To examine the variability of food portions served and consumed by African-American and Hispanic-American pre-school children attending Head Start.

Cross-sectional.

Food consumption by pre-schoolers (n 796) enrolled in sixteen Head Start centres in Houston, Texas (51 % boys, 42 % African-American, mean age 4 years) were assessed during 3 d of lunch meals using digital photography. Descriptive statistics and multilevel regression models, adjusting for classroom and school clustering effects, were determined.

Head Start pre-schoolers aged 3–5 years.

Mean amount served was 2428 kJ (580 kcal) and 572 g. Mean intake was 1421 kJ (339 kcal) and 331 g: 20 % protein, 46 % carbohydrate and 34 % fat. Plate waste was 43 % (range: 38 % (fruit) to 61 % (vegetables)). Mean CV of food served was 29 %: 33 % for entrées, 44 % for vegetables, 60 % for fruit and 76 % for starches. Mean CV of food consumed was 46 %: 58 % for entrées, 86 % for fruit, 96 % for vegetables and 111 % for starches. Total gram amount of food served was positively correlated with consumption (r = 0·43, P < 0·001).

Plate waste and variation in amounts served and consumed were substantial; amounts served were associated with amounts consumed. Large portion sizes may contribute to paediatric obesity by promoting excessive intake at meals. Understanding factors influencing portion sizes provides insight about specific intervention strategies that can be used in obesity prevention programmes.

An analysis undertaken jointly in 2009 by the UN World Food Programme, The Partnership for Child Development and the World Bank was published as Rethinking School Feeding to provide guidance on how to develop and implement effective school feeding programmes as a productive safety net and as part of the efforts to achieve Education for All. The present paper reflects on how understanding of school feeding has changed since that analysis.

Data on school feeding programme outcomes were collected through a literature review. Regression models were used to analyse relationships between school feeding costs (from data that were collected), the per capita costs of primary education and Gross Domestic Product per capita. Data on the transition to national ownership, supply chains and country examples were collected through country case studies.

School feeding programmes increase school attendance, cognition and educational achievement, as well as provide a transfer of resources to households with possible benefits to local agricultural production and local market development. Low-income countries exhibit large variations in school feeding costs, with concomitant opportunities for cost containment. Countries are increasingly looking to transition from externally supported projects to national programmes.

School feeding is now clearly evident as a major social programme in most countries with a global turnover in excess of $US 100 billion. This argues for a continuing focus on the evidence base with a view to helping countries ensure that their programmes are as cost-effective as possible. Clear policy advice has never been more important.

To evaluate plant sterol intake estimated with the eighty-four-item Northern Sweden FFQ against repeated 24 h dietary recalls (24-HDR) as the reference method.

Randomly recruited participants from the Västerbotten Intervention Programme (VIP) responded to an FFQ (FFQ1). Over the subsequent 12 months, ten repeated 24-HDR were carried out. After this, a second FFQ (FFQ2) was completed.

Västerbotten county, northern Sweden.

Ninety-six men and ninety-nine women.

The Pearson correlation coefficient for absolute total plant sterol intake estimated with FFQ1 and 24-HDR was 0·58 and 0·55 for the men and women, respectively. Cross-classification of participants into quartiles of absolute plant sterol intake estimated with FFQ1 and 24-HDR showed that 90 % of the men and 83 % of the women were classified into the same or an adjacent quartile. For energy-adjusted plant sterol intake, 71 % of the men and 74 % of the women were classified into the same or an adjacent quartile. The agreement for cross-classification of participants into quartiles between FFQ1 and FFQ2 was good for both absolute and energy-adjusted plant sterol intake.

The FFQ is able to capture absolute plant sterol intake to the same extent as other nutrients, and to rank individuals according to both their absolute and energy-adjusted plant sterol intake. The reproducibility of the FFQ was good, suggesting that the method is reliable. This makes it possible to use plant sterol data from the FFQ in large-scale studies of the association between plant sterol intake and disease.

To examine the effects of three different school snacks on morbidity outcomes.

Twelve schools were randomized to either one of three feeding groups or a Control group. There were three schools per group in this cluster randomized trial. Children in feeding group schools received school snacks of a local plant-based dish, githeri, with meat, milk or extra oil added. The oil used was later found to be fortified with retinol. Physical status, food intake and morbidity outcomes were assessed longitudinally over two years.

Rural Embu District, Kenya, an area with high prevalence of vitamin A deficiency.

