To investigate whether high doses of folic acid supplementation in early pregnancy are associated with child neurodevelopment at 18 months of age.

The study uses data from the prospective mother–child cohort ‘Rhea’ study. Pregnant women completed an interviewer-administered questionnaire on folic acid supplementation at 14–18 weeks of gestation. Neurodevelopment at 18 months was assessed with the use of the Bayley Scales of Infant and Toddler Development (3rd edition). Red-blood-cell folate concentrations in cord blood were measured in a sub-sample of the study population (n 58).

Heraklion, Crete, Greece, 2007–2010.

Five hundred and fifty-three mother–child pairs participating in the ‘Rhea’ cohort.

Sixty-eight per cent of the study participants reported high doses of supplemental folic acid use (5 mg/d), while 24 % reported excessive doses of folic acid (>5 mg/d) in early pregnancy. Compared with non-users, daily intake of 5 mg supplemental folic acid was associated with a 5-unit increase on the scale of receptive communication and a 3·5-unit increase on the scale of expressive communication. Doses of folic acid supplementation higher than 5 mg/d were not associated with additional increase in the neurodevelopmental scales.

This is the first prospective study showing that high doses of supplementary folic acid in early pregnancy may be associated with enhanced vocabulary development, communicational skills and verbal comprehension at 18 months of age. Additional longitudinal studies and trials are needed to confirm these results.

To describe ready-to-eat (RTE) cereal purchases in 2008 in the USA according to cereal nutritional quality and marketing strategy and household sociodemographic characteristics.

Cross-sectional study of purchases in one year. Each type of cereal was assigned to one of four nutrition quality categories (based on Nutrient Profile Index, NPI) and one of four advertising categories based on television exposure and analysis of packaging (child-targeted, family-targeted, adult-targeted and no television advertising). Medians and distributions of purchase indicators were calculated for the cereal categories and the distributions were compared across sociodemographic groups.

RTE cereals (n 249) with complete label and nutritional content.

RTE cereal purchases according to household sociodemographic characteristics obtained from Nielsen Homescan, a nationally representative panel of households.

Purchases of RTE cereals were highest in households with one or more child and lowest in African-American and Asian households, as well as those earning <$US 30 000 per annum. The lowest-quality products were purchased by four times as many households as the highest-quality cereals, but loyalty to these products was lower. Purchases of cereals by households with children and in African-American and Hispanic households increased as cereal nutritional quality declined. Compared with non-advertised products, advertised child-targeted cereals were purchased thirteen times more frequently; family-targeted brand purchases were ten times higher; and adult-targeted cereals were purchased four times more frequently.

Our findings suggest that improving the nutritional quality of RTE cereals with advertising targeted to children could also lead to increased consumption of healthier products by young people.

To determine the distribution and sociodemographic associations of BMI (kg/m2) among adults aged ≥40 years living in Timor-Leste.

BMI was calculated for participants of a population-based cross-sectional survey.

Urban and rural Timor-Leste.

Adults aged ≥40 years living in Timor-Leste.

Of those enumerated, 2014 participated (89·5 %). Male gender, rural domicile, older age, illiteracy and source of household income were associated with BMI < 18·5 kg/m2 on multivariate analysis. Female gender, urban domicile and literacy were associated with BMI ≥25·0 and ≥30·0 kg/m2. Adjusting for gender, age and domicile, and extrapolating to those aged ≥40 years across Timor-Leste, 9·9 %, 36·0 %, 6·6 % and 0·8 % had BMI <16·0, <18·5, ≥25·0 and ≥30·0 kg/m2, respectively.

At this time, being ‘underweight’ or ‘severely thin’ is more prevalent in the Timorese adult population than being ‘overweight’ or ‘obese’.

To signal key issues for harmonising approaches for establishing micronutrient recommendations by explaining observed variation in recommended intakes of folate, vitamin B12, Fe and Zn for adults and elderly people.

We explored differences in recommended intakes of folate, vitamin B12, Fe and Zn for adults between nine reports on micronutrient recommendations. Approaches used for setting recommendations were compared as well as eminence-based decisions regarding the selection of health indicators indicating adequacy of intakes and the consulted evidence base.

