To identify and describe dietary patterns in a cohort of pregnant women and investigate whether the dietary patterns are associated with dietary intake and sociodemographic factors.

Mothers entering the Finnish Type 1 Diabetes Prediction and Prevention (DIPP) Nutrition Study in 1997–2002 were retrospectively asked to complete a food-frequency questionnaire concerning their diet during pregnancy. Principal components analysis was used to identify dietary patterns.

Finland.

Subjects were 3730 women with a newborn infant carrying increased genetic susceptibility to type 1 diabetes mellitus.

Seven factors were identified and named. Energy intake correlated positively with ‘Healthy’, ‘Fast food’, ‘Traditional bread’, ‘Traditional meat’ and ‘Coffee’ patterns and inversely with the ‘Alcohol and butter’ pattern. Intake of dietary fibre correlated positively with ‘Healthy’, ‘Traditional bread’ and ‘Low-fat foods’ patterns and inversely with the ‘Alcohol and butter’ pattern. The seven dietary patterns seemed to account for relatively large proportions of the variance in energy and nutrient intakes except for the intake of vitamin D, vitamin C, carotenoids and calcium. Maternal age and higher level of education were associated with higher scores on ‘Healthy’, ‘Low-fat foods’ and ‘Alcohol and butter’ patterns.

Principal components analysis produced seven dietary patterns which may be useful for further research concerning maternal diet and health outcomes among both mothers and their offspring.

To assess the perceived outcomes associated with diet/food intake in the general adult population.

The Food Benefits Assessment (FBA©) questionnaire was developed from subjects’ verbatim transcripts (n 18) and after comprehension tests (n 5). Normal-weight (n 130) and overweight (n 67) subjects then completed the final questionnaire twice, 7 d apart. Psychometric properties were assessed, including construct validity by principal components analysis (PCA), concurrent validity (Spearman coefficient) with the Short Form-36 scale (SF-36), known-group validity by comparing FBA dimension scores according to lifestyle and clinical variables, internal consistency reliability (Cronbach’s α) and test–retest reproducibility in stable subjects over 1 week (intraclass correlation coefficient, ICC).

PCA and Multitrait analysis confirmed the final version of the FBA comprising forty-one items split into seven dimensions (vitality; digestive comfort; physical appearance; well-being; snacking; disease prevention; aesthetics). All dimensions displayed good item convergent validity (0·44 to 0·80), good concurrent validity (highest correlation between well-being dimension of FBA and mental health scale of SF-36, r = 0·83) and good known-group validity and reproducibility (ICC ≥ 0·76); internal consistency reliability was good to excellent (Cronbach’s α = 0·79 to 0·91).

The FBA is the first valid and reliable questionnaire that allows the assessment of diet effects and impact as perceived by subjects. It is a good candidate in the nutrition field for further use in specific population settings and with a particular food or daily diet. Linguistically validated English (UK and US) and German versions of the questionnaire are available.

The aim of the present study was to pilot-test a school-based interventiondesigned to increase consumption of whole grains by 4th and 5th gradechildren.

This multi-component school-based pilot intervention utilised aquasi-experimental study design (intervention and comparison schools) thatconsisted of a five-lesson classroom curriculum based on Social CognitiveTheory, school cafeteria menu modifications to increase the availability ofwhole-grain foods and family-oriented activities. Meal observations ofchildren estimated intake of whole grains at lunch. Children and parentscompleted questionnaires to assess changes in knowledge, availability,self-efficacy, usual food choice and role modelling.

Parent/child pairs from two schools in the Minneapolis metropolitan area; 67in the intervention and 83 in the comparison school.

Whole-grain consumption at the lunch meal increased by 1 serving (P < 0·0001) andrefined-grain consumption decreased by 1 serving for children in theintervention school compared with the comparison school post-intervention(P < 0·001).Whole-grain foods were more available in the lunches served to children inthe intervention school compared with the comparison schoolpost-intervention (P <0·0001). The ability to identify whole-grain foods by children inboth schools increased, with a trend towards a greater increase in theintervention school (P =0·06). Parenting scores for scales for role modelling (P < 0·001) and enablingbehaviours (P <0·05) were significantly greater for parents in the interventionschool compared with the comparison school post-intervention.

