To compare dietary intake and physical activity (PA) between days of the week in a large sample of the Danish population; furthermore, to investigate the influence of gender and age as determinants for weekly variation.

Analysis was based on cross-sectional data from the Danish National Survey of Diet and Physical Activity 2011–2013. Dietary intake and PA were assessed by 7 d of pre-coded food diaries and pedometer-determined step counts. Dietary intake and PA on weekdays (Monday–Thursday), Friday, and weekend days (Saturday and Sunday) were compared using linear mixed models.

Survey with national representation, conducted in Denmark between 2011 and 2013.

A random sample of 4–75-year-old Danes, n 3934 and n 3530 in analysis of dietary intake and PA, respectively.

Energy intake during Friday and weekend days was 7–20 % higher compared with weekdays, while step counts were 10 and 17 % lower on Saturday and Sunday, respectively (all P < 0·001). Energy density of liquids and solids, consumption of added sugar, alcohol, discretionary foods, beer, wine and sugar-sweetened beverages were substantially higher, and consumption of dietary fibre, vegetables, fruit and wholegrain products were lower, during Friday and weekend days compared with weekdays (all P < 0·001). The observed patterns were present across gender and age, although weekly variation was most pronounced among children and relatively modest among the elderly.

Weekend health behaviours of Danes display less favourable eating and PA behaviour compared with weekdays, making the weekend an important target for public health interventions aiming to improve dietary intake and PA behaviour.

To examine the associations between serum 25-hydroxyvitamin D (25(OH)D) levels and serum liver enzymes in a representative sample of US adults.

The cross-sectional study sample consisted of 24 229 adults with data on serum 25(OH)D levels and serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and gamma-glutamyl transaminase (GGT) concentrations, in addition to data on other potential confounders. Multivariate logistic regression and linear regression were applied to assess the associations between serum 25(OH)D levels and ALT, AST, ALP and GGT concentrations.

The National Health and Nutrition Examination Survey, 2001–2006.

The cross-sectional study sample consisted of 24 229 adults.

We found a significant association between low serum 25(OH)D levels (<30 nmol/l) and ALP levels in all participants (OR 2·67; 95 % CI 1·98, 3·59; P < 0·001), a confirmed healthy population (OR 3·02; 95 % CI 2·25, 4·07; P < 0·001) and individuals with viral hepatitis (OR 2·87; 95 % CI 1·52, 5·44; P = 0·006) compared with those who had normal 25(OH)D levels (>50 nmol/l). Moreover, in both the logistic regression and linear regression, the associations between 25(OH)D levels and ALP levels were stronger in the subgroups with obesity. No association was present between ALT, AST or GGT levels and serum 25(OH)D levels in this population.

The results of the present study provide epidemiological evidence that vitamin D deficiency is associated with liver ALP levels in humans. This finding suggests a potential adverse effect of low 25(OH)D levels on human liver function. However, the underlying mechanisms still need further investigation.

Both vitamin D and Fe micronutrient deficiencies are common in Saudi Arabia but the association between them is unclear. The present study aimed to determine whether Fe indices are associated with vitamin D status and other metabolic markers in Arab adolescents.

Single-centre, cross-sectional study gathering anthropometrics, glucose and lipid profile. Serum 25-hydroxyvitamin D (25(OH)D), Fe, total iron-binding capacity (TIBC), transferrin saturation (%) and other parameters were measured.

Vitamin D School Project Database, King Saud University (2014–2016).

Arab adolescents aged 10–17 years randomly selected from the Vitamin D School Project Database (170 Saudi students; 100 girls, seventy boys).

Among Fe indices, only TIBC was found to be significantly and inversely associated with 25(OH)D (r = −0·20; P < 0·01) and only in girls (r = −0·20; P < 0·05). Among cardiometabolic parameters, serum Fe was associated with TAG in boys (r = 0·36; P < 0·01) and inversely associated with HDL-cholesterol in girls (r = −0·29; P < 0·05). Age was the most significant predictor of serum Fe for all participants, accounting for 5 % (R2 = 0·05; P = 0·004) of variance perceived. Serum 25(OH)D and age, on the other hand, were the most significant predictors for TIBC, accounting for 10·1 % (R2 = 0·10; P < 0·001) of variance perceived.