Standard 1 schoolchildren (n 902; analytic sample) enrolled in two cohorts from the same schools one year apart.

The Meat and Plain Githeri (i.e. githeri + oil) groups showed the greatest declines in the probability of a morbidity outcome (PMO) for total and severe illnesses, malaria, poor appetite, reduced activity, fever and chills. The Meat group showed significantly greater declines in PMO for gastroenteritis (mainly diarrhoea) and typhoid compared with the Control group, for jaundice compared with the Plain Githeri group, and for skin infection compared with the Milk group. The Milk group showed the greatest decline in PMO for upper respiratory infection. For nearly all morbidity outcomes the Control group had the highest PMO and the least decline over time.

The intervention study showed beneficial effects of both animal-source foods and of vitamin A-fortified oil on morbidity status.

The aim of the study was to determine the association between dietary outcomes and the neighbourhood food environment (street network distance from home to stores) and consumer food environment (Nutrition Environment Measurement Survey-Stores (NEMS-S) audit).

The neighbourhood food environment was captured by creating 0·5-mile and 1-mile network distance (street distance) around each participant's home and the nearest food venue (convenience store, grocery store, supermarket, farmers' market and produce stand). The consumer food environment was captured by conducting NEMS-S in all grocery stores/supermarkets within 0·5 and 1 mile of participants’ homes.

Fayette County, KY, USA.

Supplemental Nutrition Assessment Program (SNAP) participants, n 147.

SNAP participants who lived within 0·5 mile of at least one farmers’ market/produce stand had higher odds of consuming one serving or more of vegetables (OR = 6·92; 95 % CI 4·09, 11·69), five servings or more of grains (OR = 1·76; 95 % CI 1·01, 3·05) and one serving or more of milk (OR = 3·79; 95 % CI 2·14, 6·71) on a daily basis. SNAP participants who lived within 0·5 mile of stores receiving a high score on the NEMS-S audit reported higher odds of consuming at least one serving of vegetables daily (OR = 3·07; 95 % CI 1·78, 5·31).

Taken together, both the neighbourhood food environment and the consumer food environment are associated with a healthy dietary intake among SNAP participants.

To determine the relative validity of a 3 d estimated food record (EFR) used to assess energy and nutrient intakes in toddlers, using a 3 d weighed food record (WDR) as the reference method.

Parents reported the food and beverage intakes of their children using an EFR concurrently with a WDR over three consecutive days. Estimation of mean differences, Spearman correlation coefficients, cross-classifications and Bland–Altman plots were used to assess the agreement between the intakes of energy and fourteen nutrients obtained from the EFR and the WDR.

Data obtained from a representative sample of infants or toddlers in Germany.

Sixty-seven toddlers aged 10–36 months who had completed an EFR for a 3 d recording period that corresponded to the WDR were included in the present analysis.

Energy and nutrient intakes did not differ between the EFR and the WDR, except for linoleic acid and retinol. For all dietary intakes, Spearman rank correlation coefficients between the EFR and the WDR ranged from 0·35 to 0·80 (P ≤ 0·004). The proportion of participants correctly classified into quartiles ranged from 75 % for ascorbic acid intake to 96 % for Fe intake, and the percentage of misclassification was 9 % or less. The weighed κ values ranking the participants ranged from 0·23 for ascorbic acid intake to 0·59 for Fe intake. The Bland–Altman plots indicated a good agreement for all dietary intakes estimated from the EFR.

Our study suggests that this EFR is a valid assessment instrument for estimating the energy and nutrient intakes among toddlers at the group level.

Although most parents know that vegetables are healthful, vegetables are served at only 23 % of American dinners. If added nutrition is not a sufficient motivation, might a parent be more inspired to serve vegetables if doing so improved either the taste of the entrée or how loving and thoughtful the server would be perceived? The present paper details two studies which investigated whether serving vegetables changes the perception of the cook and the perception of an entrée's taste.

In Study 1, people evaluated the personality of a cook who either did or did not include a vegetable in a family dinner. In Study 2, five different meals that either included or did not include a vegetable were rated in terms of the taste of the entrée and of the whole meal.

US-based online survey.

American mothers (n 500), ranging in age from 18 to 65 years (mean age 38·4 years), with at least two children under the age of 18 years living at home.

