Understanding the nutritional demands on serving military personnel is critical to inform training schedules and dietary provision. Troops deployed to Afghanistan face austere living and working environments. Observations from the military and those reported in the British and US media indicated possible physical degradation of personnel deployed to Afghanistan. Therefore, the present study aimed to investigate the changes in body composition and nutritional status of military personnel deployed to Afghanistan and how these were related to physical fitness. In a cohort of British Royal Marines (n 249) deployed to Afghanistan for 6 months, body size and body composition were estimated from body mass, height, girth and skinfold measurements. Energy intake (EI) was estimated from food diaries and energy expenditure measured using the doubly labelled water method in a representative subgroup. Strength and aerobic fitness were assessed. The mean body mass of volunteers decreased over the first half of the deployment ( − 4·6 (sd 3·7) %), predominately reflecting fat loss. Body mass partially recovered (mean +2·2 (sd 2·9) %) between the mid- and post-deployment periods (P< 0·05). Daily EI (mean 10 590 (sd 3339) kJ) was significantly lower than the estimated daily energy expenditure (mean 15 167 (sd 1883) kJ) measured in a subgroup of volunteers. However, despite the body mass loss, aerobic fitness and strength were well maintained. Nutritional provision for British military personnel in Afghanistan appeared sufficient to maintain physical capability and micronutrient status, but providing appropriate nutrition in harsh operational environments must remain a priority.

To determine the prevalence of household food insecurity in New Zealand (NZ), eight food security statements were included in the 1997 National Nutrition Survey of adults. Rasch model analysis was performed to determine whether each food security statement (addressing a food security attribute) was discrete and could be ranked on a unidimensional scale. The NZ model had marginal ‘household’ reliability (0·60–0·66), good item separation (17·20–17·77) and item infit/outfit values between 0·8 and 1·25. Indices could be ranked by level of severity and represent the experience of household food insecurity in NZ. Categories of food security were assigned and used to predict food choice, and energy and nutrient intakes. Compared with fully secure/almost fully secure households, those that were moderately secure or of low security were less likely to consume the recommended daily servings of fruit and vegetables, and more likely to consume fatty meats. Intake of total fat, saturated, monounsaturated and polyunsaturated fat, cholesterol, lactose and vitamin B12 increased with lower levels of food security. Intakes of glucose, fructose and vitamin C were highest in the fully secure/almost fully secure category. This unique eight-component food security measurement tool has less respondent burden than the US Core Food Security Measure. The relationships between the level of food insecurity and food choice and nutrient intakes illustrate that the most food-insecure households have less healthy diets. This relatively brief population-specific measurement tool is suitable to monitor population food security status, and is a useful marker of nutritional status.

Gene polymorphisms provide a means to obtain unconfounded associations between carotenoids and various health outcomes. In the present study, we tested whether gene polymorphisms and gene scores linked to low serum carotenoid status are related to metabolic disturbance and depressive symptoms in African-American adults residing in Baltimore city, MD, using cross-sectional data from the Healthy Aging in Neighborhoods of Diversity across the Life Span study (age range 30–64 years, n 873–994). We examined twenty-four SNP of various gene loci that were previously shown to be associated with low serum carotenoid status (SNPlcar). Gene risk scores were created: five low specific-carotenoid risk scores (LSCRS: α-carotene, β-carotene, lutein+zeaxanthin, β-cryptoxanthin and lycopene) and one low total-carotenoid risk score (LTCRS: total carotenoids). SNPlcar, LSCRS and LTCRS were entered as predictors for a number of health outcomes. These included obesity, National Cholesterol Education Program Adult Treatment Panel III metabolic syndrome and its components, elevated homeostatic model assessment of insulin resistance, C-reactive protein, hyperuricaemia and elevated depressive symptoms (EDS, Center for Epidemiologic Studies-Depression score ≥ 16). Among the key findings, SNPlcar were not associated with the main outcomes after correction for multiple testing. However, an inverse association was found between the LTCRS and HDL-cholesterol (HDL-C) dyslipidaemia. Specifically, the α-carotene and β-cryptoxanthin LSCRS were associated with a lower odds of HDL-C dyslipidaemia. However, the β-cryptoxanthin LSCRS was linked to a higher odds of EDS, with a linear dose–response relationship. In summary, gene risk scores linked to low serum carotenoids had mixed effects on HDL-C dyslipidaemia and EDS. Further studies using larger African-American population samples are needed.

