To refine and validate an existing home food inventory (HFI) for low-income Somali- and Spanish-speaking families.

Formative assessment was conducted using two focus groups, followed by revisions of the HFI, translation of written materials and instrument validation in participants’ homes.

Twin Cities Metropolitan Area, Minnesota, USA.

Thirty low-income families with children of pre-school age (fifteen Spanish-speaking; fifteen Somali-speaking) completed the HFI simultaneously with, but independently of, a trained staff member. Analysis consisted of calculation of both item-specific and average food group kappa coefficients, specificity, sensitivity and Spearman's correlation between participants’ and staff scores as a means of assessing criterion validity of individual items, food categories and the obesogenic score.

The formative assessment revealed the need for few changes/additions for food items typically found in Spanish-speaking households. Somali-speaking participants requested few additions, but many deletions, including frozen processed food items, non-perishable produce and many sweets as they were not typical food items kept in the home. Generally, all validity indices were within an acceptable range, with the exception of values associated with items such as ‘whole wheat bread’ (κ = 0·16). The obesogenic score (presence of high-fat, high-energy foods) had high criterion validity with κ = 0·57, sensitivity = 91·8 %, specificity = 70·6 % and Spearman correlation = 0·78.

The revised HFI is a valid assessment tool for use among Spanish and Somali households. This instrument refinement and validation process can be replicated with other population groups.

To examine the feasibility of using point-of-sale data to assess dietary quality of food sales in remote stores.

A multi-site cross-sectional assessment of food and nutrient composition of food sales. Point-of-sale data were linked to Australian Food and Nutrient Data and compared across study sites and with nutrient requirements.

Remote Aboriginal Australia.

Six stores.

Point-of-sale data were readily available and provided a low-cost, efficient and objective assessment of food and nutrient sales. Similar patterns in macronutrient distribution, food expenditure and key food sources of nutrients were observed across stores. In all stores, beverages, cereal and cereal products, and meat and meat products comprised approximately half of food sales (range 49–57 %). Fruit and vegetable sales comprised 10·4 (sd 1·9) % on average. Carbohydrate contributed 54·4 (sd 3·0) % to energy; protein 13·5 (sd 1·1) %; total sugars 28·9 (sd 4·3) %; and the contribution of total saturated fat to energy ranged from 11·0 to 14·4 % across stores. Mg, Ca, K and fibre were limiting nutrients, and Na was four to five times higher than the midpoint of the average intake range. Relatively few foods were major sources of nutrients.

Point-of-sale data enabled an assessment of dietary quality within stores and across stores with no burden on communities and at no cost, other than time required for analysis and reporting. Similar food spending patterns and nutrient profiles were observed across the six stores. This suggests potential in using point-of-sale data to monitor and evaluate dietary quality in remote Australian communities.

The current discussion regarding ‘place effects on health’ is increasingly focusing on the characteristics of a specific physical environment. Our study investigated whether socially deprived residential areas are more likely than affluent neighbourhoods to provide access to addictive substances and fast food.

In this ecological study the total number of tobacco, alcohol and fast-food outlets was recorded and visualized using a geographic information system. Area affluence was measured through the percentage of parents with children of kindergarten or school age with joint annual taxable income <€12 272.

Eighteen social areas in Cologne, Germany.

All social areas in four districts in Cologne, Germany, with a total of 92 000 inhabitants, were analysed.

In the investigation area, 339 tobacco, 353 alcohol and sixty-seven fast-food outlets were identified. As area affluence declined the availability of the following potentially health damaging sources increased: cigarettes (Kendall's tau = 0·433; P = 0·012), alcohol (Kendall's tau = 0·341, P = 0·049) and fast food (Kendall's tau = 0·473; P = 0·009).

The availability of addictive substances and fast food can be seen to have a contextual influence on an individual's lifestyle and can, in the form of physical exposure to obesogenic and addictive environments, contribute to a culmination of health risks.

The present study aimed to examine the availability of energy-dense, nutrient-poor snack foods (and fruits and vegetables) in supermarkets located in socio-economically advantaged and disadvantaged neighbourhoods.

Cross-sectional supermarket audit.

Melbourne, Australia. Measures included product shelf space and number of varieties for soft drinks, crisps, chocolate, confectionery and fruits and vegetables, as well as store size.

Thirty-five supermarkets (response 83 %) from neighbourhoods in the lowest and highest quintile of socio-economic disadvantage.