In nearly all reports, recommendations were based on the average nutrient requirement. Variation in recommended folate intakes (200–400 μg/d) was related to differences in the consulted evidence base, whereas variation in vitamin B12 recommendations (1·4–3·0 μg/d) was due to the selection of different CV (10–20 %) and health indicators (maintenance of haematological status or basal losses). Variation in recommended Fe intakes (men 8–10 mg/d, premenopausal women 14·8–19·6 mg/d, postmenopausal women 7·5–10·0 mg/d) was explained by different assumed reference weights and bioavailability factors (10–18 %). Variation in Zn recommendations (men 7–14 mg/d, women 4·9–9·0 mg/d) was also explained by different bioavailability factors (24–48 %) as well as differences in the consulted evidence base.

For the harmonisation of approaches for setting recommended intakes of folate, vitamin B12, Fe and Zn across European countries, standardised methods are needed to (i) select health indicators and define adequate biomarker concentrations, (ii) make assumptions about inter-individual variation in requirements, (iii) derive bioavailability factors and (iv) collate, select, interpret and integrate evidence on requirements.

To quantify the prevalence and trends of stunting among children using the WHO growth standards.

Five hundred and seventy-six nationally representative surveys, including anthropometric data, were analysed. Stunting was defined as the proportion of children below −2sd from the WHO length- or height-for-age standards median. Linear mixed-effects modelling was used to estimate rates and numbers of affected children from 1990 to 2010, and projections to 2020.

One hundred and forty-eight developed and developing countries.

Boys and girls from birth to 60 months.

In 2010, it is estimated that 171 million children (167 million in developing countries) were stunted. Globally, childhood stunting decreased from 39·7 (95 % CI 38·1, 41·4) % in 1990 to 26·7 (95 % CI 24·8, 28·7) % in 2010. This trend is expected to reach 21·8 (95 % CI 19·8, 23·8) %, or 142 million, in 2020. While in Africa stunting has stagnated since 1990 at about 40 % and little improvement is anticipated, Asia showed a dramatic decrease from 49 % in 1990 to 28 % in 2010, nearly halving the number of stunted children from 190 million to 100 million. It is anticipated that this trend will continue and that in 2020 Asia and Africa will have similar numbers of stunted children (68 million and 64 million, respectively). Rates are much lower (14 % or 7 million in 2010) in Latin America.

Despite an overall decrease in developing countries, stunting remains a major public health problem in many of them. The data summarize progress achieved in the last two decades and help identify regions needing effective interventions.

Transnational food, beverage and restaurant companies, and their corporate foundations, may be potential collaborators to help address complex public health nutrition challenges. While UN system guidelines are available for private-sector engagement, non-governmental organizations (NGO) have limited guidelines to navigate diverse opportunities and challenges presented by partnering with these companies through public–private partnerships (PPP) to address the global double burden of malnutrition.

We conducted a search of electronic databases, UN system websites and grey literature to identify resources about partnerships used to address the global double burden of malnutrition. A narrative summary provides a synthesis of the interdisciplinary literature identified.

We describe partnership opportunities, benefits and challenges; and tools and approaches to help NGO engage with the private sector to address global public health nutrition challenges. PPP benefits include: raising the visibility of nutrition and health on policy agendas; mobilizing funds and advocating for research; strengthening food-system processes and delivery systems; facilitating technology transfer; and expanding access to medications, vaccines, healthy food and beverage products, and nutrition assistance during humanitarian crises. PPP challenges include: balancing private commercial interests with public health interests; managing conflicts of interest; ensuring that co-branded activities support healthy products and healthy eating environments; complying with ethical codes of conduct; assessing partnership compatibility; and evaluating partnership outcomes.

NGO should adopt a systematic and transparent approach using available tools and processes to maximize benefits and minimize risks of partnering with transnational food, beverage and restaurant companies to effectively target the global double burden of malnutrition.

To determine the effect of intention to breast-feed on short-term breast-feeding outcomes in women delivering term and preterm infants.

Data from the US Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System (PRAMS) for three states, Ohio, Michigan and Arkansas, during 2000–2003 were analysed. SAS 9·1·3 and SUDAAN 10 statistical software packages were used for analyses.

