To examine dietary patterns among British adults, associations with Na and macronutrient intakes, and implications for dietary advice.

Principal component analysis of 7 d weighed dietary records.

Adults aged 19–64 years (n 1724).

National Diet and Nutrition Survey (2000/2001).

High Na intake was associated with more energy-dense diets, higher in fat and SFA (percentage of energy) but lower in non-milk extrinsic sugars (NMES). Eight patterns (PC1 to PC8) explained 40 % of the total variance in food intakes. Three patterns – PC3 (high loadings on bread, fats and cheese), PC2 (meat products, eggs and chips) and PC7 (red meat, sauces and alcohol) – were associated with high Na intake. Of these, PC3 correlated with high Na density and Na:K ratio, while PC2 correlated with fat. By contrast, three patterns – ‘health-conscious’ (PC1; vegetables, fruit, fruit juice, fish), ‘breakfast cereals and milk’ (PC6) and ‘chicken and rice’ (PC8) – were associated with modest Na intake, lower Na density and lower fat and SFA. PC2 was positively correlated, and PC1 was negatively correlated, with adding salt to food. Other patterns were ‘tea/coffee and cakes’ (PC4; associated with high SFA and NMES) and ‘soft drinks and snacks’ (PC5; associated with high NMES but not fat or SFA). The dietary patterns of males and females differed slightly.

Dietary patterns PC1, PC6, PC8 (vegetables, fruit, fish, milk, breakfast cereals, poultry) were broadly compatible with guidelines for salt, fat, SFA and NMES. However, other patterns tended to be high in either salt or NMES.

The present study sought to determine the feasibility of an experimental research design to investigate the effects of exposure to magazine advertising on children's food choices.

Children were randomized to read either a magazine with food advertisements or a magazine with no food advertisements. They then chose two food items from the intervention ‘store’ to eat after the session. Data were also collected on attitudes to advertising and snack food preferences. Finally, participants’ parents were provided with a self-completion survey on food choices and other variables (n 24).

Three vacation care centres in regional New South Wales, Australia.

Children aged 5–12 years (n 47).

Children in the experimental condition were more likely to choose advertised foods than those in the control group. Interestingly, the majority reported taste and healthiness as the most important factors in snack food choices; however, when faced with the actual food choice, they predominantly chose unhealthy foods (eighty-two unhealthy and only twelve healthy items were chosen).

This was the first study to assess the effects on children of exposure to food advertising within the context of reading a child-targeted magazine. Importantly, even with the small sample size and venue limitations, we found that exposure to magazine advertising influenced food choices. Children's magazines are an under-researched and poorly regulated medium, with considerable potential to influence children's food choices. The present study shows that the methodology is feasible, and future studies could replicate this with larger samples.

Owing to modern lifestyles, individuals are dependent on out-of-home eating. The catering sector can have a pivotal role in influencing our food choices. The objective of the present study was to examine the impact of a structured catering initiative on food choices in a public sector workplace setting.

A cross-sectional comparison study in two hospitals, one of which had implemented a catering initiative designed to provide nutritious food while reducing sugar, fat and salt intakes.

Two public sector hospitals in Cork, Ireland.

A total of 100 random participants aged 18–64 years (fifty intervention, fifty non-intervention) who consumed at least one main meal in the hospital staff canteen daily. Each respondent was asked to complete one anonymous 24 h dietary recall and questionnaire. Food and nutrient analysis was conducted using WISP (Weighed Intake Software Program).

Reported mean intakes of total sugars (P < 0·001), total fat (P < 0·000), saturated fat (P < 0·000) and salt (P < 0·046) were significantly lower in the intervention hospital when adjusted for age and gender. In the intervention hospital, 72 % of respondents, compared with 42 % in the non-intervention hospital, complied with the recommended under-3 daily servings of food high in fat and sugar (P < 0·005). In the intervention hospital, 43 % of respondents exceeded the recommended salt intake of 4–6 g/d, compared with 57 % in the non-intervention hospital.

Structured catering initiatives in the workplace are a potentially important option in the promotion of healthy food choices. Targeted public health programmes and health policy changes are needed to motivate caterers in the public sector and other industries to develop interventions that promote a healthy diet.

