Folate plays an important role in the synthesis and methylation of DNA as a cofactor in one-carbon metabolism. Inadequate folate intake has been linked to adverse health events. However, comparable information on dietary folate intake across European countries has never been reported. The objective of the present study was to describe the dietary folate intake and its food sources in ten countries in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. A cross-sectional analysis was conducted in 36 034 participants (aged 35–74 years) who completed a single 24 h dietary recall using a computerised interview software program, EPIC-Soft® (International Agency for Research on Cancer, Lyon). Dietary folate intake was estimated using the standardised EPIC Nutrient DataBase, adjusted for age, energy intake, weight and height and weighted by season and day of recall. Adjusted mean dietary folate intake in most centres ranged from 250 to 350 μg/d in men and 200 to 300 μg/d in women. Folate intake tended to be lower among current smokers and heavier alcohol drinkers and to increase with educational level, especially in women. Supplement users (any types) were likely to report higher dietary folate intake in most centres. Vegetables, cereals and fruits, nuts and seeds were the main contributors to folate intake. Nonetheless, the type and pattern of consumption of these main food items varied across the centres. These first comparisons of standardised dietary folate intakes across different European populations show moderate regional differences (except the UK health conscious group), and variation by sex, educational level, smoking and alcohol-drinking status, and supplement use.

The present experimental study was the first to investigate the impact of a remote (non-existent) peer on children's food choice of familiar v. unfamiliar low- and high-energy-dense food products. In a computer task, children (n 316; 50·3 % boys; mean age 7·13 (sd 0·75) years) were asked to choose between pictures of familiar and unfamiliar foods in four different choice blocks using the following pairs: (1) familiar v. unfamiliar low-energy-dense foods (fruits and vegetables), (2) familiar v. unfamiliar high-energy-dense foods (high sugar, salt and/or fat content), (3) familiar low-energy-dense v. unfamiliar high-energy-dense foods and (4) unfamiliar low-energy-dense v. familiar high-energy-dense foods. Participants who were not in the control group were exposed to the food choices (either always the familiar or always the unfamiliar food product) of a same-sex and same-age fictitious peer who was supposedly completing the same task at another school. The present study provided insights into children's choices between (un)familiar low- and high-energy-dense foods in an everyday situation. The findings revealed that the use of fictitious peers increased children's willingness to try unfamiliar foods, although children tended to choose high-energy-dense foods over low-energy-dense foods. Intervention programmes that use peer influence to focus on improving children's choice of healthy foods should take into account children's strong aversion to unfamiliar low-energy-dense foods as well as their general preference for familiar and unfamiliar high-energy-dense foods.

Improving health through better nutrition of the population may contribute to enhanced efficiency and sustainability of healthcare systems. A recent expert meeting investigated in detail a number of methodological aspects related to the discipline of nutrition economics. The role of nutrition in health maintenance and in the prevention of non-communicable diseases is now generally recognised. However, the main scope of those seeking to contain healthcare expenditures tends to focus on the management of existing chronic diseases. Identifying additional relevant dimensions to measure and the context of use will become increasingly important in selecting and developing outcome measurements for nutrition interventions. The translation of nutrition-related research data into public health guidance raises the challenging issue of carrying out more pragmatic trials in many areas where these would generate the most useful evidence for health policy decision-making. Nutrition exemplifies all the types of interventions and policy which need evaluating across the health field. There is a need to start actively engaging key stakeholders in order to collect data and to widen health technology assessment approaches for achieving a policy shift from evidence-based medicine to evidence-based decision-making in the field of nutrition.

