To study the relationship between dietary intake and the development of type 2 diabetes among Chinese adults.

A prospective cohort study. Dietary assessment was carried out using a validated FFQ. Principal component analysis was used to identify dietary patterns. Dietary glycaemic load and variety of snacks were also calculated.

A hospital-based centre at the Queen Mary Hospital in Hong Kong SAR, China.

A total of 1010 Chinese adults aged 25–74 years who participated in a territory-wide dietary and cardiovascular risk factor prevalence survey in 1995–1996 were followed up for 9–14 years for the development of diabetes.

A total of 690 (68·3 %) individuals completed follow-up during 2005–2008 and seventy-four cases of diabetes were identified over the follow-up period. Four dietary patterns were identified (‘more snacks and drinks’, ‘more vegetables, fruits and fish’, ‘more meat and milk products’ and ‘more refined grains’). After adjustment for age, sex, BMI, waist-to-hip ratio, smoking, alcohol intake, participation in exercise/sports and family history of diabetes, the more vegetables, fruits and fish pattern was associated with a 14 % lower risk (OR per 1 sd increase in score = 0·76; 95 % CI 0·58, 0·99), whereas the more meat and milk products pattern was associated with a 39 % greater risk of diabetes (OR per 1 sd increase in score = 1·39; 95 % CI 1·04, 1·84). Dietary glycaemic load, rice intake, snack intake and variety of snacks were not independently associated with diabetes.

The more vegetables, fruits and fish pattern was associated with reduced risk and the more meat and milk products pattern was associated with an increased risk of diabetes.

To measure folic acid awareness and intake rates among women of childbearing age in certain areas of China with a high prevalence of neural tube defects (NTD).

A cross-sectional survey was carried out utilising a nineteen-item questionnaire enquiring into individual women's knowledge of, attitude towards and practice of folic acid supplementation.

A total of 293 low-income counties in six provinces of China.

Women aged 19–44 years from six provinces with a high prevalence of NTD recruited from June to August 2008.

Among 33 025 participants, 57 % had heard of folic acid but only 15 % knew all of the core information. The intake rate was 12 %; only 8 % took the recommended dose and only 4 % of non-pregnant women took folic acid. Some women did not take folic acid because they did not know that they should take it (49 %) or they had misconceptions about it (24 %). According to logistic regression analysis, rural residence was a risk factor for folic acid awareness. Ethnicity, educational level, average annual income per person and pregnancy were the influencing factors of folic acid awareness and folic acid intake.

Although more than half of the respondents had heard of folic acid, the intake rate was still very low in areas with a high prevalence of NTD. Thus, more efforts are needed to increase folic acid awareness and intake among women of reproductive age in these areas.

Migrants tend to present higher overweight and obesity levels, but whether this relationship applies to all nationalities has seldom been studied. The present study aimed to assess the prevalence of overweight and obesity according to nationality in adults.

Cross-sectional population-based samples.

Five-year nationwide interview surveys (Swiss Health Surveys – SHS) from 1992 to 2007 (n 63 766) and a local examination survey (CoLaus Study in Lausanne 2004–2006, n 6743).

Participants were separated into Swiss, French, German, Italian, Portuguese, Spanish nationals, those from the former Republic of Yugoslavia and from other European and other countries.

Compared with Swiss nationals, German and French nationals presented a lower prevalence of overweight and obesity, whereas nationals from Italy, Spain, Portugal and the former Republic of Yugoslavia presented higher levels. Adjusting the SHS data for age, gender, education, smoking, leisure-time physical activity and survey year, a lower risk for overweight and obesity was found for German (OR = 0·80, 95 % CI 0·70, 0·92) and French (OR = 0·74, 95 % CI 0·61, 0·89) nationals, whereas higher risks were found for participants from Italy (OR = 1·45, 95 % CI 1·33, 1·58), Spain (OR = 1·36, 95 % CI 1·15, 1·61), Portugal (OR = 1·25, 95 % CI 1·06, 1·47) and the former Republic of Yugoslavia (OR = 1·98, 95 % CI 1·69, 2·32). Similar findings were observed in the CoLaus Study for Italian (OR = 1·63, 95 % CI 1·29, 2·06), Spanish (OR = 1·54, 95 % CI 1·17, 2·04) and Portuguese (OR = 1·49, 95 % CI 1·16, 1·91) participants and for those from the former Republic of Yugoslavia (OR = 5·34, 95 % CI 3·00, 9·50).

