To estimate dietary cholesterol contribution to CHD risk among US females, relative to other dietary risk factors.

A risk apportionment model was applied to apportion CHD risk shares among the lifestyle and dietary risk factors.

The model was implemented using relative risks from the Nurses’ Health Study and data on CHD risk factors and consumption from the National Health and Nutrition Examination Survey 1999–2002.

US females aged 25 years or older.

On average, poor diet contributes 20 % of the CHD risk relative to obesity, inactivity and smoking, of which trans fat intake contributes 2·9 %, dietary cholesterol 1·5 % and 16 % is due to low consumption of nutrients, i.e. MUFA (1·5 %), PUFA (1·7 %), marine n-3 fatty acids (2·7 %), α-linolenic acid (1·1 %), dietary fibre (2·4 %), vitamin B6 (4·1 %), vitamin C (0·5 %) and folate (1·8 %).

Reducing trans fat and dietary cholesterol intakes could lead to CHD reduction, but greater risk reduction may be achieved by improving intakes of heart-healthy nutrients currently deficient in US females’ diets. Total diet consideration is essential in any CHD risk reduction strategy.

To understand more specifically how the quality, quantity and frequency of snack food consumption differs in different BMI categories.

Four hundred and forty-nine school-aged children (grade 4–6) from a Kanien’kehaka (Mohawk) community provided a 24 h recall and their height and weight in 1994, 1998 and 2002, in three independent cross-sectional samples. Food consumed between two consecutive meals was defined as a snacking occasion. ANOVA and χ2 tests were used to compare food choices between BMI categories according to food quality criteria and food groups in 2006. Logistic regression models were performed to compare results between normal-weight children and those at risk of overweight and between normal-weight and overweight children.

Energy intake from snacks tended to be higher for children at risk of overweight, compared with the other two BMI categories. Food groups with a higher energy density were also consumed more frequently by these children, with larger average portions of cereal bars (P < 0·05). Except for dessert consumption, which was less frequent among overweight children, no other variable distinguished risk of overweight in the two logistic regression models tested.

Differences detected in snack food intake between normal-weight children and children at risk of overweight could explain in part the relationship between food choices and risk of overweight. Studies of dietary differences in conjunction with body weight would benefit from considering children at risk of overweight and normal-weight children, rather than children with excess weight only.

To nutritionally analyse mean energy intake (EI) from different 3 d intervals within a 7 d recording period and to evaluate the seasonal effect on energy and nutrient intake.

Cross-sectional study of dietary intake collected with 7 d food diaries.

Aberdeen, north-east Scotland, UK, between 2002 and 2004.

Participants from two long-term trials were pooled. These trials, investigating genetic and environmental influences on body weight, were the Genotyping And Phenotyping (GAP) study and a cohort observational study, Rowett Assessment of Childhood Appetite and metaboLism (RASCAL). There were 260 Caucasian adults, BMI range 16·7–49·3 kg/m2, age range 21–64 years.

Mean EI for Wednesday, Friday and Saturday had the closest approximation to the 7 d mean (0·1 % overestimate). A gender × season interaction (P = 0·019) with a different intake pattern for females and males was observed. For females, lower mean (se) EI was recorded in summer (8117 (610) kJ) and autumn (7941 (699) kJ) compared with spring (8929 (979) kJ) and winter (8132 (1041) kJ). For males, higher mean (se) EI was recorded in summer (10 420 (736) kJ) and autumn (10 490 (1041) kJ) compared with spring (9319 (1441) kJ) and winter (9103 (1505) kJ).

The study results indicate that 3 d weighed intakes recorded from Wednesday, Friday and Saturday are most representative of 7 d habitual intake in free-living subjects. They also indicate that seasonality has a limited effect on EI and no effect on macronutrient intake.

To investigate the ability of each metabolic syndrome (MetS) criterion, defined by the International Diabetes Federation, to predict insulin resistance (IR).

