The current paper aims to present the main results of the Italian National Food Consumption Survey INRAN-SCAI 2005–06.

A cross-sectional study was performed. Households were randomly selected after geographical stratification of the national territory. Food consumption was assessed on three consecutive days through individual estimated dietary records.

Italy.

The final study sample comprised 3323 subjects (1501 males and 1822 females) aged 0·1 to 97·7 years belonging to 1329 households: fifty-two infants (0–2·9 years), 193 children (3–9·9 years), 247 teenagers (10–17·9 years), 2313 adults (18–64·9 years) and 518 elderly (65 years and above).

Participation rate was 33 %. The mean ratio of estimated energy intake to estimated BMR was 1·41 in adults. Indicators of mean and high individual consumption are presented for fifteen large categories and fifty-one subcategories of foods and beverages, in the total population and in consumers, by age and sex categories. The overall consumption of fruit and vegetables was 418 g/d. The consumption of red meat was approximately 700 g/week, expressed as raw weight. Some specific aspects of the Italian food consumption pattern were confirmed: a large contribution from bread, pasta and pizza to cereals, from olive oil to fats and from wine to alcoholic beverages.

The database obtained from the survey will be the key reference for Italian food consumption during the coming years and will be utilized for a variety of purposes including the assessment of nutrient intakes and risk analysis.

To assess household availability of NOVA food groups in nineteen European countries and to analyse the association between availability of ultra-processed foods and prevalence of obesity.

Ecological, cross-sectional study.

Europe.

Estimates of ultra-processed foods calculated from national household budget surveys conducted between 1991 and 2008. Estimates of obesity prevalence obtained from national surveys undertaken near the budget survey time.

Across the nineteen countries, median average household availability amounted to 33·9 % of total purchased dietary energy for unprocessed or minimally processed foods, 20·3 % for processed culinary ingredients, 19·6 % for processed foods and 26·4 % for ultra-processed foods. The average household availability of ultra-processed foods ranged from 10·2 % in Portugal and 13·4 % in Italy to 46·2 % in Germany and 50·4 % in the UK. A significant positive association was found between national household availability of ultra-processed foods and national prevalence of obesity among adults. After adjustment for national income, prevalence of physical inactivity, prevalence of smoking, measured or self-reported prevalence of obesity, and time lag between estimates on household food availability and obesity, each percentage point increase in the household availability of ultra-processed foods resulted in an increase of 0·25 percentage points in obesity prevalence.

The study contributes to a growing literature showing that the consumption of ultra-processed foods is associated with an increased risk of diet-related non-communicable diseases. Its findings reinforce the need for public policies and actions that promote consumption of unprocessed or minimally processed foods and make ultra-processed foods less available and affordable.

To quantify the prevalence and trends of stunting among children using the WHO growth standards.

Five hundred and seventy-six nationally representative surveys, including anthropometric data, were analysed. Stunting was defined as the proportion of children below −2sd from the WHO length- or height-for-age standards median. Linear mixed-effects modelling was used to estimate rates and numbers of affected children from 1990 to 2010, and projections to 2020.

One hundred and forty-eight developed and developing countries.

Boys and girls from birth to 60 months.

In 2010, it is estimated that 171 million children (167 million in developing countries) were stunted. Globally, childhood stunting decreased from 39·7 (95 % CI 38·1, 41·4) % in 1990 to 26·7 (95 % CI 24·8, 28·7) % in 2010. This trend is expected to reach 21·8 (95 % CI 19·8, 23·8) %, or 142 million, in 2020. While in Africa stunting has stagnated since 1990 at about 40 % and little improvement is anticipated, Asia showed a dramatic decrease from 49 % in 1990 to 28 % in 2010, nearly halving the number of stunted children from 190 million to 100 million. It is anticipated that this trend will continue and that in 2020 Asia and Africa will have similar numbers of stunted children (68 million and 64 million, respectively). Rates are much lower (14 % or 7 million in 2010) in Latin America.

Despite an overall decrease in developing countries, stunting remains a major public health problem in many of them. The data summarize progress achieved in the last two decades and help identify regions needing effective interventions.

