Food-based dietary guidelines (FBDGs) are globally promoted as an importantpart of national food and nutrition policies. They are presented withinpolicy as key features of the strategy to educate the public and guidepolicy-makers and other stakeholders about a healthy diet. This paperexamines the implementation of FBDGs in four countries: Chile, Germany, NewZealand and South Africa – diverse countries chosen to explorethe realities of the FBDG within policy on public health nutrition.

A literature review was carried out, followed by interviews withrepresentatives from the governmental, academic and private sector in allfour countries.

In all four countries the FBDG is mainly implemented via written/electronicinformation provided to the public through the health and/or educationsector. Data about the impact of FBDGs on policy and consumers’food choice or dietary habits are incomplete; nutrition surveys do notenable assessment of how effective FBDGs are as a factor in dietary orbehavioural change. Despite limitations, FBDGs are seen as being valuable bykey stakeholders.

FBDGs are being implemented and there is experience which should be builtupon. The policy focus needs to move beyond merely disseminating FBDGs. Theyshould be part of a wider public health nutrition strategy involvingmultiple sectors and policy levels. Improvements in the implementation ofFBDGs are crucial given the present epidemic of chronic, non-communicablediseases.

To determine vitamin A (retinol) and fat concentrations in breast milk during early lactation.

Healthy lactating women (n 88) aged between 18 and 35 years were randomly selected for the study from urban, semi-urban, rural and estate (plantation) sectors of Galle District. Their anthropometry was recorded; breast milk samples were collected from the right breast one hour after the last feed. Breast milk retinol was determined by HPLC and fat content by the crematocrit method.

Subjects were in the 2nd to 9th month of lactation. Retinol concentrations of the breast milk samples ranged from 0·10 to 2·46 μmol/l, with a mean of 0·50 μmol/l, and correlated positively with parity (Pearson correlation coefficient, r = 0·307; P = 0·01) and negatively with period of lactation (r = −0·209; P = 0·05). The fat content of breast milk ranged between 5·09 and 56·46 g/l with a mean of 26·95 g/l. A significant difference in either breast milk fat or retinol content and mean birth weight of the babies was not seen between the groups. The ratio of retinol to fat in breast milk was positively correlated with weight (r = 0·274; P = 0·01) and height (r = 0·328; P < 0·001) of the mothers.

In this primary investigation on breast milk quality the fat content was found to be marginal; the majority of lactating mothers (92·0 %) were not providing the minimum daily requirement (1·05 μmol/l) of retinol to their babies.

To compare intake estimates, validity and reliability of two summary questions to measure fish consumption with information from a detailed semi-quantitative food-frequency questionnaire (FFQ) on fish consumption.

Population-based, cross-sectional study. Participants completed an FFQ and provided blood samples for erythrocyte membrane eicosapentaenoic acid (EPA) analysis. Aggregate measures of consumption of fresh/frozen/canned fish (fresh fish) and smoked/salted/dried fish (preserved fish) were generated from the FFQ and were compared with responses to the summary questions regarding intakes of similar items. Both methods were tested for validity, using correlation and linear regression techniques with EPA, and retest reliability.

Perth metropolitan area, Western Australia.

One hundred and nine healthy volunteers of both sexes, aged 21–75 years.

The summary fresh fish measure underestimated frequency and grams per week given by the aggregate question by about 50%, while estimates from the summary preserved fish measure were approximately three times that of the aggregate measure. Multiple linear regression analysis suggested that the aggregates accounted for more of the variation in EPA levels, but the difference was minimal. Intra-class correlations confirmed that both methods were reliable.

Our study indicates that extensive questioning results in different absolute intakes of fish compared with brief questioning, but does not add any information if ranking individuals according to overall consumption of fish.

To determine the reliability and validity of scales measuring low-fat milk consumption self-efficacy and norms during school lunch among a cohort of 5th graders.

Two hundred and seventy-five students completed lunch food records and a psychosocial questionnaire measuring self-efficacy and norms for school lunch low-fat milk consumption during the fall and spring semesters of the 1998–1999 academic year. Test–retest reliability was assessed in participants who also completed the questionnaire in the spring semester (n = 262). Principal component analyses identified and confirmatory factor analyses confirmed latent variables. Bivariate correlations measured construct validity.