A cross-sectional study. IR was defined as homeostasis model assessment of IR (HOMA-IR) ≥3·04. The MetS criteria considered were TAG ≥ 1·69 mmol/l, HDL cholesterol (HDL-C) <1·29 mmol/l, blood pressure (BP) ≥130/85 mmHg and fasting glucose (FG) ≥5·6 mmol/l.

Busan, South Korea.

Ninety-six apparently healthy Korean women (mean age 42 (sd 10·6) years) with abdominal obesity (waist circumference (WC) ≥80 cm) were studied.

Of the ninety-six obese women, 11 % were insulin-resistant and 33 % fulfilled the criteria for IDF-defined MetS. Glucose and TAG were more likely to predict IR than BP and HDL-C when assessed using receiver-operating characteristic curves, multiple regression and multiple logistic regression analyses. Of the variation in HOMA-IR, TAG, FG, WC and age explained 42 %. High FG was independently associated with the presence of IR (OR = 8·6, 95 % CI 1·8, 41·8) even after adjusting for other components of MetS. The positive predictive value and positive likelihood ratio to detect IR were the highest for the FG criterion (33 % and 3·9, respectively), followed by TAG (28 %, 3·0), BP (19 %, 1·8) and HDL-C criteria (18 %, 1·7). The IDF definition of MetS exhibited a positive predictive value of 29 % and a positive likelihood ratio of 3·1.

Of the MetS criteria, high FG and high TAG seem to be more suitable for identifying obese women with IR than high BP and low HDL-C.

Drinking habits in children are associated with diet quality, but validated assessment tools for large-scale studies in young children are lacking. Therefore, we validated a self-completion 24 h recall questionnaire (RQ) focusing on beverage consumption with a 24 h weighed record (WR).

Thirty-five voluntary participants from the DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) Study cohort aged 7–9 years completed the RQ. The illustrated RQ required ticking the number of glasses of seven beverage categories consumed in five time intervals in the previous 24 h. As a reference, parents completed weighed records of their child’s diet. Agreement between the RQ and WR was tested by classification into consumers and non-consumers (kappa coefficients, κ), by the children’s ability to estimate the exact beverage and total volume consumed (Wilcoxon signed-rank test, Spearman rank correlation), and by ranking children according to reported beverage volumes.

The RQ and WR showed a good level of agreement for classifying participants into consumers and non-consumers of the single beverage categories (κ values between 0·78 and 0·94). Correlation coefficients for the volume of the single categories ranged between 0·81 and 0·91. The total beverage volume was overestimated in the RQ, on average, by 114 ml (P = 0·015). Agreement in ranking into tertiles by beverage volume was moderate to good for juice/soft drinks (κ = 0·44), milk (κ = 0·57) and water (κ = 0·70), but fair for the total beverage volume (κ = 0·23).

Our self-completion 24 h RQ could estimate the consumption of several beverage categories among young children at the group level, but quantification of total beverage volume was flawed.

The present study aimed to investigate the determinants of overweight and obesity among 6- to 11-year-old schoolchildren in Rasht, Iran.

Cross-sectional survey. Data on age, weekly frequency of skipping breakfast, physical activity and hours of television viewing were collected. Information on birth weight, parental age, parental educational levels, parental weight and height, and mother’s employment status were gathered through self-administrated questionnaires given to the parents.

Elementary schools in Rasht.

A total of 6635 children (3551 boys and 3084 girls) attending elementary schools in Rasht were studied.

The overall prevalence of overweight was 11·5 % and 15·0 % for boys and girls, respectively; while the overall prevalence of obesity was 5·0 % and 5·9 %, respectively. Children with more educated mothers had a higher prevalence of overweight than children with less educated mothers. Logistic regression analysis showed that children with overweight/obese parents, children with more educated mothers and children who often skipped breakfast were more prone to overweight and obesity.

