To adapt and test the relative validity of an instrument measuring the usual food intake of 6–10-year-old children.

An FFQ encompassing the preceding 6 months was adapted and compared with the average of three 24 h dietary recalls.

Private and public schools in Porto Alegre, capital city of Rio Grande do Sul, the southernmost state in Brazil, with 1·5 million inhabitants.

Children aged 6–10 years attending grades 1–4 in private and public schools in Porto Alegre.

Ninety-one children were studied. The FFQ overestimated all nutrients. Correlations with the values obtained by 24 h dietary recalls were mostly above 0·50. The deattenuated correlations increased for all nutrients. The κ coefficients for the adjusted nutrients varied from 0·12 (weak) to 0·34 (reasonable). Graphically, the FFQ was shown to underestimate some of the parameters and to overestimate others, with a wide CI for all nutrients.

The FFQ does not have the required relative validity to classify the intake levels of schoolchildren, and further investigation is required to understand the sources of error.

To determine the extent to which national and local UK guidelines for the early years sector address key recommendations for encouraging healthy eating based on best available evidence.

Phase 1 comprised a literature review to identify new evidence to assess current relevance of the Caroline Walker Trust (CWT) ‘Eating well for under-5 s in child care’ guidelines. Phase 2 assessed the completeness of seven local to national-level government guidelines by comparison with the ‘gold standard’ CWT guidelines.

Desk-based review using secondary data.

Research literature and statutory guidelines on healthy eating in early years settings.

Phase 1 retrieved seventy-five papers, of which sixty were excluded as they addressed compliance with nutritional and food-based standards only. One report examined a social marketing tool and was deemed too narrow. The remaining fourteen documents assessed interventions to encourage healthy eating in early years settings. Following quality assessment, seven documents were included. Nine key recommendations were identified: (i) role of government; (ii) early years setting policy/guidelines; (iii) training; (iv) menu planning; (v) parents; (vi) atmosphere and encouragement; (vii) learning through food; (viii) sustainability; and (ix) equal opportunities. Phase 2 identified that all seven guidelines included the nine key recommendations but sporadic cover of sub-key recommendations.

More detail is needed on how early years settings can encourage children to eat healthily. Research is required to develop second-layer guidance for interactive materials. Clear processes of communication and support for parents are required. Ways food relates to children's wider learning and social development need further thought, requiring collaboration between the Department of Health and the Department for Education.

To identify the dietary, lifestyle and socio-economic factors associated with the intake of whole grains (WG) in Norway, Sweden and Denmark.

A cross-sectional study.

Subsample of the Scandinavian cohort ‘HELGA’ consisting of three prospective cohorts: The Norwegian Women and Cancer Study; The Northern Sweden Health and Disease Study; and the Danish Diet, Cancer and Health Study.

A total of 8702 men and women aged 30–65 years. Dietary data are from one 24 h dietary recall and data on socio-economic status and lifestyle factors including anthropometric values are from the baseline collection of data.

Vegetables, fruits, dairy products, fish and shellfish, coffee, tea and margarine were directly associated with the intake of WG, whereas red meat, white bread, alcohol and cakes and biscuits were inversely associated. Smoking and BMI were consistently inversely associated with the intake of WG. Furthermore, length of education was directly associated with the intake of WG among women.

The intake of WG was found to be directly associated with healthy diet, lifestyle and socio-economic factors and inversely associated with less healthy factors, suggesting that these factors are important for consideration as potential confounders when studying WG intake and disease associations.

To identify predominant dietary patterns among Hispanic women and to determine whether adherence to dietary patterns is predicted by neighbourhood-level factors: linguistic isolation, poverty rate and the retail food environment.

Cross-sectional analyses of predictors of adherence to dietary patterns identified from principal component analysis of data collected using the Study of Women's Health Across the Nation FFQ. Census data were used to measure poverty rates and the percentage of Spanish-speaking families in the neighbourhood in which no person aged ≥14 years spoke English very well (linguistic isolation) and the retail food environment was measured using business listings data.

