According to the Family Ecological Model (FEM), parenting behaviours are shaped by the contexts in which families are embedded. In the present study, we utilize the FEM to guide a mixed-methods community assessment and summarize the results. Additionally, we discuss the utility of the FEM and outline possible improvements.

Using a cross-sectional design, qualitative and quantitative methods were used to examine the ecologies of parents' cognitions and behaviours specific to children's diet, physical activity and screen-based behaviours. Results were mapped onto constructs outlined in the FEM.

The study took place in five Head Start centres in a small north-eastern city. The community assessment was part of a larger study to develop and evaluate a family-centred obesity prevention programme for low-income families.

Participants included eighty-nine low-income parents/caregivers of children enrolled in Head Start.

Parents reported a broad range of factors affecting their parenting cognitions and behaviours. Intrafamilial factors included educational and cultural backgrounds, family size and a lack of social support from partners. Organizational factors included staff stability at key organizations, a lack of service integration and differing school routines. Community factors included social connectedness to neighbours/friends, shared norms around parenting and the availability of safe public housing and play spaces. Policy- and media-related factors included requirements of public assistance programmes, back-to-work policies and children's exposure to food advertisements.

Based on these findings, the FEM was refined to create an evidence-based, temporally structured logic model to support and guide family-centred research in childhood obesity prevention.

To determine parents’ and children's attitudes towards food, beverage and alcohol sponsorship of elite and children's sports and the acceptability of policies and alternative funding models to limit this sponsorship.

Telephone surveys were conducted with parents in February–May 2011. One child from each household was invited to complete an online survey. Surveys assessed parents’ perceptions about the influence of sponsorship on children and support for limiting sponsorship, and children's awareness of and attitudes towards sponsors.

Randomly sampled households in New South Wales, Australia.

Parents (n 825) and children aged 10–16 years (n 243).

Three-quarters of parents supported the introduction of policies to restrict unhealthy food, beverage and alcohol sponsorship of children's and elite sports. More parents (81 %) supported the introduction of alternative funding models to allow these companies to sponsor sport provided there was no visible branding. Two-thirds of children recalled sponsors of their favourite elite sports team/athlete, with 428 sponsors recalled. Of these, 11 % were food/beverage companies and 3 % were alcohol-related. For 39 % of sponsors, children reported feeling better about the company after it had sponsored a team/athlete.

Australian parents support restrictions on unhealthy food, beverage and alcohol sport sponsorship. Children's positive associations regarding sponsors are likely to be linked to brand preferences and usage.

Increasing childhood asthma rates may be due to changing dietary lifestyle. We investigated the association of dietary intake of antioxidant vitamins and fatty acids with asthma in Japanese pre-school children.

Cross-sectional study.

School-based survey on lifestyle/diet and health status in children in Japan.

Parents of 452 children aged 3–6 years completed a questionnaire on the children's and parents’ lifestyle and demographics. Children were classified into asthma cases and non-asthma cases in accordance with the ATS-DLD (American Thoracic Society and Division of Lung Diseases of the National Heart, Lung, and Blood Institute) questionnaire. Children's diet was assessed using a 3 d dietary record completed by parents. Children's age, sex, BMI, history of food allergy, maternal age, parental history of allergy, maternal education, family size and second-hand smoking were included as covariates. Logistic regression models were used to examine the association between children's diet and asthma.

Compared with children with the lowest intake tertile for vitamin C and vitamin E, those in the highest were significantly inversely associated with asthma; adjusted OR (95 % CI) were 0·35 (0·14, 0·88) and 0·32 (0·12, 0·85), respectively. A statistically significant trend was also observed. Fruit intake showed an inverse but insignificant association with asthma. There were no associations of any type of fatty acids with asthma.

These data suggest that children with high intakes of vitamins C and E may be associated with a reduced prevalence of asthma.

We aimed to test the fetal overnutrition hypothesis by comparing the associations of maternal and paternal adiposity (sum of skinfolds) with adiposity and cardiovascular risk factors in children.