These data suggest that overweight and obesity is a public health concern in this age group in Rasht. The observed sex and social differences in the prevalence of overweight and obesity call for policy makers’ attention.

To describe the association between duration of exclusive breast-feeding (EBF), weight gain in infancy and childhood BMI in two populations with a long duration of EBF.

Cohort study with follow-up in childhood. Breast-feeding status was reported monthly during infancy. Weight and length were measured at birth, 2, 6 and 12 months of age, as well as in childhood at 6 or 10 years of age.

Iceland and Denmark.

Randomly selected healthy newborns from Denmark (n 85) and Iceland (n 100).

Infants exclusively breast-fed for ≤2 months gained 348 (95% CI 69, 626) g more weight from 2 to 6 months than infants exclusively breast-fed for 3–4 months (P = 0·009). Weight gain from 6 to 12 months was found to be greater among infants exclusively breast-fed for ≤2 months compared with those exclusively breast-fed for ≥5 months (P = 0·008). A greater weight change, in terms of Z-score, between the ages of 2 and 6 months was associated with higher Z-score of childhood BMI, adjusted for birth weight, country and duration of EBF (B = 0·49, se = 0·11, P < 0·001, adj. R2 = 0·15). However, the association was much stronger in the Icelandic cohort than the Danish one.

Although duration of EBF was not associated with childhood BMI in the present study it may modulate growth rate in infancy, which is related to childhood BMI. However, other factors determinative for infant growth also need to be considered when assessing the relationship of early growth and nutrition to childhood overweight, as traditions in complementary food might differ between populations.

Although diet is a modifiable lifestyle factor to reduce abdominal obesity risk, the relationship between the Health Eating Index (HEI) and waist circumference (WC) has not been studied. The present study aimed to describe relationships between the HEI and abdominal obesity among adults.

Secondary data analysis of a cross-sectional national survey, the Third National Health and Nutrition Examination Survey (NHANES III). The HEI data, including the total HEI score and HEI component scores, were collected with a 24 h recall. WC measures were taken during a physical examination. Abdominal obesity was defined as WC ≥ 102 cm for men and WC ≥ 88 cm for women. Other covariates were collected during an interview.

In total 15 658 US adults, men (n 7470) and non-pregnant women (n 8188).

The odds of abdominal obesity was 8·3 % (95 % CI 1·8, 14·9 %, P = 0·014) lower for women and 14·5 % (95 % CI 6·8, 21·9 %, P ≤ 0·001) lower for men with each 10-unit increase in total HEI score (HEI scale, 0–100). For each point increase for the fruit score, abdominal obesity risk decreased by 2·6 % (95 % CI 0·8, 4·4 %, P = 0·007) for women. Abdominal obesity risk decreased for men with each point increase in saturated fat and variety scores, by 3·1 % (95 % CI 0·1, 6·0 %, P = 0·042) and 4·0 % (95 % CI 0·1, 7·7 %, P = 0·043) respectively.

Dietary consumption that follows the HEI is associated with a lower risk for abdominal obesity.

To estimate the extent of food insecurity in South Australia and its relationship with a variety of socio-economic variables.

Data collected routinely from 2002 to 2007 by SA Health were analysed to explore food security in the State’s population. An ecological analysis of data collected by the South Australian Monitoring and Surveillance System (SAMSS) that collects data on key health indicators. Questions on food security are asked periodically from July 2002 to December 2007.

South Australia.

Over 37 000 interviewees took part in SAMSS surveys. Questions about food security were asked of 19 037 subjects. The sample was weighted by area, age and gender so that the results were representative of the South Australian population.

Seven per cent (1342/19 037) of subjects reported running out of food during the previous year and not having enough money to buy food (food insecurity). Logistic regression analysis found food insecurity to be highest in households with low levels of education, limited capacity to save money, Aboriginal households, and households with three or more children.