Overweight and obesity are unevenly distributed among migrants in Switzerland. Migrants from Southern Europe and from the former Republic of Yugoslavia present higher prevalence rates. This suggests that preventive messages should be tailored to these specific populations.

To assess the validity of FAO data on the availability of fish and vegetable oils as an indicator of national n-3 fatty acid (FA) intake and to estimate the worldwide population living in countries with low n-3 FA intake.

Levels of the essential FA α-linolenic acid (ALA) and DHA, measured by GC in adipose tissue from participants in the present study and from published studies in eleven other countries, were used to validate ALA and fish availability estimated from FAO food balance sheets. On the basis of the validated FAO data for ALA and fish availability, we estimated the global prevalence of low n-3 FA availability.

Rural and urban areas of Bulgaria.

Fifty men and fifty-eight women.

Adipose tissue ALA and DHA levels (0·34 % and 0·11 % of total FA, respectively) in Bulgaria were lower than those of the eleven other countries with available data. A strong positive correlation was found between adipose tissue DHA and fish availability (r = 0·88) and between adipose tissue ALA and ALA availability (r = 0·92). Approximately half of the world's population lived in middle- and low-income countries with limited access to n-3 FA (fish < 400 g/week and ALA < 4 % of total vegetable oils), with the largest proportion being in South-East Asia (53·6 %), followed by Africa (27·1 %) and Eastern Europe (8·5 %). Of this half, 33 % lived in countries such as Bulgaria where n-3 FA was almost unavailable (fish < 200 g/week and ALA < 2 % of total vegetable oils).

Very low availability of n-3 FA is extensive worldwide.

To assess convergent validity, factorial validity, test–retest reliability and internal consistency of a diet quality food behaviour checklist (FBC) for low-literate, low-income Spanish speakers.

Participants (n 90) completed three dietary recalls, the Spanish-language version of the US Department of Agriculture (USDA) Household Food Security Survey Module (HFSSM) and the Spanish-language FBC. Factor structure was examined using principal component analysis. Spearman correlation coefficients between FBC item responses and nutrient intakes from 24 h recalls were used to estimate convergent validity. Correlation coefficients were also calculated between FBC item responses at two time points in another group of participants (n 71) to examine test–retest reliability. Cronbach's α coefficient was determined for items within each sub-scale.

Non-profit community agencies serving low-income clients, migrant farm worker camps and low-income housing sites in four California counties.

Spanish-speaking women (n 161) who met income eligibility for the SNAP-Ed (Supplemental Nutrition Assistance Program–Education).

Factor analysis resulted in six sub-scales. Responses to nineteen food behaviour items were significantly correlated with hypothesized 24 h recall data (with a maximum correlation of 0·44 for drinking milk and calcium) or the USDA HFSSM (0·42 with the food security item). Coefficients for test–retest reliability ranged from 0·35 to 0·79. Cronbach's α ranged from 0·49 for the diet quality sub-scale to 0·80 for the fruit and vegetable sub-scale.

The twenty-two-item FBC and instruction guide will be used to evaluate USDA community nutrition education interventions with low-literate Spanish speakers. This research contributes to the body of knowledge about this at-risk population in California.

In the early years of life, influential attributes are formed and may be difficult to change later in life. Early childhood is now recognised as a key target in the prevention of overweight and obesity, and the knowledge that children gain at this time about food and its health benefits may have an important influence on their dietary choices and preferences in later life. Therefore, an activity was designed using age-appropriate methods to assess nutrition knowledge of young children.

The Healthy Food Knowledge Activity was developed using a list of thirty healthy and unhealthy foods and drinks generated from the Australian Guide to Healthy Eating.

The activity was conducted with individual children from reception classes of South Australian schools.

Children aged 5–6 years undertook the activity in a pilot study (n 13) and in the main study (n 192).

Pilot data indicated good test–retest reliability of the activity (r = 0·84, P < 0·01). In the main study, there was a good distribution of scores with acceptable skewness and kurtosis statistics. A breakdown of responses indicated good face validity, with more obvious foods being more correctly classified.