Arkansas, Michigan and Ohio, USA.

Mothers of recently delivered infants, selected by birth certificate sampling.

Of 16 839 mothers included, 9·7 % delivered preterm. Some 52·2 % expressed definite intention to breast-feed, 16·8 % expressed tentative intention, 4·3 % were uncertain and 26·8 % had no intention to breast-feed. Overall 65·2 % initiated breast-feeding, 52·0 % breast-fed for ≥4 weeks and 30·8 % breast-fed for ≥10 weeks. Women with definite intention were more likely to initiate (OR = 24·3, 95 % CI 18·4, 32·1), to breast-feed for ≥4 weeks (OR = 7·12, 95 % CI 5·95, 8·51) and to breast-feed for ≥10 weeks (OR = 2·75, 95 % CI 2·20, 3·45) compared with women with tentative intention. Levels of intention did not differ between women delivering preterm and term. Women delivering at <34 weeks were more likely to initiate breast-feeding (OR = 2·24, 95 % CI 1·64, 3·06) and to breast-feed for ≥4 weeks (OR = 2·58, 95 % CI 1·96, 3·41), but less likely to breast-feed for ≥10 weeks (OR = 0·55, 95 % CI 0·44, 0·68), compared with those delivering at term. Women delivering between 34 and 36 weeks were less likely to breast-feed for ≥10 weeks than those delivering at term (OR = 0·63, 95 % CI 0·49, 0·81).

Prenatal intention to breast-feed is a powerful predictor of short-term breast-feeding outcomes in women delivering both at term and prematurely.

The purpose of the present study was to evaluate the effects of a school-based, 2-year, multi-component intervention on BMI, eating and physical activity behaviour in Flanders, Belgium, targeting children aged 3–6 years in communities of high and low socio-economic status (SES).

Cluster-randomized controlled trial.

Thirty-one pre-primary and primary schools in three different intervention communities and three paired-matched (on SES profile) control communities in Flanders, Belgium.

BMI Z-scores at baseline and follow-up were calculated for 1102 children. Questionnaires with sociodemographic data and FFQ were available from 694 of these 1102 children.

No significant effects were found on BMI Z-scores for the total sample. However, there was a significant decrease in BMI Z-score of 0·11 in the low-SES intervention community compared with the low-SES control community, where the BMI Z-score increased by 0·04 (F = 6·26, P = 0·01). No significant intervention effects could be found for eating behaviour, physical activity or screen-time. There were no significant interaction effects of age and gender of the children on the outcome variables.

Although no significant effects were found for BMI Z-scores in the total sample, this intervention had a promising effect in the low-SES community of reducing excess weight gain among young children.

Nutrition has long been considered one of the most important environmental factors affecting human intelligence. Although carbohydrates are the most widely studied nutrient for their possible effects on cognition, limited data are available linking usual refined carbohydrate intake and intelligence. The present study was conducted to examine the relationship between long-term refined carbohydrate intake and non-verbal intelligence among schoolchildren.

Cross-sectional study.

Tehran, Iran.

In this cross-sectional study, 245 students aged 6–7 years were selected from 129 elementary schools in two western regions of Tehran. Anthropometric measurements were carried out. Non-verbal intelligence and refined carbohydrate consumption were determined using Raven's Standard Progressive Matrices test and a modified sixty-seven-item FFQ, respectively. Data about potential confounding variables were collected. Linear regression analysis was applied to examine the relationship between non-verbal intelligence scores and refined carbohydrate consumption.

Individuals in top tertile of refined carbohydrate intake had lower mean non-verbal intelligence scores in the crude model (P < 0·038). This association remained significant after controlling for age, gender, birth date, birth order and breast-feeding pattern (P = 0·045). However, further adjustments for mother's age, mother's education, father's education, parental occupation and BMI made the association statistically non-significant. We found a significant inverse association between refined carbohydrate consumption and non-verbal intelligence scores in regression models (β = −11·359, P < 0·001). This relationship remained significant in multivariate analysis after controlling for potential confounders (β = −8·495, P = 0·038).