The study confirms that food insecurity is strongly linked to economic disadvantage. Increasing cost of food is likely to exacerbate food insecurity. This is of concern given that food insecurity is associated with poor health, especially obesity and chronic disease. Comprehensive action at all levels is required to address root causes of food insecurity. Regular surveillance is required to continue to monitor levels of food security, but more in-depth understandings, via qualitative research, would be useful.

The objective of the present work was to cross-sectionally examine and compare dietary behaviours and home food environments by young adults’ living situation.

Using data from Project EAT (Eating Among Teens)-II, a large diverse youth cohort originally sampled in Minnesota, linear regression was used to examine self-reported meal frequency, dietary intake and home food availability outcomes by living situation (i.e. living with parents, renting an apartment/house or living on a college campus).

Young adults (n 1687), mean age 20·5 years.

Results suggested that young adults living with their parents or in rented apartments/houses had less frequent meals, poorer dietary intake and less healthy home food availability compared with those living on campus. These findings were evident even after controlling for sociodemographic factors (e.g. race/ethnicity, socio-economic status), particularly among females.

Although few emerging adults consume diets that are consistent with national recommendations, those living with parents and in rented apartments/houses may represent particularly at-risk groups. These differences in dietary factors across living situations appear to exist beyond the sociodemographic differences in these populations. Effective nutrition and healthy eating promotion strategies are needed for young adults.

To evaluate the effectiveness of the peer counselling (PC) programme on breast-feeding initiation among participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Missouri, and to identify factors that facilitate breast-feeding initiation.

We used the data from the 2006 Missouri Pregnancy Nutrition Surveillance System, Missouri Live Birth Records and the Missouri WIC programme to compare breast-feeding initiation rates between PC and non-PC agencies. We used multilevel logistic regression, with individual participants being nested within agencies, to control for individual- and agency-level characteristics.

The breast-feeding initiation rate in PC agencies was significantly higher than in non-PC agencies among prenatal participants, but the difference was not significant among postpartum participants. After controlling for maternal sociodemographic characteristics, compared with prenatal cases in non-PC agencies, prenatal cases in PC agencies were more likely to initiate breast-feeding (OR = 1·21; 95 % CI 1·03, 1·43), whereas postpartum cases were less likely to initiate breast-feeding. Among prenatal participants in PC agencies, longer duration of prenatal WIC enrolment was associated with a higher rate of breast-feeding initiation. After adjusting for maternal sociodemographic characteristics and other agency-level characteristics, participants of PC agencies with an international board-certified lactation consultant were more likely to initiate breast-feeding than participants of PC agencies without such a consultant (OR = 1·21; 95 % CI 1·01, 1·45).

Prenatal participation in the WIC breast-feeding PC programme (especially participation early during pregnancy) was associated with an increased rate of breast-feeding initiation in Missouri.

To study whether service of a free school lunch has an impact on weight development and food intake among pupils at a lower secondary school, and to assess the association between self-perceived school behaviour and food intake.

A controlled intervention study involving service of a free healthy school lunch to 9th grade pupils took place over 4 months, from January to May 2007. Weight and height were measured before and after the intervention. The pupils also completed a short FFQ and a questionnaire concerning self-perceived school behaviour and the classroom environment before and after the intervention. A healthy food score was calculated using the FFQ data.

All 9th graders at three different lower secondary schools in southern Norway were invited to participate. One school was randomly selected as the intervention school.

Fifty-eight pupils (91 %) from the intervention school and ninety-two pupils (77 %) from the control schools participated.

BMI did not increase among the girls at the intervention school, but increased significantly among the boys at the intervention school and among the control school groups. The healthy food score correlated positively with the trait ‘satisfied with schoolwork’ (P < 0·001). Fifteen per cent of the variance in food score could be explained by gender and the trait ‘satisfied with schoolwork’.

Serving of a healthy free school lunch to secondary-school pupils may result in restricted weight gain. Further studies are needed to clarify the impact of school meals on overweight and academic performance.