The increasing prevalence of obesity among youth has elicited calls for schools to become more active in promoting healthy weight. The present study examined associations between various aspects of school food environments (specifically the availability of snack- and beverage-vending machines and the presence of snack and beverage logos) and students’ weight status, as well as potential influences of indices of diet and food behaviours.

A cross-sectional, self-administered web-based survey. A series of multinomial logistic regressions with generalized estimating equations (GEE) were constructed to examine associations between school environment variables (i.e. the reported presence of beverage- and snack-vending machines and logos) and self-reported weight- and diet-related behaviours.

Secondary schools in Alberta, Canada.

A total of 4936 students from grades 7 to 10.

The presence of beverage-vending machines in schools was associated with the weight status of students. The presence of snack-vending machines and logos was associated with students’ frequency of consuming vended goods. The presence of snack-vending machines and logos was associated with the frequency of salty snack consumption.

The reported presence of snack- and beverage-vending machines and logos in schools is related to some indices of weight status, diet and meal behaviours but not to others. The present study supported the general hypothesis that the presence of vending machines in schools may affect students’ weight through increased consumption of vended goods, but notes that the frequency of ‘junk’ food consumption does not seem to be related to the presence of vending machines, perhaps reflecting the ubiquity of these foods in the daily lives of students.

Our physical environment influences our daily food choices unconsciously. Strategic changes in the food environment might therefore be potential measures to influence consumers’ food selection towards better nutrition, without affecting the consumers’ freedom of choice. The present study aimed to examine whether increased vegetable variety enhances healthy food choices and improves meal composition.

A randomised experiment.

Participants were instructed to serve themselves a lunch from a buffet of food replicas. Individuals were randomly assigned to one of three food combinations: condition A – cooked carrots, pasta and chicken; condition B – cooked green garden beans, pasta and chicken; condition AB – carrot sticks, green garden beans, pasta and chicken. Two one-vegetable conditions were compared with one two-vegetable condition. Data from Zurich, Switzerland, were analysed using one-way ANOVA.

Ninety-eight students (fifty-three men; mean age 22·8 (sd 2·2) years, minimum = 19 years, maximum = 29 years).

Participants who could choose from two vegetables derived significantly more energy (141 kJ) from vegetables compared with participants in the one-vegetable condition (104 and 84 kJ, respectively). Furthermore, in the two-vegetable condition, the relative energy of the meal derived from vegetables (10·9 %) increased significantly compared with the one-vegetable condition (8 % and 6·1 %, respectively). The total energy content of the meal (mean 1472 (sd 468) kJ) was not affected by the experimental manipulation.

Having a choice of vegetables increases a person's tendency to choose vegetables and leads to the selection of a more balanced meal. Serving an assortment of vegetables as side dishes might be a simple and effective strategy to improve food selection.

To gain insight into intervention components targeted specifically to mothers of young children that may contribute to attendance and effectiveness on physical activity and healthy eating.

Systematic literature searches were performed using MEDLINE, Embase and cited references. Articles were included if they evaluated the effectiveness of a lifestyle intervention to promote physical activity and/or healthy eating in an experimental design among mothers with young children (age 0–5 years). Data were extracted on study characteristics, intervention components targeted towards mothers with young children, attendance and effectiveness. Extracted data were analysed in a descriptive manner.

Eleven articles describing twelve interventions met the inclusion criteria. Of the six studies that measured attendance, two reported high attendance. Embedding the intervention within routine visits to child health clinics seems to increase attendance. Three studies found significant effects on physical activity and three on healthy eating. Effective interventions directed at physical activity included components such as counselling on mother-specific barriers or community involvement in intervention development and implementation. One of the three interventions that effectively increased healthy eating had components targeted at mothers (i.e. used targeted motivational appeals).

The number of experimental intervention studies for promoting physical activity and healthy eating among new mothers is limited. However, useful first recommendations can be set for targeting interventions towards mothers, in particular for promoting attendance and physical activity. More insight is required about the need for targeting health promotion programmes at new mothers, especially of those directed at nutritional behaviour.

The main purpose of the study was to investigate the feasibility of using workplaces to increase the fruit consumption of participants by increasing fruit availability and accessibility by a minimal fruit programme. Furthermore, it was investigated whether a potential increase in fruit intake would affect vegetable, total energy and nutrient intake.