To evaluate the effects of synbiotic supplementation on insulin resistance and lipid profile in individuals with the metabolic syndrome, we conducted a randomised, double-blind, placebo-controlled pilot study on thirty-eight subjects with the metabolic syndrome; they were supplemented with either synbiotic capsules containing 200 million of seven strains of friendly bacteria plus fructo-oligosaccharide or placebo capsules twice a day for 28 weeks. Both the synbiotic (G1) and the placebo (G2) groups were advised to follow an energy-balanced diet and physical activity recommendations. Parameters related to the metabolic syndrome and insulin resistance were measured every 7 weeks during the course of the study. After 28 weeks of treatment, the levels of fasting blood sugar and insulin resistance improved significantly in the G1 group (P< 0·001). Both the G1 and G2 groups exhibited significant reductions in TAG levels ( − 71·22 v. − 10·47 mg/dl ( − 0·80 v. − 0·12 mmol/l) respectively; P< 0·001) and total cholesterol levels ( − 21·93 v. − 14·2 mg/dl ( − 0·57 v. − 0·37 mmol/l) respectively; P= 0·01), as well as increases in HDL levels (+7·7 v. +0·05 mg/dl (+0·20 v. +>0·01 mmol/l) respectively; P< 0·001). The mean differences observed were greater in the G1 group. No significant changes were observed in LDL levels, waist circumference, BMI, metabolic equivalent of task and energy intake between the groups. The present results indicate that synbiotic supplementation increases the efficacy of diet therapy in the management of the metabolic syndrome and insulin resistance.

Little is known about the mediating effects of the determinants of fruit and vegetable (FV) intake in school-based interventions that promote FV intake, and few studies have examined the impact of the degree of implementation on the effects of an intervention. The present study examined whether the degree of implementation of an intervention had an effect on children's fruit or vegetable intake and determined possible mediators of this effect. The study is part of the European PRO GREENS intervention study which aimed to develop effective strategies to promote consumption of fruit and vegetables in schoolchildren across Europe. Data from 727 Finnish children aged 11 years were used. The baseline study was conducted in spring 2009 and the follow-up study 12 months later. The intervention was conducted during the school year 2009–2010. The effects were examined using multilevel mediation analyses. A high degree of implementation of the intervention had an effect on children's fruit intake. Knowledge of recommendations for FV intake and liking mediated the association between a high degree of implementation of the intervention and an increase in the frequency of fruit intake. Knowledge of recommendations for FV intake and bringing fruits to school as a snack mediated the association between a low degree of implementation of the intervention and an increase in the frequency of fruit intake. Overall, the model accounted for 34 % of the variance in the change in fruit intake frequency. Knowledge of recommendations acted as a mediator between the degree of implementation of the intervention and the change in vegetable intake frequency. In conclusion, the degree of implementation had an effect on fruit intake, and thus in future intervention studies the actual degree of implementation of interventions should be assessed when considering the effects of interventions.

High blood pressure (BP) variability, which may be an important determinant of hypertensive end-organ damage, is emerging as an important predictor of cardiovascular health. Dietary antioxidants can influence BP, but their effects on variability are yet to be investigated. The aim of the present study was to assess the effects of vitamin E, vitamin C and polyphenols on the rate of daytime and night-time ambulatory BP variation. To assess these effects, two randomised, double-blind, placebo-controlled trials were performed. In the first trial (vitamin E), fifty-eight individuals with type 2 diabetes were given 500 mg/d of RRR-α-tocopherol, 500 mg/d of mixed tocopherols or placebo for 6 weeks. In the second trial (vitamin C–polyphenols), sixty-nine treated hypertensive individuals were given 500 mg/d of vitamin C, 1000 mg/d of grape-seed polyphenols, both vitamin C and polyphenols, or neither (placebo) for 6 weeks. At baseline and at the end of the 6-week intervention, 24 h ambulatory BP and rate of measurement-to-measurement BP variation were assessed. Compared with placebo, treatment with α-tocopherol, mixed tocopherols, vitamin C and polyphenols did not significantly alter the rate of daytime or night-time systolic BP, diastolic BP or pulse pressure variation (P>0·05). Treatment with the vitamin C and polyphenol combination resulted in higher BP variation: the rate of night-time systolic BP variation (P= 0·022) and pulse pressure variation (P= 0·0036) were higher and the rate of daytime systolic BP variation was higher (P= 0·056). Vitamin E, vitamin C or grape-seed polyphenols did not significantly alter the rate of BP variation. However, the increase in the rate of BP variation suggests that the combination of high doses of vitamin C and polyphenols could be detrimental to treated hypertensive individuals.

