To investigate whether the consumption of ultra-processed foods (UPF) during pregnancy is associated with gestational weight gain (GWG).

Cohort study with collection of two 24-h dietary recalls during each gestational trimester obtained on non-consecutive days and differentiating weekday v. weekend/holiday. The foods were classified according to the NOVA system into fresh or minimally processed foods and their culinary preparations, processed and UPF and subsequently analysed as a percentage contribution to dietary energy. The outcome was average GWG in the second and in the third trimesters, expressed in g/week.

Botucatu, a medium-sized Brazilian city.

Pregnant women with regular obstetric risk (n 259) undergoing prenatal care in primary healthcare.

In a multiple linear regression model, it was found that an increase of 1 percentage point in energy consumption from UPF in the third gestational trimester led to an average increase of 4·17 (95 % CI 0·55; 7·79) g in weekly GWG in this period. There was no association between second-trimester UPF consumption and GWG.

Consumption of UPF in the third gestational trimester is positively associated with average weekly GWG in this period.

To date, only a few nutritional assessment methods have been validated against the biomarker of urinary-N excretion for use in children and adolescents. The aim of the present study was to validate protein intake from one day of a weighed dietary record against protein intake estimated from a simultaneously collected 24 h urine sample.

Cross-sectional analyses including 439 participants of the Dortmund Nutritional and Longitudinally Designed (DONALD) Study from four age groups (3–4, 7–8, 11–13 and 18–23 years). Mean differences, Pearson correlation coefficients (r), cross-classifications and Bland–Altman plots were used to assess agreement between methods.

Weighed dietary records significantly underestimated mean protein intake by −6·4 (95 % CI −8·2, −4·7) g/d or –11 %, with the difference increasing across the age groups from −0·6 (95 % CI −2·7, 1·5) g/d at age 3–4 years to –13·5 (95 % CI –18·7, –8·3) g/d at age 18–23 years. Correlation coefficients were r = 0·7 for the total study sample and ranged from r = 0·5 to 0·6 in the different age groups. Both methods classified 85 % into the same/adjacent quartile for the whole study group (83–86 % for the different age groups) and 2·5 % into the opposite quartile (1·9–3·1 % for the different age groups). Bland–Altman plots for the total sample indicated that differences in protein intake increased across the range of protein intake, while this bias was not obvious within the age groups.

Protein intake in children and adolescents can be estimated with acceptable validity by weighed dietary records. In this age-heterogeneous sample, validity was lower among adolescents and young adults.

To examine the effects of exposure to conflicting nutritional information (CNI) through different forms of media on nutrition-related confusion and backlash among consumers in the UK.

Cross-sectional survey administered via Qualtrics among 18–75-year-old participants in the UK. The sample was stratified by age and gender with quotas defined according to the 2011 UK census distribution.

Qualtrics’ Online panel of respondents in the UK.

676 participants comprising nearly an equal number of females (n 341) and males (n 335) and a majority (58·6 %) from households whose income was <£30 000.

Our findings showed that nearly 40 % of respondents were exposed to some or a lot of CNI. We found that while exposure to CNI from TV and online news increased nutrition confusion, CNI from health professionals increased backlash. Exposure to CNI from social media and health websites was associated with reduced backlash. We also found that nutrition confusion and backlash were negatively associated with exercise behaviour and fruit and vegetable consumption, respectively.

Our study supports the theoretical pathways that explain the influence of CNI exposure on nutrition-related cognitive and behavioural outcomes. Additionally, different types of online information sources are associated with these outcomes to varying degrees. In the context of obesity and diabetes rates in the UK, our findings call for (a) further experimental research into the effects of CNI on consumers’ diet-related cognitions and behaviours and (b) multi-stakeholder, interdisciplinary approaches to address this problem.

To investigate university students’ knowledge, attitudes and practice (KAP) regarding vitamin D.

The students were requested to answer a questionnaire related to vitamin D and sun exposure. The consumption frequency of foods rich in vitamin D was assessed. Additionally, the intake of vitamin D-containing supplements was recorded.

A medical university in Nanjing, China.

Five hundred and fifteen medical students were included.

The highest rate of correct responses for the quiz was 68·0 %, while the lowest was 9·6 %. Most students lacked sun exposure because they did not want to get tanned; 82·7 % of students used some sun protection and sunscreen use was more popular in the female group. The consumption frequency of foods rich in vitamin D was low and 5·6 % of the students used vitamin D supplements. The students’ knowledge on vitamin D was derived mainly from the media and health professionals. Most of the students were interested to know more about vitamin D.