The study provides evidence indicating an inverse relationship between refined carbohydrate consumption and non-verbal intelligence among Tehrani children aged 6–7 years. Prospective studies are needed to confirm our findings.

To review the epidemiological evidence for vegetarian diets, low-meat dietary patterns and their association with health status in adults.

Published literature review focusing primarily on prospective studies and meta-analyses examining the association between vegetarian diets and health outcomes.

Both vegetarian diets and prudent diets allowing small amounts of red meat are associated with reduced risk of diseases, particularly CHD and type 2 diabetes. There is limited evidence of an association between vegetarian diets and cancer prevention. Evidence linking red meat intake, particularly processed meat, and increased risk of CHD, cancer and type 2 diabetes is convincing and provides indirect support for consumption of a plant-based diet.

The health benefits of vegetarian diets are not unique. Prudent plant-based dietary patterns which also allow small intakes of red meat, fish and dairy products have demonstrated significant improvements in health status as well. At this time an optimal dietary intake for health status is unknown. Plant-based diets contain a host of food and nutrients known to have independent health benefits. While vegetarian diets have not shown any adverse effects on health, restrictive and monotonous vegetarian diets may result in nutrient deficiencies with deleterious effects on health. For this reason, appropriate advice is important to ensure a vegetarian diet is nutritionally adequate especially for vulnerable groups.

To assess the vitamin D status of 9–12-year-old primary-school children in Tehran during autumn and winter 2007–2008.

A descriptive cross-sectional study.

Primary schools of Tehran city, Iran.

A total of 1111 children aged 9–12 years (573 boys and 538 girls) from sixty primary schools were enrolled in the study. Weight, height, BMI and serum levels of Ca, P, Mg, 25-hydroxyvitamin D (25(OH)D), intact parathyroid hormone (iPTH), osteocalcin and bone-specific alkaline phosphatase of all the participants were assessed. Dietary Ca intake was also evaluated using a quantitative FFQ for a subsample of the study population (n 503). Vitamin D sufficiency was defined on the basis of serum levels of 25(OH)D as either ≥37 nmol/l (criterion 1) or ≥50 nmol/l (criterion 2).

Daily intake of Ca did not differ significantly between boys and girls (929·6 (sd 436·7) mg and 909·5 (sd 465·5) mg, respectively). However, on the basis of the first criterion, approximately 86 % of the children had vitamin D deficiency, with 38·3 % being severely deficient (25(OH)D < 12·5 nmol/l). According to the second criterion, prevalence of vitamin D deficiency rose to 91·7 %. Prevalence of vitamin D deficiency was higher in girls than in boys by either criterion. Serum levels of 25(OH)D inversely correlated with iPTH (r = −0·154, P < 0·001) and BMI (r = −0·092, P = 0·002) but directly correlated with duration of sun exposure (r = 0·115, P < 0·001).

The high prevalence of vitamin D deficiency among schoolchildren (especially among girls) warrants immediate interventions for proper nutritional support.

Perceptions that fruit and vegetables are expensive have been found to be associated with lower consumption of fruit and vegetables among disadvantaged women; however, the determinants of these perceptions are relatively unknown. The purpose of the current paper is to examine whether perceived availability and quality of fruit and vegetables, and social support for healthy eating, are associated with perceptions of fruit and vegetable affordability among women residing in disadvantaged neighbourhoods.

Cross-sectional self-report survey.

The study was conducted in Melbourne, Australia.

An Australian sample of 4131 women, aged 18–45 years, residing in neighbourhoods ranked in the lowest Victorian tertile of relative disadvantage by the Australian Bureau of Statistics, an index that considers aspects of disadvantage such as residents’ income, education, motor vehicle access and employment.

Results showed that irrespective of education, income and other key covariates, women who perceived poor availability and quality of fruit and vegetables in their local neighbourhood were more likely to perceive fruit and vegetables as expensive.

Our results suggest that perceptions of fruit and vegetable affordability are not driven exclusively by lack of financial or knowledge-related resources, but also by women's psychological response and interpretation of their local nutrition environment.

The study evaluated the association between consumption frequencies of the major food categories and the risk of new depression four years later in older Taiwanese.

