To describe the diet of a population of pregnant Finnish women over a period of 7 years, with special attention paid to seasonal fluctuations in food consumption and nutrient intake.

A validated 181-item FFQ was applied retrospectively, after delivery, to assess the maternal diet during the 8th month of pregnancy.

Type 1 Diabetes Prediction and Prevention Nutrition Study Cohort.

The cohort comprised a total of 4880 women who had newly delivered during the years 1997–2004, with the offspring carrying increased genetic risk for type 1 diabetes mellitus.

Over the study period, the proportion of energy derived from fat decreased while the intake from protein and carbohydrate increased. The intake of vitamin D increased from food sources. Seasonal variation was observed in the mean daily consumption of vegetables, fruits and berries and cereals. Intake of dietary fibre, total fat, MUFA, vitamins A, D, E and C, folate and iron also showed seasonal fluctuation.

These results show an overall positive trend in the diet of pregnant Finnish women through the study years. However, there is still room for improvement, particularly in the types of dietary fats. Although food fortification with vitamin D since 2003 was reflected in the increased intake of vitamin D from foods, the mean intake levels still fell below the recommendations. Seasonal changes in food consumption were observed and related to corresponding fluctuations in nutrient intakes. The mean folate intake fell below the recommendation throughout the year.

To examine the association of consumption of whole grains (WG) with diet quality and nutrient intake in children and adolescents.

Secondary analysis of cross-sectional data.

The 1999–2004 National Health and Nutrition Examination Survey.

Children aged 2–5 years (n 2278) and 6–12 years (n 3868) and adolescents aged 13–18 years (n 4931). The participants were divided into four WG consumption groups: ≥0 to <0·6, ≥0·6 to <1·5, ≥1·5 to <3·0 and ≥3·0 servings/d. Nutrient intake and diet quality, using the Healthy Eating Index (HEI)-2005, were determined for each group from a single 24 h dietary recall.

The mean number of servings of WG consumed was 0·45, 0·59 and 0·63 for children/adolescents at the age of 2–5, 6–12 and 13–18 years, respectively. In all groups, HEI and intakes of energy, fibre, vitamin B6, folate, magnesium, phosphorus and iron were significantly higher in those consuming ≥3·0 servings of WG/d; intakes of protein, total fat, SFA and MUFA and cholesterol levels were lower. Intakes of PUFA (6–12 years), vitamins B1 (2–5 and 13–18 years), B2 (13–18 years), A (2–5 and 13–18 years) and E (13–18 years) were higher in those groups consuming ≥3·0 servings of WG/d; intakes of added sugars (2–5 years), vitamin C (2–5 and 6–12 years), potassium and sodium (6–12 years) were lower.

Overall consumption of WG was low. Children and adolescents who consumed the most servings of WG had better diet quality and nutrient intake.

To identify lifestyle clusters in adolescents and to characterize their association with overweight and obesity.

Cross-sectional and longitudinal data of the Kiel Obesity Prevention Study.

Schools in Kiel, Germany.

Cross-sectional data of 1894 adolescents aged 14 years and 4-year longitudinal data of a subsample of 389 children aged 10 and 14 years. Self-reported data of physical activity, modes of commuting to school, media time, nutrition, alcohol consumption and smoking were used to identify lifestyle clusters with two-step cluster analysis. Obesity indices (height, weight, waist circumference and fat mass (FM)) were measured.

Three lifestyle clusters were identified: a ‘low activity and low-risk behaviour’ cluster (cluster 1: n 740, 39·1 %); a ‘high media time and high-risk behaviour’ cluster (cluster 2: n 498, 26·3 %); and a ‘high activity and medium-risk behaviour’ cluster (cluster 3: n 656, 34·6 %). Strictly speaking, none of these clusters was considered to be markedly healthy. The prevalence of overweight and obesity tended to be lower in cluster 3 (15·9 %) than in clusters 1 (20·4 %) and 2 (20·5 %; P = 0·053). Longitudinally, 4-year changes in FM were found to be lowest in cluster 2, but the 4-year incidence rate of obesity was lowest in cluster 3.

Explicit healthy lifestyles do not exist, but an active lifestyle reduces the incidence of obesity. In adolescents, health promotion should take into account the diversity of lifestyles and address specific lifestyle clusters.

