The effectiveness of flour fortification in reducing anaemia prevalence is equivocal. The goal was to utilise the existing national-level data to assess whether anaemia in non-pregnant women was reduced after countries began fortifying wheat flour, alone or in combination with maize flour, with at least Fe, folic acid, vitamin A or vitamin B12. Nationally representative anaemia data were identified through Demographic and Health Survey reports, the WHO Vitamin and Mineral Nutrition Information System database and other national-level nutrition surveys. Countries with at least two anaemia surveys were considered for inclusion. Within countries, surveys were excluded if altitude was not consistently adjusted for, or if the blood-draw site (e.g. capillary or venous) or Hb quantification method (e.g. HemoCue or Cyanmethaemoglobin) differed. Anaemia prevalence was modelled for countries that had pre- and post-fortification data (n 12) and for countries that never fortified flour (n 20) using logistic regression models that controlled for time effects, human development index (HDI) and endemic malaria. After adjusting for HDI and malaria, each year of fortification was associated with a 2·4 % reduction in the odds of anaemia prevalence (PR 0·976, 95 % CI 0·975, 0·978). Among countries that never fortified, no reduction in the odds of anaemia prevalence over time was observed (PR 0·999, 95 % CI 0·997, 1·002). Among both fortification and non-fortification countries, HDI and malaria were significantly associated with anaemia (P< 0·001). Although this type of evidence precludes a definitive conclusion, results suggest that after controlling for time effects, HDI and endemic malaria, anaemia prevalence has decreased significantly in countries that fortify flour with micronutrients, while remaining unchanged in countries that do not.

Decreasing sodium intake has been associated with improvements in blood pressure (BP) and proteinuria, two important risk factors for CVD and chronic kidney disease (CKD) progression. We aimed to investigate the role of sodium intake by examining the effect of changes in sodium intake over 1 year on BP and proteinuria in people with early stage CKD. From thirty-two general practices, 1607 patients with previous estimated glomerular filtration rate of 59–30 ml/min per 1·73 m2 and mean age of 72·9 (sd 9·0) years were recruited. Clinical assessment, urine and serum biochemistry testing were performed at baseline and after 1 year. Sodium intake was estimated from early morning urine specimens using an equation validated for this study population. We found that compared with people who increased their sodium intake from ≤100 to >100 mmol/d over 1 year, people who decreased their intake from >100 to ≤100 mmol/d evidenced a greater decrease in all BP variables (Δmean arterial pressure (ΔMAP)=–7·44 (sd 10·1) v. –0·23 (sd 10·4) mmHg; P<0·001) as well as in pulse wave velocity (ΔPWV=–0·47 (sd 1·3) v. 0·08 (sd 1·88) m/s; P<0·05). Albuminuria improved only in albuminuric patients who decreased their sodium intake. BP improved in people who maintained low sodium intake at both times and in those with persistent high intake, but the number of anti-hypertensive increased only in the higher sodium intake group, and PWV improved only in participants with lower sodium intake. Decreasing sodium intake was an independent determinant of ΔMAP. Although more evidence is needed, our results support the benefits of reducing and maintaining sodium intake below 100 mmol/d (2·3–2·4 g/d) in people with early stages of CKD.

Breast-feeding is associated with maternal hormonal and metabolic changes ensuring adequate milk production. In this study, we investigate the impact of breast-feeding on the profile of changes in maternal appetite-regulating hormones 3–6 months postpartum. Study participants were age- and BMI-matched lactating mothers (n 10), non-lactating mothers (n 9) and women without any history of pregnancy or breast-feeding in the previous 12 months (control group, n 10). During study sessions, young mothers breast-fed or bottle-fed their babies, and maternal blood samples were collected at five time points during 90 min: before, during and after feeding the babies. Outcome parameters were plasma concentrations of ghrelin, peptide YY (PYY), leptin, adiponectin, prolactin, cortisol, insulin, glucose and lipid values. At baseline, circulating PYY concentrations were significantly increased in lactating mothers (100·3 (se 6·7) pg/ml) v. non-lactating mothers (73·6 (se 4·9) pg/ml, P=0·008) and v. the control group (70·2 (se 9) pg/ml, P=0·021). We found no differences in ghrelin, leptin and adiponectin values. Baseline prolactin concentrations were over 4-fold higher in lactating mothers (P<0·001). Lactating women had reduced TAG levels and LDL-cholesterol:HDL-cholesterol ratio, but increased waist circumference, when compared with non-lactating women. Breast-feeding sessions further elevated circulating prolactin (P<0·001), but induced no acute effects on appetite-regulating hormones. In summary, one single breast-feeding session did not acutely modulate circulating appetite-regulating hormones, but increased baseline PYY concentrations are associated with prolonged lactation. PYY might play a role in the coordination of energy balance during lactation, increasing fat mobilisation from maternal depots and ensuring adequate milk production for the demands of the growing infant.