Evidence suggests a small beneficial effect of dietary protein on blood pressure (BP), especially for plant protein. We examined the relationship between several types of dietary protein (total, plant, animal, dairy, meat and grain) and the risk of hypertension in a general population of 3588 Dutch adults, aged 26–65 years, who were free of hypertension at baseline. Measurements were done at baseline and after 5 and 10 years of follow-up. Hazard ratios (HR), with 95 % CI, for incident hypertension were obtained in tertiles of energy-adjusted protein, using time-dependent Cox regression models. Models were adjusted for age, sex, BMI, education, smoking, baseline systolic BP, dietary confounders and protein from other sources (if applicable). Mean BP was 118/76 mmHg at baseline. Protein intake was 85 (sd 22) g/d (approximately 15 % of energy) with 62 % originating from animal sources. The main sources of protein were dairy products (28 %), meat (24 %) and grain (19 %). During the follow-up, 1568 new cases of hypertension were identified (44 % of the participants). Energy-adjusted intake of total protein, plant protein and animal protein was not significantly associated with hypertension risk (all HR approximately 1·00, P>0·60). Protein from grain showed a significant inverse association with incident hypertension, with a HR of 0·85 (95 % CI 0·73, 1·00, Ptrend = 0·04) for the upper tertile ( ≥ 18 g/d) v. the lower tertile ( < 14 g/d), whereas dairy protein and meat protein were not associated with incident hypertension. In conclusion, higher intake of grain protein may contribute to the prevention of hypertension, which warrants confirmation in other population-based studies and randomised controlled trials.

There is limited knowledge about dietary patterns and nutrient/food intake during pregnancy in women with lifetime eating disorders (ED). The objective of the present study was to determine patterns of food and nutrient intake in women with lifetime ED as part of an existing longitudinal population-based cohort: the Avon Longitudinal Study of Parents and Children. Women with singleton pregnancies and no lifetime psychiatric disorders other than ED (n 9723) were compared with women who reported lifetime (ever) ED: (anorexia nervosa (AN, n 151), bulimia nervosa (BN, n 186) or both (AN+BN, n 77)). Women reported usual food consumption using a FFQ at 32 weeks of gestation. Nutrient intakes, frequency of consumption of food groups and overall dietary patterns were examined. Women with lifetime ED were compared with control women using linear regression and logistic regression (as appropriate) after adjustment for relevant covariates, and for multiple comparisons. Women with lifetime ED scored higher on the ‘vegetarian’ dietary pattern; they had a lower intake of meat, which was compensated by a higher consumption of soya products and pulses compared with the controls. Lifetime AN increased the risk for a high ( ≥ 2500 g/week) caffeine consumption in pregnancy. No deficiencies in mineral and vitamin intake were evident across the groups, although small differences were observed in macronutrient intakes. In conclusion, despite some differences in food group consumption, women with lifetime ED had similar patterns of nutrient intake to healthy controls. Important differences in relation to meat eating and vegetarianism were highlighted, as well as high caffeine consumption. These differences might have an important impact on fetal development.

Age-related changes in leptin and adiponectin levels remain controversial, being affected by inconsistent normalisation for adiposity and body fat distribution in the literature. In a cross-sectional study on 210 Caucasians (127 women, eighty-three men, 18–78 years, BMI 16·8–46·8 kg/m2), we investigated the effect of age on adipokine levels independent of fat mass (FM measured by densitometry), visceral and subcutaneous adipose tissue volumes (VAT and SAT assessed by whole-body MRI). Adiponectin levels increased with age in both sexes, whereas leptin levels decreased with age in women only. There was an age-related increase in VAT (as a percentage of total adipose tissue, VAT%TAT), associated with a decrease in SATlegs%TAT. Adiposity was the main predictor of leptin levels, with 75·1 % of the variance explained by %FM in women and 76·6 % in men. Independent of adiposity, age had a minor contribution to the variance in leptin levels (5·2 % in women only). The variance in adiponectin levels explained by age was 14·1 % in women and 5·1 % in men. In addition, independent and inverse contributions to the variance in adiponectin levels were found for truncal SAT (explaining additional 3·0 % in women and 9·1 % in men) and VAT%TAT (explaining additional 13·0 % in men). In conclusion, age-related changes in leptin and adiponectin levels are opposite to each other and partly independent of adiposity and body fat distribution. Normalisation for adiposity but not for body fat distribution is required for leptin. Adiponectin levels are adversely affected by subcutaneous and visceral trunk fat.

