Breakfast consumption has been consistently associated with health outcomes and cognitive functioning in schoolchildren. Evidence of direct links with educational outcomes remains equivocal. We aimed to examine the link between breakfast consumption in 9–11-year-old children and educational outcomes obtained 6–18 months later.

Data on individual-level free school meal entitlement and educational outcomes (Statutory Assessment Tests (SATs) at Key Stage 2) were obtained via the SAIL databank and linked to earlier data collected on breakfast consumption. Multilevel modelling assessed associations between breakfast consumption and SATs.

Trial of the Primary School Free Breakfast Initiative in Wales.

Year 5 and 6 students, n 3093 (baseline) and n 3055 (follow-up).

Significant associations were found between all dietary behaviours and better performance in SATs, adjusted for gender and individual- and school-level free school meal entitlement (OR=1·95; CI 1·58, 2·40 for breakfast, OR=1·08; CI 1·04, 1·13 for healthy breakfast items). No association was observed between number of unhealthy breakfast items consumed and educational performance. Association of breakfast consumption with educational performance was stronger where the measure of breakfast consumption was more proximal to SATs tests (OR=2·02 measured 6 months prior to SATs, OR=1·61 measured 18 months prior).

Significant positive associations between self-reported breakfast consumption and educational outcomes were observed. Future research should aim to explore the mechanisms by which breakfast consumption and educational outcomes are linked, and understand how to promote breakfast consumption among schoolchildren. Communicating findings of educational benefits to schools may help to enhance buy-in to efforts to improve health behaviours of pupils.

To characterise German vitamin and mineral supplement users differentiated by their motives for supplement use.

Data were obtained from the German National Nutrition Monitoring (2010/11) via two 24 h dietary recalls and a telephone interview. Motive-based subgroups of supplement users were identified by factor and cluster analysis. Sociodemographic, lifestyle, health and dietary characteristics and supplement use were examined. Differences were analysed using χ2 tests, logistic and linear regression models.

Germany, nationwide.

Individuals (n 1589) aged 18–80 years.

Three motive-based subgroups were identified: a ‘Prevention’ subgroup (n 324), characterised by the motive to prevent nutrient deficiencies; a ‘Prevention and additional benefits’ subgroup (n 166), characterised by motives to prevent health problems and improve well-being and performance; and a ‘Treatment’ subgroup (n 136), characterised by motives to treat nutrient deficiencies or diseases. Members of the two prevention subgroups had a higher Healthy Eating Index score and tended to be more physically active than non-users. Those in the ‘Prevention and additional benefits’ subgroup supplemented with a greater number of micronutrients. Members of the ‘Treatment’ subgroup tended to be older and have a lower self-reported health status than non-users, and supplemented with a smaller number of micronutrients.

The majority of supplement users take supplements for preventive purposes and they are more health conscious than non-users of supplements due to their concerns about developing health problems. Those supplementing for treatment purposes may have underlying health indications and may be more likely to benefit from supplementation than those supplementing for preventive purposes.

There is evidence to suggest that individual components of dietary intake are associated with depressive symptoms. Studying the whole diet, through dietary patterns, has become popular as a way of overcoming intercorrelations between individual dietary components; however, there are conflicting results regarding associations between dietary patterns and depressive symptoms. We examined the associations between dietary patterns extracted using principal component analysis and depressive symptoms, taking account of potential temporal relationships.

Depressive symptoms in parents were assessed using the Edinburgh Postnatal Depression Scale (EPDS) when the study child was 3 and 5 years of age. Scores >12 were considered indicative of the presence of clinical depressive symptoms. Diet was assessed via FFQ when the study child was 4 years of age.

Longitudinal population-based birth cohort.

Mothers and fathers taking part in the Avon Longitudinal Study of Parents and Children when their study child was 3–5 years old.

Unadjusted results suggested that increased scores on the ‘processed’ and ‘vegetarian’ patterns in women and the ‘semi-vegetarian’ pattern in men were associated with having EPDS scores ≥13. However, after adjustment for confounders all results were attenuated. This was the case for all those with available data and when considering a sub-sample who were ‘disease free’ at baseline.

We found no association between dietary patterns and depressive symptoms after taking account of potential confounding factors and the potential temporal relationship between them. This suggests that previous studies reporting positive associations may have suffered from reverse causality and/or residual confounding.

