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.

The purpose of the present study was to examine the interactions between weight perceptions, weight control behaviours and body fatness in a multiethnic sample of adolescent girls.

A cross-sectional study.

Girls from European (37·7 %), Pacific Island (21·6 %), East Asian (15·8 %), Maori (10·2 %) and South Asian (9·6 %) populations and from other ethnicities (5·0 %).

A sample of 954 girls aged 11–15 years participated in the study. BMI was derived from height and weight, whereas body fat (BF) was determined from hand-to-foot bioimpedance measurements. Weight perceptions, weight control behaviours and pubertal stage were assessed by questionnaire.

Body size and fatness varied significantly across ethnic groups. Although few differences in weight perceptions were observed between BMI and %BF percentile groups, a relatively high degree of weight misclassification was evident across all BF categories. The number of girls trying to lose weight exceeded those who perceived themselves as being overweight, with the magnitude of the difference dependent on ethnicity. Of the girls trying to lose weight, the combination of dieting and exercise was the most common weight loss practice; however, a substantial proportion reported neither exercise nor dieting. Weight status perception was a stronger predictor of weight loss intent than actual BF when controlling for all other factors.

Interventions and educational campaigns that assist girls in recognising a state of excess BF are a priority for all ethnic groups to increase the likelihood that behavioural changes necessary to combat widespread overweight and obesity are adopted.

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.

Studies have shown that consumption of low-calorie sweeteners (LCS) may be associated with harmful health effects. The current study investigated the presence and types of LCS added to packaged foods.

Cross-sectional study analysing the presence and types of LCS in the ingredients lists of packaged foods sold at a major Brazilian supermarket. To identify types of LCS allowed for use in foods in Brazil, current legislation was consulted. Data were organised and analysed through descriptive statistics, presenting simple and relative frequencies of LCS presence categorised by food group.

Supermarket in Florianópolis, southern Brazil.

Packaged food products (n 4539) from eight food groups.

One or more LCS were found in 602 (13·3 %) of the packaged foods analysed. There were 1329 citations of LCS among these foods, with a mean of 2·2 sweeteners per food. Groups with the highest frequency of foods containing LCS were: products with energy derived from carbohydrates and fats (25·0 %); milk and dairy products (11·7 %); bakery products, cereals, legumes, roots and tubers (11·2 %); and fruits, juices, nectars and fruit drinks (8·3 %).

There was high prevalence of packaged foods with LCS, especially in food groups that form the basis of the Brazilian diet. The study was the first to extensively analyse the presence and types of LCS in packaged foods available for sale in a Brazilian supermarket and can be useful to monitor the use of LCS in these foods, as well as to support future changes in legislation to label sugars.

To assess differences in cognition functions and gross brain structure in children seven years after an episode of severe acute malnutrition (SAM), compared with other Malawian children.

Prospective longitudinal cohort assessing school grade achieved and results of five computer-based (CANTAB) tests, covering three cognitive domains. A subset underwent brain MRI scans which were reviewed using a standardized checklist of gross abnormalities and compared with a reference population of Malawian children.

Blantyre, Malawi.

Children discharged from SAM treatment in 2006 and 2007 (n 320; median age 9·3 years) were compared with controls: siblings closest in age to the SAM survivors and age/sex-matched community children.

SAM survivors were significantly more likely to be in a lower grade at school than controls (adjusted OR = 0·4; 95 % CI 0·3, 0·6; P < 0·0001) and had consistently poorer scores in all CANTAB cognitive tests. Adjusting for HIV and socio-economic status diminished statistically significant differences. There were no significant differences in odds of brain abnormalities and sinusitis between SAM survivors (n 49) and reference children (OR = 1·11; 95 % CI 0·61, 2·03; P = 0·73).

Despite apparent preservation in gross brain structure, persistent impaired school achievement is likely to be detrimental to individual attainment and economic well-being. Understanding the multifactorial causes of lower school achievement is therefore needed to design interventions for SAM survivors to thrive in adulthood. The cognitive and potential economic implications of SAM need further emphasis to better advocate for SAM prevention and early treatment.

This study examined the separate relationships between socio-economic disadvantage and the density of multiple types of food outlets, and relationships between socio-economic disadvantage and composite food environment indices.

Cross-sectional data were analysed using geospatial kernel density techniques. Food outlet data included convenience stores, discount stores, fast-food and fast casual restaurants, and grocery stores. Controlling for urbanicity and race/ethnicity, multivariate linear regression was used to examine the relationships between socio-economic disadvantage and density of food outlets.