The multi-component school-based programme implemented in the current studysuccessfully increased the intake of whole-grain foods by children.

To document the prevalence and the socio-spatial variations of obesity and to identify individual and household characteristics, lifestyles and dietary practices contributing to obesity and its socio-spatial distribution.

Population-based cross-sectional survey. We selected 1570 households from four strata characterised as unstructured and low building-density (ULBD), unstructured and high building-density (UHBD), structured and low building-density (SLBD) and structured and high building-density (SHBD) areas. Structured areas are those that were allotted by the township authority (cadastral services), with public services; unstructured areas refer to those developed with no cadastral organisation.

Ouagadougou, the capital city of Burkina Faso.

BMI was calculated in 2022 adults aged 35 years and above who were classified as obese when their BMI was ≥30 kg/m2. Obesity was investigated in relation to household and individual characteristics, lifestyles and dietary practices; adjusted odds ratios with 95 % confidence intervals were derived from a logistic regression model.

The overall prevalence of obesity was 14·7 % (males 5·5 % and females 21·9 %). Age, gender, household equipment index, usual transport with motor vehicles and micronutrient-rich food consumption were associated with obesity. After adjustment for these factors, obesity remained associated with the area of residence: residents from SHBD areas were more likely to be obese than those from ULBD areas (OR = 1·41; 95 % CI 2·59,4·76).

Obesity in Ouagadougou is a preoccupant problem that calls for more consideration. Thorough investigation is needed to assess the environmental factors that contribute to the socio-spatial disparity of obesity.

Investigate the relationship between body mass index (BMI) and intake ofsugars and fat in New Zealand adults and children.

Secondary analyses of National Nutrition Survey (1997) andChildren’s Nutrition Survey (2002) data for the New Zealandpopulation. BMI calculated from height and weight; fat, sugars and sucrose(used as a surrogate for added sugars) intakes estimated from 24-hour dietrecall. Ethnic-specific analyses of children’s data.Relationships (using linear regression) between BMI and sugars/sucroseintakes; per cent total energy from fat; mean total energy intake fromsucrose. Subjects classified into diet-type groups by levels of intake offat and sucrose; relative proportions of overweight/obese children in eachgroup compared with that of normal weight subjects using design-adjustedχ2 tests.

New Zealand homes and schools.

4379 adults (15+ years); 3049 children (5–14 years).

Sugars (but not sucrose) intake was significantly lower among obese comparedto normal weight children. In adults and children, those with the lowestintake of sugars from foods were significantly more likely to beoverweight/obese. Sucrose came predominantly from beverages; in children,45% of this was from powdered drinks. Sucrose intake from sugary beverageswas not related to BMI. Per cent total energy (%E) from sucrose wassignificantly inversely related to %E from fat among adults and children.Proportions of overweight/obese adults or children in each diet-type groupdid not differ from that of normal weight individuals.

Current sugars or sucrose intake is not associated with body weight status inthe New Zealand population.

To investigate the beliefs of South African metropolitan adults regarding the importance of influencing cardiovascular health by eating certain food types, and to compare these beliefs between different race, living standards, age and gender groups.

Randomised cross-sectional study. Trained fieldworkers administered questionnaires by conducting face-to-face interviews with consumers.

Two thousand South Africans (16 years and older) were randomly selected from metropolitan areas in South Africa. The data were weighted to be representative of the total South African metropolitan population (N = 10 695 000) based on gender, age and race distribution.

The majority (94 %) of the population indicated that it is important to influence cardiovascular risk-related health issues by eating certain food types, especially the higher LSM (Living Standard Measure) groups within the different race groups. Weight loss was considered the least important (61 % indicated that it is important) compared with cholesterol lowering (80 %), blood pressure (89 %), diabetes (86 %) and healthy blood vessels (89 %). In the higher LSM groups (7–10) higher proportions of respondents agreed than in the lower LSM groups (2 and 3). No differences were seen in responses between different gender, race and age groups.

This study shows that the metropolitan South African adult population considers the influence on cardiovascular health by eating certain food types to be important. However, modifying weight loss by eating certain food types was considered less important.

