To assess the efficacy of two school-based programmes to promote students’ willingness to engage in lifestyle changes related to eating habits and physical activity behaviours.

Elementary school-based health promotion intervention, designed as a multicomponent experimental study, based on a behavioural epidemiological model.

Nine intervention and eight comparative public and private elementary schools.

The goal was to determine the impact on the longitudinally assessed outcomes of two programmes that addressed healthy nutrition and active living in a cohort of 2038 children. The evaluations used pre-intervention and follow-up student surveys that were based on the Transtheoretical Model of the stages of behaviour change.

In the intervention group, there were significant (P < 0·001) differences between the pre- and post-intervention times in the stages of change, with a reduction in the percentage of children at the pre-contemplation and contemplation stages and increased percentages at the preparation, action and maintenance stages, leading to healthier behaviours in fatty food consumption, fruit and vegetable consumption, physical activity and time spent in sedentary activities. The determinants of the behaviour stage were the intervention programme, the type of school and the presence of motivated teachers. The comparison group did not show significant differences between the pre- and post-intervention times for any of the stages of behaviour.

The intervention programme encouraged the students to make healthy lifestyle choices related to eating habits and physical activity behaviours.

Lycopene is a potent antioxidant, and it has been suggested that intake of tomatoes and tomato products containing lycopene is associated with a decreased risk of various chronic diseases. The aim of the present study was to evaluate the distribution of dietary lycopene intake in the Belgian population and to determine the most important contributors to lycopene intake.

Cross-sectional study.

National food consumption data from the Belgian Food Consumption Survey (BFCS) 2004 were used for the intake assessment. Determination of the lycopene content in foods was performed with HPLC-UV. Individual food consumption data were multiplied by the actual mean concentrations of lycopene per food.

Individuals (n 3083) aged 15 years and older participated in the study and provided two 24 h recalls.

The mean lycopene intake among Belgian adults was 4·1 (sd 2·3) mg/d or 0·059 (sd 0·033) mg/kg body weight per d. Lycopene intake among men (4·6 (sd 2·6) mg/d) was higher than among women (3·6 (sd 2·1) mg/d), and was higher in the younger compared with the older age groups. Cis-lycopene intake represented about one-third of the total lycopene intake. Tomatoes and tomato products (43 %) and sauces and ready-to-eat meals containing tomato sauces (41 %) were the main contributors to lycopene intake in Belgium.

The lycopene intake of the Belgian adult population was comparable to intakes reported in neighbouring countries and was below the acceptable daily intake.

To examine whether the recent increasing prevalence of obesity was accompanied by variations in energy and macronutrient intakes by weight status.

Time series of cross-sectional surveys.

National Health and Nutrition Examination Surveys (NHANES) in the USA.

Adult participants of NHANES I (1971–1974), II (1976–1980), III (1988–1994) and continuous (1999–2004).

Daily energy intake increased over time for men (9832 to 11 652 kJ, P < 0·01) and women (6418 to 8142 kJ, P < 0·01) in all BMI classes. Percentage of energy intake from carbohydrate increased over time (men: 42·7 % to 48·0 %, P < 0·01; women: 45·4 % to 50·6 %, P < 0·01), whereas percentage of energy intake from fat (men: 36·7 % to 33·1 %, P < 0·01; women: 36·1 % to 33·8 %, P < 0·01) and protein (men: 16·4 % to 15·1 %, P < 0·01; women: 16·9 % to 14·7 %, P < 0·01) decreased. With surveys combined, daily energy intake varied among BMI classes for women (underweight/normal weight: 7460 kJ; overweight: 6799 kJ; obese I: 7033 kJ; obese II/III: 7401 kJ; P < 0·01) but not men. Percentage of energy intake from carbohydrate decreased with increasing BMI class (men: 46·6 % to 45·5 %, P < 0·01; women: 49·0 % to 48·6 %, P < 0·01) whereas percentage of energy intake from fat (men: 34·3 % to 36·5 %, P < 0·01; women: 34·4 % to 35·4 %, P < 0·01) and protein (men: 15·3 % to 16·5 %, P < 0·01; women: 15·2 % to 16·0 %, P < 0·01) increased. Interactions of survey period and BMI class were not statistically significant.

Time trends in energy and macronutrient intakes were similar across BMI classes. Research examining how individuals respond differently to varying dietary compositions may provide greater insight about contributors to the rise in obesity.

To determine adherence to nutritional guidelines by pregnant women in New Zealand and maternal characteristics associated with adherence.

A cohort of the pregnant women enrolled into New Zealand’s new birth cohort study, Growing Up in New Zealand.