A 5-month, controlled, workplace study where workplaces were divided into an intervention group (IG) and a control group (CG). At least one piece of free fruit was available per person per day in the IG. Total fruit and dietary intake was assessed, using two 24 h dietary recalls at baseline and at endpoint.

Eight Danish workplaces were enrolled in the study. Five workplaces were in the IG and three were in the CG.

One hundred and twenty-four (IG, n 68; CG, n 56) healthy, mainly normal-weight participants were recruited.

Mean daily fruit intake increased significantly from baseline to endpoint only in the IG by 112(se 35) g. In the IG, mean daily intake of added sugar decreased significantly by 10·7(se 4·4) g, whereas mean daily intake of dietary fibre increased significantly by 3·0(se 1·1) g. Vegetable, total energy and macronutrient intake remained unchanged through the intervention period for both groups.

The present study showed that it is feasible to increase the average fruit intake at workplaces by simply increasing fruit availability and accessibility. Increased fruit intake possibly substituted intake of foods containing added sugar. In this study population the increased fruit intake did not affect total energy intake.

The Dutch Obesity Intervention in Teenagers (DOiT) is a school-based randomised controlled trial that was effective in decreasing the consumption of sugar-sweetened beverages among adolescents. The present study examined, using mediation analysis, whether this decrease in consumption of sugar-sweetened beverages could be explained by an increase in the consumption of water or diet drinks.

Participants completed a questionnaire about their beverage consumption at baseline and at 8 months (immediately post-intervention), 12- and 20-month follow-ups. A series of multi-level linear regression analyses were performed to examine water and diet drink consumption as potential mediators of the intervention effect on the consumption of sugar-sweetened beverages.

Eighteen Dutch secondary schools.

A total of 747 adolescents (mean age: 12·7 years).

In addition to the DoiT intervention effect of a reduction in the consumption of sugar-sweetened beverages at 8 months (−284 ml/d; 95 % CI −420, −148) and 12 months (−260 ml/d; 95 % CI −360, −160), there was also a significant reduction in diet drinks at 8 months (−52 ml/d; 95 % CI −89, −16). There was no significant difference in water consumption at any follow-up. The decrease in sugar-sweetened beverage consumption could not be explained by an increase in water or diet drink consumption at any time point.

Interventions aimed at reducing sugar-sweetened beverage consumption may be effective without changing consumption of other beverages. Reducing sugar-sweetened beverages was, however, a main message of the DOiT intervention. It is possible that a concomitant promotion of water may have resulted in a greater increase in water intake and replacement of sugar-sweetened beverages with water.

Obesity levels are rising in almost all parts of the world, including the UK. School food offers children in Great Britain between 25 % and 33 % of their total daily energy, with vending typically offering products high in fat, salt or sugar. Government legislation of 2007 to improve the quality of school food now restricts what English schools can vend. In assessing the effect of this legislation on the quality of English secondary-school vending provision, the response of schools to these effects is explored through qualitative data.

A longitudinal postal and visit-based inventory survey of schools collected vending data during the academic year 2006–2007 (pre-legislation), 2007–2008 and 2008–2009 (both post-legislation). Interviews with school staff explored issues of compliance. Product categorisation and analysis were carried out by product type, nutrient profiling and by categories of foods allowed or prohibited by the legislation.

English secondary schools.

A representative sample of 279 schools including sixty-two researcher-visited inventory schools participated in the research.

School vending seems to have moved towards compliance with the new standards – now drinks vending predominates and is largely compliant, whereas food vending is significantly reduced and is mostly non-compliant. Sixth form vending takes a disproportionate share of non-compliance. Vending has declined overall, as some schools now perceive food vending as uneconomic. Schools adopting a ‘whole-school’ approach appeared the most successful in implementing the new standards.

Government legislation has achieved significant change towards improving the quality of English school vending, with the unintended consequence of reducing provision.

To identify pledges made by the food industry to change food marketing to children worldwide, examine their content and discuss their potential to reduce the harmful effects of food marketing to children.

A search for pledges and specific commitments made by participating companies and a content analysis of their scope and criteria used to define the marketing covered or excluded.

