The present paper describes a model for public health nutrition practice designed to facilitate practice improvement and provide a step-wise approach to assist with workforce development.

The bi-cycle model for public health nutrition practice has been developed based on existing cyclical models for intervention management but modified to integrate discrete capacity-building practices.

Education and practice settings.

This model will have applications for educators and practitioners.

Modifications to existing models have been informed by the authors’ observations and experiences as practitioners and educators, and reflect a conceptual framework with applications in workforce development and practice improvement. From a workforce development and educational perspective, the model is designed to reflect adult learning principles, exposing students to experiential, problem-solving and practical learning experiences that reflect the realities of work as a public health nutritionist. In doing so, it assists the development of competency beyond knowing to knowing how, showing how and doing. This progression of learning from knowledge to performance is critical to effective competency development for effective practice.

Public health nutrition practice is dynamic and varied, and models need to be adaptable and applicable to practice context to have utility. The paper serves to stimulate debate in the public health nutrition community, to encourage critical feedback about the validity, applicability and utility of this model in different practice contexts.

Little is known about current public health nutrition workforce development in Europe. The present study aimed to understand constraining and enabling factors to workforce development in seven European countries.

A qualitative study comprised of semi-structured face-to-face interviews was conducted and content analysis was used to analyse the transcribed interview data.

The study was carried out in Finland, Iceland, Ireland, Slovenia, Spain, Sweden and the UK.

Sixty key informants participated in the study.

There are constraining and enabling factors for public health nutrition workforce development. The main constraining factors relate to the lack of a supportive policy environment, fragmented organizational structures and a workforce that is not cohesive enough to implement public health nutrition strategic initiatives. Enabling factors were identified as the presence of skilled and dedicated individuals who assume roles as leaders and change agents.

There is a need to strengthen coordination between policy and implementation of programmes which may operate across the national to local spectrum. Public health organizations are advised to further define aims and objectives relevant to public health nutrition. Leaders and agents of change will play important roles in fostering intersectorial partnerships, advocating for policy change, establishing professional competencies and developing education and training programmes.

To assess and develop a consensus among a European panel of public health nutrition workforce stakeholders (academics and employers) regarding core functions required for effective public health nutrition practice.

A modified Delphi study involving data from two rounds of questionnaires administered among a panel of public health nutrition workforce stakeholders.

Europe.

A panel of fifty-three public health nutrition development stakeholders, including thirty-three academics and twenty employers, sampled from eighteen European countries.

Panellists rated 50 % (19/38) of the initially listed functions as core (i.e. without which public health capacity is limited), using a majority cut-off (>50 %). Out of the nineteen core functions seven were categorised under the heading Intervention management, emphasising high agreement on the importance of managing interventions in public health nutrition work. Only one of the identified core public health nutrition functions was rated differently between academics and employers, suggesting consistent identification of core functions between stakeholder groups.

This consensus on core functions of the public health nutrition workforce in Europe can be used to promote a consistent understanding of the role and value of public health nutritionists as a discrete disciplinary sub-specialty of the public health workforce. The convergence of opinions of academics and employers, as well as comparison with previous international studies, indicates that there is a set of core public health nutrition functions transferable between countries that can be used as a benchmark to guide further development of the public health nutrition workforce in Europe.

To test the feasibility of a pan-European professional recognition system for public health nutrition.

A multistage consultation process was used to test the feasibility of a model system for public health nutritionist certification. A review of existing national-level systems for professional quality assurance was conducted via literature review and a web-based search, followed by direct inquiries among stakeholders. This information was used to construct a consultation document circulated to key stakeholders summarising the rationale of the proposed system and inviting feedback about the feasibility of the system. Two consultation workshops were also held. The qualitative data gathered through the consultation were collated and thematically analysed.

Europe.

Public health nutrition workforce stakeholders across twenty-nine countries in the European Union.

One hundred and forty-five contacts/experts representing twenty-nine countries were contacted with responses received from a total of twenty-eight countries. The system proposed involved a certification system of professional peer review of an applicant's professional practice portfolio, utilising systems supported by information technology for document management and distribution similar to peer-review journals. Through the consultation process it was clear that there was overall agreement with the model proposed although some points of caution and concern were raised, including the need for a robust quality assurance framework that ensures transparency and is open to scrutiny.