Patients often do not eat/drink enough during hospitalization. To enable patients to meet their energy and nutritional requirements, food and catering service quality and staff support are therefore important. We assessed patients’ satisfaction with hospital food and investigated aspects influencing it.

We conducted a cross-sectional study collecting patients’ preferences using a slightly modified version of the Acute Care Hospital Foodservice Patient Satisfaction Questionnaire (ACHFPSQ). Factor analysis was carried out to reduce the number of food-quality and staff-issue variables. Univariate and multivariate ordinal categorical regression models were used to assess the association between food quality, staff issues, patients’ characteristics, hospital recovery aspects and overall foodservice satisfaction (OS).

A university hospital in Florence, Italy, in the period November–December 2009.

Hospital patients aged 18+ years (n 927).

Of the 1288 questionnaires distributed, 927 were returned completely or partially filled in by patients and 603 were considered eligible for analysis. Four factors (explained variance 64·3 %, Cronbach's alpha αC = 0.856), i.e. food quality (FQ; αC = 0·74), meal service quality (MSQ; αC = 0·73), hunger and quantity (HQ; αC = 0·74) and staff/service issues (SI; αC = 0·65), were extracted from seventeen items. Items investigating staff/service issues were the most positively rated while certain items investigating food quality were the least positively rated. After ordinal multiple regression analysis, OS was only significantly associated with the four factors: FQ, MSQ, HQ and SI (OR = 17·2, 6·16, 3·09 and 1·75, respectively, P < 0·001), and gender (OR = 1·53, P = 0·024).

The most positively scored aspects of foodservice concerned staff/service, whereas food quality was considered less positive. The aspects that most influenced patients’ satisfaction were those related to food quality.

Dietary guidelines are an essential policy tool for facilitating optimal dietary patterns and healthy eating behaviours. We report: (i) the methodological approach adopted for developing the National Dietary Guidelines of Greece (NDGGr) for Infants, Children and Adolescents; and (ii) the guidelines for children aged 1–18 years.

An evidence-based approach was employed to develop food-based recommendations according to the methodologies of the WHO, FAO and European Food Safety Authority. Physical activity recommendations were also compiled. Food education, healthy eating tips and suggestions were also provided.

The NDGGr encompass food-based nutritional and physical activity recommendations for promoting healthy dietary patterns and eating behaviours and secondarily to serve as a helpful tool for the prevention of childhood overweight and obesity.

The NDGGr include food-based recommendations, food education and health promotion messages regarding: (i) fruits; (ii) vegetables; (iii) milk and dairy products; (iv) cereals; (v) red and white meat; (vi) fish and seafood; (vii) eggs; (viii) legumes; (ix) added lipids, olives, and nuts; (x) added sugars and salt; (xi) water and beverages, and (xii) physical activity. A Nutrition Wheel, consisting of the ten most pivotal key messages, was developed to enhance the adoption of optimal dietary patterns and a healthy lifestyle. The NDGGr additionally provide recommendations regarding the optimal frequency and serving sizes of main meals, based on the traditional Greek diet.

As a policy tool for promoting healthy eating, the NDGGr have been disseminated in public schools across Greece.

To review the prevalence, severity and determinants of anaemia among women in West and Central Africa (WCA) and raise awareness among policy makers and programme planners in the region.

Systematic descriptive review of data in the public domain of the ORC Macro MEASURE Demographic and Health Surveys, national nutrition surveys, oral and technical communications at regional meetings, studies published in scientific journals, and WHO and UNICEF databases.

West and Central Africa region.

Women of childbearing age.

The prevalence of anaemia among pregnant and non-pregnant women is higher than 50 % and 40 %, respectively, in all countries. Within countries, this prevalence varies by living setting (rural v. urban), women's age and education. Across countries, socio-economic and climatic differences have no apparent association with the prevalence of anaemia among women. Several factors contribute either alone or jointly to the high rates of maternal anaemia in this region. These include widespread nutritional deficiencies; high incidence of infectious diseases; low access to and poor quality of health services; low literacy rates; ineffective design, implementation and evaluation of anaemia control programmes; and poverty.