Children as young as 5–6 years of age can correctly identify healthy foods, and this can be measured objectively. This activity also provides interesting insights regarding misconceptions about foods that could be attributed to influences such as media advertising and that can be addressed by educators of this age group.

To evaluate adolescents’ abilities to identify foods and estimate the portion size of foods consumed in order to inform development of the mobile telephone food record (mpFR).

Data were collected from two samples of adolescents (11–18 years). Adolescents in sample 1 participated in one lunch (n 63) and fifty-five of the sixty-three adolescents (87 %) returned for breakfast the next morning. Sample 2 volunteers received all meals and snacks for a 24 h period. At mealtime, sample 1 participants were asked to write down the names of the foods. Sample 2 participants identified foods in an image of their meal 10–14 h postprandial. Adolescents in sample 2 also estimated portion sizes of their breakfast foods and snacks.

Sample 1 identified thirty of the thirty-eight food items correctly, and of the misidentified foods all were identified within the correct major food group. For sample 2, eleven of the thirteen food items were identified correctly 100 % of the time. Half of the breakfast and snack foods had at least one portion size estimate within 10 % of the true amount using a variety of measurement descriptors.

The results provide evidence that adolescents can correctly identify familiar foods and they can look at an image of their meal and identify the foods in the image up to 14·5 h postprandial. The results of the present study not only inform the development of the mpFR but also provide strong evidence of the use of digital images of eating occasions in research and clinical settings.

To determine whether video-based instructions improve the accuracy of self-measures of waist and hip circumference compared with written instructions.

Population-based, cross-sectional study. Self-measurements of waist circumference (WC) and hip circumference (HC) of fifty-seven participants randomly allocated to receive either written instruction or video instruction were compared with those of a trained technician.

Aberdeen, Scotland, and Brussels, Belgium, between February and April 2010.

Adults aged 18–62 years with a high level of English language and no prior training in anthropometry.

WC was significantly overestimated by the written method (1·75 cm bias; P = 0·007) but not the video method (0·95 cm bias; P = 0·239). HC was significantly underestimated in both written (−0·35 cm bias; P = 0·009) and video methods (−0·75 cm bias; P = 0·046). Reliability was not significantly affected by age, sex, BMI or WC. Bland–Altman plots demonstrated wide limits of agreement for WC (−6·83, 6·08 cm for written method; −10·14, 6·72 cm for video method) and HC (−12·85, 1·60 cm for written method; −10·82, 2·50 cm for video method).

Video technology can support more accurate self-measurements of anthropometric data in epidemiological studies. Further research is warranted using larger and more heterogeneous samples in order that results can be generalised.

To compare the relative validity of food group intakes derived from a comprehensive self-administered diet history questionnaire (DHQ) and a brief-type DHQ (BDHQ) developed for the assessment of Japanese diets during the previous month using semi-weighed dietary records (DR) as a reference method.

Between November 2002 and September 2003, a 4 d DR (covering four non-consecutive days), a DHQ (150-item semi-quantitative questionnaire) and a BDHQ (fifty-eight-item fixed-portion-type questionnaire) were completed four times (once per season) at 3-month intervals.

Three areas in Japan: Osaka, Nagano and Tottori.

Ninety-two Japanese women aged 31–69 years and ninety-two Japanese men aged 32–76 years.

Median food group intakes were estimated well for approximately half of the food groups. No statistically significant differences were noted between a 16 d DR and the first DHQ (DHQ1) or between the DR and the first BDHQ (BDHQ1) in fifteen (44 %) and fifteen (52 %) food items for women and in fourteen (41 %) and sixteen (55 %) food items for men, respectively, indicating that both questionnaires estimated median values reasonably well. Median Spearman's correlation coefficients with the DR were 0·43 (range: −0·09 to 0·77) for DHQ1 and 0·44 (range: 0·14 to 0·82) for BDHQ1 in women, with respective values of 0·44 (range: 0·08 to 0·87) and 0·48 (range: 0·22 to 0·83) in men, indicating reasonable ranking ability. Similar results were observed for mean values of the four DHQ and BDHQ.

In terms of food intake estimates, both the DHQ and the BDHQ showed reasonable validity.

To develop a method to validate an FFQ for reported intake of episodically consumed foods when the reference instrument measures short-term intake, and to apply the method in a large prospective cohort.