The impact of acid–base balance on health is widely accepted. Here, we describe the potential renal acid load (PRAL) in the diet of healthy German children and adolescents.

The Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study is an ongoing longitudinal (open cohort) study (start 1985) collecting detailed data on diet, growth, development and metabolism in infants, children and adolescents.

Research Institute of Child Nutrition, Dortmund.

Seven hundred and twenty children and adolescents (351 boys and 369 girls), aged 3–18 years, provided 4187 yearly collected 3-day dietary records between 1995 and 2005.

Mean daily PRAL was positive in all age/sex groups (6–21 mEq day−1), and significantly higher in boys than in girls after the age of 8 years, even when calculated as mEq MJ−1. Fruits, vegetables and potatoes had a negative impact on PRAL; cheese, dairy products, cereals/bread and meat/fish/eggs had a positive impact. In a mixed linear model, PRAL, expressed as mEq day−1 and mEq MJ−1, remained stable during the study period, since time trends of PRAL-relevant food groups countervail each other. PRAL intake (mEq MJ−1) was significantly positively associated (P < 0.0001) with fat intake (% of energy intake, %E), but negatively with carbohydrate intake (%E; P < 0.0001).

The analysis of dietary habits in our sample of German children and adolescents showed a moderate excess of acidity. Especially older boys should be encouraged to eat more potatoes and vegetables as good sources of dietary alkalinity. The PRAL concept is compatible with current concepts for a healthy diet.

We evaluated the performance of the food-frequency questionnaire (FFQ) administered to participants in the US NIH–AARP (National Institutes of Health–American Association of Retired Persons) Diet and Health Study, a cohort of 566 404 persons living in the USA and aged 50–71 years at baseline in 1995.

The 124-item FFQ was evaluated within a measurement error model using two non-consecutive 24-hour dietary recalls (24HRs) as the reference.

Participants were from six states (California, Florida, Pennsylvania, New Jersey, North Carolina and Louisiana) and two metropolitan areas (Atlanta, Georgia and Detroit, Michigan).

A subgroup of the cohort consisting of 2053 individuals.

For the 26 nutrient constituents examined, estimated correlations with true intake (not energy-adjusted) ranged from 0.22 to 0.67, and attenuation factors ranged from 0.15 to 0.49. When adjusted for reported energy intake, performance improved; estimated correlations with true intake ranged from 0.36 to 0.76, and attenuation factors ranged from 0.24 to 0.68. These results compare favourably with those from other large prospective studies. However, previous biomarker-based studies suggest that, due to correlation of errors in FFQs and self-report reference instruments such as the 24HR, the correlations and attenuation factors observed in most calibration studies, including ours, tend to overestimate FFQ performance.

The performance of the FFQ in the NIH–AARP Diet and Health Study, in conjunction with the study’s large sample size and wide range of dietary intake, is likely to allow detection of moderate (≥1.8) relative risks between many energy-adjusted nutrients and common cancers.

To advance understanding of nutrition change dynamics and strategies needed to tackle complex global nutrition challenges.

Two frameworks, a descriptive framework of orders of change and a change model (Theory U), are introduced to advance understanding of how to promote effective action on a complex social problem like nutrition. The descriptive framework explores the types of change pursued by four current global nutrition initiatives and the strategies they use to achieve their goals. Theory U provides a conceptual model to help understand breakthrough or transformative change, i.e. change that shifts the entire system.

The focus is on global and regional nutrition initiatives.

Using the criteria of desired outcomes, purpose, participation and process, the orders of change framework categorizes programme strategies according to the levels of change likely to be achieved. Such a framework can help to structure conversations among actors about prerequisites for, and the likelihood of, transformative change. Theory U provides a conceptual framework to facilitate transformative change by providing insight into change processes and levers for action.

Nutrition is a complex social issue, and not only a biological or technical challenge. But nutritionists seldom inquire into the nature of changes required to achieve goals or the processes through which change occurs. Lack of understanding and failure to address such change processes directly mean that nutrition policies and programmes continue to fall short. There is a need to understand the dynamics of change in nutrition; to learn from current change experiences; and to create dynamic learning communities.

To determine factors associated with Food Stamp Program (FSP) participation in a potentially eligible California population.