Among healthy Arab adolescents, the association between vitamin D and Fe indices, particularly TIBC, is modest, inverse and sex-dependent. Larger studies with inclusion of markers such as hepcidin and ferritin, vitamin D metabolites and endogenous sex hormones may provide a clearer view of this complex association.

Premenstrual syndrome (PMS) is a common cyclic psychological and somatic disorder which reduces women’s quality of life. Evidence regarding the association between dietary patterns (DPs) and PMS is rare. The study aimed to determine the relationship between dietary patterns and PMS.

The case-control study was conducted among women with confirmed PMS and healthy individuals recruited from healthcare centres.

Dietary data were collected using a validated semi-quantitative food frequency questionnaire and DPs were derived using principal component analysis. The association between DPs and likelihood of PMS was determined using logistic regression.

In total, 225 women with PMS and 334 healthy participants aged 20–46 years took part in the study.

Three major DPs were identified: (i) ‘western DP’ characterized by high intake of fast foods, soft drink, and processed meats; (ii) ‘traditional DP’ in which eggs, tomato sauce, fruits, and red meat were highly loaded; and (iii) ‘healthy DP’ high in dried fruits, condiments and nuts. After taking all possible confounders into account, individuals in the highest tertile of the western DP were more likely to experience PMS (odds ratio (OR) = 1·49; 95 % CI: 1·01, 3·52), P < 0·001), whilst both healthy and traditional DP was inversely associated with the syndrome (OR = 0·31; 95 % CI: 0·17, 0·72, P = 0·02; OR = 0·33; 95 % CI: 0·14, 0·77, P = 0·01, respectively).

The western dietary patterns were positively associated with PMS, whilst the healthy and traditional dietary patterns were inversely associated with it. Further longitudinal studies are required to confirm our findings.

The aim of the current study was to evaluate energy intake misreporting prevalence, its associated factors and its effects on nutrient intake, in the Portuguese population aged from 18 to 84 years.

Cross-sectional study.

Portugal.

Adults participants from the National Food, Nutrition and Physical Activity Survey, IAN-AF, 2015–2016, who provided two complete 24 h dietary recall and complete covariate information.

Under, plausible and over-reporters were identified according to the Goldberg method. Total misreporting prevalence was 29·9 %, being 28·5 % of under-reporting and 1·4 % of over-reporting. The current study found higher odds of being classified as an under-reporter especially in participants with higher BMI and in those who self-reported health perception status as non-favourable. Energy intake estimation increases by 853.5 kJ/d (204 kcal/d) when misreporters are excluded, and the same tendency is observed for macro and micronutrients. It is worth mentioning that the prevalence of inadequacy for protein intake decreases by about 5 % when considering plausible reporters.

The exclusion of misreporters has a small impact on the crude energy and nutrient estimates as well as on assessing the contribution of nutrients to total energy intake. However, a moderate impact was observed in the estimation of nutrient inadequacy prevalence.

To examine the association between food insecurity and emotional eating (EE) in US Latinxs and explore the mediating role of perceived stress.

Cross-sectional analysis. Food insecurity was measured with the six-item US Department of Agriculture Household Food Security Scale; EE with the Three-Factor Eating Questionnaire R18-V2; and perceived stress with Cohen’s Perceived Stress Scale-10. Covariates included age, sex, education, marital status, household size and country of birth. Mediation was tested using the Baron and Kenny method and the mediated proportion was calculated. Analyses included multivariable linear regression and multinomial logistic regression.

A largely Latinx city in Massachusetts, USA. Participants were recruited from a community health centre serving a large portion of this Latinx community.

Latinx individuals (n 580), aged 21–84 years.

Overall, 34·4 % were food insecure and 33·8 % experienced High EE. Food insecurity was associated (adjusted OR; 95 % CI) with higher odds of High EE (1·96; 1·28, 3·02) but not Low EE (1·27; 0·82, 1·99). Food insecurity was associated (β; 95 % CI) with higher perceived stress (5·69; 4·20, 7·19). Perceived stress was associated (adjusted OR; 95 % CI) with High EE (1·09; 1·06, 1·12) but not Low EE (1·00; CI 0·97, 1·02). When perceived stress was added in the main effects model, food insecurity was no longer associated (OR; 95 % CI) with High EE (1·31; 0·83, 2·07) and explained 69·9 % of the association between food insecurity and High EE.

The association between food insecurity and high EE among Latinxs may be largely mediated by perceived stress. Longitudinal studies are needed.