Shelf space allocated to soft drinks (23·6 m v. 17·7 m, P = 0·006), crisps (16·5 m v. 13·0 m, P = 0·016), chocolate (12·2 m v. 10·1 m, P = 0·022) and confectionery (6·7 m v. 5·1 m, P = 0·003) was greater in stores from socio-economically disadvantaged neighbourhoods. After adjustment for store size (stores in disadvantaged areas being larger), shelf space for confectionery (6·3 m v. 5·6 m, P = 0·024) and combined shelf space for all energy-dense foods and drinks (55·0 m v. 48·9 m, P = 0·017) remained greater in stores from socio-economically disadvantaged neighbourhoods. The ratio of shelf space allocated to fruits and vegetables to that for energy-dense snack foods also varied by socio-economic disadvantage after adjustment for store size (most disadvantaged v. least disadvantaged: 1·7 v. 2·1, P = 0·025). Varieties of fruits and vegetables and chocolate bars were more numerous in less disadvantaged areas (P < 0·05).

Exposure to energy-dense snack foods and soft drinks in supermarkets was greater in socio-economically disadvantaged neighbourhoods. This may impact purchasing, consumption and cultural norms related to eating behaviours and may therefore work against elimination of the known socio-economic gradient in obesity levels. Reform of supermarket stocking practices may represent an effective means of obesity prevention.

The present study evaluated the restaurant and dining venues on and near post-secondary campuses varying in institution size.

The Nutrition Environment Measures Survey for Restaurants (NEMS-R) was modified to evaluate restaurants as fast food, sit down and fast casual; and campus dining venues as dining halls, student unions and snack bar/cafés. ANOVA with post hoc Tukey's B and T tests were used to distinguish differences between dining venues and associated institutions by size.

The study was conducted at fifteen US post-secondary institutions, 2009–2011.

Data presented are from a sample of 175 restaurants and sixty-eight on-campus dining venues.

There were minimal differences in dining halls by institution size, although medium-sized institutions as compared with small-sized institutions offered significantly more healthful side dish/salad bar items. Dining halls scored significantly higher than student unions or snack bar/cafés on healthful entrées, side dish/salad bar and beverages offerings, but they also had the most barriers to healthful dietary habits (i.e. all-you-can-eat). No differences were found by restaurant type for NEMS-R scores for total restaurant dining environment or healthful entrées and barriers. Snack bars had more healthful side dishes (P = 0·002) and fast-food restaurants had the highest level of facilitators (i.e. nutrition information; P = 0·002).

Based on this evaluation in fifteen institutions, the full campus dining environment provides limited support for healthy eating and obesity prevention. The quality of campus dining environments can be improved via healthful offerings, providing nutrition information and other supports to facilitate healthy eating and prevent unwanted weight gain.

Recommendations for fruit and vegetable consumption are largely unmet. Lower socio-economic status (SES), neighbourhood poverty and poor access to retail outlets selling healthy foods are thought to predict lower consumption. The objective of the present study was to assess the interrelationships between these risk factors as predictors of fruit and vegetable consumption.

Cross-sectional multilevel analyses of data on fruit and vegetable consumption, socio-demographic characteristics, neighbourhood poverty and access to healthy retail food outlets.

Survey data from the 2002 and 2004 New York City Community Health Survey, linked by residential zip code to neighbourhood data.

Adult survey respondents (n 15 634).

Overall 9·9 % of respondents reported eating ≥5 servings of fruits or vegetables in the day prior to the survey. The odds of eating ≥5 servings increased with higher income among women and with higher educational attainment among men and women. Compared with women having less than a high-school education, the OR was 1·12 (95 % CI 0·82, 1·55) for high-school graduates, 1·95 (95 % CI 1·43, 2·66) for those with some college education and 2·13 (95 % CI 1·56, 2·91) for college graduates. The association between education and fruit and vegetable consumption was significantly stronger for women living in lower- v. higher-poverty zip codes (P for interaction < 0·05). The density of healthy food outlets did not predict consumption of fruits or vegetables.

Higher SES is associated with higher consumption of produce, an association that, in women, is stronger for those residing in lower-poverty neighbourhoods.

To examine: (i) the association between home availability of fruit and vegetables and children's fruit and vegetable intake; (ii) the association between parental perception of the local food shopping environment and the home availability of fruit and vegetables; and (iii) whether the home availability of fruit and vegetables mediates the association between parental perception of the local food environment and children's fruit and vegetable consumption.

