The subject of protein quality assessment of foods and diets was addressed at the Codex Committee on Vegetable Proteins (1982–1989), FAO/WHO (1989, 2001) and WHO/FAO (2002) expert reviews. These international developments are summarized in this manuscript. In 1989, a Joint FAO/WHO Expert Consultation on Protein Quality Evaluation reviewed knowledge of protein quality assessment of foods, and specifically evaluated amino acid score corrected for protein digestibility, the method recommended by the Codex Committee on Vegetable Proteins. The report of the Consultation published in 1991 concluded that the Protein Digestibility-corrected Amino Acid Score (PDCAAS) method was the most suitable approach for routine evaluation of protein quality for humans. The Consultation recognized that the amino acid scoring pattern proposed by FAO/WHO/UNU (1985) for preschool children was at that time the most suitable pattern for calculating PDCAAS for all ages except infants in which case the amino acid composition of human milk was recommended to be the basis of the scoring pattern. The rat balance method was considered as the most suitable practical method for predicting protein digestibility by humans. Since its adoption by FAO/WHO (1991), the PDCAAS method has been criticised for a number of reasons. The FAO/WHO (2001) Working Group on analytical issues related to protein quality assessed the validity of criticisms of the PDCAAS method. While recognizing a distinct regulatory use of protein quality data, the Working Group recommended that the PDCAAS method may be inappropriate for the routine prediction of protein quality of novel and sole source foods which contain high levels of anti nutritional factors; and that for regulatory purposes, the method should be revised to permit values of >100 for high quality proteins. In evaluating the recommendations of the Working Group, the WHO/FAO (2002) Expert Consultation on Protein and Amino Acid Requirements endorsed the PDCAAS method with minor modifications to the calculation method but also raised several issues. These included the calculation of scoring patterns; prediction of amino acid digestibility by faecal and ileal methods; reduced bioavailability of lysine in processed proteins; truncation of the amino acid score and consequent PDCAAS value; protein digestibility as a first limiting factor in determining the overall available dietary nitrogen; and the calculation of amino acid score for a dietary protein mixture. These concerns were considered particularly important in relation to the regulatory aspects of protein quality of foods, and their resolution was urgently recommended through a new separate expert review.

The aim of the present study was to examine the associations of obesity, percentage body fat and visceral fat mass with body Fe status in a representative sample of 1493 schoolchildren aged 9–13 years. Anthropometric, body composition, biochemical, clinical (Tanner stage, age of menarche) and dietary intake data were collected. Fe deficiency (ID) was defined as transferrin saturation (TS) < 16 %; and Fe-deficiency anaemia (IDA) as ID with Hb < 120 g/l. Obese boys and girls and those in the highest quartiles of percentage body fat mass had significantly higher levels of serum ferritin (P ≤ 0·05) compared to their normal-weight peers and those in the corresponding lowest quartiles. Similarly, obese boys and girls and those in the highest quartiles of percentage body fat and visceral fat mass had significantly lower levels of TS (P ≤ 0·05) compared to normal-weight children and those in the corresponding lowest quartiles. The prevalence of ID and IDA was significantly higher in boys and girls in the highest quartiles of percentage body fat than in peers in the lowest quartile. Higher quartiles of percentage body fat and visceral fat mass were the main significant predictors of ID in boys, after controlling for other important confounders, with OR of 2·48 (95 % CI, 1·26, 4·88) and 2·12 (95 % CI, 1·07, 4·19), respectively. Similar significant associations were observed for girls. In conclusion, percentage body fat and visceral fat mass were positively associated with ID in both sexes of preadolescents. These associations might be attributed to the chronic inflammation induced by excess adiposity.

