To create a general framework for the simulation of intakes from mandatory or voluntary fortification, which will make outcomes of simulation studies more comparable and give insight on uncertainties.

A general framework was developed based on methods used in already published case studies of mandatory fortification. The framework was extended to be suitable for the simulation of voluntary fortification. Case studies of folic acid fortification were used to illustrate the general framework.

The developed framework consists of six steps. First, the definition of the fortification strategy (step 1), followed by the identification of potential carrier products (step 2), and the definition of fortification levels or ranges (step 3). Thereafter, virtual food/supplement composition data are created (step 4) and food/supplement consumption data are required (step 5). Finally, the intake of the functional ingredient from functional foods, other foods and dietary supplements is calculated during the simulation resulting in total habitual intake distributions (step 6).

Simulation of both mandatory and voluntary folic acid fortification in The Netherlands showed that the general framework is applicable. Also with incomplete data or data from different sources, the (habitual) intake distributions can be estimated using assumptions, statistical procedures or probabilistic modelling approaches. It is important that the simulation procedure is described well, so that an insight on uncertainties and knowledge gaps to be filled is given.

To quantify factors influencing iron supplementation compliance and haemoglobin (Hb) concentrations among pregnant women participating in an iron supplementation programme under routine field conditions.

Cross-sectional interviews and Hb measurements.

Albay and Sorsogon provinces, Bicol, Philippines.

Three hundred and forty-six pregnant women receiving iron supplements via the Philippine iron supplementation programme.

Women had a mean Hb concentration of 10.75 ± 1.43 g dl−1, and 56.4% were anaemic (Hb < 11.0 g dl−1). On average, the first prenatal visit occurred at nearly 4 months (3.80 ± 1.56). The ratio of visits to number of months pregnant was 0.51 ± 0.24. Self-reported consumption of pills received was 85% (0.85 ± 0.23), although pill counts suggested that consumption was 70% (0.70 ± 0.35). Using multiple regression, an earlier first prenatal visit and greater self-reported compliance were positively associated with Hb concentrations. Additionally, perceived health benefits from taking the supplements and higher health programme knowledge were positively associated with pill consumption, while experiencing side-effects and disliking the taste of the supplements were associated with lower pill consumption. A greater number of living children was negatively associated with the frequency of prenatal visits. The number of children was also directly negatively associated with Hb concentrations.

Compliance was positively related to Hb concentrations. Several factors associated with greater compliance were identified, including marital status, number of children, health programme knowledge, side-effects, perceived health benefits, and dislike of taste. Some of these factors may serve as avenues for interventions to increase compliance, and ultimately Hb concentrations.

To estimate the proportion of ‘healthy’ snack food and beverage choices available to an Australian consumer.

A survey of product Nutrition Information Panels (NIP) and product labels on snack foods and beverages offered for sale. Data on nutrient content were compared with criteria from different nutrient profile systems to estimate the proportion of items conforming to a ‘healthy’ choice.

A large supermarket in metropolitan Melbourne, Australia.

A consumer could choose from 1070 different snack foods and 863 different drinks. Flavour variety was more common in snacks (maximum thirteen per product) while variation in container size was more common for drinks (up to ten per product). Recommended serving size for snacks varied greatly (18–100 g) while the serving size for drinks frequently did not correspond to the size of the container. Depending on the nutrient profile system selected, only 9–22 % of snack foods presented for sale could be deemed ‘nutritious’ by multiple criteria. Similarly, only 14–27 % of beverages met ‘healthy’ criteria.

As one factor to help reduce the obesogenic environment, the supply balance needs to be shifted in favour of ‘healthier’ snack foods and beverages, e.g. by reformulation of many products by the food industry and their presentation in smaller, standardised portion-size packaging.

Being a single mother may have implications for health behaviours that can also affect the child. More information about the food intakes and body weights in single v. married/cohabiting mothers and in their children is needed. Psychological dimensions of eating behaviour and self-esteem are also of relevance to explore for single mothers and their children.

Food style patterns were assessed by self-reported consumption of fruits, vegetables, sweets and soft drinks. Eating behaviour was measured by the Dutch Eating Behaviour Questionnaire and self-esteem by the Harter self-perception scale. The participants were 1781 mothers and their 12-year-old children, of whom 278 mothers (16 %) were single.

