(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.

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.

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 nutritional quality of lunchtime food consumption among elementary-school children on Prince Edward Island according to the source of food consumed (home v. school).

Students completed a lunchtime food record during an in-class survey. Dietary adequacy was assessed by comparing median micronutrient intakes with one-third of the Estimated Average Requirement; median macronutrient intakes were compared with the Acceptable Macronutrient Distribution Ranges. The Wilcoxon signed rank test was used to assess differences in nutrient intakes according to source of food consumed.

Elementary schools in Prince Edward Island, Canada.

Grade 5 and 6 students (n 1980).

Foods purchased at school were higher in nutrient density for ten micronutrients (Ca, Mg, K, Zn, vitamin A, vitamin D, riboflavin, niacin, vitamin B6 and vitamin B12) compared with packed lunch foods from home, which were higher in three micronutrients (Fe, vitamin C and folate). School lunches provided sufficient protein but were higher in sugar and fat than home lunches. Foods brought from home were higher in carbohydrates, fibre and Na than foods purchased at school.

The overall nutritional quality of lunches was poor, regardless of source. A significant proportion of foods consumed by the students came from home sources; these were lower nutritional quality and were higher in Na than foods offered at school. Findings suggest that improving the dietary habits of school-aged children will require a collaborative effort from multiple stakeholders, including parents.

Results of previous studies on diet and gallbladder disease (GBD), defined as having gallstones or having had surgery for gallstones, have been inconsistent. This research examined patterns of food intake in Mexican Americans and their associations with GBD.

Cross-sectional.

The study population included 4641 Mexican Americans aged 20–74 years who participated in the 1988–94 third National Health and Nutrition Examination Survey (NHANES III). GBD was diagnosed by ultrasound. Food intake patterns were identified by principal components analysis based on food frequency questionnaire responses. Component scores representing the level of intake of each pattern were categorized into quartiles, and prevalence odds ratios (POR) were estimated relative to the lowest quartile along with 95% confidence intervals (CI).

There were four distinct patterns in women (vegetable, high calorie, traditional, fruit) and three in men (vegetable, high calorie, traditional). After age adjustment, none were associated with GBD in women. However, men in the third (POR = 0.42, 95%CI 0.21–0.85) and fourth (POR = 0.53, 95%CI 0.28–1.01) quartiles of the traditional intake pattern were half as likely to have GBD as those in the lowest quartile.

These findings add to a growing literature suggesting dietary intake patterns can provide potentially useful and relevant information on diet–disease associations. Nevertheless, methods to do so require further development and validation.

To characterize dietary intake for Navajo adults, to identify foods for a nutritional intervention programme and to develop a culturally appropriate quantitative FFQ (QFFQ) for evaluating the impact of the intervention programme.

A cross-sectional study was conducted using 24 h dietary recalls.

Navajo Nation, USA.

Seventy-nine (forty men, thirty-nine women) aged 18–71 years completed 24 h dietary recalls.

The median daily energy intake was 11 585 kJ (2769 kcal) for men and 8519 kJ (2036 kcal) for women. The greatest contributors to energy were fried potato dishes, sweetened juices/drinks, regular pop, bread, tortillas and burritos (contributing approximately 30 % of total energy intake). The mean number of meat servings was over twice that recommended (2–3 servings recommended v. 7·4 consumed by men and 5·3 by women). The mean servings of vegetables were well below the recommendation of 3–5 servings (1·0 serving for men and 1·2 servings for women). The final QFFQ contains 177 food and drink items.

Our study found that major contributors to total energy, fat and sugar intakes in the Navajo Nation included mostly processed meats and sweetened drinks. A nutritional intervention will target these foods and promote acceptable and healthier alternatives. In addition, we were able to identify foods and beverages for inclusion on a culturally appropriate QFFQ to assess dietary intake. This QFFQ will be used to evaluate the effectiveness of our intervention on food and food group consumption and nutrient intake.

The present study aimed to (i) assess the appetitive drives evoked by the visual cues of ultra-processed food and drink products and (ii) investigate whether text warnings reduce appetitive drives and consumers’ reported intentions to eat or drink ultra-processed products.

In Study I, a well-established psychometric tool was applied to estimate the appetitive drives associated with ultra-processed products using sixty-four image representations. Sixteen product types with four exemplars of a given product were included. Pictures from the International Affective Picture System (IAPS) served as controls. The two exemplars of each product type rated as more appetitive were selected for investigation in the second study. Study II assessed the impact of textual warnings on the appetitive drive towards these thirty-two exemplars. Each participant was exposed to two picture exemplars of the same product type preceded by a text warning or a control text. After viewing each displayed picture, the participants reported their emotional reactions and their intention to consume the product.

