In response to The New Nutrition Science Project's Giessen Declaration, we provide here a case for a more fully described and integrated ‘social’ dimension within the nutrition sciences.

This paper explores what we mean when we argue for socially engaged nutrition sciences (SENS), and describes the disciplinary fields, epistemologies and methodologies that contribute to SENS’ potential rich diversity and value. Additionally, the current positioning of ‘social nutrition’ research within the nutrition sciences is critiqued.

There is fairly broad acceptance of the ‘social’ as an important contributor to successful public health nutrition situation analyses, intervention planning and implementation. However, we assert that the ‘social’ is not merely a contributor, the usual position, but is central. Implications for policy and practice that could follow from this shift in approach are outlined.

We call for researchers, educators, policy makers and practitioners alike to re-imagine the role and purpose of social science enquiry that could enable the delivery of more socially engaged nutrition sciences.

To build a life table and determine the factors related to the time of treatment of undernourished children at a nutrition rehabilitation centre (CREN), São Paulo, Brazil.

Nutritional status was assessed from weight-for-age, height-for-age and BMI-for-age Z-scores, while neuropsychomotor development was classified according to the milestones of childhood development. Life tables, Kaplan–Meier survival curves and Cox multiple regression models were employed in data analysis.

CREN (Centre of Nutritional Recovery and Education), São Paulo, Brazil.

Undernourished children (n 228) from the southern slums of São Paulo who had received treatment at CREN under a day-hospital regime between the years 1994 and 2009.

The Kaplan–Meier curves of survival analysis showed statistically significant differences in the periods of treatment at CREN between children presenting different degrees of neuropsychomotor development (log-rank = 6·621; P = 0·037). Estimates based on the multivariate Cox model revealed that children aged ≥24 months at the time of admission exhibited a lower probability of nutritional rehabilitation (hazard ratio (HR) = 0·49; P = 0·046) at the end of the period compared with infants aged up 12 months. Children presenting slow development were better rehabilitated in comparison with those exhibiting adequate evolution (HR = 4·48; P = 0·023). No significant effects of sex, degree of undernutrition or birth weight on the probability of nutritional rehabilitation were found.

Age and neuropsychomotor developmental status at the time of admission to CREN are critical factors in determining the duration of treatment.

Traditional food systems in indigenous groups have historically had health-promoting benefits. The objectives of the present study were to determine if a traditional dietary pattern of Pacific Northwest Tribal Nations (PNwT) could be derived using reduced rank regression and if the pattern would be associated with lower BMI and current Dietary Reference Intakes.

The baseline data from the Communities Advancing the Studies of Tribal Nations Across the Lifespan (CoASTAL) cohort were used to derive dietary patterns for the total sample and those with plausibly reported energy intakes.

Pacific Northwest Coast of Washington State, USA.

Adult PNwT members of the CoASTAL cohort with laboratory-measured weight and height and up to 4 d of dietary records (n 418).

A traditional dietary pattern did not evolve from the analysis. Moderate consumption of a sweet drinks dietary pattern was associated with lower BMI while higher consumption of a vegetarian-based dietary pattern was associated with higher BMI. The highest consumers of the vegetarian-based dietary pattern were almost six times more likely to meet the recommendations for dietary fibre.

Distinct dietary patterns were found. Further exploration is needed to confirm whether the lack of finding a traditional pattern is due to methodology or the loss of a traditional dietary pattern among this population. Longitudinal assessment of the CoASTAL cohort's dietary patterns needs to continue.

The purpose of the study was to examine geographic relationships of nutritional status (BMI), including underweight, overweight and obesity, among Kenyan mothers and children.

Spatial relationships were examined concerning BMI of the mothers and BMI-for-age percentiles of their children. These included spatial statistical measures of the clustering of segments of the population, in addition to inspection of co-location of significant clusters.

Rural and urban areas of Kenya, including the cities of Nairobi and Mombasa, and the Kisumu region.

Mother–child pairs from Demographic and Health Survey data including 1541 observations in 2003 and 1592 observations in 2009. These mother–child pairs were organized into 399 locational clusters.

There is extremely strong evidence that high BMI values exhibit strong spatial clustering. There were co-locations of overweight mothers and overweight children only in the Nairobi region, while both underweight mothers and children tended to cluster in rural areas. In Mombasa clusters of overweight mothers were associated with normal-weight children, while in the Kisumu region clusters of overweight children were associated with normal-weight mothers.

