To describe the prevalence of iron depletion (ID), iron-deficiency anaemia (IDA) and risk of haemoconcentration during pregnancy and at delivery and to assess the influence of initial Fe stores and Fe supplementation on that prevalence.

Longitudinal study.

Hospital Universitari Sant Joan de Reus (Catalonia, Spain).

Two hundred and eighty-five pregnant women. Serum ferritin and Hb were measured in the first, second and third trimesters and at delivery. Women were classified according to initial Fe stores as ID or no ID (serum ferritin ≥12 μg/l) and according to Fe supplement use as supplemented or non-supplemented.

Initial ID was 16·2 %. At delivery, 45·7 % had ID, 13·5 % IDA and 13·3 % had risk of haemoconcentration. Initial ID and non-supplemented groups had significantly higher prevalences of ID and IDA and lower risk of haemoconcentration at delivery than the other groups. In the multiple logistic models, no initial ID and Fe supplementation exerted a protective effect against ID at delivery (adjusted OR = 0·28; 95 % CI 0·13, 0·58 and adjusted OR = 0·39; 95 % CI 0·22, 0·69, respectively). Moderate Fe supplementation did not seem to clearly prevent IDA (adjusted OR = 0·91; 95 % CI 0·42, 1·96) or to enhance the haemoconcentration (adjusted OR = 1·42; 95 % CI 0·58, 3·50).

The prevalence of ID and IDA was high in late pregnancy in healthy pregnant women, particularly in those with initial ID and/or those not taking supplements. Starting pregnancy with no ID and/or taking moderate Fe supplementation decreased the likelihood of ID at delivery. The risk of haemoconcentration was high at delivery, but did not seem to be promoted by Fe supplementation. Further research is necessary to determine the most appropriate nutritional advice for pregnant women.

Recently, the general public opinion is that nutritional recommendations promote obesity rather than prevent it. We created the Recommended Finnish Diet Score (RFDS) that illustrates the Finnish nutrition recommendations and assessed whether this score is associated with BMI, waist circumference (WC) and body fat percentage (BF%).

Cross-sectional study included two phases of the National FINRISK 2007 Study. Diet was assessed using a validated FFQ. Height, weight, WC and BF% were measured, and BMI values were calculated. The RFDS was developed based on the national nutrition recommendations.

A large representative sample of the Finnish population.

Men (n 2190) and women (n 2530) aged 25–74 years.

The RFDS was inversely associated with WC in men (OR = 0·48, 95 % CI 0·28, 0·81, P < 0·05) and BF% in both men (OR = 0·44, 95 % CI 0·24, 0·82, P-trend < 0·05) and women (OR = 0·63, 95 % CI 0·37, 1·08, P-trend < 0·05). The inverse association of RFDS and BF% appeared stronger among older age groups (men: OR = 0·21 CI 0·07, 0·64, P-trend < 0·01; women: OR = 0·56, 95 % CI 0·25, 1·27, P-trend < 0·05) and among women with normal BMI (OR = 0·62, 95 % CI 0·36, 1·09, P-trend < 0·05). The RFDS was not associated with BMI.

A diet following nutrition recommendations is likely to help to maintain normal WC and BF%. These findings could be useful for dietary counselling and the prevention of obesity.

To examine how increasing vegetable consumption from foods prepared at home (FAH) and foods prepared away from home (FAFH) would impact energy, dietary fibre and Na (sodium) intakes in the USA.

Using data from the 2003–2004 US National Health and Nutrition Examination Survey, dietary intake data from two separate days were fitted with a first-difference (fixed-effects) model. Vegetables consumed from all sources, including mixed foods and juices, were disaggregated and expressed as amounts equivalent to one cup of whole vegetables.

Nationally representative sample of the US population.

Individuals aged 2 years and above reporting 2 d of dietary intake data in 2003–2004 (n 7647).

Holding constant the total amount of food consumed, consuming an additional cup of tomatoes and potatoes from FAFH increases energy intake by respectively 1522 and 665 kJ, as compared with 246 and 367 kJ for FAH. Each additional cup of tomatoes from FAH is associated with an additional 179 mg of Na, compared with 113 mg for FAFH. All vegetable consumption increases fibre intake, except for potatoes and tomatoes from FAFH. Dark green and orange vegetables from FAH add the largest amount of fibre (1·38 g/cup).

Because US consumers frequently consume vegetables as part of mixed foods that add energy and Na, heavier consumption of vegetables as currently prepared raises the energy content and Na density of the overall diet. This is particularly true for vegetables prepared away from home.

