Regular dietary intake of fish is associated with reduced risk of developing cardiovascular and other chronic diseases, and may improve general well-being. If fish eaters are healthier, they may use fewer health-care resources. The present study aimed to describe the reported intake of fish and fish products in a Danish general population, and to investigate whether fish consumption is associated with generic measures of self-reported health and consumption of health-care resources.

Data on eating patterns and health status for 3422 Danish adults were obtained by telephone interview in the Funen County Health Survey. These data were merged with individual-level register data on health-care utilisation. Survey respondents were categorised into those consuming fish at least once weekly (fish eaters) and those consuming fish less frequently (non-fish eaters).

People who reported eating fish twice monthly or once weekly had significantly better overall self-reported health than those who rarely eat fish, even after adjustment for age, gender, social characteristics and lifestyle factors. Fish eaters did not have significantly lower aggregated health-care costs, although their hospital utilisation was significantly lower than that for non-fish eaters.

Moderate fish consumption was associated with better self-reported general health even after controlling for possible confounding variables. Overall, fish eaters appeared to use the same amount of health-care resources as non-eaters, although fish eaters used more medicine but were less likely to be admitted to a hospital.

To examine the joint effect of family history and BMI on diabetes.

Cross-sectional study.

A rural community in Saskatchewan, Canada.

The analysis was based on data from 2081 adults, 18–79 years of age, who participated in the Humboldt Study conducted in 2003. Doctor-diagnosed diabetes and family history of diabetes of biological parents and siblings were self-reported. Body weight and height were objectively measured. The interaction of family history and BMI on diabetes was assessed on an additive scale.

The prevalence of diabetes was 7·9 %, and BMI and history of diabetes were two important predictors. The adjusted prevalence ratios were 1·76 (95 % CI 1·37, 2·27) and 2·59 (95 % CI 2·05, 3·31) for those with a BMI of 25·0–29·9 kg/m2 and of at least 30 kg/m2, respectively, compared with a BMI of less than 25 kg/m2, and was 2·41 (95 % CI 2·08, 2·80) for those with a family history of diabetes v. those without. The data indicated an additive interaction of family history and BMI on diabetes.

When exposed to both family history and overweight/obesity, individuals would have an increased risk that was greater than the sum of their single effects. Reduction of BMI would also reduce the risk of diabetes associated family history.

Poor oral health influences the dietary quality of older individuals. The objective of the present study was to relate the number of teeth to adherence to the 2005 Dietary Guidelines for Americans among an ethnically diverse sample of older adults.

A block cluster design was used to obtain a sample of older adults. Data were weighted to census data for ethnicity and gender. Dietary intakes were assessed using an FFQ and converted into Healthy Eating Index-2005 (HEI-2005) scores.

Two counties in North Carolina, USA, with large African-American and American Indian populations.

Community-dwelling older adults (N 635).

Three hundred and twenty-six participants had severe tooth loss (0–10 teeth remaining), compared with 305 participants with 11+ teeth. After controlling for socio-economic factors, those with 0–10 teeth had lower total HEI-2005 scores and consumed less Total Fruit, Meat and Beans, and Oils, and more energy from Solid Fat, Alcohol and Added Sugar, compared with those with 11+ teeth. Less than 1 % of those with 0–10 teeth and 4 % of those with 11+ teeth met overall HEI-2005 recommendations. Those with 0–10 teeth were less likely to eat recommended amounts of Total Vegetables, Dark Green and Orange Vegetables, and energy from Solid Fat, Alcohol and Added Sugar.

Older adults with severe tooth loss are less likely than those with moderate to low tooth loss to meet current dietary recommendations. Nutrition interventions for older adults should take oral health status into consideration and include strategies that specifically address this as a barrier to healthful eating.

To establish the food consumption, dietary habits and nutritional status of people living with HIV/AIDS (PLWHA) and adults whose HIV status is not established.

Cross-sectional descriptive survey.

Thika and Bungoma Districts, Kenya.

A random sample of 439 adults; 174 adults living with HIV/AIDS and 265 adults whose HIV/AIDS status was not established in Thika and Bungoma Districts.

Majority of PLWHA consume foods that are low in nutrients to build up the immune system and help maintain adequate weight, and there is little variety in the foods they consume. More adults who are HIV-positive are undernourished than those whose status is not established. Of the HIV-positive adults, those with a BMI of ≤18·5 kg/m2 were 23·6 % (Thika 20·0 % and Bungoma 25·7 %) while of the adults whose status is not established those with BMI ≤ 18·5 kg/m2 were 13·9 % (Thika 9·3 % and Bungoma 16·7 %).