Addressing the multiple causes and minimizing the consequences of anaemia on maternal and child health and development in WCA require integrated multifactorial and multisectoral strategies. This also calls for unprecedented, historical and stronger political will and commitment that put adolescent girls and maternal health at the centre of the development agenda.

Nutrition interventions are critical to achieve the Millennium Development Goals; among them, micronutrient interventions are considered cost-effective and programmatically feasible to scale up, but there are limited tools to communicate the programme components and their relationships. The WHO/CDC (Centers for Disease Control and Prevention) logic model for micronutrient interventions in public health programmes is a useful resource for planning, implementation, monitoring and evaluation of these interventions, which depicts the programme theory and expected relationships between inputs and expected Millennium Development Goals.

The model was developed by applying principles of programme evaluation, public health nutrition theory and programmatic expertise. The multifaceted and iterative structure validation included feedback from potential users and adaptation by national stakeholders involved in public health programmes’ design and implementation.

In addition to the inputs, main activity domains identified as essential for programme development, implementation and performance include: (i) policy; (ii) products and supply; (iii) delivery systems; (iv) quality control; and (v) behaviour change communication. Outputs encompass the access to and coverage of interventions. Outcomes include knowledge and appropriate use of the intervention, as well as effects on micronutrient intake, nutritional status and health of target populations, for ultimate achievement of the Millennium Development Goals.

The WHO/CDC logic model simplifies the process of developing a logic model by providing a tool that has identified high-priority areas and concepts that apply to virtually all public health micronutrient interventions. Countries can adapt it to their context in order to support programme design, implementation, monitoring and evaluation for the successful scale-up of nutrition interventions in public health.

To define a generic diet to protect human health and food system sustainability based on three dimensions: animal:plant ratio, degree of food processing and food diversity.

The percentages of maximum animal and ultra-processed energy content were evaluated from scientific papers (Web of Science database) and reports from international scientific institutions. Then, a weekly French standard diet, including these percentages and food diversity (≥42 different foods), was designed to calculate adequacy to nutritional needs.

Based on traditional and scientifically based healthy diets, and on foresight scenarios for sustainable diets at horizon 2050, a median daily animal energy content intake of 15 % was found to be protective towards both human health and environment. Based on epidemiological studies associating ultra-processed energy consumption with increased overweight/obesity risk, a precautionary threshold of approximately 15 % ultra-processed energy content was observed. The French diet allows addressing all nutritional needs and other nutritional indicators such as maximum salt and simple sugar consumption, α-linolenic acid:linoleic acid ratio and essential amino acids. This diet was named the ‘3V rule’ for Végétal (plant), Vrai (real) and Varié (varied, if possible organic, local and seasonal). This generic diet can be adapted according to regional traditions and environmental characteristics. Excluding only one dimension of it would threaten both health and food system sustainability.

Tending towards a 3V-based diet, while respecting local constraints, should allow preserving human health, environment (greenhouse gas emissions, pollution, deforestation, etc.), small farmers, animal welfare and biodiversity, culinary traditions and socioeconomics (including an alleviation of public health cost).

School lunches have potential to foster healthy diets in all children, but data on their importance are relatively scarce. The current study aimed to describe the dietary intake from school lunches by sex and school grade, and to assess how the daily intake, school lunch intake and the daily intake provided by lunch differ by sex and parental education.

Cross-sectional. All foods and drinks consumed for 1–3 weekdays were self-reported. Energy, absolute and energy-adjusted intakes of nutrients and food groups were calculated per weekday and per school lunch. Mixed-effects linear models assessed sociodemographic differences in dietary intakes. Nutrient and energy density at lunch and during the rest of the day were compared.

Seventy-nine Swedish primary schools.

Pupils in grades 5 and 8 (N 2002), nationally representative.

Lunch provided around half of daily vegetable intake and two-thirds of daily fish intake. Nutrient density was higher and energy density lower at lunch compared with the rest of the day (P < 0·001). Boys had greater energy-adjusted intakes of red/processed meat and lower intakes of vegetables and dietary fibre compared with girls (P < 0·001), overall and at lunch. Daily energy-adjusted intakes of most nutrients/food groups were lower for pupils of lower-educated parents compared with pupils of parents with higher education, but at lunch, only Fe and fibre intakes were significantly lower in this group.