Houston-area middle school.

Fifth graders (n = 275) from one middle school in southeast Texas.

Two scales measuring psychosocial influences of low-fat milk consumption were identified and proved reliable in this population: milk self-efficacy and milk norms. Milk self-efficacy and norms were positively correlated with milk consumption and negatively correlated with consumption of sweetened beverages.

These questionnaires can be used in similar interventions to measure the impact of self-efficacy and norms for drinking low-fat milk during school lunch.

To assess the potential nutritional contribution of meals provided in a sample of community programmes for homeless individuals, to determine the effect of food donations on meal quality and to develop food-based guidance for meals that would meet adults’ total nutrient needs.

Toronto, Canada.

An analysis of weighed meal records from eighteen programmes. The energy and nutrient contents of meals were compared to requirement estimates to assess contribution to total needs, given that homeless people have limited access to nutritious foods. Mixed linear modelling was applied to determine the relationship between the use of food donations and meal quality. The composition of meals that would meet adults’ nutrient requirements was determined by constructing simulated meals, drawing on the selection of foods available to programmes.

In all, seventy meals, sampled from eighteen programmes serving homeless individuals.

On average, the meals contained 2·6 servings of grain products, 1·7 servings of meat and alternatives, 4·1 servings of vegetables and fruits and 0·4 servings of milk products. The energy and nutrient contents of most meals were below adults’ average daily requirements. Most meals included both purchased and donated foods; the vitamin C content of meals was positively associated with the percentage of energy from donations. Increasing portion sizes improved the nutrient contribution of meals, but the provision of more milk products and fruits and vegetables was required to meet adults’ nutrient requirements.

The meals assessed were inadequate to meet adults’ nutrient requirements. Improving the nutritional quality of meals requires additional resources.

A national survey found that micronutrient deficiencies are prevalent in South African children, particularly calcium, iron, zinc, riboflavin, niacin, vitamin B6, folate, vitamin A, E and C. Mandatory fortification of maize meal and wheat flour were introduced in 2003 to combat some of the deficiencies found in children. To date however, there has not been a national survey on dietary intake in adults.

The main objectives of this study were to evaluate the micronutrient intake of the diet consumed by the average adult South African by means of secondary data analyses and secondly to evaluate the effects of fortification on selected nutrient intakes.

Secondary data analysis was carried out with numerous dietary surveys on adults to create a database that included sampling (and weighting) according to ethnic/urban–rural residence in line with the population census, of which 79% were black Africans and the majority resided in rural areas. The effect of fortification was evaluated by substituting fortified foods in the diet for the unfortified products.

The combined database used in this study comprised 3229 adults.

Mean calcium, iron, folate and vitamin B6 intakes were very low particularly in women. Mean intakes of most micronutrients were lower in rural areas. Fortification of maize meal and wheat flour (bread) raised mean levels of thiamine, riboflavin, niacin, vitamin B6 and folate above the recommended nutrient intakes (RNIs). In women, despite fortification, mean iron intakes remained below the RNIs, as did calcium since it was not in the fortification mix.

The average dietary intake of adults was of poor nutrient density, particularly in rural areas. Fortification of maize meal and wheat flour (bread) considerably improved mean vitamin B6, thiamine, riboflavin, niacin, folate and iron intakes as well as the overall mean adequacy ratio of the diet.

The aim of the present study was to describe the nature and extent of food marketing on popular children’s websites and food product websites in Australia.

Food product websites (n 119) and popular children’s websites (n 196) were selected based on website traffic data and previous research on frequently marketed food brands. Coding instruments were developed to capture food marketing techniques. All references to food on popular children’s websites were also classified as either branded or non-branded and according to food categories.

Websites contained a range of marketing features. On food product websites these marketing features included branded education (79·0 % of websites), competitions (33·6 %), promotional characters (35·3 %), downloadable items (35·3 %), branded games (28·6 %) and designated children’s sections (21·8 %). Food references on popular children’s websites were strongly skewed towards unhealthy foods (60·8 % v. 39·2 % healthy food references; P < 0·001), with three times more branded food references for unhealthy foods. Branded food references displayed similar marketing features to those identified on food product websites.