Dyslipidaemia, hypertension and low-grade inflammation increase the risk of CVD. In the present meta-analysis, we examined whether adherence to a healthy Nordic diet, also called the Baltic Sea diet, may associate with a lower risk of these cardiometabolic risk factors. In 2001–2007, three cross-sectional Finnish studies were conducted: the Dietary, Lifestyle and Genetic Determinants of Obesity and Metabolic Syndrome study (n 4776); Health 2000 Survey (n 5180); Helsinki Birth Cohort Study (n 1972). The following parameters were assessed in these three studies: blood pressure, total, HDL- and LDL-cholesterol, TAG and high-sensitivity C-reactive protein (hs-CRP); a validated FFQ was used to assess the participants' dietary intakes. The Baltic Sea Diet Score (BSDS) was developed based on the healthy Nordic diet. All studies assessed confounding variables, such as physical activity and BMI, based on standardised questionnaires and measurements. The random-effects meta-analysis provided summary estimates for OR and 95 % CI by the BSDS quintiles. In the meta-analysis, the risk of elevated hs-CRP concentration was lower among men (OR 0·58, 95 % CI 0·43, 0·78) and women (OR 0·73, 95 % CI 0·58, 0·91) in the highest BSDS quintile than among those in the lowest BSDS quintile. In contrast, the risk of lowered HDL-cholesterol concentration was higher among women (OR 1·67, 95 % CI 1·12, 2·48) in the highest BSDS quintile than among those in the lowest BSDS quintile. However, no other associations were found. In conclusion, the associations between the adherence to the healthy Nordic diet and cardiometabolic risk factors are equivocal. Longitudinal studies are needed to further examine this hypothesis.

The present study evaluated the effect of different levels of energy restriction on metabolic parameters in obese ponies. Relative weight changes, markers of lipid metabolism and oxidant/antioxidant balance were monitored. A total of eighteen obese (body condition score ≥ 7/9) Shetland ponies were studied over a 23·5-week trial, which was divided into three periods. The first period involved a 4-week adaptation period in which each animal was fed 100 % of their maintenance energy requirements needed to maintain a stable obese body weight (MERob). This was followed by a 16·5-week weight-loss period in which ponies were assigned to receive either 100 % (control group, CONTROL), 80 % (slow weight-loss (SLOW) group) or 60 % (rapid weight-loss (RAPID) group) of their MERob. During the 3-week end-phase period, all ponies were again fed 100 % of their MERob. Relative weight loss was higher in the RAPID group (P< 0·001) compared with the SLOW group. No linear relationship was found as a doubling of the percentage of energy restriction was accompanied by a tripling of the percentage of weight loss. Relative weight gain afterwards in the end-phase period was higher in the RAPID group (P< 0·001) compared with the SLOW and CONTROL groups. During the weight-loss period, TAG and NEFA concentrations were highest in the RAPID group, as were α-tocopherol and ferric-reducing ability of plasma concentrations. After 8 weeks of weight loss, the concentrations of advanced oxidation protein products were higher in the RAPID group compared with the SLOW and CONTROL groups (P< 0·001). In conclusion, the level of energy restriction influences the extent of changes in oxidant/antioxidant balance. Practically, more severe energy restriction regimens may be associated with a greater regain of weight after the restriction period.

