To assess the impact of the complex survey design used in the 2007 Australian National Children's Nutrition and Physical Activity Survey (ANCNPAS07) on prevalence estimates for intakes of groups of foods in the population of children.

The impacts on prevalence estimates were determined by calculating design effects for values for food group consumption. The implications of ignoring elements of the sample design including stratification, clustering and weighting are discussed.

The ANCNPAS07 used a complex sample design involving stratification, a high degree of clustering and estimation weights.

Australian children aged 2–16 years.

Design effects ranging from <1 to 5 were found for the values of mean consumption and proportion of the population consuming the food groups. When survey weights were ignored, prevalence estimates were also biased.

Ignoring the complex survey design used in the ANCNPAS07 could result in underestimating the width of confidence intervals, higher mean square errors and biased estimators. The magnitude of these effects depends on both the parameter under consideration and the chosen estimator.

To evaluate the impact of adherence to public health recommendations on Listeria monocytogenes food safety to limit exposure to potential food sources on micronutrient intakes of pregnant women and whether more frequent consumption of ‘high-risk’ foods increases risk for adverse pregnancy outcomes.

A cohort study in women assessing Listeria exposure from an FFQ based on consumption of potential Listeria-containing food sources, the Listeria Food Exposure Score (LFES). Pregnancy status was defined as pregnant, trying to conceive, had a baby within the previous 12 months, or other. Nutrient intakes were compared with Nutrient Reference Values and self-reported pregnancy outcome history three years later.

Australia.

Women aged 25–30 years (n 7486) participating in the Australian Longitudinal Study on Women's Health.

There were weak positive correlations (r = 0·13–0·37, P < 0·001) between LFES and all nutrients, with fibre, folate, Fe and vitamin E intakes consistently below the Nutrient Reference Values in every quintile of LFES. Women in the highest quintile of LFES reported 19 % more miscarriages (rate ratio = 1·19; 95 % CI 1·02, 1·38) than those in the lowest quintile, after adjusting for important confounding factors.

More frequent consumption of foods potentially containing L. monocytogenes is associated with higher nutrient intakes, but an increased risk of miscarriage. L. monocytogenes pregnancy recommendations require review and should include the list of ‘risky’ food items in addition to low-risk alternatives that would adequately replace nutrient intakes which may be reduced through avoidance strategies.

India spans the spectrum of under- and overnutrition disorders and does so in generous proportions. India also tops the charts globally in the prevalence of risk factors for several chronic diseases. Although Public Health Nutrition (PHN) – both as an academic field as well as a means to improved health – has been around for two centuries in developed countries, it is only now coming to the fore as a conduit for tackling nutrition-related disorders in developing countries. In the light of these issues, we undertook an exercise to map the existing educational initiatives for nutrition, and in particular PHN, in India.

This situational analysis of PHN across India was conducted using a combination of Internet search, telephone calls as well as interviews with experts. Information collected was pooled and tabulated using a snowball approach.

India.

Not applicable.

Currently, there are nearly 190 institutes in India that offer one or more nutrition courses, with the majority offering full-time courses. Of these, PHN was offered in less than five institutes across India and opportunities were confined to specialization options/modules.

This situational analysis reveals the huge gap in existing nutrition ventures and points towards the urgent need to undertake newer academic initiatives especially in the field of PHN in India. Reforms in the education and employment sector need to be brought in which may include working towards making the field of nutrition attractive for career pursuit. The focus of this discipline needs to be broadened to, but not limited to, span the entire spectrum from dietetics to research and teaching. Strong synergistic collaborations and academic partnerships with other developed countries should be encouraged to catalyse finding solutions to emerging and/or existing threats to public health problems.

To examine food concern (FC) and its associations with obesity and diabetes in a racially diverse, urban population.

Cross-sectional population-based survey.

Five boroughs of New York City.

Lower-income adults (n 5981) in the 2004 New York City Community Health Survey.

