To develop a concise, simple tool for use by non-specialists to assess diet in children aged 3–7 years attending primary schools.

A 24-hour food tick list covering all aspects of the diet and with a focus on fruit and vegetable consumption was developed. This was compared against a 24-hour semi-weighed food diary obtained for the same day as the tick list.

Six primary schools with a range of socio-economic and ethnic backgrounds from a large city in the north of England (Leeds).

One hundred and eighty children returned completed packs of information; a response rate of 77% of those who were willing to take part, 48% of those approached.

On average, 2.4 items of fruit including juice (2.1 items as 5-a-day count) were eaten and 1.6 items of vegetables (excluding potato). Twenty-seven per cent and 36% of boys and 23% and 24% of girls reported not eating any fruit or vegetables, respectively, on the recording day. Correlations comparing the diary and tick list were high for both foods (range r = 0.44 to 0.89) and nutrients (range r = 0.41 to 0.68). The level of misclassification was much less than would be expected by chance. Parent and teacher evaluation of the tick list was very positive. Parents felt the tick list was easy and quick to complete.

The Child and Diet Evaluation Tool (CADET) tick list has been used successfully for rapid collection of food and nutrient information from children aged 3–7 years from diverse social and ethnic backgrounds. The tool has performed better than many food-frequency questionnaires in comparison to a food diary.

The present study examines the impact of Health Bucks, a farmers’ market incentive programme, on awareness of and access to farmers’ markets, and fruit and vegetable purchase and consumption in low-income New York City neighbourhoods.

The evaluation used two primary data collection methods: (i) an on-site point-of-purchase survey of farmers’ market shoppers; and (ii) a random-digit-dial telephone survey of residents in neighbourhoods where the programme operates. Additionally, we conducted a quasi-experimental analysis examining differential time trends in consumption before and after programme introduction using secondary Community Health Survey (CHS) data.

New York City farmers’ markets and communities.

Farmers’ market shoppers (n 2287) completing point-of-purchase surveys in a representative sample of New York City farmers’ markets in 2010; residents (n 1025) completing random-digit-dial telephone survey interviews in 2010; and respondents (n 35 606) completing CHS interviews in 2002, 2004, 2008 and 2009.

Greater Health Bucks exposure was associated with: (i) greater awareness of farmers’ markets; (ii) increased frequency and amount of farmers’ market purchases; and (iii) greater likelihood of a self-reported year-over-year increase in fruit and vegetable consumption. However, our CHS analysis did not detect impacts on consumption.

While our study provides promising evidence that use of farmers’ market incentives is associated with increased awareness and use of farmers’ markets, additional research is needed to better understand impacts on fruit and vegetable consumption.

The purpose of this study was to measure the reported use of nutrition information on food labels by a population of university students and to determine if label users differed from non-users in terms of gender and specific beliefs related to label information and diet–disease relationships, specifically fat and heart disease and fibre and cancer.

A single-stage cluster sampling technique was used. Data was obtained using a self-administered, validated questionnaire.

The present investigation took place at the University of Saskatchewan, Canada in the autumn of 1997.

A total of 553 students in randomly selected classes in the College of Arts and Science took part in the survey (92% response rate). The sample consisted of roughly equal numbers of males and females, most between the ages of 18 and 24.

There were approximately equal numbers of label users and non-users among males, while label users outnumbered non-users by almost four to one among females. The importance of nutrition information on food labels was the only belief that differed significantly between label users and non-users for both sexes. For females, no other beliefs distinguished label users from non-users. However, for males, significant differences were found between label users and non-users on the beliefs that nutrition information is truthful and that a relationship between fibre and cancer exists.

Females appear to use food labels more often than do males. The only consistently observed difference between label users and non-users (male and female) was that users believed in the importance of nutrition information on food labels while non-users did not.

To describe nutrient intakes and prevalence of overweight and obesity in a nationally representative sample of Kuwaitis and to compare intakes with reference values.