Serving vegetables improved taste expectations for the entrée as well as for the whole meal. Additionally, serving a vegetable with a meal also enhanced perceptions of the meal preparer. They were evaluated as being more thoughtful and attentive as well as less lazy, boring and self-absorbed.

These two studies show new hedonic and heroic motivations for serving vegetables: (i) they increase the hedonic appeal of the meal and (ii) they increase the heroic appeal of the cook. More vegetables are likely to be served with a meal if preparers know that the addition of vegetables makes them appear to be both a better cook and a better person.

Simulating the probable impact of grain amaranth and highly absorbable, low-Fe micronutrient powder (MNP) on Fe status in a potential target population is an essential step in choosing and developing an appropriate actual intervention.

We simulated the potential effect of fortifying maize porridge with grain amaranth or MNP on the prevalence of inadequate Fe intake and Fe deficiency using data from two cross-sectional surveys. In the first survey (2008), dietary intake data were collected by two 24 h recalls (n 197). Biochemical data (n 70) were collected in the second survey (2010). A simulation with daily consumption for 80 d of non-fortified maize porridge (60 g of maize flour), amaranth-enriched porridge (80 g of grain amaranth–maize flour, 70:30 ratio) or maize porridge fortified with MNP (2·5 mg Fe as NaFeEDTA) was done.

Mwingi District, Kenya.

Pre-school children aged 12–23 months.

Prevalence of anaemia, Fe deficiency and Fe-deficiency anaemia was 49 %, 46 % and 24 %, respectively. Consumption of non-fortified, amaranth-enriched and MNP-fortified maize porridge was estimated to provide a median daily Fe intake of 8·6 mg, 17·5 mg and 11·1 mg, respectively. The prevalence of inadequate Fe intake was reduced to 35 % in the amaranth-enriched porridge group and 45 % in the MNP-fortified porridge group, while ferritin concentration was increased in both (by 1·82 (95 % CI 1·42, 2·34) μg/l and 1·80 (95 % CI 1·40, 2·31) μg/l, respectively; P < 0·005) compared with the non-fortified maize porridge group, resulting in a decreased prevalence of Fe deficiency (27 %) in the two fortification groups.

Addition of grain amaranth or low-Fe MNP to maize-based porridge has potential to improve Fe intake and status in pre-school children.

To examine how different scoring models for a diet quality index influence associations with mortality outcomes.

A study within the Malmö Diet and Cancer cohort. Food and nutrient intakes were estimated using a diet history method. The index included six components: SFA, PUFA, fish and shellfish, fibre, fruit and vegetables, and sucrose. Component scores were assigned using predefined (based on dietary recommendations) and population-based cut-offs (based on median or quintile intakes). Multivariate Cox regression was used to model associations between index scores (low, medium, high) and all-cause and cause-specific mortality by sex.

Malmö, the third largest city in Sweden.

Men (n 6940) and women (n 10 186) aged 44–73 years. During a mean follow-up of 14·2 years, 2450 deaths occurred, 1221 from cancer and 709 from CVD.

The predictive capability of the index for mortality outcomes varied with type of scoring model and by sex. Stronger associations were seen among men using predefined cut-offs. In contrast, the quintile-based scoring model showed greater predictability for mortality outcomes among women. The scoring model using median-based cut-offs showed low predictability for mortality among both men and women.

The scoring model used for dietary indices may have a significant impact on observed associations with disease outcomes. The rationale for selection of scoring model should be included in studies investigating the association between dietary indices and disease. Adherence to the current dietary recommendations was in the present study associated with decreased risk of all-cause and cause-specific mortality, particularly among men.

To examine how the dietary patterns of children at various time points throughout childhood relate to estimated nutrient intakes.

FFQ at 3, 4, 7 and 9 years of age were completed by mothers. Dietary patterns were identified cross-sectionally using principal component analysis; ‘processed’, ‘health conscious’ and ‘traditional’ patterns were consistently obtained. Correlations between pattern scores and nutrient intakes and proportions of variance in nutrients explained by the patterns were calculated.

Avon Longitudinal Study of Parents and Children (ALSPAC), Bristol, UK.

Children provided data between 3 and 9 years of age (n 8010 to 10 023).

