To assess the stability and changes in fruit and vegetable (FV) consumption over a 3-year period during adolescence in a population-based birth cohort.

Longitudinal descriptive study. FV consumption was collected in 2008 and 2011/12 using an FFQ. We conducted descriptive analyses of medians to assess the trends in FV intake over time. Stability of FV intake was assessed by percentage of agreement and kappa coefficients.

Pelotas, Rio Grande do Sul, Brazil.

Adolescents from 15 to 18 years of age (n 3915).

We observed an overall slight decrease in FV consumption during adolescence and also a moderate stability, especially in those with higher socio-economic status (proportion of agreement 38·6 % and 40·5 % for boys and girls, respectively). About a half of those consuming low levels of FV at 15 years of age still consumed low levels 3 years later.

Our results showed that FV consumption presented a moderate stability across a 3-year period during adolescence, especially in those with higher socio-economic status. Given the great proportions of non-communicable diseases such as CVD, diabetes and obesity, knowledge about the patterns of FV consumption during adolescence has implications for health promotion interventions.

Dairy products are sources of protein and micronutrients important in a healthy diet. The purpose of the present analysis was to estimate consumption of dairy products by Brazilians and identify contributions of dairy products to nutrient intakes.

Dairy consumption data were obtained from 24 h dietary records. Dairy products were defined as milk (including flavoured), cheese and yoghurt. Estimates of dairy product intakes were generated for all individuals, individuals in urban and rural households and for age groups 10–18 years, 19–59 years and ≥60 years. Contributions to nutrient intakes were estimated for the total sample and sub-populations.

Nationwide cross-sectional survey, 2008–2009.

Nationally representative sample of individuals aged ≥10 years in the Individual Food Intake survey, a component of the Brazilian Household Budget Survey (n 34 003).

Among individuals aged ≥10 years, per capita intake of dairy products was 142 (se 2·1) g/d. Dairy product intake was higher among individuals in urban compared with rural areas and among groups 10–18 years and ≥60 years compared with adults aged 19–59 years. Dairy products accounted for 6·1 % of daily energy intake, 7·3 % of protein, 16·9 % of saturated fat, 11·1 % and 4·3 % of total and added sugars, respectively, and 10·2–37·9 % of daily Ca, vitamin D, P, vitamin A and K.

Dairy products were substantial contributors to daily intakes of selected nutrients of concern in Brazil, although mean daily dairy product consumption was less than a typical portion. Education efforts in Brazil to raise awareness about the nutritional role of dairy foods may serve to improve overall diet quality.

To compare the nutrient profile of packaged supermarket food products available in Australia and New Zealand. Eligibility to carry health claims and relationship between nutrient profile score and nutritional content were also evaluated.

Nutritional composition data were collected in six major Australian and New Zealand supermarkets in 2012. Mean Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion (NPSC) scores were calculated and the proportion of products eligible to display health claims was estimated. Regression analyses quantified associations between NPSC scores and energy density, saturated fat, sugar and sodium contents.

NPSC scores were derived for 23 596 packaged food products (mean score 7·0, range −17 to 53). Scores were lower (better nutrient profile) for foods in Australia compared with New Zealand (mean 6·6 v. 7·8). Overall, 45 % of foods were eligible to carry health claims based on NPSC thresholds: 47 % in Australia and 41 % in New Zealand. However, less than one-third of dairy (32 %), meat and meat products (28 %) and bread and bakery products (27·5 %) were eligible to carry health claims. Conversely, >75 % of convenience food products were eligible to carry health claims (82·5 %). Each two-unit higher NPSC score was associated with higher energy density (78 kJ/100 g), saturated fat (0·95 g/100 g), total sugar (1·5 g/100 g) and sodium (66 mg/100 g; all P values<0·001).

Fewer than half of all packaged foods available in Australia and New Zealand in 2012 met nutritional criteria to carry health claims. The few healthy choices available in key staple food categories is a concern. Improvements in nutritional quality of foods through product reformulation have significant potential to improve population diets.

