The ‘Smart Choices’ programme was an industry-driven, front-of-package (FOP) nutritional labelling system introduced in the USA in August 2009, ostensibly to help consumers select healthier options during food shopping. Its nutritional criteria were developed by members of the food industry in collaboration with nutrition and public health experts and government officials. The aim of the present study was to test the extent to which products labelled as ‘Smart Choices’ could be classified as healthy choices on the basis of the Nutrient Profile Model (NPM), a non-industry-developed, validated nutritional standard.

A total of 100 packaged products that qualified for a ‘Smart Choices’ designation were sampled from eight food and beverage categories. All products were evaluated using the NPM method.

In all, 64 % of the products deemed ‘Smart Choices’ did not meet the NPM standard for a healthy product. Within each ‘Smart Choices’ category, 0 % of condiments, 8·70 % of fats and oils, 15·63 % of cereals and 31·58 % of snacks and sweets met NPM thresholds. All sampled soups, beverages, desserts and grains deemed ‘Smart Choices’ were considered healthy according to the NPM standard.

The ‘Smart Choices’ programme is an example of industries’ attempts at self-regulation. More than 60 % of foods that received the ‘Smart Choices’ label did not meet standard nutritional criteria for a ‘healthy’ food choice, suggesting that industries’ involvement in designing labelling systems should be scrutinized. The NPM system may be a good option as the basis for establishing FOP labelling criteria, although more comparisons with other systems are needed.

The present study aimed to assess complementary feeding practices and identify the potential risk factors associated with inappropriate complementary feeding in Indonesia for a nationally representative sample of births from 2004 to 2007.

The data source for the analysis was the 2007 Indonesia Demographic and Health Survey. Multiple logistic regression was performed to analyse the factors associated with complementary feeding, using individual-, household- and community-level determinants.

Indonesia.

Children (n 4604) aged 6–23 months.

Multivariate analysis revealed that infants from poor households were significantly less likely to be introduced to complementary feeding (adjusted odds ratio, AOR = 4·32; 95 % CI 1·46, 12·80) and meet the minimum dietary diversity (AOR = 1·76; 95 % CI 1·16, 2·68). Mother's education (AOR for no education in dietary diversity = 1·92; 95 % CI 1·09, 3·38; AOR for no education in meal frequency = 2·03; 95 % CI 1·13, 3·64; AOR for no education in acceptable diet = 3·84; 95 % CI 2·07, 7·12), residence and decreased age of the infant were negatively associated with minimum dietary diversity, minimum meal frequency and an acceptable diet. Infants aged 6–11 months were also significantly less likely to meet minimum dietary diversity (AOR = 6·36; 95 % CI 4·73, 8·56), minimum meal frequency (AOR = 2·30; 95 % CI 1·79, 2·96) and minimum acceptable diet (AOR = 2·27; 95 % CI 1·67, 3·09). All geographical regions compared with Sumatra were more likely to give the recommended meal frequency and an acceptable diet to breast-fed children.

Public health interventions to improve complementary feeding should address individual-, household- and community-level factors which significantly influence the introduction of complementary feeding. Complementary feeding intervention programmes in Indonesia should ensure that restraints on families with low socio-economic status are addressed. Infants aged 6–11 months and mothers with low education levels may also need special focus. Promotion strategies should also target the health-care delivery system and the media.

Low serum vitamin D, which largely affects ethnic minorities, is associated with obesity and other chronic diseases. Little is known about racial/ethnic differences in intake, particularly in children, or if any differences are associated with differences in serum 25-hydroxyvitamin D (25(OH)D). The objective of the present study was to determine whether racial/ethnic differences in dietary vitamin D intake exist and whether they explain differences in 25(OH)D.

Vitamin D intakes (Block Kids 2004 FFQ) and 25(OH)D were measured. Race/ethnicity was parent-reported (white (37·9 %), Hispanic (32·4 %), black (8·3 %), Asian (10·3 %), multi-racial/other (11·0 %)). Multivariable analyses were conducted to examine the associations among dietary vitamin D and race/ethnicity, as well as 25(OH)D, independent of BMI Z-score and other covariates.