A prospective cohort study with multistage random sampling. Logistic regression analysis evaluated the significance of the longitudinal associations of intake frequencies of the major food categories with future (4 years later) risk of new depression, controlled for possible confounding factors with or without adjustment for cognitive status.

Population-based free-living elderly.

Men and women (n 1609) ≥65 years of age.

In a regression model that controlled for demographic, socio-economic, lifestyle and disease/health-related variables but not cognitive status, both fruits (OR = 0·66, 95 % CI 0·45, 0·98, P = 0·038) and vegetables (OR = 0·38, 95 % CI 0·17, 0·86, P = 0·021) were protective against depressive symptoms 4 years later. However, when the same regression model was also adjusted for cognitive status, only vegetables (OR = 0·40, 95 % CI 0·17, 0·95, P = 0·039) were protective against depressive symptoms. Higher consumption of eggs was close to being significant in both regression models (P = 0·087 and 0·069, respectively). Other food categories including meat/poultry, fish, seafood, dairy, legumes, grains and tea showed no significant associations.

Results suggest that although confounding factors cannot be totally ruled out, more frequent consumption of vegetables seems to be protective against depressive symptoms in the elderly. Further studies are needed to elucidate the causal role and the mechanism of the association.

To describe the vitamin D status of Belgian children and examine the influence of non-nutritional determinants, in particular of anthropometric variables.

Cross-sectional data of Belgian participants of the EU 6th Framework Programme IDEFICS (Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants) Study.

25-Hydroxyvitamin D (25(OH)D) was measured using RIA. Vitamin D status was categorized as deficient (<25 nmol/l), insufficient (25–50 nmol/l), sufficient (50–75 nmol/l) and optimal (≥75 nmol/l). Anthropometric measurements included height, weight, waist and hip circumferences and triceps and subscapular skinfold thicknesses.

Children (n 357) aged 4–11 years.

Serum 25(OH)D ranged from 13·6 to 123·5 nmol/l (mean 47·2 (sd 14·6) nmol/l); with 5 % deficient, 53 % insufficient, 40 % sufficient and 2 % optimal. No significant differences were found by age and gender. Significant differences in 25(OH)D were observed for month of sampling (P < 0·001), number of hours playing outside per week (r = 0·140), weight (r = −0·121), triceps (r = −0·112) and subscapular (r = −0·119) skinfold thickness, sum of two skinfold thicknesses (r = −0·125) and waist circumference (r = −0·108). Linear regression analysis of 25(OH)D adjusted for age, month of sampling and hours playing outside per week suggested that (i) weight, (ii) BMI Z-score, (iii) waist circumference and (iv) triceps and subscapular skinfold thickness (as well as the sum of both) independently influenced 25(OH)D.

The majority of Belgian children had a suboptimal vitamin D status, with more than half having an insufficient status in winter and spring. Month of the year, weekly number of hours playing outside and body composition – both central and abdominal obesity – were identified as important determinants of vitamin D status in Belgian children.

To review the prevalence, severity and determinants of anaemia among women in West and Central Africa (WCA) and raise awareness among policy makers and programme planners in the region.

Systematic descriptive review of data in the public domain of the ORC Macro MEASURE Demographic and Health Surveys, national nutrition surveys, oral and technical communications at regional meetings, studies published in scientific journals, and WHO and UNICEF databases.

West and Central Africa region.

Women of childbearing age.

The prevalence of anaemia among pregnant and non-pregnant women is higher than 50 % and 40 %, respectively, in all countries. Within countries, this prevalence varies by living setting (rural v. urban), women's age and education. Across countries, socio-economic and climatic differences have no apparent association with the prevalence of anaemia among women. Several factors contribute either alone or jointly to the high rates of maternal anaemia in this region. These include widespread nutritional deficiencies; high incidence of infectious diseases; low access to and poor quality of health services; low literacy rates; ineffective design, implementation and evaluation of anaemia control programmes; and poverty.

Addressing the multiple causes and minimizing the consequences of anaemia on maternal and child health and development in WCA require integrated multifactorial and multisectoral strategies. This also calls for unprecedented, historical and stronger political will and commitment that put adolescent girls and maternal health at the centre of the development agenda.