Olive oil is well known for its cardioprotective properties; however, epidemiological data showing that olive oil consumption reduces incident CHD events are still limited. Therefore, we studied the association between olive oil and CHD in the European Prospective Investigation into Cancer and Nutrition (EPIC) Spanish cohort study. The analysis included 40 142 participants (38 % male), free of CHD events at baseline, recruited from five EPIC-Spain centres from 1992 to 1996 and followed up until 2004. Baseline dietary and lifestyle information was collected using interview-administered questionnaires. Cox proportional regression models were used to assess the relationship between validated incident CHD events and olive oil intake (energy-adjusted quartiles and each 10 g/d per 8368 kJ (2000 kcal) increment), while adjusting for potential confounders. During a 10·4-year follow-up, 587 (79 % male) CHD events were recorded. Olive oil intake was negatively associated with CHD risk after excluding dietary mis-reporters (hazard ratio (HR) 0·93; 95 % CI 0·87, 1·00 for each 10 g/d per 8368 kJ (2000 kcal) and HR 0·78; 95 % CI 0·59, 1·03 for upper v. lower quartile). The inverse association between olive oil intake (per 10 g/d per 8368 kJ (2000 kcal)) and CHD was more pronounced in never smokers (11 % reduced CHD risk (P = 0·048)), in never/low alcohol drinkers (25 % reduced CHD risk (P < 0·001)) and in virgin olive oil consumers (14 % reduced CHD risk (P = 0·072)). In conclusion, olive oil consumption was related to a reduced risk of incident CHD events. This emphasises the need to conserve the traditional culinary use of olive oil within the Mediterranean diet to reduce the CHD burden.

The aim of the present study was to calculate the distribution of total iodine intake among Flemish preschoolers and to identify the major sources contributing to iodine intake. A simulation model using a combination of deterministic and probabilistic techniques was utilised. Scenario analyses were performed to assess iodine intake via dairy products, industrially added iodised salt in bread and discretionarily added iodised household salt. Relevant data from 3-d estimated dietary records of 696 preschoolers 2·5–6·5 years old were used. Usual iodine intakes were calculated using the Iowa State University method. With a more generalised utilisation of iodised salt in bread (44 % of the bakers in 2011 instead of 12 % in 2002), mean iodine intake increased from 159 to 164 μg/d using the McCance and Widdowson's food composition table and from 104 to 109 μg/d using the German food composition table. The percentage of preschoolers with an iodine intake below the estimated average requirement (65 μg/d) decreased from 5–12 to 4–9 %, while the percentage of preschoolers with an iodine intake above the tolerable upper intake level (300 μg/d) remained constant (0·3–4 %). Mean iodine intake via food supplements was 4·2 μg/d (total population) and 16·9 μg/d (consumers only). Both in 2002 and 2011, sugared dairy products, milk and iodised salt (21·4, 13·1, and 8·7 %, respectively in 2011) were the main contributors to total iodine intake. In conclusion, dietary iodine intake could still be improved in Flemish preschoolers. The use of adequately iodised household salt and the more generalised use of iodised salt by bakers should be further encouraged.

Few studies have examined nutrition transition in children in China. Our aim, in the present study, was to examine temporal trends in dietary energy, fat, carbohydrate and protein intake in Chinese children aged 7–17 years. The analysis used individual level, consecutive 3 d dietary recall data from seven rounds of the China Health and Nutrition Surveys in 1991 (n 2714), 1993 (n 2542), 1997 (n 2516), 2000 (n 2142), 2004 (n 1341), 2006 (n 1072) and 2009 (n 996). Mixed-effect models were constructed to obtain adjusted means and to examine trends after adjusting for intra-class correlation within clusters and for covariates including age, sex, urban/rural residence and income. From 1991 to 2009, daily energy intake steadily declined from 9511·0 to 7658·2 kJ (P < 0·0001). There was a steady decline in daily carbohydrate intake from 382·5 to 254·1 g (P < 0·0001), and in the proportion of energy from carbohydrate from 66·7 to 56·8 % (P < 0·0001). In contrast, daily fat intake steadily increased from 54·8 to 66·0 g (P < 0·0001), as did the proportion of energy from fat from 21·5 to 30·0 % (P < 0·0001). The proportion of children who consumed a diet with more than 30 % of energy from fat increased from 20·1 to 49·4 % (P < 0·0001). The proportion of energy from protein increased from 11·8 to 13·1 % (P < 0·0001), although daily protein intake dropped from 66·2 to 58·0 g (P < 0·0001). Our data suggest that Chinese children have been undergoing a rapid nutrition transition to a high-fat diet.