To analyse the socio-economic factors related to breakfast eating, the association between breakfast eating and overweight, and to gain a more thorough understanding of the relationship between these two elements in a population-based cohort of 4.5-year-old children. We hypothesised that a relationship could be observed between breakfast skipping and overweight independently of socio-economic factors such as ethnicity, maternal education, single parenting and family income.

A population-based study whereby standardised nutritional interviews were conducted with each child's parent. The children's height and weight were taken by a trained nutritionist and parents were asked about their child's breakfast eating.

The analyses were performed using data from the Québec Longitudinal Study of Child Development (1998–2002), conducted by Santé Québec (Canada).

Subjects were 1549 children between the ages of 44 and 56 months, with a mean age of 49 months.

Almost a tenth (9.8%) of the children did not eat breakfast every day. A greater proportion of children with immigrant mothers (19.4% vs. 8.3% from non-immigrant mothers), with mothers with no high school diploma (17.5% vs. <10% for higher educated mothers) and from low-income families (15% for income of $39 999 or less vs. 5–10% for better income) did not eat breakfast every day. Not eating breakfast every day nearly doubled the odds (odds ratio = 1.9, 95% confidence interval 1.2–3.2) of being overweight at 4.5 years when mother's immigrant status, household income and number of overweight/obese parents were part of the analysis.

Although our results require replication before public policy changes can be advocated, encouraging breakfast consumption among pre-school children is probably warranted and targeting families of low socio-economic status could potentially help in the prevention of childhood obesity.

Excessive consumption of discretionary foods/beverages in the Australian population has been identified, increasing the risk of obesity and chronic disease. The present study aimed to examine the associations between demographic, anthropometric and dietary factors and the consumption of discretionary foods, discretionary beverages and discretionary foods/beverages combined.

Discretionary food/beverage consumption reported in two 24 h recalls was analysed, stratified by gender, age, socio-economic status, country of birth, BMI, waist circumference, and fruit and vegetable intakes.

2011–12 National Nutrition and Physical Activity Survey.

Australian adults (n 7873) aged 19 years or above.

Mean discretionary food and beverage consumption was 631 g (28 % by weight from foods; 72 % from beverages), providing 2721 kJ of energy intake (72 % from foods; 28 % from beverages). Total discretionary food/beverage consumption was higher in younger age groups (P<0·001), those in lower socio-economic categories (P<0·001), those born in Australia (P<0·001), those with higher BMI (P<0·001) and those with lower fruit (P<0·001) or vegetable intake (P<0·001). Discretionary beverage consumption (β=6·6, P<0·001) was more strongly associated with BMI than discretionary food consumption (β=0·5, P=0·01).

Total discretionary food/beverage consumption as well as discretionary foods alone and discretionary beverages alone were associated with BMI in Australian adults. In addition, high intakes were associated with younger age, lower socio-economic status, and lower consumption of fruit and vegetables.

A high intake of sugar-sweetened beverages (SSB) has been linked to weight gain, obesity and type 2 diabetes; however, the influence on CVD risk remains unclear. Therefore, our objective was to summarize current evidence for an association between SSB consumption and cardiovascular risk factors and events.

The article search was performed in August 2013. Two independent researchers performed the article search and selection, data extraction and quality assessment. Eligible studies reported the intake of SSB and one of the following outcomes: change in blood pressure, blood lipid or blood sugar, or CVD events such as stroke or myocardial infarction. Only intervention and longitudinal studies were included.

Only studies in adults (aged 18+ years old) were considered.

Two of four prospective studies found clear direct associations between SSB consumption and CHD, while two of three studies, including both men and women, found direct associations between SSB consumption and stroke; however, the association was significant among women only. All included studies examining vascular risk factors found direct associations between SSB consumption and change in blood pressure, blood lipid or blood sugar.

The reviewed studies generally showed that SSB intake was related to vascular risk factors, whereas associations with vascular events were less consistent. Due to a limited number of published papers, especially regarding vascular events, the strength of the evidence is still limited and hence more studies are needed before firm conclusions can be made.

As numerous factors in the home environment have been related to children’s fruit and vegetable (F&V) consumption as a component of a healthy diet, the purpose of the present systematic review was to examine these factors specifically for children aged 6–12 years.