Dietary patterns explained substantial proportions of the variance of the absolute intake for most nutrients (>25 % at 3 years of age, >40 % other ages). After energy adjustment, protein, fibre, K, Mg, Fe, Zn, folate, thiamin and vitamin B6 continued to be well explained. Strong correlations were observed between the ‘processed’ pattern and macronutrients including energy (r = 0·481–0·619), total fat (r = 0·529–0·662) and total sugar (r = 0·475–0·693). However correlations with most micronutrients were reversed after energy adjustment, suggesting that the ‘processed’ pattern is energy-dense but nutrient-poor. The ‘health conscious’ and ‘traditional’ patterns were strongly positively correlated with protein, fibre and most micronutrients, whether energy adjusted or not. Higher scores on these patterns were associated with a better nutrient profile.

Dietary patterns explain a reasonable amount of the variation in the nutrient content of diets. Higher scores on the ‘health conscious’ and ‘traditional’ dietary patterns were related to better nutrient profiles; conversely, with higher scores on the ‘processed’ pattern the nutrient profile was poorer.

Nutritional interventions to decrease energy intake, aimed at portion sizes and front-of-package labelling, are effective only if people do not compensate for their reduced energy intake. Since several observational studies indicate that these interventions could prompt compensation behaviour, it is important to assess underlying beliefs. Therefore, the purpose of the two studies reported here was to develop a Diet-related Compensatory Health Beliefs Scale (Diet-CHBS).

Cross-sectional surveys were conducted for the scale development. Study 1 provided data on the factor analysis and convergent validity, while Study 2 assessed the Diet-CHBS’ test–retest reliability.

VU University Amsterdam (Study 1) and twenty-five worksite cafeterias in the Netherlands (Study 2).

Study 1 was conducted among 179 students and their parents; Study 2 was conducted among 119 worksite cafeteria visitors.

The results of Study 1 showed that the scale consisted of the hypothesized factors of compensation beliefs with regard to portion sizes (α = 0·73), front-of-package health logos (α = 0·77) and exercise (α = 0·75). The scale's overall Cronbach's α was 0·82. The Diet-CHBS had a Pearson correlation of 0·32 with a general health compensatory beliefs scale, signifying satisfactory convergent validity. Study 2 showed that the intra-class correlation coefficient between T1 and T2 was 0·69, indicating adequate test–retest reliability.

The Diet-CHBS is a valid and reliable instrument for assessing diet-related compensatory health beliefs in response to nutritional interventions. It is important to take such beliefs into account in further intervention studies aimed at preventing overweight and obesity.

The present study measured the perceived impact and political and implementation feasibility of state-level policy strategies related to increasing access to healthy foods and limiting unhealthy foods.

Potential state-level policy strategies to improve access to healthy foods were identified through a review of evidence-based literature and policy recommendations. Respondents rated the perceived impact and political and implementation feasibility of each policy on a five-point scale using online surveys.

Washington State policy process.

Forty-nine content experts (national researchers and subject experts), forty policy experts (state elected officials or their staff, gubernatorial or legislative policy analysts) and forty-five other stakeholders (state-level advocates, programme administrators, food producers).

In aggregate, respondents rated policy impact and implementation feasibility higher than political feasibility. Policy experts rated policy strategies as less politically feasible compared with content experts (P < 0·02) or other stakeholders (P < 0·001). Eight policy strategies were rated above the median for impact and political and implementation feasibility. These included policies related to nutrition standards in schools and child-care facilities, food distribution systems, urban planning projects, water availability, joint use agreements and breast-feeding supports.

Although they may be perceived as potentially impactful, some policies will be more difficult to enact than others. Information about the potential feasibility of policies to improve access to healthy foods can be used to focus limited policy process resources on strategies with the highest potential for enactment, implementation and impact.

Previous studies showed an inconsistent association of fruit and vegetable consumption with bone health. We assessed the associations in Chinese adolescents, young and postmenopausal women.

A cross-sectional study conducted in China during July 2009 to May 2010.

Bone mineral density (BMD) and content (BMC) at the whole body, lumbar spine and left hip were measured with dual-energy X-ray absorptiometry. Dietary intakes were assessed using an FFQ. All these values were separately standardized into Z-scores in each population subgroup.

One hundred and ten boys and 112 girls (11–14 years), 371 young women (20–34 years, postpartum within 2 weeks) and 333 postmenopausal women (50–70 years).