Understanding the association between diet quality and cardiometabolic risk by education level is important for preventing increased cardiometabolic risk in the Mexican population, especially considering pre-existing disparities in diet quality. The present study examined the cross-sectional association of overall diet quality with cardiometabolic risk, overall and by education level, among Mexican men and women.

Cardiometabolic risk was defined by using biomarkers and diet quality by the Mexican Diet Quality Index. We computed sex-specific multivariable logistic regression models.

Mexico.

Mexican men (n 634) and women (n 875) participating in the Mexican National Health and Nutrition Survey 2012.

We did not find associations of diet quality with cardiometabolic risk factors in the total sample or in men by education level. However, we observed that for each 10-unit increase in the dietary quality score, the odds of diabetes risk in women with no reading/writing skills was 0·47 (95 % CI 0·26, 0·85) relative to the odds in women with ≥10 years of school (referent). Similarly, for each 10-unit increase of the dietary quality score, the odds of having three v. no lipid biomarker level beyond the risk threshold in lower-educated women was 0·27 (95 % CI 0·12, 0·63) relative to the odds in higher-educated women.

Diet quality has a stronger protective association with some cardiometabolic disease risk factors for lower- than higher-educated Mexican women, but no association with cardiometabolic disease risk factors among men. Future research will be needed to understand what diet factors could be influencing the cardiometabolic disease risk disparities in this population.

To examine the impact of Nutrition for Life (NFL), a goal-setting nutrition education program, on the knowledge, self-efficacy and behaviour of adults eligible for Supplemental Nutrition Assistance Program-Education.

NFL was developed using a 4-week goal-setting behavioural strategy focused on nutrition, physical activity and meal planning techniques. A quantitative repeated-measures design using self-reported data was collected at pre- and post-interventions and at 1-week and 1-month follow-ups.

Two Federally Qualified Health Centers in Philadelphia, PA, USA.

A total of ninety-eight participants enrolled in the intervention; the majority were women (80·2 %), Black/Non-Hispanic (75·0 %) and 45–54 year old (39·6 %).

Participants showed significant improvement in knowledge, self-efficacy and behaviour. Specifically, mean daily intake for vegetables increased by 0·31 cup (P < 0·05) and for fruits by 0·39 cup (P < 0·01) at 1-week follow-up. Participants also showed healthier behaviour at 1-month follow-up. Planning at least seven meals per week increased from 14·8 to 50 % (P < 0·01), completing at least 30 min of physical activity every day in the last week increased from 16·7 to 36 % (P < 0·01) and consuming water with all meals increased from 39 to 70·6 % (P < 0·01).

The implementation of a goal-oriented nutrition education program offers a promising approach at achieving positive behaviour change among SNAP-eligible adults.

To examine the associations of changes in the local food environment, individual behaviours and perceptions with changes in dietary intake, following relocation from an established neighbourhood to a new residential development.

Spatial food environment exposure measures were generated relative to each participant’s home address using the locations of food outlets at baseline (before moving house) and follow-up (1–2 years after relocation). Self-reported data on socio-demographics, self-selection, usual dietary intake, individual behaviours and perceptions of the local food environment were sourced from the RESIDential Environments (RESIDE) Project. Changes in spatial exposure measures, individual behaviours and perceptions with changes in dietary outcomes were examined using mixed linear models.

Perth, Western Australia, 2003–2007.

Adults (n 1200) from the RESIDE Project.

Moving to a new residential development with more convenience stores and café restaurants around the home was significantly associated with an increase in unhealthy food intake (β = 0·049, 95 % CI 0·010, 0·089; β = 0·020, 95 % CI 0·007, 0·033) and was partially mediated by individual behaviours and perceptions. A greater percentage of healthy food outlets around the home following relocation was significantly associated with an increase in healthy food (β = 0·003, 95 % CI 0·001, 0·005) and fruit/vegetable intake (β = 0·002, 95 % CI 0·001, 0·004).

Policy and planning may influence dietary intakes by restricting the number of convenience stores and other unhealthy food outlets and increasing the relative percentage of healthy food outlets.

The present study investigated the association between dietary patterns and hypertension applying the Chinese Dietary Balance Index-07 (DBI-07).

A cross-sectional study on adult nutrition and chronic disease in Inner Mongolia. Dietary data were collected using 24 h recall over three consecutive days and weighing method. Dietary patterns were identified using principal components analysis. Generalized linear models and multivariate logistic regression models were used to examine the associations between DBI-07 and dietary patterns, and between dietary patterns and hypertension.