The reference organ-level body composition measurement method is MRI. Practical estimations of total adipose tissue mass (TATM), total adipose tissue fat mass (TATFM) and total body fat are valuable for epidemiology, but validated prediction equations based on MRI are not currently available. We aimed to derive and validate new anthropometric equations to estimate MRI-measured TATM/TATFM/total body fat and compare them with existing prediction equations using older methods. The derivation sample included 416 participants (222 women), aged between 18 and 88 years with BMI between 15·9 and 40·8 (kg/m2). The validation sample included 204 participants (110 women), aged between 18 and 86 years with BMI between 15·7 and 36·4 (kg/m2). Both samples included mixed ethnic/racial groups. All the participants underwent whole-body MRI to quantify TATM (dependent variable) and anthropometry (independent variables). Prediction equations developed using stepwise multiple regression were further investigated for agreement and bias before validation in separate data sets. Simplest equations with optimal R2 and Bland–Altman plots demonstrated good agreement without bias in the validation analyses: men: TATM (kg)=0·198 weight (kg)+0·478 waist (cm)−0·147 height (cm)−12·8 (validation: R2 0·79, CV=20 %, standard error of the estimate (SEE)=3·8 kg) and women: TATM (kg)=0·789 weight (kg)+0·0786 age (years)−0·342 height (cm)+24·5 (validation: R2 0·84, CV=13 %, SEE=3·0 kg). Published anthropometric prediction equations, based on MRI and computed tomographic scans, correlated strongly with MRI-measured TATM: (R2 0·70−0·82). Estimated TATFM correlated well with published prediction equations for total body fat based on underwater weighing (R2 0·70–0·80), with mean bias of 2·5–4·9 kg, correctable with log-transformation in most equations. In conclusion, new equations, using simple anthropometric measurements, estimated MRI-measured TATM with correlations and agreements suitable for use in groups and populations across a wide range of fatness.

Iodine is a key component of the thyroid hormones, which are critical for healthy growth, development and metabolism. The UK population is now classified as mildly iodine-insufficient. Adequate levels of iodine during pregnancy are essential for fetal neurodevelopment, and mild iodine deficiency is linked to developmental impairments. In the absence of prophylaxis in the UK, awareness of nutritional recommendations during pregnancy would empower mothers to make the right dietary choices leading to adequate iodine intake. The present study aimed to: estimate mothers' dietary iodine intake in pregnancy (using a FFQ); assess awareness of the importance of iodine in pregnancy with an understanding of existing pregnancy dietary and lifestyle recommendations with relevance for iodine; examine the level of confidence in meeting adequate iodine intake. A cross-sectional survey was conducted and questionnaires were distributed between August 2011 and February 2012 on local (Glasgow) and national levels (online electronic questionnaire); 1026 women, UK-resident and pregnant or mother to a child aged up to 36 months participated in the study. While self-reported awareness about general nutritional recommendations during pregnancy was high (96 %), awareness of iodine-specific recommendations was very low (12 %), as well as the level of confidence of how to achieve adequate iodine intake (28 %). Median pregnancy iodine intake, without supplements, calculated from the FFQ, was 190 μg/d (interquartile range 144–256μg/d), which was lower than that of the WHO's recommended intake for pregnant women (250 μg/d). Current dietary recommendations in pregnancy, and their dissemination, are found not to equip women to meet the requirements for iodine intake.