Cross-sectional study.

A total of ninety-one primary schools in the Netherlands.

In total 1501 primary caregivers completed a questionnaire to measure children's fruit and vegetable consumption, home availability of fruit and vegetables, parental perceptions of the local food shopping environment (price, quality and availability), the child's socio-economic status, the child's ethnicity and maternal height and weight.

The home availability of fruit and vegetables was positively associated with children's fruit and vegetable intake (P < 0·01 and P < 0·001, respectively). Negative parental perceptions of the local food shopping environment were associated with less fruit available at home (P < 0·05, P < 0·01 and P < 0·05 for price, quality and availability of fruit, respectively). No significant associations were found between parental perception of the local food shopping environment and children's fruit and vegetable consumption. We found no evidence that home availability of fruit and vegetables mediates the association between parental perception of the local food environment and children's fruit and vegetable intake.

Interventions focusing on improving the home availability of fruit and vegetables may help to increase children's fruit and vegetable consumption. However, more data are required on factors influencing the home availability of fruit and vegetables.

To systematically review evidence from field interventions on the effectiveness of monetary subsidies in promoting healthier food purchases and consumption.

Keyword and reference searches were conducted in five electronic databases: Cochrane Library, EconLit, MEDLINE, PsycINFO and Web of Science. Studies were included based on the following criteria: (i) intervention: field experiments; (ii) population: adolescents 12–17 years old or adults 18 years and older; (iii) design: randomized controlled trials, cohort studies or pre–post studies; (iv) subsidy: price discounts or vouchers for healthier foods; (v) outcome: food purchases or consumption; (vi) period: 1990–2012; and (vii) language: English. Twenty-four articles on twenty distinct experiments were included with study quality assessed using predefined methodological criteria.

Interventions were conducted in seven countries: the USA (n 14), Canada (n 1), France (n 1), Germany (n 1), Netherlands (n 1), South Africa (n 1) and the UK (n 1). Subsidies applied to different types of foods such as fruits, vegetables and low-fat snacks sold in supermarkets, cafeterias, vending machines, farmers’ markets or restaurants.

Interventions enrolled various population subgroups such as school/university students, metropolitan transit workers and low-income women.

All but one study found subsidies on healthier foods to significantly increase the purchase and consumption of promoted products. Study limitations include small and convenience samples, short intervention and follow-up duration, and lack of cost-effectiveness and overall diet assessment.

Subsidizing healthier foods tends to be effective in modifying dietary behaviour. Future studies should examine its long-term effectiveness and cost-effectiveness at the population level and its impact on overall diet intake.

The aim of the study was to determine the association between dietary outcomes and the neighbourhood food environment (street network distance from home to stores) and consumer food environment (Nutrition Environment Measurement Survey-Stores (NEMS-S) audit).

The neighbourhood food environment was captured by creating 0·5-mile and 1-mile network distance (street distance) around each participant's home and the nearest food venue (convenience store, grocery store, supermarket, farmers' market and produce stand). The consumer food environment was captured by conducting NEMS-S in all grocery stores/supermarkets within 0·5 and 1 mile of participants’ homes.

Fayette County, KY, USA.

Supplemental Nutrition Assessment Program (SNAP) participants, n 147.

SNAP participants who lived within 0·5 mile of at least one farmers’ market/produce stand had higher odds of consuming one serving or more of vegetables (OR = 6·92; 95 % CI 4·09, 11·69), five servings or more of grains (OR = 1·76; 95 % CI 1·01, 3·05) and one serving or more of milk (OR = 3·79; 95 % CI 2·14, 6·71) on a daily basis. SNAP participants who lived within 0·5 mile of stores receiving a high score on the NEMS-S audit reported higher odds of consuming at least one serving of vegetables daily (OR = 3·07; 95 % CI 1·78, 5·31).

Taken together, both the neighbourhood food environment and the consumer food environment are associated with a healthy dietary intake among SNAP participants.

To assess a county population's exposure to different types of food sources reported to affect both diet quality and obesity rates.

Food permit records obtained from the local health department served to establish the full census of food stores and restaurants. Employing prior categorization schemes which classified the relative healthfulness of food sources based on establishment type (i.e. supermarkets v. convenience stores, or full-service v. fast-food restaurants), food establishments were assigned to the healthy, unhealthy or undetermined groups.