To estimate the energy requirements of pregnant and lactating women consistent with optimal pregnancy outcome and adequate milk production.

Total energy cost of pregnancy was estimated using the factorial approach from pregnancy-induced increments in basal metabolic rate measured by respiratory calorimetry or from increments in total energy expenditure measured by the doubly labelled water method, plus energy deposition attributed to protein and fat accretion during pregnancy.

Database on changes in basal metabolic rate and total energy expenditure during pregnancy, and increments in protein based on measurements of total body potassium, and fat derived from multi-compartment body composition models was compiled. Energy requirements during lactation were derived from rates of milk production, energy density of human milk, and energy mobilisation from tissues.

Healthy pregnant and lactating women.

The estimated total cost of pregnancy for women with a mean gestational weight gain of 12.0 kg, was 321 or 325 MJ, distributed as 375, 1200, 1950 kJ day-1, for the first, second and third trimesters, respectively. For exclusive breastfeeding, the energy cost of lactation was 2.62 MJ day-1 based on a mean milk production of 749 g day-1, energy density of milk of 2.8 kJ g-1, and energetic efficiency of 0.80. In well-nourished women, this may be subsidised by energy mobilisation from tissues on the order of 0.72 MJ day-1, resulting in a net increment of 1.9 MJ day-1 over non-pregnant, non-lactating energy requirements.

Recommendations for energy intake of pregnant and lactating women should be updated based on recently available data.

To evaluate measurement error structure in dietary assessment instruments and to investigate its implications for nutritional studies, using urinary nitrogen excretion as a reference biomarker for protein intake.

The dietary assessment methods included different food-frequency questionnaires (FFQs) and such conventional dietary-report reference instruments as a series of 24-hour recalls, 4-day weighed food records or 7-day diaries.

Six original pilot validation studies within the European Prospective Investigation of Cancer (EPIC), and two validation studies conducted by the British Medical Research Council (MRC) within the Norfolk cohort that later joined as a collaborative component cohort of EPIC.

A sample of approximately 100 to 200 women and men, aged 35–74 years, from each of eight validation studies.

In assessing protein intake, all conventional dietary-report reference methods violated the critical requirements for a valid reference instrument for evaluating, and adjusting for, dietary measurement error in an FFQ. They displayed systematic bias that depended partly on true intake and partly was person-specific, correlated with person-specific bias in the FFQ. Using the dietary-report methods as reference instruments produced substantial overestimation (up to 230%) of the FFQ correlation with true usual intake and serious underestimation (up to 240%) of the degree of attenuation of FFQ-based log relative risks.

The impact of measurement error in dietary assessment instruments on the design, analysis and interpretation of nutritional studies may be much greater than has been previously estimated, at least regarding protein intake.

The British Nutrition Foundation was recently commissioned by the Food Standards Agency to conduct a review of the government's research programme on Antioxidants in Food. Part of this work involved an independent review of the scientific literature on the role of antioxidants in chronic disease prevention, which is presented in this paper.

There is consistent evidence that diets rich in fruit and vegetables and other plant foods are associated with moderately lower overall mortality rates and lower death rates from cardiovascular disease and some types of cancer. The ‘antioxidant hypothesis’ proposes that vitamin C, vitamin E, carotenoids and other antioxidant nutrients afford protection against chronic diseases by decreasing oxidative damage.

Although scientific rationale and observational studies have been convincing, randomised primary and secondary intervention trials have failed to show any consistent benefit from the use of antioxidant supplements on cardiovascular disease or cancer risk, with some trials even suggesting possible harm in certain subgroups. These trials have usually involved the administration of single antioxidant nutrients given at relatively high doses. The results of trials investigating the effect of a balanced combination of antioxidants at levels achievable by diet are awaited.

The suggestion that antioxidant supplements can prevent chronic diseases has not been proved or consistently supported by the findings of published intervention trials. Further evidence regarding the efficacy, safety and appropriate dosage of antioxidants in relation to chronic disease is needed. The most prudent public health advice remains to increase the consumption of plant foods, as such dietary patterns are associated with reduced risk of chronic disease.

To describe methods and dietary habits of a large population cohort.