Women residing within a North Island region of New Zealand, where one-third of the national population lives.

Pregnant women (n 5664) were interviewed during 2009–2010. An FFQ was administered during the face-to-face interview.

The recommended daily number of servings of vegetables and fruit (≥6) were met by 25 % of the women; of breads and cereals (≥6) by 26 %; of milk and milk products (≥3) by 58 %; and of lean meat, meat alternatives and eggs (≥2) by 21 %. One in four women did not meet the recommendations for any food group. Only 3 % met all four food group recommendations. Although adherence to recommendation for the vegetables/fruit group did not vary by ethnicity (P=0·38), it did vary for the breads/cereals, milk/milk products and meat/eggs groups (all P<0·001). Adherence to recommendations for the vegetables/fruit group was higher among older women (P=0·001); for the breads/cereals group was higher for women with previous children (P<0·001) and from lower-income households (P<0·001); and for the meat/eggs group was higher for women with previous children (P=0·003) and from lower-income households (P=0·004).

Most pregnant women in New Zealand do not adhere to nutritional guidelines in pregnancy, with only 3 % meeting the recommendations for all four food groups. Adherence varies more so with ethnicity than with other sociodemographic characteristics.

The emphasis in school nutrition policy has been on vending and competitive items. Our study was designed to characterize and quantify the amount and source of other foods and beverages on school campuses.

A cross-sectional observational study was conducted using a specially designed objective nutrition observation system.

One low-income school district in southern California with six elementary and two middle schools.

Data were not collected from individual children. A total of 4033 students, 42 % of whom were Hispanic/Latino, 26 % African American and 21 % non-Hispanic white, were observed across school settings.

Data were collected continuously from 9 January 2008 to 16 June 2010. Healthy foods had, per serving, total energy ≤732 kJ (≤175 kcal), total fat content ≤35 %, total saturated fat ≤10 %, sugar less ≤15 g, sodium <200 mg and trans-fat ≤0·5 g. Healthy beverages were only 100 % juice or water, and unflavoured non-fat, 1 %, 2 % milk and soya or rice milk. The system had high inter-rater reliability (r = 0·78 to 0·99), percentage agreement (83 % to 100 %) and test–retest reliability (r = 0·81 to 0·98). Significantly more unhealthy foods and beverages than healthy items were observed on all campuses (P < 0·001). An average of 1·26 (sd 0·46) items per student per week was found with an average of 0·86 (sd 0·34) unhealthy items per child per week.

There were substantial amounts of unhealthy foods and beverages brought onto campuses for classroom rewards, celebrations and fundraising that should be targeted for intervention.

Mandatory folic acid fortification of breads in New Zealand was put on hold in 2009. At this time, bread manufacturers were requested to adopt greater voluntary fortification and agreed to add folic acid to approximately one-third of their bread range. We sought to evaluate the impact of increased voluntary fortification of bread and the proposed mandatory fortification programme on folate intake adequacy of reproductive-age women.

Cross-sectional study conducted in 2008. Dietary data were collected using 3 d weighed food records and usual folate intakes were generated by modifying the food composition table as follows: (i) voluntary fortification of bread as of 2008 (six breads); (ii) increased voluntary fortification of bread as of 2011 (thirty-four breads); and (iii) mandatory fortification of all breads. The prevalence of inadequate folate intake was calculated for all three scenarios using the Estimated Average Requirement (320 μg dietary folate equivalents/d) cut-point method.

New Zealand.

Healthy non-pregnant women (n 125) aged 18–40 years.

Usual folate intake in 2008 was 362 μg dietary folate equivalents/d. Increased voluntary bread fortification led to a marginal increase in folate intakes (394 μg dietary folate equivalents/d) and a decline in inadequacy from 37 % to 29 %. Mandatory fortification resulted in an increase of 89 μg folic acid/d, which substantially shifted both the proportion of women with folic acid intakes above 100 μg/d and the distribution of overall folate intakes, producing a marked reduction in inadequacy to 5 %.

Increased voluntary bread fortification efforts are far inferior to mandatory fortification as a reliable public health intervention.

A simple FFQ which ranks young children's dietary habits is necessary for population-based monitoring and intervention programmes. The aim of the present study was to determine the reliability and validity of a short FFQ to assess the dietary habits of young children aged 2–5 years.

Parents completed a seventeen-item FFQ for their children by telephone on two occasions, two weeks apart. Sixty-four parents also completed 3 d food records for their children. The FFQ included daily servings of fruit and vegetables, frequency of eating lean meat, processed meats, take-away food, snack foods (biscuits, cakes, doughnuts, muesli bars), potato crisps and confectionery, and cups of soft drinks/cordials, juice, milk and water. Weighted kappa and intra-class correlation coefficients were used to assess FFQ reliability and the Bland–Altman method was used to assess validity of the FFQ compared with the 3 d food record.