King County, WA, USA.

Full census of food sources.

According to all categorization schemes, most food establishments in King County fell into the unhealthy and undetermined groups. Use of the food permit data showed that large stores, which included supermarkets as healthy food establishments, contained a sizeable number of bakery/delis, fish/meat, ethnic and standard quick-service restaurants and coffee shops, all food sources that, when housed in a separate venue or owned by a different business establishment, were classified as either unhealthy or of undetermined value to health.

To fully assess the potential health effects of exposure to the extant food environment, future research would need to establish the health value of foods in many such common establishments as individually owned grocery stores and ethnic food stores and restaurants. Within-venue exposure to foods should also be investigated.

Adequate fluid intake has been well documented as important for health but whether it has adverse effects on overall energy and sugar intakes remains under debate. Many dietary studies continue to refrain from reporting on beverage consumption, which the present study aimed to address.

A cross-sectional survey investigated self-reported measures of dietary intake and anthropometric measurements.

Primary and secondary schools in south-west London, UK.

Boys and girls (n 248) aged 9–13 years.

Boys consumed 10 % and girls consumed 9 % of their daily energy intake from beverages and most children had total sugar intakes greater than recommended. Beverages contributed between a quarter and a third of all sugars consumed, with boys aged 11–13 years consuming 32 % of their total sugar from beverages. There was a strong relationship between consumption of beverages and energy intake; however, there was no relationship between beverage type and either BMI or BMI Z-score. Fruit juices and smoothies were consumed most frequently by all girls and 9–10-year-old boys; boys aged 11–13 years preferred soft drinks and consumed more of their daily energy from soft drinks. Milk and plain water as beverages were less popular.

Although current health promotion campaigns in schools merit the attention being given to improving hydration and reducing soft drinks consumption, it may be also important to educate children on the energy and sugar contents of all beverages. These include soft drinks, as well as fruit juices and smoothies, which are both popular and consumed regularly.

To explore mediators of gender and educational differences in sugar-sweetened soft drinks consumption (SDC) and whether gender and level of future education moderate the associations of accessibility, modelling, attitudes and preferences with SDC.

A cross-sectional school-based survey within the Fruits and Vegetables Makes the Marks (FVMM) project from 2005.

The questionnaires were completed by the pupils in the classroom guided by a trained project worker during one class session. The questionnaire included questions on SDC (times/week), the potential mediators and moderators. Multilevel linear regression models were used to calculate the mediating and moderating effects.

A total of 2870 children in 9th and 10th grade (mean age 15·5 years) at thirty-three Norwegian secondary schools were included in the present study.

Girls (B = −1·06) and pupils planning higher education (B = −0·69) reported lower frequency of SDC. The strongest mediators were accessibility and modelling for future educational plans differences (explaining alone respectively 69 % and 44 %) and attitudes and preferences for gender differences (explaining alone respectively 57 % and 51 %). Significant but small moderating effects were found, and all associations between the mediators and SDC were in the same direction for both genders and for those with and without plans of higher future education.

Preferences and modelling may contribute to gender and educational differences in SDC. The small moderating effects indicate that interventions aiming to reduce SDC can target the same mediators for boys and girls and children planning different levels of future education.

To investigate the relationship between the intake of sugar-containing beverages (SCB) at the age of 13 years and adult weight status 24–30 years later.

A longitudinal study with 30 years of follow-up from adolescence (age 13 years in 1976) to adulthood (up to 2000 and 2006). Dietary intake was assessed through cross-check dietary history face-to-face interviews by a dietitian. Beverages were divided into two categories: (i) total SCB and (ii) SCB excluding 100 % fruit juices. Percentage of total fat (%total fat) and percentage of trunk fat (%trunk fat) were obtained through dual-energy X-ray absorptiometry measurements; body weight and height were measured by trained staff.

Amsterdam Growth and Health Longitudinal Study, the Netherlands.

One hundred and fourteen males and 124 females.

In males, but not in females, each additional daily serving of SCB excluding 100 % fruit juices at 13 years was associated with 1·14 % higher %total fat (95 % CI 0·04, 2·23 %; P = 0·04) and 1·62 % higher %trunk fat (95 % CI 0·14, 3·10 %; P = 0·03) in adulthood after correction for confounders. No statistically significant relationship was found between the intake of SCB excluding 100 % fruit juices at the age of 13 and BMI in both sexes. In addition, no statistically significant relationships were found between the intake of total SCB and all measures of adult weight status in both sexes.