To examine whether the German food industry directs commercials for unhealthy products to children and whether self-administered voluntary restrictions on the promotion of less healthy foods (the EU Pledge) are effective to mitigate this exposure.

By analysing German data from television (TV) channels, advertised products were categorized and food products classified as core foods (healthy) and non-core foods (less healthy). Marketing techniques were documented. Food commercials were furthermore compared with commercials for toy products, and comparisons were made between advertising patterns before and after the EU Pledge.

Data for ten German TV channels were recorded for two weekdays and two weekend days from 06.00 to 22.00 hours in 2007 and 2008. A second sample containing one weekday and one weekend day of three German TV channels was recorded again in 2010 for comparison in the same time period.

In total 16 062 advertisements from 2007–2008 and 2657 from 2010 were analysed.

In 2007–2008 19·9 % of TV commercials were for food products, of which 73 % were for non-core foods, 21 % for core foods and 6 % not classified. In three specified channels widely viewed by children and youth, 14·5 % of commercials were for food products, of which 88·2 % were for non-core foods. Commercials for unhealthy foods were broadcast significantly more often during children's peak viewing and in children's programmes, with a higher use of promotional characters and premiums than found in commercials for non-food products. In 2010, analysis of the three specified channels found that 18·5 % of commercials were for food products, of which 98·2 % were for non-core foods. While the use of premiums decreased compared with other commercials, the use of promotional characters in non-core food commercials increased, especially during children's programmes.

Children in Germany are exposed to large numbers of food commercials. The exposure to commercials for non-core foods and the use of techniques attractive to children are widespread and appear to have remained unaffected by the announcement of the EU Pledge in December 2007. We conclude that the industry's voluntary agreement has failed to fulfil its declared purpose.

The serious consequences of obesity and eating disorders (ED), difficulties encountered in treatment and the high prevalence of these conditions are important reasons to develop efforts aimed at their prevention. The implementation of integrated interventions aimed at preventing risk factors for both obesity and ED constitutes a very exciting development. In the present paper we discuss and review the main reasons for an integrated approach to the spectrum of eating- and weight-related problems, which include anorexia nervosa, bulimia nervosa, anorexic and bulimic behaviours, unhealthy dieting practices, body dissatisfaction, binge-eating disorder, overweight and obesity. Given differences between the fields with regard to current perspectives and objectives, key barriers to an integrated approach to prevention are discussed. In order to show the possibilities of development of this approach, we review the main contributions made to date in the fields of both obesity and ED prevention. In particular, environmental approaches in the prevention of obesity and ED are reviewed, given their potential for preventing a broad spectrum of eating- and weight-related problems. Furthermore, several examples of initiatives that have utilized an integrated approach to prevention are discussed.

Narrative review.

We recommend a scenario in which the two fields share knowledge to enhance the difficult work of preventing and treating both ED and obesity.

The potential effects of four interventions to improve iodine intakes of six New Zealand population groups are assessed.

A model was developed to estimate iodine intake when (i) bread is manufactured with or without iodized salt, (ii) recommended foods are consumed to augment iodine intake, (iii) iodine supplementation as recommended for pregnant women is taken and (iv) the level of iodization for use in bread manufacture is doubled from 25–65 mg to 100 mg iodine/kg salt.

New Zealanders have low and decreasing iodine intakes and low iodine status. Predictive modelling is a useful tool to assess the likely impact, and potential risk, of nutrition interventions.

Food consumption information was sourced from 24 h diet recall records for 4576 New Zealanders aged over 5 years.

Most consumers (73–100 %) are predicted to achieve an adequate iodine intake when salt iodized at 25–65 mg iodine/kg salt is used in bread manufacture, except in pregnant females of whom 37 % are likely to meet the estimated average requirement. Current dietary advice to achieve estimated average requirements is challenging for some consumers. Pregnant women are predicted to achieve adequate but not excessive iodine intakes when 150 μg of supplemental iodine is taken daily, assuming iodized salt in bread.

The manufacture of bread with iodized salt and supplemental iodine for pregnant women are predicted to be effective interventions to lift iodine intakes in New Zealand. Current estimations of iodine intake will be improved with information on discretionary salt and supplemental iodine usage.