Studies have suggested that moderate alcohol consumption is associated with a reduced risk of CVD and premature mortality in individuals with diabetes mellitus. However, history of alcohol consumption has hardly been taken into account. We investigated the association between current alcohol consumption and mortality in men and women with diabetes mellitus accounting for past alcohol consumption. Within the European Prospective Investigation into Cancer and Nutrition (EPIC), a cohort was defined of 4797 participants with a confirmed diagnosis of diabetes mellitus. Men and women were assigned to categories of baseline and past alcohol consumption. Hazard ratios (HR) and 95 % CI for total mortality were estimated with multivariable Cox regression models, using light alcohol consumption (>0–6 g/d) as the reference category. Compared with light alcohol consumption, no relationship was observed between consumption of 6 g/d or more and total mortality. HR for >6–12 g/d was 0·89 (95 % CI 0·61, 1·30) in men and 0·86 (95 % CI 0·46, 1·60) in women. Adjustment for past alcohol consumption did not change the estimates substantially. In individuals who at baseline reported abstaining from alcohol, mortality rates were increased relative to light consumers: HR was 1·52 (95 % CI 0·99, 2·35) in men and 1·81 (95 % CI 1·04, 3·17) in women. The present study in diabetic individuals showed no association between current alcohol consumption >6 g/d and mortality risk compared with light consumption. The increased mortality risk among non-consumers appeared to be affected by their past alcohol consumption rather than their current abstinence.

Obesity affects a large number of people around the world and appears to be the result of changes in food intake, eating habits and physical activity levels. Changes in dietary patterns and physical exercise are therefore strongly recommended to treat obesity and its complications. The present study tested the hypothesis that obesity and metabolic changes produced by a cafeteria diet can be prevented with dietary changes and/or physical exercise. A total of fifty-six female Wistar rats underwent one of five treatments: chow diet; cafeteria diet; cafeteria diet followed by a chow diet; cafeteria diet plus exercise; cafeteria diet followed by a chow diet plus exercise. The duration of the experiment was 34 weeks. The cafeteria diet resulted in higher energy intake, weight gain, increased visceral adipose tissue and liver weight, and insulin resistance. The cafeteria diet followed by the chow diet resulted in energy intake, body weight, visceral adipose tissue and liver weight and insulin sensitivity equal to that of the controls. Exercise increased total energy intake at week 34, but produced no changes in the animals' body weight or adipose tissue mass. However, insulin sensitivity in animals subjected to exercise and the diet was similar to that of the controls. The present study found that exposure to palatable food caused obesity and insulin resistance and a diet change was sufficient to prevent cafeteria diet-induced obesity and to maintain insulin sensitivity at normal levels. In addition, exercise resulted in normal insulin sensitivity in obese rats. These results may help to develop new approaches for the treatment of obesity and type 2 diabetes mellitus.

Food regulation aims to protect public health through a safe and nutritious food supply produced by a compliant food industry. Food standards of developed countries generally do not regulate protein content or protein quality because the risk of dietary protein inadequacy in their national populations is very low. Protein is nevertheless regulated for reasons of product quality or protein labelling or to minimise assessed health risks associated with consumption of certain animal- and vegetable-protein foods; analogue products that extend or simulate commonly available animal-protein foods; and special purpose foods such as infant formula and foods, supplementary and medical foods, and foods for weight loss. The extent and approach to protein regulation varies greatly among jurisdictions but where it occurs, it is applied through minimum and sometimes maximum limits on protein content or quality measures or both using an inter-related approach. Protein quality measures range from amino acid profiles and digestibility corrected scores to protein rating, a rat bioassay and reference proteins not further described. Regulatory methods for protein quality determination are referenced to the published scientific literature or developed nationally. Internationally, the Codex Alimentarius regulates the protein content and quality of some foods. The Codex approach varies according to the food but is similar to the approaches used in national and regional food regulation. This paper provides a comparison of the regulation of protein in foods using examples from the food regulations of Australia New Zealand, Canada, the European Union, the United States of America and the Codex Alimentarius.