Elementary/middle schools in Somerville, MA, USA, during January–April 2010.

Schoolchildren (n 145) in 4th–8th grade.

Only 2·1 % met the 2011 RDA (15 μg/d (600 IU/d)). Average dietary intake was 3.5 (sd 2.2) μg/d (140 (sd 89·0) IU/d). No racial/ethnic differences in intake were evident. Most (83·4 %) were 25(OH)D deficient (<20 ng/ml; 16·0 (sd 6·5) ng/ml). In ANOVA post hoc analyses, 25(OH)D levels were lower in Hispanics than whites (14·6 (sd 6·1) ng/ml v. 17·9 (sd 4·6) ng/ml; P < 0·01). Dietary vitamin D was associated with 25(OH)D overall (P < 0·05), but did not explain the racial/ethnic differences in 25(OH)D.

Most children in this north-east US sample did not meet dietary recommendations for vitamin D and were vitamin D deficient. Dietary vitamin D did not explain the difference in 25(OH)D between Hispanic and white children. Further research is needed to determine if changes in dietary vitamin D by race/ethnicity can impact 25(OH)D levels.

To evaluate the impact of different modes of administration (face-to-face v. telephone), recall days (first v. second), days of the week (weekday v. weekend) and interview days (1 d later v. 2 d later) on bias in protein and K intakes collected with 24 h dietary recalls (24-HDR).

Two non-consecutive 24-HDR (collected with standardised EPIC-Soft software) were used to estimate protein and K intakes by a face-to-face interview at the research centres and a telephone interview, and included all days of the week. Two 24 h urine collections were used to determine biomarkers of protein and K intake. The bias in intake was defined as the ratio between the 24-HDR estimate and the biomarker.

Five centres in Belgium, Czech Republic, France, the Netherlands and Norway in the European Food Consumption Validation (EFCOVAL) study.

About 120 adults (aged 45–65 years) per centre.

The bias in protein intake in the Czech Republic and Norway was smaller for telephone than face-to-face interviews (P = 0·01). The second 24-HDR estimates of protein intake in France and K intake in Belgium had a larger bias than the first 24-HDR (P = 0·01 and 0·04, respectively). In the Czech Republic, protein intake estimated during weekends and K intake estimated during weekdays had a larger bias than during other days of the week (P = 0·01). In addition, K intake collected 2 d later in the Czech Republic was likely to be overestimated.

The biases in protein and K intakes were comparable between modes of administration, recall days, days of the week and interview days in some, but not all, study centres.

To determine whether household food insecurity (HFI) is associated with a higher prevalence of excessive weight (EW) in a large random sample of Brazilian female adolescents.

Nationally representative cross-sectional study. EW was the outcome variable (BMI ≥ 85th percentile of WHO reference for adolescents aged 15–18 years and BMI ≥ 25 kg/m2 for those aged 19 years). HFI was measured with the Brazilian Food Insecurity Scale. Associations were measured using crude and adjusted prevalence ratios (PR) with 95 % confidence intervals through Poisson regression models taking into account the complex sampling design.

Data were derived from the third wave of the Demographic and Health Survey conducted in 2006–2007, in Brazil.

The sample included 1529 female adolescents aged 15–19 years.

The prevalence of any level of HFI was 40·8 %, with 26·6 % of households experiencing mild, 9·4 % moderate and 4·8 % severe food insecurity. The overall prevalence of EW was 21·9 % (12·9 % were overweight and 9·0 % obese). EW prevalence among those living in severely, moderately and mildly food-insecure households was 36·8 %, 14·9 % and 16·5 %, respectively (P for the overall association = 0·036). Women living in severely food-insecure households had an increased prevalence of EW compared with their food-secure counterparts (PR = 1·96; 95 % CI 1·18, 3·27; P = 0·007), after adjusting for important confounders.

