To examine associations of the frequency of eating at fast-food restaurants with demographic, behavioural and psychosocial factors and dietary intake in African American adults.

Self-reported data from a population-based cross-sectional survey of 658 African Americans, aged 20–70 years, in North Carolina. An 11-page questionnaire assessed eating at fast-food restaurants, demographic, behavioural and diet-related psychosocial factors, and dietary intake (fruit, vegetable, total fat and saturated fat intakes, and fat-related dietary behaviours).

The participants were aged 43.9±11.6 years (mean±standard deviation), 41% were male, 37% were college graduates and 75% were overweight or obese. Seventy-six per cent reported eating at fast-food restaurants during the previous 3 months: 4% usually, 22% often and 50% sometimes. Frequency of eating at fast-food restaurants was positively associated with total fat and saturated fat intakes and fat-related dietary behaviours (P < 0.0001) and inversely associated with vegetable intake (P < 0.05). For example, mean daily fat intake was 39.0 g for usually/often respondents and 28.3 g for those reporting rare/never eating at fast-food restaurants. Participants who reported usual/often eating at fast-food restaurants were younger, never married, obese, physically inactive and multivitamin non-users (all P < 0.01). Frequency of eating at fast-food restaurants was positively associated with fair/poor self-rated health, weak belief in a diet–cancer relationship, low self-efficacy for healthy eating, weight dissatisfaction, and perceived difficulties of preparing healthy meals and ordering healthy foods in restaurants (all P < 0.05). Frequency of eating at fast-food restaurants did not differ significantly by sex, education, smoking, ability to purchase healthy foods or knowledge of the Food Guide Pyramid.

Eating at fast-food restaurants is associated with higher fat and lower vegetable intakes in African Americans. Interventions to reduce fast-food consumption and obesity in African Americans should consider demographic and behavioural characteristics and address attitudes about diet–disease relationships and convenience barriers to healthy eating.

To modify the self-administered, short version of the International Physical Activity Questionnaire (IPAQ) for adults to be used in the elderly (aged 65 years and above), and to validate this modified IPAQ for the elderly (IPAQ-E).

A direct validity study using accelerometer-measured physical activity (PA) as the criterion measure, and an indirect criterion validity study using high-sensitivity C-reactive protein (hs-CRP) as a biological marker of activity.

Organisations for retired persons in Sweden.

The direct validity study consisted of fifty-four participants and the indirect criterion validity study consisted of 359 participants. All participants were retired persons (66–91 years) living independently.

All self-reported activity domains (sitting, walking, moderate and vigorous) were positively correlated with the corresponding variable objectively assessed by an accelerometer (ρ = 0·277–0·471), but a systematic error was observed. The specificity of IPAQ-E to identify low-active participants was 85 %, and the sensitivity to identify the more active participants was 81 %. A main effect of IPAQ-E category (Low, Moderate or High) was observed for hs-CRP (P = 0·041).

We found this modified version of IPAQ, the IPAQ-E, to be well accepted by our sample of socially active elderly. It provided acceptable estimates of PA, well in line with other questionnaires, even though it had a systematic error. The IPAQ-E was able to identify an expected response of a biomarker (hs-CRP) to PA. We recommend the use of the IPAQ-E to classify participants aged 65 years and above into PA categories, to rank individuals or to identify individuals meeting certain PA criteria.

To compare the prevalence of self-reported hypertension and mean systolic and diastolic blood pressures in four diet groups (meat eaters, fish eaters, vegetarians and vegans) and to investigate dietary and other lifestyle factors that might account for any differences observed between the groups.

Analysis of cross-sectional data from participants in the Oxford cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC–Oxford).

United Kingdom.

Eleven thousand and four British men and women aged 20–78 years at blood pressure measurement.

