To estimate changes in taxed and untaxed beverages by volume of beverage purchased after a sugar-sweetened beverage (SSB) tax was introduced in 2014 in Mexico.

We used household purchase data from January 2012 to December 2015. We first classified the sample into four groups based on pre-tax purchases of beverages: (i) higher purchases of taxed beverages and lower purchases of untaxed beverages (HTLU-unhealthier); (ii) higher purchases of both types of beverages (HTHU); (iii) lower purchases of taxed and untaxed beverages (LTLU); and (iv) lower purchases of taxed beverages and higher purchases of untaxed beverages (LTHU-healthier). Next, we estimated differences in purchases after the tax was implemented for each group compared with a counterfactual based on pre-tax trends using a fixed-effects model.

Areas with more than 50 000 residents in Mexico.

Households (n 6089).

The HTLU-unhealthier and HTHU groups had the largest absolute and relative reductions in taxed beverages and increased their purchases of untaxed beverages. Households with lower purchases of untaxed beverages (HTLU-unhealthier and LTLU) had the largest absolute and relative increases in untaxed beverages. We also found that among households with higher purchases of taxed beverages, the group with lowest socio-economic status had the greatest reduction in purchases of taxed beverages.

Evidence associating the SSB tax with larger reductions among high purchasers of taxed beverages prior to the tax is relevant, as higher SSB purchasers have a greater risk of obesity, diabetes and other cardiometabolic outcomes.

To investigate the association of seasonality with dietary diversity, household food security and nutritional status of pregnant women in a rural district of northern Bangladesh.

A cross-sectional study was conducted from February 2013 to February 2015. Data were collected on demographics, household food security (using the Household Food Insecurity Access Scale), dietary diversity (using the women’s dietary diversity questionnaire) and mid-upper arm circumference. Descriptive statistics were used to explore demographics, dietary diversity, household food security and nutritional status, and inferential statistics were applied to explore the role of seasonality on diversity, household food security and nutritional status.

Twelve villages of Pirganj sub-district, Rangpur District, northern Bangladesh.

Pregnant women (n 288).

Seasonality was found to be associated with dietary diversity (P=0·026) and household food security (P=0·039). Dietary diversity was significantly lower in summer (P=0·029) and spring (P=0·038). Food security deteriorated significantly in spring (P=0·006) and late autumn (P=0·009).

Seasons play a role in women’s household food security status and dietary diversity, with food security deteriorating during the lean seasons and dietary diversity deteriorating during the second ‘lesser’ lean season and the season immediately after. Interventions that aim to improve the diet of pregnant women from low-income, subsistence-farming communities need to recognise the role of seasonality on diet and food security and to incorporate initiatives to prevent seasonal declines.

To identify sociodemographic characteristics associated with frequency of consuming home-cooked meals and meals from out-of-home sources.

Cross-sectional analysis of a population-based cohort study. Frequency of consuming home-cooked meals, ready meals, takeaways and meals out were derived from a participant questionnaire. Sociodemographic characteristics regarding sex, age, ethnicity, working overtime and socio-economic status (SES; measured by household income, educational attainment, occupational status and employment status) were self-reported. Sociodemographic differences in higher v. lower meal consumption frequency were explored using logistic regression, adjusted for other key sociodemographic variables.

Cambridgeshire, UK.

Fenland Study participants (n 11 326), aged 29–64 years at baseline.

Eating home-cooked meals more frequently was associated with being female, older, of higher SES (measured by greater educational attainment and household income) and not working overtime. Being male was associated with a higher frequency of consumption for all out-of-home meal types. Consuming takeaways more frequently was associated with lower SES (measured by lower educational attainment and household income), whereas eating out more frequently was associated with higher SES (measured by greater educational attainment and household income) and working overtime.

Sociodemographic characteristics associated with frequency of eating meals from different out-of-home sources varied according to meal source. Findings may be used to target public health policies and interventions for promoting healthier diets and dietary-related health towards people consuming home-cooked meals less frequently, such as men, those with lower educational attainment and household income, and overtime workers.