Prospective assessment of diet using diet diaries and food-frequency questionnaires, and biomarkers of diet in 24-h urine collections and blood samples.

Free living individuals aged 45 to 75 years living in Norfolk, UK.

Food and nutrient intake from a food-frequency questionnaire on 23 003 men and women, and from a 7-day diet diary from 2117 men and women. Nitrogen, sodium and potassium excretion was obtained from single 24-h urine samples from 300 individuals in the EPIC cohort. Plasma vitamin C was measured for 20 846 men and women.

The food-frequency questionnaire (FFQ) and the food diary were able to determine differences in foods and nutrients between the sexes and were reliable as judged by repeated administrations of each method. Plasma vitamin C was significantly higher in women than men. There were significant (P<0.001) differences in mean intake of all nutrients measured by the two different methods in women but less so in men. The questionnaire overestimated dairy products and vegetables in both men and women when compared with intakes derived from the diary, but underestimated cereal and meat intake in men. There were some consistent trends with age in food and nutrient intakes assessed by both methods, particularly in men. Correlation coefficients between dietary intake assessed from the diary and excretion of nitrogen and potassium in a single 24-h urine sample ranged from 0.36 to 0.47. Those comparing urine excretion and intake assessed from the FFQ were 0.09 to 0.26. The correlations between plasma vitamin C and dietary intake from the first FFQ, 24-h recall or diary were 0.28, 0.35 and 0.40.

EPIC Norfolk is one of the largest epidemiological studies of nutrition in the UK and the largest on which plasma vitamin C has been obtained. Methods for obtaining food and nutrient intake are described in detail. The results shown here for food and nutrient intakes can be compared with results from other population studies utilising different methods of assessing dietary intake. The utility of different methods used in different settings within the main EPIC cohort is described. The FFQ is to be used particularly in pooled analyses of risk from diet in relation to cancer incidence within the larger European EPIC study, where measurement error is more likely to be overcome by large dietary heterogeneity on an international basis. Findings in the UK, where dietary variation between individuals is smaller and hence the need to use a more accurate individual method greater, will be derived from the 7-day diary information on a nested case–control basis. 24-h recalls can be used in the event that diary information should not be forthcoming from some eventual cases. Combinations of results utilising all dietary methods and biomarkers may also be possible.

To examine a possible problem of overreporting and to describe the degree of error with the International Physical Activity Questionnaire (IPAQ) short telephone protocol.

Cross-sectional study, using two different physical activity (PA) self-report protocols.

Telephone interviews about PA in Belgium.

Fifty adults who had previously been interviewed with IPAQ in a national survey.

Seventy-five per cent reported less PA with the modified procedure than with the IPAQ. Twenty-three of the 50 individuals were found to have reported some amounts of PA with the IPAQ (either walking, or vigorous or moderate PA) when they should have reported none. In total, based on their revised reports of PA, 50% fewer persons met PA recommendations than was the case with IPAQ. The overreporting could not be related to types of error-prone individuals.

Overreporting of PA in population samples is a serious problem that could be reduced by implementing procedure changes without changing the IPAQ items themselves.

To describe the development of the Oxford WebQ, a web-based 24 h dietary assessment tool developed for repeated administration in large prospective studies; and to report the preliminary assessment of its performance for estimating nutrient intakes.

We developed the Oxford WebQ by repeated testing until it was sufficiently comprehensive and easy to use. For the latest version, we compared nutrient intakes from volunteers who completed both the Oxford WebQ and an interviewer-administered 24 h dietary recall on the same day.

Oxford, UK.

A total of 116 men and women.

The WebQ took a median of 12·5 (interquartile range: 10·8–16·3) min to self-complete and nutrient intakes were estimated automatically. By contrast, the interviewer-administered 24 h dietary recall took 30 min to complete and 30 min to code. Compared with the 24 h dietary recall, the mean Spearman's correlation for the 21 nutrients obtained from the WebQ was 0·6, with the majority between 0·5 and 0·9. The mean differences in intake were less than ±10 % for all nutrients except for carotene and vitamins B12 and D. On rare occasions a food item was reported in only one assessment method, but this was not more frequent or systematically different between the methods.