These findings show there is geographic variability as well as some defined patterns concerning the distribution of malnutrition among mothers and children in Kenya, and suggest the need for further geographic analyses concerning the potential factors which influence nutritional status in this population. In addition, the methods used in this research may be easily applied to other Demographic and Health Survey data in order to begin to understand the geographic determinants of health in low-income countries.

To examine the availability of nutritional support services in HIV care and treatment sites across sub-Saharan Africa.

In 2008, we conducted a cross-sectional survey of sites providing antiretroviral therapy (ART) in nine sub-Saharan African countries. Outcomes included availability of: (i) nutritional counselling; (ii) micronutrient supplementation; (iii) treatment for severe malnutrition; and (iv) food rations. Associations with health system indicators were explored using bivariate and multivariate methods.

President's Emergency Plan for AIDS Relief-supported HIV treatment and care sites across nine sub-Saharan African countries.

A total of 336 HIV care and treatment sites, serving 467 175 enrolled patients.

Of the sites under study, 303 (90 %) offered some form of nutritional support service. Nutritional counselling, micronutrient supplementation, treatment for severe acute malnutrition and food rations were available at 98 %, 64 %, 36 % and 31 % of sites, respectively. In multivariate analysis, secondary or tertiary care sites were more likely to offer nutritional counselling (adjusted OR (AOR): 2·2, 95 % CI 1·1, 4·5). Rural sites (AOR: 2·3, 95 % CI 1·4, 3·8) had increased odds of micronutrient supplementation availability. Sites providing ART for >2 years had higher odds of availability of treatment for severe malnutrition (AOR: 2·4, 95 % CI 1·4, 4·1). Sites providing ART for >2 years (AOR: 1·6, 95 % CI 1·3, 1·9) and rural sites (AOR: 2·4, 95 % CI 1·4, 4·4) had greater odds of food ration availability.

Availability of nutritional support services was high in this large sample of HIV care and treatment sites in sub-Saharan Africa. Further efforts are needed to determine the uptake, quality and effectiveness of these services and their impact on patient and programme outcomes.

Results of studies on fish consumption and CHD mortality are inconsistent. The present updated meta-analysis was conducted to investigate the up-to-date pooling effects.

A random-effects model was used to pool the risk estimates. Generalized least-squares regression and restricted cubic splines were used to assess the possible dose–response relationship. Subgroup analyses were conducted to examine the sources of heterogeneity.

PubMed and ISI Web of Science databases up to September 2010 were searched and secondary referencing qualified for inclusion in the study.

Seventeen cohorts with 315 812 participants and average follow-up period of 15·9 years were identified.

Compared with the lowest fish intake (<1 serving/month or 1–3 servings/month), the pooled relative risk (RR) of fish intake on CHD mortality was 0·84 (95 % CI 0·75, 0·95) for low fish intake (1 serving/week), 0·79 (95 % CI 0·67, 0·92) for moderate fish intake (2–4 servings/week) and 0·83 (95 % CI 0·68, 1·01) for high fish intake (>5 servings/week). The dose–response analysis indicated that every 15 g/d increment of fish intake decreased the risk of CHD mortality by 6 % (RR = 0·94; 95 % CI 0·90, 0·98). The method of dietary assessment, gender and energy adjustment affected the results remarkably.

Our results indicate that either low (1 serving/week) or moderate fish consumption (2–4 servings/week) has a significantly beneficial effect on the prevention of CHD mortality. High fish consumption (>5 servings/week) possesses only a marginally protective effect on CHD mortality, possibly due to the limited studies included in this group.

In the context of the global obesity epidemic, national nutrition policies have come under scrutiny. The present paper examines whose interests – industry or public health – are served by these policies and why.

Using an exemplary case study of submissions to an inquiry into obesity, the research compared the positions of industry and public health groups with that taken by government. We assessed whether the interests were given equal consideration (a pluralist model of influence) or whether the interests of one group were favoured over the other (a neo-pluralist model).

2006 New Zealand Inquiry into Obesity.

Food and advertising industry and public health submitters.

The Government's position was largely aligned with industry interests in three of four policy domains: the national obesity strategy; food industry policy; and advertising and marketing policies. The exception to this was nutrition policy in schools, where the Government's position was aligned with public health interests. These findings support the neo-pluralist model of interest group influence.