New York City.

A total of 345 Hispanic women.

Two major dietary patterns were identified: a healthy dietary pattern loading high for vegetables, legumes, potatoes, fish and other seafood, which explained 17 % of the variance in the FFQ data and an energy-dense dietary pattern loading high for red meat, poultry, pizza, french fries and high-energy drinks, which explained 9 % of the variance in the FFQ data. Adherence to the healthy dietary pattern was positively associated with neighbourhood linguistic isolation and negatively associated with neighbourhood poverty. Presence of more fast-food restaurants per square kilometre in the neighbourhood was significantly associated with lower adherence to the healthy diet. Adherence to the energy-dense dietary pattern was inversely, but not significantly, associated with neighbourhood linguistic isolation.

These results are consistent with the hypothesis that living in immigrant enclaves is associated with healthy dietary patterns among Hispanics.

To define the Mediterranean diet model inside a Mediterranean social and cultural food framework and from the perspective of a local model of consumption.

Reflexion and review of literature available in relation to the Mediterranean diet, locality and proximity.

Mediterranean region and its populations.

The Mediterranean local food system under the term Mediterranean diet encourages local production and local consumption. From this perspective, this model takes part of every local Mediterranean lifestyles and encourages sustainability.

From a local Mediterranean point of view and as a proximity model of consumption, Mediterranean food and diet can be a sustainable resource for the Mediterranean area.

To examine (i) situational characteristics of young adults’ eating occasions, including away-from-home eating, social influences and multi-tasking, and (ii) how these characteristics are associated with specific foods/beverages consumed.

Participants logged numerous characteristics of eating occasions (n 1237) in real time over 7 d.

Minneapolis/St. Paul metropolitan area (Minnesota, USA).

Forty-eight participants, aged 18–23 years.

Half of all eating occasions (46 %) occurred alone, 26 % occurred while watching television and 36 % involved other multi-tasking. Most participants (63 %) did not think about their food choices in advance of eating occasions. Eating that occurred in the absence of television viewing and/or other multi-tasking was less likely to include sweetened beverages and more likely to include items like water, fruit, vegetables, cereal, grains and entrées. Eating occasions occurring alone, and/or those occurring at home, were more likely to include snack foods that required little preparation (e.g. cookies, baked goods) and less likely to include more traditional meal items (e.g. fruits, vegetables, entrée items).

Overall, a large proportion of young adults’ eating occasions occurred alone, while engaging in other activities and with little advanced planning. Although many young adults’ eating occasions consist of a wide range of highly processed, energy-dense, convenience products, more traditional meal settings (i.e. eating at home with others in the absence of multi-tasking) may result in more structured mealtimes and better food choices, such as more fruits and vegetables. Effective behavioural strategies promoting positive eating patterns, including home meal preparation, are urgently needed among young adults.

To compare the prevalence of modifiable risk factors for cancer and other chronic diseases between adult cancer survivors and persons with no history of cancer.

Cross-sectional.

Population-based sample residing in California and Hawaii.

A total of 177 003 men and women aged 45–75 years who participated in the Multiethnic Cohort Study (MEC). Logistic regression was used to examine adherence to recommendations regarding modifiable risk factors among cancer survivors (n 16 346) when compared with cohort members with no history of cancer (n 160 657).

Cancer survivors were less likely than cohort members with no history of cancer to meet recommendations specified in the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) 2007 report (OR = 0·97; 95 % CI 0·96, 0·99). No difference between groups was seen for adherence to dietary recommendations alone (OR = 0·99; 95 % CI 0·98, 1·01). Site-specific analyses showed that results for colorectal cancer were similar to those for all cancers combined, but survivors of breast (OR = 1·04; 95 % CI 1·02, 1·07) and prostate (OR = 1·04; 95 % CI 1·01, 1·07) cancer were more likely to meet dietary recommendations. Latino survivors were less likely to adhere to WCRF/AICR recommendations than Latino controls; however, differences across ethnic groups were not significant (Pinteraction = 0·64).