Cross-sectional, multistage stratified, cluster sample.

National nutrition survey covering all geographical areas of the country.

Kuwaitis (n 1704) between 3 and 86 years of age.

Obesity was more prevalent among women than men (50 % and 70 % for females aged 19–50 years and ≥51 years, respectively, v. 29 % and 42 % for their male counterparts). Boys were more obese than girls, with the highest obesity rate among those aged 9–13 years (37 % and 24 % of males and females, respectively). Energy intake was higher than the estimated energy requirements for almost half of Kuwaiti children and one-third of adults. The Estimated Average Requirement was exceeded by 78–100 % of the recommendation for protein and carbohydrates. More than two-thirds of males aged ≥4 years exceeded the Tolerable Upper Intake Level for Na. Conversely, less than 20 % of Kuwaitis, regardless of age, consumed 100 % or more of the Estimated Average Requirement for vitamin D, vitamin E, Ca, n-3 and n-6 fatty acids. Less than 20 % of children met the recommended level for fibre.

Nutrition transition among Kuwaitis was demonstrated by the increased prevalence of obesity and overweight, increased intakes of energy and macronutrients and decreased intakes of fibre and micronutrients. Interventions to increase awareness about healthy foods combined with modifications in subsidy policies are clearly warranted to increase consumption of low-energy, nutrient-dense foods.

To identify the factors associated with childhood undernutrition.

Cross-sectional survey.

Hlabisa health district in KwaZulu/Natal, South Africa.

Eight hundred and sixty-eight children aged 3–59 months.

Questionnaire survey and anthropometric survey of 516 random house-holds with children in the health district. Multivariate analysis took into account the hierarchical relationships between the proposed risk factors. This conceptual model was built up during qualitative studies and with reference to international research in this area.

The mean Z-scores for weight-for-age and height-for-age were −0.52 (95% confidence interval (CI)−0.44 to −0.60) and −1.25 (95% CI −1.15 to −1.35), respectively. Of the children, 26.3% (95% CI 23.3–29.3%) were stunted, 12.0% (95% CI 9.8–4.2%) were underweight-for-age (UWFA) and only 1.3% were wasted. Migrant father, mother's education, literate mother, whether the house was made of traditional materials, the presence of a toilet, whether the last child was breast-fed, duration of breast-feeding and birth weight were found to be significantly related to UWFA, the latter with an odds ratio of more than eight.

While there are individual health and feeding behaviours that need to be addressed, this study has also uncovered the maternal and socio-economic factors which present an array of constraints in the social environment shaping the infant feeding and caring practices employed by women. For the full potential of nutrition promotion activities to be realised, there is a need to address some of these ‘deeper’ constraints.

Overweight has become a public health problem in most developing countries. Evidence suggests that adolescence is a critical period in determining adulthood obesity and its complications. The present study was carried out to assess the prevalence of overweight and obesity among secondary school students.

This descriptive study was conducted in Tehran city, 2000–2001. Body weight and height were measured and body mass index (BMI) values were calculated. Underweight, overweight and obesity were defined as <5th, ≥85th and ≥95th percentile, respectively, of age- and sex-specific BMI values from the National Center for Health Statistics/Centers for Disease Control and Prevention (2000).

Using a multistage sampling method, 2321 students (1068 males and 1253 females) aged 11–16 years were assessed in Tehran, the capital city of Iran.

The overall prevalences of overweight and obesity were 21.1 and 7.8%, respectively. The prevalence of overweight among girl students (i.e. 23.1%; 95% confidence interval (CI) 20.8–25.4) was significantly higher than that among boys (i.e. 18.8%; 95% CI 16.5–21.1, P = 0.01) even after adjustment for age (odds ratio 1.26, 95% CI 1.03–1.55, P = 0.02). No significant risk of obesity associated with age was found in girls or boys. In both sexes, median values of age-specific BMI in this study were statistically higher than corresponding values collected in Tehrani adolescents 10 years ago (P = 0.03). Similarly, a significant difference was seen between girl students in this study and the reference population (P = 0.03).