Internet food marketing uses a range of techniques to ensure that children are immersed in brand-related information and activities for extended periods, thereby increasing brand familiarity and exposure. The relatively unregulated marketing environment and increasing use of the Internet by children point to the potential increase in food marketing via this medium. Further research is required to investigate the impact of Internet food marketing on children’s food preferences and consumption, and regulatory options to protect children.

To investigate the relationship between BMI and blood pressure as this is of crucial interest in evaluating both public health and the clinical impact of the so-called obesity epidemic.

Data were gathered from 1899 children aged between 6 and 14 years, analysing and evaluating a possible relationship between BMI and systolic and diastolic blood pressure values for both girls and boys. Each child was classified on the basis of age- and sex-specific BMI percentile as normal weight (<85th percentile), overweight (≥85th and <95th percentile) or obese (≥95th percentile).

In comparisons among age–sex–BMI percentile groups, systolic and diastolic blood pressure values were higher in obese and overweight groups than in normal weight groups for both sexes. Although BMI among girls was higher than among boys in all three percentile groups, there were no significant differences between sexes with respect to blood pressure values.

The present findings emphasize the importance of the prevention of obesity in order to prevent future related problems such as hypertension in children and adolescents.

This paper examines trends in the neighbourhood food store environment (defined by the number and geographic density of food stores of each type in a neighbourhood), and in food consumption behaviour and overweight risk of 5779 men and women.

The study used data gathered by the Stanford Heart Disease Prevention Program in four cross-sectional surveys conducted from 1981 to 1990.

Four mid-sized cities in agricultural regions of California.

In total, 3154 women and 2625 men, aged 25–74 years.

From 1981 to 1990, there were large increases in the number and density of neighbourhood stores selling sweets, pizza stores, small grocery stores and fast-food restaurants. During this period, the percentage of women and men who adopted healthy food behaviours increased but so did the percentage who adopted less healthy food behaviours. The percentage who were obese increased by 28% in women and 24% in men.

Findings point to increases in neighbourhood food stores that generally offer mostly unhealthy foods, and also to the importance of examining other food pattern changes that may have a substantial impact on obesity, such as large increases in portion sizes during the 1980s.

To evaluate the relative validity of a food frequency questionnaire (FFQ) for assessing nutrient intakes in 6-month-old infants.

The FFQ was developed to assess the diets of infants born to women in the Southampton Women’s Survey (SWS), a population-based survey of young women and their offspring. The energy and nutrient intakes obtained from an interviewer-administered FFQ were compared with those obtained from a 4-day weighed diary.

A sub-sample of 50 infants aged 6 months from the SWS had their diets assessed by both methods. The FFQ recorded the frequencies and amounts of milks, baby foods, regular foods and drinks consumed by the infants over the previous seven days. The diaries recorded the weights of all foods and drinks consumed by the infants on four separate days within 15 days following FFQ completion.

Spearman rank correlation coefficients for intakes of energy, macronutrients and 18 micronutrients, determined by the two methods, ranged from r = 0·39 to 0·86; adjustment for energy intake tended to increase the correlation coefficients, range ra = 0·55 to 0·89. Bland–Altman statistics showed that mean differences between methods were in the range of −12·5 % to +12·5 % except for vitamin B12 (−18·9 %).

Although there were differences in absolute energy and nutrient intakes between methods, Spearman rank correlation coefficients indicated reasonable agreement in the ranking of intakes. The interviewer-administered FFQ is a useful tool for assessing energy and nutrient intakes of healthy infants aged about 6 months.

The Western Australian Health Department’s Go for 2&5® campaign aimed to increase adults’ awareness of the need to eat more fruit and vegetables and encourage increased consumption of one serving over five years.

The multi-strategy fruit and vegetable social marketing campaign, conducted from 2002 to 2005, included mass media advertising (television, radio, press and point-of-sale), public relations events, publications, a website (www.gofor2and5.com), and school and community activities. Campaign development and the evaluation framework were designed using health promotion theory, and assessed values, beliefs, knowledge and behaviour. Two independent telephone surveys evaluated the campaign: the Campaign Tracking Survey interviewed 5032 adults monitoring fruit and vegetable attitudes, beliefs and consumption prior to, during and 12 months after the campaign; and the Health & Wellbeing Surveillance System surveyed 17 993 adults between 2001 and 2006, continuously monitoring consumption.