The purpose of the present paper is to examine the prevalence of metabolic syndrome (MetS) and its components using the harmonized definition in an interviewed sub-sample of diverse, low-income, adult South Asians (SA) of both sexes residing in Maryland. We also wanted to derive a BMI cut-off value that was highly correlated with the recommended waist circumference (WC) that we could apply to a larger sample of SA Americans for whom only BMI values were available from clinic files. We also examined differences in MetS prevalence among various Asian ethnic groups (defined by country of origin) and the clustering pattern of their MetS components.

Clinical data extraction on subjects (n 1002) and interviewees (n 401) were used in a cross-sectional study of SA Americans.

Two community health centres in Montgomery and Baltimore County, MD, USA.

SA adult males and females (n 1403) aged 20–68 years.

The prevalence of MetS using harmonized WC cut-offs (90 cm in men and 80 cm in women) was 47 % in men and 54 % in women. Using a BMI of 23·0 kg/m2 gave a similar prevalence of MetS for males (48 %) and females (47 %). Of the five MetS components, the prevalence pattern differed among the ethnic groups, particularly for SA Indians.

The prevalence of MetS in a diverse, low-income, SA American immigrant group using the harmonized definition was 51 %. Derived lowered BMI cut-off of 23·0 kg/m2 should be used by clinicians in studies on SA when WC values are not available for detecting metabolic risk. SA Indians had a higher prevalence of abnormal TAG and blood glucose values compared with other SA, and therefore results for SA Indians should not be generalized to all SA ethnic groups.

The δ13C value of human blood is an emerging novel biomarker of added sugar (AS) intake for adults. However, no free-living, community-based assessments of comparative validity of this biomarker have been conducted. The purpose of the present investigation was to determine if Healthy Eating Index-2010 (HEI-2010) score, SoFAAS score (HEI-2010 sub-component for solid fat, alcohol and AS), AS and sugar-sweetened beverage (SSB) intakes were associated with δ13C value of fingerstick blood in a community-based sample of adults, while controlling for relevant demographics.

A cross-sectional analysis of data obtained from assessments of BMI, dietary intake using 24 h recalls and a fingerstick blood sample was completed. Statistical analyses included descriptive statistics, multiple linear regression and one-way ANOVA.

Rural Southwest Virginia, USA.

Adults (n 216) aged >18 years who consumed at least 837 kJ/d (200 kcal/d) from SSB.

This sample of adult participants with low socio-economic status demonstrated a mean HEI-2010 score of 43·4 (sd 12·2), mean SoFAAS score of 10·2 (sd 5·7), mean AS intake of 93 (sd 65) g/d and mean blood δ13C value of −18·88 (sd 0·7) ‰. In four separate regression models, HEI-2010 (R2=0·16), SoFAAS (R2=0·19), AS (R2=0·15) and SSB (R2=0·14) predicted δ13C value (all P≤0·001). Age was also predictive of δ13C value, but not sex or race.

These findings suggest that fingerstick δ13C value has the potential to be a minimally invasive method for assessing AS and SSB intake and overall dietary quality in community-based settings. Strengths, limitations and future areas of research for using an objective δ13C biomarker in diet-related public health studies are discussed.

The objective of the present study was to examine the external validity of an FFQ designed to estimate dietary vitamin D intake compared with a plasma biomarker and three repeated 24 h dietary recalls in women of reproductive age in Serbia, where there is no exposure to food fortified with vitamin D. The method of triads was applied.

In a cross-sectional study, 422 women completed the Women and Reproductive Health FFQ (WRH-FFQ) during the winter months. From a representative subgroup (n 44), three 24 h dietary recalls and anthropometric parameters were collected as well as a fasting blood sample for vitamin D biomarker analyses. Correlation coefficients were calculated between each of the dietary methods. Validity coefficients, as a correlation between the measured and estimated ‘true’ exposure, were calculated using the method of triads. Bland–Altman plots were also constructed.

Three major universities in Serbia.

Healthy young women (n 422) aged 18–35 years.