The modest differences found between adult cancer survivors and persons with no history of cancer suggest that a diagnosis of cancer in itself may not be associated with improvements in health behaviours related to cancer and other chronic diseases.

Abdominal obesity is a major risk factor for chronic diseases. Yet there are no waist circumference (WC) cut-offs for children in the Arabian Gulf. We developed smoothed WC percentiles for 5–19-year-old Kuwaiti children and adolescents, which could be used in clinical and public health practice. We also examined the percentages of children who had WC ≥ 90th percentile, a value commonly associated with an elevated risk of CVD.

This is a cross-sectional study that was conducted by the Kuwait National Nutrition Surveillance System.

Data were collected from representative primary-, intermediate- and secondary-school children as part of the yearly nutrition and health monitoring. Least mean square regression was used to develop smoothed WC curves.

A total of 9593 healthy 5·0–18·9-year-old children of both sexes were studied from all areas of Kuwait. Age, gender, residency, education level, weight, height and WC were collected for all participants.

We developed the first smoothed WC curves for Kuwaiti children. Male children had higher WC than female children. WC increased with age in both genders, but larger percentages of male children had WC ≥ 90th percentile. Male children aged >10 years have higher WC percentiles than do female children at the 50th, 75th, 90th and 97th percentiles.

Male children (especially those aged >10 years) are at higher risk than female children. Few health-care professionals routinely measure WC. WC measurement should be promoted as an important tool in paediatric primary care practice. The use of these age- and gender-specific percentiles can impact public health recommendations for Kuwaiti and other Arab children from the Gulf.

To assess the public health significance of premature weaning of infants from breast milk on later-life risk of chronic illness.

A review and summary of recent meta-analyses of studies linking premature weaning from breast milk with later-life chronic disease risk is presented followed by an estimation of the approximate exposure in a developed Western country, based on historical breast-feeding prevalence data for Australia since 1927. The population-attributable proportion of chronic disease associated with current patterns of artificial feeding in infancy is estimated.

After adjustment for major confounding variables, current research suggests that the risks of chronic disease are 30–200 % higher in those who were not breast-fed compared to those who were breast-fed in infancy. Exposure to premature weaning ranges from 20 % to 90 % in post-World War II age cohorts. Overall, the attributable proportion of chronic disease in the population is estimated at 6–24 % for a 30 % exposure to premature weaning.

Breast-feeding is of public health significance in preventing chronic disease. There is a small but consistent effect of premature weaning from breast milk in increasing later-life chronic disease risk. Risk exposure in the Australian population is substantial. Approximately 90 % of current 35–45-year-olds were weaned from breast-feeding by 6 months of age. Encouraging greater duration and exclusivity of breast-feeding is a potential avenue for reducing future chronic disease burden and health system costs.

To report the prevalence rates and correlates for anaemia, iron deficiency (ID) and iron-deficiency anaemia (IDA) among Inuit preschool-aged children.

A cross-sectional study assessed iron intake, demographic information, medical history, anthropometrics, Hb, ferritin, C-reactive protein and antibodies to Helicobacter pylori.

Sixteen selected Inuit communities in Nunavut Territory, Canada.

Inuit (n 388) aged 3–5 years randomly recruited from communities.

Anaemia (3–4 years: Hb < 110 g/l; 5 years: Hb < 115 g/l) was prevalent in 16·8 % of children. The prevalence of ID (ferritin < 12 μg/l) was 18·0 % and that of IDA was 5·4 %. When ID was defined as ferritin <10 μg/l, 10·8 % of children were iron deficient and 3·3 % had IDA. In multiple logistic regression, boys were more likely to be iron deficient (OR = 2·28, 95 % CI 1·17, 8·25), but no other risk factor emerged for ID. Three- to 4-year-olds were less likely than 5-year-olds to have anaemia from causes other than ID (OR = 0·11, 95 % CI 0·08, 0·58). Anaemia from other causes was more common among children residing in crowded homes (OR = 2·30, 95 % CI 1·37, 12·31) and those treated for past-year ear infection (OR = 1·35, 95 % CI 1·05, 7·21).

