To investigate the beverage intake patterns of Canadian adults and explore characteristics of participants in different beverage clusters.

Analyses of nationally representative data with cross-sectional complex stratified design.

Canadian Community Health Survey, Cycle 2·2 (2004).

A total of 14 277 participants aged 19–65 years, in whom dietary intake was assessed using a single 24 h recall, were included in the study. After determining total intake and the contribution of beverages to total energy intake among age/sex groups, cluster analysis (K-means method) was used to classify males and females into distinct clusters based on the dominant pattern of beverage intakes. To test differences across clusters, χ2 tests and 95 % confidence intervals of the mean intakes were used.

Six beverage clusters in women and seven beverage clusters in men were identified. ‘Sugar-sweetened’ beverage clusters – regular soft drinks and fruit drinks – as well as a ‘beer’ cluster, appeared for both men and women. No ‘milk’ cluster appeared among women. The mean consumption of the dominant beverage in each cluster was higher among men than women. The ‘soft drink’ cluster in men had the lowest proportion of the higher levels of education, and in women the highest proportion of inactivity, compared with other beverage clusters.

Patterns of beverage intake in Canadian women indicate high consumption of sugar-sweetened beverages particularly fruit drinks, low intake of milk and high intake of beer. These patterns in women have implications for poor bone health, risk of obesity and other morbidities.

Emerging evidence suggests that food insecurity is a significant public health concern among people who are homeless or marginally housed. The present study assessed prevalence of food insecurity and its covariates among a group of marginally housed individuals living in single-room occupancy (SRO) dwellings, a population for which there is little extant health or nutrition research.

Cross-sectional survey incorporating the Household Food Insecurity Access Scale.

Ten private SRO residences in the Uptown neighbourhood of Chicago, IL, USA, 2013.

SRO residents over 18 years of age who were able to communicate verbally in English (n 153).

Food insecurity was widespread among SRO residents, with 75 % of the sample considered food insecure and 52 % meeting criteria for severe food insecurity. Bivariate analyses indicated that female gender, eating most meals at a soup kitchen, having a mental health condition, problem drinking, having at least one chronic health condition, and diabetes were all significantly associated with food insecurity. In the multivariate ordered logistic regression model, eating most meals at a soup kitchen remained as the only significant correlate of food insecurity (OR=10·13).

SRO residents and other marginally housed populations face unique food access challenges. Although targeted assistance in the form of food stamps and congregate meal programmes remains critical, efforts to prevent and address food insecurity among homeless and marginally housed individuals should include policy interventions that recognize poverty as the root cause of food insecurity and aim to increase overall income and improve housing conditions.

To validate estimated intakes of carotenoid-rich foods from a web-based food recall (WebFR) using carotenoids in blood as an objective reference method.

Cross-sectional validation study using carotenoids in plasma to evaluate estimated intakes of selected carotenoid-rich foods. Participants recorded their food intake in the WebFR and plasma concentrations of β-carotene, α-carotene, β-cryptoxanthin, lycopene, lutein and zeaxanthin were measured.

Schools and homes of families in a suburb of the capital of Norway.

A total of 261 participants in the age groups 8–9 and 12–14 years.

Spearman’s rank correlation coefficients ranged from 0·30 to 0·44, and cross-classification showed that 71·6–76·6 % of the participants were correctly classified, when comparing the reported intakes of carotenoid-rich foods and concentrations of the corresponding carotenoids in plasma, not including lutein and zeaxanthin.

Correlations were acceptable and cross-classification analyses demonstrated that the WebFR was able to rank participants according to their reported intake of foods rich in α-carotene, β-carotene, β-cryptoxanthin and lycopene. The WebFR is a promising tool for dietary assessment among children and adolescents.

Small food store interventions show promise to increase healthy food access in under-resourced areas. However, none have tested the impact of price discounts on healthy food supply and demand. We tested the impact of store-directed price discounts and communications strategies, separately and combined, on the stocking, sales and prices of healthier foods and on storeowner psychosocial factors.

Factorial design randomized controlled trial.

Twenty-four corner stores in low-income neighbourhoods of Baltimore City, MD, USA.