The WRH-FFQ estimate of vitamin D intake for all participants was 4·0 (sd 3·3) µg/d and 3·1 (sd 2·3) µg/d for the subgroup. Bland–Altman plots for these intakes showed high agreement. Validity coefficients for the FFQ, 24 h recall and biomarker were ρQI=0·847 (95 % CI 0·564, 0·928), ρRI=0·810 (95 % CI 0·537, 0·997) and ρBI=0·499 (95 % CI 0·190, 0·840), while the correlation coefficients were 0·686, 0·422 and 0·404.

The FFQ applied in the present study is a valid tool for assessing dietary vitamin D intake in women living in Serbia, a region without mandatory vitamin D food fortification.

We examined associations between fast-food intake and perceived and objective fast-food outlet exposure.

Information from the Health Behaviours in School-aged Children Study was linked to fast-food outlets in seventy-five school neighbourhoods. We used multivariate multilevel logistic regression analyses to examine associations between at least weekly fast-food intake and perceived and objective fast-food outlet measures.

Data represent 4642 adolescents (aged 11–15 years) in Denmark.

Boys reporting two or more fast-food outlets had 34 % higher odds consuming fast food at least weekly. We detected higher odds of at least weekly fast-food intake among 15-year-old 9th graders (ORall=1·74; 95 % CI 1·40, 2·18; ORboys=2·20; 95 % CI 1·66, 2·91; ORgirls=1·41; 95 % CI 1·03, 1·92), Danish speakers (ORall=2·32; 95 % CI 1·68, 3·19; ORboys=2·58; 95 % CI 1·69, 3·93; ORgirls=2·37; 95 % CI 1·46, 3·84) and those travelling 15 min or less to school (ORall=1·21; 95 % CI 1·00, 1·46; ORgirls=1·44; 95 % CI 1·08, 1·93) compared with 11-year-old 5th graders, non-Danish speakers and those with longer travel times. Boys from middle- (OR=1·28; 95 % CI 1·00, 1·65) and girls from low-income families (OR=1·46; 95 % CI 1·05, 2·04) had higher odds of at least weekly fast-food intake compared with those from high-income backgrounds. Girls attending schools with canteens (OR=1·47; 95 % CI 1·00, 2·15) had higher odds of at least weekly fast-food intake than girls at schools without canteens.

The present study demonstrates that perceived food outlets may impact fast-food intake in boys while proximity impacts intake in girls. Public health planning could target food environments that emphasize a better understanding of how adolescents use local resources.

To investigate weight concerns among adolescent boys and relationships with health indicators and family factors.

Analysis of the 2010 Health Behaviour in School-aged Children survey of 10–17-year-olds.

Schools in the Republic of Ireland.

Among 6187 boys, 25·1 % reported a desire to lose weight (weight ‘loss’ concern) and 7·7 % reported a desire to gain weight (weight ‘gain’ concern). Both types of weight concerns were associated with poor self-rated health, life satisfaction and happiness, and with more frequent emotional and physical symptoms. Family factors were associated with boys’ weight concerns. In adjusted analyses, the risk of weight ‘loss’ concerns decreased with daily family breakfasts (OR=0·80; 95 % CI 0·66, 0·97). The risk of weight ‘gain’ concerns decreased with frequent family evening meals (OR=0·77; 95 % CI 0·60, 0·99). Ease of communication with mother was associated with a decreased risk of weight ‘loss’ and weight ‘gain’ concerns among boys (OR=0·74; 95 % CI 0·60, 0·90 and OR=0·61; 95 % CI 0·44, 0·82, respectively). An open father–son relationship and having a father present in the home decreased the risk of weight ‘loss’ concerns (OR=0·69; 95 % CI 0·57, 0·82 and OR=0·81; 95 % CI 0·67, 0·98, respectively).

Body weight concerns were reported by a sizeable minority of boys and were associated with negative health outcomes. The findings support the need to promote frequent family meals and facilitate open communication in families.

To conduct the first nationwide population survey to examine the associations between changes in speed of eating and weight gain over 3 years. The study also explored whether faster eating at baseline was related to healthy-weight women becoming overweight after 3 years.