To investigate the influence of a trial lifestyle intervention on participants’ preferences for a range of exercise and diet programmes and whether these differ between successful and unsuccessful participants.

Hypothetical scenarios that describe attributes of diet and exercise programmes were developed using an experimental design. Participants completed an online questionnaire at baseline, 16 weeks and 12 months where they chose their most preferred of three programmes in each of sixteen scenarios. Discrete choice modelling was used to identify which attributes participants emphasised at each time point.

Fifty-five individuals who exhibited symptoms of metabolic syndrome and who participated in a 16-week trial lifestyle intervention.

There was a clear shift in programme preferences from structure to flexibility over the intervention. At baseline, emphasis was on individually designed and supervised exercise, structured diets and high levels of support, with Gainers focusing almost exclusively on support and supervision. Losers tended to consider a wider range of programme attributes. After 16 weeks preferences shifted towards self-directed rather than organised/supervised exercise and support was less important (this depended on the type of participant and whether they were in the follow-up group). Cost became significant for Gainers following the end of the primary intervention.

The stated preference method could be a useful tool in identifying potential for success and specific needs. Gainers’ relinquishment of responsibility for lifestyle change to programme staff may be a factor in their failure and in their greater cost sensitivity, since they focus on external rather than internal resources.

To evaluate the impact of nutrition education in kindergartens and to promote healthy dietary habits in children.

Prospective cohort study. Four kindergartens with 1252 children were randomized to the intervention group and three with 850 children to the control group. The personal nutritional knowledge, attitudes and dietary behaviours of the parents were also investigated. Each month, children and parents in the intervention group participated in nutrition education activities. The main outcome measures were anthropometrics and diet-related behaviours of the children and the nutritional knowledge and attitudes of the parents at baseline, 6 months (mid-term) and 1 year (post-test). Baseline demographic and socio-economic characteristics were also collected.

Seven kindergartens from Hefei, the capital city of Anhui Province, eastern China.

Two thousand one hundred and two 4- to 6-year-old pre-schoolers from seven kindergartens participated.

The prevalence of children’s unhealthy diet-related behaviours decreased significantly and good lifestyle behaviours increased in the group receiving nutrition education compared with controls. Parental eating habits and attitudes to planning their children’s diets also changed appreciably in the intervention group compared with the control group (P < 0·05). However, there were no statistically significant differences in children’s height, weight, height-for-age Z-score or weight-for-age Z-score between the two groups.

Kindergarten-based nutrition education improves pre-schoolers’ lifestyle behaviours and brings about beneficial changes in parents’ attitudes to planning their children’s diets and their own personal eating habits.

Valid and simple instruments to assess physical activity (PA) in specific populations are required for health-related research. The aim of the present study was to assess the validity of the Bouchard activity diary (AD) in Spanish adolescents using an activity monitor to compare total PA and moderate-to-vigorous PA (MVPA) obtained by both instruments.

Sixty-one Spanish adolescents, aged 12–16 years, completed the Bouchard AD and wore the ActiGraph activity monitor for three consecutive days. Validity was assessed with the Spearman correlation coefficient (ρ), the Bland–Altman method and the κ coefficient.

Thirty-seven adolescents were included in the final analysis. Correlations between the activity monitor and the AD administered over the three days (Thursday–Saturday) were moderate (ρ = 0·33–0·35, P < 0·05) or non-significant for total PA and moderate (ρ = 0·36, P < 0·05) for MVPA. Correlations between the two methods were progressively lower for each subsequent day of testing, for both total PA and MVPA. The Bland–Altman plot illustrated that the Bouchard AD overestimated MVPA (mean difference −32·05 (sd 74·56) min; 95 % limits of agreement 109·61, −173·31 min). Agreements for classification into MVPA tertiles and accordance with the international recommendations of MVPA were fair and moderate, respectively, for the 3 d means.