The present study suggested that medical students had little knowledge and unfavourable behaviours. They should get more health education through the media and health professionals. It is advisable to increase their consumption of foods rich in vitamin D.

Canadians consume approximately twice the daily Adequate Intake of sodium. The present study examined the efficacy of four types of front-of-package (FOP) sodium labels at influencing consumers’ selection of products low v. high in sodium.

Participants were randomly assigned to one of five experimental conditions: (i) control condition with no FOP label; (ii) basic numeric FOP label; (iii) numeric FOP label with ‘high’ and ‘low’ sodium content descriptors; (iv) detailed Traffic Light (TL) label with colour coding, content descriptors and numeric information; and (v) simple TL label with no numeric information. Participants were shown pairs of grocery products that varied in sodium content and told they could choose a free sample. Selection of the low-sodium v. the high-sodium product was the primary behavioural outcome, in addition to ratings of effectiveness, understanding, liking and believability.

Waterloo, Ontario, Canada.

Adults (n 430) aged ≥18 years, recruited from community settings.

Participants in the three FOP conditions with ‘high/low’ sodium content descriptors were significantly more likely to choose the lower-sodium product compared with the control group. The detailed TL label was ranked most effective at helping participants select low-sodium products, and was rated significantly higher than other formats in liking, understanding and believability. Product selection did not differ significantly across sociodemographic groups.

FOP labels that include content descriptors may be more effective in helping consumers to select lower-sodium products. TL labels, which incorporate content descriptors and colour coding, should be considered for future FOP labelling initiatives.

The study determined the impact of a community-based nutrition education programme, using trained community nutrition advisors, on the anthropometric nutritional status of mixed-race children aged between 2 and 5 years.

The programme was implemented over two years in four study areas in the Free State and Northern Cape Provinces. Two control areas were included to differentiate between the effect of the education programme and a food aid programme that were implemented simultaneously. Weight-for-age, height-for-age and weight-for-height were summarised using standard deviations from the NCHS reference median. For each of the indicators, the difference in the percentage of children below minus two standard deviations from the reference NCHS median in the initial and follow-up surveys was determined.

Initially 536 children were measured and, after two years of intervention, 815.

Weight-for-age improved in all areas, but only significantly in boys and girls in the urban study area, and in boys in one rural study area. No significant improvement in height-for-age occurred in any area. Weight-for-height improved significantly in the urban study area.

The education programme in combination with food aid succeeded in improving the weight status of children, but was unable to facilitate catch-up growth in stunted children after two years of intervention.

To define the prevalence of overweight and obesity among school-aged children resident in mountain areas, rural areas and urban areas.

The sample (n = 12 832; 50.7% boys) included 9- and 11-year-old children of the Veneto Region of north-east Italy. Overweight and obesity status were determined using the International Obesity Task Force cut-off points for body mass index. The prevalence of overweight and obese subjects was calculated with a confidence interval of 95%. The Mantel–Haenszel method was used to compare the combined prevalence of overweight and obesity among children resident in mountain areas, rural areas and urban areas.

Among boys the prevalence of overweight was 21.06%, while obesity prevalence was 5.92%; among girls overweight prevalence was 21.30%, while obesity prevalence was 5.15%. The prevalence was higher among 11-year-old boys (odds ratio (OR) = 1.19; 95% confidence interval (CI): 1.06–1.33) and 9-year-old girls (OR = 1.13; 95% CI: 1.01–1.26). Children resident in rural areas presented a higher risk of overweight and obesity compared with children resident in mountain areas (Mantel–Haenszel OR = 1.27; 95% CI: 1.13–1.42; χ2 = 17.55; P < 0.0001) and in urban areas (Mantel–Haenszel OR = 1.18; 95% CI: 1.07–1.31; χ2 = 10.39; P < 0.001).

A relevant prevalence of overweight and obesity was found; the excess weight concerns one child in four. There are differences linked to different geographical areas that must be further investigated.

To examine (i) the association of percentage of total energy intake from protein (protein intake %) with bone mineral density (BMD, g/cm2) and bone loss at the femoral neck, trochanter and lumbar spine (L2–L4) and (ii) Ca as an effect modifier.

The Framingham Offspring Study.

Men (n 1280) and women (n 1639) completed an FFQ in 1992–1995 or 1995–1998 and underwent baseline BMD measurement by dual-energy X-ray absorptiometry in 1996–2000. Men (n 495) and women (n 680) had follow-up BMD measured in 2002–2005.

Cohort study using multivariable regression to examine the association of protein intake % with each BMD, adjusting for covariates. Statistical interaction between protein intake % and Ca (total, dietary, supplemental) intake was examined.