Given the limitations associated with the measurement of food intake, we aimed to determine the reliability of a food menu to measure energy intake (EI) and macronutrient intake within the laboratory and under free-living conditions. A total of eight men and eight women (age 25·74 (sd 5·9) years, BMI 23·7 (sd 2·7) kg/m2) completed three identical in-laboratory sessions (ILS) and three out-of-laboratory sessions (OLS). During the ILS, participants had ad libitum access to a variety of foods, which they chose from a menu every hour, for 5 h. For the OLS, the foods were chosen from the menu at the start of the day and packed into containers to bring home. There were no significant differences in total EI (6118·6 (sd 2691·2), 6678·8 (sd 2371·3), 6489·5 (sd 2742·9) kJ; NS) between the three ILS and three OLS (6816·0 (sd 2713·2), 6553·5 (sd 2364·5), 6456·4 (sd 3066·8) kJ; NS). Significant intraclass correlations (ICC) for total energy (r 0·77, P < 0·0001), carbohydrate (r 0·81, P < 0·0001), dietary fat (r 0·54, P < 0·0001) and protein (r 0·81, P < 0·0001) intakes for the ILS and significant ICC for total energy (r 0·85, P < 0·0001), carbohydrate (0·85, P < 0·0001), dietary fat (0·72 P < 0·0001) and protein (0·80, P < 0·0001) intakes for the OLS were noted. The average within-subject CV for total EI was 18·3 (sd 10·0) and 16·1 (sd 10·3) % for the ILS and OLS, respectively, with a pleasantness rating for foods consumed of 124 (sd 14) mm out of 150 mm (83 %). Overall, the food menu produces a relatively reliable measure of EI inside and outside the laboratory. The results also underscore the difficulties in capturing a representative image of food intake given the relatively high day-to-day variation in the amount and composition of foods consumed.

Trans-fatty acids (TFA) have adverse effects on blood lipids, but whether TFA from different sources are associated with risk of CVD remains unresolved. The objective of the present study was to evaluate the association between TFA intake from partially hydrogenated vegetable oils (PHVO), partially hydrogenated fish oils (PHFO) and ruminant fat (rTFA) and risks of death of CVD, CHD, cerebrovascular diseases and sudden death in the Norwegian Counties Study, a population-based cohort study. Between 1974 and 1988, participants were examined for up to three times. Fat intake was assessed with a semi-quantitative FFQ. A total of 71 464 men and women were followed up through 2007. Hazard ratios (HR) and 95 % CI were estimated with Cox regression. Energy from TFA was compared to energy from all other sources, carbohydrates or unsaturated cis-fatty acids with different multivariable models. During follow-up, 3870 subjects died of CVD, 2383 of CHD, 732 of cerebrovascular diseases and 243 of sudden death. Significant risks, comparing highest to lowest intake category, were found for: TFA from PHVO and CHD (HR 1·23 (95 % CI 1·00, 1·50)) and cerebrovascular diseases (HR 0·65 (95 % CI 0·45, 0·94)); TFA from PHFO and CVD (HR 1·14 (95 % CI 1·03, 1·26)) and cerebrovascular diseases (HR 1·32 (95 % CI 1·04, 1·69)); and rTFA intake and CVD (HR 1·30 (95 % CI 1·05, 1·61)), CHD (HR 1·50 (95 % CI 1·11, 2·03)) and sudden death (HR 2·73 (95 % CI 1·19, 6·25)) in women. These associations with rTFA intake were not significant in men (Pinteraction ≥ 0·01). The present study supports that TFA intake, irrespective of source, increases CVD risk. Whether TFA from PHVO decreases risk of cerebrovascular diseases warrants further investigation.