The dominance of the food industry in national nutrition policy needs to be addressed. It is in the interests of the public, industry and the state that government regulates the food and advertising industries and limits the involvement of industry in policy making. Failure to do so will be costly for individuals, in terms of poor health and earlier death, costly to governments in terms of the associated health costs, and costly to both the government and industry due to losses in human productivity.

Young children's knowledge about healthy food may influence the formation of their eating behaviours, and parents have a major influence on the development of children's knowledge in the early years.

We investigated the extent to which parental nutrition knowledge and attitudes around food predicted young children's knowledge of healthy foods, controlling for other influences such as socio-economic status (SES) and parent education levels in a cross-sectional research design. Children were given a healthy food knowledge activity and parents completed questionnaires.

Twenty primary schools in Adelaide, Australia, stratified by SES.

We recruited 192 children aged 5–6 years and their parents.

Structural equation modelling showed that parent nutrition knowledge predicted children's nutrition knowledge (r = 0·30, P < 0·001) independently of attitudes, SES and education level.

Nutrition education for parents, targeted at low-SES areas at higher risk for obesity, may contribute to the development of healthy food knowledge in young children.

To determine the effectiveness of implementation of a prevention programme via mobile phone text messaging in enhancing knowledge, attitudes and practice concerning iodine deficiency and iodized salt consumption.

In a randomized controlled trial, participants were subjected to a brief tele-educational support regarding iodine deficiency and the importance of iodized salt consumption. The intervention group received daily text messages via mobile phone for 6 weeks. Knowledge, attitude and practice scores, urinary iodine concentration and salt iodine content were assessed at baseline and 8 weeks after the intervention.

Participants were recruited from health-care centres in Tehran, the capital city of Iran.

For the present study 205 females aged ≥18 years were randomly assigned to the intervention (n 95) and control (n 110) groups.

A significant difference was found in median knowledge scores between the intervention and control groups at follow-up (P = 0·004). There was also a significant difference in median attitude scores between the intervention and control groups (P = 0·02). The intervention group did not differ significantly in median practice score, urinary iodine concentration and salt iodine content from the control group.

Text messaging interventions are effective in improving individuals’ knowledge and attitudes regarding preventive health-care topics.

To evaluate the validity of fruit and vegetable intakes as it relates to plasma carotenoid and vitamin C concentrations in Chinese women, using three classification schemes.

Intakes were calculated using an interviewer-administered FFQ. Fruits and vegetables, botanical groups and high-nutrient groups were evaluated. These three classification schemes were compared with plasma carotenoid and vitamin C concentrations from blood samples collected within 1 week of questionnaire completion.

Shanghai, China.

Participants (n 2031) comprised women who had participated in a case–control study of diet and breast-related diseases nested within a randomized trial of breast self-examination among textile workers (n 266 064)

Fruit intake was significantly (P < 0·05) and positively associated with plasma concentrations of α-tocopherol, β-cryptoxanthin, lycopene, α-carotene, β-carotene, retinyl palmitate and vitamin C. Fruit intake was inversely associated with γ-tocopherol and lutein + zeaxanthin concentrations. Vegetable consumption was significantly and positively associated with γ-tocopherol and β-cryptoxanthin concentrations. Each botanical and high-nutrient group was also significantly associated with particular plasma nutrient concentrations. Fruit and vegetable intakes and most plasma nutrient concentrations were significantly associated with season of interview.

These results suggest that the manner in which fruits and vegetables are grouped leads to different plasma nutrient exposure information, which may be an important consideration when testing and generating hypotheses regarding disease risk in relation to diet. Interview season should be considered when evaluating the associations of reported intake and plasma nutrients with disease outcomes.

To describe the prevalence of low serum Se and determine whether HIV, hepatitis C virus (HCV) and/or the types of drugs used are associated with serum Se in a cohort of infected and uninfected drug users.

Independent correlates of low serum Se levels based on data collected from food recalls, physical examinations and clinical questionnaires were identified using multivariate regression analysis.

Buenos Aires, Argentina

A total of 205 (twenty-five female and 180 male) former and current drug users.

Drug users had an average serum Se level of 69·8 (sd 32·8) μg/dl, and 82 % were considered deficient (<85 μg/dl). Multivariate analyses found that HIV- and/or HCV-infected individuals had lower mean Se compared with healthy, uninfected drug users (HIV/HCV co-infection: −25·3 μg/l (se 7·6), P = 0·001; HIV alone: −28·9 μg/l (se 6·9), P < 0·001; HCV alone: −19·4 μg/l (se 7·1), P = 0·006). Current and previous drug use was associated with higher serum Se. Cigarette smoking and heavy alcohol consumption were not found to be associated with Se status.