Single mothers had lower intake of fruits and vegetables and lower self-worth compared to the married and cohabiting mothers, controlling for age, education and BMI. Although single mothers did not have a higher BMI, their daughters were heavier than girls from complete families. Daughters to single mothers furthermore had a higher intake of soft drinks, higher levels of restrained eating and lower self-worth. No such difference was found for the boys.

A lower sense of self-worth and lower intake of fruit and vegetables in single mothers could be seen in the context of the social disadvantages and less social support. Girls may be more inclined to be affected by family status than the boys, seen in a more unfortunate psychological pattern and a higher body weight. Boy’s health behaviours may be more unaffected by living in single families.

The purpose of this work was to identify dietary patterns in the past using cluster analysis of reported diet in childhood, and to assess predictors for dietary patterns in relation to ethnicity in the population in the Sámi core areas in Norway. The Sámis are an indigenous population living in the border areas of Norway, Sweden, Finland and Russia.

Population-based, cross-sectional study, using self-administered questionnaires. A food-frequency questionnaire covering selected food items eaten in childhood was used. The questionnaire also provided data on ethnicity.

This study was based on data collected from 7614 subjects participating in The Population Based Study of Health and Living Conditions in Areas with a Mixed Sámi and Norwegian Population (the SAMINOR study) who grew up in the SAMINOR geographical areas, i.e. areas with mixed Sámi and Norwegian populations in Norway.

Four dietary clusters were identified: a reindeer meat cluster; a cluster with high intakes of fish, traditional fish products and mutton, in addition to food sources from the local environment; a Westernised food cluster with high intakes of meat balls and sausages; and a cluster with a high intake of fish, but not any other foods in the questionnaire. The cluster distribution differed by ethnicity, but the effect of ethnicity on diet differed by coastal and inland residence.

Our study has shown that data gathered through the limited questionnaire could be used to group the study sample into different dietary clusters, which we believe will be useful for further research on relationships between diet in childhood and health in the Sámi core areas in Norway.

To compare whether serum lipids and their changes during a health education intervention are associated with the Leu7Pro polymorphism in the signal peptide part of neuropeptide Y (NPY) in children with normal weight and in those with overweight.

An intervention study.

A family-based intervention of risk factors for prevention of CHD in Finland.

Subjects were 443 children with a family history of CVD participating in family-based health education. The children were divided into two groups according to NPY genotype: children with Leu7/Pro7 or Pro7/Pro7 genotype (n 50) and children with Leu7/Leu7 genotype (n 393). The final sample of the follow-up study included 353 (80 %) children (Pro7 allelle carriers, n 43; Leu7/Leu7, n 310).

At baseline, the Leu7Pro polymorphism was not associated with serum lipid values after adjustment for body weight in boys or girls. There was a significant interaction of NPY genotype group by time and body weight (P = 0·043 for three-way interaction: time × NPY genotype × body weight) in LDL-cholesterol (LDL-C) concentration among boys. LDL-C decreased among boys with normal weight in both NPY groups and in overweight boys with the Leu7/Leu7 genotype, whereas it increased in overweight boys with the Pro7 allele. Two-way interaction (time × NPY genotype) showed no significant differences in changes of serum lipids between the NPY genotype groups among boys or girls.

The Leu7Pro polymorphism may be associated with dietary response to LDL-C concentration in overweight boys with a family history of early-onset CVD.

To report on the variety and total number of food items recorded by a true longitudinal group of urban black South African children (n = 143) from the Birth-to-Twenty Study at five interceptions at the ages of 5 (1995), 7 (1997), 9 (1999), 10 (2000) and 13 (2003) years, respectively.

Dietary intake was assessed using a semi-quantitative food-frequency questionnaire. Frequencies were calculated per week, for each interception and for all five interceptions combined, using SAS.

Five hundred and forty-six different individual food items were recorded 23 480 times for all five interceptions combined. The highest of 124 items was recorded in 1999 contributing 23% of the 546 items recorded. Each of the top 10 items (rice, stiff maize-meal porridge, chicken, sugar, sweets, tea, eggs, full-cream milk, carbonated beverages and oil) contributed between 2.5% and 3% and these items were recorded almost 600 times or more for all interceptions combined (n = 23 840). Rice and stiff maize-meal porridge were the top items recorded 684 and 676 times, both contributing 2.87% and 2.84%, respectively. The variety of food items and the ratio of the food groups to the total number of foods recorded in the present study were not significantly different but the denominators decreased over the five interceptions.