The California Women’s Health Survey is an on-going annual telephone survey that collects data about health-related attitudes and behaviours from a randomly selected sample of women. Statistical procedures included χ2 and logistic regression.

California, USA, from 2002 to 2004.

A total of 527 FSP female participants and 1405 potentially eligible non-participant females, aged 18 years and older.

The following characteristics remained independently and positively related to FSP participation: single mother with children; unemployed; on welfare; on WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children); and US-born. Women under 25 years and those over 54 years were less likely to participate than women aged 25–54 years. Hispanic/Latino ethnicity was also negatively related to participation. Over 42 % of potentially eligible non-participants cited ‘don’t need them’ as the reason for not applying for FSP, but 34·9 % either do not think they are eligible or do not know how to apply. Potentially eligible non-participants who cite ‘don’t need them’ as a reason for not applying are less likely to be food insecure, to have inadequate income and to use alternative emergency aid, compared to women citing all other reasons. The highest level of need is among those who cite worry about citizenship or stigma as reasons for not applying.

Strategies to increase participation in FSP should incorporate messages that change the public’s perception of the programme, in addition to simplifying the application process, raising awareness of eligibility criteria and improving customer service.

A nationwide study was performed in Cuba to assess vitamin A status and theintake of vitamin-A-providing foods in children aged 6–11years.

The sample comprised 1191 schoolchildren from first to sixth grade, bothsexes, from municipalities randomly selected from the five eastern provincesof Cuba in 2002 (first semester) and from the four western and four centralprovinces in 2003 (first semester). A food-frequency questionnaire wascompleted by 2038 mother-and-child pairs.

Mean (±standard deviation) plasma retinol concentrations were 1.77± 0.48 μmol l−1 in the western,2.01 ± 0.56 μmol l−1 in thecentral and 1.40 ± 0.41 μmol l−1in the eastern region. No child had plasma retinol concentration below 0.35μmol l−1, indicative of a high risk ofclinical deficiency. Subclinical deficiency, plasma retinol concentration of0.35–0.7 μmol l−1, was seen in<2% of subjects in all three regions and was <5% evenin the two provinces with the worst vitamin A status (Guantánamo,4.6%; Las Tunas, 3.0%). Adequate status (>1.05 μmoll−1) was present in >90% of subjects inall western and central provinces, and in one of the eastern provinces(Holguín), whereas in the four remaining eastern provinces,adequate status was present in >75%. Only nine fruits andvegetables were consumed frequently (>3 times per week) by>50% of children. Thirty-seven per cent regularly consumed asupplement containing vitamin A.

Most Cuban children aged 6–11 years had adequate vitamin A status.Consumption of foods rich in vitamin and provitamin A, especiallyvegetables, was frequent but limited to a small variety of foods.

To determine the correlates of central adiposity.

Population-based cross-sectional study.

A total of 926 women (aged 40–60 years) from all districts of Tehran.

Demographic data were collected and anthropometric indices were measured according to standard protocols. Dietary intakes were assessed by means of a semi-quantitative food-frequency questionnaire. The suggested cut-off point for waist-to-hip ratio (WHR≥0.84) for Tehrani people, adjusted for their age group, was used to determine central adiposity. Logistic regression analysis was used to determine the correlates of WHR, which were adjusted for age, taking medications and body mass index (BMI). The components of dietary intake were determined by factor analysis. Pearson correlation was used to determine the association between the dietary components and WHR. Analysis of covariance was employed to compare the mean values of WHR in different lifestyle groups, with adjustment for BMI and age.

Mean WHR was 0.82 ± 0.06. The possibility of being centrally obese was higher in women with light physical activity (odds ratio: 2.11; 95% confidence interval: 1.40–2.53), depressed women (1.36; 1.02–1.93), smokers (1.21; 1.02–1.56) and unemployed women (1.41; 1.13–1.72). Marriage (1.31; 1.10–1.82), menopause (1.22; 1.02–1.61), low vitamin C intake (2.31; 1.25–4.25) and low calcium intake (1.30; 1.07–3.78) were associated with central fat accumulation. Dairy consumption was inversely correlated with central fat accumulation (r = −0.2, P < 0.05).