The overall prevalence of obesity was 24 % and was higher among FC than non-FC white men and women, black women, US- and foreign-born whites and foreign-born blacks. In multivariable analysis, FC was marginally associated with obesity (OR = 1·18, 95 % CI 0·98, 1·42) among all lower-income New Yorkers, after controlling for socio-economic factors. The association of FC and obesity varied by race/ethnicity, with FC being positively associated with obesity only among white New Yorkers. FC whites had 80 % higher odds of obesity than whites without FC (OR = 1·80; 95 % CI 1·21, 2·68), with a model-adjusted obesity prevalence of 20 % among non-FC whites v. 31 % among FC whites. FC was not associated with diabetes after controlling for obesity and socio-economic factors.

The prevalence of obesity was significantly higher among FC whites and certain subgroups of blacks. FC was positively associated with obesity risk among lower-income white New Yorkers. Programmes designed to alleviate FC and poverty should promote the purchase and consumption of nutritious, lower-energy foods to help address the burden of obesity in lower-income urban populations.

Whereas the relationship between some components of diet, such as n-3 fatty acids and B-vitamins, and depression risk has been extensively studied, the role of fast-food or processed pastries consumption has received little attention.

Consumption of fast food (hamburgers, sausages, pizza) and processed pastries (muffins, doughnuts, croissants) was assessed at baseline through a validated semi-quantitative FFQ. Participants were classified as incident cases of depression if they reported a physician diagnosis of depression or the use of antidepressant medication in at least one of the follow-up questionnaires. Cox regression models were fit to assess the relationship between consumption of fast food and commercial baked goods and the incidence of depression.

The SUN (Seguimiento Universidad de Navarra – University of Navarra Follow-up) Project, Spain.

Participants (n 8964) from a Spanish cohort.

After a median follow-up of 6·2 years, 493 cases of depression were reported. A higher risk of depression was associated with consumption of fast food (fifth (Q5) v. first quintile (Q1): hazard ratio (HR) = 1·36; 95 % CI 1·02, 1·81; P trend = 0·003). The results did not change after adjustment for the consumption of other food items. No linear relationship was found between the consumption of commercial baked goods and depression. Participants belonging to consumption quintiles Q2–Q5 showed an increased risk of depression compared with those belonging to the lowest level of consumption (Q1; HR = 1·38; 95 % CI 1·06, 1·80).

Fast-food and commercial baked goods consumption may have a detrimental effect on depression risk.

Examine the association between energy intake and television (TV) viewing in Americans.

Nationally representative, cross-sectional study of 2003–2006 National Health and Nutrition Examination Survey.

Total energy intake was determined by two 24 h recalls. TV viewing was reported as low (≤1 h/d), middle (2–3 h/d), and high (≥4 h/d). Multivariate linear regression models were used to analyse TV viewing and energy intake, adjusted for BMI (percentile for children 2–18 years), age, ethnicity and physical activity.

Pre-school children (2–5 years; n 1369), school-age children (6–11 years; n 1759), adolescents (12–18 years; n 3233) and adults (≥19 years; n 7850) in the USA.

There was a significant association between TV viewing and energy intake for adolescent girls (high v. low: β = 195·2, P = 0·03) and men (high v. low: β = −113·0, P = 0·02; middle v. low: β = −131·1, P = 0·0002). Mean adjusted energy intake for adolescent girls was 7801·0, 8088·5 and 8618·2 kJ/d for low, middle and high TV viewing, respectively. Mean adjusted energy intake for men was 9845·9, 9297·2 and 9372·8 kJ/d for low, middle and high TV viewing.

TV viewing was associated with energy intake in US children and adults only in 12–18-year-old girls and men. For girls, the high TV viewing category consumed more energy daily (816·3 kJ (195 kcal)) than the low category. In men, the middle and high TV viewing categories consumed less energy daily (548·4 kJ (131 kcal) and 473·0 kJ (113 kcal), respectively) than the low category. Our findings support some, but not all previous research. Future research is needed to explore this complicated relationship with rigorous measures of energy intake and TV viewing.

To analyse the trends and factors associated with anaemia in 6- to 59-month-old children in Northeast Brazil.

Cross-sectional study assessed information from the second and third Pernambuco State Health and Nutrition Surveys carried out in 1997 and 2006. A multiple regression analysis was performed from a conceptual model addressing biological and socio-economic factors, housing and sanitation conditions, maternal factors, health care and nutrition, consumption, morbidity and nutritional status. Poisson's regression with robust variance was used.

Pernambuco, Brazil.

A total of 777 and 993 children, respectively, in the second and third Pernambuco State Health and Nutrition Surveys.