Stores were randomized to pricing intervention, communications intervention, combined pricing and communications intervention, or control. Stores that received the pricing intervention were given a 10–30 % price discount by wholesalers on selected healthier food items during the 6-month trial. Communications stores received visual and interactive materials to promote healthy items, including signage, taste tests and refrigerators.

All interventions showed significantly increased stock of promoted foods v. control. There was a significant treatment effect for daily unit sales of healthy snacks (β=6·4, 95 % CI 0·9, 11·9) and prices of healthy staple foods (β=–0·49, 95 % CI –0·90, –0·03) for the combined group v. control, but not for other intervention groups. There were no significant intervention effects on storeowner psychosocial factors.

All interventions led to increased stock of healthier foods. The combined intervention was effective in increasing sales of healthier snacks, even though discounts on snacks were not passed to the consumer. Experimental research in small stores is needed to understand the mechanisms by which store-directed price promotions can increase healthy food supply and demand.

To evaluate the reliability and validity of a six-item food security scale when self-administered by adolescents.

Cross-sectional questionnaire survey including the six-item food security measure, socio-economic variables and a food-frequency questionnaire.

Representative sample of 29 schools in Trinidad.

In total 1903 students aged approximately 16 years.

Item affirmatives ranged from 514 (27%) for the ‘balanced meal’ item to 128 (7%) for the ‘skipped or cut meals often’ item and 141 (7%) for the ‘hungry’ item. Item-score correlations ranged from 0.444 to 0.580. Cronbach's α was 0.77. Relative item severities from the Rasch model ranged from −1.622 (standard error 0.043) for the ‘balanced meal’ item to 1.103 (0.068) for the ‘skipped or cut meals often’ item and 0.944 (0.062) for the ‘hungry’ item. The ‘hungry’ item gave a slightly lower relative severity in boys than girls. Food insecurity was associated with household overcrowding (adjusted odds ratio comparing highest and lowest quartiles 2.61, 95% confidence interval 1.75 to 3.91), lack of pipe-borne water in the home, low paternal education or paternal unemployment. After adjusting for socio-economic variables, food insecurity was associated with less frequent consumption of fruit (0.75, 0.60 to 0.94) or fish (0.72, 0.58 to 0.88) but more frequent consumption of biscuits or cakes (1.47, 1.02 to 2.11).

The food security scale provides a valid, reliable measure in adolescents, although young people report being hungry but not eating relatively more frequently than adults. Food-insecure adolescents have low socio-economic position and may eat less healthy diets.

To study risk factors for overweight among Brazilian adolescents of low-income families.

Case–control study of obese and non-obese adolescents.

Anthropometric survey including 1420 students (aged 14–19 years) attending a public high school in São Paulo, Brazil.

Selection of 83 overweight (body mass index (BMI) >85th percentile) and 89 non-overweight (BMI >5th percentile and <85th percentile) subjects, frequency-matched by age, gender, pubertal development and socio-economic status. Among the nutritional, familial and behavioural data available, five covariates (parents' obesity, adolescents' past obesity, to have a best friend, dietary restriction and habit of napping) were included in the fitted hierarchical conditional logistic regression models.

Parents or guardians and adolescents were weighed, measured and answered a pre-tested questionnaire applied by trained nutritionists and paediatricians.

The prevalence of overweight was 15.2%. As previous risks, obese parents and obesity during infancy presented odds ratios (OR) and 95% confidence intervals (CI) of 2.23 (1.15–4.35) and 3.60 (1.47–8.80), respectively. As concurrent factors, the habit of napping, to have a best friend and reported dietary restriction presented OR (95% CI) of 3.43 (1.32–8.92), 5.15 (1.76–15.07) and 7.26 (2.95–17.88), respectively. Dietary patterns, frequency of obesogenic foods and other physical activity indicators presented no statistical significance.

In case–control studies, OR may overestimate the true risks. Parents' obesity and previous childhood obesity were identified as risk factors; therefore these factors should be the target for preventive programmes and policies in order to prevent the burden of obesity in the near future.

Psychosocial and demographic correlates of fruit, juice and vegetable (FJV) consumption were investigated to guide how to increase FJV intake.

Hierarchical multiple regression analysis of FJV consumption on demographics and psychosocial variables.

Houston, Texas, USA.

Boys aged 11–14 years (n = 473).