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

Cross-sectional supermarket audit.

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

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

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

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

To provide an overview of school food and nutrition monitoring from 1980 to the Healthy Hunger-Free Kids Act of 2010 and data on school food availability in the USA.

A review of the history of school food and nutrition policy, monitoring and evaluation efforts in the USA over the past three decades.

USA.

School food service, school districts and schools nationwide.

The school food environment in the USA is governed by a patchwork of federal, state and local laws and policies. The federal government has primary authority over the school meal programmes and has recently issued updated regulations governing the food and nutrient requirements for meals sold or served through the National School Lunch and School Breakfast Programs. Competitive foods (i.e. foods and beverages sold/served outside the meal programmes) are governed primarily by state and district laws and policies, although new federal regulations are expected to set minimum standards in this area. The USA has a long history of data monitoring and evaluation funded by government and private foundations which has enabled decision makers to monitor progress and opportunities to improve the foods and beverages made available to students in school.

School food-related monitoring and evaluation research has been highly influential in influencing legislation and policy, leading to improvements in the foods and beverages available to children at school as part of planned meals and individual items sold outside the meal programmes. The lessons learned from the US experience provide insights that may be valuable for implementation, monitoring and evaluation of school food programmes in other countries.

We examined associations between access to food venues (farmers’ markets and supermarkets), shopping patterns, fruit and vegetable consumption and health indicators among women of reproductive age in eastern North Carolina, USA.

Access to food venues was measured using a Geographic Information System incorporating distance, seasonality and business hours, to quantify access to farmers’ markets. Produce consumption was assessed by self-report of eating five or more fruits and vegetables daily. BMI and blood pressure were assessed by clinical measurements. Poisson regression with robust variance was used for dichotomous outcomes and multiple linear regression was used for continuous outcomes. As the study occurred in a university town and university students are likely to have different shopping patterns from non-students, we stratified analyses by student status.

Eastern North Carolina.

Low-income women of reproductive age (18–44 years) with valid address information accessing family planning services at a local health department (n 400).

Over a quarter reported ever shopping at farmers’ markets (114/400). A larger percentage of women who shopped at farmers’ markets consumed five or more fruits and vegetables daily (42·1 %) than those who did not (24·0 %; P < 0·001). The mean objectively measured distance to the farmers’ markets where women reported shopping was 11·4 (sd 9·0) km (7·1 (sd 5·6) miles), while the mean distance to the farmers’ market closest to the residence was 4·0 (sd 3·7) km (2·5 (sd 2·3) miles).

Among non-students, those who shopped at farmers’ markets were more likely to consume five or more servings of fruits and vegetables daily. Future research should further explore potential health benefits of farmers’ markets.

To determine risk factors for consumption of soda and other sugar-sweetened beverages (SSB) among 2-year-old children.

The analysis was performed using three linked data sets: the 2004–2005 Oregon Pregnancy Risk Assessment Monitoring Survey (PRAMS); its longitudinal follow-up, 2006–2007 Oregon PRAMS-2; and 2004–2005 Oregon birth certificates.

PRAMS is a surveillance programme supported by the federal Centers for Disease Control and Prevention and implemented by participating state health departments. Using mixed methods, PRAMS surveys women 2–6 months after a live birth. Oregon PRAMS-2 re-interviews respondents shortly after the index child's second birthday. Oregon PRAMS oversamples minority women.

Using monthly cohorts, we randomly selected 5851 women from the 2004–2005 birth certificates. In total 1911 women completed both PRAMS and PRAMS-2. The weighted response rate of PRAMS-2 was 43·5 %.

Almost half of mothers (49·9 %) reported that their child drank SSB on at least 1 d/week. Mothers whose children drank SSB at least once weekly were more likely to have low income (adjusted OR = 2·83, 95 % CI 2·09, 3·83) and to eat out on ≥2 d/week (OR = 2·11 %, 95 % CI 1·66, 2·70). Hispanic and non-Hispanic black women were most likely to report that their child drank SSB at least once weekly.

Half of mothers reported that their 2-year-old children drank SSB at least once weekly. Public health interventions and policies should address childhood SSB consumption including educating health-care providers and parents.

There is increasing pressure for adolescents to be thin and this may not always be acted upon in healthy ways; for example, certain foods or food groups may be restricted or meals skipped. As foods are not eaten in isolation it is useful to examine dietary patterns and associated psychosocial factors to better understand eating behaviour. The aim of the present study was to identify correlates of ‘dieting’ in adolescents from Otago, New Zealand.