Longitudinal. At baseline, participants were randomly selected from a nationally representative sampling frame to participate in a prospective study. Women completed self-administered baseline questionnaires on demographic and health measures. Self-reported speed of eating, smoking status, physical activity, menopause status, and height and weight were collected at baseline and again 3 years later.

Nationwide study, New Zealand.

Women (n 1601) aged 40–50 years were recruited at baseline from New Zealand electoral rolls.

There was no evidence of associations between 3-year BMI adjusting for baseline BMI and either baseline speed of eating (slower and faster; P=0·524) or change in speed of eating (consistently faster eating, consistently slower eating, slower eating at baseline but not at 3 years, faster eating at baseline but not at 3 years; P=0·845). Of the 488 women with healthy BMI (18·5 to <25·0 kg/m2) at baseline, seventy-seven (15·8 %) became overweight (BMI≥25·0 kg/m2) after 3 years. Compared with those who were slower eaters at baseline, faster eating at baseline did not increase the risk of becoming overweight 3 years later (P=0·958) nor did change in speed of eating (P=0·236).

Results suggest that once women have reached mid-life, faster eating does not predict further weight gain.

Vitamin D plays a major role in Ca and bone metabolism, and its extraskeletal functions are being appraised. Although inadequate vitamin D concentrations have been reported in populations worldwide, too little is known about vitamin D status and its determinants among children in developing countries. We aimed to determine vitamin D status and its determinants in Nepalese children of pre-school age.

A community-based, cross-sectional study.

Rural Nepal at latitude 27·39°N.

Healthy children (n 280) aged 12–60 months, selected randomly from the records of a vitamin A supplementation programme. Blood samples were collected using the dried blood spot technique and analysed for serum 25-hydroxyvitamin D (s-25(OH)D) concentration using liquid chromatography–tandem mass spectrometry. Ca intake and background variables were assessed with a structured questionnaire.

Hypovitaminosis D, defined as s-25(OH)D concentration less than 50 nmol/l, was found in 91·1 % of the children. S-25(OH)D concentration was not related to gender, socio-economic indicators, sun exposure or nutritional status. Currently breast-fed children had higher s-25(OH)D concentrations (36·4 (sd 13·2) nmol/l) than those who were not (28·6 (sd 9·8) nmol/l, P<0·001). Adjustment for sociodemographic factors did not alter the results.

There is widespread vitamin D deficiency among pre-school children in a rural area of Nepal. In our sample, sociodemographic factors did not affect the vitamin D status of children, but prolonged breast-feeding was associated with higher s-25(OH)D concentrations. Further research is required to investigate the health consequences of poor vitamin D status for this population.

We aimed to investigate the association between multiple measures of socio-economic position (SEP) and diet quality, using a diet quality index representing current national dietary guidelines, in the Australian adult population.

Cross-sectional study. Linear regression analyses were used to estimate the association between indicators of SEP (educational attainment, level of income and area-level disadvantage) and diet quality (measured using the Dietary Guideline Index (DGI)) in the total sample and stratified by sex and age (≤55 years and >55 years).

A large randomly selected sample of the Australian adult population.

Australian adults (n 9296; aged ≥25 years) from the Australian Diabetes, Obesity and Lifestyle Study.

A higher level of educational attainment and income and a lower level of area-level disadvantage were significantly associated with a higher DGI score, across the gradient of SEP. The association between indicators of SEP and DGI score was consistently stronger among those aged ≤55 years compared with their older counterparts. The most disadvantaged group had a DGI score between 2 and 5 units lower (depending on the marker of SEP) compared with the group with the least disadvantage.

A higher level of SEP was consistently associated with a higher level of diet quality for all indicators of SEP examined. In order to reduce socio-economic inequalities in diet quality, healthy eating initiatives need to act across the gradient of socio-economic disadvantage with a proportionate focus on those with greater socio-economic disadvantage.

To analyse the prevalence of cardiovascular risk factors in healthy adolescents of low to middle socio-economic status and to study the influence of anthropometric, biological and lifestyle factors on the risk of metabolic syndrome (MetS).