The dietary and health traits of organic food (OF) consumers have not been comprehensively described. The aim of this study was to identify factors associated with OF consumption. Data were collected from 54 283 participants from the NutriNet-Santé cohort using self-administered web-based questionnaires. Occasional organic food consumers and regular organic food consumers (ROFC) were compared with non-organic food consumers (NOFC) using logistical regression providing an OR and 95 % CI. Adherence to the French food-based guidelines and interactions between nutritional knowledge and OF consumption in adherence to dietary guidelines were investigated. Medical history was also assessed in relation to OF consumption. Compared with NOFC, ROFC were more likely to be vegetarian (OR 9·93; 95 % CI 7·42, 13·29 in women; OR 13·07; CI 7·00, 24·41 in men) and were less likely to be aware of nutritional guidelines regarding meat consumption (OR 0·37; CI 0·34, 0·40 in women; OR 0·41; CI 0·36, 0·47 in men). Compared with NOFC, ROFC had a lower risk of type II diabetes, hypertension and CVD; however, this effect was only significant for men. In contrast, organic consumers were more likely to report food allergies. Consuming OF appeared to affect the relationship between nutritional knowledge and adequate intake of meat/poultry/seafood/eggs and starchy food among both sexes. Our study provides new insights into the diet- and health-related behaviours of OF consumers in a large sample of participants residing in France. This should be taken into account in future studies investigating relationships between health and OF consumption.

Despite appropriate antiepileptic drug treatment, approximately one-third of humans and dogs with epilepsy continue experiencing seizures, emphasising the importance for new treatment strategies to improve the quality of life of people or dogs with epilepsy. A 6-month prospective, randomised, double-blinded, placebo-controlled cross-over dietary trial was designed to compare a ketogenic medium-chain TAG diet (MCTD) with a standardised placebo diet in chronically antiepileptic drug-treated dogs with idiopathic epilepsy. Dogs were fed either MCTD or placebo diet for 3 months followed by a subsequent respective switch of diet for a further 3 months. Seizure frequency, clinical and laboratory data were collected and evaluated for twenty-one dogs completing the study. Seizure frequency was significantly lower when dogs were fed the MCTD (2·31/month, 0–9·89/month) in comparison with the placebo diet (2·67/month, 0·33–22·92/month, P=0·020); three dogs achieved seizure freedom, seven additional dogs had ≥50 % reduction in seizure frequency, five had an overall <50 % reduction in seizures (38·87 %, 35·68–43·27 %) and six showed no response. Seizure day frequency were also significantly lower when dogs were fed the MCTD (1·63/month, 0–7·58/month) in comparison with the placebo diet (1·69/month, 0·33–13·82/month, P=0·022). Consumption of the MCTD also resulted in significant elevation of blood β-hydroxybutyrate concentrations in comparison with placebo diet (0·041 (sd 0·004) v. 0·031 (sd 0·016) mmol/l, P=0·028). There were no significant changes in serum concentrations of glucose (P=0·903), phenobarbital (P=0·422), potassium bromide (P=0·404) and weight (P=0·300) between diet groups. In conclusion, the data show antiepileptic properties associated with ketogenic diets and provide evidence for the efficacy of the MCTD used in this study as a therapeutic option for epilepsy treatment.

Convincing evidence has identified inflammation as an initiator of atherosclerosis, underpinning CVD. We investigated (i) whether dietary inflammation, as measured by the ‘dietary inflammatory index (DII)’, was predictive of 5-year CVD in men and (ii) its predictive ability compared with that of SFA intake alone. The sample consisted of 1363 men enrolled in the Geelong Osteoporosis Study who completed an FFQ at baseline (2001–2006) (excluding participants who were identified as having previous CVD). DII scores were computed from participants’ reported intakes of carbohydrate, micronutrients and glycaemic load. DII scores were dichotomised into a pro-inflammatory diet (positive values) or an anti-inflammatory diet (negative values). The primary outcome was a formal diagnosis of CVD resulting in hospitalisation over the 5-year study period. In total, seventy-six events were observed during the 5-year follow-up period. Men with a pro-inflammatory diet at baseline were twice as likely to experience a CVD event over the study period (OR 2·07; 95 % CI 1·20, 3·55). This association held following adjustment for traditional CVD risk factors and total energy intake (adjusted OR 2·00; 95 % CI 1·03, 3·96). This effect appeared to be stronger with the inclusion of an age-by-DII score interaction. In contrast, SFA intake alone did not predict 5-year CVD events after adjustment for covariates (adjusted OR 1·40; 95 % CI 0·73, 2·70). We conclude that an association exists between a pro-inflammatory diet and CVD in Australian men. CVD clinical guidelines and public health recommendations may have to expand to include dietary patterns in the context of vascular inflammation.