A web-based survey was conducted in 2009, collecting information on food consumption and factors potentially associated with food consumption. Principal components analysis was used to investigate dietary patterns. Correlates were examined in 1329 students using multiple logistic regression analysis.

Nineteen secondary schools in the province of Otago, New Zealand.

Students from school years 9 and 10 (mean age 14·1 (sd 0·7) years).

There was no relationship between dieting and dietary patterns. Those not dieting were 17 % (95 % CI 7, 26 %) more likely to eat lunch and 22 % (95 % CI 3, 37 %) more likely to eat an evening meal on one more weekday than those who were dieting. Those who reported dieting were more likely to report healthiness (OR = 2·18, 95 % CI 1·11, 4·26) as an important factor when choosing food and that eating fruit and vegetables makes you better looking. No sex by dieting interaction was found.

In this cohort, while there was no difference in actual food consumption between dieters and non-dieters, there were significant differences in attitudes to food.

To assess the validity of food photographs in portion size estimation among adolescent girls in Mozambique. The study was carried out in preparation for the larger ZANE study, which used the 24 h dietary recall method.

Life-sized photographs of three portion sizes of two staple foods and three sauces were produced. Participants ate weighed portions of one staple food and one sauce. After the meal, they were asked to estimate the amount of food with the aid of the food photographs.

Zambezia Province, Mozambique.

Ninety-nine girls aged 13–18 years.

The mean differences between estimated and actual portion sizes relative to the actual portion size ranged from −19 % to 8 % for different foods. The respective mean difference for all foods combined was −5 % (95 % CI −12, 2 %). Especially larger portions of the staple foods were often underestimated. For the staple foods, between 62 % and 64 % of the participants were classified into the same thirds of the distribution of estimated and actual food consumption and for sauces, the percentages ranged from 38 % to 63 %. Bland–Altman plots showed wide limits of agreement.

Using life-sized food photographs among adolescent Mozambican girls resulted in a rather large variation in the accuracy of individuals’ estimates. The ability to rank individuals according to their consumption was, however, satisfactory for most foods. There seems to be a need to further develop and test food photographs used in different populations in Sub-Saharan Africa to improve the accuracy of portion size estimates.

Numerous localities have mandated that chain restaurants post nutrition information at the point of purchase. However, some studies suggest that consumers are not highly responsive to menu labelling. The present qualitative study explored influences on full-service restaurant customers’ noticing and using menu labelling.

Five focus groups were conducted with thirty-six consumers. A semi-structured script elicited barriers and facilitators to using nutrition information by showing excerpts of real menus from full-service chain restaurants.

Participants were recruited from a full-service restaurant chain in Philadelphia, Pennsylvania, USA, in September 2011.

Focus group participants were mostly female, African American, with incomes <$US 60 000, mean age 36 years and education 14·5 years. At recruitment, 33 % (n 12) reported changing their order after seeing nutrition information on the menu.

Three themes characterized influences on label use in restaurants: nutrition knowledge, menu design and display, and normative attitudes and behaviours. Barriers to using labels were low prior knowledge of nutrition; displaying nutrition information using codes; low expectations of the nutritional quality of restaurant food; and restaurant discounts, promotions and social influences that overwhelmed interest in nutrition and reinforced disinterest in nutrition. Facilitators were higher prior knowledge of recommended daily intake; spending time reading the menu; having strong prior interest in nutrition/healthy eating; and being with people who reinforced dietary priorities.

Menu labelling use may increase if consumers learn a few key recommended dietary reference values, understand basic energy intake/expenditure scenarios and if chain restaurants present nutrition information in a user-friendly way and promote healthier items.

Information about healthy and unhealthy nutrients is increasingly conveyed at the point of purchase. Many studies have investigated the effects of product health information on attitudes and intentions, but the empirical evidence becomes sketchier when the focus of research is actual purchase behaviour. The present paper provides an overview of empirical evidence on the effectiveness of product health information for food products at the point of purchase.

A systematic literature review was conducted.

Only studies were included that assessed the effect of product health information at the point of purchase on actual purchase behaviour, using data provided by stores’ sales records or obtained by investigating customer receipts as the primary outcome measure.

The included studies’ target group comprised supermarket clientele.

Several studies found no significant effects of product health information on actual purchase behaviour. Interventions were more likely to be effective when they lasted for a longer time, when they included additional intervention components, and when they targeted the absence of unhealthy nutrients instead of or in addition to the presence of healthy nutrients.