Central adiposity is associated with poor lifestyle factors including low physical activity, depression, smoking, low intake of vitamin C, low intake of calcium and dairy products and high fat consumption. Thus lifestyle modifications should be encouraged to achieve a healthier body shape.

Previous studies on the relationship of dietary intake to the neighbourhood food environment have focused on access to supermarkets, quantified by geographic distance or store concentration measures. However, in-store food availability may also be an important determinant, particularly for urban neighbourhoods with a greater concentration of small food stores. This study synthesises both types of information – store access and in-store availability – to determine their potential relationship to fruit and vegetable consumption.

Residents in four census tracts were surveyed in 2001 about their fruit and vegetable intake. Household distances to food stores in these and surrounding tracts were obtained using geographical information system mapping techniques. In-store fruit and vegetable availability was measured by linear shelf space. Multivariate linear regression models were used to measure the association of these neighbourhood availability measures with consumption.

Four contiguous census tracts in central-city New Orleans.

A random sample of 102 households.

Greater fresh vegetable availability within 100 m of a residence was a positive predictor of vegetable intake; each additional metre of shelf space was associated with 0.35 servings per day of increased intake. Fresh fruit availability was not associated with intake, although having a small food store within this same distance was a marginal predictor of fruit consumption.

The findings suggest the possible importance of small neighbourhood food stores and their fresh produce availability in affecting fruit and vegetable intake.

To evaluate the factors associated with discontinuation of breast-feeding before 12 months in order to make suggestions for achieving long-term breast-feeding.

A descriptive cross-sectional study.

Gazi University Medical School, Ankara, Turkey.

Mothers of 1230 children who discontinued breast-feeding at least 15 d before the last visit were asked to fill out a questionnaire about the discontinuation process. Logistic regression analysis was performed to assess the independent effects of factors that might influence breast-feeding discontinuation.

Mean breast-feeding duration of the study group was 11·04 (sd 7·45) months. Introduction of bottle-feeding correlated with discontinuation of breast-feeding (r = 0·507, P = 0·001). Important risk factors for discontinuation of breast-feeding before the first 12 months were not exclusively breast-feeding at 3 and 6 months, prematurity, not having a plan about breast-feeding duration and maternity leave duration of ≤91 d for working mothers. The common reasons for abandoning breast-feeding in the first and second 6 months were similar, namely the mother’s concerns about the sufficiency of breast milk. After 12 months and 18 months the reasons for discontinuation were the baby’s unwillingness to eat solid foods while breast-feeding and the mother’s perception that ‘the baby is old enough’, respectively.

The factors that improve long-term breast-feeding are successful exclusive breast-feeding in the first few months, intention of the mother to breast-feed and sufficient duration of maternity leave. This study emphasizes the importance of successful breast-feeding counselling during the first few months to achieve the desired long-term breast-feeding.

To measure factors affecting food choice in a sample of Greek schoolchildren attending 5th and 6th grade.

Three self-administered questionnaires were distributed to the participants – one on nutritional knowledge, one on self-efficacy and social support for dietary change and a food-frequency questionnaire.

One hundred Greek primary schools from Attica and Thessaloniki regions.

In total, 2439 students in 5th and 6th grades.

Principal components analysis was applied to extract the main factors affecting food choice of our subjects. Six components were derived explaining 66% of the total variation in factors affecting food choice. The first component was characterised by readiness to make the healthier choice when competitive foods are considered (explained variation 29%); the second was characterised by the impact of parents, friends and advertisements on students’ choices and also the impact of taste, smell and cooking method on the consumption of vegetables (explained variation 11%); the third component was characterised by readiness to choose fresh foods instead of ready-to-eat, pre-packaged choices as a main meal and awareness of the health value of fruits and vegetables (explained variation 8%); the other components mainly expressed the interdependence of the main factors.

Nutrition education and health promotion programs in Greece must include family members and activities regarding food preparation, as well as education and environmental changes in schools. Public health measures must include regulation of advertising. Moreover, the categorisation of foods as ‘healthier but less tasty’ and ‘appealing but unhealthy’ needs to be challenged in the future, since balanced nutrition is founded in variety and norm.