Adults who are HIV-positive are more likely to be undernourished than those whose status is not established, as there is a significant difference (P = 0·000) between the nutritional status (BMI) of PLWHA and those whose HIV/AIDS status is not established. PLWHA consume foods that are low in nutrients to promote their nutritional well-being and health.

To assess the intake frequency of fruit and vegetables, serving sizes, reasons for and barriers to consumption, and the potential for increasing fruit and vegetable intake.

A nationwide postal questionnaire survey was conducted in 2006 over all four seasons. The participants were stratified according to occupation and sex. The response rate for 5130 questionnaires sent out was 52·7 %.

Austria.

Austrian adults, aged 19–64 years.

Daily fruit consumption was reported by 57·1 % of the participants and daily vegetable consumption by 36·2 %. On average, 2·1 (sd 1·9) servings (250 (sd 225) g) of fruit and 1·7 (sd 1·3) servings (198 (sd 159) g) of vegetables were consumed daily. Women ate fruit and vegetables both more frequently and in greater quantities than men. Both intake frequency and the number of fruit and vegetable servings were largely independent of seasonal fluctuations. The primary reason for the consumption of both fruit and vegetables was taste. The greatest barrier to higher intake was the perception that current individual consumption was already sufficient. Price did not constitute a relevant barrier in Austria. At present, the potential for increasing fruit and vegetable intake can be estimated at two servings.

Austrian adults still consume less fruit and vegetables than recommended. Strategies to increase intake should pay more attention to the taste instead of the various health aspects.

To identify the optimal waist:height ratio (WHtR) cut-off point that discriminates cardiometabolic risk factors in Turkish adults.

Cross-sectional study. Hypertension, dyslipidaemia, diabetes, metabolic syndrome score ≥2 (presence of two or more metabolic syndrome components except for waist circumference) and at least one risk factor (diabetes, hypertension or dyslipidaemia) were categorical outcome variables. Receiver-operating characteristic (ROC) curves were prepared by plotting 1 − specificity on the x-axis and sensitivity on the y-axis. The WHtR value that had the highest Youden index was selected as the optimal cut-off point for each cardiometabolic risk factor (Youden index = sensitivity + specificity − 1).

Turkey, 2003.

Adults (1121 women and 571 men) aged 18 years and over were examined.

Analysis of ROC coordinate tables showed that the optimal cut-off value ranged between 0·55 and 0·60 and was almost equal between men and women. The sensitivities of the identified cut-offs were between 0·63 and 0·81, the specificities were between 0·42 and 0·71 and the accuracies were between 0·65 and 0·73, for men and women. The cut-off point of 0·59 was the most frequently identified value for discrimination of the studied cardiometabolic risk factors. Subjects classified as having WHtR ≥ 0·59 had significantly higher age and sociodemographic multivariable-adjusted odds ratios for cardiometabolic risk factors than subjects with WHtR < 0·59, except for diabetes in men.

We show that the optimal WHtR cut-off point to discriminate cardiometabolic risk factors is 0·59 in Turkish adults.

To report on the prevalence of overweight and obesity among pre-school children in Kenya and examine the associations between childhood overweight and selected maternal and child-related factors.

Demographic Health Survey data, multistage stratified cluster sampling methodology.

Rural and urban areas of Kenya.

A total of 1495 children between the ages of 3 and 5 years in Kenya.

Over 30 % of the children were stunted, approximately 16 % were underweight, 4 % were wasted, approximately 18 % were overweight and 4 % were obese; 8 % were both overweight/obese and stunted. Maternal overweight and obesity, higher levels of maternal education, being a large or very large child at birth, and being stunted were each associated with higher odds of overweight and obesity among Kenyan children. Older children and large household size were each associated with lower odds of overweight and obesity among Kenyan children.

The analysis demonstrates the presence of under- and overnutrition among Kenyan pre-school children and the importance of focusing on expanding efforts to prevent and treat malnutrition within this population. It also identifies some of the modifiable factors that can be targeted in these efforts.

To assess milk feeding on the maternity ward and during infancy, and their relationship to sociodemographic determinants. The validity of our 3-month questionnaire in measuring hospital feeding was assessed.

A prospective Finnish birth cohort with increased risk to type 1 diabetes recruited between 1996 and 2004. The families completed a follow-up form on the age at introduction of new foods and age-specific dietary questionnaires.