The age-adjusted prevalence of self-reported hypertension was significantly different between the four diet groups, ranging from 15.0% in male meat eaters to 5.8% in male vegans, and from 12.1% in female meat eaters to 7.7% in female vegans, with fish eaters and vegetarians having similar and intermediate prevalences. Mean systolic and diastolic blood pressures were significantly different between the four diet groups, with meat eaters having the highest values and vegans the lowest values. The differences in age-adjusted mean blood pressure between meat eaters and vegans among participants with no self-reported hypertension were 4.2 and 2.6 mmHg systolic and 2.8 and 1.7 mmHg diastolic for men and women, respectively. Much of the variation was attributable to differences in body mass index between the diet groups.

Non-meat eaters, especially vegans, have a lower prevalence of hypertension and lower systolic and diastolic blood pressures than meat eaters, largely because of differences in body mass index.

A tax on sugar-sweetened beverages (SSB) has been proposed to address population weight gain but the effect across socio-economic position (SEP) is unclear. The current study aimed to clarify the differential impact(s) of SSB taxes on beverage purchases and consumption, weight outcomes and the amount paid in SSB taxes according to SEP.

Databases (OVID and EMBASE) and grey literature were systematically searched in June 2015 to identify studies that examined effects of an SSB price increase on beverage purchases or consumption, weight outcomes or the amount paid in tax across SEP, within high-income countries.

Of the eleven included articles, three study types were identified: (i) those that examined the association between variation in SSB taxes and SSB consumption and/or body weight (n 3); (ii) price elasticity estimation of SSB demand (n 1); and (iii) modelling of hypothetical SSB taxes by combining price elasticity estimates with population SEP-specific beverage consumption, energy intake or body weight (n 7). Few studies statistically tested differences in outcomes between SEP groups. Nevertheless, of the seven studies that reported on changes in weight outcomes for the total population following an increase in SSB price, all reported either similar reductions in weight across SEP groups or greater reductions for lower compared with higher SEP groups. All studies that examined the average household amount paid in tax (n 5) reported that an SSB tax would be regressive, but with small differences between higher- and lower-income households (0·10–1·0 % and 0·03 %–0·60 % of annual household income paid in SSB tax for low- and high-income households, respectively).

Based on the available evidence, a tax on SSB will deliver similar population weight benefits across socio-economic strata or greater benefits for lower SEP groups. An SSB tax is shown to be consistently financially regressive, but to a small degree.

Diet is an important determinant of health outcomes, but physicians have few ways to identify persons with suboptimal diets. The purposes of this study were to examine the reproducibility of a short dietary assessment questionnaire (PrimeScreen) and to compare its results with those of a longer food frequency questionnaire and with plasma levels of selected nutrients.

Each subject completed two PrimeScreen questionnaires at an interval of 2 weeks and one full length, 131-item, semiquantitative food frequency questionnaire (SFFQ), and had a sample of blood drawn. We compared the PrimeScreen with two reference standards, the SFFQ and plasma levels of selected nutrients.

A large managed care organization in New England.

A total of 160 men and women, aged 19–65 years, participated.

For foods and food groups, the mean correlation coefficient (r) was 0.70 for reproducibility and 0.61 for comparability with the SFFQ. For nutrients, the mean r was 0.74 for reproducibility and 0.60 for comparability with the SFFQ. No substantial differences were evident by sex, race, body mass index, occupation or education. Correlation coefficients for the comparison of vitamin E, β-carotene and lutein/zeaxanthin intakes from the PrimeScreen with plasma levels were 0.33, 0.43 and 0.43, respectively. These values were similar to those comparing the SFFQ with plasma levels. The median time to complete PrimeScreen was 5 min; 87% of participants required fewer than 10 min.

A quick way to assess quality of diet among adults, PrimeScreen has adequate reproducibility and its results compare well with a longer food frequency questionnaire and biomarkers.

To review existing methods and illustrate the use of a new, simple method for identifying inaccurate reports of dietary energy intake (rEI).

Comparison of rEI with energy requirements estimated by using total energy expenditure predicted (pTEE) from age, weight, height and sex using a previously published equation. Propagation of error calculations was performed and cut-offs for excluding rEI at plus or minus two standard deviations (±2 SD) and ±1 SD for the agreement between rEI and pTEE were established.