FJV preference and availability were both significant predictors of FJV consumption, controlling for demographics and clustering of Boy Scout troops. Vegetable self-efficacy was associated with vegetable consumption. The interaction of preference by home availability was a significant predictor of FJV. The interaction of self-efficacy by home availability showed a trend towards significantly predicting vegetable consumption. No significant interactions were found between body mass index and the psychosocial variables.

Findings suggest that future interventions emphasising an increase in preference, availability and efficacy may increase consumption of FJV in similar populations.

Increasing childhood asthma rates may be due to changing dietary lifestyle. We investigated the association of dietary intake of antioxidant vitamins and fatty acids with asthma in Japanese pre-school children.

Cross-sectional study.

School-based survey on lifestyle/diet and health status in children in Japan.

Parents of 452 children aged 3–6 years completed a questionnaire on the children's and parents’ lifestyle and demographics. Children were classified into asthma cases and non-asthma cases in accordance with the ATS-DLD (American Thoracic Society and Division of Lung Diseases of the National Heart, Lung, and Blood Institute) questionnaire. Children's diet was assessed using a 3 d dietary record completed by parents. Children's age, sex, BMI, history of food allergy, maternal age, parental history of allergy, maternal education, family size and second-hand smoking were included as covariates. Logistic regression models were used to examine the association between children's diet and asthma.

Compared with children with the lowest intake tertile for vitamin C and vitamin E, those in the highest were significantly inversely associated with asthma; adjusted OR (95 % CI) were 0·35 (0·14, 0·88) and 0·32 (0·12, 0·85), respectively. A statistically significant trend was also observed. Fruit intake showed an inverse but insignificant association with asthma. There were no associations of any type of fatty acids with asthma.

These data suggest that children with high intakes of vitamins C and E may be associated with a reduced prevalence of asthma.

Our objective was to determine whether a questionnaire can identify individuals with vitamin D insufficiency (VDI).

Women completed the Vitamin D & Sun (VIDSUN) questionnaire and we measured their serum 25-hydrocyvitamin D (25(OH)D) levels. We assessed the sensitivity and specificity of the questionnaire to identify VDI (25(OH)D level <50 nmol/l).

Clinical Research Unit, University of Wisconsin–Madison.

Postmenopausal women.

We recruited 609 postmenopausal women with a mean age of 61 (sd 6 years), of whom 113 (19 %) had VDI. Women with VDI were more likely to be black (17 % v. 2 %, P < 0·001), heavier (BMI 33·0 (sd 7) kg/m2 v. 29·0 (sd 7) kg/m2, P < 0·001) and less likely to tan in the past year (49 % v. 72 %, P < 0·001), use sunscreen (57 % v. 72 %, P < 0·001) or report sun exposure in the last 3 months. They consumed less vitamin D from supplements (2·15 (sd 5·24) μg/d (86 (sd 210) IU/d) v. 4·55 (sd 8·48) μg/d (188 (sd 344) IU/d), P = 0·003). In logistic regression models, black race, BMI, suntan within the past year, sun exposure in the past 3 months, sunscreen use and supplemental vitamin D intake were the most useful questions to identify VDI. From these six items, a composite score of ≤2·25 demonstrated ≥89 % sensitivity but ≤35 % specificity for VDI.

The VIDSUN questionnaire provides an initial tool to identify postmenopausal women at high or low risk of VDI. Existing studies suggest that inclusion of physical activity and TAG levels might improve the performance of the VIDSUN questionnaire.

To understand who engages in home gardening and whether gardening is associated with fruit and vegetable intake and weight status.

A national cross-sectional survey.

Online survey panel in the USA.

Adults aged 18–75 years representing the US population with respect to gender, age, race/ethnicity, income and geographic region (n 3889).

Approximately 30 % of survey respondents reported growing edible plants in a home garden. Gardeners were more likely to be White or Asian, employed, have higher income, be married, have children in the household and live in rural areas. Gardeners were less likely to be obese and more likely to meet US dietary recommendations for fruit and vegetable consumption. In multivariable analyses, home gardens remained associated with fruit and vegetable intake and BMI when controlling for a range of socio-demographic characteristics and level of rurality.

The current study identifies who is gardening in the USA and provides useful information for public health efforts to increase gardening as a nutrition intervention. Future research should examine the benefits of home gardening and interventions to increase home gardening using more rigorous designs.