Compared with an interviewer-based 24 h dietary recall, the WebQ captures similar food items and estimates similar nutrient intakes for a single day's dietary intake. The WebQ is self-administered and nutrients are estimated automatically, providing a low-cost method for measuring dietary intake in large-scale studies.

To examine the validity of the short, last 7-day, self-administered form of the International Physical Activity Questionnaire (IPAQ).

All subjects wore an accelerometer for seven consecutive days and completed the IPAQ questionnaire on the eighth day. Criterion validity was assessed by linear regression analysis and by modified Bland–Altman analysis. Specificity and sensitivity were calculated for classifying respondents according to the physical activity guidelines of the American College of Sports Medicine/Centers for Disease Control and Prevention.

Workplaces in Uppsala, Sweden.

One hundred and eighty-five (87 males) participants, aged 20 to 69 years.

Total self-reported physical activity (PA) (MET-min day−1) was significantly correlated with average intensity of activity (counts min−1) from accelerometry (r=0.34, P<0.001). Gender, age, education and body mass index did not affect this relationship. Further, subcomponents of self-reported PA (time spent sitting, time in PA, time in moderate and vigorous activity (MVPA)) were significantly correlated with objectively measured PA (P<0.05). Self-reported time in PA was significantly different from time measured by accelerometry (mean difference: −25.9 min day−1; 95% limits of agreement: −172 to 120 min day−1; P<0.001). IPAQ identified 77% (specificity) of those who met the current PA guidelines of accumulating more than 30 min day−1 in MVPA as determined by accelerometry, whereas only 45% (sensitivity) of those not meeting the guidelines were classified correctly.

Our results indicate that the short, last 7-days version of the IPAQ has acceptable criterion validity for use in Swedish adults. However, the IPAQ instrument significantly overestimated self-reported time spent in PA. The specificity to correctly classify people achieving current PA guidelines was acceptable, whereas the sensitivity was low.

Through a literature review, we investigated the geographic information systems (GIS) methods used to define the food environment and the types of spatial measurements they generate.

Review study.

Searches were conducted in health science databases, including Medline/Pubmed, PsycINFO, Francis and GeoBase. We included studies using GIS-based measures of the food environment published up to 1 June 2008.

Twenty-nine papers were included. Two different spatial approaches were identified. The density approach quantifies the availability of food outlets using the buffer method, kernel density estimation or spatial clustering. The proximity approach assesses the distance to food outlets by measuring distances or travel times. GIS network analysis tools enable the modelling of travel time between referent addresses (home) and food outlets for a given transportation network and mode, and the assumption of travel routing behaviours. Numerous studies combined both approaches to compare food outlet spatial accessibility between different types of neighbourhoods or to investigate relationships between characteristics of the food environment and individual food behaviour.

GIS methods provide new approaches for assessing the food environment by modelling spatial accessibility to food outlets. On the basis of the available literature, it appears that only some GIS methods have been used, while other GIS methods combining availability and proximity, such as spatial interaction models, have not yet been applied to this field. Future research would also benefit from a combination of GIS methods with survey approaches to describe both spatial and social food outlet accessibility as important determinants of individual food behaviours.

To investigate consumption of ultra-processed products in Canada and to assess their association with dietary quality.

Application of a classification of foodstuffs based on the nature, extent and purpose of food processing to data from a national household food budget survey. Foods are classified as unprocessed/minimally processed foods (Group 1), processed culinary ingredients (Group 2) or ultra-processed products (Group 3).

All provinces and territories of Canada, 2001.

Households (n 5643).

Food purchases provided a mean per capita energy availability of 8908 (se 81) kJ/d (2129 (se 19) kcal/d). Over 61·7 % of dietary energy came from ultra-processed products (Group 3), 25·6 % from Group 1 and 12·7 % from Group 2. The overall diet exceeded WHO upper limits for fat, saturated fat, free sugars and Na density, with less fibre than recommended. It also exceeded the average energy density target of the World Cancer Research Fund/American Institute for Cancer Research. Group 3 products taken together are more fatty, sugary, salty and energy-dense than a combination of Group 1 and Group 2 items. Only the 20 % lowest consumers of ultra-processed products (who consumed 33·2 % of energy from these products) were anywhere near reaching all nutrient goals for the prevention of obesity and chronic non-communicable diseases.

