To investigate the predictors of change in physical activity (PA) from early to mid adolescence in a cohort of adolescents.

Prospective, population-based birth cohort study. PA level was evaluated by means of questionnaire, and was analysed in continuous form (min/week) and as a trajectory (inactive–inactive, inactive–active, active–inactive, active–active) based on the cut-off point of 300 min/week.

Pelotas, a city of 340 000 inhabitants in southern Brazil.

Adolescents (n 4120) followed from 11 to 15 years of age.

Maternal PA change and more exposure to outdoors were directly associated with a positive change in PA level (min/week) for both genders. Higher maturation status (among boys) and later menarche were also associated with positive PA change in min/week. Predictors to remain inactive were: maternal PA change (inverse association), more exposure to outdoors, higher socio-economic level, fear of living in the neighbourhood and non-overweight girls. Predictors to become inactive were higher socio-economic level among boys and increase in screen time among girls.

The study demonstrates that social, family, biological, behavioural and environmental factors exert an important role in the PA change among youngsters as they move into adolescence. These findings may be relevant to the design of policies and intervention programmes aimed at promoting PA in teenagers.

Nutrition-related health problems such as obesity are frequent among children and adolescents of Turkish descent living in Germany, yet data on their dietary habits are scarce. One reason might be the lack of validated assessment tools for this target group. We therefore aimed to validate protein and K intakes from one 24 h recall against levels estimated from one 24 h urine sample in children and adolescents of Turkish descent living in Germany.

Cross-sectional analyses comprised estimation of mean differences, Pearson correlation coefficients, cross-classifications and Bland–Altman plots to assess the agreement between the nutritional intake estimated from a single 24 h recall and a single 24 h urine sample collected on the previous day.

Dortmund, Germany.

Data from forty-three study participants (aged 5–18 years; 26 % overweight) with a traditional Turkish background were included.

The 24 h recall significantly overestimated mean protein and K intake by 10·7 g/d (95 % CI of mean difference: 0·6, 20·7 g/d) and 344 mg/d (95 % CI 8, 680 mg/d), respectively. Correlations between intake estimates were r = 0·25 (P = 0·1) and 0·31 (P = 0·05). Both methods classified 70 % and 69 % of the participants into the same/adjacent quartile of protein and K intake and misclassified 7 % and 7 %, respectively, into the opposite quartile. Bland–Altman plots indicated a wide scattering of differences in both protein and K intake.

Among children and adolescents of traditional Turkish descent living in Germany, one 24 h recall may only be valid for categorizing subjects into high, medium or low consumers.

The current study examined clustering of dietary intake and activity behaviours (i.e. physical activity (PA) and sedentary behaviour) in 5-year-old children, as well as the longitudinal association with BMI and overweight development.

Principal component analysis (PCA) was used to identify behavioural patterns. Backward regression analyses were used to examine the association of behavioural patterns with parent and child background characteristics, as well as the association of the patterns with BMI Z-score and overweight development up to ages 7 and 8 years.

The Netherlands.

Data originated from the KOALA Birth Cohort Study (n 2074 at age 5 years).

Four patterns emerged: a ‘sedentary-snacking’ pattern (including television viewing and snack consumption), a ‘healthy intake’ pattern (including healthy items such as fruit, vegetables and fish), a ‘sandwich’ pattern (including bread and sandwich fillings) and a ‘sporty-traditional meal’ pattern (including sports, meat and potatoes). The patterns were related to child gender, general appetite and various parental characteristics. The sedentary-snacking pattern was positively associated with longitudinal BMI development.

Cross-behavioural energy balance-related behavioural patterns exist at age 5 years. Different activity types (e.g. sports, television viewing) clustered differently with the behavioural patterns, indicating the need to incorporate these different types instead of one general PA measure in energy balance-related pattern analyses. The clustering and potential synergy between activity behaviours and dietary intake, as well as the associations with weight status development, stress the importance of an integrated approach to PA and healthy nutrition promotion in preventing childhood overweight.

Despite widespread concern over exploitation of the European Union's fish stocks, dietary guidelines in the UK continue to recommend two portions of fish per week. The present study sought to investigate whether health and/or sustainability are motivating factors when purchasing and consuming fish and whether there are sociodemographic trends.

A structured, self-completion postal questionnaire exploring consumers’ attitudes towards purchasing fish, their dietary intake, stated purchasing behaviour and sociodemographic information.

Nottinghamshire, UK.

Adults from 842 households randomly selected from the electoral register.