The aim of this study was to estimate the association between birth order and number of siblings with body composition in adolescents. Data are from a birth cohort study conducted in Pelotas, Brazil. At the age of 18 years, 4563 adolescents were located, of whom 4106 were interviewed (follow-up rate 81·3 %). Of these, 3974 had complete data and were thus included in our analysis. The variables used in the analysis were measured during the perinatal period, or at 11, 15 and/or 18 years of age. Body composition at 18 years was collected by air displacement plethysmography (BOD POD®). Crude and adjusted analyses of the association between birth order and number of siblings with body composition were performed using linear regression. All analyses were stratified by the adolescent sex. The means of BMI, fat mass index and fat-free mass index among adolescents were 23·4 (sd 4·5) kg/m2, 6·1 (sd 3·9) kg/m2 and 17·3 (sd 2·5) kg/m2, respectively. In adjusted models, the total siblings remained inversely associated with fat mass index (β = − 0·37 z-scores, 95 % CI − 0·52, − 0·23) and BMI in boys (β = − 0·39 z-scores, 95 % CI − 0·55, − 0·22). Fat-free mass index was related to the total siblings in girls (β = 0·06 z-scores, 95 % CI − 0·04, 0·17). This research has found that number of total siblings, and not birth order, is related to the fat mass index, fat-free mass index and BMI in adolescents. It suggests the need for early prevention of obesity or fat mass accumulation in only children.

Little is known about the clustering patterns of lifestyle behaviours in adult populations. We explored clusters in multiple lifestyle behaviours including physical activity (PA), smoking, alcohol use and eating habits in a sample of adult population. A cross-sectional and multi-centre study was performed with six participating groups distributed throughout Spain. Participants (n 1327) were part of the Lifestyles and Endothelial Dysfunction (EVIDENT) study and were aged between 20 and 80 years. The lifestyle and cardiovascular risk (CVR) factors were analysed using a clustering method based on the HJ-biplot coordinates to understand the variables underlying these groupings. The following three clusters were identified. Cluster 1: unhealthy, 677 subjects (51 %), with a slight majority of men (58·7 %), who were more sedentary and smokers with higher consumption of whole-fat dairy products, bigger waist circumference as well as higher TAG levels, systolic blood pressure (SBP) and CVR. Cluster 2: healthy/PA, 265 subjects (20 %), including 24·0 % of males with high PA. Cluster 3: healthy/diet, including 29 % of the participants, with a higher consumption of olive oil, fish, fruits, nuts, vegetables and lower alcohol consumption. Using the unhealthy cluster as a reference, and after adjusting for age and sex, the multiple regression analysis showed that belonging to the healthy/PA cluster was associated with a lower waist circumference, body fat percentage, SBP and CVR. In summary, the three clusters were identified according to lifestyles. The ‘unhealthy’ cluster had the least favourable clinical parameters, the ‘healthy/PA’ cluster had good HDL-cholesterol levels and low SBP and the ‘healthy/diet’ cluster had lower LDL-cholesterol levels and clinical blood pressure.

Tomato product consumption and estimated lycopene intake are hypothesised to reduce the risk of prostate cancer. To define the impact of typical servings of commercially available tomato products on resultant plasma and prostate lycopene concentrations, men scheduled to undergo prostatectomy (n 33) were randomised either to a lycopene-restricted control group ( < 5 mg lycopene/d) or to a tomato soup (2–2¾ cups prepared/d), tomato sauce (142–198 g/d or 5–7 ounces/d) or vegetable juice (325–488 ml/d or 11–16·5 fluid ounces/d) intervention providing 25–35 mg lycopene/d. Plasma and prostate carotenoid concentrations were measured by HPLC. Tomato soup, sauce and juice consumption significantly increased plasma lycopene concentration from 0·68 (sem 0·1) to 1·13 (sem 0·09) μmol/l (66 %), 0·48 (sem 0·09) to 0·82 (sem 0·12) μmol/l (71 %) and 0·49 (sem 0·12) to 0·78 (sem 0·1) μmol/l (59 %), respectively, while the controls consuming the lycopene-restricted diet showed a decline in plasma lycopene concentration from 0·55 (sem 0·60) to 0·42 (sem 0·07) μmol/l ( − 24 %). The end-of-study prostate lycopene concentration was 0·16 (sem 0·02) nmol/g in the controls, but was 3·5-, 3·6- and 2·2-fold higher in tomato soup (P= 0·001), sauce (P= 0·001) and juice (P= 0·165) consumers, respectively. Prostate lycopene concentration was moderately correlated with post-intervention plasma lycopene concentrations (r 0·60, P =0·001), indicating that additional factors have an impact on tissue concentrations. While the primary geometric lycopene isomer in tomato products was all-trans (80–90 %), plasma and prostate isomers were 47 and 80 % cis, respectively, demonstrating a shift towards cis accumulation. Consumption of typical servings of processed tomato products results in differing plasma and prostate lycopene concentrations. Factors including meal composition and genetics deserve further evaluation to determine their impacts on lycopene absorption and biodistribution.