Controlled classroom experiments

Undergraduate students (Study I: n 215, 135 women; Study II: n 98, 52 women).

In Study I, the pictures of ultra-processed products prompted an appetitive motivation associated with the products’ nutritional content. In Study II, text warnings were effective in reducing the intention to consume and the appetitive drive evoked by ultra-processed products.

This research provides initial evidence favouring the use of text warnings as a public policy tool to curb the powerful influence of highly appetitive ultra-processed food cues.

The purpose of the present study was to explore food preparation behaviours, attitudes, meal planning and shopping among Mexican-American mothers.

Data were collected through four focus groups with mothers of Mexican origin/ancestry who considered themselves to be the primary food preparer. Topics included food preparation behaviours and influencers (culture, family, attitudes, barriers, meal planning and shopping). Data were analysed using a qualitative grounded theory approach. All focus groups were audio recorded, transcribed verbatim and coded for themes.

Data were collected in southern California, USA in 2013.

Of the sample of twenty-one Mexican-American mothers, thirteen were born outside the USA and the mean household size was five members.

Participants reported that food was often prepared using traditional staples and food preparation behaviours were learned from maternal family members. Participants also suggested that health was influenced by foods eaten and how they were prepared. Salient factors influencing food preparation behaviours included culture and tradition, maternal family members’ food preparation behaviours, food preparation self-efficacy and attitudes towards healthy eating. Time and busy schedules were cited as barriers.

Future interventions should consider utilizing family-based approaches and teaching culturally relevant food preparation skills, especially to youth, while reinforcing more healthful dietary practices.

To examine the association between consumption of red and processed meat (RPM) and iron intakes and status in adults.

Further analysis of the Dietary and Nutritional Survey of British Adults, a cross-sectional study of 2197 adults aged 16–64 years carried out in 1986/7.

Adults (836 men and 838 women) with serum ferritin measurements, who were not taking iron supplements, were classified into four groups according to RPM consumption (from 7-day weighed records). Iron absorbed was estimated from equations based on haem and non-haem iron and the influence of iron stores.

Women who ate least meat (<90gday-1) had three times the risk of a low iron intake (below the Lower Reference Nutrient Intake) compared with high consumers of RPM (>140gday-1). Men who ate no RPM also had a higher risk of low iron intake. Using an estimate of minimal values for iron losses, there was a twofold difference in the potential risk of negative iron balance between women non-RPM consumers and high RPM consumers. Status measurements indicated that, among women, anaemia was least prevalent (6%) among high consumers compared with 12–14% among average RPM consumers. Inverse trends were also observed for serum ferritin in both sexes.

Low consumption of RPM has implications for iron intakes and iron status in men and women, since the risk of negative iron balance and its consequences are increased. Dietary messages must consider these implications and provide appropriate advice.

Although there is growing awareness of the impact of diet on health, little attention has been given to the food available in our sports stadia. We used a football club (Citygrene FC) – Citygrene is a fictional name – in the English Premier League as a case study to examine the attitudes of male and female football supporters to the food and drink available at their home stadium (Citygrene Stadium).

The research design used five focus groups of male and female fans. The discourse was audiotaped, transcribed, coded and analysed for themes.

A football stadium in the English Premier League, England.

The participants were season ticket holders drawn from two stands at Citygrene Stadium.

The research showed a high level of dissatisfaction with the food and drink supplied. There were key differences in the views of the male and female participants in the focus groups, with the women more concerned about wider issues such as the lack of healthy food. Both men and women were aware of their role as consumers and felt that there was an opportunity for Citygrene to improve their catering profits, if they provided a better selection of food and drink and an improved service.

The study shows that there is a demand for healthier food options (and a wider choice of food and drink in general), which may provide an economic opportunity for stadium and catering managers. In addition, a stadium may be considered a potential ‘healthy setting’, which can serve as a supportive environment for healthier food choices.

To examine to what extent the obesity epidemic is a general phenomenon in adults by assessing the secular change, by birth cohort and age, in the prevalence of obesity and median body mass index (BMI) in Danish men and women measured between 1964 and 1994.

Multiple cross-sectional population surveys.

The greater Copenhagen area of Denmark.

The study included 17 065 men (30 336 observations) and 13 417 women (24 065 observations), aged 20–84 years.

Trends in median BMI and prevalence of obesity estimated from measured height and weight in 10-year age groups.