Over half of the participants (57·0 %) were aware of the health benefits of fish consumption and reported health as a primary motivator for purchasing fish; however, only 26·8 % actively sought to purchase fish from a sustainable source (e.g. Marine Stewardship Council (MSC) certified fish). Only 30·6 % of participants met current dietary recommendations for fish intake. Older respondents (>60 years of age) were more likely to report purchasing fish for health reasons and to buy MSC fish. Participants were significantly less likely to report MSC purchases if they agreed with the statement ‘I am confused about which type of fish I should be eating to protect fish stocks’ (P < 0·001).

The number of consumers purchasing fish for health reasons was more than those seeking sustainably sourced fish; yet, they still failed to meet the recommended intake set by the Food Standards Agency. Dietary advice to the public to increase consumption of fish conflicts with the prevailing pressure on fish stocks. Clear advice should be communicated enabling consumers to meet nutritional needs while protecting fish stocks.

The purpose of the present research was to investigate the epidemiological profile of the metabolic syndrome (MetS) and to explore its potential dietary, behavioural and socio-economic determinants among European adults residing in Luxembourg.

Cross-sectional, population-based ORISCAV-LUX survey.

European adults aged 18–69 years residing in Luxembourg.

A total of 1349 Europid adults, who participated in the ORISCAV-LUX survey, were included in the study. The prevalence of MetS was estimated according to the Revised-Adult Treatment Panel (R-ATPIII) criteria. Multivariate logistic regression was used to identify the dietary, behavioural and socio-economic factors independently associated with MetS.

The overall prevalence of MetS was 24·7 % with significant gender difference (18·5 % for women v. 30·8 % for men, P < 0·0001). Age, male gender, primary level of education, physical inactivity, family history of diabetes and hypertension and inadequate protein intake were identified as significant determinants of MetS, after adjusting for other socio-economic, family medical history and lifestyle factors.

MetS is a common condition among Europid adults in Luxembourg and increases dramatically with age, in both genders. Several dietary, socio-economic and behavioural factors explain the disparity observed. These findings highlight the importance of a comprehensive approach to MetS encompassing dietary, lifestyle and socio-economic aspects, both in clinical and community settings.

To examine the contribution of 100 % fruit juice (FJ) consumption to dietary adequacy of shortfall nutrients by children and adolescents.

Cross-sectional.

Secondary analysis of data from the 2003–2006 National Health and Nutrition Examination Survey (NHANES).

Children and adolescents aged 2–18 years (n 7250). Usual intake, determined from two 24 h dietary recalls, was calculated using the National Cancer Institute method. The population was dichotomized into consumers or non-consumers of 100 % FJ. The age/gender-specific percentage of the two consumption groups with intakes less than the Estimated Average Requirement or that exceeded the Adequate Intake for selected nutrients was determined. A Z-statistic for differences in population proportions was used to determine significance (P < 0·05).

Children aged 2–5 years had the highest percentage of 100 % FJ consumers (71·1 %), followed by children aged 6–12 years (57·0 %) and adolescents aged 13–18 years (44·5 %). Compared with 100 % FJ consumers, a significantly higher percentage of non-consumers had intakes below the Estimated Average Requirement for vitamin A (24·4 (se 2·5) % v. 42·2 (se 2·5) %), vitamin C (0·1 (se 0·2) % v. 38·9 (se 4·1) %), folate (8·8 (se 1·5) % v. 22·1 (se 2·4) %), P (11·6 (se 2·1) % v. 21·3 (se 2·6) %) and Mg (25·8 (se 1·7) % v. 46·1 (se 2·0) %). A greater percentage of 100 % FJ consumers exceeded the Adequate Intake for K (2·4 (se 0·5) v. 0·5 (se 0·2) %) compared with non-consumers.

Consumption of 100 % FJ is associated with improved nutrient adequacy and can contribute to a healthy diet.

To evaluate the successes and shortcomings of the community service programme implemented by the Department of Health (DOH) in South Africa by evaluating community service dietitians’ experiences and challenges during the 2009 community service year.

The study employed both quantitative and qualitative research designs. A national survey was conducted using a questionnaire to illicit information on community service dietitians’ working environments and the challenges they experienced. Furthermore individual interviews were conducted with a purposively selected subsample of community service dietitians to further explore issues that arose in the survey.

Data were collected from community service dietitians in the public health sector in South Africa.

Dietitians completing their community service year in 2009.

Of the 168 community service dietitians placed in 2009, 134 (80 %) participated in the survey, while five community service dietitians in each province (n 45) were interviewed. Overall the community service dietitians were positive about the community service year and reported that it improved their confidence, skills and competencies. However, they experienced challenges related to the orientation programme, supervision/mentoring, resources available, patient referrals and communication.