Seven pre-school centres in metropolitan Sydney, Australia.

Seventy-seven children aged 2–5 years.

The majority of questions had moderate to good reliability: κw ranged from 0·37 (lean meat) to 0·85 (take-away food consumption). Validity analysis showed a significant increase in mean values from the food record with increasing ordered categories from the FFQ for servings of vegetables and fruit and cups of drinks (all trend P ≤ 0·01). Spearman rank correlation coefficient was >0·5 for vegetables, fruit, diet soft drinks and fruit juice.

The FFQ provides reliable and moderately valid information about the dietary intakes and habits of children aged 2–5 years, in particular for fruit, vegetables and beverages.

To identify factors associated with the presence and severity of food insecurity among a sample of Honduran caregivers of young children.

Cross-sectional study in which the dependent variable, household food insecurity, was measured using a fourteen-item questionnaire developed and validated in a population of similar cultural context. A predictive modelling strategy used backwards elimination in logistic regression and multinomial logit regression models to compute odds ratios and 95 % confidence intervals for food insecurity.

Rural Honduras in the department of Intibucá, between March and April 2009.

Two-hundred and ninety-eight Honduran caregivers of children aged 6–18 months.

Ninety-three per cent of households were classified as having some degree of food insecurity (mild, moderate or severe). After controlling for caregiver age and marital status, compared with caregivers with more than primary-school education, those with less than primary-school education had 3·47 (95 % CI 1·34, 8·99) times the odds of severe food insecurity and 2·29 (95 % CI 1·00, 5·25) times the odds of moderate food insecurity. Our results also found that child anthropometric status was not associated with the presence or severity of food insecurity.

These results show that among the sociodemographic factors assessed, food insecurity in rural Honduras is associated with maternal education. Understanding key factors associated with food insecurity that are unique to Honduras can inform the design of interventions to effectively mitigate the negative impact of food insecurity on children.

High prevalence of hypovitaminosis D has been reported to be common in different regions of the Middle East. The objective of the present study was to examine the predictors of vitamin D deficiency and insufficiency in Bahrainis.

A cross-sectional study.

Blood transfusion volunteers at a blood bank.

Serum levels of total 25-hydroxyvitamin D, bone markers and other parameters such age, sex, season and clothing style in the 500 healthy Bahrainis were investigated.

In the entire cohort the prevalence of vitamin D deficiency was 49·4 % and the relative risk of vitamin D deficiency increased significantly by 1·1, 1·2, 1·5, 1·7 and 1·2 fold with younger age group (P = 0·03), hyperparathyroidism (P = 0·01), low serum Ca (P < 0·001), warm and hot months of the year (P < 0·0001) and female sex (P = 0·002), respectively. In females the prevalence of vitamin D deficiency was 67·6 % and the relative risk of vitamin D deficiency increased significantly by 1·1, 1·2, 1·2, 1·2 and 1·4 fold with younger age group (P = 0·04), hyperparathyroidism (P = 0·03), low serum Ca (P = 0·001), warm and hot months of the year (P = 0·001) and conservative clothing style (P = 0·04), respectively. In contrast, in males the prevalence of vitamin D deficiency was 31·2 % and the relative risk of vitamin D deficiency was increased by 1·6 fold in warm and hot months of the year (P < 0·0001).

High prevalence of low circulating levels of vitamin D and the relative risk factors associated with vitamin D deficiency and insufficiency observed in the present study suggest an urgent need for public health interventions including vitamin D food fortification in Bahrain.

The prevalence of overweight and obesity among children is on the rise worldwide. Prior studies find that parents’ child-feeding practices are associated with child weight status and the efficacy of specific parental child-feeding practices can be moderated by parenting styles. In the current longitudinal study, we examined the associations between child-feeding practices and weight status changes over 1 year among a sample of school-aged children in Taiwan.

In autumn 2008, a child-feeding questionnaire and parenting-style questionnaire were administered to parents of the second and fourth graders in an elementary school in Taiwan. The weight and height of the students were measured by a trained school nurse in 2008 and again in 2009.

An elementary school in central Taiwan.

A total of 465 parent–child pairs were included in the analysis.

Using a gender- and age-adjusted BMI classification scheme issued by the Taiwan Department of Health, 29·2 % of the students were considered overweight at the 2009 measurement. Controlling for 2008 weight status revealed moderating effects of parenting style on the relationship between child-feeding practices and child weight status. Both authoritative and authoritarian mothers might monitor their children's dietary intake; however, the effectiveness of this practice was better, in terms of weight status control, among the authoritative mothers.