After adjustment for potential covariates, analysis of covariance showed a significantly positive association between fruit intake and BMD and BMC in all participants combined (P-trend: < 0·001 to 0·002). BMD Z-score increased by 0·25 (or 2·1 % of the mean), 0·22 (3·5 %), 0·23 (3·0 %) and 0·25 (3·5 %), and BMC Z-score increased by 0·33 (5·7 %), 0·25 (5·8 %), 0·34 (5·9 %) and 0·29 (4·7 %), at the total body, lumbar spine, total hip and femoral neck in participants belonging to the top tertile compared with the bottom tertile of fruit intake (all P < 0·05), respectively. There was no significant association between vegetable intake and bone mass at all bone sites studied except for total body BMD (P = 0·030). Relatively more pronounced effects were observed in boys and postmenopausal women.

Our findings add to the existing evidence that fruits and vegetables may have a bone sparing effect.

To assess a county population's exposure to different types of food sources reported to affect both diet quality and obesity rates.

Food permit records obtained from the local health department served to establish the full census of food stores and restaurants. Employing prior categorization schemes which classified the relative healthfulness of food sources based on establishment type (i.e. supermarkets v. convenience stores, or full-service v. fast-food restaurants), food establishments were assigned to the healthy, unhealthy or undetermined groups.

King County, WA, USA.

Full census of food sources.

According to all categorization schemes, most food establishments in King County fell into the unhealthy and undetermined groups. Use of the food permit data showed that large stores, which included supermarkets as healthy food establishments, contained a sizeable number of bakery/delis, fish/meat, ethnic and standard quick-service restaurants and coffee shops, all food sources that, when housed in a separate venue or owned by a different business establishment, were classified as either unhealthy or of undetermined value to health.

To fully assess the potential health effects of exposure to the extant food environment, future research would need to establish the health value of foods in many such common establishments as individually owned grocery stores and ethnic food stores and restaurants. Within-venue exposure to foods should also be investigated.

Pattern analysis of adolescent diets may provide an important basis for nutritional health promotion. The aims of the present study were to examine and compare dietary patterns in adolescents using cluster analysis and principal component analysis (PCA) and to examine the impact of the format of the dietary variables on the solutions.

Analysis was based on the Irish National Teens Food Survey, in which food intake data were collected using a semi-quantitative 7 d food diary. Thirty-two food groups were created and were expressed as either g/d or percentage contribution to total energy. Dietary patterns were identified using cluster analysis (k-means) and PCA.

Republic of Ireland, 2005–2006.

A representative sample of 441 adolescents aged 13–17 years.

Five clusters based on percentage contribution to total energy were identified, ‘Healthy’, ‘Unhealthy’, ‘Rice/Pasta dishes’, ‘Sandwich’ and ‘Breakfast cereal & Main meal-type foods’. Four principal components based on g/d were identified which explained 28 % of total variance: ‘Healthy foods’, ‘Traditional foods’, ‘Sandwich foods’ and ‘Unhealthy foods’.

A ‘Sandwich’ and an ‘Unhealthy’ pattern are the main dietary patterns in this sample. Patterns derived from either cluster analysis or PCA were comparable, although it appears that cluster analysis also identifies dietary patterns not identified through PCA, such as a ‘Breakfast cereal & Main meal-type foods’ pattern. Consideration of the format of the dietary variable is important as it can directly impact on the patterns obtained for both cluster analysis and PCA.

FFQ are popular instruments for assessing dietary intakes in epidemiological studies but have not been validated for use in severely obese pregnancy. The aim of the present study was to compare nutrient intakes assessed by an FFQ with those obtained from a food diary among severely obese pregnant women.

Comparison of an FFQ containing 170 food items and a food diary for 4 d (three weekdays and one weekend day); absolute agreement was assessed using the paired t test and relative agreement by Pearson/Spearman correlation, cross-classification into tertiles and weighted kappa values.

Antenatal metabolic clinic for severely obese women.

Thirty-one severely obese (BMI at booking ≥40·0 kg/m2) and thirty-two lean control (BMI = 20·0–24·9 kg/m2) pregnant women.

The findings showed that nutrient intakes estimated by the FFQ were significantly higher than those from the food diary; average correlation was 0·32 in obese and 0·43 in lean women. A mean of 48·5 % of obese and 47·3 % of lean women were correctly classified, while 12·9 % (obese) and 10·0 % (lean) were grossly misclassified. Weighted κ values ranged from −0·04 to 0·79 in obese women and from 0·16 to 0·78 in lean women.

Overall, the relative agreement between the FFQ and food diary was lower in the obese group than in the lean group, but was comparable with earlier studies conducted in pregnant women. The validity assessments suggest that the FFQ is a useful tool for ranking severely obese pregnant women according to the levels of their dietary intake.