Despite the overall success of the community service year there are still challenges which the DOH needs to address in order to provide the best nutrition service possible for its patients.

The objective of the present study was to investigate the prevalences of overweight and obesity and their association with physical activity pattern among adolescents in northern Iran.

A cross-sectional study.

Babol, northern Iran.

A representative sample of 1200 adolescents aged 12–17 years was recruited. All selected adolescents were interviewed, their leisure-time and sport physical activities were collected by a standard Baecke questionnaire and their height and weight were measured by standard methods. The diagnosis of overweight and obesity was determined by comparing BMI values with the BMI index for age and sex percentiles set by the US Centers for Disease Control and Prevention in 2000.

The prevalences of overweight and obesity were 15·1 % and 8·3 %, respectively. The proportion of obesity was significantly higher in boys than in girls (10·2 % v. 6·5 %, P = 0·028). Overall, the levels of high, moderate and low leisure-time physical activity were 2·9 %, 79·4 % and 17·7 %, respectively. The corresponding levels of high, moderate and low sport physical activity were 17·4 %, 75·2 % and 7·4 %. The levels of leisure-time and sport physical activities were significantly higher among the boys than the girls (P < 0·001). There was also a significant association of studying in private schools and playing computer games with overweight/obesity (P < 0·001). Moderate leisure-time physical activity was unexpectedly associated with a greater risk of overweight/obesity compared with the low level (P = 0·002).

The findings indicate a high prevalence of overweight/obesity in these Iranian adolescents, particularly the boys. The influence of physical activity and diet on overweight/obesity requires further prospective studies.

The USA currently fortifies enriched cereal grain products (ECGP) with folic acid at 140 μg/100 g. In addition, folic acid can be voluntarily added to ready-to-eat cereals (RTEC) up to 400 μg/serving and it is found in many dietary supplements, most often at a dose of 400 μg. We sought to model folic acid intake under various fortification and supplementation scenarios.

The National Health and Nutrition Examination Survey is a population-based cross-sectional survey representative of the non-institutionalized, civilian US population. Information on folic acid intake is collected in two 24 h dietary recalls and survey questions on dietary supplement use, which allows estimation of usual total folic acid intake. We modelled five different levels of folic acid fortification in ECGP, while varying the amounts in RTEC and dietary supplements.

United States.

US adults (n 14 353) aged ≥19 years; non-pregnant women of childbearing age (n 4272).

The percentage of adults with usual daily folic acid intake above the tolerable upper intake level of 1000 μg was influenced more by the typical amount in supplements, while the median intake was influenced more by the ECGP fortification level. By manipulating the amount in at least two sources, it was possible to shift the distribution such that more women of childbearing age consumed the recommended intake of 400 μg of folic acid without increasing the percentage of adults with intake above the tolerable upper intake level. The results varied among population subgroups.

Our results suggest that combined strategies are required to meet population recommendations for folic acid intake.

To assess the presence of an association between vitamin D deficiency and anaemia in Jordanian infants and toddlers, in whom both vitamin D deficiency and anaemia have previously been proved to be common separately.

Cross-sectional prospective study.

Department of Paediatrics, Princess Rahma Teaching Hospital, Jordan.

Healthy infants and children aged 6–36 months who were seen for primary care.

Out of 203 infants and toddlers included in the study, the anaemia prevalence was 40·4 %. The prevalence of anaemia among infants (n 110) was 51·8 %, whereas it was 26·9 % among toddlers (n 93). No association between vitamin D status and anaemia was found.

Vitamin D deficiency is not a risk for anaemia in infants and toddlers.

Dairy food consumption is important for Australian children as it contributes key nutrients such as protein and Ca. The aim of the present paper is to describe dietary intake from dairy foods for Australian children aged 2–16 years in 2007.

Secondary analysis of a quota-sampled survey using population-weighted, 1 d (24 h) dietary recall data.

Australian national survey conducted from February to August 2007.

Children (n 4487) aged 2–16 years.

Most Australian children consumed dairy foods (84–98 %), with the proportion consuming tending to decrease with age and males consuming significantly more than females from the age of 4 years. Milk was the most commonly consumed dairy food (58–88 %) and consumed in the greatest amount (243–384 g/d). Most children consumed regular-fat dairy products. The contribution of dairy foods to total energy intake decreased with age; from 22 % of total energy at age 2–3 years to 11 % at age 14–16 years. This trend was similar for all nutrients analysed. Dairy food intake peaked between 06.00 and 10.00 hours (typical breakfast hours) corresponding with the peak in dairy Ca intake. Australian children (older than 4 years) did not reach recommendations for dairy food intake, consuming ≤2 servings/d.