In general the prevalence of obesity was increasing, although in an irregular way: among men in two phases, during the 1970s and 1990s and among women only during the 1990s. Great heterogeneity was observed between birth cohorts and age groups. There was only little indication of an increasing trend in obesity prevalence for women, except for the 55–64-year-olds. In men, the prevalence of obesity was increasing in all age groups except in the youngest ones, and it was statistically significant only for men aged 35–74 years. There was no significant linear change in median BMI in any group, except for an increasing trend among men aged 50 years and above.

Although the overall Danish trend for obesity prevalence, similar to trends world-wide, showed a marked increase, the trend was very heterogeneous and generally neither uniform nor significantly positive; the changes were irregular, different among men and women, and different in the different age and birth cohorts. The obesity problem in middle-aged and older men of certain birth cohorts poses a specific public health challenge. Future studies of determinants behind the heterogeneity in the development of the obesity epidemic may provide clues to its causes.

Higher levels of insulin-like growth factor-I (IGF-I) and lower levels of IGF binding protein-3 (IGFBP-3) have been associated with an increased risk of prostate cancer. Nutrition is known to partially regulate IGF levels and it is possible that nutritional factors mediate the impact of IGF levels on prostate cancer risk.

A cross-sectional analysis of the impact of nutritional factors measured by a dietary questionnaire on plasma levels of IGF-I, IGFBP-3 and their molar ratio. Multiple linear regression analysis was used to test for effects of nutrients on IGF levels.

Prostate cancer screening at the Hollings Cancer Center in Charleston, South Carolina.

Ninety-five African American and 138 white males aged 33–83 years attending the screening.

In whites, intakes of total, saturated and monounsaturated fats were positively associated with an increase in the molar ratio, while there was no association in African Americans. In African Americans, we found that increasing intake of calcium and dairy servings was positively associated with IGF-I levels. Increased vegetable intake was positively associated with IGFBP-3 in African Americans, while there was no effect in whites. A higher percentage of alcohol in the total diet was significantly associated with a decrease in the molar ratio and an increase in IGFBP-3 in both groups.

Our results confirm previous findings of nutritional determinants of IGF levels. Additionally, we found the impact of several nutrients on IGF levels to be different in whites and African Americans, which warrants further investigation.

To examine socio-economic inequalities in malnutrition among Colombian children and adolescents, and to assess the contribution of individual-, household- and community-level factors to those inequalities.

Cross-sectional data were used from two sources: 2005 Colombian Demographic and Health Survey and 2005 Colombian census. Malnutrition outcomes included stunting and overweight. Multilevel Poisson models were used to estimate the association between individual, household and contextual characteristics and malnutrition. Changes in prevalence ratios of the poorest quintile (v. richest) were compared to assess the contribution of different characteristics to inequalities in malnutrition.

Population-based, representative of Colombia.

Children and adolescents <18 years of age (n 30 779) from the Colombian Demographic and Health Survey.

Children and adolescents living in the poorest households were close to five times more likely to be stunted, while those from the richest households were 1·3–2·8 times more likely than their poorest counterparts to be overweight. Care practices and household characteristics, particularly mother's education, explained over one-third of socio-economic inequalities in stunting. The proportion explained by access to services was not negligible (between 6 % and 14 %). Access to sanitation was significantly associated with a lower prevalence of stunting for all age groups. Between 14 % and 32 % of socio-economic disparities in overweight were explained by maternal and household characteristics. Mother's overweight was positively associated with overweight of the child.

Socio-economic inequalities in stunting and overweight coexist among children and adolescents in Colombia. Malnutrition inequalities are largely explained by household characteristics, suggesting the need for targeted interventions.

We investigated the association between the consumption of tomato and lycopene and cancer mortality among US adults.

Prospective.

The National Health and Nutrition Examination Survey (1999–2010).

Participants with estimated dietary data on tomato and lycopene consumption were included. Outcome data up until 31 December 2011 were also ascertained. Cox proportional hazard regression models were used to relate baseline tomato and lycopene consumption with cancer mortality. We conducted a competing-risk survival analysis to account for deaths from other causes.

Adjusted Cox models showed that tomato and lycopene intake were inversely related (hazard ratio (95 % CI)) to cancer mortality: 0·86 (0·81, 0·92) and 0·79 (0·74, 0·82), respectively. In the adjusted competing-risk models, the sub-hazard ratios (95 % CI) were 0·89 (0·83, 0·94) and 0·82 (0·78, 0·86) for cancer mortality for tomato and lycopene intake, respectively. No significant interaction was found for the association between tomato and lycopene consumption and cancer mortality while comparing older (aged >50 years) v. younger adults (Pinteraction > 0·173 for all) and obese v. non-obese (Pinteraction > 0·352 for all).

Our results demonstrate the potential beneficial effects of a high dietary intake of tomato and lycopene on cancer death. Further prospective studies are needed to explore the association.