The low prevalence of ID and IDA is encouraging, but efforts are still needed to reduce rates as they continue to be higher than general population rates. Household crowding and infections may contribute to anaemia and warrant further research.

Health logos are introduced to distinguish foods with ‘healthier’ nutrient composition from regular foods. In the present study, we evaluated the effects of changed food compositions according to health logo criteria on the intake of saturated fat, sugar and sodium in a Dutch population of young adults.

Foods in the Dutch food composition table were evaluated against nutrient criteria for logo eligibility. Three replacement scenarios were compared with the nutrient intake ‘as measured’ in the Dutch consumption survey. The foods not complying with health logo criteria were replaced either by ‘virtual’ foods exactly complying with the health logo criteria, with real 2007 market shares (scenario I) and 100 % market shares (scenario II), or by existing similar foods with a composition that already complied with the health logo criteria (scenario III).

The percentage reduction in nutrient intake with the current 2007 market shares of ‘health logo foods’ was −2·5 % for SFA, 0 % for sodium and −1 % for sugar. With a 100 % market share these reductions would be −10 % for SFA, −4 % for sodium and −6 % for sugar. This may lead to a reduction of −40 % for SFA, −23 % for sodium and −36 % for sugar in the most optimal replacement scenario.

With ‘health logo foods’, available in 2007 and current consumption patterns, small reductions can be achieved for SFA and sugar. For additional reductions, lowering the fat/sodium content of meat (products) towards health logo criteria and drinks without sugar towards limits far below health logo criteria would be the most effective reformulation strategy.

To develop a diet quality index (DQI) that assesses adherence to the Swedish nutrition recommendations (SNR) and the Swedish dietary guidelines (SDG).

A cross-sectional study within the Malmö Diet and Cancer (MDC) cohort. A diet history method collected dietary data, a structured questionnaire lifestyle and socio-economic information, and anthropometric data were collected by direct measurements. The index (DQI-SNR) included six components: SFA, PUFA, fish and shellfish, dietary fibre, fruit and vegetables, and sucrose.

Malmö, Sweden.

Men (n 4525) and women (n 8491) of the MDC cohort enrolled from September 1994 to October 1996.

For participants with high DQI-SNR scores, nutrient and food intakes were close to recommendations. However, most of the study population exceeded the recommended intake for SFA (98 %) and few reached recommended intakes for dietary fibre (24 %), fruit and vegetables (32 %), vitamin D (18 %) and folate (2 %). A high DQI-SNR score was positively associated with age, physical activity, not smoking, past food habit change, education and socio-economic status. Individuals with high scores were more likely to have a diabetes diagnosis or experienced a cardiovascular event.

Results suggest that the DQI-SNR is a useful tool for assessing adherence to the SNR 2005 and the SDG in the MDC cohort. No index has previously been developed with the aim of evaluating adherence to the current dietary recommendations in Sweden. Further validation of the DQI-SNR, and evaluation of its utility, is needed.

To assess race-specific validity of food and food group intakes measured using an FFQ.

Calibration study participants were randomly selected from the Adventist Health Study-2 (AHS-2) cohort by church, and then by subject-within-church. Intakes of forty-seven foods and food groups were assessed using an FFQ and then compared with intake estimates measured using six 24 h dietary recalls (24HDR). We used two approaches to assess the validity of the questionnaire: (i) cross-classification by quartile and (ii) de-attenuated correlation coefficients.

Seventh-day Adventist church members geographically spread throughout the USA and Canada.

Members of the AHS-2 calibration study (550 whites and 461 blacks).

The proportion of participants with exact quartile agreement in the FFQ and 24HDR averaged 46 % (range: 29–87 %) in whites and 44 % (range: 25–88 %) in blacks. The proportion of quartile gross misclassification ranged from 1 % to 11 % in whites and from 1 % to 15 % in blacks. De-attenuated validity correlations averaged 0·59 in whites and 0·48 in blacks. Of the forty-seven foods and food groups, forty-three in whites and thirty-three in blacks had validity correlations >0·4.