The consultation process suggested that the added value of such a system goes beyond workforce development to enhancing recognition of the important role of public health nutrition as a professional discipline in the European public health workforce.

Nutritionists in the UK are at the start of an exciting time of professional development. The establishment of the Association for Nutrition in 2010 has presented an opportunity to review, revitalize and expand the UK Voluntary Register of Nutritionists. In the UK and elsewhere, there is a need for a specialist register of nutritionists with title protection as a public safeguard.

The new structure will base professional registration on demonstration of knowledge and application in five core competencies. Initially, there will be five specialist areas: animal; public health; nutritional scientist; food; sports and exercise. The wording and requirements linking the specialist areas to the competencies have been carefully defined by leading individuals currently on the existing register in these specialist areas. These have been evaluated by a random sample of existing registrants to check for accuracy of definitions and examples. Other work aims to establish a clear quality assurance framework in nutrition for workers in the health and social care sectors (UK Public Health Skills and Career Framework Levels 1–4) who contribute to nutrition activity, such as community food workers, nutrition assistants and pharmacists. Students, co-professional affiliates and senior fellows will also find a place in the new Association. The title ‘nutritionist’ is not currently legally protected in the UK and it is used freely to cover a range of unregulated practice.

The establishment of a professional register to protect the public and to provide a clear identity for nutritionists is a vital step forward.

India spans the spectrum of under- and overnutrition disorders and does so in generous proportions. India also tops the charts globally in the prevalence of risk factors for several chronic diseases. Although Public Health Nutrition (PHN) – both as an academic field as well as a means to improved health – has been around for two centuries in developed countries, it is only now coming to the fore as a conduit for tackling nutrition-related disorders in developing countries. In the light of these issues, we undertook an exercise to map the existing educational initiatives for nutrition, and in particular PHN, in India.

This situational analysis of PHN across India was conducted using a combination of Internet search, telephone calls as well as interviews with experts. Information collected was pooled and tabulated using a snowball approach.

India.

Not applicable.

Currently, there are nearly 190 institutes in India that offer one or more nutrition courses, with the majority offering full-time courses. Of these, PHN was offered in less than five institutes across India and opportunities were confined to specialization options/modules.

This situational analysis reveals the huge gap in existing nutrition ventures and points towards the urgent need to undertake newer academic initiatives especially in the field of PHN in India. Reforms in the education and employment sector need to be brought in which may include working towards making the field of nutrition attractive for career pursuit. The focus of this discipline needs to be broadened to, but not limited to, span the entire spectrum from dietetics to research and teaching. Strong synergistic collaborations and academic partnerships with other developed countries should be encouraged to catalyse finding solutions to emerging and/or existing threats to public health problems.

To examine associations between the availability of residential-area food sources and dietary patterns among seniors.

Cross-sectional analyses. Individual-level data from the NuAge study on nutrition and healthy ageing were merged with geographic information system data on food store availability and area-level social composition. Two dietary patterns reflecting lower- and higher-quality diets (respectively designated ‘western’ and ‘prudent’) were identified from FFQ data. Two food source relative availability measures were calculated for a 500 m road-network buffer around participants’ homes: (i) proportion of fast-food outlets (%FFO) relative to all restaurants and (ii) proportion of stores potentially selling healthful foods (%HFS, healthful food stores) relative to all food stores. Associations between dietary patterns and food source exposure were tested in linear regression models accounting for individual (health and sociodemographic) and area-level (socio-economic and ethnicity) covariates.

Montréal metropolitan area, Canada.

Urban-dwelling older adults (n 751), aged 68 to 84 years.

%FFO was inversely associated with prudent diet (β = −0·105; P < 0·05) and this association remained statistically significant in models accounting for %HFS. %HFS was inversely associated with lower western diet scores (β = −0·124; P < 0·01). This latter association no longer reached significance once models were adjusted for area-level covariates.