Findings suggest that parenting styles have a moderating effect on specific parental child-feeding practices. Parenting styles and parent's feeding practices could be an important focus for future public health interventions addressing the rising childhood obesity epidemic.

Low- and middle-income countries are experiencing rises in the prevalence of adult obesity. Whether these increases disproportionately affect vulnerable subpopulations is unclear because most previous investigations were not nationally representative, were limited to women, or relied on self-reported anthropometric data which are subject to bias. The aim of the present study was to assess changes in the prevalence of obesity from 2005 to 2010 in Colombian adults; overall and by levels of sociodemographic characteristics.

Two cross-sectional, nationally representative surveys.

Colombia.

Men and women 18–64 years old (n 31 105 in 2005; n 81 115 in 2010).

The prevalence of obesity (BMI ≥30 kg/m2) was 13·9 % in 2005 and 16·4 % in 2010 (prevalence difference = 2·7 %; 95 % CI 1·9, 3·4 %). In multivariable analyses, obesity was positively associated with female sex, age, wealth, and living in the Pacific or National Territories regions in each year. In 2010, obesity was also associated with living in an urban area. The change in the prevalence of obesity from 2005 to 2010 varied significantly according to wealth; 5·0 % (95 % CI 3·3, 6·7 %) among the poorest and 0·3 % (95 % CI −1·6, 2·2 %) in the wealthiest (P, test for interaction = 0·007), after adjustment. Obesity rates also increased faster in older than younger people (P, test for interaction = 0·01), among people from urban compared with non-urban areas (P, test for interaction = 0·06) and in adults living in the Atlantic region compared with others.

Adult obesity prevalence has increased in Colombia and its burden is shifting towards the poor and urban populations.

To examine changes in the Na content of lunch/dinner menu offerings at eight of the leading fast-food restaurants in the USA between 1997/1998 and 2009/2010.

Menu offerings and nutrient composition information for the menu items were obtained from archival versions of the University of Minnesota Nutrition Coordinating Center (NCC) Food and Nutrient Database. Nutrient composition information for lunch/dinner menu items sold by the fast-food restaurants included in the present study was updated in the database biannually. Menus were analysed for changes in mean Na content of all menu offerings (except beverages) and specific categories of menu items among all restaurants and for each individual restaurant.

USA.

Lunch/dinner food menu of eight leading US fast-food restaurants.

Between 1997/1998 and 2009/2010 the mean Na content of menu offerings across the eight restaurants increased by 23·4 %. Examining specific food categories, mean Na content of entrées by increased 17·2 % and that of condiments increased by 26·1 %. Only side dishes showed a decrease of 6·6 %. None of the restaurants examined had a decrease in Na across the lunch/dinner menu offerings over the 14 years examined.

Results suggest that over the time period studied there has been no meaningful reduction in the Na content of lunch/dinner menu offerings at the leading fast-food restaurants examined in the present study.

To examine trends in stunting and overweight in Peruvian children, using 2006 WHO Multicentre Growth Reference Study criteria.

Trend analyses using nationally representative cross-sectional surveys from Demographic and Health Surveys (1991–2011). We performed logistic regression analyses of stunting and overweight trends in sociodemographic groups (sex, age, urban–rural residence, region, maternal education and household wealth), adjusted for sampling design effects (strata, clusters and sampling weights).

Peru.

Children aged 0–59 months surveyed in 1991–92 (n 7999), 1996 (n 14 877), 2000 (n 11 754), 2007–08 (n 8232) and 2011 (n 8186).

Child stunting declined (F(1, 5149) = 174·8, P ≤ 0·00) and child overweight was stable in the period 1991–2011 (F(1, 5147) = 0·4, P ≤ 0·54). Over the study period, levels of stunting were highest in rural compared with urban areas, the Andean and Amazon regions compared with the Coast, among children of low-educated mothers and among children living in households in the poorest wealth quintile. The trend in overweight rose among males in coastal areas (F(1, 2250) = 4·779, P ≤ 0·029) and among males in the richest wealth quintile (F(1, 1730) = 5·458, P ≤ 0·020).

The 2011 levels of stunting and overweight were eight times and three and a half times higher, respectively, than the expected levels from the 2006 WHO growth standards. The trend over the study period in stunting declined in most sociodemographic subgroups. The trend in overweight was stable in most sociodemographic subgroups.

Our objective was to determine whether a questionnaire can identify individuals with vitamin D insufficiency (VDI).