Global.

Food industry pledges.

Between 2005 and 2009, the food industry developed thirteen pledges on food marketing to children, involving fifty-two food companies. Two of the pledges were global, two were regional and nine applied to specific countries. Three were specific to the soft drinks industry and to the fast-food industry, with the rest being food industry wide. Ten of the pledges required companies to publish individual commitments; a total of eighty-two such commitments were published, many of which extended beyond the minimum standards set in the pledges. All pledges included definitions of children and child-targeted media, as well as the communication channels and marketing techniques covered, and permitted companies to set criteria for foods that are exempted from any restrictions. There were many similarities between the pledges and individual commitments; however, there were also many differences.

The development of pledges on food marketing to children in such a short span of time is impressive. However, limitations and inconsistencies in the pledges and commitments suggest that the food industry has a long way to go if its pledges are to comprehensively reduce the exposure and power of marketing to children.

To report the prevalence rates and correlates for anaemia, iron deficiency (ID) and iron-deficiency anaemia (IDA) among Inuit preschool-aged children.

A cross-sectional study assessed iron intake, demographic information, medical history, anthropometrics, Hb, ferritin, C-reactive protein and antibodies to Helicobacter pylori.

Sixteen selected Inuit communities in Nunavut Territory, Canada.

Inuit (n 388) aged 3–5 years randomly recruited from communities.

Anaemia (3–4 years: Hb < 110 g/l; 5 years: Hb < 115 g/l) was prevalent in 16·8 % of children. The prevalence of ID (ferritin < 12 μg/l) was 18·0 % and that of IDA was 5·4 %. When ID was defined as ferritin <10 μg/l, 10·8 % of children were iron deficient and 3·3 % had IDA. In multiple logistic regression, boys were more likely to be iron deficient (OR = 2·28, 95 % CI 1·17, 8·25), but no other risk factor emerged for ID. Three- to 4-year-olds were less likely than 5-year-olds to have anaemia from causes other than ID (OR = 0·11, 95 % CI 0·08, 0·58). Anaemia from other causes was more common among children residing in crowded homes (OR = 2·30, 95 % CI 1·37, 12·31) and those treated for past-year ear infection (OR = 1·35, 95 % CI 1·05, 7·21).

The low prevalence of ID and IDA is encouraging, but efforts are still needed to reduce rates as they continue to be higher than general population rates. Household crowding and infections may contribute to anaemia and warrant further research.

Low-income children are routinely screened for anaemia and elevated blood lead levels (EBLL) but not for vitamin D deficiency. We sought to determine the relative prevalence of and the relationship among vitamin D deficiency, anaemia and EBLL among healthy low-income paediatric clinic patients.

Retrospective chart review.

Paediatric outpatient clinic in an urban safety net hospital in a northern US state.

Healthy toddlers and children under 6 years of age (n 127) who were seen for a routine well child check-up (WCC).

The prevalence of vitamin D insufficiency (25-hydroxyvitamin D (25(OH)D) < 30 ng/ml) was 62 %; the prevalence of vitamin D deficiency (25(OH)D < 20 ng/ml) was 29 %. These rates were far higher than those for anaemia (Hb < 11·0 g/dl) at 10 %, EBLL (Pb > 9 μg/dl) at 1 % or even mildly EBLL (Pb 5–9 μg/dl) at 4 % (range: 1–11). There was no relationship among any of the following: vitamin D status, anaemia or EBLL. The vast majority of children with vitamin D deficiency had both normal Hb (86 %) and Pb level (100 %). After controlling for child's age, gender and race/ethnicity, there was no association between Hb (continuous, g/dl) and vitamin D deficiency (adjusted OR (aOR) = 0·97, 95 % CI 0·64, 1·47; P = 0·88). The only significant predictor of vitamin D deficiency was increasing age in years (aOR = 1·39, 95 % CI 1·03, 1·86; P = 0·03). None of these associations changed materially when deficiency was defined as <15 ng/ml.

Vitamin D deficiency was far more common than anaemia or EBLL, and Hb and Pb status were not predictors of vitamin D status.

The present study aimed to evaluate the knowledge and practices of public-sector primary-care health professionals and final-year students regarding the role of nutrition, physical activity and smoking cessation (lifestyle modification) in the management of chronic diseases of lifestyle within the public health-care sector.