Low serum Se levels are highly prevalent among drug users in Buenos Aires, Argentina. Se supplementation and/or dietary interventions may be warranted in drug users who are at high risk for HIV and/or HCV infection.

To investigate marketing techniques used on the packaging of child-oriented products sold through supermarkets.

Food and beverage products which met criteria for ‘marketed to children’ were recorded as child-oriented. The products were analysed for food categories, nutritional value, and type and extent of marketing techniques used.

A major supermarket chain in Adelaide, South Australia.

Child-oriented food and beverage products.

One hundred and fifty-seven discrete products were marketed to children via product packaging; most (75·2 %) represented non-core foods, being high in fat or sugar. Many marketing techniques (more than sixteen unique marketing techniques) were used to promote child-oriented food products. Claims about health and nutrition were found on 55·5 % of non-core foods. A median of 6·43 marketing techniques per product was found.

The high volume and power of marketing non-core foods to children via product packaging in supermarkets should be of concern to policy makers wanting to improve children's diet for their health and to tackle childhood obesity. Claims about health or nutrition on non-core foods deserve urgent attention owing to their potential to mislead and confuse child and adult consumers.

To identify and assess healthy eating policies at national level which have been evaluated in terms of their impact on awareness of healthy eating, food consumption, health outcome or cost/benefit.

Review of policy documents and their evaluations when available.

European Member States.

One hundred and twenty-one policy documents revised, 107 retained.

Of the 107 selected interventions, twenty-two had been evaluated for their impact on awareness or knowledge and twenty-seven for their impact on consumption. Furthermore sixteen interventions provided an evaluation of health impact, while three actions specifically measured any cost/benefit ratio. The indicators used in these evaluations were in most cases not comparable. Evaluation was more often found for public information campaigns, regulation of meals at schools/canteens and nutrition education programmes.

The study highlights the need not only to develop harmonized and verifiable procedures but also indicators for measuring effectiveness and success and for comparing between interventions and countries. EU policies are recommended to provide a set of indicators that may be measured consistently and regularly in all countries. Furthermore, public information campaigns should be accompanied by other interventions, as evaluations may show an impact on awareness and intention, but rarely on consumption patterns and health outcome.

While the role of nutrition, physical activity and body size on breast cancer risk has been extensively investigated, most of these studies were conducted in Caucasian populations. However, there are well-known differences in tumour biology and the prevalence of these factors between African-American and Caucasian women. The objective of the present paper was to conduct a review of the role of dietary factors, anthropometry and physical activity on breast cancer risk in African-American women.

Twenty-six research articles that presented risk estimates on these factors in African-American women and five articles involving non-US black women were included in the current review.

Racial disparities in the impact of anthropometric and nutritional factors on breast cancer risk.

African-American and non-US black women.

Based on the few studies that presented findings in African-American women, an inverse association with physical activity was found for pre- and postmenopausal African-American women, while the association for anthropometric and other dietary factors, such as alcohol, was unclear. Studies assessing the effect by molecular subtypes in African-American women were too few and based on sample sizes too small to provide definitive conclusions.

The effect of certain nutrition and lifestyle factors on breast cancer in African-American women is not starkly distinct from those observed in white women. However, there is an enormous need for further research on this minority group to obtain more confirmatory findings.

The present study assessed the impact of the 2009 food packages mandated by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on perceived sales, product selection and stocking habits of small, WIC-authorized food stores.

A cross-sectional study involving in-depth interviews with store managers/owners.

Small, WIC-authorized food stores in eight major cities in the USA.

Fifty-two store managers/owners who had at least 1 year of experience in the store prior to study participation.

The WIC-approved food products (fresh, canned and frozen fruits; fresh, canned and frozen vegetables; wholegrain/whole-wheat bread; white corn/whole-wheat tortillas; brown rice; lower-fat milk (<2 %)) were acquired in multiple ways, although acquisition generally occurred 1–2 times/week. Factors such as customer requests (87 %), refrigerator/freezer availability (65 %) and profitability (71 %) were rated as very important when making stocking decisions. Most managers/owners perceived increases in sales of new WIC-approved foods including those considered most profitable (wholegrain/whole-wheat bread (89 %), lower-fat milk (89 %), white corn/whole wheat tortillas (54 %)), but perceived no changes in sales of processed fruits and vegetables. Supply mechanisms and frequency of supply acquisition were only moderately associated with perceived sales increases.