Excess Na intake and insufficient K intake are well-known risk factors for CVD. International comparative studies have reported that Japan has the highest intake of Na and the lowest intake of K in the world. However, no recent study has precisely assessed Na and K intakes in Japanese adults. In the present study, Na and K intakes were estimated from two 24 h urine collections implemented in twenty-three out of forty-seven prefectures in Japan. Apparently healthy men (n 384) and women (n 376), aged 20 to 69 years, who had been working in welfare facilities were recruited, with data collection conducted in February and March 2013. The mean Na excretion was 206·0 mmol/d in men and 173·9 mmol/d in women. The respective values of K excretion were 51·6 and 47·2 mmol/d. The excretion of both Na and K varied considerably among the prefectures, and was higher in subjects with a higher BMI. In contrast, only K excretion was associated with age. After estimating the usual intakes of Na and K, it was found that none of the male subjects met the recommended Na intake values of the WHO, and that only 3·2 % met those of the Japanese government. The respective values for females were 0·1 and 5·0 %. For K intake, 7·5 % of the total subjects met the recommended values of the WHO and 21·7 % met those of the Japanese government. These findings suggest that there is an urgent need for the development of an effective intervention programme to reduce Na intake and promote K intake in the Japanese population.

Despite dietary recommendations that have repeatedly underscored the importance of increasing consumption of fruits and vegetables, intakes worldwide are lower than recommended levels. Consequently, the diets of many individuals may be lacking in nutrients and phytonutrients typical of a diet rich in a variety of fruits and vegetables. In the present study, we estimated phytonutrient intakes by adults categorised by sex, level of fruit and vegetable consumption ( < 5 v. ≥ 5 servings/d), and geographic diet cluster. Intakes of nine select phytonutrients were estimated from the 2002–4 World Health Survey fruit and vegetable servings intake data (n 198 637), the FAO supply utilisation accounts data, and phytonutrient concentration data obtained from the US Department of Agriculture databases and the published literature. Percentage contributions to each phytonutrient intake from fruit and vegetable sources were also estimated. Estimated intakes of phytonutrients from fruits and vegetables varied across the thirteen geographic diet clusters, reflecting regional differences in both numbers and proportions of fruit and vegetable servings consumed, and the specific types of fruits and vegetables available in the diet. The mean phytonutrient intakes by adults consuming ≥ 5 servings/d of fruits and vegetables were approximately 2- to 6-fold the mean phytonutrient intakes by adults with low fruit and vegetable consumption ( < 5 servings/d). In some cases, phytonutrient intakes by adults consuming ≥ 5 servings/d of fruits and vegetables in one geographic diet cluster were lower than the intakes by adults reporting < 5 servings/d in another cluster. The findings from this assessment provide important information regarding the major dietary patterns of phytonutrient intakes across geographic diet clusters.

The present study aimed to investigate the relationships between macronutrient intake and serum lipid profile in adolescents from eight European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) cross-sectional study (2006–7), and to assess the role of body fat-related variables in these associations. Weight, height, waist circumference, skinfold thicknesses, total cholesterol, HDL-cholesterol (HDL-C), LDL-cholesterol, TAG, apoB and apoA1 were measured in 454 adolescents (44 % boys) aged 12·5–17·5 years. Macronutrient intake (g/4180 kJ per d (1000 kcal per d)) was assessed using two non-consecutive 24 h dietary recalls. Associations were evaluated by multi-level analysis and adjusted for sex, age, maternal education, centre, sum of four skinfolds, moderate-to-vigorous physical activity, sedentary behaviours and diet quality index for adolescents. Carbohydrate intake was inversely associated with HDL-C (β = − 0·189, P< 0·001). An inverse association was found between fat intake and TAG (β = − 0·319, P< 0·001). Associations between macronutrient intake and serum lipids varied according to adiposity levels, i.e. an inverse association between carbohydrate intake and HDL-C was only observed in those adolescents with a higher waist:height ratio. As serum lipids and excess body fat are the major markers of CVD, these findings should be considered when developing strategies to prevent the risk of CVD among adolescents.