A comparative cross-sectional descriptive quantitative study was conducted in thirty primary health-care facilities and four tertiary institutions offering medical and/or nursing programmes in Cape Town in the Western Cape Metropole. Stratified random sampling, based on geographical location, was used to select the health facilities while convenience sampling was used to select students at the tertiary institutions. A validated self-administered knowledge test was used to obtain data from the health professionals.

Differential lifestyle modification knowledge exists among both health professionals and students, with less than 10 % achieving the desired scores of 80 % or higher. The majority of health professionals seem to be promoting the theoretical concepts of lifestyle modification but experience difficulty in providing practical advice to patients. Of the health professionals evaluated, doctors appeared to have the best knowledge of lifestyle modification. Lack of time, lack of patient adherence and language barriers were given as the main barriers to providing lifestyle counselling.

The undergraduate curricula of medical and nursing students should include sufficient training on lifestyle modification, particularly practical advice on diet, physical activity and smoking cessation. Health professionals working at primary health-care facilities should be updated by providing lifestyle modification education as part of continuing medical education.

To assess and develop consensus among a European panel of public health nutrition stakeholders regarding the competencies required for effective public health nutrition practice and the level of proficiency required in different practice contexts.

A modified Delphi study involving three rounds of questionnaires.

European Union.

Public health nutrition workforce development stakeholders, including academics, practitioners and employers, from twenty European countries.

A total of fifty-two expert panellists (84 % of an initial panel of sixty-two Delphi participants) completed all three rounds of the Delphi study. The panellists rated the importance of fifty-seven competency units possibly required of a public health nutritionist to effectively practice (Essential competencies). Twenty-nine of the fifty-seven competency units (51 %) met the consensus criteria (≥66·7 % agreement) at the second round of the Delphi survey, with the highest agreement for competencies clustered within the Nutrition science, Professional, Analytical and Public health services competency domains. Ratings of the level of competencies required for different levels in the workforce indicated that for a public health nutrition specialist, advanced-level competency was required across almost all the twenty-nine competencies rated as essential. There were limited differences in rating responses between academics and employer panellists throughout the Delphi study.

Competencies identified as essential can be used to review current public health nutrition practices and provide the basis for curriculum design and re-development, continuing education and workforce quality assurance systems in Europe. These are all important tools for systematic and strategic workforce development.

To test the impact of training for educators on the health of children enrolled in public and philanthropic day-care nurseries.

A randomised, institutional, non-blind clinical trial was conducted. An educational intervention was performed in four day-care centres and the control group consisted of four other day-care centres. Interviews with the mothers, collection of blood from the children by digital puncture and anthropometry were performed. The chosen indicator for the improvement of health was anaemia (Hb <11 g/dl). An unconditional logistic regression model was set for the risk factors for anaemia, considering associations with P ≤ 0·05 as statistically significant.

Eight day-care centres in the city of Sao Paulo, Brazil.

Two hundred and fifty-two children from day-care nurseries.

The children from the day-care centres that were not subject to intervention presented a 2·11 times greater risk (95% CI 1·04, 4·30; P = 0·40) of having anaemia at the end of the study independent of the control variables (sex, age, time in the day-care centre, anaemia at the beginning of the study, maternal age, use of oral iron supplements, number of siblings, per capita family income, use of antibiotics and the necessity of avoidable hospitalisations) used in the construction of the final logistical model.

The assessed educational intervention promoted significant changes in the health status of the children, reinforcing the importance of training for professionals who care for young children in day-care centres in developing countries in order to promote child health.

To evaluate a mentoring circle workforce development intervention among a group of public health nutrition novices.

The mentoring circle intervention focused on facilitating practice-based public health nutrition competence development and supporting reorientation of practice from clinical services to preventive services. A retrospective post-intervention qualitative semi-structured interview was used to explore the experiences of those participating in the mentoring circle and to make evaluative judgements about intervention attributes and effectiveness.

Victoria, Australia.

Thirty-two novice public health nutrition practitioners employed in the state public health system.