There are no data on optimal cut-off points to classify obesity among OmaniArabs. The existing cut-off points were obtained from studies of Europeanpopulations.

To determine gender-specific optimal cut-off points for body mass index(BMI), waist circumference (WC) and waist-to-hip ratio (WHR) associated withelevated prevalent cardiovascular disease (CVD) risk among Omani Arabs.

A community-based cross-sectional study.

The survey was conducted in the city of Nizwa in Oman in 2001.

The study contained a probabilistic random sample of 1421 adults aged≥20 years. Prevalent CVD risk was defined as the presence of atleast two of the following three risk factors: hyperglycaemia, hypertensionand dyslipidaemia. Logistic regression and receiver-operating characteristic(ROC) curve analyses were used to determine optimal cut-off points for BMI,WC and WHR in relation to the area under the curve (AUC), sensitivity andspecificity.

Over 87% of Omanis had at least one CVD risk factor (38% had hyperglycaemia,19% hypertension and 34.5% had high total cholesterol). All three indicesincluding BMI (AUC = 0.766), WC (AUC = 0.772) and WHR (AUC = 0.767)predicted prevalent CVD risk factors equally well. The optimal cut-offpoints for men and women respectively were 23.2 and 26.8 kgm−2 for BMI, 80.0 and 84.5 cm for WC, and 0.91 and0.91 for WHR.

To identify Omani subjects of Arab ethnicity at high risk of CVD, cut-offpoints lower than currently recommended for BMI, WC and WHR are needed formen while higher cut-off points are suggested for women.

A substantial fall in high-density lipoprotein cholesterol (HDL-C) during puberty in boys, but not girls, has been reported in Western populations. The fall in boys is believed to be due to hormonal changes – androgens have been shown to be associated with lower HDL-C, whereas oestrogens are associated with higher HDL-C. The fall in HDL-C during puberty was not observed, however, in a study of Moslem boys in Israel, nor in a group of Japanese boys. A diet high in phyto-oestrogens may account for the lack of a fall in HDL-C in these populations.

To examine the effect of dietary supplementation with phyto-oestrogens on the HDL-C concentration of adolescent boys from a Western population. We hypothesised that dietary supplementation of 50 mg of the isoflavones daidzein and genistein would produce a 12% higher HDL-C concentration than in controls at the end of a 6-week intervention period.

A randomised controlled trial.

Hellyer College in Burnie (Tasmania, Australia).

Adolescent boys (aged 16–18 years) were recruited through a letter sent to parents. A total of 132 eligible participants enrolled and five subjects withdrew from the trial.

No significant increase in HDL-C was observed in the treatment group (–0.02 mmol l–1, standard error (SE)=0.03, P = 0.53) or the placebo group (0.05 mmol l–1, SE = 0.03, P = 0.11).

Factors other than isolated dietary isoflavones may be responsible for the lack of fall in HDL-C during puberty in Japanese and Moslem boys.

To investigate time patterns of compliance with nutrient goals recommended by the World Health Organization (WHO).

A single aggregated indicator of distance from the key WHO recommendations for a healthy diet is built using FAOSTAT intake data, bounded between 0 (maximum possible distance from goals) and 1 (perfect adherence). Two hypotheses are tested for different country groupings: (1) whether adherence has improved over time; and (2) whether cross-country disparities in terms of diet healthiness have decreased.

One hundred and forty-nine countries, including 26 countries belonging to the Organisation for Economic Co-operation and Development (OECD) and 115 developing countries (including 43 least developed countries), with yearly data over the period 1961–2002.

The Recommendation Compliance Index (RCI) shows significant improvements in adherence to WHO goals for both developing and especially OECD countries. The latter group of countries show the highest levels of the RCI and the largest increase over time, especially between 1981 and 2002. No improvement is detected for least developed countries. A reduction in disparities (convergence of the RCI) is observed only within the OECD grouping.

Adherence to healthy eating guidelines depends on economic development. Diets are improving and converging in advanced economies, but developing and especially least developed countries are still far from meeting WHO nutrition goals. This confirms findings on the double burden of malnutrition and suggests that economic drivers are more relevant than socio-cultural factors in determining the healthiness of diets.