Cross-sectional study. BMI, waist circumference, blood pressure, fat and lean mass (by dual-energy X-ray absorptiometry), TAG, HDL-cholesterol, glucose, insulin, homeostatic model assessment–insulin resistance index (HOMA-IR), food intake and physical activity were measured. Cardiovascular risk factors were defined using the International Diabetes Federation criteria and insulin resistance using HOMA-IR ≥2·6. Bivariate and multivariate regressions examined the associations between MetS and anthropometric, biological and lifestyle factors.

Observational cohort study including Chilean adolescents, who were part of a follow-up study beginning in infancy.

Adolescents aged 16–17 years (n 667).

In the sample, 16·2 % had obesity and 9·5 % had MetS. Low HDL-cholesterol (69·9 %), abdominal obesity (33·3 %) and fasting hyperglycaemia (8·7 %) were the most prevalent cardiovascular risk factors. In males, obesity (OR=3·7; 95 % CI 1·2, 10·8), insulin resistance (OR=3·0; 95 % CI 1·1, 8·2), physical inactivity (OR=2·9; 95 % CI 1·1, 7·7) and sarcopenia (OR=21·2; 95 % CI 4·2, 107·5) significantly increased the risk of MetS. In females, insulin resistance (OR=4·9; 95 % CI 1·9, 12·6) and sarcopenia (OR=3·6; 95 % CI 1·1, 11·9) were significantly associated with MetS.

High prevalences of obesity, abdominal obesity, dyslipidaemia, fasting hyperglycaemia and MetS were found in healthy adolescents. In both sexes, sarcopenia and insulin resistance were important risk factors of MetS. Promotion of active lifestyles at the school level and regulation of the sale of energy-dense foods are needed.

Studies have suggested that total intake of trans-fatty acids (TFA) is positively associated with changes in body weight and waist circumference, whereas intake of TFA from ruminant dairy and meat products (R-TFA) has not been associated with weight gain. However, these previous studies are limited by self-reported measures of body weight and waist circumference or by a cross-sectional design. The objective of the present study was to investigate if R-TFA intake was associated with subsequent changes in anthropometry (body weight, waist and hip circumference) measured by technicians and body composition (body fat percentage).

A 6-year follow-up study. Information on dietary intake was collected through diet history interviews, and anthropometric and bioelectrical impedance measurements were obtained by trained technicians at baseline (1987–1988) and at follow-up (1993–1994). Multiple regression with cubic spline modelling was used to analyse the data.

Copenhagen County, Denmark.

Two hundred and sixty-seven men and women aged 35–65 years from the Danish MONICA (MONItoring of trends and determinants in CArdiovascular diseases) cohort.

The median R-TFA intake was 1·3 g/d (5th, 95th percentile: 0·4, 2·7 g/d) or 0·6 % of the total energy intake (5th, 95th percentile: 0·2, 1·1 %). No significant associations were observed between R-TFA intake and changes in body weight, waist and hip circumference or body fat percentage.

R-TFA intake within the range present in the Danish population was not significantly associated with subsequent changes in body size, shape or composition and the 95 % confidence intervals indicate that any relevant associations are unlikely to have produced these observations.

To investigate whether intakes of Ca, vitamin D, casein and whey are associated with periodontitis and to investigate the possibility of interactions between them.

Cross-sectional study. An Internet-based, 267-item FFQ was used to assess dietary intake. Intakes of casein (32·0 g/d), whey proteins (9·6 g/d) and vitamin D (5·8 μg/d) were classified as within v. above the 50th percentile. Ca intake was classified as within v. below age-specific recommendations. Severe periodontitis was defined as having ≥2 inter-proximal sites with clinical attachment loss ≥6 mm (not on the same tooth) and ≥1 inter-proximal site with pocket depth ≥5 mm. Since vitamin D influences Ca absorption, models were stratified by lower and higher (<5·8 v. ≥5·8 µg/d) vitamin D intake.

Danish Health Examination Survey (DANHES) 2007–2008.