Inner Mongolia (n 1861).

A representative sample of adults aged ≥18 years in Inner Mongolia.

Four major dietary patterns were identified: ‘high protein’, ‘traditional northern’, ‘modern’ and ‘condiments’. Generalized linear models showed higher factor scores in the ‘high protein’ pattern were associated with lower DBI-07 (βLBS = −1·993, βHBS = −0·206, βDQD = −2·199; all P < 0·001); the opposite in the ‘condiments’ pattern (βLBS = 0·967, βHBS = 0·751, βDQD = 1·718; all P < 0·001). OR for hypertension in the highest quartile of the ‘high protein’ pattern compared with the lowest was 0·374 (95 % CI 0·244, 0·573; Ptrend < 0·001) in males. OR for hypertension in the ‘condiments’ pattern was 1·663 (95 % CI 1·113, 2·483; Ptrend < 0·001) in males, 1·788 (95 % CI 1·155, 2·766; Ptrend < 0·001) in females.

Our findings suggested a higher-quality dietary pattern evaluated by DBI-07 was related to decreased risk for hypertension, whereas a lower-quality dietary pattern was related to increased risk for hypertension in Inner Mongolia.

The origin of malnutrition in older age is multifactorial and risk factors may vary according to health and living situation. The present study aimed to identify setting-specific risk profiles of malnutrition in older adults and to investigate the association of the number of individual risk factors with malnutrition.

Data of four cross-sectional studies were harmonized and uniformly analysed. Malnutrition was defined as BMI < 20 kg/m2 and/or weight loss of >3 kg in the previous 3–6 months. Associations between factors of six domains (demographics, health, mental function, physical function, dietary intake-related problems, dietary behaviour), the number of individual risk factors and malnutrition were analysed using logistic regression.

Community (CD), geriatric day hospital (GDH), home care (HC), nursing home (NH).

CD older adults (n 1073), GDH patients (n 180), HC receivers (n 335) and NH residents (n 197), all ≥65 years.

Malnutrition prevalence was lower in CD (11 %) than in the other settings (16–19 %). In the CD sample, poor appetite, difficulties with eating, respiratory and gastrointestinal diseases were associated with malnutrition; in GDH patients, poor appetite and respiratory diseases; in HC receivers, younger age, poor appetite and nausea; and in NH residents, older age and mobility limitations. In all settings the likelihood of malnutrition increased with the number of potential individual risk factors.

The study indicates a varying relevance of certain risk factors of malnutrition in different settings. However, the relationship of the number of individual risk factors with malnutrition in all settings implies comprehensive approaches to identify persons at risk of malnutrition early.

To analyse usual intakes of energy, macronutrients and micronutrients, and their percentage of inadequacy, in a Brazilian population at severe food insecurity (SFI) risk, determined from a predictive model using two national databases.

Cross-sectional study. Our study used a statistical model to predict SFI using the 2009 National Sample Household Survey, where the Brazilian Food Insecurity Scale measured SFI.

Brazil.

The model was applied in a probabilistic sample of 34 003 Brazilians aged 10 years or older that participated in a national dietary survey during 2008–2009. The application of the model generated the probability of each individual being in SFI. The probability of SFI was grouped into quartiles (first quartile with the lowest SFI risk, fourth quartile with highest probability of SFI risk).

The intakes of macro- and micronutrients were associated with SFI. The amount of energy and nutrients in the diet tended to be lower among individuals in the fourth quartile, with highest probability of SFI. The average intake of all studied minerals (Ca, Fe, Na, Mg) was less in individuals in the fourth quartile. Only Na presented a higher percentage of inadequacy in the first quartile, the one with a lower chance of SFI.

The food intake of the Brazilian population at higher SFI risk is characterized by energy reduction, reduced consumption of macronutrients and high prevalence of inadequate micronutrient intakes, as well as a lower mean intakes, when compared with the first quartile with the lowest SFI risk.

To examine nutrient and food intakes according to the levels of skeletal muscle mass index (SMI) in the elderly.

Cross-sectional study.

Data were derived from the 2017 National Health and Nutrition Survey in Japan. SMI was calculated by dividing appendicular skeletal muscle (or lean) mass (kg) by height squared (m2). We calculated the multivariable-adjusted means of individuals’ dietary intake. Dietary intake of energy, nutrients and food categories was assessed by examining dietary records using a semi-weighed method and compared according to the sex-specific quartiles of SMI.