The 2001 Canadian diet was dominated by ultra-processed products. As a group, these products are unhealthy. The present analysis indicates that any substantial improvement of the diet would involve much lower consumption of ultra-processed products and much higher consumption of meals and dishes prepared from minimally processed foods and processed culinary ingredients.

To evaluate the reproducibility of a semi-quantitative FFQ used in the Seguimiento Universidad de Navarra (SUN) project.

The data that were analysed were collected from an FFQ answered twice by a 326-participant subsample of the SUN project (115 men, 35·3 %; 211 women, 64·7 %), with either less than 1 year or more than 1 year between responses. The questionnaire included 136 items. Pearson correlation coefficients (r) were calculated to evaluate the magnitude of the association between both measures after energy adjustment and correcting for within-person variability. We also evaluated misclassification by quintiles distribution.

The highest corrected correlations among participants who answered before 1 year were found for PUFA (r = 0·99). Among participants who answered after 1 year between both questionnaires, olive oil had the highest corrected correlation (r = 0·99). The highest percentage of gross misclassification, lowest quintile in FFQ1 and highest quintile in FFQ2 or highest quintile in FFQ1 and lowest quintile in FFQ2 was for cereals, fish or seafood, and n-3 fatty acids (7·6 %). Alcoholic drinks had the highest percentage of reasonable classification, same or adjacent quintile, in FFQ1 and FFQ2 (86·4 %).

Our study suggests that FFQ reproducibility is acceptable for participants who answered the same questionnaire twice less than 1 year apart. Participants who answered FFQ more than 1 year apart showed worse values on reproducibility. We consider this Spanish FFQ as an important, valid and reproducible tool in nutritional epidemiology.

This paper explores the unique nutrition transition shifts in diet and activity patterns from the period termed the receding famine pattern to the one dominated by nutrition-related non-communicable diseases (NR-NCDs). The paper examines the speed and timing of these changes; unique components, such as the issue of finding both under- and overnutrition in the same household; potential exacerbating biological relationships that contribute to differences in the rates of changes; and political issues.

The focus is on lower-and middle-income countries of Asia, Africa, the Middle East and Latin America.

These changes are occurring at great speed and at earlier stages of these countries economic and social development. There are some unique issues that relate to body composition and potential genetic factors. The significance of the high number of persons exposed to heavy insults during pregnancy and infancy (foetalorigins hypothesis) and the subsequent rapid shifts in energy imbalance remains to be understood. Countries that are still addressing major concerns of undernutrition are not ready to address these NR-NCDs.

The developing world needs to give far greater emphasis to addressing the prevention of the adverse health consequences of this shift to the nutrition transition stage of degenerative diseases.

To examine and quantify the potential dose–response relationship between red and processed meat consumption and risk of all-cause, cardiovascular and cancer mortality.

We searched MEDLINE, Embase, ISI Web of Knowledge, CINHAL, Scopus, the Cochrane library and reference lists of retrieved articles up to 30 November 2014 without language restrictions. We retrieved prospective cohort studies that reported risk estimates for all-cause, cardiovascular and cancer mortality by red and/or processed meat intake levels. The dose–response relationships were estimated using data from red and processed meat intake categories in each study. Random-effects models were used to calculate pooled relative risks and 95 % confidence intervals and to incorporate between-study variations.

Nine articles with seventeen prospective cohorts were eligible in this meta-analysis, including a total of 150 328 deaths. There was evidence of a non-linear association between processed meat consumption and risk of all-cause and cardiovascular mortality, but not for cancer mortality. For processed meat, the pooled relative risk with an increase of one serving per day was 1·15 (95 % CI 1·11, 1·19) for all-cause mortality (five studies; P<0·001 for linear trend), 1·15 (95 % CI 1·07, 1·24) for cardiovascular mortality (six studies; P<0·001) and 1·08 (95 % CI 1·06, 1·11) for cancer mortality (five studies; P<0·001). Similar associations were found with total meat intake. The association between unprocessed red meat consumption and mortality risk was found in the US populations, but not in European or Asian populations.