Dietary survey in a US national cohort: the Continuing Survey of Food Intakes by Individuals (CSFII), 1994–96.

Men and non-pregnant, non-lactating women aged 21–45 years in the CSFII who provided two multiple-pass 24-hour recalls, height and weight(n = 3755).

Average rEI was 77% of pTEE in men, and 64% of pTEE in women. Calculated cut-offs were rEI <40% or >160% of pTEE (±2 SD) and <70% or >130% of pTEE (±1 SD), respectively. Use of only the ±1 SD cut-offs, not the ±2 SD cut-offs, resulted in a relationship between rEI and body weight similar to what was expected (based on an independently calculated relationship between rEI and measured TEE). Exclusion of rEI outside either the ±2 SD (11% of subjects) or ±1 SD (57% of subjects) cut-offs did not affect mean reported macronutrient intakes, but did markedly affect relationships between dietary composition and body mass index.

When examining relationships between diet and health, use of ±1 SD cut-offs may be preferable to ±2 SD cut-offs for excluding inaccurate dietary reports.

To review the available data on risk factors for cardiovascular disease (CVD), the influence of urbanisation of Africans on these risk factors, and to examine why stroke emerges as a higher risk than ischaemic heart disease (IHD) in the health transition of black South Africans.

A review of published data on mortality from and risk factors of CVD in South Africans.

South Africa.

South African population groups and communities.

The available data on the contribution of stroke and IHD to CVD mortality in South Africa are briefly reviewed, followed by a comparison of published data on the prevalence and/or levels of CVD risk factors in the different South African population groups. The impact of urbanisation of black South Africans on these risk factors is assessed by comparing rural and urban Africans who participated in the Transition and Health during Urbanisation of South Africans (THUSA) study.

Results and conclusions: The mortality rates from CVD confirmed that stroke is a major public health problem amongst black South Africans, possibly because of an increase in hypertension, obesity, smoking habit and hyperfibrinogenaemia during various stages of urbanisation. The available data further suggest that black South Africans may be protected against IHD because of favourable serum lipid profiles (low cholesterol and high ratios of high-density lipoprotein cholesterol) and low homocysteine values. However, increases in total fat and animal protein intake of affluent black South Africans, who can afford Western diets, are associated with increases in body mass indices of men and women and in total serum cholesterol. These exposures may increase IHD risk in the future.

To critique current practice in, and provide recommendations for, mediating variable analyses (MVA) of nutrition and physical activity behaviour change.

Theory-based behavioural nutrition and physical activity interventions aim at changing mediating variables that are hypothesized to be responsible for changes in the outcome of interest. MVA are useful because they help to identify the most promising theoretical approaches, mediators and intervention components for behaviour change. However, the current literature suggests that MVA are often inappropriately conducted, poorly understood and inadequately presented. Main problems encountered in the published literature are explained and suggestions for overcoming weaknesses of current practice are proposed.

The use of the most appropriate, currently available methods of MVA, and a correct, comprehensive presentation and interpretation of their findings, is of paramount importance for understanding how obesity can be treated and prevented.

An absence of food literacy measurement tools makes it challenging for nutrition practitioners to assess the impact of food literacy on healthy diets and to evaluate the outcomes of food literacy interventions. The objective of the present scoping review was to identify the attributes of food literacy.

A scoping review of peer-reviewed and grey literature was conducted and attributes of food literacy identified. Subjects included in the search were high-risk groups. Eligible articles were limited to research from Canada, USA, the UK, Australia and New Zealand.

The search identified nineteen peer-reviewed and thirty grey literature sources. Fifteen identified food literacy attributes were organized into five categories. Food and Nutrition Knowledge informs decisions about intake and distinguishing between ‘healthy’ and ‘unhealthy’ foods. Food Skills focuses on techniques of food purchasing, preparation, handling and storage. Self-Efficacy and Confidence represent one’s capacity to perform successfully in specific situations. Ecologic refers to beyond self and the interaction of macro- and microsystems with food decisions and behaviours. Food Decisions reflects the application of knowledge, information and skills to make food choices. These interdependent attributes are depicted in a proposed conceptual model.