Men and women aged ≥60 years.

Among 797 men and 969 women, individuals with a higher SMI consumed more energy and more nutrients than did those with a lower SMI after adjusting for age, lifestyle and physical activity factors. After further adjusting for energy intake, total dietary fibre, vitamin A, vitamin B6, K, Fe and Cu were positively associated with higher SMI in men (Pfor trend < 0·05). For food categories, men with a higher SMI consumed more vegetables and meats, but the associations were attenuated after adjustment for energy and remained significant for vegetable only (Pfor trend = 0·018).

Japanese elderly people with a higher SMI consumed more energy and nutrients and more vegetables than did those with a lower SMI. This finding shows that diet is important in preventing muscle loss among the elderly in an ageing society.

To explore dietary differences according to socio-economic and sociocultural characteristics of adolescents and young adults.

A systematic review was conducted.

The main search source was MEDLINE, consulted between January 2012 and March 2017. Quality of selected studies was assessed based on dietary measurement method, sample selection, socio-economic indicator choice and statistical modelling.

Cross-sectional and longitudinal studies, assessing relationships between socio-economic status and dietary intake (patterns, scores and food groups) in the 10- to 40-year-old general population of high-income countries, were selected.

Among the 7250 reports identified, forty were selected, seventeen of which were of high quality; their conclusions, related only to adolescents, were combined and presented. The most favourable dietary patterns, higher dietary scores, greater consumption of fruits, vegetables and dairy products, and lower consumption of sugary sweetened beverages and energy-dense foods, were associated with better parental socio-economic status, particularly in terms of higher education. Migrant status was associated with plant-based patterns, greater consumption of fruits and vegetables and of sugary sweetened beverages and energy-dense foods. For the other food groups, and for young adults, very few high-quality studies were found.

The socio-economic gradient in adolescent diets requires confirmation by higher-grade studies of a wider set of food groups and must be extended to young adult populations. Future nutritional interventions should involve the most vulnerable adolescent populations, taking account of socio-economic status and migration.

To explore the relationships of serum 25-hydroxyvitamin D (25(OH)D) with obesity and metabolic parameters in US children.

Cross-sectional analysis. We evaluated the associations between serum 25(OH)D and multiple measurements of adiposity, serum lipid concentrations, fasting glucose and insulin resistance in children aged 6–18 years with adjustments for multiple covariates.

The National Health and Nutrition Examination Survey, 2001–2006.

A nationally representative sample of 6311 children and adolescents aged 6–18 years.

Among US children and adolescents, the prevalence of vitamin D deficiency has been especially high in older children, girls and the non-Hispanic Black population. Higher odds of obesity were found at a 25(OH)D concentration of <30 nmol/l (deficiency) than at >50 nmol/l under both criteria for obesity in children (OR = 3·27, Ptrend ≤ 0.001). Moreover, increased odds of having abnormal HDL-cholesterol (OR = 1·71, Ptrend ≤ 0.001) and impaired insulin resistance (OR = 4·15, Ptrend ≤ 0·001) were found for children deficient in 25(OH)D compared with those with normal 25(OH)D concentrations. When the children and adolescents were stratified by gender, we found stronger associations between serum 25(OH)D concentration and both HDL-cholesterol and insulin resistance in girls. No association of 25(OH)D with any other metabolic parameter was found.

Our results suggest a potential harmful association between low serum 25(OH)D concentration and the risk of obesity among children. However, the underlying mechanisms require further investigation.

Previous studies evaluating the associations of circulating Zn and Se levels with asthma have produced inconsistent results. Therefore, we conducted a meta-analysis to summarize and quantitatively synthesize the evidence from observational research.

Meta-analysis.

We searched PubMed, Web of Science and Scopus databases up to May 2019 for relevant available articles. Random-effects model was adopted to estimate the pooled standardized mean difference (SMD) with 95 % CI. Meta-regression analysis and ‘leave-one-out’ sensitivity analysis were used to assess heterogeneity.

The meta-analysis focused on general populations.