This study occurred in a large Southeastern US county containing 255 census block groups with a total population of 474 266, of which 77·1 % was Non-Hispanic White, the median household income was $48 886 and 15·0 % of residents lived below 125 % of the federal poverty line.

The unit of analysis was block groups; all data about neighbourhood socio-economic disadvantage and food outlets were publicly available.

As block group socio-economic disadvantage increased, so too did access to all types of food outlets. The total food environment index, calculated as the ratio of unhealthy food outlets to all food outlets, decreased as block group disadvantage increased.

Those who reside in more disadvantaged block groups have greater access to both healthy and unhealthy food outlets. The density of unhealthy establishments was greater in more disadvantaged areas; however, because of having greater access to grocery stores, disadvantaged populations have less obesogenic total food environments. Structural changes are needed to reduce access to unhealthy food outlets to ensure environmental injustice and reduce obesity risk.

To evaluate the association between overweight and the occurrence of asthma and atopy in a cohort of children of 4–12 years of age living in the city of Salvador in 2005.

Cross-sectional study nested in a cohort.

The metropolitan region of Salvador, Bahia, Brazil.

The study included 1129 children of 4–12 years age who presented complete information on the variables used here. Skin tests for allergy, spirometry, faecal parasitology, serum IgE and anthropometric surveys were conducted. Poisson's multivariate regression was adopted.

Wheezing was found in 29·1% and asthma in 22·8% of children, both conditions being more common in those under 6 years of age and 34% more common in overweight children (prevalence ratio (PR) = 1·34; 95% CI 1·07, 1·67) following adjustment. The ratio between forced expiratory volume in 1s and forced vital capacity was associated with overweight (PR = 1·35; 95% CI 1·11, 1·61). No statistically significant association was found between overweight and allergen-specific IgE or with wheezing.

These results are in agreement with the hypothesis that overweight is associated with asthma and pulmonary function, even following adjustment for intervening variables known to be associated with the pathogeny of asthma.

To evaluate the validity and reproducibility of a 122-item interviewer-administered quantitative FFQ developed to determine food and nutrient intakes of adults in Botswana.

Relative validity of the FFQ was evaluated by comparing nutrient and food group intakes against four non-consecutive 24 h recalls administered over 12 months. The FFQ was repeated after 1 year to assess reproducibility.

Kanye, Botswana.

Seventy-nine adults aged 18–75 years.

Spearman correlation coefficients for the validity of energy-adjusted nutrients ranged from 0·42 (carbohydrate) to 0·49 (protein) for macronutrients and from 0·23 (Fe) to 0·44 (PUFA) for micronutrients. Exact agreement of quartile distribution for nutrients between the FFQ and recalls ranged from 27 % to 72 %. Weighted kappa values were lowest for retinol (0·13), Fe (0·22) and β-carotene (0·25) and ranged from 0·33 (SFA) to 0·59 (folate) for other nutrients (energy, carbohydrate, protein, fat, Ca and vitamin E). Spearman correlation coefficients between the recalls and FFQ for food groups ranged from 0·18 (dark green leafy and yellow vegetables) to 0·58 (poultry). Reproducibility correlation coefficients (energy-adjusted) varied between 0·39 for retinol and 0·66 for vitamin E, with most values falling between 0·50 and 0·60.

The FFQ had good relative validity for estimating habitual food group and nutrient intakes, but was poor for some micronutrients (Fe, retinol and β-carotene) and foods (fruits and dark green leafy vegetables).

To compare two approaches to analysing energy- and nutrient-converted data from dietary validation (and relative validation) studies – conventional analyses, in which the accuracy of reported items is not ascertained, and reporting-error-sensitive analyses, in which reported items are classified as matches (items actually eaten) or intrusions (items not actually eaten), and reported amounts are classified as corresponding or overreported.

Subjects were observed eating school breakfast and lunch, and interviewed that evening about that day's intake. For conventional analyses, reference and reported information were converted to energy and macronutrients; then t-tests, correlation coefficients and report rates (reported/reference) were calculated. For reporting error-sensitive analyses, reported items were classified as matches or intrusions, reported amounts were classified as corresponding or overreported, and correspondence rates (corresponding amount/reference amount) and inflation ratios (overreported amount/reference amount) were calculated.

Sixty-nine fourth-grade children (35 girls) from 10 elementary schools in Georgia (USA).