The prevalence of anaemia (Hb < 11 g/dl) decreased by 19·3 % (40·9 % down to 33·0 %) between surveys. Maternal education level (less than 8 years in school), households ranked in the lowest environmental index tertile and children between 6 and 23 months of age were the variables common to the final models in the surveys of 1997 and 2006. Elements like living in rural areas, household income less than two minimum official wages and low birth weight were still present in the final model of the 1997 survey. Households ranked in the lowest economic index tertile were associated with anaemia in the model of the 2006 survey.

The study results are quite encouraging from the perspective of reducing the prevalence of anaemia. Maternal education level, environmental conditions and child age were determinant factors in both surveys, and economic factors were determinant in 2006.

To investigate the purchase and use of fortified foods, and to explore and compare background characteristics, food consumption and nutrient intakes among users and non-users of voluntarily fortified foods in Finland.

A study based on the National FINDIET Survey 2007 (48 h recall), which included also a barcode-based product diary developed to assess the type, amount and users of voluntarily fortified foods. Logistic regression analysis was employed to investigate associations between background characteristics and the use of fortified foods.

Randomly chosen subgroup of 918 adult participants in the National FINDIET 2007 Survey.

Men and women aged 25–64 years from five regions.

The product group of voluntarily fortified foods purchased in the highest volume was yoghurts (44 % of the weight of all fortified food), followed by fruit drinks (36 %). The only characteristics independently associated with the use of voluntarily fortified foods were age (older people used them less commonly) and the consumption of fruit and vegetables (participants with the highest consumption used them more commonly). Users of fortified foods had higher consumption of yoghurt, juice drinks and ready-to-eat breakfast cereals (women only) than non-users, and lower consumption of boiled potatoes (men only).

Use of voluntarily fortified foods is associated with high consumption of fruit and vegetables but not with other health-related behaviours. The use of voluntarily fortified foods does not seem to even out the differences in nutrient intake among Finnish adults.

To assess the accuracy and reliability of self-reported weight and height and identify the factors associated with reporting accuracy.

Analysis of self-reported and measured weight and height from participants in the Sister Study (2003–2009), a nationwide cohort of 50 884 women aged 35–74 years in the USA with a sister with breast cancer.

Weight and height were reported via computer-assisted telephone interview (CATI) and self-administered questionnaires, and measured by examiners.

Early enrolees in the Sister Study. There were 18 639 women available for the accuracy analyses and 13 316 for the reliability analyses.

Using weighted kappa statistics, comparisons were made between CATI responses and examiner measures to assess accuracy and CATI and questionnaire responses to assess reliability. Polytomous logistic regression evaluated factors associated with over- or under-reporting. Compared with measured values, agreement was 96 % for reported height (±1 inch (±2·5 cm); weighted κ = 0·84) and 67 % for weight (±3 lb (±1·36 kg); weighted κ = 0·92). Obese women (BMI ≥ 30 kg/m2) were more likely than normal-weight women to under-report weight by ≥5 % and underweight women (BMI < 18·5 kg/m2) were more likely to over-report. Among normal-weight and overweight women (18·5 kg/m2 ≤ BMI < 30 kg/m2), weight cycling and lifetime weight difference ≥50 lb (≥22·68 kg) were associated with over-reporting.

US women in the Sister Study were reasonably reliable and accurate in reporting weight and height. Women with normal-range BMI reported most accurately. Overweight and obese women and those with weight fluctuations were less accurate, but even among obese women, few under-reported their weight by >10 %.

To assess classical and non-classical metabolic risk biomarkers in prepubertal children with different levels of cardiorespiratory fitness (CRF).

CRF was assessed by the 20 m shuttle run test. To estimate physical activity, participants were observed while engaged in an after-school programme. Additionally, a short test based on a validated questionnaire was used to obtain information about physical activity practice and sedentary habits. Anthropometric parameters, blood pressure, and classical and non-traditional metabolic risk biomarkers – plasma lipid profile, glucose and insulin, homeostasis model assessment–insulin resistance index (HOMA-IR), plasma uric acid, transaminases and C-reactive protein (CRP) – were measured.

The study was conducted in local elementary schools in Córdoba, Spain.