The variety of food items recorded did not vary between 1995 and 2003 – the fact that new items were not added to the questionnaire as the children grew older could have contributed to this phenomenon. However, there was a difference in the ranking of these items that may suggest a change in eating patterns.

To assess the nutritional quality of food aid delivered by food banks in France and to identify practical modifications to improve it.

National-level data were collected for all food aid distributed by French food banks in 2004, and its nutrient content per 2000 kcal was estimated and compared with French recommendations for adults. Starting with the actual donation and allowing new foods into the food aid donation, linear programming was used to identify the minimum changes required in the actual donation to achieve the French recommendations.

French food-bank-delivered food aid does not achieve the French recommendations for dietary fibre, ascorbic acid, vitamin D, folate, magnesium, docosahexaenoic acid, α-linolenic acid and the percentage of energy from saturated fatty acids. Linear programming analysis showed that these recommendations are achievable if more fruits, vegetables, legumes and fish were collected and less cheese, refined cereals and foods rich in fat, sugar and/or salt. In addition, new foods not previously collected are needed, particularly nuts, wholemeal bread and rapeseed oil. These changes increased the total edible weight (42%) and economic value (55%) of the food aid donation, with one-third of its edible weight coming from fruits and vegetables, one-third from staples, one-quarter from dairy products and approximately a tenth from meat/fish/eggs.

Important changes in the types and amounts of food collected will improve the nutritional quality of food-bank-delivered food aid in France. Such changes are recommended to improve the diets of deprived French populations.

To assess changes in the Fe and vitamin A status of the population of Nangweshi refugee camp associated with the introduction of maize meal fortification.

Pre- and post-intervention study using a longitudinal cohort.

Nangweshi refugee camp, Zambia.

Two hundred and twelve adolescents (10–19 years), 157 children (6–59 months) and 118 women (20–49 years) were selected at random by household survey in July 2003 and followed up after 12 months.

Maize grain was milled and fortified in two custom-designed mills installed at a central location in the camp and a daily ration of 400 g per person was distributed twice monthly to households as part of the routine food aid ration. During the intervention period mean Hb increased in children (0·87 g/dl; P < 0·001) and adolescents (0·24 g/dl; P = 0·043) but did not increase in women. Anaemia decreased in children by 23·4 % (P < 0·001) but there was no significant change in adolescents or women. Serum transferrin receptor (log10-transformed) decreased by −0·082 μg/ml (P = 0·036) indicating an improvement in the Fe status of adolescents but there was no significant decrease in the prevalence of deficiency (−8·5 %; P = 0·079). In adolescents, serum retinol increased by 0·16 μmol/l (P < 0·001) and vitamin A deficiency decreased by 26·1 % (P < 0·001).

The introduction of fortified maize meal led to a decrease in anaemia in children and a decrease in vitamin A deficiency in adolescents. Centralised, camp-level milling and fortification of maize meal is a feasible and pertinent intervention in food aid operations.

The present paper examines the relationship between social factors, food consumption during television viewing, and overall television viewing and how these are associated with BMI when the role of familial and social factors are considered in a population-based birth cohort of pre-school children from Québec (Canada).

The analyses were performed using data from the Longitudinal Study of Child Development in Québec (1998–2002) (LSCDQ). The study follows a representative sample (n 2103) of children born in 1998 in the Canadian province of Québec. A nutrition assessment was conducted on 1549 children aged 4·5 years and included a 24 h dietary recall, an eating behaviour and television viewing questionnaire, and a measurement of children’s heights and weights. Statistical analyses were performed.

Nearly one-quarter of children ate at least twice daily in front of the television. Children who consumed snacks while watching television on a daily basis had higher BMI than children who did so less frequently. Children who ate snacks in front of the television every day, or some times during the week, ate more carbohydrates (total), more fat and less protein, fewer fruits and vegetables, and drank soft drinks more often than children who never ate snacks in front of the television.

Health professionals should target parents of children at risk of overweight/obesity with focused strategies to help children change the types of foods consumed during television viewing and to reduce the time spent watching television, particularly during meal times, which may change children’s dietary intake and eating patterns.

To describe the relationship between dietary intake and different levels and types of physical activity (PA).

Cross-sectional evaluation of the EPIPorto study. Energy expenditure (metabolic energy equivalent tasks) and dietary intake during the past year were assessed using a PA questionnaire and a semi-quantitative food-frequency questionnaire, respectively.