The mean age at baseline was 61 (sd 9) years. In the cross-sectional analyses, protein intake % was positively associated with all BMD sites (P range: 0·02–0·04) in women but not in men. Significant interactions were observed with total Ca intake (<800 mg/d v. ≥800 mg/d) in women at all bone sites (P range: 0·002–0·02). Upon stratification, protein intake % was positively associated with all BMD sites (P range: 0·04–0·10) in women with low Ca intakes but not in those with high Ca intakes. In the longitudinal analyses, in men, higher protein intake % was associated with more bone loss at the trochanter (P = 0·01) while no associations were seen in women, regardless of Ca intake.

This suggests that greater protein intake benefits women especially those with lower Ca intakes. However, protein effects are not significant for short-term changes in bone density. Contrastingly, in men, higher protein intakes lead to greater bone loss at the trochanter. Longer follow-up is required to examine the impact of protein on bone loss.

In the USA, community-based food pantries provide free groceries to people struggling with food insecurity. Many pantries obtain food from regional food banks using an online shopping platform. A food bank introduced a visible nutrition rank (i.e. green, yellow or red) onto its platform. The hypothesis was that pantry orders would increase for the healthiest options (green) and decrease for the least healthy options (red).

Interrupted time series (ITS) analysis of a natural experiment. Monthly data included nutrition ranks of available inventory and itemised records of all products ordered during the 15-month baseline period and 14-month intervention.

A New England food bank.

The twenty-five largest food pantries in the network based on pounds of food ordered.

Descriptive analyses of 63 922 pantry ordering records before and after the visible ranks identified an increase in the proportion of green items ordered (39·3–45·4 %) and a decrease in the proportion of red items ordered (10·5–5·1 %). ITS analyses controlling for monthly changes in inventory available and pantry variables indicated that average monthly orders of green items increased by 1286 pounds (P < 0·001) and red orders decreased by 631 pounds (P = 0·045). Among the largest changes were increases in orders of fresh produce, brown rice, low-fat dairy and low-fat meats and decreases in orders of sugary juice drinks, canned fruit with added sugar, higher fat dairy and higher fat meats.

This promising practice can support system-wide efforts to promote healthier foods within the food banking network.

To explore and compare nutrition knowledge, attitudes and behaviours (KAB) between non-parent and parent caregivers of children under 7 years old in Chinese rural areas, and to identify the factors influencing their nutrition KAB.

Face-to-face interviews were carried out with 1691 non-parent caregivers and 1670 parent caregivers in the selected study areas; multivariate logistic regression models were used to identify the factors influencing nutrition KAB in caregivers.

The awareness rate of nutrition knowledge, the rate of positive attitudes and the rate of optimal behaviours in non-parent caregivers (52·2 %, 56·9 % and 37·7 %, respectively) were significantly lower than in the parent group (63·8 %, 62·1 % and 42·8 %, respectively). Multivariate logistic regression modelling showed that caregivers’ family income and care will, and children’s age and gender, were associated with caregivers’ nutrition KAB after controlling the possible confounding variables (caregivers’ age, gender, education and occupation).

Non-parent caregivers had relatively poor nutrition KAB. Extra efforts and targeted education programmes aimed to improve rural non-parent caregivers’ nutrition KAB are wanted and need to be emphasized.

The purpose of the present research was to investigate the epidemiological profile of the metabolic syndrome (MetS) and to explore its potential dietary, behavioural and socio-economic determinants among European adults residing in Luxembourg.

Cross-sectional, population-based ORISCAV-LUX survey.

European adults aged 18–69 years residing in Luxembourg.

A total of 1349 Europid adults, who participated in the ORISCAV-LUX survey, were included in the study. The prevalence of MetS was estimated according to the Revised-Adult Treatment Panel (R-ATPIII) criteria. Multivariate logistic regression was used to identify the dietary, behavioural and socio-economic factors independently associated with MetS.

The overall prevalence of MetS was 24·7 % with significant gender difference (18·5 % for women v. 30·8 % for men, P < 0·0001). Age, male gender, primary level of education, physical inactivity, family history of diabetes and hypertension and inadequate protein intake were identified as significant determinants of MetS, after adjusting for other socio-economic, family medical history and lifestyle factors.

MetS is a common condition among Europid adults in Luxembourg and increases dramatically with age, in both genders. Several dietary, socio-economic and behavioural factors explain the disparity observed. These findings highlight the importance of a comprehensive approach to MetS encompassing dietary, lifestyle and socio-economic aspects, both in clinical and community settings.