Previous studies have reported inconsistent associations between maternal serum ferritin concentrations and the risk of spontaneous preterm birth (sPTB). The aim of the present study was to examine the association between Fe biomarkers, including serum ferritin concentrations, and the risk of total ( < 37 weeks), early ( < 34 weeks) and moderate-to-late (34–36 weeks) sPTB. The study cohort included 2254 women with singleton pregnancies attending first-trimester screening in New South Wales, Australia. sPTB included births following spontaneous labour or preterm premature rupture of the membranes. Serum collected at a mean gestational age of 12·0 (sd 0·9) weeks was analysed for Fe biomarkers, including serum ferritin and soluble transferrin receptor (sTfR), and the inflammatory biomarker C-reactive protein. Multivariate logistic regression analysis evaluated the association between low and high Fe levels and sPTB. Women with elevated serum ferritin concentrations were more likely to be older, nulliparous or have gestational diabetes. The multivariate analysis found increased odds of sPTB for women with elevated ferritin levels defined as >75th percentile ( ≥ 43 μg/l) (OR 1·49, 95 % CI 1·06, 2·10) and >90th percentile ( ≥ 68 μg/l) (OR 1·92, 95 % CI 1·25, 2·96). Increased odds of early and moderate-to-late sPTB were associated with ferritin levels >90th percentile (OR 2·50, 95 % CI 1·32, 4·73) and >75th percentile (OR 1·56, 95 % CI 1·03, 2·37), respectively. No association was found between the risk of sPTB and elevated sTfR levels or Fe deficiency. In conclusion, elevated maternal serum ferritin levels in early pregnancy are associated with an increased risk of sPTB from 34 weeks of gestation. The usefulness of early pregnancy ferritin levels in identifying women at risk of sPTB warrants further investigation.

Recent evidence suggests that Ca supplements increase the risk of cardiovascular events, but the mechanism(s) by which this occurs is uncertain. In a study primarily assessing the effects of various Ca supplements on blood Ca levels, we also investigated the effects of Ca supplements on blood pressure and their acute effects on blood coagulation. We randomised 100 post-menopausal women to 1 g/d of Ca or a placebo containing no Ca. Blood pressure was measured at baseline and every 2 h up to 8 h after their first dose and after 3 months of supplementation. Blood coagulation was measured by thromboelastography (TEG) in a subgroup of participants (n 40) up to 8 h only. Blood pressure declined over 8 h in both the groups, consistent with its normal diurnal rhythm. The reduction in systolic blood pressure was smaller in the Ca group compared with the control group by >5 mmHg between 2 and 6 h (P≤0·02), and the reduction in diastolic blood pressure was smaller at 2 h (between-groups difference 4·5 mmHg, P=0·004). Blood coagulability, assessed by TEG, increased from baseline over 8 h in the calcium citrate and control groups. At 4 h, the increase in the coagulation index was greater in the calcium citrate group compared with the control group (P=0·03), which appeared to be due to a greater reduction in the time to clot initiation. These data suggest that Ca supplements may acutely influence blood pressure and blood coagulation. Further investigation of this possibility is required.