Studies of individual nutrients or foods have revealed much about dietary influences on bone. Multiple food or nutrient approaches, such as dietary pattern analysis, could offer further insight but research is limited and largely confined to older adults. We examined the relationship between dietary patterns, obtained by a posteriori and a priori methods, and bone mineral status (BMS; collective term for bone mineral content (BMC) and bone mineral density (BMD)) in young adults (20–25 years; n 489). Diet was assessed by 7 d diet history and BMD and BMC were determined at the lumbar spine and femoral neck (FN). A posteriori dietary patterns were derived using principal component analysis (PCA) and three a priori dietary quality scores were applied (dietary diversity score (DDS), nutritional risk score and Mediterranean diet score). For the PCA-derived dietary patterns, women in the top compared to the bottom fifth of the ‘Nuts and Meat’ pattern had greater FN BMD by 0·074 g/cm2 (P = 0·049) and FN BMC by 0·40 g (P = 0·034) after adjustment for confounders. Similarly, men in the top compared to the bottom fifth of the ‘Refined’ pattern had lower FN BMC by 0·41 g (P = 0·049). For the a priori DDS, women in the top compared to the bottom third had lower FN BMD by 0·05 g/cm2 after adjustments (P = 0·052), but no other relationships with BMS were identified. In conclusion, adherence to a ‘Nuts and Meat’ dietary pattern may be associated with greater BMS in young women and a ‘Refined’ dietary pattern may be detrimental for bone health in young men.

Epidemiological and other evidence suggests that vitamin D may be protective against several chronic diseases. Assessing vitamin D status in epidemiological studies, however, is challenging given finite resources and limitations of commonly used approaches. Using multivariable linear regression, we derived predicted 25-hydroxyvitamin D (25(OH)D) scores based on known determinants of circulating 25(OH)D, including age, race, UV-B radiation flux at residence, dietary and supplementary vitamin D intakes, BMI, physical activity, alcohol intake, post-menopausal hormone use (women only) and season of blood draw, in three nationwide cohorts: the Nurses' Health Study, Nurses' Health Study II and the Health Professionals Follow-up Study. The model r2 for each cohort ranged from 0·25 to 0·33. We validated the prediction models in independent samples of participants from these studies. Mean measured 25(OH)D levels rose with increasing decile of predicted 25(OH)D score, such that the differences in mean measured 25(OH)D between the extreme deciles of predicted 25(OH)D were in the range 8·7–12·3 ng/ml. Substituting predicted 25(OH)D scores for measured 25(OH)D in a previously published case–control analysis of colorectal cancer yielded similar effect estimates with OR of approximately 0·8 for a 10 ng/ml difference in either plasma or predicted 25(OH)D. We conclude that these data provide reasonable evidence that a predicted 25(OH)D score is an acceptable marker for ranking individuals by long-term vitamin D status and may be particularly useful in research settings where biomarkers are not available for the majority of a study population.

In the present study, we investigated the prevalence of anaemia and Fe deficiency anaemia (IDA) and explored the relationship between Helicobacter pylori infection and IDA in adolescent girls. A total of 1037 adolescent girls from Suihua, China were enrolled. Hb, serum ferritin (SF), serum transferrin receptor (sTfR) and serum IgG antibodies to H. pylori were measured. Participants with IDA and co-existing H. pylori infection (n 80) who had an intake of >25 mg/d of Fe were assigned randomly to the intervention and control groups. Patients in the intervention group were administered a 12-week course of oral EDTA–Na–Fe (60 mg Fe/dose, three times a week) and a 2-week course of colloidal bismuth subcitrate, amoxicillin and metronidazole. Subjects in the control group were administered EDTA–Na–Fe alone. Hb, SF and sTfR were reassessed 3 months after the 12-week regimen ended. Prevalence of anaemia, Fe deficiency (defined as SF < 12·0 μg/l), IDA and H. pylori infection in the population of 1037 was 19·5, 40·4, 17·1 and 31·2 %, respectively. The prevalence of H. pylori infection in the IDA group was 46·9 %, while the non-anaemic group had 28·1 % prevalence. A significant increase in Hb and SF and a decrease in sTfR value were found in the intervention group and the H. pylori-negative group. Findings suggest that IDA is still one of the prominent problems in adolescent girls. There is an association between H. pylori infection and IDA. Treatment of H. pylori infection is associated with a more rapid response to oral Fe therapy.