No strong evidence for the effectiveness of product health information was found. The effect of intervention duration, additional promotional activities and targeting of healthy v. unhealthy nutrients should be closely examined in future studies.

To determine the association of birth weight with obesity risk at first grade of high school in Chilean children after accounting for potential confounding factors.

National non-concurrent cohort of newborns. Sociodemographic information, height, weight and anthropometric measurements at first grade of high school were analysed. Birth weight was classified as macrosomia (≥4000 g), by gestational age and by ponderal index. The relationship between birth weight and obesity at first grade of high school (BMI ≥ 95th percentile of the US Centers for Disease Control and Prevention's reference) was assessed using logistic regression models adjusted for sociodemographic information at delivery.

First grade of public high school of low and middle socio-economic status in the whole country (about 77 % of Chilean children in this age group).

Newborns (n 119 070) and the same number of high-school students.

A positive relationship of high ponderal index (OR = 1·86, 95 % CI 1·69, 2·03), birth weight ≥4000 g (OR = 1·66, 95 % CI 1·54, 1·78) and large for gestational age (OR = 1·69, 95 % CI 1·58, 1·81) with obesity at adolescence (P < 0·001) was found. Macrosomic children had a higher risk of being obese at first grade of high school after controlling for prenatal confounding variables (OR = 1·63, 95 % CI 1·52, 1·76; P < 0·001).

A direct relationship between high birth weight and obesity at first grade of high school was observed in this group of Chilean children. The results highlight the significance of birth weight as a simple tool to be used as an indicator of obesity risk for children by health-care providers.

The present paper analyses the advances and challenges of the school feeding programme in Brazil (PNAE), as part of the Brazilian experience building up an integrated food and nutrition security national system. It explores the role of policy and regulatory frameworks in constructing quality service delivery and intersectoral integration.

Review of PNAE and federal government technical documents and studies, legislation, minutes of meetings and official documents of the National Council of Food and Nutrition Security from 2003 to 2011.

Food insecurity has decreased significantly in Brazil in the last decade, indicating that appropriate choices were made in terms of public policies and institutional arrangements, which other countries can learn from.

Brazil food and nutrition security system; school feeding; school food.

Brazil's integrated food and nutrition security policy approach promoted intersectorality in the food system, articulating actions to guarantee access to healthy food and to strengthen family farming. The quality of school meals has progressively improved; in particular, the availability of fruits and vegetables increased. However, national standards regarding menu composition have not yet been met. Regulations were an important factor, along with the policy approach linking food production, nutrition, health and education. Challenges are related to conflict of interests and to farmers’ insufficient capacity to meet supply requirements and comply with technical procedures.

Local food production, school meals and nutrition education can be linked through integrated programmes and policies, improving access to healthier foods. Government leadership, strong legislation, civil society participation and intersectoral decision making are determinant.

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

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

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

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

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

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

To develop a menu and resource to illustrate to consumers and health professionals what a healthy balanced diet looks like over the course of a week.

Development and analysis of an illustrative 7 d ‘eatwell week’ menu to meet current UK recommendations for nutrients with a Dietary Reference Value, with a daily energy base of 8368 kJ (2000 kcal). Foods were selected using market research data on meals and snacks commonly consumed by UK adults. Analysis used the food composition data set from year 1 (2008) of the UK National Diet and Nutrition Survey rolling programme. The eatwell week menu was developed using an iterative process of nutritional analysis with adjustments made to portion sizes and the inclusion/exclusion of foods in order to achieve the target macronutrient composition.

Three main meals and two snacks were presented as interchangeable within the weekdays and two weekend days to achieve adult food and nutrient recommendations. Main meals were based on potatoes, rice or pasta with fish (two meals; one oily), red meat (two meals), poultry or vegetarian accompaniments. The 5-a-day target for fruit and vegetables (range 5–6·7 portions) was achieved daily. Mean salt content was below recommended maximum levels (<6 g/d). All key macro- and micronutrient values were achieved.

Affordable foods, and those widely consumed by British adults, can be incorporated within a 7 d healthy balanced menu. Future research should investigate the effect of using the eatwell week on adults’ dietary habits and health-related outcomes.

To investigate evolving food retail systems in Thailand.

Rapid assessment procedures based on qualitative research methods including interviews, focus groups discussions and site visits.

Seven fresh markets located in the four main regions of Thailand.