It has been hypothesised that, at non-limiting water oxygen conditions, voluntary feed intake (FI) in fish is limited by the maximal physiological capacity of oxygen use (i.e. an ‘oxystatic control of FI in fish’). This implies that fish will adjust FI when fed diets differing in oxygen demand, resulting in identical oxygen consumption. Therefore, FI, digestible energy (DE) intake, energy balance and oxygen consumption were monitored at non-limiting water oxygen conditions in Nile tilapia fed diets with contrasting macronutrient composition. Diets were formulated in a 2 × 2 factorial design in order to create contrasts in oxygen demand: two ratios of digestible protein (DP):DE (‘high’ v. ‘low’); and a contrast in the type of non-protein energy source (‘starch’ v. ‘fat’). Triplicate groups of tilapia were fed each diet twice daily to satiation for 48 d. FI (g DM/kg0·8 per d) was significantly lower (9·5 %) in tilapia fed the starch diets relative to the fat diets. The DP:DE ratio affected DE intakes (P < 0·05), being 11 % lower with ‘high’ than with ‘low’ DP:DE ratio diets, which was in line with the 11·9 % higher oxygen demand of these diets. Indeed, DE intakes of fish showed an inverse linear relationship with dietary oxygen demand (DOD; R2 0·81, P < 0·001). As hypothesised (‘oxystatic’ theory), oxygen consumption of fish was identical among three out of the four diets. Altogether, these results demonstrate the involvement of metabolic oxygen use and DOD in the control of FI in tilapia.

Obesity is associated with impaired health-related quality of life (QOL) and reduced productivity; less is known about the effect of dietary factors. The present study investigated how dietary behaviours, physical activity and BMI relate to weight-specific QOL and work productivity. The study was conducted in thirty-one small blue-collar and service industry worksites in Seattle. Participants were 747 employees (33·5 % non-White). Measures included self-reported servings of fruits and vegetables, dietary behaviours such as fast food consumption, Godin free-time physical activity scores, measured height and weight, Obesity and Weight-Loss QOL (OWLQOL) scores, and Work Limitations Questionnaire scores. Baseline data were analysed using linear mixed models separately for men (n 348) and women (n 399), since sex modified the effects. BMI was negatively associated with OWLQOL in both women (P < 0·001) and men (P < 0·001). The linear effect estimate for OWLQOL scores associated with a one-category increase in BMI was 30 (95 % CI 25, 44) % for women and 14 (95 % CI 10, 17) % for men. BMI was positively associated with productivity loss only in women (exp(slope) = 1·46, 95 % CI 1·02, 2·11, P = 0·04). Eating while doing another activity was negatively associated with OWLQOL scores in men (P = 0·0006, independent of BMI) and with productivity in women (P = 0·04, although the effect diminished when adjusting for BMI). Fast-food meals were associated with decreased productivity in men (P = 0·038, independent of BMI). The results suggest that obesogenic dietary behaviours and higher BMI are associated with decreased QOL and productivity to different degrees in women and men.

As stress is hypothesised to influence dietary behaviour, the relationship between perceived stress and diet quality in European adolescents was investigated. Within the Healthy Lifestyle in Europe by Nutrition in Adolescence study, adolescents (n 704, aged 12–17 years) from schools in five European cities (Ghent, Stockholm, Zaragoza, Athens and Vienna) completed a 2 d 24 h dietary recall assessment and an Adolescent Stress Questionnaire. Measurements and information were taken on height, weight, pubertal stage, parental education level, the level of moderate-to-vigorous physical activity (MVPA) and sleep duration. The Diet Quality Index for Adolescents (DQI-A) was calculated from the dietary data, which comprised three components reflecting dietary diversity, quality and equilibrium. Hierarchical linear models were performed to investigate the relationship between the adolescents' level of perceived stress and the DQI-A and its components, adjusting for relevant covariates (age, BMI z-score, pubertal stage and parental education). These models were additionally adjusted for MVPA or sleep duration. In both boys and girls, perceived stress was a significant independent negative predictor for their overall DQI-A. This inverse relationship was observed for all dietary components, except for dietary diversity in boys, and it was unaltered when additionally adjusted for MVPA or sleep duration. The observed inverse relationship between stress and diet quality within these European adolescents supports the hypothesis that stress influences dietary behaviour, thus emphasising the need for preventive stress-coping strategies for adolescents.