Nutrition label use could help consumers eat healthfully. Despite consumers reporting label use, diets are not very healthful and obesity rates continue to rise. The present study investigated whether self-reported label use matches objectively measured label viewing by monitoring the gaze of individuals viewing labels.

The present study monitored adults viewing sixty-four food items on a computer equipped with an eye-tracking camera as they made simulated food purchasing decisions. ANOVA and t tests were used to compare label viewing across various subgroups (e.g. normal weight v. overweight v. obese; married v. unmarried) and also across various types of foods (e.g. snacks v. fruits and vegetables).

Participants came to the University of Minnesota's Epidemiology Clinical Research Center in spring 2010.

The 203 participants were ⩾18 years old and capable of reading English words on a computer 76 cm (30 in) away.

Participants looked longer at labels for ‘meal’ items like pizza, soup and yoghurt compared with fruits and vegetables, snack items like crackers and nuts, and dessert items like ice cream and cookies. Participants spent longer looking at labels for foods they decided to purchase compared with foods they decided not to purchase. There were few between-group differences in nutrition label viewing across sex, race, age, BMI, marital status, income or educational attainment.

Nutrition label viewing is related to food purchasing, and labels are viewed more when a food's healthfulness is ambiguous. Objectively measuring nutrition label viewing provides new insight into label use by various sociodemographic groups.

To assess the relationship of acculturation with physical activity and sedentary behaviours among Hispanic women in California.

Data from the 2005 California Women's Health Survey (CWHS) – a cross-sectional telephonic survey of health indicators and health-related behaviours and attitudes – were used.

Using a random-digit dialling process, data were collected monthly from January to December 2005.

A total of 1298 women aged ≥18 years in California who self-identified as Hispanic.

Of the participants included in the analysis, 49 % were adherent to physical activity recommendations (with 150 min of weekly activity signifying adherence). There was no significant association between language acculturation and moderate or vigorous physical activity after controlling for potential confounders such as smoking, age and employment status. There was also no association between duration of residence in the USA and moderate or vigorous physical activity. Language acculturation was positively associated with television (TV) viewing, with highly acculturated women reporting more hours of TV viewing compared with women with an intermediate acculturation score (P = 0·0001), and those with an intermediate score reporting more hours of TV viewing compared with those with a low score (P = 0·003). This relationship persisted after inclusion of smoking, employment status, age and education in the model.

Higher levels of language acculturation may be associated with increased sedentary behaviours because of the influence of US culture on those women who have assimilated to the culture. Acculturation is an important factor to be taken into account when designing health education interventions for the Hispanic female population.

To profile adults who eat less than the recommended servings of fruit and vegetables per day.

Australia-wide population telephone survey on a random sample of the Australian population, with results analysed by univariate and multivariate models.

Australia.

One thousand one hundred and eight interviews, respondents’ (49·3 % males) mean age was 45·12 (sd 17·63) years.

Overall 54·8 % and 10·7 % were eating the recommended number of servings of fruit and vegetables. Variables included in the multivariate model indicating low fruit consumption included gender, age, employment, education and those who were less likely to consider the safety and quality of food as important. In regard to low vegetable consumption, people who were more likely to do the food shopping only ‘some of the time’ and have a high level of trust in groups of people such as immediate family, neighbours, doctors and different levels of government were included in the final model. They were also less likely to neither consider the safety and quality of food as important nor trust organisations/institutions such as the press, television and politicians. In the final model depicting both low fruit and low vegetable servings, sex, age and a low level of importance with regard to safety and quality of food were included.

To increase fruit and vegetable consumption, research into a broad range of determinants associated with behaviours should be coupled with a deeper understanding of the process associated with changing behaviours. While levels of trust are related to behaviour change, knowledge and attitudes about aspects associated with safety and quality of food are also of importance.

To examine socio-economic differences in the frequency and types of takeaway foods consumed.

A cross-sectional postal survey.