Soluble maize fibre (SCF) has been found to significantly improve bone mineral density and strength in growing rats compared with several other novel prebiotic fibres. The objective of the present study was to investigate the effect of SCF on Ca absorption and retention in pubertal children by studying the potential absorption mechanisms of the intestinal microbiota. A total of twenty-four adolescent boys and girls (12–15 years) participated in two 3-week metabolic balance studies testing 0 g/d SCF (control (CON) treatment) and 12 g/d SCF (SCF treatment) in a random order by inclusion in a low-Ca diet (600 mg/d). Fractional Ca absorption was measured at the end of the two intervention periods using a dual-stable isotope method. Diet composites and faecal and urine samples were collected daily and analysed for Ca content. Ca retention was calculated as dietary Ca intake minus Ca excretion in faeces and urine over the last 2 weeks. Microbial community composition in the faecal samples collected at the beginning and end of each session was determined by 454 pyrosequencing of the PCR-amplified 16S ribosomal RNA gene. Fractional Ca absorption was 12 % higher (41 mg/d) after the SCF treatment compared with that after the CON treatment (0·664 (sd 0·129) and 0·595 (sd 0·142), respectively; P= 0·02), but Ca retention was unaffected. The average proportion of bacteria of the phylum Bacteroidetes was significantly greater in the participants after the SCF treatment than after the CON treatment. These results suggest that moderate daily intake of SCF, a well-tolerated prebiotic fibre, increases short-term Ca absorption in adolescents consuming less than the recommended amounts of Ca.

Children of low socio-economic position (SEP) consume poorer diets than those of high SEP; however, there is limited understanding of why socio-economic gradients in diet occur. Some evidence suggests that determinants of dietary intake may differ between SEP groups. The aim of the present study was to determine whether the associations between personal and environmental variables and children's fruit and vegetable intake, and healthy dietary behaviours are moderated by SEP. A total of 395 children aged 9 to 13 years and their parents were recruited in Adelaide, South Australia. Personal and environmental dietary predictors were measured using child-completed online questionnaires and telephone interviews with parents. Dietary intake was measured using an online FFQ. First, dietary predictors were identified using correlated component regression, and subsequently tested for moderation by four SEP indicators using partial least-squares structural equation modelling. Fruit and vegetable intake and healthy behaviours were predicted by self-efficacy, attitudes and a supportive home environment. For girls, only the associations of self-efficacy with healthy behaviours were moderated by occupation. For boys, income moderated the associations of fruit and vegetable intake with attitudes, and healthy behaviours with supportive home environments. Occupation and employment moderated the associations of boys' family environments and fruit intake, and attitudes with healthy behaviours. Reducing socio-economic disparities in children's healthy dietary intake may be more successfully achieved by tailoring health promotion policies and interventions according to variables that moderate the relationships between dietary intake and SEP.

It has not been established which specific measures of obesity might be most appropriate for predicting CVD risk in Asians. The objectives of the present study were to determine the associations of BMI, waist circumference (WC) and waist:height ratio (WHtR) with CVD risk factors and to evaluate the optimal cut-off values to define overweight or obesity in Chinese adults. Data collected from seven nationwide health examination centres during 2008 and 2009 were analysed. The BMI, WC and WHtR of 244 266 Chinese adults aged ≥ 20 years included in the study were measured. Logistic regression models were fit to evaluate the OR of each CVD risk factor according to various anthropometric indices. Receiver operating characteristic (ROC) analyses were conducted to assess the optimal cut-off values to predict the risk of diabetes, hypertension, dyslipidaemia and the metabolic syndrome. WHtR had the largest areas under the ROC curve for all CVD risk factors in both sexes, followed by WC and BMI. The optimal cut-off values were approximately 24·0 and 23·0 kg/m2 for BMI, 85·0 and 75·0 cm for WC, and 0·50 and 0·48 for WHtR for men and women, respectively. According to well-established cut-off values, BMI was found to be a more sensitive indicator of hypertension in both men and women, while WC and WHtR were found to be better indicators of diabetes and dyslipidaemia. A combination of BMI and central obesity measures was found to be associated with greater OR of CVD risk factors than either of them alone in both sexes. The present study demonstrated that WHtR and WC may be better indicators of CVD risk factors for Chinese people than BMI.