Intake of SCB excluding 100 % fruit juices at the age of 13 years was positively associated with adult %total fat and %trunk fat in males, but not in females.

To evaluate whether food behaviours of parents are associated with children's dietary intakes outside the child-care setting, and to compare children's dietary intakes at home with foods and beverages consumed when they are at child-care centres.

In 2005–2006, a survey was completed by parents of at least one child between 3 and 5 years old who attended group child-care centres. Surveys about nutrition practices were completed by centre directors. Research assistants observed foods and beverages consumed by children at lunchtime at the centres.

Sixteen licensed group child-care centres in three underserved New York City communities (South Bronx, East/Central Harlem, Central Brooklyn) and the Lower East Side of Manhattan.

Two hundred parents.

Children were more likely to consume healthful foods including fruits or vegetables if parents reported purchasing food from produce stands/farmers’ markets, shopped for frozen or canned fruits frequently and ate family meals or meals prepared at home daily. Children were more likely to consume less healthful foods such as French fries, or fruit drinks, more frequently if parents reported eating meals from fast-food or other restaurants at least once weekly, or if children ate while watching television. Types of foods and beverages offered to children at home (e.g. higher-fat milk, soft drinks and desserts) were less healthful than those offered at child-care centres.

Children's dietary intakes at home need to be improved. Parents need to understand the importance of providing home environments that support healthful food behaviours in children.

The goal of the current study was to examine if the completeness of programme implementation and the completeness of implementation of specific programme elements of the Dutch school-based healthy diet promotion programme Krachtvoer are related to short- and longer-term changes in students’ fruit, sweets and breakfast intakes.

Data on students’ dietary intakes were collected 1–4 weeks and 6 months after programme implementation. Teachers filled in a logbook on programme implementation after each lesson. The relationships between changes in students’ dietary intakes and completeness of implementation of the programme and of specific programme elements were tested using mixed linear regression analyses.

Thirteen Dutch prevocational schools.

Eight hundred and seventy-six of the 1117 participating students and eighteen of the twenty-two participating teachers.

Completeness of programme implementation was positively related to an increase in fruit consumption in the short term. Completeness of implementation of food exposure activities and a practical lesson on advertisements were related to an increase in fruit consumption in the short as well as the longer term. No such relationships were found for sweets and breakfast consumption.

Our results indicate that efforts should be made to help teachers implement the programme as fully as possible.

To examine the association between breakfast consumption and physical activity in a well-characterised sample of English children.

Cross-sectional study using food diaries to record breakfast consumption and accelerometry to assess physical activity.

Norfolk county, England.

Children (n 1697) aged 9–10 years from the SPEEDY (Sport, Physical Activity and Eating behaviour: Environmental Determinants in Young people) study.

Boys who consumed a poor-quality breakfast based on dairy product, cereal and fruit intakes spent approximately 7 min more time in moderate-to-vigorous physical activity (MVPA) during weekday afternoons and evenings compared with those who did not consume breakfast (P < 0·05). On weekend days, boys who consumed a poor- or good-quality breakfast spent approximately 6 and 5 min less time respectively being sedentary during the mornings compared with breakfast non-consumers (P < 0·05). Boys who consumed a good-quality breakfast spent almost 3 min more in MVPA during the morning on weekend days compared with non-consumers, and boys who consumed a poor- or good-quality breakfast were 22 % and 16 % more active overall respectively than breakfast non-consumers (P < 0·05). During the rest of the day, boys who consumed a good-quality breakfast spent about 11 min less time being sedentary (P < 0·05) and 7 min more time in MVPA (P < 0·01).

Although some associations between breakfast consumption and physical activity were detected for boys, the present study does not provide strong evidence that failing to consume breakfast, or having a low energy intake at breakfast time, is detrimental to children's physical activity levels.

Snacks, stress and parties all contribute to the weight gain – the elusive ‘Freshman 15’ – that some college-goers unfortunately experience. The present study examines how à la carte snack choice changes on a university campus during each progressing week of the academic calendar.

How à la carte snack choices change on a university campus with each progressing week of the academic calendar was examined.

The data were collected from three large cafeterias (or dining halls) on Cornell University's campus during four semesters (Fall 2006, Spring 2007, Fall 2007 and Spring 2008), for 18 weeks in each semester.