In Montréal, the food environment is related to the diet of older adults but these links are more complex than straightforward. The absence of significant relationships between healthful food stores and prudent diets, and between fast-food outlets and western diets, deserves further investigation.

Breakfast has been linked to several aspects of health, yet breakfast skipping is rampant across the globe. Studies in India have focused mostly on children. Hence the present study examined breakfast behaviour across different age and gender groups.

Cross-sectional sample, purposive sampling. Nutrient intakes of the participants derived from 24 h dietary recall and 3 d breakfast record data were compared with RDA values prescribed by the Indian Council of Medical Research using Student's t test, with P < 0·05 taken to indicate significance.

Mumbai, India.

Participants (n 1027) aged 8 years and above.

Nutritional adequacy of the breakfast meal and that of the day's diet were the main outcome measures. Eighty-one per cent of the participants had a nutritionally inadequate breakfast. Intakes of Fe and dietary fibre were notably low. Consumption of just milk or milk plus a milk food-based drink among schoolchildren (49 %) and increased breakfast skipping among adolescents (37 %) were seen.

The study identifies both irregularities and/or nutritional inadequacies with respect to the breakfast meal. Age- and gender-specific challenges in breakfast behaviour need to be addressed. Development of ‘nutrient-dense’ breakfast foods that can be prepared easily, school breakfast programmes and education on the importance of breakfast are the needs of the hour.

Low serum vitamin D, which largely affects ethnic minorities, is associated with obesity and other chronic diseases. Little is known about racial/ethnic differences in intake, particularly in children, or if any differences are associated with differences in serum 25-hydroxyvitamin D (25(OH)D). The objective of the present study was to determine whether racial/ethnic differences in dietary vitamin D intake exist and whether they explain differences in 25(OH)D.

Vitamin D intakes (Block Kids 2004 FFQ) and 25(OH)D were measured. Race/ethnicity was parent-reported (white (37·9 %), Hispanic (32·4 %), black (8·3 %), Asian (10·3 %), multi-racial/other (11·0 %)). Multivariable analyses were conducted to examine the associations among dietary vitamin D and race/ethnicity, as well as 25(OH)D, independent of BMI Z-score and other covariates.

Elementary/middle schools in Somerville, MA, USA, during January–April 2010.

Schoolchildren (n 145) in 4th–8th grade.

Only 2·1 % met the 2011 RDA (15 μg/d (600 IU/d)). Average dietary intake was 3.5 (sd 2.2) μg/d (140 (sd 89·0) IU/d). No racial/ethnic differences in intake were evident. Most (83·4 %) were 25(OH)D deficient (<20 ng/ml; 16·0 (sd 6·5) ng/ml). In ANOVA post hoc analyses, 25(OH)D levels were lower in Hispanics than whites (14·6 (sd 6·1) ng/ml v. 17·9 (sd 4·6) ng/ml; P < 0·01). Dietary vitamin D was associated with 25(OH)D overall (P < 0·05), but did not explain the racial/ethnic differences in 25(OH)D.

Most children in this north-east US sample did not meet dietary recommendations for vitamin D and were vitamin D deficient. Dietary vitamin D did not explain the difference in 25(OH)D between Hispanic and white children. Further research is needed to determine if changes in dietary vitamin D by race/ethnicity can impact 25(OH)D levels.

To describe detailed physical activity and sedentary behaviour in French adults across physical activity categories.

The French Nutrition and Health Survey (Etude Nationale Nutrition Santé, ENNS), conducted in 2006–2007, was a national cross-sectional survey based on three-stage random sampling. The International Physical Activity Questionnaire (IPAQ) was used to classify participants into three physical activity categories. Time spent in a sitting position and time spent in front of a screen were used as markers of sedentary behaviour.

France.

Adults (n 2971) aged 18 to 74 years were included.

Overall, 29·5 % of men and 23·6 % of women were classified into the high-IPAQ category, while 36·1 % of men and 37·5 % of women were in the low-IPAQ category. For each intensity level of physical activity (vigorous intensity, moderate intensity or walking), the number of active days per week decreased from the high- to the low-IPAQ category and daily duration of physical activity was longer in the high-IPAQ category than in the other two categories; 6 % of adults declared neither vigorous nor moderate nor walking activities.