Type 1 Diabetes Prediction and Prevention (DIPP) project, Finland.

A cohort of 5993 children (77 % of those invited) participated in the main study, and 117 randomly selected infants in the validation study.

Breast milk was the predominant milk on the maternity ward given to 99 % of the infants. Altogether, 80 % of the women recalled their child being fed supplementary milk (donated breast milk or infant formula) on the maternity ward. The median duration of exclusive breast-feeding was 1·4 months (range 0–8) and that of total breast-feeding 7·0 months (0–25). Additional milk feeding on the maternity ward, short parental education, maternal smoking during pregnancy, small gestational age and having no siblings were associated with a risk of short duration of both exclusive and total breast-feeding. In the validation study, 78 % of the milk types given on the maternity ward fell into the same category, according to the questionnaire and hospital records.

The recommendations for infant feeding were not achieved. Infant feeding is strongly influenced by sociodemographic determinants and feeding practices on the maternity wards. Long-term breast-feeding may be supported by active promotion on the maternity ward.

To investigate barriers to increasing fruit and vegetable (f + v) intakes in a large sample of the older population of Northern Ireland (NI), in relation to current intakes.

The study was conducted using a telephone survey assessing f + v intakes, barriers to increasing intakes and various demographic and lifestyle characteristics. Barriers to increasing intakes were investigated using twenty-two closed-response items and one open-response item.

NI.

Four hundred and twenty-six older people from NI, representative of the older population of NI.

Principal component analysis of the twenty-two closed-response items revealed five factors affecting f + v consumption. Significant associations with current intakes were found where greater f + v consumption was associated with greater ‘liking’ for f + v (B = 0·675, P < 0·01), greater ‘awareness of current recommendations’ for consumption (B = 0·197, P < 0·01) and greater ‘willingness to change’ (B = 0·281, P < 0·01). ‘Ease of consumption’ and ‘difficulties in achieving consumption’ were not associated with f + v intakes. Similar associations between f + v intakes and ‘liking’ and ‘awareness’ were also found in those consuming low intakes of f + v or those at risk of consuming low intakes. Low awareness and knowledge of recommendations were also found in response to the open-ended question in all groups, although some weight was also given here to environmental difficulties, such as cost and access.

These findings suggest that interventions aiming to increase f + v intakes in the older population of NI should focus predominantly on improving liking and improving knowledge and awareness of current recommendations.

Introduction of solid foods before the recommended age of 4–6 months is a common practice in the USA, and appears to be especially prevalent among infants who are enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Currently, little is known about how fathers influence early infant feeding decisions, outside the decision to breast- or formula-feed. The purpose of the current study was to explore how fathers perceive the role they play in feeding and caring for their infants.

Participants were twenty-one male caregivers, who were fathers or partners of the mothers of WIC income-eligible infants residing in two rural East Tennessee counties. In-depth, audio-taped telephone interviews were completed. Interviews were transcribed, coded and analysed according to standard grounded theory procedures to identify emergent concepts. These concepts were explored and linked together to become themes.

Three themes emerged: (i) fathers’ roles; (ii) fathers’ perceptions; and (iii) control. Concepts within the theme of fathers’ roles included physical and emotional support for both mother and infant, validation of maternal decisions, and financial support. In the present study, fathers’ perceptions were primarily shaped by their own experiences, advice from those with experience, and information sought by the fathers. The theme of control appears to be the linkage between the fathers’ attempts to modify infant behaviour and infants’ response.

A final conceptual model was created to explain the interrelated nature of the themes and may be helpful to those who work with fathers and/or families of new infants.

To determine the vitamin D status of women of South Asian origin living in Auckland, New Zealand, and to investigate their attitudes and behaviours with regard to sun exposure.

Cross-sectional study.

Auckland, New Zealand.

Women of South Asian origin (n 235) aged 20 years and older were tested for serum 25(OH)D, and 228 were included in these analyses. Of these, 140 completed a questionnaire about attitudes and behaviours to sun exposure, and health motivation. Exclusion criteria included high dose (>1000 IU/d) supplementation with 25(OH)D3, or any supplementation with 1,25(OH)2D3.

As serum vitamin D concentrations were not normally distributed, data are reported as median (25th, 75th percentile). Median serum 25(OH)D3 was 27·5 (18·0, 41·0) nmol/l. Adequate concentrations (>50 nmol/l) were observed in only 16 % of the subjects. Concern about skin cancer and the strength of the New Zealand sun were the most prevalent reasons given for sun avoidance, with 65 % saying they did avoid the sun. However, a seasonal variation was observed, with concentrations reducing significantly (P < 0·001) from summer through to early spring by 19·5 nmol/l.