The study suggests that severe but not mild or moderate HFI is independently associated with EW among adolescents residing in Brazil, a middle-income country undergoing the nutrition transition.

The present study analysed the impact of using the 2006 WHO Child Growth Standards (‘the WHO standards’) compared with the 1977 National Center for Health Statistics (NCHS) international growth reference (‘the NCHS reference’) on the calculated prevalence of chronic malnutrition in children aged 6·0–59·9 months.

Anthropometric data were collected as part of a cross-sectional study exploring the association between household environments and nutritional status of children. Z-scores were computed for height-for-age (HAZ), weight-for-age (WAZ) and weight-for-height (WHZ) using each reference/standard. Results were compared using Bland–Altman plots, percentage agreement, kappa statistics, line graphs and proportion of children in Z-score categories.

The study was conducted in thirteen rural villages within Honduras's department of Intibucá.

Children aged 6·0–59·9 months were the focus of the analysis, and households with children in this age range served as the sampling unit for the study.

The WHO standards yielded lower means for HAZ and higher means for WAZ and WHZ compared with the NCHS reference. The WHO standards and NCHS reference showed good agreement between Z-score categories, except for HAZ among males aged 24·0–35·9 months and WHZ among males aged >24·0 months. Using the WHO standards resulted in higher proportions of stunting (low HAZ) and overweight (high WHZ) and lower proportions of underweight (low WAZ). The degree of difference among these measures varied by age and gender.

The choice of growth reference/standard employed in nutritional surveys may have important methodological and policy implications. While ostensibly comparable, data on nutritional indicators derived with different growth references/standards must be interpreted cautiously.

To validate an eighty-nine-item semi-quantitative FFQ for measurement of nutrient intakes in elderly women.

FFQ and 3 d food records were filled in by women participating in the Kuopio Fracture Prevention Study (OSTPRE-FPS). Data on intakes of energy, fat, protein, carbohydrate, fibre, Ca, Fe, P, K, Mg, folic acid, vitamin B12, vitamin C, vitamin D and vitamin K from ninety-nine women were available to assess the agreement of the two methods. Validity was assessed using correlation coefficients, cross-classification into quintile categories and Bland–Altman plots. Nutrients relevant to bone health were assessed.

OSTPRE-FPS in Finland.

Elderly women with a mean age 71·3 years.

The FFQ overestimated energy and nutrient intakes as compared with food records by 30–50 %. The highest correlation coefficients of the energy-adjusted nutrient intakes between the methods were observed for fibre (0·60), Mg (0·56) and folic acid (0·49) and the lowest for protein and vitamin D (both 0·19). The cross-classification of energy-adjusted nutrient intakes showed that on average 68 % of the participants (range 62–78 %) were classified into the same or an adjacent quintile category.

The validity of energy and nutrient intakes measured with the FFQ was moderate as compared with 3 d food records in elderly women. The FFQ is a useful tool for the nutrient assessment of elderly women in epidemiological research.

To assess the nutritional adequacy of Seychellois children in relation to nutrients reported to be important for cognitive development.

Dietary intakes were assessed by 4 d weighed food diaries and analysed using dietary analysis software (WISP version 3·0; Tinuviel Software, UK). Individual nutrient intakes were adjusted to usual intakes and, in order to investigate adequacy, were compared with the UK Estimated Average Requirements for children aged 4–6 years.

Children 5 years old were followed up as part of the Seychelles Child Development Nutrition Study (SCDNS), located in the high-fish-consuming population of Mahé, Republic of Seychelles.

Analysis was carried out on a sample of 229 children (118 boys, 111 girls).

Children consumed a diet of which fortified cereal and milk products contributed the most to nutrient intakes. The majority (≥80 %) of children met requirements for several nutrients important for child development including Fe, folate and Se. Adjusted dietary intakes of Cu, Zn, iodine, niacin and vitamin A were below the Estimated Average Requirement or Recommended Nutrient Intake. Mean adjusted energy intakes (boys 4769 kJ/d (1139·84 kcal/d), girls 4759 kJ/d (1137·43 kcal/d)) were lower than the estimated energy requirement (boys 5104 kJ/d (1220 kcal/d), girls 5042 kJ/d (1205 kcal/d)) for 88 % of boys and 86 % of girls.