For most adults in the low-IPAQ category, an increasing number of active days per week would be sufficient to attain the moderate-IPAQ category. This should be taken into account in public health initiatives aimed at promoting physical activity.

Dairy food consumption is important for Australian children as it contributes key nutrients such as protein and Ca. The aim of the present paper is to describe dietary intake from dairy foods for Australian children aged 2–16 years in 2007.

Secondary analysis of a quota-sampled survey using population-weighted, 1 d (24 h) dietary recall data.

Australian national survey conducted from February to August 2007.

Children (n 4487) aged 2–16 years.

Most Australian children consumed dairy foods (84–98 %), with the proportion consuming tending to decrease with age and males consuming significantly more than females from the age of 4 years. Milk was the most commonly consumed dairy food (58–88 %) and consumed in the greatest amount (243–384 g/d). Most children consumed regular-fat dairy products. The contribution of dairy foods to total energy intake decreased with age; from 22 % of total energy at age 2–3 years to 11 % at age 14–16 years. This trend was similar for all nutrients analysed. Dairy food intake peaked between 06.00 and 10.00 hours (typical breakfast hours) corresponding with the peak in dairy Ca intake. Australian children (older than 4 years) did not reach recommendations for dairy food intake, consuming ≤2 servings/d.

The under-consumption of dairy foods by Australian children has important implications for intake of key nutrients and should be addressed by multiple strategies.

To validate the general nutrition knowledge questionnaire developed by Parmenter and Wardle (1999) in a Turkish student sample.

The original questionnaire of Parmenter and Wardle (1999) was modified and translated into Turkish. The modified questionnaire was administered to second year undergraduate students. Some students completed the questionnaire twice for the measurement of test–retest reliability. Statistical analysis was performed on the responses to measure the internal reliability, test–retest reliability and construct validity.

Students completed the questionnaire under supervision. The questionnaire was completed at the end of lectures. Retest was carried out two weeks after first administration of the test.

A total of 195 undergraduate students studying either nutrition and dietetics (n 90) or engineering (n 105) participated in the study. Of these, 125 students completed the questionnaire on two occasions.

Overall internal reliability (Cronbach's α = 0·89) and test–retest reliability (0·86) were high. Significant differences between the scores of the two groups of students indicated that the questionnaire had satisfactory construct validity.

The modified version of the general nutrition knowledge questionnaire can be used as a tool to examine the nutrition knowledge of adults in Turkey. In the next stage of the study, some adjustments need to be made to the items that led to low reliability values so that these items will be more applicable to the eating habits and patterns of Turkish people.

To compare estimates of underweight, stunting, wasting, overweight and obesity based on three growth charts.

Cross-sectional study to estimate weight-for-age, length/height-for-age and weight-for-height comparing the 2006 WHO Child Growth Standards (‘the WHO standards’), the 1977 National Center for Health Statistics (NCHS) international growth reference (‘the NCHS reference’) and the 1987 Argentine Pediatric Society Committee of Growth and Development reference (‘the APS reference’). Cut-off points were defined as mean values ±2 sd. Epi-Info software version 6·0 (Centers for Disease Control and Prevention) was used for statistical evaluations (χ2, P ≤ 0·05).

Greater La Plata conurbation, Buenos Aires, Argentina.

A total of 2644 healthy, full-term children from 0 to 5 years of age.

Prevalence of underweight was higher with the WHO standards than with the other references up to the first 6 months. For the rest of the ages, prevalence was lower with the WHO standards. Stunting prevalence was higher with the WHO standards at all ages. Prevalence of wasting was higher with the WHO standards compared with the NCHS reference up to the first 6 months and lower at 2–5 years of age. Overweight and obesity prevalences were higher with the WHO standards at all ages.