According to this study, overweight, especially in girls, should be considered an epidemic health problem among adolescent students in Tehran.

To estimate changes in blood pressure and the incidence of hypertension associated with consumption of ultra-processed foods (UPF) by Brazilian civil servants at a 4-year follow-up.

Longitudinal analysis of the ELSA-Brasil with non-hypertensive individuals at baseline. We applied the FFQ at the baseline and categorised energy intake by degree of processing, using the NOVA classification. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured at baseline (2008–2010) and again at first follow-up (2012–2014). Incidence of arterial hypertension was defined as SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or antihypertensive medication during the previous 2 weeks. A mixed-effect linear regression model and mixed-effect logistic regression model were used to estimate associations between UPF consumption and, respectively, changes in blood pressure and incidence of hypertension.

Brazil.

Civil servants of Brazilian public academic institutions in six cities (n 8754), aged 35–74 years at baseline (2008–2010).

UPF consumption contributed 25·2 % (sd = 9·6) of total energies consumed. After adjustment, participants with high UPF consumption presented a 23 % greater risk of developing hypertension (OR = 1·23, 95 % CI 1·06, 1·44) than those with low UPF consumption. We did not find association between UPF consumption and changes in blood pressure over time.

The higher the UPF consumption, the higher the risk of hypertension in adults. Reducing UPF consumption is thus important to promote health and prevent hypertension.

The present study aimed to evaluate the validity and reproducibility of a thirteen-item FFQ regarding identification of dietary conditions in a rural population in China.

A reproducibility study repeated the first FFQ (FFQ1) approximately 4 weeks later (FFQ2). A validity study evaluated the mean of three consecutive 24 h diet recalls as the reference measure.

Cross-sectional study.

Residents of a rural area in Henan Province, which is located in the central region of China.

A total of 295 individuals participated in the reproducibility study. In addition, 123 people agreed to participate in the validity study. Spearman’s correlation coefficients between the two FFQ ranged from 0·06 (vegetables) to 0·58 (eggs). Spearman’s correlation coefficients between the two methods of collection ranged from 0·01 for cereal to 0·49 for staple foods. The mean of the intraclass correlation coefficients of the two FFQ (FFQ1 v. FFQ2) was 0·19. Bland–Altman analysis indicated good agreement for most food groups across the range of intake for the two studies.

The study demonstrated that our FFQ design could be used as a representative tool to conduct a dietary evaluation of a rural population.

This paper examines trends in the neighbourhood food store environment (defined by the number and geographic density of food stores of each type in a neighbourhood), and in food consumption behaviour and overweight risk of 5779 men and women.

The study used data gathered by the Stanford Heart Disease Prevention Program in four cross-sectional surveys conducted from 1981 to 1990.

Four mid-sized cities in agricultural regions of California.

In total, 3154 women and 2625 men, aged 25–74 years.

From 1981 to 1990, there were large increases in the number and density of neighbourhood stores selling sweets, pizza stores, small grocery stores and fast-food restaurants. During this period, the percentage of women and men who adopted healthy food behaviours increased but so did the percentage who adopted less healthy food behaviours. The percentage who were obese increased by 28% in women and 24% in men.

Findings point to increases in neighbourhood food stores that generally offer mostly unhealthy foods, and also to the importance of examining other food pattern changes that may have a substantial impact on obesity, such as large increases in portion sizes during the 1980s.

To conduct a pilot study to determine if improving the visibility and quality of fresh produce (choice architecture) in corner stores would increase fruit/vegetable purchases by families participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Six stores were randomly assigned to choice architecture intervention or control. Store-level WIC sales data were provided by the state. Primary outcomes were WIC fruit/vegetable voucher and non-fruit/vegetable voucher sales, comparing trends from baseline (December 2012–October 2013) with the five-month intervention period (December 2013–April 2014). Secondary outcomes were differences in customer self-reported fruit/vegetable purchases between baseline and end of the intervention.

