Low BMI is a major risk factor for early mortality among HIV-infected persons starting antiretrovial therapy (ART) in sub-Saharan Africa and the common patient belief that antiretroviral medications produce distressing levels of hunger is a barrier to treatment adherence. We assessed relationships between appetite, dietary intake and treatment outcome 12 weeks after ART initiation among HIV-infected adults with advanced malnutrition and immunosuppression.

A prospective, observational cohort study. Dietary intake was assessed using a 24 h recall survey. The relationships of appetite, intake and treatment outcome were analysed using time-varying Cox models.

A public-sector HIV clinic in Lusaka, Zambia.

One hundred and forty-two HIV-infected adults starting ART with BMI <16 kg/m2 and/or CD4+ lymphocyte count <50 cells/μl.

Median age, BMI and CD4+ lymphocyte count were 32 years, 16 kg/m2 and 34 cells/μl, respectively. Twenty-five participants (18 %) died before 12 weeks and another thirty-three (23 %) were lost to care. A 500 kJ/d higher energy intake at any time after ART initiation was associated with an approximate 16 % reduction in the hazard of death (adjusted hazard ratio = 0·84; P = 0·01), but the relative contribution of carbohydrate, protein or fat to total energy was not a significant predictor of outcome. Appetite normalized gradually among survivors and hunger was rarely reported.

Poor early ART outcomes were strikingly high in a cohort of HIV-infected adults with advanced malnutrition and mortality was predicted by lower dietary intake. Intervention trials to promote post-ART intake in this population may benefit survival and are warranted.

To determine whether an association exists between different clusters of fruit- and vegetable-specific family-environmental factors and children's daily fruit and vegetable intake, and whether these associations differ between countries with different school lunch policies.

Cross-sectional data from four European countries participating in the Pro Greens project in 2009. These countries have different school food policies: two serve free school lunches and two do not. Self-administered data were used. Food frequency questions served to assess fruit and vegetable intakes. The study assessed sixteen children-perceived family-environmental factors, which were clustered based on principal component analysis into five sum variables: fruit and vegetable encouragement; vegetable modelling, family routine and demand; fruit modelling; fruit and vegetable snacking practices; and fruit and vegetable allowing.

Schools in Finland, Germany, Sweden and the Netherlands.

Schoolchildren aged 11 years (n 3317).

Multilevel logistic regression analyses revealed positive associations between nearly all clustered family-environmental factors and daily fruit and vegetable intake. The study tested a moderation effect between family-environmental factors and school lunch policy. In five out of twenty models significant interactions occurred. In the stratified analyses, most of the associations between family-environmental factors and raw and cooked vegetable intake were stronger in Germany and the Netherlands, neither of which provided free school lunches.

Children reporting more fruit- and vegetable-promoting family-environmental factors had a more frequent intake of fruits and vegetables; the associations were stronger for vegetable intakes in countries providing no free school lunches, suggesting that parental involvement is crucial when schools offer no vegetables.

To assess the relative risk of low daily fruit and vegetable consumption for six large migrant groups in Switzerland.

Cross-sectional health survey carried out 2007 (Swiss Health Survey) and 2010 (Swiss Migrant Health Survey) in Switzerland. Multinomial logistic regression models were used to estimate relative risk rates (RRR) of migrants relative to Swiss nationals.

Data obtained from representative samples of Swiss and foreign nationals living in Switzerland.

A random sample (n 14637) of the Portuguese, German, Italian, Turkish, Serbian, Kosovan and Swiss permanent resident adult population (17–64 years old) was interviewed.

The proportion of participants who adhered to the recommended fruit and vegetable consumption was below one-third in all study populations. Compared with Swiss nationals, the relative risk of low daily fruit and vegetable intake relative to recommended intake was higher in Turkish nationals (RRR = 2·92, 95 % CI 1·91, 4·48; P = 0·0000) and Kosovan nationals (RRR = 4·76, 95 % CI 3·01, 7·55; P = 0·0000). The respective relative risks of Portuguese, Serbian, German and Italian nationals were not significantly different from the Swiss reference group.