Representative sample of adults in Porto, Portugal.

Data were analysed for 2404 Portuguese Caucasian adults, aged between 18 and 92 years.

For total PA, males who were active had significantly higher mean intake of energy (10·76 (2570·7) vs. 9·78 (2336·9) MJ/d (kcal/d), P < 0·001) and lower level of protein consumption (16·9 vs. 17·6 % of energy, P < 0·001) compared with sedentary males. In males, the association between total PA and energy intake remained after adjustment for age, education and body mass index. Similar results were observed when occupational activity was analysed. Concerning the energy expended in leisure time, in both genders, after adjustment for the previously described variables, a significant positive association was found between PA and intake of vitamin C (g/d): β = 0·12, 99 % confidence interval (CI) 0·02, 0·21 for females and β = 0·13, 99 % CI 0·03, 0·22 for males. Leisure-time activity in females was also positively associated with intakes of fibre, vitamin E, folate, calcium and magnesium, and negatively associated with saturated fat.

Higher levels of PA in leisure time were associated with higher intakes of micronutrients and lower intakes of saturated fat, particularly in females. For total and occupational PA, similar nutrient intake was observed between active and sedentary individuals.

To identify aetiological factors in anaemia and to explore knowledge, perceptions and attitudes towards anaemia.

Two cross-sectional surveys and sixteen focus group discussions.

The two regions with the highest prevalence of anaemia in Tunisia, Greater Tunis (GT) and the South West (SW).

Two representative samples of 687 (GT) and 729 (SW) women of reproductive age; 108 women were included in focus group discussions.

Among anaemic women, 63·4 % in the GT region and 80·2 % in the SW displayed iron deficiency (ID). Genetic haemoglobinopathies accounted for 10·0 % and 3·6 % of the cases of anaemia in the two regions, respectively. After adjustment for confounders, the major factors for iron-deficiency anaemia were low dietary Fe intake (OR = 5·0, 95 % CI 3·0, 8·4), drinking tea after eating (OR = 3·4, 95 % CI 2·0, 5·7) and pica (OR = 2·1, 95 % CI 1·1, 3·9). Most of the women related anaemia to the following causes: malnutrition, lack of hygiene, and their heavy workload and responsibilities in the household. Many women connected anaemia with hypotension. Few established a relationship between ID and anaemia. They had confidence in their doctor for treatment, but many complained they were not given sufficient information. Low dietary Fe intake, inappropriate food practices and inadequate perceptions contribute to the aetiology of anaemia in women.

These results point out to the need for a strategy combining food fortification, Fe supplementation for pregnant women, nutritional education for the general public and at-risk specific target groups, and training of health professionals.

To analyse the nutritional status component of the nutrition transition in Chile in relation to the evolution of obesity rates in all age groups until 2005, comparing these with the goals established by the Ministry of Health for the period 2000–2010.

A descriptive study which includes data on the nutritional status of the Chilean population categorised by age. The data originate from: (1) institutions which administer nutritional programmes – the National Board for Day-Care Centres (JUNJI) and the National Board for School Assistance and Scholarships (JUNAEB); (2) the Ministry of Health and the National Institute of Statistics; and (3) epidemiological studies which include adolescents and the elderly.

The prevalence of obesity in pre-school children attending JUNJI was 10.6% in 2005; by age group, it was 6% in 2-year-olds, 11% in 3-year-olds and 14% in 4-year-olds. Among schoolchildren in first grade, obesity prevalence was 18.5%. In pregnant women, obesity has increased from 12% in 1987 to 33% in 2004. For adults, the 2003 National Health Survey showed that the prevalence of obesity (body mass index (BMI) ≥ 30 kg m−2) was 22% and of morbid obesity (BMI≥40 kg m−2), 1.3%. Obesity varied according to gender and educational level, being higher among women (25% vs. 19% in men) and adults from low socio-economic levels. In the elderly there was a high prevalence of obesity in the 60–64 years age group for both men (35.6%) and women (44.1%), decreasing to 18% and 26%, respectively, in those aged 75 years and older.