The lack of evaluated tools inhibits the ability to assess and monitor food literacy; tailor, target and evaluate programmes; identify gaps in programming; engage in advocacy; and allocate resources. The present scoping review provides the foundation for the development of a food literacy measurement tool to address these gaps.

The ready-meal market has grown considerably in recent years. At the same time, a degradation of traditional cooking skills has been observed. Ready meals are often rich in energy, fat and sugar and lack vegetables; however, studies investigating associations between ready-meal consumption, overweight and cooking skills are lacking. The present study examines whether demographic factors, overweight, beliefs about the nutritional value and taste of ready meals and cooking skills are associated with ready-meal consumption.

Cross-sectional survey.

Ready-meal consumption, weight status, cooking skills, beliefs about the taste and nutritional value of ready meals and demographic variables were assessed with self-administered questionnaires. Data were analysed with one-way ANOVA and multiple regression analysis.

A total of 1017 adults from the German-speaking part of Switzerland.

Men reported being more positive about ready meals and having fewer cooking skills compared with women. Overweight adults (BMI > 25 kg/m2) were more positive about nutrients and vitamins in ready meals compared with normal-weight adults. Ready-meal consumption was associated with cooking skills (β = −0·192), age (β =− 0·228), overweight (β = 0·129), nutritional value (β = −0·131), taste (β = −0·126), working status (β = 0·096) and gender (β = 0·084).

Cooking skills were identified as a strong predictor of ready-meal consumption. The importance of cooking skills as a barrier to healthy eating should be explored, as it is plausible that cooking skills will further decrease in the future. Next, the study provided evidence for an association between ready-meal consumption and overweight. Further research should examine the importance of ready meals for the overweight epidemic.

A low socio-economic status (SES) is related to less healthy dietary habits, but the reasons for this remain unclear. We examined whether the absolute or relative importance of various food choice motives contributed to SES disparities in vegetable/fruit and energy-dense food intake.

We analysed cross-sectional data from the FINRISK Study 2007 by means of structural equation modelling and used a shortened version of the Food Choice Questionnaire to assess the absolute importance of health, pleasure, convenience, price, familiarity and ethicality motives. We calculated the relative importance of each motive by dividing the participant's rating of it by his/her mean score on all motives. Dietary intake was measured with an FFQ.

A population-based survey in Finland.

Men (n 1691) and women (n 2059) aged 25–64 years.

Higher education and income were related to a greater vegetable/fruit intake (β = 0·12, P < 0·001), while education was associated negatively with the consumption of energy-dense foods (β = −0·09, P < 0·001). Socio-economically disadvantaged individuals considered price and/or familiarity more important in their food choices in both absolute and relative terms. A higher income was related to a greater relative importance of health considerations. Relative motives were more strongly associated with vegetable/fruit and energy-dense food consumption than absolute motives and the relative importance of price, familiarity and health partly mediated the effects of the SES indicators on the consumption of these food items.

Individual priorities in food choice motives, rather than the absolute importance of single motives, play a role in producing SES disparities in diet.

To present the Mediterranean diet as an example of a sustainable diet, in which nutrition, biodiversity, local food production, culture and sustainability are strongly interconnected.

Review of notions and activities contributing towards the acknowledgement of the Mediterranean diet as a sustainable diet.

The Mediterranean region and its populations.

Mediterranean populations.

The acknowledgement of the Mediterranean diet as a sustainable diet needs the development of new cross-cutting intersectoral case studies to demonstrate further the synergies among nutrition, biodiversity and sustainability as expressed by the Mediterranean diet for the benefit of present and future generations.

To investigate the impact of school garden-enhanced nutrition education (NE) on children’s fruit and vegetable consumption, vegetable preferences, fruit and vegetable knowledge and quality of school life.