Participants were asked about their usual consumption of overall takeaway food (<4 times/month or ≥4 times/month) and of twenty-two specific takeaway food items (<1 time/month or ≥1 time/month); these latter foods were grouped into ‘healthy’ and ‘less healthy’ choices. Socio-economic position was measured on the basis of educational level and equivalised household income, and differences in takeaway food consumption were assessed by calculating prevalence ratios using log binomial regression.

Adults aged 25–64 years from Brisbane, Australia, were randomly selected from the electoral roll (n 903; 63·7 % response rate).

Compared with their more educated counterparts, the least educated were more regular consumers of overall takeaway food and fruit or vegetable juice and less regular consumers of sushi. For the ‘less healthy’ items, the least educated more regularly consumed potato chips, savoury pies, fried chicken and non-diet soft drinks; however, the least educated were less likely to consume curry. Household income was not associated with overall takeaway consumption. The lowest-income group was a more regular consumer of fruit or vegetable juice compared with the highest-income group. Among the ‘less healthy’ items, the lowest-income group was a more regular consumer of fried fish, ice cream and milk shakes, whereas curry was consumed less regularly.

The frequency and types of takeaway foods consumed by socio-economically disadvantaged groups may contribute to inequalities in overweight or obesity and to chronic disease.

Food insecurity is the limited or uncertain availability or access to nutritionally adequate, culturally appropriate and safe foods. Food insecurity may result in inadequate dietary intakes, overweight or obesity and the development of chronic disease. Internationally, few studies have focused on the range of potential health outcomes related to food insecurity among adults residing in disadvantaged locations and no such Australian studies exist. The objective of the present study was to investigate associations between food insecurity, sociodemographic and health factors and dietary intakes among adults residing in disadvantaged urban areas.

Data were collected by mail survey (n 505, 53 % response rate), which ascertained information about food security status, demographic characteristics (such as age, gender, household income, education) fruit and vegetable intakes, takeaway and meat consumption, general health, depression and chronic disease.

Disadvantaged suburbs of Brisbane city, Australia, 2009.

Individuals aged ≥ 20 years.

Approximately one in four households (25 %) was food insecure. Food insecurity was associated with lower household income, poorer general health, increased health-care utilisation and depression. These associations remained after adjustment for age, gender and household income.

Food insecurity is prevalent in urbanised disadvantaged areas in developed countries such as Australia. Low-income households are at high risk of experiencing food insecurity. Food insecurity may result in significant health burdens among the population, and this may be concentrated in socio-economically disadvantaged suburbs.

To experimentally compare the effects of eating or skipping breakfast on energy expenditure, activity levels and dietary habits.

A randomised cross-over trial, lasting 2 weeks. Participants were provided breakfast during one week and were required to fast until mid-day during the other week.

University campus.

Forty-nine participants (twenty-six female and twenty-three male participants) were recruited. Food intake was monitored using food diaries, and energy expenditure was assessed using pedometers and heart rate monitors. Morningness–eveningness, physical activity and health were assessed using validated questionnaires.

Across all participants, daily energy expenditure did not differ between the two experimental conditions. Total energy intake over 24 h did not vary with condition (male participants: 8134 (sd 447) kJ/d and 7514 (sd 368) kJ/d; female participants: 7778 (sd 410) kJ/d and 7531 (sd 535) kJ/d, for the breakfast and no-breakfast conditions, respectively). However, when comparing habitual breakfast eaters with those with irregular or breakfast-skipping habits, it was found that male non-habitual breakfast eaters consumed significantly (P = 0·029) more energy during the breakfast condition. Furthermore, female participants who were habitual breakfast eaters were found to eat significantly (P = 0·005) more and later in the day under the no-breakfast condition.

Although the suggestion that breakfast is a behavioural marker for appropriate dietary and physical activity patterns is not refuted by the present findings, our data suggest that the effect of breakfast may vary as a function of gender and morning eating habits, and thus there may be other mechanisms that link BMI and breakfast consumption behaviour.

To assess Australian consumers’ perception of portion size of fast-food items and their ability to estimate energy content.