Initiatives for the promotion of fruit and vegetable consumption should continue to address the population at large. At the same time, programmes that are tailored to the specific needs of migrants from Turkey and Kosovo should be considered.

To evaluate patterns of physical activity (PA), the prevalence of physical inactivity and the relationships between PA and sociodemographic, clinical and biochemical parameters among Sri Lankan adults.

Descriptive cross-sectional study.

Nationally representative population-based survey conducted in Sri Lanka.

Data on PA and associated details were obtained from 5000 adults. PA was assessed using the International Physical Activity Questionnaire (short-form). A binary logistic regression analysis was performed using the dichotomous variable ‘health-enhancing PA’ (0 = ‘active’, 1 = ‘inactive’).

Sample size was 4485. Mean age was 46·1 (sd 15·1) years, 39·5 % were males. The mean weekly total MET (metabolic equivalents of task) minutes of PA among the study population was 4703 (sd 4369). Males (5464 (sd 5452)) had a significantly higher weekly total MET minutes than females (4205 (sd 3394); P < 0·001). Rural adults (5175 (sd 4583)) were significantly more active than urban adults (2956 (sd 2847); P < 0·001). Tamils had the highest mean weekly total MET minutes among ethnicities. Those with tertiary education had lowest mean weekly total MET minutes. In all adults 60·0 % were in the ‘highly active’ category, while only 11·0 % were ‘inactive’ (males 14·6 %, females 8·7 %; P < 0·001). Of the ‘highly active’ adults, 85·8 % were residing in rural areas. Results of the binary logistic regression analysis indicated that female gender (OR = 2·1), age >70 years (OR = 3·8), urban living (OR = 2·5), Muslim ethnicity (OR = 2·7), tertiary education (OR = 3·6), obesity (OR = 1·8), diabetes (OR = 1·6), hypertension (OR = 1·2) and metabolic syndrome (OR = 1·3) were all associated with significantly increased odds of being physically ‘inactive’.

The majority of Sri Lankan adults were ‘highly active’ physically. Female gender, older age, urban living, Muslim ethnicity and tertiary education were all significant predictors of physical inactivity. Physical inactivity was associated with obesity, diabetes, hypertension and metabolic syndrome.

To investigate the association between dietary behaviours and colorectal cancer (CRC) in the context of the Mediterranean diet.

Case–control study.

All patients (cases) were recruited from Saint Savvas Cancer Hospital and Alexandra General Hospital in Athens, Greece. Controls were voluntarily selected from the general population and matched to cases by age group (±10 years) and sex.

Two hundred and fifty cases with newly diagnosed CRC (mean age 63 (sd 12) years, 59·6 % males) and 250 controls matched on age and sex were studied. A standardized questionnaire assessing sociodemographic, clinical, lifestyle, dietary characteristics and nutritional behaviours was applied. Multiple logistic regression analysis was used to evaluate the aforementioned factors in addition to the MedDietScore (an index that evaluates adherence to the Mediterranean diet) on CRC development.

The higher the daily number of meals, the lower the likelihood of having CRC (OR = 0·74, 95 % CI 0·61, 0·89); coffee drinking was associated with higher likelihood of having CRC (OR = 3·27, 95 % CI 1·09, 9·8); the use of non-stick cookware was positively associated with CRC (OR = 1·57, 95 % CI 1·02, 2·4). However, these associations slightly lost their significance when adherence to the Mediterranean diet was taken into account. Moreover, a 1/75 increase in the modified-MedDietScore plus the aforementioned nutritional behaviours was associated with 13 % lower odds (95 % CI 0·83, 0·91, P < 0·001) of having CRC.

Nutritional behaviours in addition to dietary habits should be taken into account in detecting individuals prone to the development of CRC.

Trinidad and Tobago has experienced an epidemiological transition over recent decades characterised by reduced rates of communicable diseases but rapidly increasing rates of obesity and non-communicable chronic diseases. The objective of the present study was to investigate the changes in energy and nutrient supply that have taken place in Trinidad and Tobago between 1961 and 2007.