Chelsea, MA, USA, a low-income urban community.

Adult customers (n 575) completing store exit interviews.

During baseline, WIC fruit/vegetable and non-fruit/vegetable sales decreased in both intervention and control stores by $US 16/month. During the intervention period, WIC fruit/vegetable sales increased in intervention stores by $US 40/month but decreased in control stores by $US 23/month (difference in trends: $US 63/month; 95 % CI 4, 121 $US/month; P=0·036); WIC non-fruit/vegetable sales were not different (P=0·45). Comparing baseline and intervention-period exit interview responses by customers participating in WIC (n 134), intervention store customers reported increased fruit/vegetable purchases compared with control store customers (18 v. −2 %), but this did not achieve statistical significance (P=0·11).

Placement of fruits/vegetables near the front of corner stores increased purchase of produce by customers using WIC. New policies that incentivize stores to stock and prominently display good-quality produce could promote healthier food choices of low-income families.

This study examines the relationship between family–work conflicts with food habits and physical activity, and whether the relationship is dependent on family structure and work-related factors.

Cross-sectional postal surveys were carried out in 2001 and 2002 among employees of the City of Helsinki, Finland, aged 40–60 years (n = 5346, response rate 66%; for women 70% and for men 60%). Dependent variables in logistic regression analyses were nationally recommended food habits and physical activity. Independent variables were work–family conflicts and family–work conflicts. Covariates included age, marital status, number of children, occupational class, working hours, time travelling to work, and physical and mental work load.

Women reporting strong work–family conflicts were more likely to follow recommended food habits (odds ratio (OR) and 95% confidence intervals 1.49 (1.19–1.86)), but this relationship weakened when adjusting for work-related factors (OR 1.20 (0.93–1.55)). Women and men with strong family–work conflicts were less likely to report recommended food habits after adjusting for family structure and work-related factors (women OR 0.75 (0.61–0.92), men OR 0.57 (0.34–0.96)). Women and men with strong work–family conflicts were less likely to follow the recommended amount of physical activity (women OR 0.76 (0.60–0.96), men OR 0.54 (0.34–0.87)). Additionally, women with strong family–work conflicts were less likely to follow the recommended amount of physical activity (OR 0.77 (0.63–0.94)). Adjusting for family and work-related factors did not affect these associations.

Conflicts between paid work and family life are likely to constitute barriers for a physically active lifestyle and possibly also for healthy food habits. Improving the balance between work and family may provide a route for promoting health-related behaviours.

To examine the nutritional and functional status of community older adults in China, to identify the related factors and best predictors of elder nutrition.

A cross-sectional, descriptive correlation design was utilized. A convenience sample of 162 community older adults (aged ≥65 years) were administered three questionnaires, which were used to obtain demographic characteristics, nutritional status (Mini Nutritional Assessment, MNA) and functional status (Instrumental Activities of Daily Living, IADL).

The mean MNA score was 23·8 (sd 3·92), 36·4 % of elders were at risk of malnutrition and 8·0 % were malnourished; 61·7 % were functionally independent. Spearman’s correlation analysis indicated that age, marital status, education level, personal income, number of chronic medical conditions suffered and functional status had significant correlations with nutritional status. Stepwise multiple linear regression analysis identified that the best predictors were the number of chronic conditions suffered, age, functional status and marital status.

The study has suggested that nutritional health remains a problem among older adults in the Chinese community. A large proportion was on the borderline of malnutrition, and deficiency as well as excesses coexisted. Malnutrition is an increasing hazard especially for those suffering from more diseases, at a highly advanced age, functionally dependent and widowed.