Nutrition was adequate for most children within the SCDNS cohort. Low intakes of some nutrients (including Zn, niacin and vitamin A) could reflect nutritional database inaccuracies, but may require further investigation. The study provides valuable information on the adequacy of intakes of nutrients which could affect the growth and development of Seychellois children.

To investigate the effectiveness of a relatively novel concept of providing employees with healthy ready-to-heat meals to bring home to their families, here referred to as Canteen Take Away (CTA).

Employees’ dietary intake on two weekdays when they received free CTA was compared with that on weekdays when they did not receive CTA. Four non-consecutive 24 h dietary recalls were applied to assess dietary intake on a daily basis. Moreover, a digital photographic method was used to assess evening meal intake for three consecutive weeks. Data were analysed using a mixed-effects model.

A financial worksite offering CTA.

Twenty-seven employees.

Overall dietary quality as expressed by the energy density of the food (excluding beverages) was found to be significantly lower on days consuming CTA meals compared to days not consuming CTA with regard to evening meal intake (average difference: −187 (95 % CI −225, −149) kJ/100 g) and on a daily basis (average difference: −77 (95 % CI −132, −21) kJ/100 g). Other favourable differences included increased vegetable intake (average difference: 83 (95 % CI 67, 98) g/evening meal, 109 (95 % CI 62, 155) g/d).

The present study shows that providing healthy take-away dinners has potential for promoting healthy dietary habits among employees. This reinforces the importance of availability and convenience as effective tools to promote healthy eating habits.

To assess the errors between estimates of amounts based on photographs and actual quantities of food presented to adults or eaten on the previous day.

A photographic atlas was constructed by taking digital photographs of three pre-weighed portion sizes of 212 traditional Lebanese dishes. In a first approach, ten portions of real pre-weighed foods were assessed using the photographic atlas. In a second approach, the participants weighed all foods consumed at one meal and recalled the amount of food that was eaten the previous day using the photographic atlas. Differences between actual quantities and estimation were assessed using a signed rank test (P < 0·05). Spearman's correlation coefficients and bias (Bland–Altman plot) between the methods were calculated.

Lebanese university canteen and Lebanese homes.

Forty adults (twenty males, twenty females) completed the first protocol and fifty adults (twenty-five males, twenty-five females) completed the second protocol; all were volunteers aged 21 to 62 years.

Mean differences between actual and estimated portion sizes by photographs were between −13·1 % and +24·5 % when pre-weighed foods were presented, and between −10·4 % and +3·8 % when foods were consumed the day before. No significant differences were found between actual and estimated portion sizes except for three dishes (loubieh bil zeit, tabbouleh and yachnet bazella). Bland–Altman plots showed good agreement for all dishes with a negligible bias of −0·2 g between estimated and presented portions, and −6·3 g between estimated and eaten portions.

In the Lebanese diet, food photographs seem a reliable tool for quantification of food portion sizes.

Developing countries have adopted universal, high-potency vitamin A (VA) supplementation and food fortification as major strategies to control deficiency, prevent nutritional blindness and reduce child mortality. Yet questions persist regarding how best to measure impact and when to phase out supplementation. The present paper provides guidance on the use and interpretation of serum retinol (SROL) distributions as indicators of both programme impact and adequate VA intake in a population.

We reviewed extant data on SROL's response to high-potency VA supplementation and VA-fortified foods in children.

Supplementation virtually eliminates xerophthalmia and reduces child mortality; however, it shifts the SROL distribution only transiently (<2 months). Regular consumption of VA-fortified foods prevents xerophthalmia, lowers mortality and sustainably improves SROL distributions, from which both compliance and public health impact can be inferred.