Cross-sectional computer-based survey.

Australia.

Fast-food consumers (168 male, 324 female) were asked to recall the items eaten at the most recent visit to a fast-food restaurant, rate the prospective satiety and estimate the energy content of seven fast-food or ‘standard’ meals relative to a 9000 kJ Guideline Daily Amount. Nine dietitians also completed the energy estimation task.

Ratings of prospective satiety generally aligned with the actual size of the meals and indicated that consumers perceived all meals to provide an adequate amount of food, although this differed by gender. The magnitude of the error in energy estimation by consumers was three to ten times that of the dietitians. In both males and females, the average error in energy estimation for the fast-food meals (females: mean 3911 (sd 1998) kJ; males: mean 3382 (sd 1957) kJ) was significantly (P < 0·001) larger than for the standard meals (females: mean 2607 (sd 1623) kJ; males: mean 2754 (sd 1652) kJ). In women, error in energy estimation for fast-food items predicted actual energy intake from fast-food items (β = 0·16, P < 0·01).

Knowledge of the energy content of standard and fast-food meals in fast-food consumers in Australia is poor. Awareness of dietary energy should be a focus of health promotion if nutrition information, in its current format, is going to alter behaviour.

To describe the UK Food Standards Agency's (FSA) salt reduction programme undertaken between 2003 and 2010 and to discuss its effectiveness.

Relevant scientific papers, campaign materials and evaluations and consultation responses to the FSA's salt reduction programme were used.

Adult salt intakes, monitored using urinary Na data collected from UK-wide surveys, indicate a statistically significant reduction in the population's average salt intake from 9·5 g/d in 2000–2001 to 8·6 g/d in 2008, which is likely to have health benefits.

Reducing salt intake will have an impact on blood pressure; an estimated 6 % of deaths from CHD in the UK can be avoided if the number of people with high blood pressure is reduced by 50 %.

Salt levels in food, monitored using commercial label data and information collected through an industry self-reporting framework, indicated that substantial reductions of up to 70 % in some foods had been achieved. The FSA's consumer campaign evaluation showed increased awareness of the benefits of reducing salt intake on health, with 43 % of adults in 2009 claiming to have made a special effort to reduce salt in their diet compared with 34 % of adults in 2004, before the campaign commenced.

The UK's salt reduction programme successfully reduced the average salt intake of the population and increased consumers’ awareness. Significant challenges remain in achieving the population average salt intake of 6 g/d recommended by the UK's Scientific Advisory Committee on Nutrition. However, the UK has demonstrated the success of its programme and this approach is now being implemented elsewhere in the world.

The ‘Smart Choices’ programme was an industry-driven, front-of-package (FOP) nutritional labelling system introduced in the USA in August 2009, ostensibly to help consumers select healthier options during food shopping. Its nutritional criteria were developed by members of the food industry in collaboration with nutrition and public health experts and government officials. The aim of the present study was to test the extent to which products labelled as ‘Smart Choices’ could be classified as healthy choices on the basis of the Nutrient Profile Model (NPM), a non-industry-developed, validated nutritional standard.

A total of 100 packaged products that qualified for a ‘Smart Choices’ designation were sampled from eight food and beverage categories. All products were evaluated using the NPM method.

In all, 64 % of the products deemed ‘Smart Choices’ did not meet the NPM standard for a healthy product. Within each ‘Smart Choices’ category, 0 % of condiments, 8·70 % of fats and oils, 15·63 % of cereals and 31·58 % of snacks and sweets met NPM thresholds. All sampled soups, beverages, desserts and grains deemed ‘Smart Choices’ were considered healthy according to the NPM standard.

The ‘Smart Choices’ programme is an example of industries’ attempts at self-regulation. More than 60 % of foods that received the ‘Smart Choices’ label did not meet standard nutritional criteria for a ‘healthy’ food choice, suggesting that industries’ involvement in designing labelling systems should be scrutinized. The NPM system may be a good option as the basis for establishing FOP labelling criteria, although more comparisons with other systems are needed.