School lunches are making a positive contribution to the diets of Swedish children and may mitigate well-established sex differences and social inequalities in dietary intake.

To assess the association between exclusive breast-feeding and childhood overweight.

Cross-sectional data are from the baseline survey of the longitudinal cohort study IDEFICS. Exclusive rather than partial breast-feeding is the focus of the study due to the theoretical relationship between exclusive breast-feeding and development of dietary self-regulation. Children's measured heights and weights were used to calculate weight status, while waist-to-height ratio (WtHR) and skinfold measures were examined as alternative indicators of adiposity and fat patterning.

Examination centres in eight European countries (Italy, Estonia, Cyprus, Belgium, Sweden, Hungary, Germany and Spain).

The analysis included 14 726 children aged 2–9 years for whom early feeding practices were reported by parents in standardized questionnaires.

After controlling for education, income and other potential confounders, breast-feeding exclusively for 4–6 months was protective of overweight (including obesity) when compared with children never exclusively breast-fed (OR = 0·73; 95 % CI 0·63, 0·85) across all measures of overweight. Exclusively breast-feeding for 6 months offered slightly more protection than for 4 and 5 months combined (OR = 0·71; 95 % CI 0·58, 0·85). The associations could not be explained by socio-economic characteristics or maternal overweight.

This multi-country investigation indicated that exclusive breast-feeding for 4–6 months may confer protection against overweight in addition to other known benefits. There was no demonstrated benefit of exclusive breast-feeding for more than 6 months or combination feeding for any duration across all measures of overweight examined.

To describe obesity among students of public schools in São Paulo and to identify risk factors for this nutritional and physical activity disorder.

Case– control study of obese and non-obese schoolchildren to study risk factors for obesity.

Anthropometric survey including 2519 children attending eight elementary public schools in Sã o Paulo, Brazil.

Schoolchildren aged 7–10 years, of whom 223 were obese (cases; weight-for-height greater than or equal to two standard deviations(≥2SD) above the median of the National Center for Health Statistics (NCHS) reference population) and 223 were eutrophic (controls; weight-for-height ±1SD from NCHS median).

Parents or guardians of the 446 cases and controls were interviewed about the children's eating behaviours and habits.

The prevalence of obesity (weight-for-height ≥2SD) in the surveyed population was 10.5%. A logistic regression model fitted to the case–control dataset showed that obesity was positively associated with the following factors: birth weight ≥3500 g (odds ratio (OR) 1.83, 95% confidence interval (CI) 1.21–2.78), child's appetite at meals (OR 3.81, 95% CI 2.49–5.83), watching television for 4h per day or longer (OR 2.07, 95% CI 1.32–3.24), mother's schooling>4 years (OR 1.85, 95% CI 1.25–2.75) and parents' body mass index ≥ 30 kgm−2(OR 2.50, 95% CI 1.43–4.37).

The explanatory multivariate model points to preventive measures that would encourage knowledge of the children and their guardians in relation to a balanced diet and a less sedentary lifestyle, such as reducing television viewing. Schoolchildren with a birth weight of 3500g or more or whose parents are obese should receive special attention in the prevention of obesity.

To investigate trends in child malnutrition in six countries in southern Africa, in relation to the HIV epidemic and drought in crop years 2001/2 and 2002/3.

Epidemiological analysis of sub-national and national surveys with related data.

Data from Lesotho, Malawi, Mozambique, Swaziland, Zambia and Zimbabwe, compiled and analysed under UNICEF auspices.

Secondary data: children 0–5 years for weight-for-age; HIV prevalence data from various sources especially antenatal clinic surveillance.

Child nutritional status as measured by prevalence of underweight deteriorated from 2001 onwards in all countries except Lesotho, with very substantial increases in some provinces/districts (e.g. from 5 to 20% in Maputo (Mozambique, 1997–2002), 17 to 32% in Copperbelt (Zambia, 1999–2001/2) and 11 to 26% in Midlands province (Zimbabwe, 1999–2002)). Greater deterioration in underweight occurred in better-off areas. Areas with higher HIV/AIDS prevalences had (so far) lower malnutrition rates (and infant mortality rates), presumably because more modern areas – with greater reliance on trade and wage employment – have more HIV/AIDS. Areas with higher HIV/AIDS showed more deterioration in child nutrition. A significant area-level interaction was found of HIV/AIDS with the drought period, associated with particularly rapid deterioration in nutritional status.