Key evaluative theme categories relating to the mentoring circle intervention were identified, including the structure and function of the group, the utility of using advanced-level competency items to guide planning, having a safe and supportive environment for learning and the utility of learning via mentoring and on-the-job experiences. These qualitative evaluation data identify the attributes of the mentoring circle intervention contributing to intervention effectiveness.

This qualitative evaluation indicates that mentoring circles can be an effective workforce capacity-building intervention, particularly in novice workforces characterised by professional isolation and split function roles.

To investigate whether children in households involved in a participatory agriculture and nutrition intervention had improved growth compared to children in matched comparable households and whether the level of involvement and length of time in the project had an effect on child growth.

A prospective quasi-experimental study comparing baseline and follow-up data in ‘intervention’ villages with matched subjects in ‘comparison’ villages. Mixed model analyses were conducted on standardized child growth scores (weight- and height-for-age Z-scores), controlling for child age and testing for effects of length of time and intensity of village involvement in the intervention.

A participatory agriculture and nutrition project (the Soils, Food and Healthy Communities (SFHC) project) was initiated by Ekwendeni Hospital aimed at improving child nutritional status with smallholder farmers in a rural area in northern Malawi. Agricultural interventions involved intercropping legumes and visits from farmer researchers, while nutrition education involved home visits and group meetings.

Participants in intervention villages were self-selected, and control participants were matched by age and household food security status of the child. Over a 6-year period, nine surveys were conducted, taking 3838 height and weight measures of children under the age of 3 years.

There was an improvement over initial conditions of up to 0·6 in weight-for-age Z-score (WAZ; from −0·4 (sd 0·5) to 0·3 (sd 0·4)) for children in the longest involved villages, and an improvement over initial conditions of 0·8 in WAZ for children in the most intensely involved villages (from −0·6 (sd 0·4) to 0·2 (sd 0·4)).

Long-term efforts to improve child nutrition through participatory agricultural interventions had a significant effect on child growth.

Home-delivered nutrition programmes that are federally subsidized by the US Administration on Aging seek to ensure that socially isolated older adults who are unable to purchase and prepare their own food have nutritious meals delivered to them regularly by both employed and volunteer staff. Unfortunately, there are long waiting lists in some neighbourhoods that are often due to a shortage of volunteers. The present paper describes a theoretically driven community-based project designed to increase volunteer participation in serving Meals on Wheels (MOW) clients.

A Support Team model was applied in the project wherein existing social capital among religious faith communities, and social networks within those organizations, was joined with a local MOW programme to create a sustainable meal delivery route to vulnerable homebound older adults.

The programme participants were in one underserved neighbourhood in Birmingham, Alabama, an urban city in the south-eastern USA.

The subjects under consideration are both MOW clients and volunteers. MOW clients are those individuals aged 60 years and above who qualify for the service; the volunteers are from community churches.

One volunteer route, comprising six congregations that delivered meals to sixteen homebound older adults, was created. The route served more than 2000 meals in 2006 (the year the programme began) and continues to serve clients today.

The programme’s successful implementation provides evidence that reliance on theory is critical in planning and developing effective community-based programme interventions.

Public health renewal in Canada has highlighted the need for development and expansion of the public health nutrition workforce, particularly in northern and rural communities. The purpose of the present paper is to describe the planning of a more accessible graduate programme for experienced nutrition professionals. The planning effort was challenged by a short timeframe between programme approval and implementation and required intense collaboration with stakeholders and students.

The programme planning model developed by The Health Communication Unit (THCU) at the Centre for Health Promotion was used to guide the process. This six-step model was familiar to key stakeholders and involved pre-planning, conducting a situational assessment, establishing goals and objectives, developing strategies and outcome indicators, and monitoring feedback.

Resource constraints, short timelines and debates around distance education options presented challenges that were overcome by conducting a thorough needs assessment, creating an advisory committee, engaging key stakeholders in the planning process, and building on existing resources. Extensive involvement of the first cohort of students in ongoing planning and evaluation was particularly helpful in informing the evolution of the programme.

The THCU planning model provided a useful framework for stakeholder collaboration and for planning and implementing the new graduate programme in public health nutrition. Preliminary data suggest that graduates are benefiting from their educational experiences through career enhancement opportunities. The evaluation strategies built into the programme design will be useful in informing ongoing programme development.