Despite widespread concern over exploitation of the European Union's fish stocks, dietary guidelines in the UK continue to recommend two portions of fish per week. The present study sought to investigate whether health and/or sustainability are motivating factors when purchasing and consuming fish and whether there are sociodemographic trends.

A structured, self-completion postal questionnaire exploring consumers’ attitudes towards purchasing fish, their dietary intake, stated purchasing behaviour and sociodemographic information.

Nottinghamshire, UK.

Adults from 842 households randomly selected from the electoral register.

Over half of the participants (57·0 %) were aware of the health benefits of fish consumption and reported health as a primary motivator for purchasing fish; however, only 26·8 % actively sought to purchase fish from a sustainable source (e.g. Marine Stewardship Council (MSC) certified fish). Only 30·6 % of participants met current dietary recommendations for fish intake. Older respondents (>60 years of age) were more likely to report purchasing fish for health reasons and to buy MSC fish. Participants were significantly less likely to report MSC purchases if they agreed with the statement ‘I am confused about which type of fish I should be eating to protect fish stocks’ (P < 0·001).

The number of consumers purchasing fish for health reasons was more than those seeking sustainably sourced fish; yet, they still failed to meet the recommended intake set by the Food Standards Agency. Dietary advice to the public to increase consumption of fish conflicts with the prevailing pressure on fish stocks. Clear advice should be communicated enabling consumers to meet nutritional needs while protecting fish stocks.

California Assembly Bill 1535 awarded $US 15 million to California public schools to promote, develop and sustain instructional school gardens through the California Instructional School Garden Program (CISGP). The present study was designed to assess the effectiveness of the CISGP at assisting schools in implementing, maintaining and sustaining an academic school garden programme, determine how schools utilized the funding they received and assess the impact of the California state budget crisis on the CISGP.

A mid-term evaluation was used to assess the degree to which schools achieved their instructional garden-related goals.

California.

Only schools that applied for the CIGSP grant as part of a school district and also provided a contact email and had a unique contact person were included in the study (n 3103, 80·6 %).

In general, many schools reported not achieving their predicted goals with regard to the CISGP grant. Only 39·4 % of schools reported accomplishing all of their garden-related goals. Over one-third (37·8 %) of schools reported that their school gardens were negatively affected by the California budget deficit.

The difference between predicted and actual utilization of the CISGP grants may be due to a combination of the effects of budget shortfall and insufficiency of the grant award amount.

The present study examined whether objective measures of the food environment are associated with perceptions of the food environment and whether this relationship varies by socio-economic disadvantage.

The study is a cross-sectional analysis of self-report surveys and objective environment data. Women reported their perceptions on the nutrition environment. Participants’ homes and food stores were geocoded to measure the objective community nutrition environment. Data on the average price and variety of fruit and vegetables were used to measure the objective consumer nutrition environment.

The study was conducted in Melbourne, Australia, in 2003–2004.

Data presented are from a sample of 1393 women aged 18–65 years.

Overall the match between the perceived and objective environment was poor, underscoring the limitations in using perceptions of the environment as a proxy for the objective environment. Socio-economic disadvantage had limited impact on the relationship between perceived and objective nutrition environment.

Further research is needed to understand the determinants of perceptions of the nutrition environment to enhance our understanding of the role of perceptions in nutrition choices and drivers of socio-economic inequalities in nutrition.

To assess the relationship between adolescent perception of time to walk to neighbourhood food retail outlets and purchasing of sugar-sweetened beverages (SSB), fast and convenience food items, and to test for differences by urban v. suburban environment.

Cross-sectional observational study.

Twin Cities Metropolitan Area, Minnesota, USA.

Adolescents from two studies completed survey-based measures on perceptions of time to walk to food retail outlets from home, purchasing patterns of SSB and fast and convenience store items, perceptions of personal safety and pedestrian infrastructure, and demographic characteristics. Descriptive analysis, Spearman correlations and multivariate linear regression, accounting for clustering, were conducted.