To evaluate the trends of overweight and obesity prevalences in the population of Catalonia, Spain, aged 18–75 years, and the influence of socio-economic determinants on these prevalence trends.

Analysis based on data from two representative population-based cross-sectional surveys.

Data from the two Evaluations of Nutritional Status in Catalonia (ENCAT 1992–93 and ENCAT 2002–03), Spain. Weights and heights were obtained by direct measurement in standardised conditions by trained interviewers. Overweight and obesity were defined using body mass index (BMI) and waist circumference (WC), categorised according to WHO criteria.

In total, 1015 men and 1233 women from ENCAT 1992–93, and 791 men and 924 women from ENCAT 2002–03.

Mean BMI and mean WC were higher in males in 2002–03 as compared to 1992–93, while for females mean BMI was lower except for the youngest group, and mean WC was higher. In men, overall BMI overweight prevalence remained stable (from 44.1% to 43.7%), while obesity increased (from 9.9% to 16.6%); total WC overweight remained stable (from 21.7 to 23.8%), while WC obesity increased (from 13.1% to 24.4%). In women, overall BMI overweight increased (from 29.1% to 30.1%), whereas BMI obesity remained stable (from 15.0% to 15.2%); total WC overweight decreased (from 21.8% to 17.7%), while WC obesity increased (from 24.5% to 31.1%). The socio-economic and education variables had an influence on BMI and WC overweight and obesity rates mainly on females in both surveys and on the youngest men only in the 1992–93 survey.

Ten-year trends indicate that Catalan males are getting bigger overall (BMI) and around the waistline (WC), while Catalan females only have bigger waistlines (WC). BMI male obesity prevalence has overtaken that of females. WC obesity continues to be more prevalent among females than males.

Fat mass (FM) and fat-free mass (FFM) are frequently measured to define body composition phenotypes. The load–capacity model integrates the effects of both FM and FFM to improve disease-risk prediction. We aimed to derive age-, gender- and BMI-specific reference curves of load–capacity model indices in an adult population (≥18 years).

Cross-sectional study. Dual-energy X-ray absorptiometry was used to measure FM, FFM, appendicular skeletal muscle mass (ASM) and truncal fat mass (TrFM). Two metabolic load–capacity indices were calculated: ratio of FM (kg) to FFM (kg) and ratio of TrFM (kg) to ASM (kg). Age-standardised reference curves, stratified by gender and BMI (<25·0 kg/m2, 25·0–29·9 kg/m2, ≥30·0 kg/m2), were constructed using an LMS approach. Percentiles of the reference curves were 5th, 15th, 25th, 50th, 75th, 85th and 95th.

Secondary analysis of data from the 1999–2004 National Health and Nutrition Examination Survey (NHANES).

The population included 6580 females and 6656 males.

The unweighted proportions of obesity in males and females were 25·5 % and 34·7 %, respectively. The average values of both FM:FFM and TrFM:ASM were greater in female and obese subjects. Gender and BMI influenced the shape of the association of age with FM:FFM and TrFM:ASM, as a curvilinear relationship was observed in female and obese subjects. Menopause appeared to modify the steepness of the reference curves of both indices.

This is a novel risk-stratification approach integrating the effects of high adiposity and low muscle mass which may be particularly useful to identify cases of sarcopenic obesity and improve disease-risk prediction.

To investigate the prevalence and incidence of overweight and obesity, the frequency of overweight resolution and the influence of parental adiposity during middle childhood.

As part of a prospective cohort study, height and weight were measured in 1997 and 2000/2001. Children were classified as non-overweight, overweight or obese based on standard international definitions. Body mass index (BMI) was transformed into age- and gender-specific Z-scores employing the LMS method and 2000 growth chart data of the Centers for Disease Control and Prevention. Parents self-reported height and weight, and were classified as underweight, healthy weight, overweight or obese based on World Health Organization definitions.

Primary schools in Victoria, Australia.