Given SROL's limited responsiveness to high-potency VA supplementation, target population coverage remains the preferred performance indicator. However, periodic SROL surveys do reflect underlying dietary risk and can guide programming: low or marginal SROL distributions in areas with high supplementation coverage do not signify programme failure, but rather suggest the need to continue supplementation while working to effectively raise dietary VA intakes. We propose that a sustained rise in the SROL distribution, defined as ≤5 % prevalence of SROL < 0·70 μmol/l among vulnerable population groups in at least two consecutive surveys (≥1 year apart), be used as an indicator of stable and adequate dietary VA intake and status in a population, at which point programmes may re-evaluate the need for continued universal supplementation.

Previous studies on maternal work hours and child diet quality have reported conflicting findings possibly due to differences in study design, lack of a comprehensive measure of diet quality and differing ages of the children under investigation. The present study aimed to prospectively examine the impact of parental work hours from age 1 year to age 14 years on adolescent diet quality.

Multivariate linear regression models were used to examine independent associations between parents’ work hours at each follow-up and across 14 years and adolescent diet quality at age 14 years. A diet quality index was based on the international literature and Australian recommendations, consisting of six food groups and nine nutrients.

Perth, Western Australia.

Children (n 1629) participating in the Western Australian Pregnancy Cohort (Raine) Study.

Compared with children of mothers in full-time employment, children of mothers who were not employed in early childhood up to age 5 years had a higher average diet quality score at age 14 years, independent of maternal and family socio-economic status. Across 14 years the number of years the mother worked full time and increasing average weekly hours were associated with lower diet quality. Father's work hours had little association with adolescent diet quality.

Having a mother stay at home in early to middle childhood is associated with better diet quality in adolescence. Support may be beneficial for families where the mother returns to full-time employment before the child reaches 8 years of age.

Misperception of social norms may result in normalising unhealthy behaviours. The present study tested the hypothesis that parents overestimate both the frequency of unhealthy snacking in pre-school children other than their own (descriptive norms) and its acceptability to other parents (injunctive norms).

A cross-sectional, self-report community survey. Questions assessed the frequency with which respondents’ own child ate unhealthy snacks and their beliefs about the appropriate frequency for children to snack. Perceived descriptive norms were assessed by asking parents to estimate how often other 2–4 year-old children in their area ate snacks. Perceived injunctive norms were assessed by asking them about other parents’ beliefs regarding the appropriate frequency for snacks. Misperceptions were assessed from (i) the difference between the prevalence of daily snacking and parents’ perceived prevalence and (ii) the difference between acceptability of daily snacking and parents’ beliefs about its acceptability to others.

Pre-schools and children's centres in one borough of London, UK.

Parents (n 432) of children age 2–4 years.

On average, parents believed that more than half of ‘other’ children had snacks at least daily, while prevalence data indicated this occurred in only 10 % of families. The same discrepancy was observed for perceived injunctive norms: parents overestimated other parents’ acceptance of frequent snacking, with two-thirds of parents having a self v. others discrepancy.

Misperceptions were identified for descriptive and injunctive norms for children's snacking. Accurate information could create less permissive norms and motivate parents to limit their child's intake of unhealthy snacks.

To assess how diet quality, physical activity and body weight are related to health-related quality of life (HRQOL) among children in the Canadian province of Alberta.

In 2008, we surveyed 3421 grade 5 students and their parents from 148 randomly selected schools. Students completed the Harvard Food Frequency Questionnaire, questions on physical activities, and had their height and weight measured. The HRQOL of the students was assessed using the EQ-5D-Y. Parents completed questions on socio-economic background and children's lifestyle. We applied multilevel regression methods to examine the importance of children's diet quality, physical activity and weight status for the EQ-5D-Y Visual Analogue Scale and for the EQ-5D-Y dimensions.

The province of Alberta, Canada.

Grade 5 students.

Students with better diet quality, higher physical activity levels and normal body weights were statistically significantly more likely to report better HRQOL than students who ate less healthily, were less active or were overweight or obese.

The importance of diet quality, physical activity and body weight status for HRQOL may help justify broader implementation of school health programmes that promote healthy eating and active living, as these programmes will help reduce the burden of childhood obesity and improve quality of life.