Response to dietary fat manipulation is highly heterogeneous, yet generic population-based recommendations aimed at reducing the burden of CVD are given. The APOE epsilon genotype has been proposed to be an important determinant of this response. The present study reports on the dietary strategy employed in the SATgenɛ (SATurated fat and gene APOE) study, to assess the impact of altered fat content and composition on the blood lipid profile according to the APOE genotype. A flexible dietary exchange model was developed to implement three isoenergetic diets: a low-fat (LF) diet (target composition: 24 % of energy (%E) as fat, 8 %E SFA and 59 %E carbohydrate), a high-saturated fat (HSF) diet (38 %E fat, 18 %E SFA and 45 %E carbohydrate) and a HSF-DHA diet (HSF diet with 3 g DHA/d). Free-living participants (n 88; n 44 E3/E3 and n 44 E3/E4) followed the diets in a sequential design for 8 weeks, each using commercially available spreads, oils and snacks with specific fatty acid profiles. Dietary compositional targets were broadly met with significantly higher total fat (42·8 %E and 41·0 %E v. 25·1 %E, P ≤ 0·0011) and SFA (19·3 %E and 18·6 %E v. 8·33 %E, P ≤ 0·0011) intakes during the HSF and HSF-DHA diets compared with the LF diet, in addition to significantly higher DHA intake during the HSF-DHA diet (P ≤ 0·0011). Plasma phospholipid fatty acid analysis revealed a 2-fold increase in the proportion of DHA after consumption of the HSF-DHA diet for 8 weeks, which was independent of the APOE genotype. In summary, the dietary strategy was successfully implemented in a free-living population resulting in well-tolerated diets which broadly met the dietary targets set.

In 1989 the Joint FAO/WHO Expert Consultation on Protein Quality Evaluation recommended the use of the Protein Digestibility Corrected Amino Acid Score (PDCAAS) method for evaluating protein quality. In calculating PDCAAS, the limiting amino acid score (i.e., ratio of first limiting amino acid in a gram of target food to that in a reference protein or requirement) is multiplied by protein digestibility. The PDCAAS method has now been in use for 20 years. Research emerging during this time has provided useful data on various aspects of protein quality evaluation that has made a review of the current methods used in assessing protein quality necessary. This paper provides an overview of the use of the PDCAAS method as compared to other methods and addresses some of the key challenges that remain in regards to protein quality evaluation. Furthermore, specific factors influencing protein quality including the effects of processing conditions and preparation methods are presented. Protein quality evaluation methods and recommended protein intakes currently used in different countries vis-à-vis the WHO/FAO/UNU standards are further provided. As foods are frequently consumed in complement with other foods, the significance of the PDCAAS of single protein sources may not be evident, thus, protein quality of some key food groups and challenges surrounding the calculation of the amino acid score for dietary protein mixtures are further discussed. As results from new research emerge, recommendations may need to be updated or revised to maintain relevance of methods used in calculating protein quality.