In total, 1438 children aged 5–10 years at baseline.

The prevalence of overweight and obesity increased between baseline (15.0 and 4.3%, respectively) and follow-up (19.7 and 4.8%, respectively; P < 0.001 for increase in overweight and obesity combined). There were 140 incident cases of overweight (9.7% of the cohort) and 24 of obesity (1.7% of the cohort); only 3.8% of the cohort (19.8% of overweight/obese children) resolved to a healthy weight. The stability of child adiposity as measured by BMI category (84.8% remained in the same category) and BMI Z-score (r = 0.84; mean change = −0.05) was extremely high. Mean change in BMI Z-score decreased with age (linear trend β = 0.03, 95% confidence interval 0.01–0.05). The influence of parental adiposity largely disappeared when children's baseline BMI was adjusted for.

During middle childhood, the incidence of overweight/obesity exceeds the proportion of children resolving to non-overweight. However, for most children adiposity remains stable, and stability appears to increase with age. Prevention strategies targeting children in early childhood are required.

To describe the use of dietary supplements in a group of Danish adults and to investigate the differences between users and non-users with respect to age, gender, health and lifestyle factors.

Cross-sectional study in two Danish cities.

The Danish Investigation on Iodine Intake and Thyroid Diseases, 1997–1998.

Participants were 3707 women (selected age groups between 18 and 65 years) and 942 men (60–65 years). Participation rate was 50%. Supplement data were collected in a personal interview. Data on education, smoking, alcohol intake, physical activity, use of medication and self-perceived health were derived from a self-administered questionnaire. Multiple logistic regression was used for the statistical analysis.

Participants were asked about all kinds of supplements, ranging from products containing vitamins and minerals, to fish oils and products of herbal origin. On average 59% reported use of some kind of dietary supplement. Most common were combined multivitamin/mineral products (48%) followed by single vitamin C products (10%). Twelve per cent used three or more different supplements. Supplement use was strongly associated with age and gender, being highest among elderly women (78%). Ex-smokers were more likely to use supplements than subjects who had never smoked (odds ratio (OR) 1.36, 95% confidence interval (CI) 1.09–1.76). Supplement use was more likely among subjects who had many days of illness (OR = 1.37, 95% CI 1.12–1.66) and among users of medication (OR = 1.22, 95% CI 1.04–1.42). Subjects who perceived their health as poor were more likely to use supplements other than just a multivitamin/mineral tablet (OR = 2.2, 95% CI 1.31–3.77).

Use of dietary supplements was related to age, gender and smoking, but also to poor self-perceived health status and absence from work. This indicates that a group of people use supplements as a form of self-medication.

To undertake secondary analyses of the 1997 National Diet and Nutrition Survey of Young People aged 4–18 years in order to describe the contribution of school meals to daily food and nutrient intakes; and to compare the findings from 1997 with data collected in English primary and secondary schools in 2004–2005.

Cross-sectional analysis of 7-day weighed inventory food consumption data according to age, sex, household income, free school meals and breakfast consumption. Comparison of food consumption with the Balance of Good Health and of nutrient intake data with the Caroline Walker Trust (CWT) guidelines.

United Kingdom.

One thousand four hundred and fifty-six UK schoolchildren aged 4–18 years, 7058 English primary-school pupils and 5695 English secondary-school pupils.

Pupils' school meal choices in 1997 did not accord with the Balance of Good Health. Food choices in school were less healthy than choices outside school. School meals failed to make good the shortfalls in daily intakes of non-starch polysaccharides and zinc in primary-school pupils, and of calcium, iron, zinc, vitamin A and non-starch polysaccharides in secondary-school pupils, nor excess daily intakes of saturated fatty acids, non-milk extrinsic sugars and sodium at all ages. School meals typically failed to meet CWT guidelines. They were more likely to meet CWT guidelines when choice of foods was restricted.