Adult participants (n 3287) in the oral health study of DANHES 2007–2008.

Intakes of Ca within recommendations (OR=0·76; 95 % CI 0·58, 0·99), whey ≥9·6 g/d (OR=0·75; 95 % CI 0·58, 0·97) and casein ≥32 g/d (OR=0·75 95 % CI 0·58, 0·97) were associated with lower likelihood of severe periodontitis after adjustment for age, gender, education, smoking, sucrose intake, alcohol consumption, number of teeth, daily brushing, regular visits to the dentist and chronic illness, irrespective of vitamin D intake levels. Intake of vitamin D alone was not associated severe with periodontitis.

Intakes of Ca, casein and whey protein were inversely associated with periodontitis. Consumption of foods rich in Ca, casein and whey (e.g. dairy foods) should be promoted, as they may contribute to the prevention of periodontitis. Further longitudinal studies are required to confirm these associations.

The present study examined the association between unemployment and household food insecurity during the 2007–2009 economic recession in the USA.

Longitudinal survey of the Survey of Income and Program Participation (SIPP; 2008–2011). Food insecurity was measured by five questions excerpted from an eighteen-item Food Security Scale. Unemployment was measured by a dichotomous indicator, the number of job losses and the total duration of all episodes in the observation period.

As nationally representative data, the SIPP interviewed respondents in multiple waves with a time interval of four months.

The study created two analytic samples including working-age household heads employed at the beginning of the observation period. The size of the two samples was 14 417 and 13 080.

Unemployment was positively associated with food insecurity (OR=1·55; 95 % CI 1·32, 1·83; P<0·001). Similar results were obtained when the analysis controlled for food insecurity status measured before unemployment (OR=1·54; 95 % CI 1·27, 1·88; P<0·001). For households with the same duration of unemployment, one more episode of unemployment increased the odds of food insecurity by 8 % (OR=1·08; 95 % CI 1·00, 1·18; P<0·001).

More in-depth understanding of the relationship between unemployment and food insecurity is useful to better identify and serve the at-risk population. Connecting unemployment assistance closely to nutrition assistance could lower the prevalence of food insecurity among unemployed households. Public policy should better account for both episodes and duration of unemployment to reduce food insecurity.

To measure the impact of a reimbursement-based consumer subsidy on vegetable expenditures, consumption and waste.

Two-arm randomized controlled trial; two-week baseline observation period, three-week intervention period. Participants’ vegetable expenditures, consumption and waste were monitored using receipts collection and through an FFQ. During the intervention period, the treatment group received reimbursement of up to 50 US dollars ($) for purchased vegetables.

Participants were solicited from Palo Alto, CA, USA using materials advertising a ‘consumer behavior study’ and a small participation incentive. To prevent selection bias, solicitation materials did not describe the specific behaviour being evaluated.

One hundred and fifty potential participants responded to the solicitations and 144 participants enrolled in the study; 138 participants completed all five weekly surveys.

Accounting for the control group (n 69) and the two-week baseline period, the intervention significantly impacted the treatment group’s (n 69) vegetable expenditures (+$8·16 (sd 2·67)/week, P<0·01), but not vegetable consumption (+1·3 (sd 1·2) servings/week, P=0·28) or waste (−0·23 (sd 1·2) servings/week, P=0·60).

The consumer subsidy significantly increased participants’ vegetable expenditures, but not consumption or waste, suggesting that this type of subsidy might not have the effects anticipated. Reimbursement-based consumer subsidies may therefore not be as useful a policy tool for impacting vegetable consumption as earlier studies have suggested. Moreover, moderation analysis revealed that the subsidy’s effect on participants’ vegetable expenditures was significant only in men. Additional research should seek to determine how far reaching gender-specific effects are in this context. Further research should also examine the effect of a similar consumer subsidy on high-risk populations and explore to what extent increases in participants’ expenditures are due to the purchase of more expensive vegetables, purchasing of vegetables during the study period that were consumed outside the study period, or a shift from restaurant vegetable consumption to grocery vegetable consumption.