Children from a prospective birth cohort had anthropometry, fat percentage (bio-impedance), plasma glucose, insulin and lipid concentrations and blood pressure measured at 9·5 years of age. Detailed anthropometric measurements were recorded for mothers (at 30 ± 2 weeks’ gestation) and fathers (5 years following the index pregnancy).

Holdsworth Memorial Hospital, Mysore, India.

Children (n 504), born to mothers with normal glucose tolerance during pregnancy.

Twenty-eight per cent of mothers and 38 % of fathers were overweight/obese (BMI ≥ 25·0 kg/m2), but only 4 % of the children were overweight/obese (WHO age- and sex-specific BMI ≥ 18·2 kg/m2). The children's adiposity (BMI, sum of skinfolds, fat percentage and waist circumference), fasting insulin concentration and insulin resistance increased with increasing maternal and paternal sum of skinfolds adjusted for the child's sex, age and socio-economic status. Maternal and paternal effects were similar. The associations with fasting insulin and insulin resistance were attenuated after adjusting for the child's current adiposity.

In this population, both maternal and paternal adiposity equally predict adiposity and insulin resistance in the children. This suggests that shared family environment and lifestyle, or genetic/epigenetic factors, influence child adiposity. Our findings do not support the hypothesis that there is an intra-uterine overnutrition effect of maternal adiposity in non-diabetic pregnancies, although we cannot rule out such an effect in cases of extreme maternal obesity, which is rare in our population.

To review the impact of folic acid fortification of flour on the prevalence of neural tube defects (NTD).

Systematic review of the literature on MEDLINE via PubMed, Scopus, OvidSP and LILACS (Latin American and Caribbean Health Sciences Literature) reporting the impact of folic acid fortification of flour on the prevalence of NTD in 2000–2011. Focusing on Santiago of Chile's birth defects registry (1999–2009) and the monitoring of flour fortification, we analysed the prevalence (NTD cases/10 000 births) pre and post flour fortification and the percentile distribution of folic acid content in flour (2005–2009). We explored the potential association between median folic acid in flour (mg/kg) and the prevalence of NTD.

Chile, Argentina, Brazil, Canada, Costa Rica, Iran, Jordan, South Africa and the USA.

Live births and stillbirths.

Twenty-seven studies that met inclusion criteria were evaluated. Costa Rica showed a significant reduction in NTD (∼60 %). Prevalence in Chile decreased from 18·6 to 7·3/10 000 births from 1999 to 2007 and showed a slight increase to 8·5 in 2008–2009, possibly due to changes in fortification limits. When we related the prevalence of NTD with levels of flour fortification, the lowest prevalence was observed at a folic acid level of 1·5 mg/kg.

Fortification of flour with folic acid has had a major impact on NTD in all countries where this has been reported. Chile showed a 55 % reduction in NTD prevalence between 1999 and 2009. There is a need to constantly monitor the levels of flour fortification to maximize benefits and prevent the potential risk of folic acid excess, moreover to be vigilant for any new adverse effects associated with excess.

To assess caregivers’ perceptions of the extent to which the food marketing environment influences food consumption among African-American children (aged 3–11 years) in order to generate potential strategies to make the marketing environment more favourable to healthier eating.

Individual semi-structured interviews with caregivers were conducted by trained community leaders to ascertain their awareness of and perceptions about food marketing environments contributing to African-American children's food consumption.

Six predominantly African-American communities in metro Birmingham, Alabama, USA with high proportions of school-age children and lower-income residents.

Caregivers (n 25) were predominantly female (93 %) and either parents/guardians (64 %) or grandparents (28 %) of African-American children aged 3–11 years. Caregiver mean age was 43 years and 46 % had lived in their current residence for over 10 years.