To assess the association between food insecurity and depression symptom severity stratified by sex, and test for evidence of effect modification by social network characteristics.

A population-based cross-sectional study. The nine-item Household Food Insecurity Access Scale captured food insecurity. Five name generator questions elicited network ties. A sixteen-item version of the Hopkins Symptom Checklist for Depression captured depression symptom severity. Linear regression was used to estimate the association between food insecurity and depression symptom severity while adjusting for potential confounders and to test for potential network moderators.

In-home survey interviews in south-western Uganda.

All adult residents across eight rural villages; 96 % response rate (n 1669).

Severe food insecurity was associated with greater depression symptom severity (b=0·4, 95 % CI 0·3, 0·5, P<0·001 for women; b=0·3, 95 % CI 0·2, 0·4, P<0·001 for men). There was no evidence of effect modification by social network factors for women. However, for men who are highly embedded within in their village social network, and (separately) for men who have few poor contacts in their personal network, the relationship between severe food insecurity and depression symptoms was stronger than for men on the periphery of their village social network, and for men with many poor personal network contacts, respectively.

In this population-based study from rural Uganda, food insecurity was associated with mental health for both men and women. Future research is needed on networks and food insecurity-related shame in relation to depression symptoms among food-insecure men.

To look at trends in generalised (body mass index (BMI) ≥30 kg m–2) and abdominal (waist circumference (WC) >102 cm in men, >88 cm in women) obesity among adults between 1993 and 2003, and to evaluate their association with diabetes, hypertension and hypertension–diabetes co-morbidity (HDC) in England.

Analyses of nationally representative cross-sectional population surveys, the Health Survey for England (HSE).

Non-institutionalised men and women aged ≥35 years.

Interviewer-administered questionnaire (sociodemographic information, risk factors, doctor-diagnosed diabetes), measurements of height and weight to calculate BMI. WC and blood pressure measurements were taken by trained nurses.

Generalised obesity increased among men from 15.8% in 1993 to 26.3% in 2003, and among women from 19.3% to 25.8%. Abdominal obesity also increased in both sexes (men: 26.2% in 1993 to 39.0% in 2003; women: 32.4% to 47.0%). In 1994, 1998 and 2003, generalised and abdominal obesity were independently associated with risk of hypertension, diabetes and HDC. The odds of diabetes associated with generalised obesity in 1994, 1998 and 2003 were 1.62, 2.26 and 2.62, respectively, in women and 1.24, 1.82 and 2.10, respectively, in men. Similar differences were observed for hypertension and HDC. Men and women with abdominal obesity also showed a higher risk for diabetes, hypertension and HDC than those with a normal WC.

If current trends in obesity continue then the risk of related morbidities may also increase. This will impact on cardiovascular disease morbidity and mortality, with cost implications for the health service. Therefore there is an urgent need to control the epidemic of obesity.

To determine the prevalence of metabolic syndrome (MetS) and its components and to evaluate the relationship between this diagnosis and cardiovascular risk factors, demographic and socio-economic variables.

A cross-sectional study using a questionnaire including information on sociodemographic and CVD risk factors. Blood pressure, anthropometric indices, fasting glucose and lipid profile were measured. MetS was defined according to the criteria of the National Cholesterol Education Program, Adult Treatment Panel III.

The whole Tunisian territory; Transition and Health Impact in North Africa (TAHINA) project.

A total of 4654 individuals (1840 men and 2814 women), aged 35 to 74 years, who participated in the Tunisian national survey.

The overall prevalence of MetS was 30·0 %, higher in women (36·1 %) than in men (20·6 %; P < 0·001). In both genders MetS prevalence increased significantly with age (P < 0·001), but this increase was more important in women. Multiple regression analyses showed that the odds for MetS increased significantly with urban area for both men and women (P < 0·05 and P < 0·001, respectively). The multivariate models showed also that the odds for MetS increased significantly with increasing level of education and in those with a family history of CVD for men (both P < 0·05) and after the menopausal transition for women (P < 0·05).

The study highlights the MetS problem in a middle-income developing country. There is an urgent need for a comprehensive, integrated, population-based intervention programme to ameliorate the growing problem of MetS in Tunisians.