To assess the association of breakfast intake with Mediterranean diet adherence, physical activity levels, obesity, selected cardiovascular risk markers and Fe status.

Cross-sectional study. BMI, body fat percentage and waist circumference were assessed. Physical activity was assessed using a pedometer and diet quality was evaluated by applying the KIDMED index. Blood tests to assess blood lipids, high-sensitivity C-reactive protein, fasting glucose, serum Fe and ferritin, as well as Hb, were performed.

Primary-school children of the Troodos mountainous area in Cyprus.

Eighty-three Cypriot children (mean age 9·2 (sd 1·7) years).

Compared with breakfast skippers, regular breakfast eaters were 40 % more likely to have a KIDMED score higher by one point on average (OR=1·41; 95 % CI 1·08, 1·84) after accounting for obesity levels and other confounders. Breakfast skippers, on the other hand, were by about 14 % more likely to have a body fat percentage value higher by one unit, as well as higher values for both BMI and waist circumference. The relationship was significantly strengthened when combining body fat percentage and waist circumference into a composite variable (OR=0·20; 95 % CI 0·06, 0·69). Fasting glucose was inversely correlated to breakfast intake in descriptive analyses, whereas serum Fe was positively correlated to breakfast intake after considering age, gender and diet quality. The latter relationship disappeared, however, after considering physical activity levels.

Cypriot children who take breakfast regularly exhibit a higher adherence to the Mediterranean diet and have higher serum Fe concentrations and lower BMI, waist circumference, body fat percentage and fasting glucose levels, compared with children who skip breakfast. Public health professionals, educators and parents should prioritize on actions that will motivate children to regularly eat breakfast.

India has proposed legislating an upper limit of trans fat in partially hydrogenated vegetable oils and mandating trans fat labelling in an effort to reduce intakes. The objective of the present study was to examine the complexities of regulating trans fat in India by examining the policy processes involved and the perceived implementation challenges.

Semi-structured interviews (n 18) were conducted with key informants from various sectors. Interviewees were asked about sources of trans fat in the food supply, existing policies that may influence trans fats and perceived challenges related to the proposed trans fat regulation, in addition to questions tailored to their area of expertise. Interview data were organised based on common themes.

Interviews were conducted in India.

Interviewees were key informants from various sectors including agriculture, trade, industry and health.

Several themes were identified related to the complexity of regulating trans fat in India. A lack of trans fat awareness, the large unorganised retail sector, a need for suitable alternative products that are both acceptable to consumers and affordable, and a need to build capacity were crucial factors affecting India's ability to successfully regulate trans fat. The limited number of food inspectors will create an additional challenge in terms of enforcement of trans fat regulation.

Although India will face challenges in regulating trans fat, legislating an upper limit of trans fat in partially hydrogenated vegetable oils will likely be the most effective approach to reducing it in the food supply. Ongoing engagement with industry, agriculture, trade and processing sectors will prove essential in terms of product reformulation.

To explore the perceptions of soldiers participating in a US Army Office of The Surgeon General’s worksite health promotion programme (WHPP) on the local food environment within their campus-style workplace.

Focus groups were conducted to evaluate the perceived effectiveness of the WHPP implementation. Further exploration of focus group data through thematic analysis focused on perceived contributions of the military campus-style food environment to soldiers’ nutrition behaviours.

Three US Army installations located in the continental USA.

Active duty soldiers (n 366) participating in one of the fifty-eight focus groups.

Soldiers shared a common belief of self-discipline and personal responsibility as the foothold to nutrition behaviour change. Soldiers described aspects of the military campus-style food environment as factors impeding achievement of optimal nutrition. Collectively, soldiers perceived the proximity and density of fast-food restaurants, lack of healthy alternatives on the installation and the cost of healthy food as inhibitors to choosing healthy foods. Overwhelmingly, soldiers also perceived time constraints as a factor contributing to unhealthy food choices.

Although nutrition behaviour is individually driven, soldiers perceived the military campus-style food environment inhibits healthy decision making. Nutrition programming in military WHPP must integrate food environment changes to improve soldiers’ nutrition behaviour outcomes. Applicable to the military, food choice behaviour studies suggest environmental changes must be appealing to young adults. Considerations for environmental changes should include an increased portion size for healthy options, broadened use of soldiers’ daily food allowances on local produce and increased availability of grab-and-go options.