The new WHO standards appear to be a solid and reliable tool for diagnosis and treatment of nutritional diseases, also being the only one built with infants fed according to WHO recommendations. Therefore, our results support the decision of the National Ministry of Health about the utilization of the new WHO standards to monitor the nutritional status of Argentinean children aged less than 5 years.

School lunch programmes are one strategy to promote healthier dietary habits in children, but better evaluation tools for assessing the dietary quality of such programmes are needed. The aim of the present study was to develop and validate a simple index to assess the dietary quality of school lunches for children aged 7–13 years.

A Meal Index of dietary Quality (Meal IQ) was developed to consist of seven components (nutrients and food groups) based on dietary issues for children aged 7–13 years, which were identified in a national dietary survey. The Meal IQ was validated against calculated nutrient contents of school lunches both provided by the school and brought from home.

At eight public schools from all over Denmark, data were collected on 191 individual lunches brought from home (which is most common in Denmark) and thirty-one lunches provided as part of a school food programme. In addition thirty-two lunches provided at eighteen other public schools were included.

A total of 254 school lunches.

A higher Meal IQ score was associated with a higher overall dietary quality, including lower contents of fat, saturated fat and added sugars, higher contents of fibre, various vitamins and minerals, and more fruits, vegetables and fish.

The Meal IQ is a valid and useful evaluation tool for assessing the dietary quality of lunches provided by schools or brought to school from home.

Socio-economic status (SES) has been positively associated with physical activity (PA) levels in adolescents. In order to tackle these social inequalities, information is needed about the underlying mechanisms of this association. The present study aimed to investigate the potential mediating role of psychosocial correlates of PA on the relationship between SES and PA in European adolescents.

Cross-sectional study testing the mediating role of psychosocial correlates in the SES–PA association using the product-of-coefficients test of MacKinnon.

Ten European cities in nine different countries, the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study.

Adolescents (n 2780) aged 12·5–17·49 years self-reported on PA (moderate-to-vigorous intensity PA and total PA), SES indicators (education of the mother and Family Affluence Scale) and psychosocial correlates of PA (stage of change, attitudes, awareness, modelling, social support, self-efficacy, benefits, barriers and environmental correlates).

SES (Family Affluence Scale) was significantly associated with moderate-to-vigorous intensity PA. According to single-mediator models, this association was significantly mediated by stage of change (t = 3·6, P ≤ 0·001), awareness (t = 2·7, 0·001 < P ≤ 0·01), modelling (t = 4·8, P ≤ 0·001), self-efficacy (t = 2·5, 0·01<P ≤ 0·05), barriers (t = 2·7, 0·001 < P ≤ 0·01) and environmental (t = 3·0, 0·001 < P ≤ 0·01) correlates of PA. The multiple-mediators model showed that the mediating role of the combination of these psychosocial correlates was also significant (t = 6·2, P ≤ 0·001).

Adolescents with low family wealth scored lower on stage of change, awareness, modelling, self-efficacy and environmental correlates of PA, and higher on PA barriers, which in turn resulted in lower levels of moderate-to-vigorous PA. Future interventions should target these individual and environmental constructs in order to tackle and intervene on social inequalities in PA among adolescents.

To identify and compare suggested food portion sizes in UK schemes.

The study collated and compared suggested portion sizes from selected UK schemes intended both for general advice and weight-loss advice.

Portion size schemes were included if they were relevant to the UK, provided actual portion size information, were intended for adults and were obtainable from the public domain in November 2010. Included schemes were from the food industry, non-governmental organisations and health-care professionals. Suggested portion sizes of foods occurring in at least one scheme for general advice and at least one scheme for weight loss were included. Own brand on-pack portion size labelling from a large UK-wide supermarket was added to represent portion size advice from UK food retailers.

Not applicable.

The suggested portion sizes in the weight-loss advice schemes were often concordant, as were the general advice schemes, except one general advice scheme from a non-governmental organisation which was more closely aligned with the portion sizes for weight loss. Overall there were substantial discrepancies between suggested portion sizes for muesli and crunchy breakfast cereals, rice, pasta and potatoes, meat, fish and pulses, whereas portion sizes for cooked vegetables, dried fruit, some breakfast cereals and cheese were broadly consistent.