After the à la carte snack items were divided into healthy snacks and unhealthy snacks, the percentage share for each food category was calculated.

Within each semester, the unhealthy snack food choices increased consistently by 0·4 % per week (β = 0·00418, P < 0·01). Furthermore, a sharp (8 %) increase occurred in the final two weeks of the semester. In contrast, healthy snack food choices decreased by almost 4 % (β = −0·0408, P < 0·01) in the final two weeks during the fall semester.

These results demonstrate an increased demand for hedonic, or unhealthy, snack foods as the college semester progresses and in particular at the very end of the semester. To counter this tendency towards unhealthy snacking, cafeterias and stores should make extra effort to promote healthy alternatives during the later weeks of the semester.

To examine the association between breakfast consumption and CVD risk factors in European adolescents.

Cross-sectional. Breakfast consumption was assessed by the statement ‘I often skip breakfast’ and categorized into ‘consumer’, ‘occasional consumer’ and ‘skipper’. Blood pressure, weight, height, waist circumference, skinfold thickness, total cholesterol (TC), HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), TAG, insulin and glucose were measured and BMI, TC:HDL-C, LDL-C:HDL-C and homeostasis model assessment–insulin resistance index (HOMA-IR) were calculated.

The European Union-funded HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study.

European adolescents, aged 12·50–17·49 years, from ten cities within the HELENA study (n 2929, n 925 with blood sample, 53 % females).

In males, significant differences across breakfast consumption category (‘consumer’, ‘occasional consumer’ and ‘skipper’) were seen for age, BMI, skinfold thickness, waist circumference, cardiorespiratory fitness, systolic and diastolic blood pressures, TC:HDL-C, LDL-C:HDL-C, glucose, insulin, HOMA-IR and LDL-C; in females, for cardiorespiratory fitness, skinfold thickness, BMI, insulin and HOMA-IR. In overweight/obese males significant differences were also seen for TC and LDL-C, whereas no differences were observed in non-overweight males or in females regardless of weight status.

Our findings among European adolescents confirm previous data indicating that adolescents who regularly consume breakfast have lower body fat content. The results also show that regular breakfast consumption is associated with higher cardiorespiratory fitness in adolescents, and with a healthier cardiovascular profile, especially in males. Eating breakfast regularly may also negate somewhat the effect of excess adiposity on TC and LDL-C, especially in male adolescents.

To investigate the frequency of vitamin D deficiency in relation to demographics, clinical diagnosis, season of measurement and laboratory parameters in adult out-patients.

Descriptive, retrospective study concerning evaluation of the initial 25-hydroxyvitamin D (25(OH)D) levels determined at admission in relation to demographics, clinical diagnosis, season of measurement and laboratory parameters. 25(OH)D levels <20 ng/ml were classified as deficiency, 20–30 ng/ml as insufficiency and >30 ng/ml as sufficiency.

Out-patient clinics at a tertiary care centre.

A total of 2488 adult patients (mean age: 53·3 (sd 15·2) years; 85·2 % were females) admitted to out-patient clinics at Baskent University Istanbul Hospital were included.

Mean level of 25(OH)D in the overall population was 17·4 (sd 11·5) ng/ml while insufficiency and deficiency were evident in 24 % and 66 % of patients, respectively. Mean 25(OH)D levels in males >45 years old were higher than in their female counterparts (19·4 (sd 11·3) ng/ml v. 17·8 (sd 12·2) ng/ml; P < 0·05). Mean 25(OH)D levels obtained in summer (18·6 (sd 11·1) ng/ml) and autumn (23·3 (sd 13·6) ng/ml) were significantly higher than levels in spring (16·1 (sd 10·3) ng/ml) and winter (14·6 (sd 10·2) ng/ml; P < 0·01). Mean 25(OH)D levels were determined to be significantly lower in obese patients compared with non-obese patients (15·6 (sd 10·4) ng/ml v. 17·6 (sd 11·6) ng/ml; P < 0·05). Levels of 25(OH)D were significantly negatively correlated with serum parathyroid hormone levels (r = −0·194; P < 0·001) while significantly positively correlated with phosphorus (r = 0·059; P < 0·01) and HDL cholesterol (r = 0·070; P < 0·01) levels.

Our findings indicate that vitamin D deficiency is very common among out-patients in Turkey, regardless of gender and age, especially among obese people and during winter and spring.