The goals for the decade (2000–2010) consider a reduction of obesity rates from 10% to 7% in pre-school children attending JUNJI, and from 16% to 12% in schoolchildren attending first grade. For pregnant women, the goal is to reduce the prevalence from 32% to 28%. Despite the implementation of initiatives in nutrition and physical activity, these have been insufficient to shift the rising trend in obesity. The explanation could be that after a rapid rise in obesity in children and pregnant women between 1987 and 2000, a stabilisation period or a ‘plateau’ is observed. In that situation, very effective interventions are required to reduce obesity, because it is extremely difficult to reverse the trend. Some positive experiences are being implemented in Chile, but government priorities are not focused in health promotion. A comprehensive State Policy in health promotion, that includes the public and private sectors related with obesity, is needed to reverse this trend.

To identify dietary and lifestyle variables that may affect cognitive function in the elderly.

Population-based prospective cohort study.

General community residing in Athens and the surrounding Attica region of Greece.

A total of 732 men and women, 60 years or older, participating in the EPIC–Greece cohort (European Prospective Investigation into Cancer and Nutrition) and residing in the Attica region had sociodemographic, anthropometric, medical, dietary and lifestyle variables ascertained at enrolment (1993–1999). Six to 13 years later, cognitive function was evaluated through the Mini-Mental State Examination (MMSE) score and affective state through the Geriatric Depression Scale (GDS).

MMSE score was positively associated with years of formal education, height and physical activity and inversely with age, diabetes mellitus and GDS score (P < 0·05 for all). Among dietary variables, intake of PUFA was inversely associated with cognitive function and this association was largely accounted for by a similar association with seed oils. Adherence to the Mediterranean diet, as well as intake of olive oil, MUFA and SFA exhibited weakly positive but not significant associations.

Physical activity and early life factors as reflected in height are significant predictors of cognitive function in the elderly. Seed oil consumption may adversely affect cognition, whereas other nutritional factors do not appear to have a quantitatively large effect.

To identify the main knowledge gaps and to propose research lines that will be developed within the European Union-funded ‘Healthy Lifestyle in Europe by Nutrition in Adolescence’ (HELENA) project, concerning the nutritional status, physical fitness and physical activity of adolescents in Europe.

Review of the currently existing literature.

The main gaps identified were: lack of harmonised and comparable data on food intake; lack of understanding regarding the role of eating attitudes, food choices and food preferences; lack of harmonised and comparable data on levels and patterns of physical activity and physical fitness; lack of comparable data about obesity prevalence and body composition; lack of comparable data about micronutrient and immunological status; and lack of effective intervention methodologies for healthier lifestyles.

The HELENA Study Group should develop, test and describe harmonised and state-of-the-art methods to assess the nutritional status and lifestyle of adolescents across Europe; develop and evaluate an intervention on eating habits and physical activity; and develop and test new healthy food products attractive for European adolescents.

Childhood obesity is a growing public health problem. We have examined the association between sociodemographic profile and eating and physical activity patterns with overweight among primary-school students in Athens, Greece.

Cross-sectional study.

Eleven primary schools in the greater Athens area, Greece.

A total of 633 children aged 10–12 years (50 % boys, 50 % girls) were interviewed in person during spring 2003. Multivariate logistic regression was used to investigate the association between eating and physical activity patterns and overweight (≥85th sex- and age-specific BMI centile). Results are presented as odds ratios and 95 % confidence intervals.

Overweight was more common among girls than among boys (OR=1·73; 95% CI 1·11, 2·69) and substantially less common among children born outside Greece (OR=0·46; CI 0·22, 0·95). Reported physical activity (per 1·5 h per day) was unrelated to overweight (OR=0·97; CI 0·85, 1·12) but patent physical inactivity, operationalised as time spent watching television or working/playing with the computer (per 1·5 h per day) was a highly significant predictor of overweight (OR=1·20; CI 1·05, 1·36). Composition of diet was unrelated to overweight but the daily number of eating occasions, controlling for total energy intake, was significantly inversely associated with overweight (OR=0·61; CI 0·48, 0·76).

The principal factor underlying overweight among children in Athens appears to be the extended inactivity imposed by modern childhood lifestyles. An intriguing finding is that spreading a given energy intake over several eating occasions was inversely associated with the likelihood of childhood obesity.

To develop and validate a short food-frequency questionnaire to assess habitual dietary salt intake in South Africans and to allow classification of individuals according to intakes above or below the maximum recommended intake of 6 g salt day−1.

Cross-sectional validation study in 324 conveniently sampled men and women.