For energy and each macronutrient, conventional analyses found that reported amounts were significantly less than reference amounts (every P < 0.021; paired t-tests); correlations between reported and reference amounts exceeded 0.52 (every P < 0.001); and median report rates ranged from 76% to 95%. Analyses sensitive to reporting errors found median correspondence rates between 67% and 79%, and that median inflation ratios, which ranged from 7% to 17%, differed significantly from 0 (every P < 0.0001; sign tests).

Conventional analyses of energy and nutrient data from dietary reporting validation (and relative validation) studies may overestimate accuracy and mask the complexity of dietary reporting error.

To determine whether food security, diet diversity and diet quality are associated with anthropometric measurements and body composition among women of reproductive age. The association between food security and anaemia prevalence was also tested.

Secondary analysis of cross-sectional data from the Healthy Life Trajectories Initiative (HeLTI) study. Food security and dietary data were collected by an interviewer-administered questionnaire. Hb levels were measured using a HemoCue, and anaemia was classified as an altitude-adjusted haemoglobin level < 12·5 g/dl. Body size and composition were assessed using anthropometry and dual-energy x-ray absorptiometry.

The urban township of Soweto, Johannesburg, South Africa.

Non-pregnant women aged 18–25 years (n 1534).

Almost half of the women were overweight or obese (44 %), and 9 % were underweight. Almost a third of women were anaemic (30 %). The prevalence rates of anaemia and food insecurity were similar across BMI categories. Food insecure women had the least diverse diets, and food security was negatively associated with diet quality (food security category v. diet quality score: B = –0·35, 95 % CI –0·70, –0·01, P = 0·049). Significant univariate associations were observed between food security and total lean mass. However, there were no associations between food security and body size or composition variables in multivariate models.

Our data indicate that food security is an important determinant of diet quality in this urban-poor, highly transitioned setting. Interventions to improve maternal and child nutrition should recognise both food security and the food environment as critical elements within their developmental phases.

In women, the risk for non-communicable diseases increases after menopause. We aimed to identify major dietary patterns and study their associations with nutrient intake, sociodemographic factors and risk factors for non-communicable diseases among women aged 50–69 years.

A cross-sectional study. Food intake was recorded by a 253-item FFQ. Dietary patterns were identified using principal component analysis. The associations between the dietary patterns and nutrients were described by Pearson’s correlation coefficients and multiple regression analysis was used to examine the associations between the dietary patterns and age, education, BMI, physical activity and smoking.

The Norwegian Breast Cancer Screening Programme.

Women (n 6298) aged 50–69 years.

Three dietary patterns were identified: ‘Prudent’, ‘Western’ and ‘Continental’. Adherence to the ‘Prudent’ pattern was related to older age, higher education, higher BMI, more physical activity (Ptrend<0·001) and being a non-smoker (P<0·001). Adherence to the ‘Western’ pattern was related to older age, lower education, higher BMI, less physical activity (0·001≤Ptrend≤0·006) and lower alcohol intake (r =−0·28). Adherence to the ‘Continental’ pattern was related to younger age, higher education, higher BMI, less physical activity, (Ptrend<0·001), being a smoker (P<0·001) and higher alcohol intake (r=0·36).

Three distinct dietary patterns were identified. High adherence to a ‘Prudent’ pattern was associated with a healthy lifestyle, while high adherence to a ‘Western’ or ‘Continental’ pattern was associated with an unhealthy lifestyle. These findings are valuable knowledge for health authorities when forming strategies to promote a healthier lifestyle among women.

To determine the prevalence of metabolic syndrome (MetS) in schoolchildren from 6 to 16 years old, while considering their socio-economic status and other potential risk factors.

A cross-sectional study was conducted between April and November of 2005 in a semi-rural city with a total population of 13 000 inhabitants.

The study was conducted in Maracai city, located in the Brazilian state of Sao Paulo.

Schoolchildren (n 2170) of both genders, corresponding to approximately 82 % of all Maracai schoolchildren, were evaluated for components of MetS, as defined by the National Cholesterol Education Program; reference values for children and adolescents were adjusted for age and sex.