There were 634 adolescents, approximately half male, predominantly white, with a middle-class background. Greater perceived time to food outlets was associated with less frequent purchasing of SSB, convenience store foods and fast-food items. Multivariate models showed that a perceived shorter walking time (i.e. 1−5 v. 31+ min) was significantly associated with more SSB purchasing. SSB purchases were also significantly associated with the number of food outlets within a 10 min walk (B = 0·05, P = 0·02).

A reduction in consumption of SSB and other energy-dense snacks is an important obesity prevention approach. An approach offering alternatives or reducing exposure in addition to education to alter purchasing habits may contribute to improving dietary habits and reducing the obesity epidemic.

Distribution of breast milk substitutes (BMS) after the 2006 Yogyakarta earthquake was uncontrolled and widespread. We assessed the magnitude of BMS distribution after the earthquake, its impact on feeding practices and the association between consumption of infant formula and diarrhoea among infants and young children.

One month after the earthquake, caregivers of 831 children aged 0–23 months were surveyed regarding receipt of unsolicited donations of BMS, and on recent child-feeding practices and diarrhoeal illness.

Community-level survey in an earthquake-affected district.

Primary caregivers of surveyed children.

In all, 75 % of households with an infant aged 0–5 months and 80 % of all households surveyed received donated infant formula; 76 % of all households received commercial porridge and 49 % received powdered milk. Only 32 % of 0–5-month-old infants had consumed formula before the earthquake, but 43 % had in the 24 h preceding the survey (P < 0·001). Consumption of all types of BMS was significantly higher among those who received donated commodities, regardless of age (P < 0·01). One-week diarrhoea incidence among those who received donated infant formula (25·4 %) was higher than among those who did not (11·5 %; relative risk = 2·12, 95 % CI = 1·34, 3·35). The rate of diarrhoea among those aged 12–23 months was around five times the pre-earthquake rate.

There were strong associations between receipt of BMS and changes in feeding practices, and between receipt of infant formula and diarrhoea. Uncontrolled distribution of infant formula exacerbates the risk of diarrhoea among infants and young children in emergencies.

To understand factors affecting the compliance of malnourished, HIV-positive adults with a nutritional protocol using ready-to-use therapeutic food (RUTF; Plumpy'nut®).

Qualitative study using key informant interviews, focus group discussions and direct observations.

Ministry of Health HIV/programme supported by Médecins Sans Frontièrs (MSF) in Nyanza Province, Kenya.

Adult patients (n 46) currently or previously affected by HIV-associated wasting and receiving anti-retroviral therapy, their caregivers (n 2) and MoH/MSF medical employees (n 8).

Thirty-four out of forty-six patients were receiving RUTF (8360 kJ/d) at the time of the study and nineteen of them were wasted (BMI < 17 kg/m2). Six of the thirteen wasted out-patients came to the clinic without a caregiver and were unable to carry their monthly provision (12 kg) of RUTF home because of physical frailty. Despite the patients’ enthusiasm about their weight gain and rapid resumption of labour activities, the taste of the product, diet monotony and clinical conditions associated with HIV made it impossible for half of them to consume the daily prescription. Sharing the RUTF with other household members and mixing with other foods were common. Staff training did not include therapeutic dietetic counselling.

The level of reported compliance with the prescribed dose of RUTF was low. An improved approach to treating malnourished HIV-positive adults in limited resource contexts is needed and must consider strategies to support patients without a caregiver, development of therapeutic foods more suited to adult taste, specific dietetic training for health staff and the provision of liquid therapeutic foods for severely ill patients.

To assess the vitamin D status of 9–12-year-old primary-school children in Tehran during autumn and winter 2007–2008.

A descriptive cross-sectional study.

Primary schools of Tehran city, Iran.