Population public health intervention–social marketing campaign in Western Australia, population of 2 010 113 in 2005.

Adults in the Perth metropolitan area.

The campaign reached the target audience, increasing awareness of the recommended servings of fruit and vegetables. There was a population net increase of 0.8 in the mean number of servings of fruit and vegetables per day over three years (0.2 for fruit (1.6 in 2002 to 1.8 in 2005) and 0.6 for vegetables (2.6 in 2002 to 3.2 in 2005), significant at P < 0.05).

Sustained, well-executed social marketing is effective in improving nutrition knowledge, attitudes and consumption behaviour. The Go for 2&5® campaign provides guidance to future nutrition promotion through social marketing.

To assess the clinical and cost-effectiveness of different methods of cleaning and sterilisation of infant feeding equipment used in the home.

Systematic review of studies from developed countries on the effectiveness of methods of cleaning and sterilisation of infant feeding equipment used in the home. A brief telephone survey of UK-based manufacturers of infant feeding equipment and formula to ascertain the evidence base used for their recommendations, and a comparison of current relevant guidelines in developed countries, informed the work.

National guidelines from six countries demonstrated variation and lack of evidence to support current guidance. Manufacturers did not report evidence of effectiveness to support their recommendations. Nine studies were identified; eight conducted between 1962 and 1985 and one in 1997. All had methodological weaknesses. Hand-washing was identified as fundamentally important. Health professionals were reported as not providing appropriate education on the importance and methods of cleaning and sterilisation. Mothers of subsequent babies and women from lower socio-economic groups were less likely to follow recommended procedures.

There is a lack of good-quality evidence on effective ways of cleaning and sterilising infant feeding equipment in the home. The evidence base does not answer the question about which of the methods in common use is most effective or most likely to be used by parents. Hand-washing before handling feeding equipment remains important. Further research on the range of methods used in the home environment, including assessment of the views of parents and carers, is required.

To assess the nutritional status of Tunisian adolescents and associated factors.

A cross-sectional study based on a national stratified random cluster sample.

In all, 1295 boys and 1577 girls aged 15–19 years, of whom 28·4 % had already left school. Socio-economic characteristics of the parents, anthropometric measurements, food behaviours and physical activity of the adolescents were recorded during home visits.

Prevalence of underweight, overweight and obesity (WHO/National Center for Health Statistics reference) were, respectively, 8·1 %, 17·4 % and 4·1 % among boys and 1·3 %, 20·7 % and 4·4 % among girls; abdominal obesity was highly prevalent among both sexes. Prevalence of overweight differed by region (from 11·5 % to 22·2 %) and was higher in urban v. rural areas for males (21·7 % v. 10·4 %) but not for females (21·7 % v. 19·2 %). These differences were partially mediated by socio-economic and lifestyle factors for males. For females, influence of cultural factors is hypothesised. In rural areas, overweight was more prevalent among boys of higher economic level households, having a working mother or a sedentary lifestyle; for girls, prevalence increased with the level of education of the mother. In urban areas, prevalence of overweight was related to eating habits: it was higher for boys with irregular snacking habits and for girls skipping daily meals. Urban girls having left school were also more overweight.

Overweight and abdominal obesity in late adolescence have become a true public health problem in Tunisia with the combined effects of cultural tradition for girls in rural areas, and of rapid economic development for boys and girls in cities.

In light of the emerging obesity pandemic, front-of-pack calories labels may be an important tool to assist consumers in making informed healthier food choices. However, there is little prior research to guide key decisions on whether caloric content should be expressed in absolute terms or relative to recommended daily intake, whether it should be expressed in per serving or per 100 g and whether the information should be further brought alive for consumers in terms of what the extra calorie intake implies in relation to activity levels. The present study aimed at providing more insight into consumers’ appreciation of front-of-pack labelling of caloric content of food products and their specific preferences for alternative execution formats for such information in Europe.

For this purpose, eight executions of front-of-pack calorie flags were designed and their appeal and information value were extensively discussed with consumers through qualitative research in four different countries (Germany, The Netherlands, France and the UK).