Repeated 24-hour urinary Na values and 24-hour dietary recalls were obtained on three occasions. Food items consumed by >5% of the sample and which contributed ≥50 mg Na serving−1 were included in the questionnaire in 42 categories. A scoring system was devised, based on Na content of one index food per category and frequency of consumption.

Positive correlations were found between Na content of 35 of the 42 food categories in the questionnaire and total Na intake, calculated from 24-hour recall data. Total Na content of the questionnaire was associated with Na estimations from 24-hour recall data (r = 0.750; P < 0.0001; n = 328) and urinary Na (r = 0.152; P = 0.0105; n = 284). Urinary Na was higher for subjects in tertile 3 than tertile 1 of questionnaire Na content (P < 0.05). Questionnaire Na content of <2400 and ≥2400 mg day−1 equated to a reference cut-off score of 48 and corresponded to mean (standard deviation) urinary Na values of 145 (68) and 176 (99) mmol day−1, respectively (P < 0.05). Sensitivity and specificity against urinary Na ≥100 and <100 mmol day−1 was 12.4% and 93.9%, respectively.

A 42-item food-frequency questionnaire has been shown to have content-, construct- and criterion-related validity, as well as internal consistency, with regard to categorising individuals according to their habitual salt intake; however, the devised scoring system needs to show improved sensitivity.

To look at trends in generalised (body mass index (BMI) ≥30 kg m–2) and abdominal (waist circumference (WC) >102 cm in men, >88 cm in women) obesity among adults between 1993 and 2003, and to evaluate their association with diabetes, hypertension and hypertension–diabetes co-morbidity (HDC) in England.

Analyses of nationally representative cross-sectional population surveys, the Health Survey for England (HSE).

Non-institutionalised men and women aged ≥35 years.

Interviewer-administered questionnaire (sociodemographic information, risk factors, doctor-diagnosed diabetes), measurements of height and weight to calculate BMI. WC and blood pressure measurements were taken by trained nurses.

Generalised obesity increased among men from 15.8% in 1993 to 26.3% in 2003, and among women from 19.3% to 25.8%. Abdominal obesity also increased in both sexes (men: 26.2% in 1993 to 39.0% in 2003; women: 32.4% to 47.0%). In 1994, 1998 and 2003, generalised and abdominal obesity were independently associated with risk of hypertension, diabetes and HDC. The odds of diabetes associated with generalised obesity in 1994, 1998 and 2003 were 1.62, 2.26 and 2.62, respectively, in women and 1.24, 1.82 and 2.10, respectively, in men. Similar differences were observed for hypertension and HDC. Men and women with abdominal obesity also showed a higher risk for diabetes, hypertension and HDC than those with a normal WC.

If current trends in obesity continue then the risk of related morbidities may also increase. This will impact on cardiovascular disease morbidity and mortality, with cost implications for the health service. Therefore there is an urgent need to control the epidemic of obesity.

To assess the perceived outcomes associated with diet/food intake in the general adult population.

The Food Benefits Assessment (FBA©) questionnaire was developed from subjects’ verbatim transcripts (n 18) and after comprehension tests (n 5). Normal-weight (n 130) and overweight (n 67) subjects then completed the final questionnaire twice, 7 d apart. Psychometric properties were assessed, including construct validity by principal components analysis (PCA), concurrent validity (Spearman coefficient) with the Short Form-36 scale (SF-36), known-group validity by comparing FBA dimension scores according to lifestyle and clinical variables, internal consistency reliability (Cronbach’s α) and test–retest reproducibility in stable subjects over 1 week (intraclass correlation coefficient, ICC).

PCA and Multitrait analysis confirmed the final version of the FBA comprising forty-one items split into seven dimensions (vitality; digestive comfort; physical appearance; well-being; snacking; disease prevention; aesthetics). All dimensions displayed good item convergent validity (0·44 to 0·80), good concurrent validity (highest correlation between well-being dimension of FBA and mental health scale of SF-36, r = 0·83) and good known-group validity and reproducibility (ICC ≥ 0·76); internal consistency reliability was good to excellent (Cronbach’s α = 0·79 to 0·91).

The FBA is the first valid and reliable questionnaire that allows the assessment of diet effects and impact as perceived by subjects. It is a good candidate in the nutrition field for further use in specific population settings and with a particular food or daily diet. Linguistically validated English (UK and US) and German versions of the questionnaire are available.