The under-consumption of dairy foods by Australian children has important implications for intake of key nutrients and should be addressed by multiple strategies.

To assess the short-term impact of a nutritional intervention aimed at reducing childhood overweight in German pre-school children.

Using a cluster-randomized study design with waiting-list controls, we tested a 6-month intervention administered once weekly by a nutrition expert consisting of joint meal preparation and activities for children and parents such as tasting and preparing nutritious, fresh foods. At baseline, 6 and 12 months, a parent-completed questionnaire assessed fruit and vegetable intakes (primary outcomes) and water and sugared drinks consumption (secondary outcomes). Direct measurement assessed BMI, skinfold thickness and waist-to-height-ratio. An intention-to-treat analysis used random-effects panel regression models to assess the intervention effect, adjusted for each child's age, gender, immigrant background and maternal education.

Eighteen pre-schools from three south German regions.

Healthy children aged 3–6 years.

Three hundred and seventy-seven (80 %) eligible pre-school children participated in the study. Of these, 348 provided sufficient data for analysis. The sample mean age was 4·26 (sd 0·78) years; the majority (53·2 %) were boys. Children's fruit and vegetable intakes increased significantly (P < 0·001 and P < 0·05, respectively); no significant changes in the consumption of water, sugared drinks or anthropometric measurements were noted.

Nutritional interventions in pre-schools have the potential to change eating behaviours in young children, which in the long term might reduce risk for developing overweight.

To estimate the association between food intake and metabolic syndrome (MetS).

Cross-sectional design conducted from July 2006 to December 2007.

Adolescents assisted by the Family Doctor Program (FDP) in Niterói, a metropolitan area in Rio de Janeiro State, Brazil.

Survey of 210 adolescents. Individuals with three or more of the following components of MetS were classified as having this syndrome: TAG ≥ 110 mg/dl; HDL cholesterol < 50 mg/dl for girls aged 12–19 years and boys aged 12–14 years or <45 mg/dl for boys aged 15–19 years; waist circumference ≥75th percentile; serum glucose >100 mg/dl; and blood pressure ≥90th percentile. A semi-quantitative FFQ was used, and foods were grouped as: unprocessed or minimally processed foods (Group 1), processed culinary and food industry ingredients (Group 2) and ultra-processed foods (Group 3). The associations between food consumption and MetS were adjusted for sociodemographic, behavioural and family history covariates and were estimated using generalized estimation equations with the Poisson regression model.

MetS was diagnosed in 6·7 % of the adolescents; the most frequent diagnostic criteria included the reduction of HDL cholesterol (46·7 %), elevated serum glucose (17·1 %) and the elevation of waist circumference (16·7 %). Crude analysis showed higher average daily intakes of energy, carbohydrates and ultra-processed foods among adolescents with MetS. After statistical adjustment, the intake of ultra-processed foods (≥3rd quartile) remained associated with MetS (prevalence ratio = 2·5; P = 0·012).

High consumption of ultra-processed foods was associated with the prevalence of MetS in this adolescents group.

The relationship between food insecurity, maternal emotional distress and childhood morbidity in resource-poor settings is not well clarified. The present study aimed to assess independent associations between household food insecurity and childhood morbidity and potential modifications by maternal emotional distress.

A cross-sectional survey. A food security scale was used to assess household food insecurity; maternal reports were used to assess recent childhood illness; and the Hopkins Symptom Checklist was used to assess symptoms of emotional distress among mothers.

The Oromia Region, Ethiopia (rural area).

A total of 936 mother–child pairs.

Of 936 children assessed, 22·4 % had experienced diarrhoea, 20·7 % had cough and 21·5 % had fever in the 2 weeks preceding the interview. Household food insecurity was reported by 39 % of mothers. Greater food insecurity and greater maternal emotional distress were each independently associated with higher prevalence of cough and fever. Among mothers with low emotional distress, food insecurity was associated with a 2·3 times greater odds of diarrhoea in their children.

Household food insecurity may increase the risk of childhood illness in rural Ethiopia, and children having mothers with greater emotional distress may be at highest risk. These findings highlight the importance of strengthening policy initiatives aimed at reducing the high prevalence of food insecurity and emotional distress in Ethiopia.

To examine the contribution of selected child-, maternal- and household-related factors to child undernutrition across two different age groups of Kenyan under-5s.

Demographic and Health Survey data, multistage stratified cluster sampling methodology.

Rural and urban areas of Kenya.

A total of 1851 children between the ages of 0 and 24 months and 1942 children between the ages of 25 and 59 months in Kenya.