The results show that calories are well-understood and that participants were generally positive about front-of-pack flags, particularly when flags are uniform across products. The most liked flags are the simpler flags depicting only the number of calories per serving or per 100 g, while more complex flags including references to daily needs or exercise and the flag including a phrase referring to balanced lifestyle were least preferred. Some relevant differences between countries were observed. Although participants seem to be familiar with the notion of calories, they do not seem to fully understand how to apply them.

From the results, managerial implications for the design and implementation of front-of-pack calorie labelling as well as important directions for future research are discussed.

Among adults with diabetes attempting to change their own diets, we explored how these adults approached providing food for their children and how their children reacted to dietary changes in the household.

The research design used semi-structured parallel individual interviews of adults and a child (aged 10–17 years) in their home. Interviews were audio-taped, transcribed, coded and analysed for themes.

Subjects included families in which one inner-city African American or Latino adult with diabetes had completed a diabetes intervention promoting healthy dietary behaviours.

We completed 29 interviews (14 adult–child pairs and one child). Adults approached making dietary changes for themselves and also providing food for their family in different ways, ranging from expecting everyone to eat the same thing to preparing two separate meals. Many children resisted dietary changes while fewer acquiesced. Among children who went along with changes, some reported resisting initially then adjusting, while others did not resist because the food still tasted good or they could obtain preferred foods outside the house. The intersection of adults’ meal strategies and children’s reactions to the changes can be used to categorise families into different patterns. These patterns highlight the tension between an adult who must make dietary changes to control diabetes and a child who is not necessarily motivated to change.

From this framework we suggest hypotheses about how these patterns might influence dietary behaviour in adults and children. Understanding these patterns could guide interventions to assist parents in successfully including children in their dietary changes.

To evaluate the effect of two types of iron pots on haemoglobin (Hb) and serum ferritin (SF) concentrations in young children (6–24 months), adolescent girls (11–15 years) and women of reproductive age (15–44 years), whose households were provided with iron pots for cooking food over a period of 6 months, compared with controls.

We randomly assigned 161 households including 339 individuals from the three subgroups to cast iron pots, blue steel pots or oral iron supplements (control). In the control group, children received micronutrient Sprinkles™, and adolescent girls and women received iron tablets daily for 6 months. We measured Hb, SF and C-reactive protein concentrations at baseline and 6 months, and compared groups using regression models.

Anaemia prevalence (Hb < 110 g l−1 in infants, Hb < 120 g l−1 in girls or women) was 47% (cast iron group), 50% (blue steel group) and 50% (control) at baseline. At 6 months, there were no significant differences in Hb concentrations among groups; however, differences in SF concentrations were significant (P < 0.0001) – the control group had higher SF concentrations compared with the groups using iron pots. Also, differences in the prevalence of iron-deficiency anaemia (IDA; anaemia plus SF < 15 μg l−1) were almost significant between cast iron and control groups (P = 0.08), and blue steel and control groups (P = 0.05).

There is no evidence that iron cooking pots are effective against IDA. Further research is warranted to determine whether the iron leached from the pots is bioavailable.

To explore why boys eat less fruit and vegetables (F&V) than girls, using longitudinal data following pupils from the age of 12.5 to 15.5 years, including perceived accessibility, modelling, intention, preferences, self-efficacy and knowledge of recommendations as potential mediators.

A longitudinal study, based on data collected among the control schools within the intervention project ‘Fruits and Vegetables Make the Marks’. This sample contains 896 6th and 7th graders from 20 randomly selected elementary schools within two Norwegian counties. Questionnaires were administered in May 2002 and May 2005 (when the participants were in 9th and 10th grade in 18 secondary elementary schools).

In single mediation analyses all determinants mediated parts of the gender difference, but only preferences decreased the gender difference to a level below statistical significance. Preferences alone explained 81% of the gender difference. In the multiple mediation analyses, the six mediators together explained 91% of the gender difference, but only preferences and perceived accessibility contributed uniquely to the explanation, with 25% and 10% respectively.

Preference appears as the strongest mediator of the difference in F&V intakes between boys and girls. Further research should explore why girls like F&V more than boys.