A total of 1111 children aged 9–12 years (573 boys and 538 girls) from sixty primary schools were enrolled in the study. Weight, height, BMI and serum levels of Ca, P, Mg, 25-hydroxyvitamin D (25(OH)D), intact parathyroid hormone (iPTH), osteocalcin and bone-specific alkaline phosphatase of all the participants were assessed. Dietary Ca intake was also evaluated using a quantitative FFQ for a subsample of the study population (n 503). Vitamin D sufficiency was defined on the basis of serum levels of 25(OH)D as either ≥37 nmol/l (criterion 1) or ≥50 nmol/l (criterion 2).

Daily intake of Ca did not differ significantly between boys and girls (929·6 (sd 436·7) mg and 909·5 (sd 465·5) mg, respectively). However, on the basis of the first criterion, approximately 86 % of the children had vitamin D deficiency, with 38·3 % being severely deficient (25(OH)D < 12·5 nmol/l). According to the second criterion, prevalence of vitamin D deficiency rose to 91·7 %. Prevalence of vitamin D deficiency was higher in girls than in boys by either criterion. Serum levels of 25(OH)D inversely correlated with iPTH (r = −0·154, P < 0·001) and BMI (r = −0·092, P = 0·002) but directly correlated with duration of sun exposure (r = 0·115, P < 0·001).

The high prevalence of vitamin D deficiency among schoolchildren (especially among girls) warrants immediate interventions for proper nutritional support.

The study aimed to (i) segment parents of early adolescents into subgroups according to their Ca-rich-food (CRF) practices and perceptions regarding early adolescent CRF intake and (ii) determine whether Ca intake of parents and early adolescents differed by subgroup.

A cross-sectional convenience sample of 509 parents and their early adolescent children completed a questionnaire in 2006–2007 to assess parent CRF practices and perceptions and to estimate parent and child Ca intakes.

Self-administered questionnaires were completed in community settings or homes across nine US states.

Parents self-reporting as Asian, Hispanic or non-Hispanic White with a child aged 10–13 years were recruited through youth or parent events.

Three parent CRF practice/perception segments were identified, including ‘Dedicated-Milk Providers/Drinkers’ (49 %), ‘Water Regulars’ (30 %) and ‘Sweet-Drink-Permissive Parents’ (23 %). Dedicated-Milk Providers/Drinkers were somewhat older and more likely to be non-Hispanic White than other groups. Ca intakes from all food sources, milk/dairy foods and milk only, and milk intakes, were higher among early adolescent children of Dedicated-Milk Providers/Drinkers compared with early adolescents of parents in other segments. Soda pop intakes were highest for early adolescents with parents in the Water Regulars group than other groups. Dedicated-Milk Providers/Drinkers scored higher on culture/tradition, health benefits and ease of use/convenience subscales and lower on a dairy/milk intolerance subscale and were more likely to report eating family dinners daily than parents in the other groups.

Parent education programmes should address CRF practices/perceptions tailored to parent group to improve Ca intake of early adolescent children.

To document nutrient and food group serving intakes from food sources among Latina subgroups living in the same geographical area.

A cross-sectional study. Nutrient and food group serving intakes were assessed by means of a 24 h recall administered immediately after a prenatal survey.

Hartford, CT, USA.

A total of 233 low-income pregnant Latinas. For analyses, Latinas were classified into two groups on the basis of self-reported ethnic identity: Puerto Ricans and non-Puerto Rican Latinas.

Puerto Rican Latinas were more likely than non-Puerto Rican Latinas to be more acculturated and to consume foods (i.e. processed meat, cheese, soft drinks) and higher levels of nutrients (i.e. fat, SFA, MUFA, trans fatty acids) that have been implicated in the development of chronic diseases. By contrast, non-Puerto Rican Latinas were more likely to consume foods (i.e. fruits, dark green/yellow vegetables, tomatoes, non-starchy vegetables) and higher levels of nutrients (i.e. fibre, vegetable protein, folate, β-carotene) that promote health when compared with Puerto Rican Latinas.

Findings suggest that acculturation may play a role in dietary intake. Clinicians and dietitians need to be aware of these differences to encourage healthy eating patterns among more acculturated pregnant Latina clients.