The current study sought to examine Guatemalan adolescents’ consumption of sugar-sweetened beverages (SSB), identify which individual-level characteristics are associated with SSB consumption and describe school characteristics that may influence students’ SSB consumption.

Within this observational pilot study, a questionnaire was used to assess students’ consumption of three varieties of SSB (soft drinks, energy drinks, sweetened coffees/teas), as well as a variety of sociodemographic and behavioural characteristics. We collected built environment data to examine aspects of the school food environment. We developed Poisson regression models for each SSB variety and used descriptive analyses to characterize the sample.

Guatemala City, Guatemala.

Guatemalan adolescents (n 1042) from four (two public, two private) secondary schools.

Built environment data revealed that students from the two public schools lacked access to water fountains/coolers. The SSB industry had a presence in the schools through advertisements, sponsored food kiosks and products available for sale. Common correlates of SSB consumption included school type, sedentary behaviour, frequency of purchasing lunch in the cafeteria, and frequency of purchasing snacks from vending machines in school and off school property.

Guatemalan adolescents frequently consume SSB, which may be encouraged by aspects of the school environment. Schools represent a viable setting for equitable population health interventions designed to reduce SSB consumption, including increasing access to clean drinking-water, reducing access to SSB, restricting SSB marketing and greater enforcement of existing food policies.

(1) To identify the major sources of nutrition information, and the perceived credibility thereof, among urban black South African women; and (2) to determine the level of knowledge regarding nutrition, particularly regarding the topic of obesity.

A cross–sectional descriptive study that was both qualitative (focus groups) and quantitative (individual questionnaires). Three hundred and ninety–four black women aged 17–49 years were conveniently sampled from the Western Cape and Gauteng provinces in South Africa.

Four focus groups were held with 39 women to identify common themes relating to nutrition knowledge. Based on these data, a questionnaire instrument was developed and administered to 394 women by trained fieldworkers.

The most frequently encountered source of nutrition information was the media, particularly the radio and TV (73.4% and 72.1% of subjects, respectively, obtained information from this source in the past year), followed by family/friends (64.6%). Despite only 48.5% of subjects having received nutrition information from a health professional, this was the most highly credible information source. Factors being most influential in choice of foods were taste, preferences of the rest of the family, and price. A lack of knowledge on certain aspects of nutrition was identified, as well as misconceptions regarding diet and obesity.

To improve nutrition knowledge and the effectiveness of nutrition education activities in South Africa, it is recommended that health and nutrition educators become more actively involved with the training of health professionals, particularly those engaged in delivery of services at primary care level, and in turn encourage health professionals to engage more with media sources. Nutrition messages delivered from health professionals via the media will enable public exposure to nutrition information which is not only easily accessible but also perceived to be highly credible.

Pakistani women in Oslo have high risk of overweight and type 2 diabetes. The objective is to present the effect of an intervention study on Pakistani women’s intentions to change dietary behaviour and changes made in dietary intake.

The intervention group received culturally adapted lifestyle education, including diet and physical activity. The questionnaire, applied before and after the 7-month intervention, included FFQ and questions on intentions to change.

Oslo, Norway.

A total of 198 Pakistani women, aged 25–63 years, randomised into control and intervention groups.

There was a shift in distribution of intentions to change the intake of selected foods in the intervention group after the intervention, resulting in significant differences between the groups. The daily intake of vegetables, fruits and fruit juice had increased (P = 0·043), and the intake of red meats (P = 0·001), full fat milk/yoghurt (P = 0·027) and sugar-rich drinks (P ≤ 0·007) was reduced in the intervention group. The differences between intervention and control after the intervention were significant for sugar-rich drinks (P ≤ 0·022). More women in the intervention group used olive and rapeseed oil and fewer used ‘vegetable’ oil after than before intervention (P < 0·011). Differences between intervention and control were significant (P = 0·001) for rapeseed oil. Comparing those who attended at least 60 % of the group sessions with the control group resulted in minor changes in these estimates.

Culturally adapted education has the potential to change Norwegian–Pakistani women`s intentions to make their diet healthier, and also to induce some beneficial, however modest, self-reported changes in diet.

To assess the relative validity of a semi-quantitative, web-based FFQ completed by female pregnancy planners in the Danish ‘Snart Forældre’ study.

We validated a web-based FFQ based on the FFQ used in the Danish National Birth Cohort against a 4 d food diary (FD) and assessed the relative validity of intakes of foods and nutrients. We compared means and medians of intakes, and calculated Pearson correlation coefficients and de-attenuated coefficients to assess agreement between the two methods. We also calculated the proportion correctly classified based on the same or adjacent quintile of intake and the proportion of grossly misclassified (extreme quintiles).