One hundred and forty-one healthy children (eighty-eight boys, fifty-three girls) aged 7–12 years, in Tanner stage I, were recruited. They were divided into two groups after they performed the 20 m shuttle run test: equal or higher cardiovascular fitness (EHCF) group and low cardiovascular fitness (LCF) group.

The LCF group displayed significantly higher TAG (P = 0·004) and lower HDL cholesterol levels (P = 0·001), as well as significantly lower values for the non-traditional lipid marker apo-A1 (P = 0·001) compared with the EHCF group. The LCF children displayed higher plasma glucose (P = 0·003) and insulin levels, higher HOMA-IR scores (P < 0·001) and higher plasma uric acid and CRP levels (P < 0·05). After adjustment for BMI, age and sex, no statistically significant differences were found between groups for the biomarkers analysed.

The study provides new information to understand the role not only of weight status but also of the level of CRF on the metabolic health profile of prepubertal children.

To assess the strength of the relationships between serum carotenoids and three self-reported dietary intake instruments often used to characterize carotenoid intake in studies of diet and disease.

Participants completed a Diet History Questionnaire (DHQ), two 24 h dietary recalls (24HR), a fruit and vegetable screener and a fasting blood draw. We derived dietary intake estimates of α-carotene, β-carotene, cryptoxanthin, lutein, zeaxanthin and lycopene from each diet instrument and calculated sex-specific multivariate correlations between dietary intake estimates and their corresponding serum values.

Montgomery County, Maryland, USA.

Four hundred and seventy women and men aged 40–69 years in the National Cancer Institute's Observing Protein and Energy Nutrition (OPEN) Study.

Serum carotenoids correlated more strongly with the DHQ (r = 0·34–0·54 for women; r = 0·38–0·56 for men) than with the average of two recalls (r = 0·26–0·47 for women; r = 0·26–0·40 for men) with the exception of zeaxanthin, for which the correlations using recalls were higher. With adjustment for within-person variation, correlations between serum carotenoids and recalls were greatly improved (r = 0·38–0·83 for women; r = 0·42–0·74 for men). In most cases, correlations between serum carotenoids and the fruit and vegetable screener resembled serum–DHQ correlations.

Evidence from the study provides support for the use of the DHQ, a fruit and vegetable screener and deattenuated recalls for estimating carotenoid status in studies without serum measures, and draws attention to the importance of adjusting for intra-individual variability when using recalls to estimate carotenoid values.

The present study aimed to define the complexity of the relationships between the family environment, health behaviours and obesity. A conceptual model that quantifies the relationships and interactions between parent factors, family environment, and certain aspects of children's behaviour and weight status is presented.

Exploratory structural equation modelling was used to quantitatively model the relationships between parent, child and family environmental factors.

Adelaide, South Australia.

Families (n 157) with children aged 5–10 years completed self-reported questionnaires, providing data on parents’ knowledge, diet quality and activity habits; child feeding and general parenting styles; and the food and physical activity environments. Outcome variables included children's fruit and vegetable intake, activity and sedentary habits and weight status.

The proposed model was an acceptable fit (normed fit index = 0·457; comparative fit index = 0·746; root-mean-squared error associated = 0·044). Parents’ BMI (β = 0·32) and nutrition and physical activity knowledge (β = 0·17) had the strongest direct associations with children's BMI Z-score. Parents’ dietary intake and energy expenditure behaviours were indirectly associated with children's behaviour through the creation of the home environment. The physical activity and food environments were associated with children's sedentary (β = −0·44) and activity habits (β = 0·29), and fruit and vegetable intake (β = 0·47), respectively.

A conceptual model that quantifies the complex network of family environment factors influencing children's behaviour and weight status is presented. The model provides a basis for future research on larger representative samples with a view to guiding obesity prevention interventions.

To compare differences in children's diet quality on weekdays (Monday–Thursday), Fridays and weekend days.

A representative cross-sectional study in which participants completed a 7 d pre-coded food record. Mean intakes of energy, macronutrients and selected food items (g/10 MJ) as well as energy density were compared between weekdays, Fridays and weekend days for each gender in three age groups (4–6, 7–10 and 11–14 years) using Tobit analysis to account for zero intakes.

The Danish National Survey of Dietary Habits and Physical Activity 2003–2008.

