To describe an approach for assessing the prevalence of nutrient inadequacy in a group, using daily intake data and the new Estimated Average Requirement (EAR).

Observing the proportion of individuals in a group whose usual intake of a nutrient is below their requirement for the nutrient is not possible in general. We argue that this proportion can be well approximated in many cases by counting, instead, the number of individuals in the group whose intakes are below the EAR for the nutrient.

This is a methodological paper, and thus emphasis is not on analysing specific data sets. For illustration of one of the statistical methods presented herein, we have used the 1989–91 Continuing Survey on Food Intakes by Individuals.

We show that the EAR and a reliable estimate of the usual intake distribution in the group of interest can be used to assess the proportion of individuals in the group whose usual intakes are not meeting their requirements. This approach, while simple, does not perform well in every case. For example, it cannot be used on energy, since intakes and requirements for energy are highly correlated. Similarly, iron in menstruating women presents some difficulties, due to the fact that the distribution of iron requirements in this group is known to be skewed.

The apparently intractable problem of assessing the proportion of individuals in a group whose usual intakes of a nutrient are not meeting their requirements can be solved by comparing usual intakes to the EAR for the nutrient, as long as some conditions are met. These are: (1) intakes and requirements for the nutrient must be independent, (2) the distribution of requirements must be approximately symmetric around its mean, the EAR, and (3) the variance of the distribution of requirements should be smaller than the variance of the usual intake distribution.

To review the available literature on the association between consumption of ultra-processed foods and body fat during childhood and adolescence.

A systematic review was conducted in the PubMed, Web of Science and LILACS databases. Studies that evaluated the association between consumption of ultra-processed food (exposure) and body fat (outcome) during childhood and adolescence were eligible.

Healthy children and adolescents.

Twenty-six studies that evaluated groups of ultra-processed foods (such as snacks, fast foods, junk foods and convenience foods) or specific ultra-processed foods (soft drinks/sweetened beverages, sweets, chocolate and ready-to-eat cereals) were selected. Most of the studies (n 15) had a cohort design. Consumption was generally evaluated by means of FFQ or food records; and body composition, by means of double indirect methods (bioelectrical impedance analysis and skinfolds). Most of the studies that evaluated consumption of groups of ultra-processed foods and soft drinks/sweetened beverages found positive associations with body fat.

Our review showed that most studies have found positive associations between consumption of ultra-processed food and body fat during childhood and adolescence. There is a need to use a standardized classification that considers the level of food processing to promote comparability between studies.

To estimate the association between food intake and metabolic syndrome (MetS).

Cross-sectional design conducted from July 2006 to December 2007.

Adolescents assisted by the Family Doctor Program (FDP) in Niterói, a metropolitan area in Rio de Janeiro State, Brazil.

Survey of 210 adolescents. Individuals with three or more of the following components of MetS were classified as having this syndrome: TAG ≥ 110 mg/dl; HDL cholesterol < 50 mg/dl for girls aged 12–19 years and boys aged 12–14 years or <45 mg/dl for boys aged 15–19 years; waist circumference ≥75th percentile; serum glucose >100 mg/dl; and blood pressure ≥90th percentile. A semi-quantitative FFQ was used, and foods were grouped as: unprocessed or minimally processed foods (Group 1), processed culinary and food industry ingredients (Group 2) and ultra-processed foods (Group 3). The associations between food consumption and MetS were adjusted for sociodemographic, behavioural and family history covariates and were estimated using generalized estimation equations with the Poisson regression model.

MetS was diagnosed in 6·7 % of the adolescents; the most frequent diagnostic criteria included the reduction of HDL cholesterol (46·7 %), elevated serum glucose (17·1 %) and the elevation of waist circumference (16·7 %). Crude analysis showed higher average daily intakes of energy, carbohydrates and ultra-processed foods among adolescents with MetS. After statistical adjustment, the intake of ultra-processed foods (≥3rd quartile) remained associated with MetS (prevalence ratio = 2·5; P = 0·012).

High consumption of ultra-processed foods was associated with the prevalence of MetS in this adolescents group.

The purpose of the present study was to characterise the food landscape of an inner city African American neighbourhood and its mixed-race suburban neighbour. Detailed analysis focuses on the relationship between community store mix and price, availability and produce quality.

A market basket study was completed by members of the Chicago Food Systems Collaborative. The US Department of Agriculture's standard market basket survey and methodology were used. Additional items and analyses were added in consultation with community members.

Austin is a lower-middle-class African American community of 117 500 on the western edge of Chicago. Oak Park, which borders Austin, is an upper-middle-income suburb of 52 500 with a mixed racial profile.

A market basket survey of every retail food store in Austin and Oak Park was completed. A total of 134 were included.

Results indicate that Austin has many grocery stores and few supermarkets. Many Austin groceries stores carry produce that is usually competitively priced, but often of unacceptable quality. Supermarkets had the best selection. Prices were lowest at discount supermarkets. Prices of packaged items were higher at independent stores than at chain supermarkets, but fresh items were cheaper.

Food access is related more to store type than number. In this study, item availability and produce quality varied greatly between store types. Price differences were complicated and varied by store type and food category. This has consequences in terms of food purchasing decisions and dietary quality that public health professionals should acknowledge.