To characterize energy and macronutrient intakes in Brazil and to describe the top food items contributing to energy and macronutrient intakes.

Two non-consecutive 24 h dietary records were collected and energy and macronutrient data were adjusted for usual intake distribution. Descriptive statistics and ANOVA with the Bonferroni post hoc test were analysed using SAS version 9·1. Means and standard deviations were estimated for sex, age and income strata.

Nationwide cross-sectional survey, 2008–2009.

Nationally representative sample of individuals ≥10 years old (n32 749), excluding pregnant and lactating women (n 1254).

The average energy intake was 7958 kJ/d (1902 kcal/d) and mean energy density was 6·82 kJ/g (1·63 kcal/g). Added sugar represented 13 % of total energy intake and animal protein represented 10 %. The mean contribution of total fat to energy intake was 27 %, while the mean saturated fat contribution was 9 %. Compared with the lowest quartile of income, individuals in the highest income quartile had greater mean intakes of energy, added sugar, alcohol, animal protein, total fat, saturated fat, monounsaturated fat and trans fat. Rice, beans, beef, bread and coffee were among the top five foods contributing most to the intakes of energy, carbohydrates, protein, fat and fibre.

In general, Brazilians’ dietary intake is compatible with a high risk of obesity and non-communicable chronic diseases, being characterized by high intakes of added sugar and saturated fat. Income may be a major determinant of diet nutritional characteristics.

Vitamin D deficiency (serum 25-hydroxyvitamin D<25 nmol/l) is extremely common in Western-dwelling South Asians but evidence regarding vitamin D supplement usage in this group is very limited. This work identifies demographic, dietary and lifestyle predictors associated with vitamin D supplement use.

Cross-sectional analysis of baseline vitamin D supplement use data.

UK Biobank cohort.

In total, 8024 South Asians (Bangladeshi, Indian, Pakistani), aged 40–69 years.

Twenty-three per cent of men and 39 % of women (P<0·001) (22 % of Bangladeshis, 32 % of Indians, 25 % of Pakistanis (P<0·001)) took a vitamin-D-containing supplement. Median vitamin D intakes from diet were low at 1·0–3·0 µg/d, being highest in Bangladeshis and lowest in Indians (P<0·001). Logistic regression modelling showed that females had a higher odds of vitamin D supplement use than males (OR=2·02; 95 % CI 1·79, 2·28). A lower supplement usage was seen in younger persons (40–60 years v. >60 years: OR=0·75; 95 % CI 0·65, 0·86) and in those living outside Greater London (OR=0·53 to 0·77), with borderline trends for a lower BMI, higher oily fish intake and higher household income associated with increased odds of vitamin D supplement use.

Vitamin D supplements were not used by most South Asians and intakes from diet alone are likely to be insufficient to maintain adequate vitamin D status. Public health strategies are now urgently required to promote the use of vitamin D supplements in these specific UK South Asian subgroups.

To validate a 171-item semi-quantitative food-frequency questionnaire (FFQ) for measurement of nutrient intake in an intervention trial based on walnut supplementation.

Free-living adults from Southern California were randomly assigned to either an intervention (walnut-supplemented) or a control diet. The prescribed 6-month intervention was ≥ 28 g of walnuts per day for the walnut-supplemented group and ≤ 2 g of walnuts per day for the control group. Participants provided at least six 24-hour dietary recalls and completed a self-administered FFQ.

Eighty-seven adults aged 30–72 years (48 females, 39 males).

Our findings from validation (by correlation with six diet recall measures) of the measurement of 32 nutrients by the FFQ are as follows. We found significant positive correlations (corrected for measurement error) between the FFQ and diet recalls for total energy (r = 0.34), total carbohydrate (r = 0.42), vegetable protein (r = 0.43), total fat (r = 0.51), polyunsaturated fat (r = 0.77), total fibre (r = 0.60), linoleic acid (r = 0.78) and α-linolenic acid (r = 0.79) – the last nutrient being an excellent nutrient biomarker of the intervention (walnut supplementation). Significant positive correlations were also found for vitamin C (r = 0.96) and certain minerals (r = 0.46–0.80 for calcium, phosphorus, magnesium, iron and potassium). Uncorrected correlations were also high (r>0.40) for retinol, β-carotene, folate and alcohol. Both diet recalls and FFQ showed a similar significant difference in α-linolenic acid content between the walnut-supplemented and control diets.