Skipping meals is particularly common during adolescence and can have a detrimental effect on multiple aspects of adolescent health. Understanding the correlates of meal-skipping behaviours is important for the design of nutrition interventions. The present study examined maternal and best friends’ influences on adolescent meal-skipping behaviours. Frequency of skipping breakfast, lunch and dinner was assessed using a Web-based survey completed by 3001 adolescent boys and girls from years 7 and 9 of secondary schools in Victoria, Australia. Perceived best friend and maternal meal skipping, modelling of healthy eating (eating healthy food, limiting junk food, eating fruit and vegetables) and weight watching were assessed. Best friend and maternal factors were differentially associated with meal-skipping behaviours. For example, boys and girls who perceived that their best friend often skipped meals were more likely to skip lunch (OR = 2·01, 95 % CI 1·33, 3·04 and OR = 1·93, 95 % CI 1·41, 2·65; P < 0·001). Boys and girls who perceived that their mother often skipped meals were more likely to skip breakfast (OR = 1·48, 95 % CI 1·01, 2·15; P < 0·05 and OR = 1·93, 95 % CI 1·42, 2·59; P < 0·001) and lunch (OR = 2·05, 95 % CI 1·35, 3·12 and OR = 2·02, 95 % CI 1·43, 2·86; P < 0·001). Educating adolescents on how to assess and interpret unhealthy eating behaviours that they observe from significant others may be one nutrition promotion strategy to reduce meal-skipping behaviour. The involvement of mothers may be particularly important in such efforts. Encouraging a peer subculture that promotes regular consumption of meals and educates adolescents on the detrimental impact of meal-skipping behaviour on health may also offer a promising nutrition promotion strategy.

Novel ways to increase liking and intake of food are needed to encourage acceptance of healthier food. How enjoyable we remember food to have been is likely to be a significant predictor of food choice. Two studies examined whether remembered enjoyment of eating a food can be increased and whether this makes individuals more likely to eat that food in the future. In Study One, a simple manipulation of instructing participants to rehearse what they found enjoyable about a food immediately after eating it was used to increase remembered enjoyment (relative to controls). In a separate study; Study Two, the effect of increasing remembered enjoyment on food choice was tested by examining whether the manipulation to increase remembered enjoyment resulted in participants choosing to eat more of a food as part of a later buffet lunch. The experimental manipulation increased remembered enjoyment for the food (Study One). A change in remembered enjoyment was shown to have a significant effect on the amount of a food participants chose to eat the following day for lunch (Study Two). The present studies suggest that remembered enjoyment can be increased via a simple act of rehearsal, resulting in a later increase in the amount of food chosen and eaten. Interventions based on altering remembered enjoyment of healthy food choices warrant further investigation.

Fatty acids (FA) are known to have a number of immunological effects and, accordingly, may play a role in the development of allergic diseases. We investigated the effect of maternal intake of FA during pregnancy on the risk of allergic rhinitis, wheeze and atopic eczema in children aged 5 years. The present study analysed data from the Finnish Type 1 Diabetes Prediction and Prevention Nutrition Study, a population-based birth cohort study with a 5-year follow-up. Complete information on maternal diet (assessed by a validated FFQ) and International Study of Asthma and Allergies in Childhood-based allergic outcomes was available for 2441 children. Cox proportional regression and logistic regression were used for the analyses. After adjusting for potential confounding variables, high maternal consumption of butter and butter spreads (hazard ratio (HR) 1·33; 95 % CI 1·03, 1·71) and higher ratio of n-6:n-3 FA (HR 1·37; 95 % CI 1·07, 1·77) during pregnancy were associated with an increased risk of allergic rhinitis in the offspring by 5 years of age. High maternal intakes of total PUFA (HR 0·71; 95 % CI 0·52, 0·96) and α-linolenic FA (HR 0·73; 95 % CI 0·54, 0·98) were associated with a decreased risk of allergic rhinitis. However, these results lost their significance after adjustment for multiple comparisons. Overall, our data suggest that maternal consumption of butter, the ratio of n-6:n-3 FA and intake of PUFA and α-linolenic FA during pregnancy may be potential determinants of allergic rhinitis in the offspring.