Relevant observational studies published in English between January 2007 and December 2015 were obtained through electronic database searches. Studies were included if the researchers reported on a potentially modifiable measure of the home physical, political and sociocultural environment related to child F&V consumption.

Of the thirty-three articles reviewed, overall methodological quality was poor with twenty studies rated as weak, mainly due to cross-sectional design (majority of studies), selection bias, convenience sampling and voluntary participation. Half of the studies had strong–moderate ratings for using valid and/or reliable tools while for the other half, psychometric properties were either not reported or weak. The most consistent evidence for children’s combined F&V consumption was found for availability and accessibility of F&V, parental role modelling of F&V and maternal intake of F&V.

A vast array of home environment components and their influence on children’s consumption of fruits and/or vegetables have been studied in recent years. Specific components of the home environment may have more influence than others, but more compelling evidence is needed to draw strong conclusions. Recommendations are made for future studies to be based upon conceptual/theoretical models to provide consistency in defining the home environment and investigation of potential moderators, such as personal or contextual factors.

To review the available literature on accountability frameworks to construct a framework that is relevant to voluntary partnerships between government and food industry stakeholders.

Between November 2012 and May 2013, a desk review of ten databases was conducted to identify principles, conceptual frameworks, underlying theories, and strengths and limitations of existing accountability frameworks for institutional performance to construct a new framework relevant to promoting healthy food environments.

Food policy contexts within high-income countries to address obesity and diet-related non-communicable diseases.

Eligible resources (n 26) were reviewed and the guiding principles of fifteen interdisciplinary frameworks were used to construct a new accountability framework.

Strengths included shared principles across existing frameworks, such as trust, inclusivity, transparency and verification; government leadership and good governance; public deliberations; independent bodies recognizing compliance and performance achievements; remedial actions to improve accountability systems; and capacity to manage conflicts of interest and settle disputes. Limitations of the three-step frameworks and ‘mutual accountability’ approach were an explicit absence of an empowered authority to hold all stakeholders to account for their performance.

We propose a four-step accountability framework to guide government and food industry engagement to address unhealthy food environments as part of a broader government-led strategy to address obesity and diet-related non-communicable diseases. An independent body develops clear objectives, a governance process and performance standards for all stakeholders to address unhealthy food environments. The empowered body takes account (assessment), shares the account (communication), holds to account (enforcement) and responds to the account (improvements).

To find diets optimised on nutrition and environmental impact close to the current Dutch diet and to identify the most effective and acceptable options for mitigating environmental impact.

Linear programming was used to optimise diets of Dutch men and women aged 9–69 years, divided into ten age–gender groups. The analysis included nutrient composition, a metric for popularity and life cycle assessments of 207 food products. Greenhouse gas emissions, fossil energy use and land occupation were used to calculate a weighted score for the overall environmental impact. Optimised diets were solutions that minimised changes to the current diet while satisfying all nutritional constraints, with stepwise reductions in environmental impact.

The Netherlands.

Dutch children and adults aged 9–69 years.

Meat was always reduced. Vegetable, fruit and dairy contents remained similar, while bread, fatty fish and legumes increased. The extent of changes depended on age and gender. Beverages were not heavily reduced. Nutrients critical for the outcome were α-linoleic acid, retinol, Ca, Na, Se, dietary fibre, SFA, thiamin and Fe (women of childbearing age). Total protein, essential amino acids and carbohydrates were not critical.

Reducing meat is the most effective option for lowering the environmental impact of diets in all age–gender groups. Reducing alcoholic and non-alcoholic beverages is another option. Leaving out fish and dairy products are not. The differences in nutritional requirements related to age and gender have a significant effect on the composition of the optimised diets.

Evidence suggesting that a diet high in fruits and vegetables may be beneficial to bone health has sparked interest in the potential benefit of a vegetarian diet. However, other studies have raised a question regarding the adequacy of protein in such a diet.

The aim of the present study was to take a whole foods approach in examining the effects of foods high in protein on the risk of wrist fracture (WF) in a cohort with a significant proportion consuming a meat-free diet.

A cohort study of women who completed two lifestyle surveys 25 years apart.

One thousand eight hundred and sixty-five peri- and postmenopausal women at the time of the first survey.