The Bouchard AD has reasonable validity to assess total PA and MVPA in Spanish adolescents. The results show lower levels of agreement on the third day but it is not clear if this is due to design features (weekday v. weekend) or to participant compliance with the survey or the activity monitoring protocol.

The objective of the present study was to examine associations between exposure to nutrition information as covered in mass media and daily fruit and vegetable (FV) consumption among adolescents.

Cross-sectional nutrition survey.

Vocational schools in Vienna, Austria.

A sample of 2949 ethnically diverse adolescents with mean age 17·3 (sd 1·7) years. An FFQ was used to assess usual FV consumption. Data on mass media exposure and sociodemographic characteristics were collected by means of a self-administered questionnaire. Multiple logistic regression analyses were used to control for potentially confounding variables.

Adolescents who reported exposure to nutrition information provided by booklets, the Internet or newspaper articles were more likely to eat FV daily. For example, the OR for daily fruit consumption (ORfru) was 1·6 (P < 0·001) when exposure to the Internet was reported after adjustment for age, gender, ethnicity, BMI and salary. No such associations were found for radio, television and magazines as sources of nutrition information. A negative impact on daily FV consumption was found for exposure to radio commercials (ORfru = 0·74, P = 0·04 and ORveg = 0·67, P = 0·03). Exposure to TV commercials had a negative impact on vegetable consumption (ORveg = 0·81, P = 0·05).

Newspaper articles, the Internet and booklets as a source of nutrition information are positively associated with daily FV consumption among adolescents, whereas radio commercials have a negative impact. Dissemination of ‘healthy eating’ slogans should make use of print media and the Internet.

The present study evaluated the association between fruit and vegetable intake and the incidence of upper respiratory tract infection (URTI) during pregnancy.

In a cohort of 1034 North American women, each subject was asked retrospectively about their fruit and vegetable intake during the six months before the pregnancy and their occurrences of URTI during the first half of pregnancy. Multivariable-adjusted hazard ratios (HR) were calculated with Cox proportional hazards models.

The adjusted HR of URTI for women in the highest quartile (median 8·54 servings/d) v. the lowest quartile (median 1·91 servings/d) of total fruit and vegetable intake was 0·74 (95 % CI 0·53, 1·05) for the 5-month follow-up period and 0·61 (95 % CI 0·39, 0·97) for the 3-month follow-up period, respectively. A dose-related reduction of URTI risk according to quartile of intake was found in the 3-month (P for trend = 0·03) but not the 5-month follow-up. No association was found between either fruit or vegetable intake alone in relation to the 5-month or the 3-month risk of URTI.

Women who consume more fruits and vegetables have a moderate reduction in risk of URTI during pregnancy, and this benefit appears to be derived from both fruits and vegetables instead of either alone.

The present study aimed to investigate weight retention and body composition in the postpartum period between adolescent girls and older women.

A prospective cohort study. Anthropometry and skinfold thickness measurements were performed at the first antenatal visit and at 6 weeks postpartum. An FFQ was administered at 6 weeks postpartum to explore the relationship between diet and postpartum weight retention.

Clinics at the University of the West Indies, Kingston, Jamaica.

Recruitment included women aged 19 years and younger (adolescent girls) and 20 years and older (older women).

Three hundred and forty women were studied. Adolescent girls had significantly lower measurements compared with the older women at the first antenatal visit and at 6 weeks postpartum. Dietary intakes of energy and macronutrients were similar in both groups. Postnatal assessments showed that adolescent girls retained more weight (P = 0·003) and a greater percentage of body fat (P < 0·002) than older women. In multiple regression analyses, 0·982 kg more fat mass was retained postpartum in the adolescent group compared with the older women, while there was no significant difference in lean body mass retained between the two groups.

Adolescent girls retained more weight postpartum and this was predominantly fat mass as opposed to lean body mass.