The present literature review aimed to review the evidence for community-based distribution (CBD) of iron–folic acid (IFA) supplementation as a feasible approach to improve anaemia rates in low- and middle-income countries.

The literature review included peer-reviewed studies and grey literature from PubMed, Cochrane Library, LILAC and Scopus databases.

Low- and middle-income countries.

Non-pregnant women, pregnant women, and girls.

CBD programmes had moderate success with midwives and community health workers (CHW) who counselled on health benefits and compliance with IFA supplementation. CHW were more likely to identify and reach a greater number of women earlier in pregnancy, as women tended to present late to antenatal care. CBD channels had greater consistency in terms of adequate supplies of IFA in comparison to clinics and vendors, who faced stock outages. Targeting women of reproductive age through school and community settings showed high compliance and demonstrated reductions in anaemia.

CBD of IFA supplementation can be a valuable platform for improving knowledge about anaemia, addressing compliance and temporary side-effects of IFA supplements, and increasing access and coverage of IFA supplementation. Programmatic efforts focusing on community-based platforms should complement services and information provided at the health facility level. Provision of training and supportive supervision for CHW on how to counsel women on benefits, side-effects, and when, why, and how to take IFA supplements, as part of behaviour change communication, can be strengthened, alongside logistics and supply systems to ensure consistent supplies of IFA tablets at both the facility and community levels.

To appraise critically the relevance and value of the evidence base to promote and support the duration of breast-feeding, with a specific focus on disadvantaged groups.

A systematic review was conducted of intervention studies relevant to enhancing the duration of breast-feeding; topics included public health, public policy, clinical issues, and education, training and practice change. A systematic search was conducted. Eighty studies met the inclusion criteria. Data were systematically extracted and analysed. Full results and recommendations are reported elsewhere. Here a critique of the evidence base – topics, quality and gaps – is reported.

Many studies were substantially methodologically flawed, with problems including small sample sizes, inconsistent definitions of breast-feeding and lack of appropriate outcomes. Few were based on relevant theory. Only a small number of included studies (10%) were conducted in the UK. Very few targeted disadvantaged subgroups of women. No studies of policy initiatives or of community interventions were identified. There were virtually no robust studies of interventions to prevent and treat common clinical problems, or of strategies related to women's health issues. Studies of health professional education and practice change were limited. Cost-effectiveness studies were rare.

Policy goals both in the UK and internationally support exclusive breast-feeding until 6 months of age. The evidence base to enable women to continue to breast-feed needs to be strengthened to include robust evaluations of policies and practices related to breast-feeding; a step change is needed in the quality and quantity of research funded.

The present review aimed to identify and synthesize studies that used an empowerment approach within the field of healthy nutrition.

A systematic review was conducted. Studies were identified by database searching (PubMed, PsycINFO, Web of Science and Psyndex). Searching, selecting and reporting were done according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) Statement.

Health promotion including the subject of healthy nutrition.

Individuals from non-clinical populations.

A total of 1226 studies were screened for eligibility, eight studies were finally included. Three studies used the empowerment approach within a qualitative research paradigm and five studies within (quasi-) experimental intervention studies. Heterogeneity in settings, samples and evaluation methods was high. Most studies referred to the key message of empowerment, i.e. taking control over one’s own life. However, the ways in which this key message was implemented in the interventions differed considerably.

The number of studies included was very low. Furthermore, most studies had some limitations in terms of reporting how the empowerment approach was actually applied. The empowerment approach still seems to be unfamiliar within the field of healthy nutrition.

To investigate the predictors of change in physical activity (PA) from early to mid adolescence in a cohort of adolescents.

Prospective, population-based birth cohort study. PA level was evaluated by means of questionnaire, and was analysed in continuous form (min/week) and as a trajectory (inactive–inactive, inactive–active, active–inactive, active–active) based on the cut-off point of 300 min/week.

Pelotas, a city of 340 000 inhabitants in southern Brazil.

Adolescents (n 4120) followed from 11 to 15 years of age.

Maternal PA change and more exposure to outdoors were directly associated with a positive change in PA level (min/week) for both genders. Higher maturation status (among boys) and later menarche were also associated with positive PA change in min/week. Predictors to remain inactive were: maternal PA change (inverse association), more exposure to outdoors, higher socio-economic level, fear of living in the neighbourhood and non-overweight girls. Predictors to become inactive were higher socio-economic level among boys and increase in screen time among girls.

The study demonstrates that social, family, biological, behavioural and environmental factors exert an important role in the PA change among youngsters as they move into adolescence. These findings may be relevant to the design of policies and intervention programmes aimed at promoting PA in teenagers.