The FFQ demonstrated good relative validity in the estimation intake of some of the major nutrients in a dietary intervention trial and was a particularly valid estimate of an important nutrient biomarker of walnut supplementation.

The impact of acid–base balance on health is widely accepted. Here, we describe the potential renal acid load (PRAL) in the diet of healthy German children and adolescents.

The Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study is an ongoing longitudinal (open cohort) study (start 1985) collecting detailed data on diet, growth, development and metabolism in infants, children and adolescents.

Research Institute of Child Nutrition, Dortmund.

Seven hundred and twenty children and adolescents (351 boys and 369 girls), aged 3–18 years, provided 4187 yearly collected 3-day dietary records between 1995 and 2005.

Mean daily PRAL was positive in all age/sex groups (6–21 mEq day−1), and significantly higher in boys than in girls after the age of 8 years, even when calculated as mEq MJ−1. Fruits, vegetables and potatoes had a negative impact on PRAL; cheese, dairy products, cereals/bread and meat/fish/eggs had a positive impact. In a mixed linear model, PRAL, expressed as mEq day−1 and mEq MJ−1, remained stable during the study period, since time trends of PRAL-relevant food groups countervail each other. PRAL intake (mEq MJ−1) was significantly positively associated (P < 0.0001) with fat intake (% of energy intake, %E), but negatively with carbohydrate intake (%E; P < 0.0001).

The analysis of dietary habits in our sample of German children and adolescents showed a moderate excess of acidity. Especially older boys should be encouraged to eat more potatoes and vegetables as good sources of dietary alkalinity. The PRAL concept is compatible with current concepts for a healthy diet.

Research about the prevalence of underweight and overweight/obesity in the Saudi Arabian female population is limited. The aim of the present study was to examine the dietary habits and the prevalence of underweight and overweight/obesity and associated factors among female university students.

A cross-sectional study.

A university centre for female students in south-western Saudi Arabia.

The study involved 663 randomly selected female university students who self-reported their physical activities, nutritional habits and socio-economic factors. Multiple linear and logistic regression analyses were used to identify factors associated with the students’ BMI, dietary variables, underweight and overweight/obesity.

The majority of the university females were normal weight (56·9 %), but a high prevalence of underweight (19·2 %) and overweight/obesity (23·8 %) occurred. Social factors significantly associated with BMI were the presence of obese parents and siblings as well as physical activity levels, marital status, number of sisters, father’s level of education and more frequent intake of French fries/potato chips (>3 times/week). Several variables were found to correlate with dietary habits, underweight and overweight/obesity. Of special interest is the association between the number of siblings and the participants’ BMI and dietary intake in both negative and positive ways.

The findings of this research have implications for health promotion and prevention of malnutrition among college-aged females. Health-care providers and policy makers need to involve the whole family when promoting females’ physical activity. The study serves as an evidence-based background for planning and implementation of interventions targeting improvement of highly educated populations’ nutritional habits.

To describe and analyse the changes in diet, physical activity and body composition of the Cuban population during the 1990s and the health implications of these changes.

Design and setting: Data on national food balance and physical activity are from government agencies and the Ministry of Public Health; nation-wide and local representative surveys were used to analyse body composition and leisure activities. Data on morbidity and mortality arefrom the Ministry of Public Health.

The collapse of the European socialist countries and the Soviet Union, as well as the reinforced United States' blockade, provoked a sudden shortage of fuel, raw materials, imported foods and essential supplies. Per capita energy availability decreased, physical activity increased, and the prevalence of obesity decreased. Nutrition deficiencies were observed in the early 1990s, while the trend of morbidity from non-communicable disease continued to increase. The nutrition transition characteristics following the economic recovery in 1995–1996 resembled those of the 1980s because of the increased food availability, decreased physical activity and increased obesity prevalence.

Programmes to deal with the complex situation generated a response in a remarkably short time. Undesirable changes in diet composition and the reduction of physical activity constitute a challenge in the current post-critical stage that must be prevented.