First, the most vulnerable may be households in more modern areas, nearer towns, to whom resources need to be directed. Second, the causes of this vulnerability need to be investigated. Third, HIV/AIDS amplifies the effect of drought on nutrition, so rapid and effective response will be crucial if drought strikes again. Fourth, expanded nutritional surveillance is now needed to monitor and respond to deteriorating trends. Finally, with or without drought, new means are needed of bringing help, comfort and assistance to the child population.

Adolescence is a critical period for development of depression and understanding of behavioural risk factors is needed to support appropriate preventive strategies. We examined associations between adolescent diet quality and depressive symptoms, cross-sectionally and prospectively, in a large community cohort, adjusting for behavioural and psychosocial covariates.

Prospective community-based cohort study (ROOTS).

Secondary schools in Cambridgeshire and Suffolk, UK.

Study participants (n 603) who completed 4 d diet diaries at age 14 years and reported depressive symptoms (Moods and Feelings Questionnaire (MFQ)) at 14 and 17 years of age.

Diet data were processed to derive a Mediterranean diet score (MDS) and daily servings of fruit and vegetables, and fish. At age 14 years, a negative association between fruit and vegetable intake and MFQ score was seen in the unadjusted cross-sectional regression model (β=−0·40; 95 % CI −0·71,−0·10), but adjustment for behavioural covariates, including smoking and alcohol consumption, attenuated this association. Fish intake and MDS were not cross-sectionally associated with MFQ score. No prospective associations were found between MDS, fruit and vegetable intake or fish intake and later MFQ score.

Diet quality was not associated with depressive symptoms in mid-adolescence. Previously reported associations in this age range may be due to confounding. Further longitudinal studies are needed that investigate associations between adolescent diet and depression across different time frames and populations, ensuring appropriate adjustment for covariates.

To evaluate the associations between sociodemographic and psychosocial characteristics and food label (FL) use in US adults.

Data from the 1994–1996 Continuing Survey of Food Intakes by Individuals and the Diet and Health Knowledge Survey were used. High socio-economic status (SES) was defined as >high school education and poverty–income ratio (PIR) >350 %, low SES as <high school level or PIR <130 %. Dietary intakes were assessed using 24 h recalls.

Metropolitan statistical area-central city, -suburban, and rural areas in the USA.

US adults (n 2797; 1460 men, 1337 women) aged 20–64 years.

Approximately 80 % of Americans reported using FL, including checking the nutrition panel, list of ingredients, short phrases, serving size, or health benefits. Only 26 % used all FL information. Compared with white women of higher SES, white men, black men and women with lower SES were 77–90 % less likely to use FL. Rural residents were 40 % less likely (OR = 0·60; 95 % CI 0·42, 0·86). Participants with good nutrition knowledge, perceptions and beliefs were twice as likely to check FL for nutrient content of foods (OR = 2·28; 95 % CI 1·53–3·40). Those who were unaware of diet–disease relationships were less likely to use FL (OR = 0·53; 95 % CI 0·32–0·85). Among overweight/obese Americans (BMI ≥ 25 kg/m2), those who perceived their weight ‘about right’ were 51 % less likely to use FL than those perceiving themselves as overweight.

Men, especially black men, women of low SES, rural residents and overweight Americans with inaccurate self-perception of body weight are less likely to use FL and should be targeted for increased intervention.

The purpose of the present study was to investigate the associations of family sociodemographic characteristics with children’s weight status and whether these potential associations are mediated by children’s breakfast habits.

A school-based survey among 10–12-year-old children was conducted in eight European countries. Children’s weight and height were measured and breakfast habits and family sociodemographic characteristics were self-reported by 5444 children and their parents. International Obesity Task Force cut-off points were used to categorize children as overweight/obese or normal weight. Mediation analyses were used to test the potential mediating effect of children’s breakfast consumption on the associations between family sociodemographic characteristics and children’s overweight/obesity.

Schools in eight European countries participating in the ENERGY (EuropeaN Energy balance Research to prevent excessive weight Gain among Youth) project.

Children aged 10–12 years and their parents (n 5444).