Studies using 24 h urine collections need to incorporate ways to validate the completeness of the urine samples. Models to predict urinary creatinine excretion (UCE) have been developed for this purpose; however, information on their usefulness to identify incomplete urine collections is limited. We aimed to develop a model for predicting UCE and to assess the performance of a creatinine index using para-aminobenzoic acid (PABA) as a reference. Data were taken from the European Food Consumption Validation study comprising two non-consecutive 24 h urine collections from 600 subjects in five European countries. Data from one collection were used to build a multiple linear regression model to predict UCE, and data from the other collection were used for performance testing of a creatinine index-based strategy to identify incomplete collections. Multiple linear regression (n 458) of UCE showed a significant positive association for body weight (β = 0·07), the interaction term sex × weight (β = 0·09, reference women) and protein intake (β = 0·02). A significant negative association was found for age (β = − 0·09) and sex (β = − 3·14, reference women). An index of observed-to-predicted creatinine resulted in a sensitivity to identify incomplete collections of 0·06 (95 % CI 0·01, 0·20) and 0·11 (95 % CI 0·03, 0·22) in men and women, respectively. Specificity was 0·97 (95 % CI 0·97, 0·98) in men and 0·98 (95 % CI 0·98, 0·99) in women. The present study shows that UCE can be predicted from weight, age and sex. However, the results revealed that a creatinine index based on these predictions is not sufficiently sensitive to exclude incomplete 24 h urine collections.

The objective of the present study was to determine the proportion of adults meeting national recommendations for food and nutrient intake and to identify the demographic, socio-economic and behavioural factors that may contribute to weaken dietary compliance. ORISCAV-LUX is a cross-sectional study that took place in Luxembourg (2007–8). A representative stratified random sample of 1352 adults aged 18–69 years participated in the nationwide cardiovascular health survey. A FFQ was used to estimate food intake. Radar charts were built to compare graphically the compliance of the participants with different key dietary guidelines on the same set of axes. The thirteen food- and nutrient-based recommendations were scored and summed to create a recommendation compliance index (range − 0·5 to 14). Ordinal logistic regression analyses were performed to determine the factors contributing to poor dietary compliance. Several food- and nutrient-based guidelines were insufficiently respected compared with others. The greatest gaps occurred in the adherence to grain and dairy product consumption guidelines, as well as to total fat and notably to SFA recommendations. Age, country of birth, economic status, smoking status and subject's awareness of the importance of balanced meals emerged as independently associated with weak dietary compliance. Obese subjects conformed more to dietary recommendations compared with normal-weight subjects. The findings underscore the need for specific nutrition education messages along with targeted interventions. Efforts should be continued to increase population awareness of the importance of a healthy lifestyle and a balanced diet.

Many dietary recommendations include reduction of excessive intake of sugar-sweetened beverages (SSB) and other energy-rich beverages such as juices and alcohol. The present study examines surveys of both individual dietary intake data and household food expenditure surveys to provide a picture of patterns and trends in beverage intake and purchases in Great Britain from 1986 to 2009, and estimates the potential for pricing policy to promote more healthful beverage purchase patterns. In 2008–9, beverages accounted for 21, 14 and 18 % of daily energy intake for children aged 1·5–18 and 4–18 years, and adults (19–64 years), respectively. Since the 1990s, the most important shifts have been a reduction in consumption of high-fat dairy products and an increased consumption of fruit juices and reduced-fat milk among preschoolers, children and adolescents. Among adults, consumption of high-fat milk beverages, sweetened tea and coffee and other energy-containing drinks fell, but reduced-fat milk, alcohol (particularly beer) and fruit juice rose. In testing taxation as an option for shifting beverage purchase patterns, we calculate that a 10 % increase in the price of SSB could potentially result in a decrease of 7·5 ml/capita per d. A similar 10 % tax on high-fat milk is associated with a reduction of high-fat milk purchases by 5 ml/capita per d and increased reduced-fat milk purchase by 7 ml/capita per d. This analysis implies that taxation or other methods of shifting relative costs of these beverages could be a way to improve beverage choices in Great Britain.