Food balance sheets for each year between 1961 and 2007 were downloaded from the FAOSTAT database and daily per capita supply for seventeen food commodity groupings was calculated. After appropriate coding, energy and nutrient supply were determined using dietary analysis software.

FAO food balance sheets for Trinidad and Tobago from 1961 to 2007.

None.

The food supply in 2007 provided an extra 1561 kJ (373 kcal)/capita per d than it did in 1961. Energy from carbohydrate as a percentage of total energy fell from 62 % in 1961 to 57 % in 2007, whereas energy from fat as a percentage of total energy increased from 26 % to over 30 % and now lies at the upper end of WHO recommendations. Sugars increased from 20 % to over 26 % of total energy and are well above WHO recommendations. When expressed on a nutrient density basis, supplies of vitamin A, folate and Ca are lower than WHO recommendations.

Nutritional imbalances in the Trinidadian food supply need to be addressed to combat the rise in nutrition-related chronic disease that is projected to cause increased disability and premature death in the country in the coming years.

The Heart Foundation Tick aims to help consumers make healthier food choices and overcome confusion in understanding food labels. Little is known about what factors differentiate frequent from infrequent users and the effectiveness of this scheme in helping Australians make healthier food choices.

A cross-sectional survey was used to explore use of the Tick and associations with a range of individual characteristics.

A national panel of Australians, living in each state and territory, completed an online survey (n 1446).

Adult men (41 %) and women participated in the study.

Most trusted the Heart Foundation (79 %), and used the Tick at least occasionally (19 % regularly, 21 % often, 35 % occasionally, 24 % never). A majority was classified as overweight/obese (60 %), 3·5 % were diagnosed with CHD, 5·2 % with diabetes and 23 % with hypertension. Many did not meet recommendations for the consumption of red meat (30 %), processed meat (23 %), vegetables (78 %), fruit (43 %) and fast foods (47 %). Female frequent users tended to have hypertension, be married/de facto, older than 45 years, rural dwellers, and limit their intake of fast foods. Male frequent users tended to have hypertension, meet recommendations for fruit, vegetables and processed meats, but not have a tertiary education.

The Heart Foundation Tick is a highly trusted, highly recognizable food labelling scheme and helpful to consumers who are motivated to make healthier food choices. More inter-sector collaboration is required to incorporate these schemes into public health campaigns to help consumers make healthier food choices.

Patients often do not eat/drink enough during hospitalization. To enable patients to meet their energy and nutritional requirements, food and catering service quality and staff support are therefore important. We assessed patients’ satisfaction with hospital food and investigated aspects influencing it.

We conducted a cross-sectional study collecting patients’ preferences using a slightly modified version of the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire (ACHFPSQ). Factor analysis was carried out to reduce the number of food-quality and staff-issue variables. Univariate and multivariate ordinal categorical regression models were used to assess the association between food quality, staff issues, patients’ characteristics, hospital recovery aspects and overall foodservice satisfaction (OS).

A university hospital in Florence, Italy, in the period November–December 2009.

Hospital patients aged 18+ years (n 927).

Of the 1288 questionnaires distributed, 927 were returned completely or partially filled in by patients and 603 were considered eligible for analysis. Four factors (explained variance 64·3 %, Cronbach's alpha αC = 0.856), i.e. food quality (FQ; αC = 0·74), meal service quality (MSQ; αC = 0·73), hunger and quantity (HQ; αC = 0·74) and staff/service issues (SI; αC = 0·65), were extracted from seventeen items. Items investigating staff/service issues were the most positively rated while certain items investigating food quality were the least positively rated. After ordinal multiple regression analysis, OS was only significantly associated with the four factors: FQ, MSQ, HQ and SI (OR = 17·2, 6·16, 3·09 and 1·75, respectively, P < 0·001), and gender (OR = 1·53, P = 0·024).