Quasi-experimental 10-week intervention with nutrition education and garden (NE&G), NE only and control groups. Fruit and vegetable knowledge, vegetable preferences (willingness to taste and taste ratings), fruit and vegetable consumption (24 h recall × 2) and quality of school life (QoSL) were measured at baseline and 4-month follow-up.

Two primary schools in the Hunter Region, New South Wales, Australia.

A total of 127 students in Grades 5 and 6 (11–12 years old; 54 % boys).

Relative to controls, significant between-group differences were found for NE&G and NE students for overall willingness to taste vegetables (P < 0·001) and overall taste ratings of vegetables (P < 0·001). A treatment effect was found for the NE&G group for: ability to identify vegetables (P < 0·001); willingness to taste capsicum (P = 0·04), broccoli (P = 0·01), tomato (P < 0·001) and pea (P = 0·02); and student preference to eat broccoli (P < 0·001) and pea (P < 0·001) as a snack. No group-by-time differences were found for vegetable intake (P = 0·22), fruit intake (P = 0·23) or QoSL (P = 0·98).

School gardens can impact positively on primary-school students’ willingness to taste vegetables and their vegetable taste ratings, but given the complexity of dietary behaviour change, more comprehensive strategies are required to increase vegetable intake.

To study differences in the role of price and value in food choice between low-income and higher-income consumers and to study the perception of consumers about pricing strategies that are of relevance during grocery shopping.

A cross-sectional study was conducted using structured, written questionnaires. Food choice motives as well as price perceptions and opinion on pricing strategies were measured.

The study was carried out in point-of-purchase settings, i.e. supermarkets, fast-food restaurants and sports canteens.

Adults (n 159) visiting a point-of-purchase setting were included.

Price is an important factor in food choice, especially for low-income consumers. Low-income consumers were significantly more conscious of value and price than higher-income consumers. The most attractive strategies, according to the consumers, were discounting healthy food more often and applying a lower VAT (Value Added Tax) rate on healthy food. Low-income consumers differ in their preferences for pricing strategies.

Since price is more important for low-income consumers we recommend mainly focusing on their preferences and needs.

A school-based nutrition information programme was initiated in 1992 in two towns in northern France (Fleurbaix and Laventie, FL) and was followed by a number of community-based interventions. We took the opportunity to measure the outcomes in terms of childhood obesity and overweight over the next 12 years.

Repeated, cross-sectional, school-based survey. For the school years beginning in 1992, 2000, 2002, 2003 and 2004, the height and weight of all 5- to 12-year-old children attending school were measured in FL. In 2004, the same assessments were made in two comparison towns with similar socio-economic characteristics but no intervention.

Fleurbaix and Laventie (intervention towns), Bois-Grenier and Violaines (comparison towns), northern France.

In 2002, 2003 and 2004, respectively 515, 592 and 633 children were measured in FL (participation rate of 95–98 % of all eligible individuals); in the comparison towns, 349 children were measured in the 2004 school year (98 % of the towns’ school population).

After an initial increase, trends in mean BMI and prevalence of overweight started to reverse. Compared with 2002, the age-adjusted OR for overweight in FL was significantly lower in 2003 and 2004 (but for girls only). In the 2004 school year, the overweight prevalence was significantly lower in FL (8·8 %) than in the comparison towns (17·8 %, P < 0·0001).

These data suggest that, over a long period of time, interventions targeting a variety of population groups can have synergistic effects on overweight prevalence. This gives hope that it is possible to reverse trends towards increasing overweight by actions at the community level.

Since inadequate food consumption patterns during adolescence are not only linked with the occurrence of obesity in youth but also with the subsequent risk of developing diseases in adulthood, the establishment and maintenance of a healthy diet early in life is of great public health importance. Therefore, the aim of the present study was to describe and evaluate the food consumption of a well-characterized sample of European adolescents against food-based dietary guidelines for the first time.

The HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study is a cross-sectional study, whose main objective was to obtain comparable data on a variety of nutritional and health-related parameters in adolescents aged 12·5–17·5 years.