To describe detailed physical activity and sedentary behaviour in French adults across physical activity categories.

The French Nutrition and Health Survey (Etude Nationale Nutrition Santé, ENNS), conducted in 2006–2007, was a national cross-sectional survey based on three-stage random sampling. The International Physical Activity Questionnaire (IPAQ) was used to classify participants into three physical activity categories. Time spent in a sitting position and time spent in front of a screen were used as markers of sedentary behaviour.

France.

Adults (n 2971) aged 18 to 74 years were included.

Overall, 29·5 % of men and 23·6 % of women were classified into the high-IPAQ category, while 36·1 % of men and 37·5 % of women were in the low-IPAQ category. For each intensity level of physical activity (vigorous intensity, moderate intensity or walking), the number of active days per week decreased from the high- to the low-IPAQ category and daily duration of physical activity was longer in the high-IPAQ category than in the other two categories; 6 % of adults declared neither vigorous nor moderate nor walking activities.

For most adults in the low-IPAQ category, an increasing number of active days per week would be sufficient to attain the moderate-IPAQ category. This should be taken into account in public health initiatives aimed at promoting physical activity.

To determine whether pre-pregnancy BMI influences breast-feeding practice.

Retrospective epidemiological study.

University Hospital Leuven, Catholic University Leuven, Belgium.

Two hundred women (median age 29 years, interquartile range (IQR) 4; 52 % nulliparae) were grouped into four categories according to pre-pregnancy BMI using WHO cut-offs.

The incidence of intention and initiation of breast-feeding was significantly lower in underweight (64 %) and obese women (68 %) compared with normal weight (92 %) and overweight women (80 %). Initiation was also related to parity (OR = 0·582; 95 % CI 0·400, 0·846), but not to gestational weight gain, method of delivery or hypertensive disorders. Fifty-two per cent of underweight, 70 % of normal weight and 56 % of overweight women were exclusively breast-feeding their infant during the first month of life. This incidence was significantly lower in the obese group (34 %; P = 0·030). Only 40 % of all infants were exclusively breast-fed at 3 months of age, with the lowest prevalence among women with obesity (P = 0·0 0 1). The median duration of any breast-feeding in the obese group (1·8 months, IQR 3·4) was significantly shorter than in the underweight (3·0 months, IQR 3·1), normal weight (3·0 months, IQR 2·4) and overweight group (3·0 months, IQR 3·5; P = 0·024). Reasons given for ceasing breast-feeding in the obese group were maternal complications (29 %), insufficient milk supply (23 %), sucking problems (21 %) and work resumption (21 %).

Breast-feeding practice in the total population, but especially among women with obesity, fell short of global WHO recommended standards. Policy initiatives and local interventions should continue to support breast-feeding, but also prevent maternal obesity.

The present analysis evaluates the overall appreciation and implementation of an intervention, Project Tomato, designed to maintain fruit and vegetable intake in children aged 8–9 years.

A random sample of fifty-four English primary schools (658 children) were randomised to either the intervention group or the control. The intervention group received a multi-component programme delivered in school by teachers and items sent home for parents/children. Dietary measurements were collected at baseline and follow-up. The intervention participants completed questionnaires on the intervention materials, to identify implementation and appreciation of the intervention, and other environmental mechanisms.

Fifty-four primary schools were randomly selected, with twenty-seven schools allocated to the intervention group.

A total of 311 children received the intervention.

Implementation of the intervention was low, 21·3 % of school items and 56·0 % of home items were implemented. The intervention materials were well received by teachers, parents and children. Other mechanisms that may affect fruit and vegetable intake were explored. Children who ate their main meal with their parents 3–7 nights/week on average consumed 37·6 (95 % CI 9·8, 65·4) g more fruit and vegetables than children who ate with their parents 0–2 times/week.

Implementation of the trial components was poor. However, the results identified the importance of parental environment and mealtime structure on children's fruit and vegetable intake.