The aim of the present study was to examine the associations of sugary drink consumption and its substitution with alternative beverages with body weight gain among young children predisposed to future weight gain. Secondary analysis of the Healthy Start Study, a 1·5-year randomised controlled trial designed to prevent overweight among Danish children aged 2−6 years (n 366), was carried out. Multivariate linear regression models were used to investigate the associations of beverage consumption with change in body weight (Δweight) or BMI(ΔBMI) z-score. Substitution models were used to extrapolate the influence of replacing sugary drinks with alternative beverages (water, milk and diet drinks) on Δweight or ΔBMI z-score. Sugary drink intake at baseline and substitution of sugary drinks with milk were associated with both Δweight and ΔBMI z-score. Every 100 g/d increase in sugary drink intake was associated with 0·10 kg and 0·06 unit increases in body weight (P=0·048) and BMI z-score (P=0·04), respectively. Substitution of 100 g/d sugary drinks with 100 g/d milk was inversely associated with Δweight (β=−0·16 kg; P=0·045) and ΔBMI z-score (β=−0·07 units; P=0·04). The results of this study suggest that sugary drink consumption was associated with body weight gain among young children with high predisposition for future overweight. In line with the current recommendations, sugary drinks, whether high in added or natural sugar, should be discouraged to help prevent childhood obesity. Milk may be a good alternative to sugary drinks with regard to weight management among young obesity-predisposed children.

Weight loss is crucial for treating type 2 diabetes mellitus (T2DM). It remains unclear which dietary intervention is best for optimising glycaemic control, or whether weight loss itself is the main reason behind observed improvements. The objective of this study was to assess the effects of various dietary interventions on glycaemic control in overweight and obese adults with T2DM when controlling for weight loss between dietary interventions. A systematic review of randomised controlled trials (RCT) was conducted. Electronic searches of Medline, Embase, Cinahl and Web of Science databases were conducted. Inclusion criteria included RCT with minimum 6 months duration, with participants having BMI≥25·0 kg/m2, a diagnosis of T2DM using HbA1c, and no statistically significant difference in mean weight loss at the end point of intervention between dietary arms. Results showed that eleven studies met the inclusion criteria. Only four RCT indicated the benefit of a particular dietary intervention over another in improving HbA1c levels, including the Mediterranean, vegan and low glycaemic index (GI) diets. However the findings from one of the four studies showing a significant benefit are questionable because of failure to control for diabetes medications and poor adherence to the prescribed diets. In conclusion there is currently insufficient evidence to suggest that any particular diet is superior in treating overweight and obese patients with T2DM. Although the Mediterranean, vegan and low-GI diets appear to be promising, further research that controls for weight loss and the effects of diabetes medications in larger samples is needed.

Very few effective field methods are available for accurate, non-invasive estimation of skeletal muscle volume (SMV) and mass in children. We aimed to develop regression-based prediction equations for SMV, using ultrasonography, in Japanese prepubertal children, and to assess the validity of these equations. In total, 145 healthy Japanese prepubertal children aged 6–12 years were randomly divided into two groups: the model development group (sixty boys, thirty-seven girls) and the validation group (twenty-nine boys, nineteen girls). Reference data in the form of contiguous MRI with 1-cm slice thickness were obtained from the first cervical vertebra to the ankle joints. The SMV was calculated by the summation of digitised cross-sectional areas. Muscle thickness was measured using B-mode ultrasonography at nine sites in different regions. In the model development group, strong, statistically significant correlations were observed between the site-matched SMV (total, arms, trunk, thigh and lower legs) measured by MRI and the muscle thickness×height measures obtained by ultrasonography, for both boys and girls. When these SMV prediction equations were applied to the validation groups, the measured total and regional SMV were also very similar to the values predicted for boys and girls, respectively. With the exception of the trunk region in girls, the Bland–Altman analysis for the validation group did not indicate any bias for either boys or girls. These results suggest that ultrasonography-derived prediction equations for boys and girls are useful for the estimation of total and regional SMV.