School meals need substantial improvement to meet CWT guidelines for healthy eating. The introduction of food-based guidelines for school meals in England in 2001 did not improve the food choices in school meals.

In France, an excise tax on sugar-sweetened beverages was introduced on 1 January 2012. Our objective was to assess perception of this tax as well as the sociodemographic characteristics of its supporters and opponents.

Cross-sectional study within the Nutrinet-Santé cohort. A sub-sample of 1996 individuals was selected among participants in the Nutrinet-Santé cohort study. Perceptions of the sugar-sweetened beverage tax were assessed via self-administered questionnaires. The sociodemographic and dietary profiles of supporters and opponents of this tax were explored by multinomial logistic regression.

Nationally representative French sample, 2012.

Adults aged >18 years (largest sample n 1996).

Half of the study sample was generally supportive of the tax and 57·7 % perceived it as helpful in improving population health. Participants were more likely to support the tax model if the revenue it generated would be used for health-care system improvement (72·7 %) and if such taxing was associated with a corresponding decrease in the prices of other foodstuffs (71·5 %). Older participants were more likely to support the tax than were their younger counterparts (OR=2·37; 95 % CI 1·60, 3·49 for >65 years v. 26–45 years; P<0·001). Participants with lower educational levels were less likely to support the tax than were those with more formal education (OR=0·31; 95 % CI 0·19, 0·52 for low educational level v. high education level; P<0·001). In our models, sugar-sweetened beverage consumption was not associated with tax perception.

The French sugar-sweetened beverage tax appeared to be favourably perceived by the public. Sociodemographic factors modulated such perceptions and should thus be taken into consideration when drafting future public health measures.

To summarize the recent scientific evidence regarding the wellness-promoting capacity of the Mediterranean lifestyle (ML), with a special focus on physical, social and environmental wellness.

Narrative review of English-language publications in PubMed, Scopus and Embase, from 1 January 2010 to 31 October 2018.

Prospective cohort studies, interventional studies, meta-analyses and reviews of those investigating the effect of at least one component of the ML on wellness parameters.

General population.

Although an explicit definition of ML is missing, compliance with various combinations of its components improves metabolic health and protects against or ameliorates disease state. However, there is heterogeneity in the healthy behaviours that the ML-focused studies include in their design and the way these are assessed. Also, despite that features of the ML could contribute to other wellness dimensions, there are no studies exploring the effect this healthy lifestyle could confer to them.

Chronic lifestyle diseases are of multifactorial aetiology and they warrant multifaceted approaches targeting the general way of living. ML, if thoroughly evaluated, can provide a valuable tool to holistically promote health and wellness.

The role of school lunches in diet quality has not been well studied. Here, we aimed to determine the contribution of school lunches to overall nutrient intake in Japanese schoolchildren.

The study was conducted nationwide under a cross-sectional design. A non-consecutive, three-day diet record was performed on two school days and a non-school day separately. The prevalence of inadequate nutrient intake was estimated for intakes on one of the school days and the non-school day, and for daily habitual intake estimated by the best-power method. The relationship between food intake and nutrient intake adequacy was examined.

Fourteen elementary and thirteen junior high schools in Japan.

Elementary-school children (n 629) and junior high-school children (n 281).

Intakes between the school and non-school days were significantly different for ≥60 % of nutrients. Almost all inadequacies were more prevalent on the non-school day. Regarding habitual intake, a high prevalence of inadequacy was observed for fat (29·9–47·7 %), dietary fibre (18·1–76·1 %) and salt (97·0–100 %). Inadequate habitual intake of vitamins and minerals (except Na) was infrequent in elementary-school children, but was observed in junior high-school children, particularly boys.

School lunches appear to improve total diet quality, particularly intake of most vitamins and minerals in Japanese children. However, excess intakes of fat and salt and insufficient intake of dietary fibre were major problems in this population. The contribution of school lunches to improving the intakes of these three nutrients was considered insufficient.