Participants (n 128) in the ‘Snart Forældre’ study who had completed the web-based FFQ were invited to participate in the validation study.

Participants in the ‘Snart Forældre’ study, in total ninety-seven women aged 20–42 years.

Reported intakes of dairy products, vegetables and potatoes were higher in the FFQ compared with the FD, whereas reported intakes of fruit, meat, sugar and beverages were lower in the FFQ than in the FD. Overall the de-attenuated correlation coefficients were acceptable, ranging from 0·33 for energy to 0·93 for vitamin D. The majority of the women were classified in the same or adjacent quintile and few women were misclassified (extreme quintiles).

The web-based FFQ performs well for ranking women of reproductive age according to high or low intake of foods and nutrients and, thus, provides a solid basis for investigating associations between diet and fertility.

The objective of the present study was to investigate the prevalences of overweight and obesity and their association with physical activity pattern among adolescents in northern Iran.

A cross-sectional study.

Babol, northern Iran.

A representative sample of 1200 adolescents aged 12–17 years was recruited. All selected adolescents were interviewed, their leisure-time and sport physical activities were collected by a standard Baecke questionnaire and their height and weight were measured by standard methods. The diagnosis of overweight and obesity was determined by comparing BMI values with the BMI index for age and sex percentiles set by the US Centers for Disease Control and Prevention in 2000.

The prevalences of overweight and obesity were 15·1 % and 8·3 %, respectively. The proportion of obesity was significantly higher in boys than in girls (10·2 % v. 6·5 %, P = 0·028). Overall, the levels of high, moderate and low leisure-time physical activity were 2·9 %, 79·4 % and 17·7 %, respectively. The corresponding levels of high, moderate and low sport physical activity were 17·4 %, 75·2 % and 7·4 %. The levels of leisure-time and sport physical activities were significantly higher among the boys than the girls (P < 0·001). There was also a significant association of studying in private schools and playing computer games with overweight/obesity (P < 0·001). Moderate leisure-time physical activity was unexpectedly associated with a greater risk of overweight/obesity compared with the low level (P = 0·002).

The findings indicate a high prevalence of overweight/obesity in these Iranian adolescents, particularly the boys. The influence of physical activity and diet on overweight/obesity requires further prospective studies.

Malnutrition is one of the most important health problems, especially in developing countries. The present study aimed to describe the socio-economic inequality in stunting and its determinants in Iran for the first time.

Cross-sectional, population-based survey, carried out in 2009. Using randomized cluster sampling, weight and height of children were measured and anthropometric indices were calculated based on child growth standards given by the WHO. Socio-economic status of families was determined using principal component analysis on household assets and social specifications of families. The concentration index was used to calculate socio-economic inequality in stunting and its determinants were measured by decomposition of this index. Factors affecting the gap between socio-economic groups were recognized by using the Oaxaca–Blinder decomposition method.

Shahroud District in north-eastern Iran.

Children (n 1395) aged <6 years.

The concentration index for socio-economic inequality in stunting was −0·1913. Mother's education contributed 70 % in decomposition of this index. Mean height-for-age Z-score was −0·544 and −0·335 for low and high socio-economic groups, respectively. Mother's education was the factor contributing most to the gap between these two groups.

There was a significant socio-economic inequality in the studied children. If mother's education is distributed equally in all the different groups of Iranian society, one can expect to eliminate 70 % of the socio-economic inequalities. Even in high socio-economic groups, the mean height-for-age Z-score was lower than the international standards. These issues emphasize the necessity of applying new interventions especially for the improvement of maternal education.

It is hypothesised that mothers' social networks can positively affect child nutrition through the sharing of health knowledge and other resources. The present study describes the composition of mothers' networks, examines their association with child nutrition, and assesses whether health knowledge is shared within networks.

Cross-sectional data for mothers of young children from Andhra Pradesh (south India) were combined with existing data from the Young Lives study, in which the mothers were participating (n = 282).

The composition of social networks varied between urban and rural areas, with urban networks being larger, more female, more literate and with a greater proportion of members living outside the household and being non-family. There was a positive association between child's height-for-age Z-score and mother's network size and network literacy rate. The association with network literacy was stronger among the poorest households. Women commonly reported seeking or receiving health advice from network members.

Big and literate social networks are associated with better child nutrition, especially among the poor. The dissemination of health knowledge between network members is a plausible way in which social networks benefit child nutrition in India. Further research into the underlying mechanisms is necessary to inform the development of interventions that channel health information through word of mouth to the most excluded and vulnerable families.