We found non-linear associations of maternal CHO intake during pregnancy with offspring metabolic health during peripuberty. After adjusting for maternal age, and child age, sex and pubertal status, children whose mothers were in the fourth v. first quartile of total CHO intake during the third trimester had 0·42 (95 % CI –0·01, 0·08) ng/ml lower C-peptide and 0·10 (95 % CI –0·02, 0·22) units lower C-peptide insulin resistance (CP-IR). We found similar magnitude and direction of association with respect to net CHO intake during the first trimester and offspring C-peptide and CP-IR. Maternal CHO intake during pregnancy was not associated with offspring adiposity.

In this study of mother–child pairs in Mexico City, children born to women in the highest quartile of CHO intake during pregnancy had lowest C-peptide and CP-IR during peripuberty. Additional research is warranted to replicate and identify mechanisms.

To identify factors influencing Black immigrant mothers’ perceptions and concerns about child weight and to compare children’s diet quality according to these perceptions and concerns.

Mothers’ perceptions and concerns about child weight were assessed with sex-specific figure rating scales and the Child Feeding Questionnaire, respectively. Participants’ weights and heights were measured and characterised using WHO references. Children’s dietary intakes were estimated using a 24-h dietary recall. Children’s diet quality was evaluated using the relative proportion of their energy intake provided by ultra-processed products, which were identified with the NOVA classification. χ2 tests, multivariate logistic regressions and t tests were performed.

Ottawa, Ontario, Canada.

Black immigrant mothers of Sub-Saharan African and Caribbean origin (n 186) and their 6–12-year-old children.

Among mothers, 32·4 % perceived their child as having overweight while 48·4 % expressed concerns about child weight. Girls and children with overweight or obesity were significantly more likely to be perceived as having overweight by their mothers than boys and normal-weight children, respectively. Mothers of children living with obesity, but not overweight, were significantly more likely to be concerned about their child’s weight than mothers of normal-weight children. Children’s diet quality did not differ according to mothers’ perceptions and concerns.

Children’s gender and weight status were major determinants of perceptions and concerns about child weight among Black immigrant mothers. Including knowledge about mothers’ perceptions and concerns about child weight will help nutrition professionals develop interventions tailored to specific family needs within the context of their cultural backgrounds.

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.

Consumption of sugar-sweetened beverages (SSB) is associated with overweight and obesity in children and adolescents. Although existing research confirms the significance of economic and social factors as determinants of SSB intake, comparative studies on political factors and cross-national analyses are lacking. Research indicates that including women in the process of political decision-making promotes healthcare and child protection. This study examined how women’s parliamentary representation influences children’s and adolescents’ SSB intake compared with adults.

The study used cross-national food and beverage intake data from the Global Dietary Database. The outcome measurement was SSB consumption (g/day) for different population groups. We modelled SSB intake as a function of age groups, women’s parliamentary representation at the national level (the independent variable), regime types (the contextual factor) and import tariffs on SSB (the mediator) using country and time-fixed effects regression models.

One-hundred eighty-five countries across three waves from 2005 to 2015.

Different population groups.

The impact of female representation on reducing SSB consumption is more prevalent in children and adolescents than in adults. Furthermore, the effect of women’s parliamentary representation on SSB consumption among children and adolescents is conditional on a country’s democratic status. Finally, the marginal effect decreases when import tariffs on SSB are considered a link in a causal chain. No changes in adult SSB intake are statistically significant.

The findings suggest that the presence of women in the legislature can have a substantial impact on child and adolescent health.

To identify the relationship between preschool children’s dietary diversity and parents’ care behaviours related to their diet including contents of foods and snacks, mealtime practice and parent–child communication.

Cross-sectional study. Data were extracted from the National Nutrition Survey on Preschool Children in 2015 by Japan’s Ministry of Health, Labour and Welfare.