Ten cities in Europe.

The initial sample consisted of more than 3000 European adolescents. Among these, 1593 adolescents (54 % female) had sufficient and plausible dietary data on energy and food intakes from two 24 h recalls using the HELENA-DIAT software.

Food intake of adolescents in Europe is not optimal compared with the two food-based dietary guidelines, Optimized Mixed Diet and Food Guide Pyramid, examined in this study. Adolescents eat half of the recommended amount of fruit and vegetables and less than two-thirds of the recommended amount of milk (and milk products), but consume much more meat (and meat products), fats and sweets than recommended. However, median total energy intake may be estimated to be nearly in line with the recommendations.

The results urge the need to improve the dietary habits of adolescents in order to maintain health in later life.

To examine the association between breakfast skipping and type of breakfast consumed with overweight/obesity, abdominal obesity, other cardiometabolic risk factors and the metabolic syndrome (MetS).

Cross-sectional. Three breakfast groups were identified, breakfast skippers (BS), ready-to-eat-cereal (RTEC) consumers and other breakfast (OB) consumers, using a 24 h dietary recall. Risk factors were compared between the breakfast groups using covariate-adjusted statistical procedures.

The 1999–2006 National Health and Nutrition Examination Survey, USA.

Young adults (20–39 years of age).

Among these young adults (n 5316), 23·8 % were BS, 16·5 % were RTEC consumers and 59·7 % were OB consumers. Relative to the BS, the RTEC consumers were 31 %, 39 %, 37 %, 28 %, 23 %, 40 % and 42 % less likely to be overweight/obese or have abdominal obesity, elevated blood pressure, elevated serum total cholesterol, elevated serum LDL-cholesterol, reduced serum HDL-cholesterol or elevated serum insulin, respectively. Relative to the OB consumers, the BS were 1·24, 1·26 and 1·44 times more likely to have elevated serum total cholesterol, elevated serum LDL-cholesterol or reduced serum HDL-cholesterol, respectively. Relative to the OB consumers, the RTEC consumers were 22 %, 31 % and 24 % less likely to be overweight/obese or have abdominal obesity or elevated blood pressure, respectively. No difference was seen in the prevalence of the MetS by breakfast skipping or type of breakfast consumed.

Results suggest that consumption of breakfast, especially that included an RTEC, was associated with an improved cardiometabolic risk profile in US young adults. Additional studies are needed to determine the nature of these relationships.

To determine the association of gestational weight gain (GWG) or pre-pregnancy BMI with postpartum weight retention (PPWR).

Meta-analysis.

PubMed, Cochrane Controlled Trials Register, EMBASE, Science Citation Index Expanded, Current Contents Connects and Biosis Previews were used to search articles.

Publications that described the influence of pre-pregnancy BMI or GWG on PPWR.

Seventeen studies that satisfied the eligibility criteria were included in the analyses. Women with inadequate and excessive GWG had significantly lower mean PPWR of −2·14 kg (95 % CI –2·43, –1·85 kg) and higher PPWR of 3·21 kg (95 % CI 2·79, 3·62 kg), respectively, than women with adequate GWG. When postpartum time spans were stratified into 1–3 months, 3–6 months, 6–12 months, 12–36 months and ≥15 years, the association between inadequate GWG and PPWR faded over time and became insignificant (−1·42 kg; 95 % CI −3·08, 0·24 kg) after ≥15 years. However, PPWR in women with excess GWG exhibited a U-shaped trend; that is, a decline during the early postpartum time span (year 1) and then an increase in the following period. Meta-analysis of qualitative studies showed a significant relationship between excessive GWG and higher PPWR risk (OR=2·08; 95 % CI 1·60, 2·70). Moreover, meta-analysis of pre-pregnancy BMI on PPWR indicated that mean PPWR decreased with increasing BMI group.

These findings suggest that GWG, rather than pre-pregnancy BMI, determines the shorter- or longer-term PPWR.