The most positively scored aspects of foodservice concerned staff/service, whereas food quality was considered less positive. The aspects that most influenced patients’ satisfaction were those related to food quality.

Separate meta-analyses based on case–control and cohort studies have reported different results on the relationship between coffee consumption and colorectal cancer risk. To clarify the effect of coffee intake on colorectal cancer risk, we performed a meta-analysis based on both case–control and cohort studies.

Review study.

We identified case–control and cohort studies related to coffee consumption and colorectal cancer risk listed on MEDLINE, the Cochrane Controlled Trials Register, EMBASE, Science Citation Index and PubMed (until May 2011).

Research literature on the relationship between coffee consumption and colorectal cancer risk.

Twenty-five case–control (15 522 cases) and sixteen cohort studies (10 443 cases) were included in the meta-analysis. Comparing the highest v. the lowest/non category of coffee consumption, the combined results from case–control studies showed a significant relationship with colorectal cancer (OR = 0·85, 95 % CI 0·75, 0·97) and colon cancer (OR = 0·79, 95 % CI 0·67, 0·95), but not rectal cancer (OR = 0·95, 95 % CI 0·79, 1·15). For cohort studies, there was a slight suggestion of an inverse association with colorectal cancer (relative ratio = 0·94; 95 % CI 0·88, 1·01) and colon cancer (OR = 0·93, 95 % CI 0·86, 1·01), rather than rectal cancer (OR = 0·98, 95 % CI 0·88, 1·09). In subgroup analyses using case–control studies, significant inverse associations were found in females for colorectal cancer and in Europe for colorectal and colon cancer, while the subgroup analyses of cohort studies found that coffee drinks substantially decreased risk of colon cancer only in Asian women.

Results from case–control studies suggest coffee consumption can significantly decrease the risks of colorectal cancer and colon cancer, especially in Europe and for females.

To compare food and nutrient intakes from midday meals provided by schools with those from packed lunches and to estimate the contribution from food eaten at midday to the total daily energy and nutrient intakes of teenagers.

Dietary data were recorded in 4 d estimated diaries of which 2 d were school days. The school day data were analysed for total and midday energy and nutrient intakes. The latter were compared with the recommendations of the Caroline Walker Trust (CWT).

Cambridgeshire, UK, 2006.

Teenagers (n 757) aged 14–15 years, from eighteen secondary schools, who reported food eaten at school.

The contribution to total daily energy intake from all lunches eaten at school was 29 % (boys) and 28 % (girls). School meals provided greater quantities of protein, starch, carotene and folate but also more saturated fats and Na than packed lunches. Intakes of energy and several nutrients fell below the CWT recommendations for both types of lunch. School meals and packed lunches provided different types of foods; greater quantities of rice, pasta and vegetables in school meals; more yoghurt, cheese, fruit and juices but also more confectionery and soft drinks in packed lunches.

There has been concern that schoolchildren who are not opting for lunch provided by schools are compromising the overall quality of their diet, but the present study showed small differences in nutrient content between packed and school lunches. These data were collected in 2005–2007 before the government programme of improvements reached secondary schools.

To evaluate the nutritional quality of products advertised on television (TV) during children's viewing time in Spain, applying the UK nutrient profile model (UKNPM).

We recorded 80 h of four general TV station broadcasts during children's viewing time in May and June 2008, and identified all advertisements for foods and beverages. Nutritional information was obtained from the product labels or websites and from food composition tables. Each product was classified as healthy (e.g. gazpacho, a vegetable juice) or less healthy (e.g. potato crisp snacks) according to the UKNPM criteria.

Four free-of-charge TV channels in Spain: two national channels and two regional ones.

TV commercials of food and beverages.

A total of 486 commercials were broadcast for ninety-six different products, with a mean frequency of 5·1 advertisements per product. Some 61·5 % of the ninety-six products were less healthy, and the percentage was higher for foods (74·1 %). All (100 %) of the breakfast cereals and 80 % of the non-alcoholic drinks and soft drinks were less healthy. Of the total sample of commercials, 59·7 % were for less healthy products, a percentage that rose to 71·2 % during children's reinforced protection viewing time.