To investigate and compare feeding practices among infants of less than 7 months of age in a rural and an urban area in Tanzania.

Cross-sectional, questionnaire-based interview of mothers and focus group discussions with extension workers and community leaders.

Eleven villages in a rural district and 10 wards in an urban district in the Morogoro region, Tanzania, west of Dar es Salaam.

Probability samples of mothers with infants of less than 7 months of age (n = 320 from each area).

Exclusive breast-feeding was rarely practised in either the rural or urban areas investigated. However, the urban mothers initiated breast-feeding earlier, discarded colostrum less frequently, breast-fed exclusively for a longer period, gave breast milk as the first feed more often and delayed the introduction of solid foods for longer than their rural counterparts. The rural mothers, on the other hand, breast-fed their previous infants slightly longer than the urban mothers.

The better performance of urban mothers could be partly due to sustained breast-feeding support in hospital settings and other campaigns which may not have reached the rural areas. In both the rural and urban areas more efforts are needed to encourage exclusive breast-feeding, to avoid premature complementation and, in the case of the urban areas, to protect extended breast-feeding.

The purpose of this study was to investigate the knowledge and health beliefs regarding osteoporosis risk factors of New Zealand women aged 20–49 years.

A descriptive, web-based survey.

An opportunistic sample of 622 women aged between 20 and 49 years living in Auckland, New Zealand was recruited by email.

There was a moderate level of knowledge about osteoporosis risk factors among the women surveyed, with a mean total score for all subjects of 16.4 (standard deviation (SD) 4.0) out of a possible 26 correct responses. Mean scores for osteoporosis knowledge were statistically different by age group, with women aged 40–49 years scoring higher than those aged 30–39 years and 20–29 years (17.3 (SD 4.0), 16.4 (SD 4.1) and 15.8 (SD 3.9), respectively, P < 0.001). Overall, about a third of the women perceived that they were likely to develop osteoporosis and 22% believed the disease to be potentially crippling. Most women were aware of the benefits of exercise and optimal calcium nutrition in preventing osteoporosis. Few women perceived barriers to exercise participation and eating calcium-rich foods. Older women (40–49 years) were more motivated to take care of their health than younger women (P < 0.001). A large percentage of subjects (77%) thought that calcium-rich foods contained too much cholesterol.

Despite reporting higher than average educational attainment and health consciousness, these women demonstrated average levels of knowledge about osteoporosis risk factors. They had low feelings of susceptibility towards development of osteoporosis, but most considered it to be a serious disease.

The study aim was to assess the prevalence of Helicobacter pylori infection in Egyptian schoolchildren and its effect on growth parameters.

A cross-sectional population-based study was conducted among 286 schoolchildren (168 boys and 118 girls), with a mean age of 11.04 ± 0.19 years, to determine the prevalence of H. pylori. The presence of the bacterium was assessed using the [13C]urea breath test. Relevant personal and socio-economic data on risk factors for infection were collected. Height and weight were analysed in relation to H. pylori infection.

The overall prevalence of H. pylori infection was 72.38%. Attending school in a socially deprived area and residing in an overcrowded home were the major risk factors for infection. Differences between infected and non-infected children were significant with regard to body weight and height (weight: 39.5 ± 1.0 vs. 44.6 ± 1.8 kg, P = 0.05; height: 139.9 ± 1.3 vs. 144.2 ± 2.1 cm; P = 0.009). The number of children (both boys and girls) falling below the 5th percentile of height-for-age was significantly higher in infected than non-infected children (P = 001), similarly for Z-scores for height-for-age below –2.0 (P = 0.003).

The results demonstrate not only that the prevalence of H. pylori infection is extremely high among Egyptian schoolchildren, but also that the adverse effects of the infection reach far beyond the stomach. Evidence of the burden of infection on growth failure is presented.

Few dietary surveys have been done with reference to chronic diseases, such as diabetes, in India, which is considered to be the diabetes capital of the world. We report on the dietary intake of urban adults living in Chennai, South India.

A population-based cross-sectional study.

A representative population of urban Chennai in southern India.