The distribution of food diversity score (FDS) (maximum of eight points) was confirmed. The participants were divided into higher (≥4 points) and lower (≤3 points) food diversity groups. A comparison between the two groups examined parents’ socio-economic status, children’s health and living conditions, and parental care concerning children’s diets (thirteen items). A multiple regression analysis was performed relating FDS to the factors of parental socio-economic status and child health, and a logistic regression analysis was conducted to identify factors of parental care related to the higher food diversity group.

2143 persons from households with children aged 2–6 years.

Parental care concerning children’s diets was the factor most strongly associated with children’s FDS. Those factors most strongly associated with higher food diversity were nutritional balance of foods (OR: 1·76; 95 % CI 1·44, 2·16; P < 0 0001), snack contents (OR: 1·41; 95 % CI 1·07, 1·86; P = 0·014) and regular mealtimes (OR: 1·30; 95 % CI 1·08, 1·55; P = 0·005).

The findings indicate the importance of parents paying attention to the contents of children’s foods and snacks, ensuring that children eat regularly, and increasing the diversity of their diets.

The double burden of malnutrition (DBM) has become an emerging public health issue in many low- and middle-income countries. This study aims to provide important evidence for the prevalence of different types of DBM at the national and subnational levels in Bangladesh.

The study utilised data from the latest Bangladesh Demographic and Health Survey (BDHS) 2017–2018. Multivariable logistic regression was performed to identify the sociodemographic factors associated with DBM.

Nationally representative cross-sectional survey.

8697 mothers aged 15 to 49 years with <5 children.

The overall prevalence of the DBM was approximately 21 %, where the prevalence of overweight mother (OWM) & stunted child/wasted child/underweight child (SC/WC/UWC) and underweight mother (UWM) & overweight child (OWC) was 13·35 % and 7·69 %, respectively, with a higher prevalence among urban households (OWM & SC/WC/UWC = 14·22 %; UWM & OWC = 10·58 %) in Bangladesh. High inequality was observed among UWM & OWC dyads, concentration index (CI) = -0·2998, while low level of inequality of DBM were observed for OWM & SC (CI = 0·0153), OWM & WC (CI = 0·1165) and OWM & UWC (CI = 0·0135) dyads. We observed that the age and educational status of the mother, number of children, fathers’ occupation, size and wealth index of the household, and administrative division were significantly associated with all types of DBM.

Health policymakers, concerned authorities and various stakeholders should stress the prevalence of DBM issues and take necessary actions aimed at identifying and addressing the DBM in Bangladesh.

We examined the association between serum antioxidant status and mortality from influenza and pneumonia in US adults.

Serum concentrations of antioxidants included vitamin C, vitamin A, vitamin E, sum of α- and β-carotene, β-cryptoxanthin, lutein + zeaxanthin and lycopene. We computed total antioxidant capacity (TAC) as a measure of composite antioxidant status in serum. Survey-weighted Cox proportional hazard models were used to compute hazard ratios (HR) and 95 % CI comparing quartiles of each antioxidant and TAC.

Data from the US National Health and Nutrition Examination Survey (NHANES)-III.

A total of 7428 NHANES-III participants ≥45 years of age.

With a weighted-median follow-up of 16·8 years, 154 participants died from influenza/pneumonia. After adjustment for covariates, serum vitamin C, the sum of α- and β-carotene and TAC were nonlinearly associated with influenza/pneumonia mortality, with the statistically significant smallest HR at the third quartile v. the first quartile (HR = 0·38 (95 % CI: 0·19, 0·77), 0·29 (0·16, 0·51) and 0·30 (0·15, 0·59), respectively). HR comparing the fourth v. the first quartiles were weaker and nonsignificant: 0·57 (95 % CI: 0·27, 1·17), 0·70 (0·41, 1·19) and 0·65 (0·31, 1·35), respectively. Serum lycopene had a monotonic association with influenza/pneumonia mortality (HR = 0·43 (95 % CI: 0·23, 0·83) comparing the fourth v. the first quartile, Pfor trend = 0·01).

The current study suggests that antioxidant intake as reflected by serum concentrations may reduce mortality risk from influenza or pneumonia in the US general population. These findings warrant further confirmation in other populations with different settings (e.g. a shorter-term association with influenza infection).