A New Nordic Diet (NND) was developed in the context of the Danish OPUS Study (Optimal well-being, development and health for Danish children through a healthy New Nordic Diet). Health, gastronomic potential, sustainability and Nordic identity were crucial principles of the NND. The aim of the present study was to investigate the effects of serving NND school meals compared with the usual packed lunches on the dietary intake of NND signature foods. For two 3-month periods, 834 Danish children aged 8–11 years received NND school meals or their usual packed lunches brought from home (control) in random order. The entire diet was recorded over 7 consecutive days using a validated Web-based Dietary Assessment Software for Children. The NND resulted in higher intakes during the entire week (% increase) of root vegetables (116 (95 % CI 1·93, 2·42)), cabbage (26 (95 % CI 1·08, 1·47)), legumes (22 (95 % CI 1·06, 1·40)), herbs (175 (95 % CI 2·36, 3·20)), fresh berries (48 (95 % CI 1·13, 1·94)), nuts and seeds (18 (95 % CI 1·02, 1·38)), lean fish and fish products (47 (95 % CI 1·31, 1·66)), fat fish and fish products (18 (95 % CI 1·02, 1·37)) and potatoes (129 (95 % CI 2·05, 2·56)). Furthermore, there was a decrease in the number of children with zero intakes when their habitual packed lunches were replaced by NND school meals. In conclusion, this study showed that the children increased their intake of NND signature foods, and, furthermore, there was a decrease in the number of children with zero intakes of NND signature foods when their habitual packed lunches were replaced by school meals following the NND principles.

The present randomised controlled trial (RCT) was conducted to evaluate the effect of two regimens of Zn supplementation on pregnancy outcomes in Alexandria, Egypt. Healthy pregnant women aged 20–45 years and having low serum Zn level below the estimated median for the gestational age were eligible to participate in the trial. Of 1055 pregnant women assessed for the eligibility of low serum Zn level, 675 were eligible. These women were randomly assigned to one of the three groups: the Zn alone group (n 225) received a daily dose of 30 mg ZnSO4, the combined group (n 227) received 30 mg ZnSO4 plus multivitamins (B1, B6, D3, C and E) and the control group (n 223) received placebo (270 mg lactose). They were followed up from the time of recruitment till 1 week after delivery. Overall, there was no detectable difference in the mean birth weight between the three groups (mean 2929·12 (sd 330·28), 2922·22 (sd 324·05) and 2938·48 (sd 317·39) g for the placebo, Zn and Zn plus multivitamin groups, respectively, P= 0·88). Both the single and the combined Zn supplements were almost equally effective in reducing second- and third-stage complications (relative risk (RR) 0·43, 95 % CI 0·31, 0·60 for the Zn group and RR 0·54, 95 % CI 0·40, 0·73 for the combined group). Stillbirth and preterm delivery were significantly lower among the two supplemented groups than the placebo group (P= 0·001). Early neonatal morbidity was also significantly lower in the supplemented groups (RR 0·23, 95 % CI 0·15, 0·35 for the Zn group and RR 0·25, 95 % CI 0·16, 0·37 for the combined group). Collectively, Zn supplementation was effective in reducing pregnancy complications and early neonatal infection among the Zn-deficient women of the present trial.

Egg consumption is a major source of dietary cholesterol, a nutrient that may disrupt glucose metabolism. We prospectively evaluated the relation between egg consumption and cholesterol-intake and diabetes in 65 364 French disease-free women who responded to a validated diet history questionnaire in 1993. Egg consumption included hardboiled eggs and eggs consumed in an omelette or a mixed dish, and dietary cholesterol was estimated using a French nutrient database. Over 14 years of follow-up, 1803 incident diabetes cases were identified through self-reports, supplementary questionnaires and drug reimbursement information. Multivariable Cox regression models were adjusted for age, education, menopause, menopausal hormone therapy, hypertension and hypercholesterolaemia, BMI, physical activity, smoking, alcohol, fruit, vegetables, processed red meat, coffee and sugar and artificially sweetened beverages. No association was observed between egg consumption and risk of type 2 diabetes. When comparing women who consumed at least five eggs per week with non-consumers, the multivariable hazard ratio (HR) was found to be 1·00 (95 % CI 0·78, 1·29; across categories, Ptrend=0·11). Women in the highest quintile of dietary cholesterol had a 40 % higher rate of diabetes compared with those in the lowest quintile (HR 1·40; 95 % CI 1·19, 1·63; across quintiles, Ptrend<0·0001). A 100 mg increase of dietary cholesterol per 4184 kJ (or 1000 kcal) was associated with a 14 % increase in the risk of diabetes (HR 1·14; 95 % CI 1·02, 1·26). In this large prospective cohort, we observed an association between dietary cholesterol and type 2 diabetes, but no association with egg consumption. In the absence of a clear underlying mechanism and potential residual confounding, these results should be interpreted with caution.