Caregivers reported all aspects of the food marketing matrix as supporting unhealthy eating among African-American youth. Child preference for foods higher in fat and sugar, lower pricing of less healthy foods, limited access to healthier food retailers and targeted advertisements were particularly influential on the food selection, acquisition and consumption of children. Company loyalty, corporate sponsorship of local events and conflicts over parental v. food company responsibility contributed to less consensus about the overall impact (positive or negative) of food companies in African-American communities.

While caregivers perceived aspects of their food marketing environments as primarily contributing to unhealthy eating among African-American children, framing the demand for changes in the food marketing environments of African-American youth may be particularly challenging.

The present study aimed to assess the relationship between dietary habits, change in socio-economic status and BMI Z-score and fat mass in a cohort of South African adolescents.

In the longitudinal study, data were collected at ages 13, 15 and 17 years on a birth cohort who have been followed since 1990. Black participants with complete dietary habits data (breakfast consumption during the week and at weekends, snacking while watching television, eating main meal with family, lunchbox use, number of tuck shop purchases, fast-food consumption, confectionery consumption and sweetened beverage consumption) at all three ages and body composition data at age 17 years were included in the analyses. Generalized estimating equations were used to test the associations between individual longitudinal dietary habits and obesity (denoted by BMI Z-score and fat mass) with adjustments for change in socio-economic status between birth and age 12 years.

Birth to Twenty (Bt20) study, Soweto-Johannesburg, South Africa.

Adolescents (n 1298; 49·7 % male).

In males, the multivariable analyses showed that soft drink consumption was positively associated with both BMI Z-score and fat mass (P < 0·05). Furthermore, these relationships remained the same after adjustment for socio-economic indicators (P < 0·05). No associations were found in females.

Longitudinal soft drink consumption was associated with increased BMI Z-score and fat mass in males only. Fridge ownership at birth (a proxy for greater household disposable income in this cohort) was shown to be associated with both BMI Z-score and fat mass.

The present study aimed to determine whether a multi-component school-based intervention can maintain children's fruit and vegetable intake post eligibility for free school fruit and vegetables.

A random sample of fifty-four English primary schools was randomised to receive the 10-month intervention Project Tomato, a multi-component theory-based intervention, or the control. Each group consisted of twenty-seven schools.

Children's intake of fruit and vegetables is below recommendations. The English School Fruit and Vegetable Scheme has a short-term impact on intake while children are eligible for the scheme.

Dietary measurements were collected from 658 Year 2 pupils aged 7–8 years at baseline and at follow-up 20 months later.

Following an intention to treat analysis, the intervention as delivered compared with the control had no impact on the intake of fruit and vegetables (2 g/d, 95 % CI −23, 26 g/d) or on the number of portions of fruit (0·0 portions, 95 % CI −0·3, 0·3) or vegetables (0·0 portions, 95 % CI −0·2, 0·3) consumed daily by children. Intake of fruit and vegetables at school and home dropped by ∼100 g/d and 50 g/d, respectively, between baseline and follow-up in both the intervention and control groups.

Implementation of the intervention was low, with associated lack of impact on fruit and vegetable consumption in children. Alternatives to the delivery of an intervention by teachers and parents are needed to improve the dietary intake of primary-school children.

We examined associations between snack frequency, sociodemographic characteristics, BMI, dietary and eating behaviour. In order to identify whether various subgroups of high-frequency snack consumers exist, we investigated underlying food patterns and lifestyle factors.

The data were based on the Swiss Food Panel Questionnaire of 2010, which included an FFQ, questions relating to sociodemographics and lifestyle factors. Data were examined using ANOVA, regression analysis and hierarchical cluster analysis. Gender differences were also investigated in the analysis of the data.

A sample of 6189 adults participating in the Swiss Food Panel filled in a questionnaire (response rate 30 %).

The sample consisted of both men and women, with a mean age of 54·4 (sd 13·5) years.