Thirty per cent of the younger children were stunted, 13 % were underweight and 8 % were wasted. Forty per cent of the older children were stunted, 17 % were underweight and 4 % were wasted. Longer breast-feeding duration, small birth size, childhood diarrhoea and/or cough, poor maternal nutritional status and urban residence were associated with higher odds of at least one form of undernutrition, while female gender, large birth size, up-to-date immunization, higher maternal age at first birth, BMI and education level at the time of the survey and higher household wealth were each associated with lower odds of at least one form of undernutrition among Kenyan children. The more proximal child factors had the strongest impact on the younger group of children while the intermediate and more distal maternal and household factors had the strongest impact on child undernutrition among the older group of children.

The present analysis identifies determinants of undernutrition among two age groups of Kenyan pre-school children and demonstrates that the contribution of child, maternal and household factors on children's nutritional status varies with children's age.

We examined the quality of food outlet addresses provided by secondary sources and determined whether they could be physically located in the field.

Addresses of food outlets in fourteen school districts in the northern part of Copenhagen were obtained from multiple business locators. We geocoded 202 addresses using a geographic information system and cross-referenced the sources against each other using a validation grid. Physical presence was determined via street survey. We applied gamma statistics and calculated positive predictive value, sensitivity and percentage agreement to assess the overall correspondence between our test of physical presence and each source of secondary information.

The study took place within city boundaries of Copenhagen, Denmark.

Food outlets within fourteen school districts within Copenhagen.

Positive predictive value between field results and secondary sources indicated good to excellent correspondence (range: 0·81–0·98), comparable with other studies. Gamma coefficients indicated low to high positive correspondence (range: 0·23–0·98).

Despite moderately high correspondence between secondary sources of address information and field observation, the findings illustrate that the use of combined sources is recommended.

To evaluate the effects on anencephaly risk of the interaction between the maternal profile of folate, vitamin B12 and homocysteine and the 677C→T polymorphism in the gene encoding methylenetetrahydrofolate reductase (MTHFR).

Case–control study paired (1:1) on maternity clinic, date of birth and state of residence. Cases of anencephaly were identified using the Registry of the Mexican Neural Tube Defect Epidemiological Surveillance System. Case and control mothers were selected from the same maternity departments. All mothers completed a structured questionnaire and blood samples were obtained to determine the MTHFR 677C→T polymorphism and biochemical profile.

Mexico, Puebla and Guerrero states, Mexico.

A total of 151 mothers of cases and controls were enrolled from March 2000 to February 2001. We had complete information on biochemical profile and MTHFR C677T polymorphism for ninety-eight mothers of cases and ninety-one mothers of controls.

The adjusted models show that the risk of anencephaly in mothers with 677TT genotype was reduced by 18 % (OR = 0·82; 95 % CI 0·72, 0·94) for each 1 ng/ml increment in serum folate. In terms of tertiles, mothers with 677TT genotype with serum folate levels in the upper tertile (>14·1 ng/ml) had a 95 % lower risk to have a child with anencephaly than mothers with serum folate levels in the first and second tertiles (P trend = 0·012).

Our data agree with the hypothesis of a gene–nutrient interaction between MTHFR 677C→T polymorphism and folate status. We observed a protective effect on anencephaly risk only in mothers with 677TT genotype as serum folate levels increased.

The aim of the present study was to investigate dietary sources of Na and K intakes among Flemish pre-school children using multiple linear regression analyses.

Three-day estimated diet records were used to assess dietary intakes. The contribution to Na and K intakes of fifty-seven food groups was computed by summing the amount provided by the food group for all individuals divided by the total intake for all individuals.

A random cluster sampling design at the level of schools, stratified by province and age, was used.

A representative sample of 696 Flemish pre-school children aged 2·5–6·5 years was recruited.

Mean Na intake was above and mean K intake was largely below the recommendation for children. Bread (22 %) and soup (13 %) were main contributors to Na intake followed by cold meat cuts and other meat products (12 % and 11 %, respectively). Sugared milk drinks, fried potatoes, milk and fruit juices were the main K sources (13 %, 12 %, 11 % and 11 %, respectively). Although Na and K intakes were positively correlated, several food categories showed Na:K intake ratio well above one (water, cheeses, soup, butter/margarine, fast foods and light beverages) whereas others presented a ratio well below one (oil & fat, fruits & juices, potatoes, vegetables and hot beverages).

Flemish pre-school children had too high Na and too low K intakes. The finding that main dietary sources of Na and K are clearly different indicates the feasibility of simultaneously decreasing Na and increasing K intake among children.