The results of the present study suggest that South Asian women are at high risk of hypovitaminosis D, due, in part, to deliberate sun avoidance and an indoor lifestyle, and that they are especially vulnerable in winter and spring.

To examine whether television viewing, computer game playing or book reading during meals predicts meal skipping with the aim of watching television, playing computer games or reading books (media meal skipping).

A cross-sectional study was conducted using a standardized self-administered questionnaire. Analyses were controlled for age, gender and BMI.

Data were obtained from a random sample of adolescents in Flanders, Belgium.

Seven hundred and ten participants aged 12, 14 and 16 years.

Of the participants, 11·8 % skipped meals to watch television, 10·5 % skipped meals to play computer games and 8·2 % skipped meals to read books. Compared with those who did not use these media during meals, the risk of skipping meals in order to watch television was significantly higher for those children who watched television during meals (2·9 times higher in those who watched television during at least one meal a day). The risk of skipping meals for computer game playing was 9·5 times higher in those who played computer games weekly or more while eating, and the risk of meal skipping in order to read books was 22·9 times higher in those who read books during meals less than weekly. The more meals the respondents ate with the entire family, the less likely they were to skip meals to watch television.

The use of media during meals predicts meal skipping for using that same medium. Family meals appear to be inversely related to meal skipping for television viewing.

We examined the halo effect of a 2-year weight-loss diet trial, the Dietary Intervention Randomized Controlled Trial (DIRECT), on the weight and nutritional patterns of participants' spouses.

DIRECT participants in a research centre workplace were randomly assigned to one of three diets: Low-fat, Mediterranean or Low-carbohydrate. A sample of wives of the DIRECT participants, who attended support update meetings specific to their husband's diet during the first 6 months, were followed for 2 years.

South Israel.

Seventy-four women (mean age = 51 years, mean BMI =26·6 kg/m2).

Among the wives of husbands randomised to the Low-fat, Mediterranean and Low-carbohydrate diet, self-reported weight change was respectively −1·48 kg, −2·30 kg and −4·62 kg after 6 months, and +0·39 kg, −3·00 kg and −2·30 kg after 2 years. Weight loss among wives whose husbands were in the alternative diet groups combined (Mediterranean+Low-carbohydrate) was significantly greater than among wives whose husbands were in the Low-fat group after 6 months (P = 0·031) and 2 years (P = 0·034). Overweight wives experienced more weight loss. The weight change of couples was significantly correlated (r = 0·42, P < 0·001). Across all dietary groups, wives had significant improvement in their dietary patterns in all food groups according to their husbands' diets, mainly by a larger significant decrease in carbohydrate consumption in the Low-carbohydrate group (P = 0·013 compared to Low-fat). Six-month weight change among the seventy-four DIRECT participants whose wives took part in the group support sessions was −5·2 kg, compared to −3·5 kg among the 248 DIRECT participants whose wives did not take part in these sessions (P = 0·020).

Focusing on the couple as a unit could provide a cost-effective approach to weight-loss programmes.

The present study examines the receptivity to and potential effects of menu labelling on food choices of low-income and minority individuals – a group often at disproportionate risk for preventable, lifestyle-related health conditions (e.g. obesity, diabetes and CVD).

We conducted a cross-sectional survey to examine the knowledge, attitudes and potential response to menu labelling in an urban public health clinic population.

United States.

A total of 639 clinic patients were recruited in the waiting rooms of six, large public health centres in Los Angeles County (2007–2008). These centres provide services to a largely uninsured or under-insured, low-income, Latino and African-American population.

Among those approached and who met eligibility criteria, 88 % completed the survey. Of the 639 respondents, 55 % were overweight or obese based on self-reported heights and weights; 74 % reported visiting a fast food restaurant at least once in the past year, including 22 % at least once a week; 93 % thought that calorie information was ‘important’; and 86 % thought that restaurants should be required to post calorie information on their menu boards. In multivariate analyses, respondents who were obese, female, Latino and supportive of calorie postings were more likely than others to report that they would choose food and beverages with lower calories as a result of menu labelling.

These findings suggest that clinic patients are receptive to this population-based strategy and that they would be inclined to change their food selections in response to menu labelling.

Inappropriate complementary feeding is one of the major causes of malnutrition in young children in developing countries. We developed an educational intervention, delivered by local health-care providers, aimed at improving complementary feeding practices and child nutrition.