The AHS-2 questionnaire has good validity for most foods in both races; however, validity correlations tend to be higher in whites than in blacks.

To describe associations between demographic and individual and area-level socio-economic variables and restricted household food access due to lack of money, inability to lift groceries and lack of access to a car to do food shopping.

Multilevel study of three measures of restricted food access, i.e. running out of money to buy food, inability to lift groceries and lack of access to a car for food shopping. Multilevel logistic regression was conducted to examine the risk of each of these outcomes according to demographic and socio-economic variables.

Random selection of households from fifty small areas in Melbourne, Australia, in 2003.

The main food shoppers in each household (n 2564).

A lack of money was significantly more likely among the young and in households with single adults. Difficultly lifting was more likely among the elderly and those born overseas. The youngest and highest age groups both reported reduced car access, as did those born overseas and single-adult households. All three factors were most likely among those with a lower individual or household socio-economic position. Increased levels of area disadvantage were independently associated with difficultly lifting and reduced car access.

In Melbourne, households with lower individual socio-economic position and area disadvantage have restricted access to food because of a lack of money and/or having physical limitations due difficulty lifting or lack of access to a car for food shopping. Further research is required to explore the relationship between physical restrictions and food access.

Poor-quality diet, regarded as an important contributor to health inequalities, is linked to adverse health outcomes. We investigated sociodemographic and lifestyle predictors of poor-quality diet in a population sample.

A cross-sectional analysis of the Survey of Lifestyle, Attitudes and Nutrition (SLÁN). Diet was assessed using an FFQ (n 9223, response rate = 89 %), from which a dietary score (the DASH (Dietary Approaches to Stop Hypertension) score) was constructed.

General population of the Republic of Ireland.

The SLÁN survey is a two-stage clustered sample of 10 364 individuals aged 18 years.

Adjusting for age and gender, a number of sociodemographic, lifestyle and health-related variables were associated with poor-quality diet: social class, education, marital status, social support, food poverty (FP), smoking status, alcohol consumption, underweight and self-perceived general health. These associations persisted when adjusted for age, gender and social class. They were not significantly altered in the multivariate analysis, although the association with social support was attenuated and that with FP was borderline significant (OR = 1·2, 95 % CI 1·03, 1·45). A classical U-shaped relationship between alcohol consumption and dietary quality was observed. Dietary quality was associated with social class, educational attainment, FP and related core determinants of health.

The extent to which social inequalities in health can be explained by socially determined differences in dietary intake is probably underestimated. The use of composite dietary quality scores such as the DASH score to address the issue of confounding by diet in the relationship between alcohol consumption and health merits further study.

Fruit and vegetable consumption is a focus of research and nutrition education; yet, there is no universal agreement on the meaning of ‘fruits’ and ‘vegetables’. Our objective was to describe survey respondent perceptions about a set of foods with regard to whether the food is a fruit, vegetable or something else.

Three cross-sectional studies.

Two small studies involving cognitive interviewing sessions; and one large self-administered population survey.

US adults in two small studies (n 55 and 80) and one large survey (n 3312), all with multiple race/ethnicities.

Perceptions varied. In the survey, rice was considered a vegetable by about 20 % of respondents. In one small study, Spanish speakers were more likely to consider rice a vegetable, and Chinese speakers less likely, than were English speakers. Black beans were frequently classified as something other than vegetable or fruit. Among Hispanics, Spanish speakers were less likely than English speakers to consider beans a vegetable. Overall, tomatoes were classified as both fruit and vegetable, and these perceptions varied by race/ethnicity.

Substantial disagreement among the fruit, vegetable and other food domains highlights the importance of clearly defining the desired constructs. Foods that require specific instruction include rice, dried beans, potatoes, tomatoes and fruits and vegetables in mixtures and condiments. For measurement, additional questions or explanations may be needed to clarify which foods are of interest. For communication, the global message to increase consumption of fruit and vegetables should be reinforced with specific guidance.