There was a significant interaction between meat consumption and foods high in vegetable protein. Among vegetarians, those who consumed the least vegetable protein intake were at highest risk for fracture. However, increasing levels of plant-based high-protein foods decreased WF risk, with a 68% reduction in risk (hazard ratio (HR) = 0.32, 95% confidence interval (CI) 0.13–0.79) in the highest intake group. Among those with lowest vegetable protein consumption, increasing meat intake decreased the risk of WF, with the highest consumption decreasing risk by 80% (HR = 0.20, 95% CI 0.06–0.66).

The finding that higher consumption frequencies of foods rich in protein were associated with reduced WF supports the importance of adequate protein for bone health. The similarity in risk reduction by vegetable protein foods compared with meat intake suggests that adequate protein intake is attainable in a vegetarian diet.

To understand stakeholders’ perspectives on food waste in a universal free School Breakfast Program implementing a Breakfast in the Classroom model.

Semi-structured focus groups and interviews were conducted with school district stakeholders. Inductive methods were used to code resulting transcripts, from which themes were identified. The analysis provides a thematic analysis of stakeholders’ perspectives on food waste in the School Breakfast Program.

Ten elementary schools in a large urban school district implementing a universal free Breakfast in the Classroom model of the US national School Breakfast Program.

Elementary-school students (n 85), parents (n 86), teachers (n 44), cafeteria managers (n 10) and school principals (n 10).

Stakeholders perceived food waste as a problem and expressed concern regarding the amount of food wasted. Explanations reported for food waste included food-related (palatability and accessibility), child-related (taste preferences and satiation) and programme-related (duration, food service policies, and coordination) factors. Milk and fruit were perceived as foods particularly susceptible to waste. Several food waste mitigation strategies were identified by participants: saving food for later, actively encouraging children’s consumption, assisting children with foods during mealtime, increasing staff support, serving smaller portion sizes, and composting and donating uneaten food.

Stakeholders recognized food waste as a problem, reported myriad contributing factors, and have considered and employed multiple and diverse mitigation strategies. Changes to the menu and/or implementation logistics, as well as efforts to use leftover food productively, may be possible strategies of reducing waste and improving the School Breakfast Program’s economic, environmental and nutritional impact.

Literature on food environments has expanded rapidly, yet most research focuses on stores and community characteristics without integrating customer-level data. The present study combines customer shopping behaviour with store food inventory data.

Face-to-face interviews were conducted with customers shopping in corner stores to measure food shopping behaviour, household food security and demographics. Store inventories were conducted to measure availability of healthy food in corner stores. Multilevel logistic regression models estimated the probability of customers purchasing a food item given the availability of that item in the store.

Nineteen corner stores in Hartford, CT, USA, average size 669 ft2 (62·15 m2).

Sample of 372 customers.

The majority of customers were Black or Hispanic (54 % and 40 %, respectively) and 61 % experienced food insecurity. For each additional type of fruits or vegetables available in the store, the estimated odds of a customer purchasing fruits increased by 12 % (P = 0·03) and the odds for purchasing vegetables increased by 15 % (P = 0·01). Customers receiving the Supplemental Nutrition Assistance Program (SNAP) were 1·7 times as likely to purchase fruit as those not receiving SNAP (P = 0·04). Greater availability of reduced-fat milk was not associated with increased likelihood of customers purchasing reduced-fat milk.

There is a positive association between fruit and vegetable variety and the probability that a customer purchases fruits and vegetables. Increasing the selection of produce in corner stores may increase their consumption by food-insecure and low-income residents at risk for health disparities. These findings have implications for future store interventions and food policies.

The main objective of this paper is to describe the approach and specific findings of the European Physical Activity Surveillance System (EUPASS) research project. In particular, the analysis presented aims at testing the reliability, comparability and predictive power of different sets of physical activity (PA) indicators.

First, a panel study based on computer-aided telephone interview (CATI) was designed to report PA data of a representative, selected group of about 100 persons per country at three points in time. Second, a CATI time series survey was carried out with the goal of realising about 100 interviews per month over six consecutive months.

The project was carried out in eight European countries to support the development of the European Union's (EU) Health Monitoring Programme.

Random population samples (subjects aged 18 years and older) were drawn from each participating country.