Managers, food specialists, vendors and shoppers from seven fresh markets who participated in interviews and focus group discussions.

Fresh markets are under economic pressure and are declining in number. They are attempting to resist the competition from supermarkets by improving convenience, food diversity, quality and safety.

Obesity has increased in Thailand at the same time as rapid growth of modern food retail formats has occurred. As fresh markets are overtaken by supermarkets there is a likely loss of fresh, healthy, affordable food for poorer Thais, and a diminution of regional culinary culture, women's jobs and social capital, with implications for the health and nutrition transition in Thailand.

To assess food and nutrient intakes and compliance with nutritional recommendations in pregnant women according to selected sociodemographic characteristics.

Cross-sectional study based on data from the INMA-Valencia cohort (Spain), which recruited pregnant women between 2004 and 2005. Information on maternal sociodemographics and anthropometry was collected. Dietary intake was assessed through an FFQ. Intakes of foods were compared with Spanish food-based dietary guidelines. Intake inadequacy for nutrients was assessed using the Dietary Reference Intakes of the US Institute of Medicine.

Valencia, Spain.

We studied 822 pregnant women who had information on dietary intake during their first trimester of pregnancy.

More than 50 % of pregnant women did not meet the guidelines for cereals and legumes; reported intakes of carbohydrates, n-3 and n-6 fatty acids were below recommendations and exceeded the total fat intake according to dietary references. Dietary inadequacy for folate, Fe and vitamin E ranged from 99 % to 68 %. Vegetable intake was related to age only. Younger and less educated women showed lower intakes of protein and n-3 fatty acids and higher intakes of trans-fatty acids as well as greater inadequacy for micronutrients. Spanish women reported lower intakes of fruit and carbohydrates and higher intakes of protein, total fat, SFA, MUFA and n-3 fatty acids compared with their foreign-born counterparts.

Women in the studied area have inadequate intakes of several nutrients relevant during pregnancy. Age, education and country of origin are factors significantly related to dietary intake and adequacy.

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

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

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

Adult survey respondents (n 15 634).

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

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

The aim of the present study was to examine the prevalence and associated factors of dietary supplement use, particularly supplements containing vitamin D and fatty acids, in pregnant women enrolled in a multi-national study.

The Environmental Determinants of Diabetes in the Young (TEDDY) study is a prospective longitudinal cohort study. Maternal dietary supplement use was self-reported through questionnaires at month 3 to 4 postpartum.

Six clinical research centres; three in the USA (Colorado, Georgia/Florida and Washington) and three in Europe (Sweden, Finland and Germany).

Mothers (n 7326) to infants screened for high-risk HLA-DQ genotypes of type 1 diabetes.

Ninety-two per cent of the 7326 women used one or more types of supplement during pregnancy. Vitamin D supplements were taken by 65 % of the women, with the highest proportion of users in the USA (80·5 %). Overall, 16 % of the women reported taking fatty acid supplements and a growing trend was seen in all countries between 2004 and 2010 (P < 0·0001). The use was more common in Germany (32 %) and the USA (24 %) compared with Finland (8·5 %) and Sweden (7·0 %). Being pregnant with the first child was a strong predictor for any supplement use in all countries. Low maternal age (<25 years), higher education, BMI ≥ 25·0 kg/m2 and smoking during pregnancy were factors associated with supplement use in some but not all countries.

The majority of the women used dietary supplements during pregnancy. The use was associated with sociodemographic and behavioural factors, such as parity, maternal age, education, BMI and maternal smoking.

The relationship between a child's environment and nutritional status is difficult to examine yet could offer an important guide to policy. The objective of the present work was to examine individual and environmental correlates with childhood height-for-age in Ghana.

Data were derived from the 2008 MEASURE Demographic and Health Survey in Ghana, the 2000 Ghana Population and Housing Census, and the World Wide Fund for Nature's eco-regions database. A generalized linear mixed regression model was used to estimate the effects of individual and environmental correlates on height-for-age.

The study examined 2225 Ghanaian children aged 0–59 months.

The setting was all districts in Ghana for the year 2008.

After accounting for individual characteristics of children, mothers and households, height-for-age was significantly associated with population density. Other significantly associated variables in the final model were the age of the child, vaccination status, the size of the child at birth, months of breast-feeding, mother's BMI, whether the child's mother had health insurance and wealth quintile.

In addition to a number of characteristics of the children and their households, the social milieu is important to understanding differences in height-for-age among children in Ghana. The biophysical environment was not associated with height-for-age.