There was no association between snack frequency and BMI. Consumption frequency of sweets and savouries as well as fruit intake increased with increasing snack frequency. Additionally, three different subgroups of high-frequency snack consumers could be revealed: healthy, moderate and unhealthy dietary-pattern groups. The latter included respondents who were less health-conscious and was characterized by high alcohol consumption frequency, daily breakfast skipping and watching television during the main meal.

High snack frequency occurred in the context of healthy as well as unhealthy dietary behaviour and lifestyle patterns. Women made healthier dietary food choices and were more likely to consume fruits as snacks, while men chose unhealthy foods, such as sweets and savouries, more often.

Household food access remains a concern among primarily agricultural households in lower- and middle-income countries. We examined the associations among domains representing livelihood assets (human capital, social capital, natural capital, physical capital and financial capital) and household food access.

Cross-sectional survey (two questionnaires) on livelihood assets.

Metropolitan Pillaro, Ecuador; Cochabamba, Bolivia; and Huancayo, Peru.

Households (n 570) involved in small-scale agricultural production in 2008.

Food access, defined as the number of months of adequate food provisioning in the previous year, was relatively good; 41 % of the respondents indicated to have had no difficulty in obtaining food for their household in the past year. Using bivariate analysis, key livelihood assets indicators associated with better household food access were identified as: age of household survey respondent (P = 0·05), participation in agricultural associations (P = 0·09), church membership (P = 0·08), area of irrigated land (P = 0·08), housing material (P = 0·06), space within the household residence (P = 0·02) and satisfaction with health status (P = 0·02). In path models both direct and indirect effects were observed, underscoring the complexity of the relationships between livelihood assets and household food access. Paths significantly associated with better household food access included: better housing conditions (P = 0·01), more space within the household residence (P = 0·001) and greater satisfaction with health status (P = 0·001).

Multiple factors were associated with household food access in these peri-urban agricultural households. Food security intervention programmes focusing on food access need to deal with both agricultural factors and determinants of health to bolster household food security in challenging lower- and middle-income country contexts.

Community kitchens have been implemented by communities as a public health strategy to prevent food insecurity through reducing social isolation, improving food and cooking skills and empowering participants. The aim of the present paper was to investigate whether community kitchens can improve the social and nutritional health of participants and their families.

A systematic review of the literature was conducted including searches of seven databases with no date limitations.

Community kitchens internationally.

Participants of community kitchens across the world.

Ten studies (eight qualitative studies, one mixed-method study and one cross-sectional study) were selected for inclusion. Evidence synthesis suggested that community kitchens may be an effective strategy to improve participants’ cooking skills, social interactions and nutritional intake. Community kitchens may also play a role in improving participants’ budgeting skills and address some concerns around food insecurity. Long-term solutions are required to address income-related food insecurity.

Community kitchens may improve social interactions and nutritional intake of participants and their families. More rigorous research methods, for both qualitative and quantitative studies, are required to effectively assess the impact of community kitchens on social and nutritional health in order to confidently recommend them as a strategy in evidence-based public health practice.

To evaluate implementation and effectiveness of nutrition promotion programmes using the health-promoting schools (HPS) approach, to indicate areas where further research is needed and to make recommendations for practice in this field.

The searched electronic databases included: CINAHL, Cochrane Library, Health Reference Center, Informit Search, MEDLINE, ProQuest, PsycINFO, PubMed, ScienceDirect, Scopus, Social Services Abstracts and Web of Science. Inclusion criteria were: (i) controlled or before-and-after studies evaluating a nutrition intervention and involving the HPS approach, either fully or in part; (ii) provision of information about components and delivery of the intervention; and (iii) report on all evaluated outcomes.

Schools.

Students, parents and school staff.

All included studies described intervention delivery and six reported on process evaluation. In intervention schools school environment and ethos were more supportive, appropriate curriculum was delivered and parents and/or the community were more engaged and involved. Students participated in interventions at differing levels, but the majority was satisfied with the intervention. The evidence indicates that nutrition promotion programmes using the HPS approach can increase participants’ consumption of high-fibre foods, healthier snacks, water, milk, fruit and vegetables. It can also reduce participants’ ‘breakfast skipping’, as well as reduce intakes of red food, low-nutrient dense foods, fatty and cream foods, sweet drinks consumption and eating disorders. It can help to develop hygienic habits and improved food safety behaviours.