There is a lack of consistency in the portion sizes communicated to the public. An independent and authoritative scheme of suggested portion sizes for all foods, with distinct recommendations for general advice and for weight-loss advice, could be of benefit.

To determine the distribution and sociodemographic associations of BMI (kg/m2) among adults aged ≥40 years living in Timor-Leste.

BMI was calculated for participants of a population-based cross-sectional survey.

Urban and rural Timor-Leste.

Adults aged ≥40 years living in Timor-Leste.

Of those enumerated, 2014 participated (89·5 %). Male gender, rural domicile, older age, illiteracy and source of household income were associated with BMI < 18·5 kg/m2 on multivariate analysis. Female gender, urban domicile and literacy were associated with BMI ≥25·0 and ≥30·0 kg/m2. Adjusting for gender, age and domicile, and extrapolating to those aged ≥40 years across Timor-Leste, 9·9 %, 36·0 %, 6·6 % and 0·8 % had BMI <16·0, <18·5, ≥25·0 and ≥30·0 kg/m2, respectively.

At this time, being ‘underweight’ or ‘severely thin’ is more prevalent in the Timorese adult population than being ‘overweight’ or ‘obese’.

To determine trends in prevalence of overweight and obesity in Kuwaiti adults, and to examine their association with selected sociodemographic and lifestyle factors.

Analysis of cross-sectional population survey data from the Kuwait National Nutrition Surveillance System.

Social and health facilities in Kuwait.

Males (n 17 491) and females (n 21 120) aged 20–69 years attending registration for employment or pensions, or Hajj Pilgrimage health check-ups, or parents accompanying their children for immunization 1998 through 2009. Sociodemographic, lifestyle and anthropometric data were collected.

Prevalence of BMI ≥ 25 kg/m2 rose from 61·8 % and 59·3 % in females and males respectively, peaked in 2004–2005 (81·4 % and 79·2 %) and fell slightly in 2008–2009 (77·3 % and 77·4 %). Obesity prevalence in females exceeded males for all years and age groups; by 2009, it had increased by 11·3 % in males and 14·6 % in females. Overweight and obesity prevalences in both genders increased until 2004–2005 but fell thereafter, with significant falls for females in 2008–2009. Logistic and linear regression analyses confirmed these temporal changes for both prevalence and BMI in both genders. The odds of obesity increased with age until the fifth decade for both genders and then declined significantly for males. Education level was negatively associated with obesity prevalence in females, while participation in leisure-time exercise was negatively associated with obesity prevalence in males.

Although the combined prevalence of overweight and obesity (BMI ≥ 25 kg/m2) seemed to decrease from 2005 to 2009 among Kuwaiti adults, further research to clarify the identified confounders and continued monitoring are needed to confirm the decrease observed.

To ascertain the prevalence of and association between main lifestyle factors (diet, physical activity, alcohol consumption and smoking) in students from the Balearic Islands University.

A cross-sectional, descriptive study. A questionnaire including questions on lifestyle, dietary habits and physical activity habits was administered to the students. Four different diet quality scores were calculated (Diet Diversity Score, Mediterranean Diet Score, Dietary Guidelines Score and Global Dietary Guidelines Score).

A sample of students from the Balearic Islands University.

Nine hundred and eighty-seven students (45·5 % males; mean age 21·5 (sd 3·3) years).

The dietary pattern of the student population was characterized by a low consumption of cereals and tubers, fruits, vegetables, olive oil, legumes and nuts, and a high consumption of processed meat, sweets, snacks, soft drinks and pastries. Linear, positive and statistically significant correlations were found between the number of meals consumed daily and all of the diet quality scores determined. Determinants of diet quality, both in the univariate and multivariate analyses, were physical activity practice, sex, age and number of meals consumed daily.

Risk factors such as smoking, diet and physical inactivity had a tendency of clustering among Spanish university students. Overall diet quality was low, due to important departures from dietary recommendations and loss of the traditional Mediterranean dietary pattern. Nutritional education campaigns that include promotion of physical activity practice are needed to improve the overall health status of this population.