We investigated whether repeated consumption of a low-energy-dense (LED; 208 kJ/100 g) or high-energy-dense (HED; 645 kJ/100 g) soup modifies expectations relating to the satiating capacity of the food, and its subsequent intake. In study 1, participants consumed either a novel-flavoured LED (n 32; 21 (sd 1·6) years, BMI 21·4 (sd 1·6) kg/m2) or HED soup (n 32; 21 (sd 1·6) years, BMI 21·3 (sd 1·7) kg/m2). Soup was served in a fixed amount on days 1–4 and ad libitum on day 5. ‘Expected satiation’ was measured on days 1, 2 and 5. Expected satiation did not change after repeated consumption of the LED or HED soup. Ad libitum intake did not differ between the LED (461 (sd 213) g) and HED soup (391 (sd 164) g). Only on day 1, expected satiation was higher for the HED soup than for the LED soup (P = 0·03), suggesting a role for sensory attributes in expected satiation. In study 2, thirty participants (21 (sd 1·6) years, BMI 21·3 (sd 1·7) kg/m2) performed a single measurement of expected satiation of the LED and HED soup, and four commercially available types of soup. Ratings on sensory attributes were associated with expected satiation. Results on expected satiation coincided with those of study 1. Thickness and intensity of taste were independently associated with expected satiation. Expectations may initially rely on sensory attributes and previous experiences, and are not easily changed.

α-Linolenic acid (18 : 3n-3) intake and linoleic acid (18 : 2n-6) intake have been associated with lower rates of CHD, though results have not been consistent. The relationship of these fatty acids with incident heart failure (HF) is not well established. We examined the hypothesis that women with higher intakes of 18 : 3n-3 and 18 : 2n-6 would have lower rates of HF hospitalisation and mortality. We measured 18 : 3n-3 and 18 : 2n-6 intake in 36 234 Swedish Mammography Cohort participants aged 48–83 years using FFQ and followed participants through Swedish inpatient and cause-of-death registers from 1 January 1998 until 31 December 2006. Cox models were used to calculate incidence rate ratios (RR) and 95 % CI. Because of multicollinearity, 18 : 3n-3 and 18 : 2n-6 were examined separately. Over 9 years, 596 women were hospitalised and fifty-five died due to HF. In models accounting for age and other covariates, the RR for HF comparing the top quintile of 18 : 3n-3 (median 1·50 g/d) with the bottom quintile (median 0·88 g/d) was 0·91 (95 % CI 0·71, 1·17, Ptrend = 0·41). The RR comparing the top quintile of 18 : 2n-6 (median 7·8 g/d) with the bottom quintile (median 4·6 g/d) was 1·14 (95 % CI 0·88, 1·46, Ptrend = 0·36). We did not find evidence for the interaction of 18 : 3n-3 and 18 : 2n-6 with each other or with long-chain n-3 fatty acids. In conclusion, these data do not support our hypothesis that 18 : 3n-3 and 18 : 2n-6 are associated with HF. However, these results may not be generalisable to populations with higher intakes of 18 : 3n-3.

The School Fruit and Vegetable Scheme (SFVS) provides children in government-run schools in England with a free piece of fruit or a vegetable each school day for the first 3 years of school. The present study examines the impact of the SFVS, in terms of its contribution towards the total daily intake of fruit and vegetables by children across England. Quantitative dietary data were collected from 2306 children in their third year of school, from 128 schools, using a 24 h food diary. The data were examined at different spatial scales, and variations in the impact of the scheme across areas with different socio-economic characteristics were analysed using a deprivation index and a geodemographic classification. The uptake of the SFVS and the total intake of fruit and vegetables by children varied across different parts of England. Participation in the SFVS was positively associated with fruit and vegetable consumption. That is, in any one area, those children who participated in the SFVS consumed more fruit and vegetables. However, children living in deprived areas still consumed less fruit and vegetables than children living in more advantaged areas: the mean daily frequency of fruit and vegetables consumed, and rates of consumption of fruit or vegetables five times or more per d, decreased as deprivation increased (r − 0·860; P = 0·001; r − 0·842; P = 0·002). So the SFVS does not eliminate the socio-economic gradient in fruit and vegetable consumption, but it does help to increase fruit and vegetable consumption in deprived (and affluent) areas.