Overall, MetS prevalence was 3·6 % (95 % CI 2·9, 4·5) and did not differ statistically between genders, skin colour, between children and adolescents. However, when we analysed groups of subjects by weight, MetS prevalence progressively increased from 0·3 % (95 % CI 0·1, 0·8) in normal-weight subjects to 10·7 % (95 % CI 7·4, 14·8) and 34·5 % (95 % CI 25·9, 43·9) in overweight and obese subjects, respectively (both P < 0·001 compared to normal-weight controls). When socio-economic classes were considered, 4·7 % high-income students (95 % CI 3·5, 6·2) had MetS, which was significantly greater than low-income students (2·7 %; 95 % CI 1·9, 3·9; P = 0·023).

MetS prevalence was high in overweight and obese schoolchildren and these risk factors were present during childhood and adolescence. Changes in lifestyle and alimentary safety should be encouraged to avoid future cardiovascular morbidity and type 2 diabetes mellitus.

To determine the nutritional and health status of urban infants in two disadvantaged communities in the Western Cape, South Africa with special reference to micronutrient status. The results of this study will serve to plan an intervention study in these communities in the same age group.

Cross-sectional study.

Two disadvantaged urban black and ‘coloured’ communities in the Western Cape, South Africa.

Sixty infants aged 6–12 months from each community.

Dietary intake, anthropometric measurements, micronutrient status and psychomotor development.

Stunting and underweight were more prevalent in coloured infants (18% and 7%, respectively) than in black infants (8% and 2%, respectively). Anaemia (haemoglobin (Hb)<11 g dl−1 ) was prevalent in 64% of coloured and 83% of black infants. Iron-deficiency anaemia ( Hb<11 g dl−1 and ferritin < 10 ng ml−1) was found in 32% of coloured infants and in 46% of black infants. Zinc deficiency was prevalent in 35% and 33% of the coloured and black infants, respectively. Marginal vitamin A deficiency (serum retinol < 20 μg dl−1) was observed in 23% of black infants compared with 2% of coloured infants. Of black infants, 43% and of coloured infants 6% were deficient in two or more micronutrients. Six per cent of coloured infants had C-reactive protein concentrations above 5 mg l−1 compared with 38% of the black infants. The dietary intake of micronutrients was in general lower in black infants than in coloured infants. The overall psychomotor development, assessed by the Denver Developmental Screening Test, was different between the two groups. The coloured infants scored higher in three out of the four categories as well as in their overall score.

This study shows that information on stunting and wasting only in urban disadvantaged infants is not sufficient to make recommendations about specific community intervention programmes. Information on the micronutrient status, independent of wasting and stunting, is necessary to design nutrition programmes for different communities. The study also showed a substantially higher prevalence of micronutrient deficiencies among black infants.

To evaluate the prevalence of vitamin D deficiency and insufficiency, as well as their association with Hb and elevated blood lead levels (BLL) in children in China.

A cross-sectional and 1-year retrospective study.

Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, China.

Children aged from 6 months to 14 years living in south-west China who were taken to physical examinations (January–December 2011).

Of 1218 children included in the study, 25-hydroxyvitamin D (25(OH)D) concentration (mean 33·18 (sd 16·48) ng/ml) was deficient in 21·6 % and insufficient in 27·4 %, which were higher than the prevalence of both anaemia at 8·5 % and elevated BLL (Pb ≥ 10 μg/dl) at 1·8 %, but lower than mildly elevated BLL prevalence (5 μg/dl ≤ Pb < 10 μg/dl) at 56·9 %. There was a negative correlation between 25(OH)D concentration and BLL (r = −0·216, P < 0·001) while no significant relationship was found between 25(OH)D concentration and Hb (r = −0·012, P > 0·05). After multivariable adjustment, the significant predictors of 25(OH)D deficiency and insufficiency were increasing child age especially between 8 and 14 years (OR = 18·29; 95 % CI 10·14, 32·99; P < 0·001) and BLL (OR = 1·01; 95 % CI 1·00, 1·02; P = 0·045).

The prevalence of 25(OH)D deficiency and insufficiency was much higher than that of anaemia or elevated BLL in south-west China, and associated with increasing age and BLL.

Every society follows its own traditional health-care beliefs and practices during and after pregnancy, which is intimately linked to its socio-cultural environment. The objective of the present study was to document pregnancy-related food practices and the social-cultural factors linked with them.

The present study was a cross-sectional one conducted among a group of women residing in five villages in east Sikkim, India. Mothers who had given birth to a child one year before the survey participated in the study. The mothers answered a pre-tested questionnaire on food habits and practices followed antepartum and for 6 weeks postpartum.

The study group consisted of 199 women of Nepali caste groups with variations in economic condition.