The present meta-analysis indicates that higher consumption of total red meat and processed meat is associated with an increased risk of total, cardiovascular and cancer mortality.

To compare different statistical methods for assessing the relative validity of a self-administered, 150-item, semi-quantitative food-frequency questionnaire (FFQ) with 4-day weighed diet records (WR).

Subjects completed the Scottish Collaborative Group FFQ and carried out a 4-day WR. Relative agreement between the FFQ and WR for energy-adjusted nutrient intakes was assessed by Pearson and Spearman rank correlation coefficients, the percentages of subjects classified into the same and opposite thirds of intake, and Cohen's weighted kappa.

Forty-one men, mean age 36 (range 21-56) years, and 40 women, mean age 33 (range 19-58) years, recruited from different locations in Aberdeen, Scotland.

Spearman correlation coefficients tended to be lower than Pearson correlation coefficients, and were above 0.5 for 10 of the 27 nutrients in men and 17 of the 27 nutrients in women. For nutrients with Spearman correlation coefficients above 0.5, the percentage of subjects correctly classified into thirds ranged from 39 to 78%, and weighted kappa values ranged from 0.23 to 0.66.

Both Spearman correlation coefficients and weighted kappa values are useful in assessing the relative validity of estimates of nutrient intake by FFQs. Spearman correlation coefficients above 0.5, more than 50% of subjects correctly classified and less than 10% of subjects grossly misclassified into thirds, and weighted kappa values above 0.4 are recommended for nutrients of interest in epidemiological studies.

Previous studies on the relationship of dietary intake to the neighbourhood food environment have focused on access to supermarkets, quantified by geographic distance or store concentration measures. However, in-store food availability may also be an important determinant, particularly for urban neighbourhoods with a greater concentration of small food stores. This study synthesises both types of information – store access and in-store availability – to determine their potential relationship to fruit and vegetable consumption.

Residents in four census tracts were surveyed in 2001 about their fruit and vegetable intake. Household distances to food stores in these and surrounding tracts were obtained using geographical information system mapping techniques. In-store fruit and vegetable availability was measured by linear shelf space. Multivariate linear regression models were used to measure the association of these neighbourhood availability measures with consumption.

Four contiguous census tracts in central-city New Orleans.

A random sample of 102 households.

Greater fresh vegetable availability within 100 m of a residence was a positive predictor of vegetable intake; each additional metre of shelf space was associated with 0.35 servings per day of increased intake. Fresh fruit availability was not associated with intake, although having a small food store within this same distance was a marginal predictor of fruit consumption.

The findings suggest the possible importance of small neighbourhood food stores and their fresh produce availability in affecting fruit and vegetable intake.

Food security has been suggested to be a risk factor for depression, stress and anxiety. We therefore undertook a systematic review and meta-analysis of available publications to examine these associations further.

Relevant studies were identified by searching Web of Science, Embase, Scopus and PubMed databases up to January 2019.

OR was pooled using a random-effects model. Standard methods were used for assessment of heterogeneity and publication bias.

Data were available from nineteen studies with 372 143 individual participants from ten different countries that were pooled for the meta-analysis.

The results showed there was a positive relationship between food insecurity (FI) and risk of depression (OR = 1·40; 95 % CI: 1·30, 1·58) and stress (OR = 1·34; 95 % CI: 1·24, 1·44) but not anxiety. Subgroup analysis by age showed that subjects older than ≥65 years exhibited a higher risk of depression (OR = 1·75; 95 % CI: 1·20, 2·56) than younger participants (OR = 1·34; 95 % CI: 1·20, 1·50), as well as a greater risk of depression in men (OR = 1·42; 95 % CI: 1·17, 1·72) than women (OR = 1·30; 95 % CI: 1·16, 1·46). Finally, subgroup analysis according to geographical location illustrated that food insecure households living in North America had the highest risk of stress and anxiety.

The evidence from this meta-analysis suggests that FI has a significant effect on the likelihood of being stressed or depressed. This indicates that health care services, which alleviate FI, would also promote holistic well-being in adults.