While many PA indicators used in EU countries to date as well as the psychosocial and environmental measures tested in the present study had acceptable to good reliability coefficients, the test–retest reliability scores of the International Physical Activity Questionnaire (IPAQ) version tested (the short (last 7 days) telephone interview IPAQ; IPAQ-S7T) were rather low. The comparability between extant national PA items and the IPAQ-S7T was low for all countries. The strongest predictors of perceived health were the psychosocial and environmental PA indicators.

According to the results of the present study, more research is needed to further investigate and improve the quality of the IPAQ. In addition, the specific predictive power of the tested psychosocial and environmental PA indicators on perceived health should be of particular interest for designing health surveillance activities in the future.

The purpose of the study was to assess the validity of a 52-item semiquantitative food-frequency questionnaire (FFQ) by comparing it with multiple 24-hour dietary recalls.

Three non-consecutive 24-hour dietary recalls and one FFQ were administered over a one-month period.

Four communities of El Progreso, Guatemala.

Seventy-three individuals aged 22–55 years.

Intakes of energy and other nutrients as measured by the FFQ were higher than intakes measured by 24-hour recalls. Energy was overestimated by 361 kcal, and nutrient overestimates were particularly great for vitamin C and iron. Pearson correlation coefficients for crude energy and nutrients intakes ranged from 0.64 for energy to 0.12 for vitamin C. Exact agreement for both methods (measured by the concordance correlation coefficient) ranged from 0.59 (fat) to 0.06 (vitamin C). Pearson correlation coefficients for energy-adjusted nutrients ranged from 0.59 (carbohydrates) to 0.11 (thiamin). Pearson correlation coefficients for the proportion of total energy derived from specific foods ranged from 0.59 (tortillas) to 0.01 (sugared beverages). Cross-classification of quartiles of crude nutrient intakes for both methods indicated that <11% were grossly misclassified; after adjusting for energy intake, <13% were grossly misclassified.

This FFQ provides good measures of energy and macronutrient intakes and a reasonably reliable measure of micronutrient intake, indicating its suitability for comparing exposures within a study population in reference to heath-related endpoints. Our results highlight the need to adapt any FFQ to specific cultural needs – in this case, the Guatemalan ‘core foods’ (tortilla, bread and beans), for which inter-individual variability in intake is high.

There is increasing evidence that the school food environment contributes to childhood obesity and health in various locations. We investigated the influence of fast-food stores and convenience food stores (FS and CS, respectively) on growth and body composition in a range of residential densities for North-east Asian food culture.

Anthropometrics and birth weight of schoolchildren were obtained. Geocoded mapping of schools and food outlets was conducted. Multivariable linear regression models, adjusted for father's ethnicity and education, as well as for household income, pocket money, birth weight, physical activity, television watching, food quality and region, were used to predict body composition from school food environments.

Elementary schools and school neighbourhoods in 359 townships/districts of Taiwan.

A total of 2283 schoolchildren aged 6–13 years from the Elementary School Children's Nutrition and Health Survey in Taiwan conducted in 2001–2002.

Remote and socially disadvantaged locations had the highest prevalence of lower weight, BMI, waist circumference and triceps skinfold thickness. Food store densities, FS and CS, were highest in urban Taiwan and lowest in remote Taiwan. In the fully adjusted models, FS densities predicted weight and BMI in boys; there was a similar association for waist circumference, except when adjusted for region. FS densities also predicted height for girls. Except for weight and BMI in boys, CS did not have effects evident with FS for either boys or girls.

A high FS density, more than CS density, in Taiwan increased the risk of general (BMI) and abdominal (waist circumference) obesity in boys and stature in girls. These findings have long-term implications for chronic disease in adulthood.

To review and update the current knowledge on the potential impact of strawberry on human health, with particular attention on compounds and indirect mechanisms of action not exhaustively considered.

Personal perspectives and recent data.

International.

Our research group was among the few groups that have recently investigated the folate content in fresh, stored and processed strawberries, and the data look very promising. As well, some in vivo evidence of the impact of strawberry intake on the folate status in humans have already been reported, but a new increasing interest on this field is strongly hoped. Furthermore, the hypouricaemic effects previously ascribed to cherry consumption need to be evaluated in respect to strawberry intake. At the moment, inconsistent results come from the few investigations designed at this proposal. In our studies, a great interindividual variability was observed on plasma urate levels in response to strawberry intake, suggesting a putative effect.