More than 86 % of mothers consumed special foods during the postpartum period. Taboos on different food categories during the postpartum were reported only by 65·3 % of mothers. Factors found to be significantly associated with special food consumption were literacy status during the antepartum and parity during the postpartum.

The change in consumption patterns reflects the success of a safe motherhood campaign propagated by the government. Detailed investigation in this area, involving per capita daily consumption during pregnancy and the postpartum period, is needed.

The present study aims at measuring the association between household food insecurity and psychological distress in adolescents in Inuit communities, concurrently and overtime from childhood to adolescence.

The study used measures of internalising behaviours (anxiety, withdrawn attitude, somatic complaints and depression) as indicators of psychological distress during adolescence, a concurrent measure of household food insecurity in adolescence and an assessment of longitudinal patterns of household food insecurity from childhood to adolescence. We collected descriptive information at birth, childhood and adolescence on potential confounders.

Inuit communities of Nunavik in northern Quebec, Canada

The study consisted of 212 participants from the Nunavik Child Development Study, who have been assessed at birth, childhood (mean age = 11 years, range = 9–13 years) and adolescence (mean age = 18 years, range = 16–21 years).

Concurrent severe household food insecurity in adolescence was associated with higher measures of psychological distress: depression (βstd = 0·26, P < 0·01) and withdrawn attitude (βstd = 0·20, P = 0·04). Persistent household food insecurity (both at childhood and adolescence) was associated with higher levels of adolescent depression (βstd = 0·18, P = 0·02) and anxiety (βstd = 0·17, P = 0·03).

Adolescents from Nunavik living with higher food insecurity and those having experienced food insecurity in both childhood and adolescence were more likely to report symptoms of psychological distress. Considering the high level of distress experienced by young Inuit, existing initiatives to reduce food insecurity in Nunavik communities should be targeted to include children and adolescents.

To examine food and nutrient availability in New Zealand using supermarket sales data in conjunction with a brand-specific supermarket food composition database (SFD).

The SFD was developed by selecting the top-selling supermarket food products and linking them to food composition data from a variety of sources, before merging with individualised sales data. Supermarket food and nutrient data were then compared with data from national nutrition and household budget/economic surveys.

A supermarket in Wellington, New Zealand.

Eight hundred and eighty-two customers (73% female; mean age 38 years) who shopped regularly at the participating supermarket store and for whom electronic sales data were available for the period February 2004–January 2005.

Top-selling supermarket food products included full-fat milk, white bread, sugary soft drinks and butter. Key food sources of macronutrients were similar between the supermarket sales database and national nutrition surveys. For example, bread was the major source of energy and contributed 12–13% of energy in all three data sources. Proportional expenditure on fruit, vegetables, meat, poultry, fish, farm products and oils, and cereal products recorded in the Household Economic Survey and supermarket sales data were within 2% of each other.

Electronic supermarket sales data can be used to evaluate a number of important aspects of food and nutrient availability. Many of our findings were broadly comparable with national nutrition and food expenditure survey data, and supermarket sales have the advantage of being an objective, convenient, up-to-date and cost-effective measure of household food purchases.

In many countries of the world millions of people are not registered at birth. However, in order to assess children’s nutritional status it is necessary to have an exact knowledge of their age. In the present paper we discuss the effects of insufficient or imprecise age data on estimates of undernutrition prevalence.

Birth registration rates and levels of stunting, underweight and wasting were retrieved from Multiple Indicator Cluster Surveys and Demographic and Health Surveys of thirty-seven sub-Saharan African countries, considering the subdivision in wealth quintiles. The composition of the cross-sectional sample used for nutritional evaluation was analysed using a permutation test. Logistic regression was applied to analyse the relationship between birth registration and undernutrition. The 95 % probability intervals and Student’s t test were used to evaluate the effect of age bias and error.

Heterogeneous sampling designs were detected among countries, with different percentages of children selected for anthropometry. Further, registered children were slightly more represented within samples used for nutritional analysis than in the total sample. A negative relationship between birth registration and undernutrition was recognized, with registered children showing a better nutritional status than unregistered ones, even within each wealth quintile. The over- or underestimation of undernutrition in the case of systematic over- or underestimation of age, respectively, the latter being more probable, was quantified up to 28 %. Age imprecision was shown to slightly overestimate undernutrition.

Selection bias towards registered children and underestimation of children’s age can lead to an underestimation of the prevalence of undernutrition.