The FFQ was evaluated in a sub-study of cohort participants who, in addition to the questionnaire, were asked to complete two non-consecutive 24 h dietary recalls (24HR). FFQ-reported intakes of twenty-nine food groups were analysed using a two-part measurement error model that allows for non-consumption on a given day, using 24HR as a reference instrument under the assumption that 24HR is unbiased for true intake at the individual level.

The National Institutes of Health–AARP Diet and Health Study, a cohort of 567 169 participants living in the USA and aged 50–71 years at baseline in 1995.

A sub-study of the cohort consisting of 2055 participants.

Estimated correlations of true and FFQ-reported energy-adjusted intakes were 0·5 or greater for most of the twenty-nine food groups evaluated, and estimated attenuation factors (a measure of bias in estimated diet–disease associations) were 0·4 or greater for most food groups.

The proposed methodology extends the class of foods and nutrients for which an FFQ can be evaluated in studies with short-term reference instruments. Although violations of the assumption that the 24HR is unbiased could be inflating some of the observed correlations and attenuation factors, results suggest that the FFQ is suitable for testing many, but not all, diet–disease hypotheses in a cohort of this size.

Fruit and vegetable consumption is a focus of research and nutrition education; yet, there is no universal agreement on the meaning of ‘fruits’ and ‘vegetables’. Our objective was to describe survey respondent perceptions about a set of foods with regard to whether the food is a fruit, vegetable or something else.

Three cross-sectional studies.

Two small studies involving cognitive interviewing sessions; and one large self-administered population survey.

US adults in two small studies (n 55 and 80) and one large survey (n 3312), all with multiple race/ethnicities.

Perceptions varied. In the survey, rice was considered a vegetable by about 20 % of respondents. In one small study, Spanish speakers were more likely to consider rice a vegetable, and Chinese speakers less likely, than were English speakers. Black beans were frequently classified as something other than vegetable or fruit. Among Hispanics, Spanish speakers were less likely than English speakers to consider beans a vegetable. Overall, tomatoes were classified as both fruit and vegetable, and these perceptions varied by race/ethnicity.

Substantial disagreement among the fruit, vegetable and other food domains highlights the importance of clearly defining the desired constructs. Foods that require specific instruction include rice, dried beans, potatoes, tomatoes and fruits and vegetables in mixtures and condiments. For measurement, additional questions or explanations may be needed to clarify which foods are of interest. For communication, the global message to increase consumption of fruit and vegetables should be reinforced with specific guidance.

To determine the relative validity of a quantitative FFQ in assessing dietary fluoride intakes using 3 d food and beverage diaries for reference.

Parents were asked to complete questionnaires for the preceding week and diaries for 3 d for their children. Fluoride intakes were estimated from ‘selected’ foods and beverages for questionnaires and from ‘all foods and beverages’ for diaries. Data collected at 6, 9, 12, 16, 20, 24, 36, 48 and 60 months were analysed cross-sectionally.

A 3 d food and beverage diary and an FFQ collected through mail from children living in the state of Iowa.

Children from the Iowa Fluoride Study whose parents completed both an FFQ and a 3 d food and beverage diary at each analysed time point.

Correlations between daily mean dietary fluoride intake estimated from questionnaires and diaries range from 0·90 to 0·65.

A quantitative FFQ can provide relative estimates of dietary fluoride intake.

To assess associations between childhood body weight, weight gain during childhood to adolescence/young adulthood and incidence of adult metabolic syndrome (MetS).

A dynamic prospective cohort study (the SUN Project; Seguimiento Universidad de Navarra). Participants were asked to select which of nine body images most closely represented their body shape at ages 5 and 20 years, and it was used as a proxy of BMI. An incident case of MetS was diagnosed according to criteria of the International Diabetes Federation. Associations between childhood body weight, weight gain during childhood to adolescence/young adulthood and incidence of adult MetS were estimated by multiple-adjusted odds ratios and their 95 % confidence intervals.

University of Navarra, Spain.

The study included 5317 university graduates, followed-up for a median of 6·1 years.