Children (n 784; 49·9 % boys) aged 4–14 years.

For both genders in all age groups (P < 0·05), energy intake was higher during weekends than on weekdays, and intakes of sugar-sweetened beverages and white bread were higher, whereas intake of rye bread was lower. This contributed to a higher percentage of energy from added sugars, a lower fibre content and a higher energy density on weekend days v. weekdays. In children aged 4–6 and 7–10 years, the diet on weekend days was also characterized by higher intakes of sweets and chocolate and lower intakes of fruit and vegetables. Overall, the diet on Fridays appeared as a mix of the diets on weekdays and weekend days.

Significant differences and distinct characteristic patterns were found in children's diet quality during weekdays, Fridays and weekend days. The present study suggests that in prevention of childhood overweight and obesity, more attention should be paid to the higher energy intake, especially from sugar-rich foods and beverages, on Fridays and weekend days.

To assess Australian consumers’ perception of portion size of fast-food items and their ability to estimate energy content.

Cross-sectional computer-based survey.

Australia.

Fast-food consumers (168 male, 324 female) were asked to recall the items eaten at the most recent visit to a fast-food restaurant, rate the prospective satiety and estimate the energy content of seven fast-food or ‘standard’ meals relative to a 9000 kJ Guideline Daily Amount. Nine dietitians also completed the energy estimation task.

Ratings of prospective satiety generally aligned with the actual size of the meals and indicated that consumers perceived all meals to provide an adequate amount of food, although this differed by gender. The magnitude of the error in energy estimation by consumers was three to ten times that of the dietitians. In both males and females, the average error in energy estimation for the fast-food meals (females: mean 3911 (sd 1998) kJ; males: mean 3382 (sd 1957) kJ) was significantly (P < 0·001) larger than for the standard meals (females: mean 2607 (sd 1623) kJ; males: mean 2754 (sd 1652) kJ). In women, error in energy estimation for fast-food items predicted actual energy intake from fast-food items (β = 0·16, P < 0·01).

Knowledge of the energy content of standard and fast-food meals in fast-food consumers in Australia is poor. Awareness of dietary energy should be a focus of health promotion if nutrition information, in its current format, is going to alter behaviour.

Highly processed foods such as convenience foods usually have a high salt content and therefore might indirectly act as adipogenic due to an increasing consumption of sugar-containing beverages (SCB). We examined the association between dietary salt and body weight status.

We used data on urinary Na excretion as an indicator of dietary salt and BMI standard deviation score (BMI-SDS) and percentage body fat (%BF) of children and adolescents participating in the DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) Study.

Dortmund, Germany.

Children and adolescents (n 364) who had at least two 24 h urine samples and two dietary records in the observational period between 2003 and 2009 were considered in our data analysis.

Repeated-measures regression models revealed that urinary Na was positively associated with BMI-SDS (+0·202 SDS/g Na excretion at baseline; P < 0·001) and %BF (+1·303 %BF/g Na excretion at baseline; P < 0·01) at baseline in boys and girls. These associations remained significant after adjustment for SCB consumption and total energy intake. Furthermore, there was a positive trend between baseline Na excretion and the individual change in %BF in the study period (+0·364 increase in %BF/g Na excretion at baseline), which was confirmed after inclusion of SCB consumption or total energy intake. There was no significant association between the change in Na excretion and the concurrent change of either BMI-SDS or %BF in any model.

Our results suggest that a high intake of processed salty foods could have a negative impact on body weight status in children and adolescents independently from their consumption of SCB.

To estimate the effect of the US Supplemental Nutrition Assistance Program (SNAP) on the food security (consistent access to adequate food) of recipients, net of the effect of the self-selection of more food-needy households into the programme.

The food security of current SNAP recipients and recent leavers is compared in cross-sectional survey data, adjusting for economic and demographic differences using multivariate logistic regression methods. A similar analysis in 2-year longitudinal panels provides additional control for selection on unobserved variables based on food security status in the previous year.

Household survey data collected for the US Department of Agriculture by the US Census Bureau.

Households interviewed in the Current Population Survey Food Security Supplements from 2001 to 2009.

The odds of very low food security among households that continued on SNAP through the end of a survey year were 28 % lower than among those that left SNAP prior to the 30-d period during which food security was assessed. In 2-year panels with controls for the severity of food insecurity in the previous year, the difference in odds was 45 %.