Women completed the Vitamin D & Sun (VIDSUN) questionnaire and we measured their serum 25-hydrocyvitamin D (25(OH)D) levels. We assessed the sensitivity and specificity of the questionnaire to identify VDI (25(OH)D level <50 nmol/l).

Clinical Research Unit, University of Wisconsin–Madison.

Postmenopausal women.

We recruited 609 postmenopausal women with a mean age of 61 (sd 6 years), of whom 113 (19 %) had VDI. Women with VDI were more likely to be black (17 % v. 2 %, P < 0·001), heavier (BMI 33·0 (sd 7) kg/m2 v. 29·0 (sd 7) kg/m2, P < 0·001) and less likely to tan in the past year (49 % v. 72 %, P < 0·001), use sunscreen (57 % v. 72 %, P < 0·001) or report sun exposure in the last 3 months. They consumed less vitamin D from supplements (2·15 (sd 5·24) μg/d (86 (sd 210) IU/d) v. 4·55 (sd 8·48) μg/d (188 (sd 344) IU/d), P = 0·003). In logistic regression models, black race, BMI, suntan within the past year, sun exposure in the past 3 months, sunscreen use and supplemental vitamin D intake were the most useful questions to identify VDI. From these six items, a composite score of ≤2·25 demonstrated ≥89 % sensitivity but ≤35 % specificity for VDI.

The VIDSUN questionnaire provides an initial tool to identify postmenopausal women at high or low risk of VDI. Existing studies suggest that inclusion of physical activity and TAG levels might improve the performance of the VIDSUN questionnaire.

The Dietary Approaches to Stop Hypertension (DASH) dietary pattern has been shown to reduce cardiometabolic risk. Little is understood about the relationship between objective diet quality and perceived diet quality (PDQ), a potential psychosocial barrier to appropriate dietary intake. We compared PDQ and diet quality measured by a nutrient-based DASH index score in the USA.

Cross-sectional study. Participants in the 2005–2006 National Health and Nutrition Examination Survey (NHANES) rated diet quality on a 5-point Likert scale and PDQ scores were generated (low, medium, high). A single 24 h dietary recall was used to estimate DASH index scores (range 0–9 points) by assigning 0, 0·5 or 1 point (optimal) for nine target nutrients: total fat, saturated fat, protein, cholesterol, fibre, Ca, Mg, K and Na.

Nationally representative sample of the US population.

Adults aged ≥19 years in 2005–2006 NHANES (n 4419).

Participants with high PDQ (33 %) had higher DASH index scores (mean 3·0 (sd 0·07)) than those with low PDQ (mean 2·5 (sd 0·06), P < 0·001), but average scores did not align with targets for intermediate or optimal DASH accordance. Adults with high PDQ reported higher total fat, saturated fat and Na intakes compared with optimal DASH nutrient goals. Differences between those with high v. low PDQ were similar for Whites and Blacks, but there was no difference between PDQ groups for Mexican Americans.

Among Whites and Blacks, but not Mexican Americans, high PDQ may be associated with higher diet quality, but not necessarily a diet meeting DASH nutrient goals. This disconnect between PDQ and actual diet quality may serve as a target in obesity prevention.

The present study investigated parents’ understanding and approaches to providing energy-dense and nutrient-poor ‘extra foods’ to pre-school children and explored variation between parents of low and high socio-economic status in relation to these issues.

We conducted thirteen focus groups. Data were subject to framework analysis.

Child-care centres in distinctly socially disadvantaged and socially advantaged areas.

Eighty-eight parents of children aged 3–5 years.

The three most common terms parents identified to describe foods that are not ‘everyday foods’ were ‘treats’, ‘sometimes foods’ and ‘junk’. Parents’ perceptions regarding what influences them in providing food to their children included seven sub-themes: (i) the influence of the child; (ii) food-related parenting practices; (iii) health considerations; (iv) food costs and convenience; (v) external factors perceived as influencing their child; (vi) factors related to child care; and (vii) social influences and occasions. Parents’ decision-making processes regarding provision of ‘extra foods’ related to moderation and balance. Parents generally expressed the position that as long as a child is eating healthy foods, then treats are appropriate; and for many parents, this might apply frequently. All groups described the health of their child as an influence, but parents in low socio-economic groups were more likely to describe immediate concerns (dental health, behaviour) in relation to avoiding sugar-dense food or drink.

The belief that provision of ‘extra foods’ can be frequent as long as children are eating a healthy balance of foods is factored into parents’ decision making. Challenging this belief may be important for reducing the consumption of ‘extra foods’ by young children.