More professional training for teachers in the HPS approach, further qualitative studies, longer intervention periods, improved follow-up evaluations and adequate funding are required for future school-based nutrition promotion programmes.

To investigate consumption of ultra-processed products in Canada and to assess their association with dietary quality.

Application of a classification of foodstuffs based on the nature, extent and purpose of food processing to data from a national household food budget survey. Foods are classified as unprocessed/minimally processed foods (Group 1), processed culinary ingredients (Group 2) or ultra-processed products (Group 3).

All provinces and territories of Canada, 2001.

Households (n 5643).

Food purchases provided a mean per capita energy availability of 8908 (se 81) kJ/d (2129 (se 19) kcal/d). Over 61·7 % of dietary energy came from ultra-processed products (Group 3), 25·6 % from Group 1 and 12·7 % from Group 2. The overall diet exceeded WHO upper limits for fat, saturated fat, free sugars and Na density, with less fibre than recommended. It also exceeded the average energy density target of the World Cancer Research Fund/American Institute for Cancer Research. Group 3 products taken together are more fatty, sugary, salty and energy-dense than a combination of Group 1 and Group 2 items. Only the 20 % lowest consumers of ultra-processed products (who consumed 33·2 % of energy from these products) were anywhere near reaching all nutrient goals for the prevention of obesity and chronic non-communicable diseases.

The 2001 Canadian diet was dominated by ultra-processed products. As a group, these products are unhealthy. The present analysis indicates that any substantial improvement of the diet would involve much lower consumption of ultra-processed products and much higher consumption of meals and dishes prepared from minimally processed foods and processed culinary ingredients.

Healthy Eating Nova Scotia represents the first provincial comprehensive healthy eating strategy in Canada and a strategy that is framed within a population-health model. Five years after strategy launch, our objective was to evaluate Healthy Eating Nova Scotia to determine perceptions of strategy implementation and strategy outputs. The focus of the current paper is on the findings of this evaluation.

We conducted an evaluation of the strategy through three activities that included a document review, survey of key stakeholders and in-depth interviews with key strategy informants. The findings from each of the activities were integrated to determine what has worked well with strategy implementation, what could be improved and what outputs have resulted.

The evaluation was conducted in the Canadian province of Nova Scotia.

Participants for this evaluation included survey respondents (n 120) and key informants (n 16). A total of 156 documents were also reviewed.

Significant investments have been made towards inter-sectoral partnerships and resourcing that has provided the necessary leadership and momentum for the strategy. Policy development has been leveraged through the strategy primarily in the health and education sectors and is perceived as a visible success. Clarity of human resource roles and funding within the context of a provincial strategy may be beneficial for continued strategy implementation, as is expansion of policy development.

Known to be the first evaluation of its kind, these findings and related considerations will be of interest to policy makers developing and implementing similar strategies in their own jurisdictions.

To document the scale-up of India's Adolescent Girls’ Anaemia Control Programme following a knowledge-centred framework for scaling up nutrition interventions and to identify the critical elements of and lessons learned from a decade of programme experience for the control of anaemia in adolescent girls.

We reviewed all articles, programme and project reports, and baseline and endline assessments published between 1995 and 2012 regarding the control of anaemia through intermittent iron and folic acid supplementation; key programme specialists and managers were interviewed to complete or verify information wherever needed.

India.

Adolescent girls.

The scale-up of India's Adolescent Girls’ Anaemia Control Programme followed a knowledge-centred programme cycle comprising five phases: Evidence, Innovation, Evaluation, Replication and Universalization. By the end of 2011, the programme was being rolled out in thirteen states and was reaching 27·6 million adolescent girls of whom 16·3 million were school-going girls and 11·3 million were out-of-school girls. Building on the critical elements of and lessons learned from the programme, the Government of India launched in 2012 the national Weekly Iron and Folic Acid Supplementation (WIFS) programme to universalize the benefits of anaemia control to the overall population of Indian adolescents.