The study population comprised 2042 individuals aged ≥20 years selected from the Chennai Urban Rural Epidemiological Study (CURES). Dietary intake was measured using a validated and previously published interviewer-administered semi-quantitative meal-based FFQ.

The mean daily energy intake was 10 393 (sd 2347) kJ (male: 10953 (sd 2364) kJ v. female: 9832 (sd 233) kJ). Carbohydrates were the major source of energy (64 %), followed by fat (24 %) and protein (12 %). Refined cereals contributed to the bulk of the energy (45·8 %), followed by visible fats and oils (12·4 %) and pulses and legumes (7·8 %). However, energy supply from sugar and sweetened beverages was within the recommended levels. Intake of micronutrient-rich foods, such as fruit and vegetable consumption (265 g/d), and fish and seafoods (20 g/d), was far below the FAO/WHO recommendation. Dairy and meat products intake was within the national recommended intake.

The diet of this urban South Indian population consists mainly of refined cereals with low intake of fish, fruit and vegetables, and all of these could possibly contribute to the risk of non-communicable diseases such as diabetes in this population.

To investigate the association between eating patterns and mental health problems in young Norwegian adolescents (12–13 years of age).

Cross-sectional study. Dietary information was reported by parents using a retrospective FFQ. Eating patterns were identified using principal component analysis. The Strengths and Difficulties Questionnaire was used to measure mental health problems. The association between eating patterns and mental health problems was examined using multiple logistic regression analysis.

Primary schools, Telemark County, Norway.

Children (n 1095) aged 12–13 years and their parents.

Children with high scores on a ‘varied Norwegian’ eating pattern were less likely to have indications of any psychiatric disorders (adjusted OR = 0·5; 95 % CI 0·3, 1·0) and hyperactivity-inattention disorders (adjusted OR = 0·4; 95 % CI 0·2, 0·8) than children with low scores on this pattern. Children with high scores on a ‘junk/convenient’ eating pattern were more likely to have indications of hyperactivity-inattention disorders (adjusted OR = 3·4; 95 % CI 1·3, 8·6) than children with low scores on this pattern. Children with high scores on a ‘snacking’ eating pattern were more likely to have indications of conduct/oppositional disorders (adjusted OR = 3·8; 95 % CI 1·2, 11·5) than those with low scores on this eating pattern.

We identified a significant association between eating patterns and mental health problems in young adolescents, independently of physical activity, sedentary activity and background variables. A diverse diet rich in unrefined plant foods, fish and regular meals was associated with better mental health, while energy-dense, nutrient-poor diets and irregular meals were associated with poorer mental health.

A number of studies have pointed to the pressure that housing costs can exert on the resources available for food. The objectives of the present study were to characterise the relationship between the proportion of income absorbed by housing and the adequacy of household food expenditures across the Canadian population and within income quintiles; and to elucidate the impact of receipt of a housing subsidy on adequacy of food expenditures among low-income tenant households.

The 2001 Survey of Household Spending, conducted by Statistics Canada, was a national cross-sectional survey that collected detailed information on expenditures on goods and services. The adequacy of food spending was assessed in relation to the cost of a basic nutritious diet.

Canada.

The person with primary responsibility for financial maintenance from 15 535 households from all provinces and territories.

As the proportion of income allocated to housing increased, food spending adequacy declined significantly among households in the three lowest income quintiles. After accounting for household income and composition, receipt of a housing subsidy was associated with an improvement in adequacy of food spending among low-income tenant households, but still mean food spending fell below the cost of a basic nutritious diet even among subsidised households.

This study indicates that housing costs compromise the food access of some low-income households and speaks to the need to re-examine policies related to housing affordability and income adequacy.

The current review aimed to synthesise the literature on food literacy interventions among adolescents in secondary schools, the attitudes and perceptions of food literacy interventions in secondary schools, and their effects on dietary outcomes.

The systematic review searched five electronic databases from the earliest record to present.