Over half the commercials were for less healthy products, a proportion that rose to over two-thirds during the hours of special protection for children. This suggests that applying the UKNPM to regulate food advertising during this slot would entail the withdrawal of most food commercials in Spain. TV advertising of products with low nutritional quality should be restricted.

Although undernutrition is recognized as a risk factor for mortality among people living with HIV (PLWHIV), even among those initiating antiretroviral therapy, few studies have explored the underlying determinants of undernutrition. The objectives of the present study were to: (i) examine the independent association between household food security, individual diet quality and nutritional status; and (ii) determine if any association between food security and nutritional status is mediated through diet quality.

Cross-sectional baseline survey.

Gulu and Soroti districts, Uganda.

Nine hundred and two PLWHIV recruited into a study evaluating the impact of a food assistance programme supported by the World Food Programme.

Food security and diet quality were measured using the Household Food Insecurity Access Scale (HFIAS) and the Individual Dietary Diversity Score (IDDS), respectively. Multivariate regression results demonstrated that HFIAS and IDDS independently predict BMI (P < 0·01) and mid upper-arm circumference (P < 0·05). The adjusted odds ratio of being underweight (BMI < 18·5 kg/m2) among individuals living in severely food-insecure households was 1·92 (P < 0·0 0 1); individuals consuming a highly diverse diet had an adjusted odds ratio of being underweight of 0·56 (P < 0·05) compared with those consuming a diet of low diversity. Similar results were observed when mid upper-arm circumference and wasting were modelled as outcomes. Using path analysis, we observed that the indirect effect of food insecurity on BMI mediated through dietary diversity is negligible, and mostly a result of the direct effect of food insecurity on BMI.

Our results provide an empirical basis for focused efforts on improving food access and diet quality among PLWHIV. Addressing the broader structural determinants of food security of people infected and affected by HIV is crucial.

To explore if and how female adolescents engage in shared eating and joint food choices with best friends within the context of living in urban Soweto, South Africa.

A qualitative, exploratory, multiple case study was conducted using semi-structured duo interviews of best friend pairs to ascertain their eating patterns, friendship and social interactions around dietary habits.

Participants were recruited from three high schools in the urban township of Soweto, South Africa.

Fifty-eight female adolescents (twenty-nine friend pairs) still in high school (mean age of 18 years) were enrolled.

Although overweight rates were high, no association between friends was found; neither did friends share dieting behaviours. Both at school and during visits to the shopping mall, foods were commonly shared and money pooled together by friends to make joint purchases. Some friends carefully planned expenditures together. Foods often bought at school were mostly unhealthy. Availability, price and quality were reported to affect choice of foods purchased at school. Preference shaped joint choices within the shopping mall environment.

Food sharing practices should be investigated in other settings so as to identify specific behaviours and contexts for targeted and tailored obesity prevention interventions. School-based interventions focusing on price and portion size should be considered. In the Sowetan context, larger portions of healthy food may improve dietary intake of fruit and vegetables where friends are likely to share portions.

To report the design and baseline results of a rewards-based incentive to promote purchase of fruit and vegetables by lower-income households.

A four-phase randomized trial with wait-listed controls. In a pilot study, despite inadequate study coupon use, purchases of fresh fruit (but not vegetables) increased, but with little maintenance. In the present study, credits on the study store gift card replace paper coupons and a tapering phase is added. The primary outcome is the number of servings of fresh and frozen fruit and vegetables purchased per week.

A large full-service supermarket located in a predominantly minority community in Philadelphia, Pennsylvania, USA.

Fifty-eight households, with at least one child living in the home.

During the baseline period, households purchased an average of 3·7 servings of fresh vegetables and an average of less than 1 serving of frozen vegetables per week. Households purchased an average of 1·9 servings of fresh fruit per week, with little to no frozen fruit purchases. Overall, the range of fresh and frozen produce purchased during this pre-intervention period was limited.