The results are consistent with, or somewhat higher than, the estimates from the strongest previous research designs and suggest that the ameliorative effect of SNAP on very low food security is in the range of 20–50 %.

Middle Eastern and North African countries are undergoing nutrition transition, a transition which is associated with an increased burden of non-communicable diseases. This necessitates the evaluation of dietary patterns in these regions. The present study aimed to assess changes in dietary patterns in Middle Eastern and North African countries between 1961 and 2007.

Availability of energy and fifteen main food items during 1961–2007 was examined using FAO food balance sheets from the FAOSTAT database.

Fifteen countries including nine in the Middle East and six in North Africa were selected and the average availability of total energy and different food items in these regions were compared.

Over the 47 years studied, energy and food availability (apart from animal fats and alcoholic beverages) has increased in the Middle East and North Africa. In both regions the proportion of energy derived from meat and vegetable oils has increased significantly while that from cereals decreased significantly. In addition, the proportion of energy from milk and dairy products and vegetables has shown an ascending trend in North Africa while the proportion of energy from fruits has shown a descending trend in the Middle East.

The study results reveal an unfavourable trend towards a Westernized diet in the Middle East and, to a certain extent, in North Africa. Tailored nutritional education encouraging healthy eating for prevention of the burden of chronic diseases in these countries seems essential.

To document the double burden of malnutrition and cardiometabolic risk factors (CMRF) in adults and its occurrence according to different sociodemographic parameters.

Population-based cross-sectional observational study. We first randomly selected 330 households stratified by tertile of the income levels proxy as low, middle and high income.

Northern district of Ouagadougou, the capital city of Burkina Faso.

In each income stratum, 110 individuals aged 25–60 years and who had lived permanently in Ouagadougou for at least 6 months were randomly selected, followed with collection of anthropometric, socio-economic and clinical data, and blood samples.

The overall obesity/overweight prevalence was 24·2 % and it was twice as high in women as in men (34·1 % v. 15·5 %, P < 0·001). Hypertension, hyperglycaemia and low HDL cholesterol prevalence was 21·9 %, 22·3 % and 30·0 %, respectively, without gender difference. The prevalence of the metabolic syndrome was 10·3 %. Iron depletion and vitamin A deficiency affected 15·7 % and 25·7 % of participants, respectively, with higher rates in women. Coexistence of at least one nutritional deficiency and one CMRF was observed in 23·5 % of participants, and this ‘double burden’ was significantly higher in women than in men (30·4 % v. 16·1 %, P = 0·008) and in the low income group.

CMRF are becoming a leading nutritional problem in adults of Ouagadougou, while nutritional deficiencies persist. The double nutritional burden exacerbates health inequities and calls for action addressing both malnutrition and nutrition-related chronic diseases.

An urgent need in dietary assessment is the development of short tools that provide valid assessments of dietary quality for use in time-limited settings. The present study assessed concurrent and construct validity of the short Diet Quality Screener (sDQS) and brief Mediterranean Diet Screener (bMDSC) questionnaires.

Relative validity was measured by comparing three dietary quality indices – the Diet Quality Index (DQI), the modified Mediterranean Diet Score (mMDS) and the Antioxidant Score (ANTOX-S) – derived from the two questionnaires with those from multiple 24 h recalls over 12 months. Construct validity was demonstrated by correlations between average nutrient intake recorded on multiple 24 h recalls and the DQI, mMDS and ANTOX-S derived by the short screeners.

Both short questionnaires were administered to 102 participants recruited from a population-based survey in Spain.

DQI, mMDS and ANTOX-S correlated (P < 0·001) with the corresponding 24 h recall indices (r = 0·61, 0·40 and 0·45, respectively). Limits of agreement lay between 96 and 126 %, 59 and 144 % and 61 and 118 % for the DQI, ANTOX-S and mMDS, respectively. Dietary intakes of fibre, vitamin C, vitamin E, Mg and K reported on the 24 h recalls were positively associated (P < 0·04) with the DQI, mMDS and ANTOX-S indices.

The sDQS and bMDSC provide reasonable approximations to food-based dietary indices and accurately situate subjects within the indices constructed for the present validation study.