The studies selected for the review were from sixteen countries: Australia (n 10), Canada (n 1), China (n 1), France (n 1), Greece (n 2), Iran (n 1), South Africa (n 1), South India (n 1), Kenya (n 1), Norway (n 2), Portugal (n 1), Denmark (n 1), Northern Ireland (n 1), USA (n 17), UK (n 1) and Sweden (n 2).

Adolescents aged 10–19 years.

Forty-four studies were eligible for inclusion. Adolescents with greater nutritional knowledge and food skills showed healthier dietary practices. Studies found a mixed association between food literacy and long-term healthy dietary behaviour. Two studies showed an improvement in adolescents’ cooking skills and food safety knowledge; six studies showed an improvement in overall food safety knowledge; six studies showed an improvement in overall food and nutritional knowledge; and two studies showed an improvement in short-term healthy dietary behaviour.

Food literacy interventions conducted in a secondary-school setting have demonstrated a positive impact on healthy food and nutritional knowledge. However, there appears to be limited evidence supporting food literacy interventions and long-term dietary behaviours in adolescents. More evidence-based research is required to adequately measure all domains of food literacy and more age-specific food literacy interventions.

Findings regarding alcohol consumption and bone mineral density (BMD) in elderly women have been inconsistent. The objective of the present study was to explore the association of alcohol intake with BMD in elderly women.

This cohort study included women from the population-based Kuopio Osteoporosis Risk Factor and Prevention – Fracture Prevention Study (OSTPRE-FPS). Alcohol intake and potential confounders were assessed at baseline and after 3 years of follow-up using a lifestyle questionnaire. In addition, an FFQ was distributed in the third year to measure dietary intake, including alcohol. Women underwent BMD measurements at the femoral neck and lumbar spine at baseline and after 3 years of follow-up.

Kuopio Province, Finland.

Three hundred elderly women (mean age 67·8 years) who provided both BMD measurements and FFQ data.

Alcohol consumption estimated from the FFQ and lifestyle questionnaire was significantly associated with BMD at both measurement sites after adjustment for potential confounders, including lifestyle and dietary factors (P < 0·05). Using the FFQ, women drinking >3 alcoholic drinks/week had significantly higher BMD than abstainers, 12·0 % at the femoral neck and 9·2 % at the lumbar spine. Results based on the lifestyle questionnaire showed higher BMD values for all alcohol-consuming women at the femoral neck and for women drinking 1–3 alcoholic beverages/week at the lumbar spine, compared with non-users.

The results from OSTPRE-FPS suggest that low to moderate alcohol intake may exert protective effects on bone health in elderly women.

The relationship of meal and snacking patterns with overall dietary intake and relative weight in children is unclear. The current study was done to examine how eating, snack and meal frequencies relate to total energy intake and diet quality.

The cross-sectional associations of eating, meal and snack frequencies with total energy intake and diet quality, measured by the Healthy Eating Index 2005 (HEI-2005), were examined in separate multivariable mixed models. Differences were examined between elementary school-age participants (9–11 years) and adolescents (12–15 years).

Two non-consecutive 24 h diet recalls were collected from children attending four schools in the greater Boston area, MA, USA.

One hundred and seventy-six schoolchildren, aged 9–15 years.

Overall, 82 % of participants consumed three daily meals. Eating, meal and snack frequencies were statistically significantly and positively associated with total energy intake. Each additional reported meal and snack was associated with an 18·5 % and a 9·4 % increase in total energy intake, respectively (P<0·001). The relationships of eating, meal and snack frequencies with diet quality differed by age category. In elementary school-age participants, total eating occasions and snacks increased HEI-2005 score. In adolescents, each additional meal increased HEI-2005 score by 5·40 points (P=0·01), whereas each additional snack decreased HEI-2005 score by 2·73 points (P=0·006).

Findings suggest that snacking increases energy intake in schoolchildren. Snacking is associated with better diet quality in elementary school-age children and lower diet quality in adolescents. Further research is needed to elucidate the role of snacking in excess weight gain in children and adolescents.

To quantify factors influencing iron supplementation compliance andhaemoglobin (Hb) concentrations among pregnant women participating in aniron supplementation programme under routine field conditions.

Cross-sectional interviews and Hb measurements.

Albay and Sorsogon provinces, Bicol, Philippines.