Children’s reported daily breakfast consumption varied from 56 % in Slovenia to 92 % in Spain on weekdays and from 79 % in Greece to 93 % in Norway on weekends. Children of native parents, with both parents employed and with at least one parent having more than 14 years of education were more likely to consume breakfast daily and less likely to be overweight/obese. Finally, mediation analyses revealed that the association of parental nationality and parental educational status with children’s overweight/obesity was partially mediated by children’s daily breakfast consumption.

The study shows that the lower likelihood of being overweight/obese among 10–12-year-old children of native background and higher parental educational status was partially mediated by children’s daily breakfast consumption.

Assessing how the Italian average food pattern would be affected in terms of consumption structure and expenditure by the adoption of nutritional prescriptions.

A linear programming model with nutritional and food habits constraints was employed to generate a pattern following recommended daily allowances (RDAs) and nutritional guidelines provided for the Italian population.

Food consumption data from ISTAT Household Budget Survey of Italian population.

Italian families investigated by the Family Budget Survey of the National Institute of Statistics.

Compared to actual behaviour, the pattern generated by the model implies an increased consumption of vegetables, pasta, rice and fresh fish, and a decreased consumption of meats, bread, sugars and cakes, and especially fats and oils. At given prices, total expenditure is lower than actual expenditure.

Differences between actual behaviour and the generated pattern are consistent with long-term trends in food consumption. The adoption of RDAs is unlikely to result in an increased food expenditure.

To identify and describe factors associated with food shop (known as tuck shop in South Africa) and lunchbox behaviours of primary-school learners in South Africa.

Analysis of data collected in 2008 from a cross-sectional survey.

Sixteen primary schools in the Western Cape, South Africa.

A total of 717 grade 4 learners aged 10–12 years.

A 24 h recall established that 69 % of learners carried a lunchbox to school and 49 % had consumed at least one item purchased from the school food shop/vendor. Most lunchboxes contained white bread with processed meat, whereas the most frequent food shop/vendor purchase comprised chips/crisps. Learners who carried a lunchbox to school had significantly lower BMI percentiles (P = 0·002) and BMI-for-age (P = 0·034), compared with their counterparts. Moreover, they were younger, had higher standard-of-living and dietary diversity scores, consumed more meals per day, had greater self-efficacy and came from predominantly urban schools, compared with those who did not carry a lunchbox to school. Learners who ate food shop/vendor purchases had a lower standard-of-living score and higher dietary diversity and meal scores. Only 2 % of learners were underweight, whereas 19 % were stunted and 21 % were overweight/obese (BMI ≥ 25 kg/m2).

Children who carried a lunchbox to school appeared to have greater dietary diversity, consumed more regular meals, had a higher standard of living and greater nutritional self-efficacy compared with those who did not carry a lunchbox to school.

To develop a worked example of product reformulation of a very popular ‘junk food’ to meet nutritional guidelines for public health in a ready meal.

Indicative survey of popular Margherita pizzas, followed by product reformulation, applying dietary guidelines to generate a single-item pizza meal containing 30 % daily amounts of energy and all nutrients. An iterative process was used; first to optimize nutrient balance by adjusting the proportions of bread base, tomato-based sauce and mozzarella topping, then adding ingredients to provide specific nutrients and consumer tasting.

Urban areas of contrasting socio-economic status.

Untrained unselected adults (n 49) and children (n 63), assessing pizza at tasting stations.

Most commercial pizzas provide insufficient information to assess all nutrients and traditional Margherita pizza ingredients provide insufficient Fe, Zn, iodine, and vitamins C and B12. Energy content of the portions currently sold as standard range from 837 to 2351 kJ (200 to 562 kcal), and most exceed 30 % Guideline Daily Amounts for saturated fat and Na when a 2510 kJ (600 kcal) notional meal is considered. The ‘nutritionally balanced pizza’ provides the required energy for a single-item meal (2510 kJ/600 kcal), with all nutrients within recommended ranges: Na (473 mg, ∼45 % below recommended level), saturated fat (<11 % energy) and dietary fibre (13·7 g). Most adults (77 %) and children (81 %) rated it ‘as good as’ or ‘better than’ their usual choice.

Nutritional guidelines to reduce chronic diseases can be applied to reformulate ‘junk food’ ready meals, to improve public health through a health-by-stealth approach without requiring change in eating habits.