The present study aimed to (i) describe the availability of nutrition information in major chain restaurants, (ii) document the energy and nutrient levels of menu items, (iii) evaluate relationships with restaurant characteristics, menu labelling and trans fat laws, and nutrition information accessibility, and (iv) compare energy and nutrient levels against industry-sponsored and government-issued nutrition criteria.

Descriptive statistics and multivariate regression analysis of the energy, total fat, saturated fat, trans fat, sodium, carbohydrate and protein levels of 28 433 regular and 1833 children's menu items.

Energy and nutrition information provided on restaurant websites or upon request, and secondary databases on restaurant characteristics.

The top 400 US chain restaurants by sales, based on the 2009 list of the Restaurants & Institutions magazine.

Complete nutrition information was reported for 245 (61 %) restaurants. Appetizers had more energy, fat and sodium than all other item types. Children's menu specialty beverages had more fat, saturated fat and carbohydrates than comparable regular menu beverages. The majority of main entrées fell below one-third of the US Department of Agriculture's estimated daily energy needs, but as few as 3 % were also within limits for sodium, fat and saturated fat. Main entrées had significantly more energy, fat and saturated fat in family-style restaurants than in fast-food restaurants. Restaurants that made nutrition information easily accessible on websites had significantly lower energy, fat and sodium contents across menu offerings than those providing information only upon request.

The paper provides a comprehensive view of chain restaurant menu nutrition prior to nationwide labelling laws. It offers baseline data to evaluate how restaurants respond after laws are implemented.

The present study aimed to evaluate the relationship between the consumption of selected food groups and insulin resistance, with an emphasis on sugar-sweetened beverages (SSB).

The present research is a large multicentre European study in adolescents, the HELENA-CSS (Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study).

Homeostasis model assessment–insulin resistance index (HOMA-IR) was calculated. Several anthropometric and lifestyle characteristics were recorded. Dietary assessment was conducted by using a short FFQ.

The participants were a subset of the original sample (n 546) with complete data on glucose, insulin and FFQ. All participants were recruited at schools.

Median (25th, 75th percentile) HOMA-IR was 0·62 (0·44, 0·87). Mean HOMA-IR was significantly higher among adolescents consuming brown bread ≤1 time/week than among those consuming 2–6 times/week (P = 0·011). Mean values of HOMA-IR were also higher in adolescents consuming SSB >5 times/week compared with those consuming less frequently, although a statistically significant difference was detected between those consuming SSB 5–6 times/week and 2–4 times/week (P = 0·049). Multiple linear regression analysis showed that only the frequency of SSB consumption was significantly associated with HOMA-IR after controlling for potential confounders. In particular, it was found that HOMA-IR levels were higher among adolescents consuming SSB 5–6 times/week and ≥1 time/d compared with those consuming ≤1 time/week by 0·281 and 0·191 units, respectively (P = 0·009 and 0·046, respectively).

The present study revealed that daily consumption of SSB was related with increased HOMA-IR in adolescents.

Childhood obesity is a growing problem in the USA. As parents play a major role in shaping a child's diet, the present study examines food advertisements (ads) directed towards parents in parenting and family magazines.

Given the potential for magazines to influence attitudes and knowledge, we used content analysis to examine the food ads appearing in four issues each of six different parenting and family magazines from 2008 (n 24).

USA.

Food ads in parenting and family magazines.

We identified 476 food ads, which represented approximately 32 % of all ads in the magazine sample. Snack foods (13 %) were the most frequently observed food ads, followed by dairy products (7 %). The most frequently used sales theme was ‘taste’ (55 %). Some ads promoted foods as ‘healthy’ (14 %) and some made specific health claims (18 %), such as asserting the product would help lower cholesterol. In addition to taste and health and nutrition appeals, we found several themes used in ad messages to promote products, including the following: ‘convenience’, ‘economical’, ‘fun’ and ‘helping families spend time together’. We also found that over half (n 405, 55·9 %) of products (n 725) advertised were products of poor nutritional quality based on total fat, saturated fat, sodium, protein, sugar and fibre contents, and that ads for such products were slightly more likely to use certain sales themes like ‘fun’ (P = 0·04) and ‘no guilt’ (P = 0·03).

Interventions should be developed to help parents understand nutritional information seen in food ads and to learn how various foods contribute to providing a balanced family diet.