Three hundred and forty-six pregnant women receiving iron supplements via thePhilippine iron supplementation programme.

Women had a mean Hb concentration of 10.75 ± 1.43 gdl−1, and 56.4% were anaemic (Hb < 11.0g dl−1). On average, the first prenatal visit occurredat nearly 4 months (3.80 ± 1.56). The ratio of visits to numberof months pregnant was 0.51 ± 0.24. Self-reported consumption ofpills received was 85% (0.85 ± 0.23), although pill countssuggested that consumption was 70% (0.70 ± 0.35). Using multipleregression, an earlier first prenatal visit and greater self-reportedcompliance were positively associated with Hb concentrations. Additionally,perceived health benefits from taking the supplements and higher healthprogramme knowledge were positively associated with pill consumption, whileexperiencing side-effects and disliking the taste of the supplements wereassociated with lower pill consumption. A greater number of living childrenwas negatively associated with the frequency of prenatal visits. The numberof children was also directly negatively associated with Hbconcentrations.

Compliance was positively related to Hb concentrations. Several factorsassociated with greater compliance were identified, including maritalstatus, number of children, health programme knowledge, side-effects,perceived health benefits, and dislike of taste. Some of these factors mayserve as avenues for interventions to increase compliance, and ultimately Hbconcentrations.

The risk of many important diseases can be reduced by consuming a diet rich in vegetables and fruit. For this reason the World Health Organization (WHO) recommends a daily intake of more than 400 g person−1. The pattern of both the supply and intake of vegetables and fruit and the potential health gain achieved by increasing intake in the European Union (EU) and three accession countries are presented in this paper.

Patterns of supply and dietary intake were assessed using (1) FAO food balance sheets, which allow comparison between the levels of supply in countries but do not reflect actual intake; and (2) survey data reflecting dietary intake. Using WHO mortality data for coronary heart and cerebrovascular disease and major cancers up to age 65 years, the number of preventable deaths is estimated, assuming vegetable and fruit consumption were levelled up to that of the highest consuming group, and assuming relative risks of 0.5, 0.7 or 0.9.

Vegetable and fruit consumption varies considerably between EU Member States. The populations of about half (seven) of the EU Member States have a mean daily intake of less than 275 g. Using the best current estimates of relative risk, over 26,000 deaths before the age of 65 years would be prevented annually in the EU if intake was levelled up to the highest consumption levels (and about double this number of deaths before the age of 75 years).

Increasing the intake of vegetables and fruit is feasible and could result in considerable improvements in public health within the EU. Priority should be given to developing methods that demonstrate the burden of disease caused by too low intakes of vegetables and fruit. This would enable the appropriate social, cultural and economic policies to be developed within the EU.

To examine socio-economic differences in the frequency and types of takeaway foods consumed.

A cross-sectional postal survey.

Participants were asked about their usual consumption of overall takeaway food (<4 times/month or ≥4 times/month) and of twenty-two specific takeaway food items (<1 time/month or ≥1 time/month); these latter foods were grouped into ‘healthy’ and ‘less healthy’ choices. Socio-economic position was measured on the basis of educational level and equivalised household income, and differences in takeaway food consumption were assessed by calculating prevalence ratios using log binomial regression.

Adults aged 25–64 years from Brisbane, Australia, were randomly selected from the electoral roll (n 903; 63·7 % response rate).

Compared with their more educated counterparts, the least educated were more regular consumers of overall takeaway food and fruit or vegetable juice and less regular consumers of sushi. For the ‘less healthy’ items, the least educated more regularly consumed potato chips, savoury pies, fried chicken and non-diet soft drinks; however, the least educated were less likely to consume curry. Household income was not associated with overall takeaway consumption. The lowest-income group was a more regular consumer of fruit or vegetable juice compared with the highest-income group. Among the ‘less healthy’ items, the lowest-income group was a more regular consumer of fried fish, ice cream and milk shakes, whereas curry was consumed less regularly.

The frequency and types of takeaway foods consumed by socio-economically disadvantaged groups may contribute to inequalities in overweight or obesity and to chronic disease.