The Adolescent Girls’ Anaemia Control Programme in India provides a good example of how a knowledge-centred approach can successfully guide the scaling up of public health nutrition interventions and facilitate intersectoral convergence among different government departments and development partners to break the inter-generational cycle of undernutrition and deprivation.

Cardiorespiratory fitness is known to be cardioprotective and its association with the components of the metabolic syndrome in children is becoming clearer. The aim of the present study was to examine the extent to which cardiorespiratory fitness may offset the weight-related association with mean arterial pressure (MAP) in schoolchildren.

Cross-sectional study.

Schoolchildren from the East of England, UK.

A total of 5983 (48 % females) schoolchildren, 10 to 16 years of age, had height, weight and blood pressure measured by standard procedures and cardiorespiratory fitness assessed by the 20 m shuttle-run test. Participants were classified as fit or unfit using internationally accepted fitness cut-off points; and as normal weight, overweight or obese based on BMI, again using international cut-off points. Age-adjusted ANCOVA was used to determine the main effects and interaction of fitness and BMI on MAP Z-score. Logistic regression models were used to estimate odds ratios of elevated MAP.

Prevalence of elevated MAP in schoolchildren was 14·8 % overall and 35·7 % in those who were obese-unfit. Approximately 21 % of participants were overweight and 5 % obese, while 23 % were classified as unfit. MAP generally increased across BMI categories and was higher in the aerobically unfit participants. Obese-fit males had lower MAP compared with obese-unfit males (P < 0·001); this trend was similar in females (P = 0·05).

Increasing fitness level may have a positive impact on the weight-related elevations of MAP seen in obese and overweight schoolchildren.

Findings regarding alcohol consumption and bone mineral density (BMD) in elderly women have been inconsistent. The objective of the present study was to explore the association of alcohol intake with BMD in elderly women.

This cohort study included women from the population-based Kuopio Osteoporosis Risk Factor and Prevention – Fracture Prevention Study (OSTPRE-FPS). Alcohol intake and potential confounders were assessed at baseline and after 3 years of follow-up using a lifestyle questionnaire. In addition, an FFQ was distributed in the third year to measure dietary intake, including alcohol. Women underwent BMD measurements at the femoral neck and lumbar spine at baseline and after 3 years of follow-up.

Kuopio Province, Finland.

Three hundred elderly women (mean age 67·8 years) who provided both BMD measurements and FFQ data.

Alcohol consumption estimated from the FFQ and lifestyle questionnaire was significantly associated with BMD at both measurement sites after adjustment for potential confounders, including lifestyle and dietary factors (P < 0·05). Using the FFQ, women drinking >3 alcoholic drinks/week had significantly higher BMD than abstainers, 12·0 % at the femoral neck and 9·2 % at the lumbar spine. Results based on the lifestyle questionnaire showed higher BMD values for all alcohol-consuming women at the femoral neck and for women drinking 1–3 alcoholic beverages/week at the lumbar spine, compared with non-users.

The results from OSTPRE-FPS suggest that low to moderate alcohol intake may exert protective effects on bone health in elderly women.

To systematically review the efficacy and safety of oral Fe therapy in pre-school children (1–5 years) with non-anaemic Fe deficiency, determined by children's developmental and haematological status and the incidence of reported side-effects.

A random-effects model was used to show mean differences with 95 % confidence intervals of developmental and haematological scores between Fe-treated and non-treated groups.

MEDLINE, EMBASE, Cochrane library and bibliographies of identified articles were searched up to September 2011. Randomized and observational studies were assessed by two reviewers independently. Quality of the trials was assessed on the basis of concealment of allocation, method of randomization, masking of outcome assessment and completeness of follow-up.