Identifying toddlers at dietary risk is crucial for determining who requires intervention to improve dietary patterns and reduce health consequences. The objectives of the present study were to develop a simple tool that assesses toddlers' dietary risk and investigate its reliability and validity. The nineteen-item Toddler Dietary Questionnaire (TDQ) is informed by dietary patterns observed in Australian children aged 14 (n 552) and 24 (n 493) months and the Australian dietary guidelines. It assesses the intake of ‘core’ food groups (e.g. fruit, vegetables and dairy products) and ‘non-core’ food groups (e.g. high-fat, high-sugar and/or high-salt foods and sweetened beverages) over the previous 7 d, which is then scored against a dietary risk criterion (0–100; higher score = higher risk). Parents of toddlers aged 12–36 months (Socio-Economic Index for Areas decile range 5–9) were asked to complete the TDQ for their child (n 111) on two occasions, 3·2 (sd 1·8) weeks apart, to assess test–retest reliability. They were also asked to complete a validated FFQ from which the risk score was calculated and compared with the TDQ-derived risk score (relative validity). Mean scores were highly correlated and not significantly different for reliability (intra-class correlation = 0·90, TDQ1 30·2 (sd 8·6) v. TDQ2 30·9 (sd 8·9); P= 0·14) and validity (r 0·83, average TDQ ((TDQ1+TDQ2)/2) 30·5 (sd 8·4) v. FFQ 31·4 (sd 8·1); P= 0·05). All the participants were classified into the same (reliability 75 %; validity 79 %) or adjacent (reliability 25 %; validity 21 %) risk category (low (0–24), moderate (25–49), high (50–74) and very high (75–100)). Overall, the TDQ is a valid and reliable screening tool for identifying at-risk toddlers in relatively advantaged samples.

Varied diets are diverse with respect to diet quality, and existing dietary variety indices do not capture this heterogeneity. We developed and evaluated the multidimensional US Healthy Food Diversity (HFD) index, which measures dietary variety, dietary quality and proportionality according to the 2010 Dietary Guidelines for Americans (DGA). In the present study, two 24 h dietary recalls from the 2003–6 National Health and Nutrition Examination Survey (NHANES) were used to estimate the intake of twenty-six food groups and health weights for each food group were informed by the 2010 DGA. The US HFD index can range between 0 (poor) and 1 − 1/n, where n is the number of foods; the score is maximised by consuming a variety of foods in proportions recommended by the 2010 DGA. Energy-adjusted Pearson's correlations were computed between the US HFD index and each food group and the probability of adequacy for fifteen nutrients. Linear regression was run to test whether the index differentiated between subpopulations with differences in dietary quality commonly reported in the literature. The observed mean index score was 0·36, indicating that participants did not consume a variety of healthful foods. The index positively correlated with nutrient-dense foods including whole grains, fruits, orange vegetables and low-fat dairy (r 0·12 to 0·64) and negatively correlated with added sugars and lean meats (r − 0·14 to − 0·23). The index also positively correlated with the mean probability of nutrient adequacy (r 0·41; P< 0·0001) and identified non-smokers, women and older adults as subpopulations with better dietary qualities. The US HFD index may be used to inform national dietary guidance and investigate whether healthful dietary variety promotes weight control.

Vitamin E is believed to play a preventive role in diseases associated with oxidative stress. The aims of the present study were to quantify vitamin E intake levels and plasma concentrations and to assess dietary vitamin E adequacy in Irish adults. Intake data from the National Adult Nutrition Survey were used; plasma samples were obtained from a representative cohort of survey participants. Plasma α- and γ-tocopherol concentrations were measured by HPLC. The main sources of vitamin E in the diet were ‘butter, spreadable fats and oils’ and ‘vegetables and vegetable dishes’. When vitamin E intake from supplements was taken into account, supplements were found to be the main contributor, making a contribution of 29·2 % to vitamin E intake in the total population. Supplement consumers had significantly higher plasma α-tocopherol concentrations and lower plasma γ-tocopherol concentrations when compared with non-consumers. Consumers of ‘vitamin E’ supplements had significantly higher vitamin E intake levels and plasma α-tocopherol concentrations compared with consumers of other types of supplements, such as multivitamin and fish oil. Comparison with the Institute of Medicine Estimated Average Requirement of 12 mg/d indicated that when vitamin E intake from food and supplement sources was taken into account, 100 % of the study participants achieved the recommended intake levels. When vitamin E intake from food sources was taken into account, only 68·4 % of the females were found to achieve the recommended intake levels compared with 99·2 % of the males. The results of the present study show that dietary vitamin E intake has a significant effect on plasma α- and γ-tocopherol concentrations. Furthermore, they show that the consumption of supplements is a major contributor to overall intake and has a significant effect on plasma vitamin E concentrations in the Irish population.