Eight townships in Laishui, a rural area in China, were randomly assigned to the educational intervention or control group. A total of 599 healthy infants were enrolled at age 2–4 months and followed up until 1 year of age. In the intervention group, educational messages and enhanced home-prepared recipes were disseminated to caregivers through group trainings and home visits. Questionnaire surveys and anthropometric measurements were taken at baseline and ages 6, 9 and 12 months. Analysis was by intention to treat.

It was found that food diversity, meal frequency and hygiene practices were improved in the intervention group. Infants in the intervention group gained 0·22 kg more weight (95 % CI 0·003, 0·45 kg, P = 0·047) and gained 0·66 cm more length (95 % CI 0·03, 1·29 cm, P = 0·04) than did controls over the study period.

Findings from the study suggest that an educational intervention delivered through local health-care providers can lead to substantial behavioural changes of caregivers and improve infant growth.

To provide input to Australian and New Zealand government decision making regarding an optimal strategy to reduce the rate of neural tube defects (NTD).

Standard comparative health economic evaluation techniques were employed for a set of intervention options for promoting folate/folic acid consumption in women capable of or planning a pregnancy. Evidence of effectiveness was informed by the international literature and costs were derived for Australia and New Zealand.

Population-wide campaigns to promote supplement use and mandatory fortification were the most effective at reducing NTD, at an estimated 36 and 31 fewer cases per annum respectively for Australia and New Zealand, representing an 8 % reduction in the current annual NTD rate. Population-wide and targeted approaches to increase supplement use were cost-effective, at less than $AU 12 500 per disability-adjusted life year (DALY) averted ($US 9893, £5074), as was extending voluntary fortification. Mandatory fortification was not cost-effective for New Zealand at $AU 138 500 per DALY ($US 109 609, £56 216), with results uncertain for Australia, given widely varying cost estimates. Promoting a folate-rich diet was least cost-effective, with benefits restricted to impact on NTD.

Several options for reducing NTD appear to fall well within accepted societal cost-effectiveness norms. All estimates are subject to considerable uncertainty, exacerbated by possible interactions between interventions, including impacts on currently effective strategies. The Australian and New Zealand governments have decided to proceed with mandatory fortification; it is hoped they will support a rigorous evaluation which will contribute to the evidence base.

Although teachers are the key participants in health-promoting schools (HPS) programme delivery, it is still unknown whether teachers are appropriate health information resources and role models for students with respect to healthy diets. The present study aimed to investigate the effects of implementing HPS programmes on teachers’ nutrition knowledge and diets.

One HPS programme aiming at dietary intervention (HP-D) and one HPS not aiming at dietary intervention (HP-ND) were selected, along with two non-health-promoting (NHP) schools matched for school size and urbanization level with the two HPS. All 361 teachers in the four schools were invited to participate, yielding a 78·4 % overall valid response rate. A structured, self-reported questionnaire was administered, with regression models used for statistical analysis.

Teachers in the HP-D group had a mean score of 21·1 on a range of 0–30 for nutrition knowledge, which was significantly higher than the mean scores of 18·5 in the HP-ND group and 19·1 in the NHP group (P < 0·001). Better dietary behaviours were also observed among HP-D teachers. Further, being a ‘health education’ course instructor was associated with significantly higher scores on nutrition knowledge (β = 2·6, P < 0·001) and vegetable and fruit consumption (β = 1·4, P = 0·02) in the HP-D group than in the NHP group. The HP-ND and NHP groups exhibited similar patterns of non-significant differences compared with the HP-D group.

Implementation of a coordinated HPS framework on nutrition and diet was positively correlated with schoolteachers’ nutrition knowledge and dietary intake.

We investigated whether having a policy regarding the availability of sweetened beverages in school was associated with children’s purchase and total weekly and daily consumption of sweetened beverages.

Data were obtained from 10 719 children aged 9–13 years and 2065 elementary schools in the Early Childhood Longitudinal Study–Kindergarten cohort. Multilevel logistic regression was used to determine the magnitude and significance of relationships between the availability of different beverages and purchase of sweetened beverages at school and overall consumption of beverages.

The purchase of sweetened beverages by children in school was strongly associated with the administrative policy of sweetened beverage availability. Compared with children in schools without an administrative policy that allowed sweetened beverages, children in schools with the policy were three times more likely to be either occasional or frequent consumers of sweetened beverages.

A policy of availability of sweetened beverages makes an independent contribution to children’s purchase and consumption of sweetened beverages in the 5th grade year.