From the titles of 743 articles, full text review was completed on forty-six and two randomized trials of acceptable quality met the inclusion criteria. The two trials included a total of sixty-nine children.

One study showed a statistically significant difference in the post-treatment Mental Developmental Index score among children who received oral Fe therapy v. no therapy (mean difference = 6·3, 95 % CI 1·5, 11·0, P value not provided). Both studies showed significant improvement in serum ferritin level (μg/l: mean difference = 51·1, 95 % CI 33·6, 68·6, P < 0·01 and mean difference = 17·1, 95 % CI 7·5, 26·6, P value not provided, respectively) in children who received Fe therapy.

Evidence is insufficient to recommend oral Fe therapy to children with non-anaemic Fe deficiency. There is urgent need of conducting adequately powered, randomized trials examining the efficacy of oral Fe therapy in pre-school children with non-anaemic Fe deficiency.

Pregnancy is one of the most critical periods for iodine deficiency. The aim of the present study was to assess the iodine status and dietary intake of pregnant women in a population changing from high to lower consumption of milk and fish.

Cross-sectional observational study. Urine samples were collected for measuring urinary iodine concentration (UIC) and creatinine, and blood samples for measuring serum thyroid-stimulating hormone (TSH). Frequency of consumption of selected food and beverages was obtained through a semi-quantitative validated FFQ. The difference in the distribution of UIC, ratio of iodine to creatinine (I:Cr) and TSH between groups following recommendations on fish and dairy product intake or not (fish ≥2 times/week as a main meal, diary products ≥2 portions/d) was assessed.

Primary Health Care of the Capital Area, Reykjavik, Iceland.

Randomly selected pregnant women (19–43 years old, n 162).

The median UIC was 180 μg/l, I:Cr 173 μg/g and TSH 1·5 mmol/l. Women who did not consume fish ≥2 times/week and also did not consume dairy products in line with the recommended intake level of ≥2 portions/d had median UIC of 160 μg/l (I:Cr 149 μg/g) compared with 220 μg/l (I:Cr 190 μg/g) in the group following both the recommendations for fish and those for dairy products. Use of dietary supplements in the two groups was similar.

Iodine status in the population studied was within the optimal range (150–249 μg/d) defined by the WHO.

Hispanics with lower acculturation may be at higher risk for neural tube defects compared with those with higher acculturation due to lower total folic acid intake or other undetermined factors. Modelling has indicated that fortification of corn masa flour with folic acid could selectively target Mexican Americans more than other race/ethnicities. We assessed whether fortification of corn masa flour with folic acid could selectively increase folic acid intake among Mexican-American women with lower acculturation, as indicated by specific factors (language preference, country of origin, time living in the USA).

We used dietary intake and dietary supplement data from the National Health and Nutrition Examination Survey 2001–2008, to estimate the amount of additional total folic acid that could be consumed if products considered to contain corn masa flour were fortified at 140 μg of folic acid per 100 g of corn masa flour.

USA.

Non-pregnant women aged 15–44 years (n 5369).

Mexican-American women who reported speaking Spanish had a relative percentage change in usual daily total folic acid intake of 30·5 (95 % CI 27·8, 33·4) %, compared with 8·3 (95 % CI 7·3, 9·4) % for Mexican-American women who reported speaking English. We observed similar results for other acculturation factors. An increase of 6·0 percentage points in the number of Mexican-American women who would achieve the recommended intake of ≥400 μg folic acid/d occurred with fortification of corn masa flour; compared with increases of 1·1 percentage points for non-Hispanic whites and 1·3 percentage points for non-Hispanic blacks. An even greater percentage point increase was observed among Mexican-American women who reported speaking Spanish (8·2).

Fortification of corn masa flour could selectively increase total folic acid intake among Mexican-American women, especially targeting Mexican-American women with lower acculturation, and result in a decrease in the number of pregnancies affected by neural tube defects.