The incidence of MetS was 2·9 % (1·7 % in women and 5·1 % in men). Among men, body shape at age 5 years was inversely related to adult MetS (OR = 0·83, 95 % CI 0·72, 0·97), whereas weight gain during childhood to adolescence/young adulthood was directly associated with adult MetS (OR = 1·49, 95 % CI 1·01, 2·18); both childhood underweight (OR = 5·20, 95 % CI 1·87, 14·50) and childhood obesity (OR = 4·66, 95 % CI 1·40, 15·51) increased the likelihood of adult MetS. No association was apparent among women.

These results support treating childhood underweight and weight gain during childhood to adolescence/young adulthood as part of comprehensive adult MetS prevention efforts in men.

In many studies it has been shown that breakfast is associated with normal weight in children and adolescents. Other meals, family meals and a regular meal pattern have been less studied. Therefore, the aim of the present study was to examine whether a regular meal pattern, or breakfast, lunch or dinner as separate regular meals, is associated with the BMI of children.

A cross-sectional study conducted within the Helsinki region during 2006. Study participants were measured and weighed by research staff. Children filled in a study questionnaire on their health behaviour, including the frequency of consuming meals. A regular meal was defined as one usually eaten on every school day. A regular meal pattern was defined as one consisting of a usual consumption of breakfast, school lunch and dinner on every school day. Covariance analysis was used as the statistical analysis method.

Capital region, Finland, 2006.

A total of 604 schoolchildren (312 girls) aged 9–11 years.

Irregular breakfast and an irregular meal pattern were associated with higher BMI. Regularity of school lunch, dinner or family dinner was not associated with BMI.

A regular breakfast and meal pattern was associated with lower BMI in children, although breakfast was the only single meal associated with BMI. We conclude that, although the association between breakfast and weight status in children is fairly consistent, the role of other meals is less convincing.

We examined the relationships between exclusive breast-feeding and the risks of respiratory, diarrhoea and nutritional morbidities during the first 2 years of life among children born to women infected with HIV-1.

We prospectively determined the incidence of respiratory illnesses, diarrhoea, fever, hospitalizations, outpatient visits and nutritional morbidities. Generalized estimating equations were used to estimate the relative risks for morbidity episodes and Cox proportional hazards models to estimate the incidence rate ratios of nutritional morbidities.

Dar es Salaam, Tanzania.

The sample consisted of 666 children born to HIV-infected women.

The 666 children were followed for 2 years. Exclusive breast-feeding was associated with lower risk for cough (rate ratio (RR) = 0·49, 95 % CI 0·41, 0·60, P < 0·0001), cough and fever (RR = 0·44, 95 % CI 0·32, 0·60, P < 0·0001) and cough and difficulty breathing or refusal to feed (RR = 0·31, 95 % CI 0·18, 0·55, P < 0·0001). Exclusive breast-feeding was also associated with lower risk of acute diarrhoea, watery diarrhoea, dysentery, fever and outpatient visits during the first 6 months of life, but showed no effect at 6–24 months of life. Exclusive breast-feeding did not significantly reduce the risks of nutritional morbidities during the first 2 years of life.

Exclusive breast-feeding is strongly associated with reductions in the risk of respiratory and diarrhoea morbidities during the first 6 months of life among children born to HIV-infected women.

To investigate the associations between obesity and self-rated health and psychological well-being in Spanish women.

Cross-sectional study. Three dependent variables were defined: self-rated health; self-declared diagnosis of psychiatric disorders or use of psychiatric drugs; and General Health Questionnaire-12 (GHQ-12) score. A set of variables (sociodemographic, morbidity and lifestyle) were used to adjust for possible confounding effects.

The National Health Survey was conducted in Spain in 2006.

A total of 15 099 women aged ≥18 years. Participants were classified into groups according to their BMI.

In all, 55·4 % of the women had normal weight, 29·4 % were overweight and 15·2 % were obese. Self-perception of poor health in obese women was 57·8 %, a significantly higher value than in women of normal weight (28·8 %). Prevalence of psychiatric disease was 35·5 % in obese women and 18·9 % in women of normal weight. In multivariate analysis, obese women had 34 % higher odds of declaring poor self-perception of health (OR = 1·34; 95 % CI 1·12, 1·61), 18 % higher odds of self-reporting psychiatric disease (OR = 1·18; 95 % CI 1·02, 1·38) and 26 % higher odds (OR = 1·26; 95 % CI 1·02, 1·55) of having an abnormal outcome (≥3) on the GHQ-12 than women of normal weight.