A total of twenty-six studies for Zn and forty studies for Se were included in the meta-analysis. The overall analyses identified that asthma patients had lower Zn (SMD = −0·40; 95 % CI −0·77, −0·03; I2 = 94·1 %) and Se (SMD = −0·32; 95 % CI −0·48, −0·17; I2 = 90·9 %) levels in serum or plasma compared with healthy controls. After removing the studies that contributed to the heterogeneity, the pooled SMD were −0·26 (95 % CI −0·40, −0·13; I2 = 37·42 %) for Zn and −0·06 (95 % CI −0·13, 0·02; I2 = 43·54 %) for Se.

Lower circulating Zn and Se levels might be associated with an increased risk of asthma.

Women in South Asia, including Nepal, have some of the poorest nutritional indicators globally, leading to poor maternal and child health outcomes. Nepal also suffers from high levels of household food insecurity, and newly married women are at high risk. Intra-household relationships may mediate the relationship between food insecurity and women’s nutrition in Nepal for newly married women. Our aim is to understand how newly married, preconception, women’s food consumption changes when she enters her husband’s home, compared with her natal home. We also explore whether relationship quality with husbands and mothers-in-law mediates the association between food insecurity and eating less high-quality food, using structural equation modelling.

Cross-sectional survey data.

Rural Nepal in 2018.

Data were collected from 200 newly married, preconception women.

Women had poor diet quality, and most ate fewer high-quality foods important for pregnancy in their marital, compared with natal, home. Higher quality relationships with mothers-in-laws mediated the association between food insecurity and a woman eating fewer high-quality foods in her marital, compared with natal, home. Relationship quality with husbands was not associated with changes in food consumption.

Preconception, newly married women in Nepal are eating less high-quality foods important for women’s health during the preconception period – a key period for avoiding adverse maternal and infant health outcomes. Relationships with mothers-in-law are key to women’s access to high-quality food, suggesting that interventions aiming to improve maternal and child nutrition should target all household members.

The Child Eating Behaviour Questionnaire (CEBQ), a widely used instrument that has been validated mostly in high-income countries, has limitations in its factorial validity when used among different cultures. This study examines whether the CEBQ instrument is culturally appropriate and valid to be used in a low- and middle-income country (LMIC) in a setting where child undernutrition remains prevalent.

The study employed a qualitative process to validate the content of items relative to the culture and setting, which was followed by a survey to test the psychometric properties of the instrument. Tests of factorial validity, convergent validity and reliability were performed.

Three different socio-economic settings of Yogyakarta, Indonesia.

The participants of this study were mothers of children aged 25–60 months. In-depth interviews were conducted with twenty-four mothers and the questionnaire validation process involved 238 mothers in the survey.

A Confirmatory Factor Analysis model with eight subscales provided the best fit (root-mean-square error of approximation = 0·048 (90 % CI 0·040, 0·057); Comparative Fit Index = 0·95 and Tucker Lewis Index = 0·95) after three new items and eight items from the original CEBQ were removed. Convergent validity with child’s weight was found for two subscales, slowness in eating and satiety responsiveness. Reliability measured using Cronbach’s alpha provided values between 0·62 and 0·78.

The original eight-factor structure of the CEBQ showed adequate content validity and provided factorial, discriminant and convergent validity with mothers of preschool children living in a LMIC where child nutrition remains a significant public health issue.

To examine if increased intake of locally available nutrient-dense foods among pregnant women improved the quality of their dietary intake and if use of the Theory of Planned Behaviour could explain changes in their dietary behaviour.

We used data from a randomised controlled trial where the intervention group received nutrition education and dietary counselling. We promoted the use of recipes that utilised powders to enhance dietary diversity. We examined how the intervention achieved changes in dietary intakes and used mixed effects logistic regression models with random effects at village level to explore changes over time of the outcomes, adjusted for selected explanatory variables.

The study was conducted in twenty villages in rural Malawi.

Data from 257 pregnant women who were enrolled during late first trimester and followed until birth.

The intervention achieved improvements in the Dietary Diversity Score (DDS) and the Six Food Group Pyramid (SFG) score, especially in intakes of micronutrient-rich foods. A third of the women in the intervention group attained optimal DDS, whereas about 50 % attained optimal SFG. The theorised behaviour mediators (i.e. nutrition attitudes, nutrition behaviour control and subjective norm) that had improved were also significantly associated with high DDS.

Improved dietary intakes were achieved through promoting the use of locally available nutrient-dense foods. Attainment of high DDS was a consequence of the women’s belief in the effectiveness of the proposed nutrition recommendations. We identified critical personal and environmental constraints related to dietary intakes during pregnancy in a low-resource setting.