To estimate dietary habits and other factors associated with inadequate blood pressure (BP) control in hypertensive patients adherent to antihypertensive drug treatment assisted by a Brazilian Family Doctor Program (FDP).

A cross-sectional study.

FDP units, Niterói, Rio de Janeiro, Brazil.

We included data from both male and female participants aged ≥20 years. Participants completed a standardized questionnaire containing questions related to demographics, socio-economic factors, comorbidities and lifestyle, as well as a validated FFQ and eleven additional qualitative questions to investigate dietary habits. Food items were divided into sixteen groups. Medical consultations were performed, BP measurements were taken, blood and urine samples were assessed and anthropometric and nutritional status was evaluated.

Individuals with inadequate BP control presented higher BMI values (prevalence ratio (PR) = 1·027, 95 % CI 1·009, 1·045) and also consumed more meat (PR = 1·091, 95 % CI 1·022, 1·165), which are potentially modifiable variables. Higher levels of serum creatinine (PR = 1·894, 95 % CI 1·241, 2·892) were also associated with inadequate BP control, as were skin colour (white). After inclusion of the Na excretion index, which is an indirect measure of salt intake, a slight decrease was observed in the PR for meat, which resulted in loss of statistical significance.

The results indicate that salt consumption, skin colour, BMI and serum creatinine are associated with inadequate BP control.

To describe the development of the Oxford WebQ, a web-based 24 h dietary assessment tool developed for repeated administration in large prospective studies; and to report the preliminary assessment of its performance for estimating nutrient intakes.

We developed the Oxford WebQ by repeated testing until it was sufficiently comprehensive and easy to use. For the latest version, we compared nutrient intakes from volunteers who completed both the Oxford WebQ and an interviewer-administered 24 h dietary recall on the same day.

Oxford, UK.

A total of 116 men and women.

The WebQ took a median of 12·5 (interquartile range: 10·8–16·3) min to self-complete and nutrient intakes were estimated automatically. By contrast, the interviewer-administered 24 h dietary recall took 30 min to complete and 30 min to code. Compared with the 24 h dietary recall, the mean Spearman's correlation for the 21 nutrients obtained from the WebQ was 0·6, with the majority between 0·5 and 0·9. The mean differences in intake were less than ±10 % for all nutrients except for carotene and vitamins B12 and D. On rare occasions a food item was reported in only one assessment method, but this was not more frequent or systematically different between the methods.

Compared with an interviewer-based 24 h dietary recall, the WebQ captures similar food items and estimates similar nutrient intakes for a single day's dietary intake. The WebQ is self-administered and nutrients are estimated automatically, providing a low-cost method for measuring dietary intake in large-scale studies.

Dietary fish is the main source of methylmercury (MeHg) for man, and fish consumption has been used as a measure of MeHg exposure. However, other dietary sources of exposure exist and MeHg metabolism may also be modified by nutritional factors. The aim of the present study was to examine the association between blood MeHg concentration and consumption of different foods in a Finnish population with high fish consumption.

Blood samples, a detailed FFQ and additional frequency data on fish consumption were collected. MeHg was analysed from whole blood by the isotope dilution method with high-resolution MS. The consumption of different foods was calculated by MeHg quartiles and tested for linear trend.

Finnish southern and south-western coast of the Baltic Sea.

Two hundred and ninety-nine professional fishermen, their spouses and other family members.

Mean (range) blood MeHg concentration was 4·6 (0·21–22) μg/l among men and 2·8 (<0·15–20) μg/l among women. Fish had the strongest positive association with MeHg (P for linear trend <0·001 among both men and women). Among men, positive associations were also observed for fruit vegetables, wheat and wine. Among women, positive associations were observed for root vegetables, legumes, potato and game, but adjustment for fish consumption attenuated these trends.

The study shows that, besides fish, MeHg may have other dietary sources that should be taken into account in risk assessment studies. Due to the observed high blood MeHg concentration, a thorough exposure assessment among the general Finnish population is recommended.