The present study highlights that obese Spanish women have worse self-rated health and psychological health than those with normal weight. These aspects are relevant because of the growing importance placed on the functionality of patients and their mental health within the obesity epidemic.

To investigate the association between eating behaviour and metabolic risk in the broader population.

The association between metabolic risk factors (overweight, hypertension, hyperglycaemia, hypertriacylglycerolaemia, low HDL cholesterol, hyperuricaemia and fatty liver) and various eating behaviours were compared for four groups defined by subjective reporting: not eating until feeling full and not eating rapidly (G1); eating until feeling full only (G2); eating rapidly only (G3); and eating both rapidly and until feeling full (G4).

A medical centre for health examinations in Tokyo, Japan.

Men (n 8240) and women (n 2955) who underwent health examinations.

The distribution of participants in G1 to G4 was 49·8 %, 11·5 %, 26·3 % and 12·4 % among men and 55·3 %, 15·0 %, 19·0 % and 10·7 % among women, respectively. Compared with G1, the age-adjusted OR (95 % CI) for overweight were significantly higher in G2 to G4, being respectively 1·85 (1·58, 2·17), 1·98 (1·76, 2·23) and 3·46 (2·99, 4·01) for men and 2·20 (1·62, 2·97), 2·59 (1·97, 3·39) and 3·12 (2·27, 4·26) for women. The age-adjusted OR were also significantly higher for hypertriacylglycerolaemia, hyperuricaemia and fatty liver in G2 and for all risks in G3 and G4 among men; and for hyperuricaemia in G2, for hyperglycaemia, hypertriacylglycerolaemia and fatty liver in G3 and for hypertriacylglycerolaemia and fatty liver in G4 among women.

Both eating until feeling full and eating rapidly increase metabolic risk factors. Although the mechanism between rapid eating and metabolic risk requires further exploration, eating slowly and ending meals shortly before feeling full are important public health messages for reducing metabolic risk factors.

To evaluate the association between overweight and the occurrence of asthma and atopy in a cohort of children of 4–12 years of age living in the city of Salvador in 2005.

Cross-sectional study nested in a cohort.

The metropolitan region of Salvador, Bahia, Brazil.

The study included 1129 children of 4–12 years age who presented complete information on the variables used here. Skin tests for allergy, spirometry, faecal parasitology, serum IgE and anthropometric surveys were conducted. Poisson's multivariate regression was adopted.

Wheezing was found in 29·1% and asthma in 22·8% of children, both conditions being more common in those under 6 years of age and 34% more common in overweight children (prevalence ratio (PR) = 1·34; 95% CI 1·07, 1·67) following adjustment. The ratio between forced expiratory volume in 1s and forced vital capacity was associated with overweight (PR = 1·35; 95% CI 1·11, 1·61). No statistically significant association was found between overweight and allergen-specific IgE or with wheezing.

These results are in agreement with the hypothesis that overweight is associated with asthma and pulmonary function, even following adjustment for intervening variables known to be associated with the pathogeny of asthma.

Nutrition plays a central role in health, with poor dietary habits and nutritional intake being associated with a range of chronic diseases. The aim was to examine grocery purchasing behaviour in relation to chewing ability, dietary knowledge and socio-economic status (SES) among older adults.

Data were collected by mailed survey in 2008. Grocery purchasing was measured using a sixteen-item index of compliance of food purchasing with dietary guidelines. Self-reported number of teeth was classified as an inadequate dentition if less than twenty-one teeth were present. Chewing ability was based on a five-item chewing index. Dietary knowledge was collected using twenty true/false items. SES was assessed using a subjective social status rating representing where people stand in society.

Population survey in Adelaide, South Australia.

Adults aged 60–71 years.

Responses were collected from 444 persons (response rate = 68·8 %). Among dentate persons, 24·4 % had an inadequate dentition with 10·3 % defined as ‘chewing deficient’. Multivariate regression coefficients adjusted for age, sex and income showed chewing deficiency (−5·8) and low SES (−3·6) was associated (P < 0·05) with lower grocery purchasing scores, but dietary knowledge was not statistically significant.

For older adults, chewing deficiency and lower social status were associated with lower compliance with dietary guidelines, independent of dietary knowledge.