At baseline, produce purchases were small and of limited variety. The study will contribute to understanding the impact of financial incentives on increasing the purchases of healthier foods by lower-income populations.

To evaluate red and processed meat intake, and the impact meat consumption has on diet quality and the environment.

A large cross-sectional health survey performed in São Paulo, Brazil.

Diet was assessed by two 24 h dietary recalls. Usual intakes were calculated using the Multiple Source Method. The World Cancer Research Fund recommendation of an average of 71·4 g/d was used as the cut-off point to estimate excessive red and processed meat consumption. To investigate the relationship between meat consumption and diet quality we used the Brazilian Healthy Eating Index Revised. The environmental impact was analysed according to estimates of CO2 equivalent emissions from meat consumption.

Brazilians (n 1677) aged 19 years and older were studied.

The mean red and processed meat intake was 138 g/d for men and 81 g/d for women. About 81 % of men and 58 % of women consumed more meat than recommended. Diet quality was inversely associated with excessive meat intake in men. In Brazil alone, greenhouse gas emissions from meat consumption, in 2003, were estimated at approximately 18 071 988 tonnes of CO2 equivalents, representing about 4 % of the total CO2 emitted by agriculture.

The excessive meat intake, associated with poorer diet quality observed, support initiatives and policies advising to reduce red and processed meat intake to within the recommended amounts, as part of a healthy and environmentally sustainable diet.

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.

General practitioners (GP) are uniquely placed to guide their patients on nutrition and physical activity. The aims of the present study were to assess: (i) the extent to which GP guide on nutrition and physical activity; (ii) the determinants that cause GP to give guidance on nutrition and physical activity; and (iii) the extent to which these guidance practices have the same determinants.

Cross-sectional study, mail questionnaire.

Dutch general practice.

Four hundred and seventy-two GP in practice for 5–30 years.

Our study showed that the majority of GP had similar practices for both nutrition and physical activity guidance. Fair associations were found between nutrition and physical activity guidance practices. More than half of the explained variance in the models of physical activity guidance practices was improved by the inclusion of nutrition guidance practices in the models. Moreover, GP reported higher frequencies of physical activity guidance practices than nutrition guidance practices. Nutrition guidance practices predicted the same physical activity guidance practices.

The majority of GP had similar practices for nutrition and physical activity guidance. GP were more inclined to guide their patients on physical activity than on nutrition. Self-efficacy was found to be a determinant in most models for guidance practices. Guidance practices proved to be a mix of prevention and treatment components. Consequently, we advise raising the self-efficacy of GP by training in medical school and in continuing medical education. We also recommend the combination of both nutrition and physical activity guidance in general practice.

India has proposed legislating an upper limit of trans fat in partially hydrogenated vegetable oils and mandating trans fat labelling in an effort to reduce intakes. The objective of the present study was to examine the complexities of regulating trans fat in India by examining the policy processes involved and the perceived implementation challenges.

Semi-structured interviews (n 18) were conducted with key informants from various sectors. Interviewees were asked about sources of trans fat in the food supply, existing policies that may influence trans fats and perceived challenges related to the proposed trans fat regulation, in addition to questions tailored to their area of expertise. Interview data were organised based on common themes.

Interviews were conducted in India.

Interviewees were key informants from various sectors including agriculture, trade, industry and health.

Several themes were identified related to the complexity of regulating trans fat in India. A lack of trans fat awareness, the large unorganised retail sector, a need for suitable alternative products that are both acceptable to consumers and affordable, and a need to build capacity were crucial factors affecting India's ability to successfully regulate trans fat. The limited number of food inspectors will create an additional challenge in terms of enforcement of trans fat regulation.

Although India will face challenges in regulating trans fat, legislating an upper limit of trans fat in partially hydrogenated vegetable oils will likely be the most effective approach to reducing it in the food supply. Ongoing engagement with industry, agriculture, trade and processing sectors will prove essential in terms of product reformulation.