The mechanisms responsible for the potential health-promoting effects of strawberry may not be necessarily searched in the activity of phytochemicals. Particularly, a greater interest should be addressed to show whether a prolonged strawberry consumption may effectively improve the folate status and reduce the incidence of folate-related pathological conditions. Furthermore, the hypouricaemic effects of cherries need to be evaluated also in respect to strawberry intake, and the mechanisms of actions and anti-gout potentialities need to be studied in detail.

Future investigations involving human trials should be aimed at following these underestimated scientific tracks.

To examine the associations of vegetable and/or fruit consumption with metabolic syndrome (MetS).

Meta-analysis of observational studies.

The electronic databases of PubMed, Web of Science and EMBASE were searched up to September 2017 for observational studies concerning the associations of vegetable and/or fruit consumption with MetS. The pooled relative risk (RR) of MetS for the highest v. the lowest category of vegetable and/or fruit consumption, as well as their corresponding 95 % CI, were calculated.

A total of twenty-six observational studies (twenty cross-sectional, one case–control and five cohort studies) were included in the meta-analysis. Specifically, sixteen studies were related to vegetable consumption and the overall multivariable-adjusted RR evidenced a negative association between vegetable consumption and MetS (RR=0·89, 95 % CI 0·85, 0·93; P<0·001). For fruit consumption, sixteen studies were included and the overall multivariable-adjusted RR demonstrated that fruit consumption was inversely associated with MetS (RR=0·81, 95 % CI 0·75, 0·88; P<0·001). For vegetable and fruit consumption, eight studies were included; the overall multivariable-adjusted RR showed that vegetable and fruit consumption was also negatively associated with MetS (RR=0·75, 95 % CI 0·63, 0·90; P=0·002).

The existing evidence suggests that vegetable and/or fruit consumption is negatively associated with MetS. More well-designed prospective cohort studies are needed to elaborate the concerned issues further.

To analyse changes in the distribution of BMI in Australia between 1980 and 2000.

Data were from the 1980, 1983 and 1989 National Heart Foundation Risk Factor Prevalence Study, the 1995 National Nutrition Survey and the 1999/2000 Australian Diabetes, Obesity and Lifestyle Study. Survey participants were aged 25–64 years and resident in Australian capital cities. BMI was calculated as weight divided by height squared (kg/m2), where weight and height were measured using standard procedures.

Mean BMI was higher in 2000 than 1980 in all sex and age groups. The age-adjusted increase was 1·4 kg/m2 in men and 2·1 kg/m2 in women. The BMI distribution shifted rightwards for all sex and age groups and became increasingly right-skewed. The change between 1980 and 2000 ranged from a decrease of 0·04 kg/m2 at the lower end of the distribution for men aged 25–34 years to an increase of 7·4 kg/m2 at the higher end for women aged 55–64 years. While the prevalence of obesity (BMI ≥ 30 kg/m2) doubled, the prevalence of obesity class III (BMI ≥ 40 kg/m2) increased fourfold.

BMI in urban Australian adults has increased and its distribution has become increasingly right-skewed. This has resulted in a large increase in the prevalence of obesity, particularly the more severe levels of obesity. It will be important to monitor changes in the different classes of obesity and the extent to which obesity interventions both shift the BMI distribution leftwards and decrease the skew of the distribution.

To test the viability of the Mediterranean diet as an affordable low-energy-density model for dietary change.

Foods characteristic of the Mediterranean diet were identified using previously published criteria. For these foods, energy density (kJ/100 g) and nutrient density in relation to both energy ($/MJ) and nutrient cost were examined.

Some nutrient-rich low-energy-density foods associated with the Mediterranean diet were expensive, however, others that also fit within the Mediterranean dietary pattern were not.

The Mediterranean diet provides a socially acceptable framework for the inclusion of grains, pulses, legumes, nuts, vegetables and both fresh and dried fruit into a nutrient-rich everyday diet. The precise balance between good nutrition, affordability and acceptable social norms is an area that deserves further study. The new Mediterranean diet can be a valuable tool in helping to stem the global obesity epidemic.