Regardless of type or frequency of supply acquisition, perceived increases in sales provided some evidence for the potential sustainability of these WIC policy efforts and translation of this policy-based strategy to other health promotion efforts aimed at improving healthy food access in underserved communities.

To assess nutritional status using red-cell folate (RCF) and associated health behaviours including fruit and vegetable intake, smoking, drinking and physical activity in two Indigenous populations living in remote northern Australia.

A cross-sectional survey conducted during 1998–2000.

Twenty-six rural communities in north Queensland, Australia.

A total of 2524 Indigenous people aged 15 years and over was included in the study. Self-reported fruit and vegetable intake, tobacco smoking, alcohol intake and physical activity were recorded. RCF was measured using the Bayer Advia Centaur automated immunoassay system. The association between low RCF (RCF<295 nmol/l) and risk factors was analysed using general linear models adjusted for demographic factors and covariates, namely BMI, diabetes and dyslipidaemia.

The prevalence of RCF deficiency was higher in Aboriginal participants compared with Torres Strait Islanders (25·6 % v. 14·8 %, P < 0·001). Young women of childbearing age were more likely to have low RCF. Among Aboriginal adults, smoking was strongly associated with low RCF (risk ratio = 1·9, 95 % CI 1·5, 2·5 in females and risk ratio = 2·9, 95 % CI 1·9, 4·2 in males).

Indigenous Australians, especially women of childbearing age, had high prevalence of low RCF. Smoking was associated with insufficient folate independent of fruit and vegetable intake and alcohol consumption in the Aboriginal population. This population with an already higher risk of obesity and higher rate of tobacco smoking should be targeted to improve nutrition status to prevent ill health such as diabetes and CVD.

The Hmong are a growing population of South-East Asian immigrants with increasing rates of obesity and diabetes, yet little is known about their dietary consumption patterns. The present study aimed to investigate the dietary intake of Hmong children and whether acculturation and/or time lived in the USA influences dietary intake, BMI and nutritional status.

Two 24 h dietary recalls were collected on non-consecutive days using the multiple-pass interviewing method and were averaged. Heights and weights were measured, from which BMI was calculated. An acculturation score was computed.

Schools, churches, Hmong organizations, and community centres.

Three hundred and thirty-five Hmong children aged 9–18 years from Twin Cities, Minnesota, USA.

Approximately half of our participants were either overweight or obese. US-born children were significantly heavier, taller, had a higher BMI, and in general consumed more energy, saturated fat and Na than those who were born in Thailand/Laos and were living in the USA for <5 years. Children who were more acculturated to US norms including language use, social connections and dietary habits had higher BMI-for-age and consumed significantly more saturated fat, trans fatty acids, Na and Ca compared with their less acculturated counterparts.

Diets of most Hmong children appear below the recommendations for fibre, vitamins A, D and E, Ca, P, Mg and K, and are higher in fats, sugars and Na. Living in an obesogenic US environment is a probable reason for poor dietary quality of Hmong and may be a contributing factor to the rising rates of obesity and diabetes in this population.

Hyperosmotic stress on cells limits many aspects of cell function, metabolism and health. International data suggest that schoolchildren may be at risk of hyperosmotic stress on cells because of suboptimal water intake. The present study explored the cell hydration status of two samples of children in the USA.

Cross-sectional study describing the urine osmolality (an index of hyperosmotic cell shrinkage) and water intake of convenience samples from Los Angeles (LA) and New York City (NYC).

Each participant collected a urine sample at an outpatient clinic on the way to school on a weekday morning in spring 2009. Each was instructed to wake, eat, drink and do as usual before school, and complete a dietary record form describing the type and amounts of all foods and beverages consumed after waking, before giving the sample.

The children (9–11 years) in LA (n 337) and NYC (n 211) considered themselves healthy enough to go to school on the day they gave the urine sample.

Elevated urine osmolality (>800 mmol/kg) was observed in 63 % and 66 % of participants in LA and NYC, respectively. In multivariable-adjusted logistic regression models, elevated urine osmolality was associated with not reporting intake of drinking water in the morning (LA: OR = 2·1, 95 % CI 1·2, 3·5; NYC: OR = 1·8, 95 % CI 1·0, 3·5). Although over 90 % of both samples had breakfast before giving the urine sample, 75 % did not drink water.

Research is warranted to confirm these results and pursue their potential health implications.