To review the evidence on diet and nutrition relating to osteoporosis and provide recommendations for preventing osteoporosis, in particular, osteopototic fracture.

Firstly, to review the definition, diagnosis and epidemiology of osteoporosis, to discuss the difficulties in using bone mineral density to define osteoporosis risk in a world-wide context and to propose that fragility fracture should be considered as the disease endpoint. Secondly, to provide an overview of the scientific data, the strengths and weaknesses of the evidence and the conceptual difficulties in interpreting studies linking diet, nutrition and osteoporosis. The following were considered: calcium, vitamin D, phosphorus, magnesium, protein and fluorine. Other potential dietary influences on bone health were also discussed, including vitamins, trace elements, electrolytes, acid–base balance, phyto-oestrogens, vegetarianism and lactose intolerance.

There is insufficient knowledge linking bone mineral status, growth rates or bone turnover in children and adolescents to long-term benefits in old age for these indices to be used as markers of osteoporotic disease risk. For adults, the evidence of a link between intakes of any dietary component and fracture risk is not sufficiently secure to make firm recommendations, with the exception of calcium and vitamin D. For other aspects of the diet, accumulating evidence suggests that current healthy-eating advice to decrease sodium intake, to increase potassium intake, and to consume more fresh fruits and vegetables is unlikely to be detrimental to bone health and may be beneficial.

To build a comprehensive overview of the potential role of fish in improving nutrition with respect to certain micronutrient deficiencies in developing countries.

A comprehensive literature review was completed. For this the electronic library databases ASFA, CABD and Scopus were systematically searched and relevant references cited in these sources were carefully analysed. The search terms used were ‘fish’, ‘small fish species’, ‘micronutrients’, ‘food-based strategies’, ‘fish consumption’ and ‘developing countries’. The quality of data on nutritional analyses was carefully reviewed and data that lacked proper information on methods, units and samples were excluded.

The evidence collected confirmed the high levels of vitamin A, Fe and Zn in some of the small fish species in developing countries. These small fish are reported to be more affordable and accessible than the larger fish and other usual animal-source foods and vegetables. Evidence suggests that these locally available small fish have considerable potential as cost-effective food-based strategies to enhance micronutrient intakes or as a complementary food for undernourished children. However, the present review shows that only a few studies have been able to rigorously assess the impact of fish consumption on improved nutritional status in developing countries.

Further research is required in areas such as determination of fish consumption patterns of poor households, the nutritional value of local fish and other aquatic animals and the impact of fish intake on improved nutritional status in developing countries where undernutrition is a major public health problem.

To estimate the dietary share of ultra-processed foods and to determine its association with the overall nutritional quality of diets in Brazil.

Cross-sectional.

Brazil.

A representative sample of 32 898 Brazilians aged ≥10 years was studied. Food intake data were collected. We calculated the average dietary content of individual nutrients and compared them across quintiles of energy share of ultra-processed foods. Then we identified nutrient-based dietary patterns, and evaluated the association between quintiles of dietary share of ultra-processed foods and the patterns’ scores.

The mean per capita daily dietary energy intake was 7933 kJ (1896 kcal), with 58·1 % from unprocessed or minimally processed foods, 10·9 % from processed culinary ingredients, 10·6 % from processed foods and 20·4 % from ultra-processed foods. Consumption of ultra-processed foods was directly associated with high consumption of free sugars and total, saturated and trans fats, and with low consumption of protein, dietary fibre, and most of the assessed vitamins and minerals. Four nutrient-based dietary patterns were identified. ‘Healthy pattern 1’ carried more protein and micronutrients, and less free sugars. ‘Healthy pattern 2’ carried more vitamins. ‘Healthy pattern 3’ carried more dietary fibre and minerals and less free sugars. ‘Unhealthy pattern’ carried more total, saturated and trans fats, and less dietary fibre. The dietary share of ultra-processed foods was inversely associated with ‘healthy pattern 1’ (−0·16; 95 % CI −0·17, −0·15) and ‘healthy pattern 3’ (−0·18; 95 % CI −0·19, −0·17), and directly associated with ‘unhealthy pattern’ (0·17; 95 % CI 0·15, 0·18).

Dietary share of ultra-processed foods determines the overall nutritional quality of diets in Brazil.

The present study aimed to analyse the worldwide trends of adherence to the Mediterranean diet (MD), in 1961–1965 and 2000–2003.

Data were obtained from the FAO food balance sheets in two periods: 1961–1965 and 2000–2003. In order to have a sample from across the world, forty-one countries were selected. The average of available energy for different food groups was calculated for all selected countries. These values were used to evaluate the adherence to the MD through a variation of Mediterranean Adequacy Index (MAI).

The majority of the forty-one countries in this study have tended to drift away from a Mediterranean-like dietary pattern. Mediterranean Europe and the Other Mediterranean country groups suffered a significant decrease in their MAI values. The Mediterranean European group, especially Greece, experienced the greatest decrease in MAI value.

In both periods, the Other Mediterranean countries showed the highest MAI values. In an analysis by countries, Iran had the highest increase in MAI across the time periods, and Egypt occupied the first place in the ranking in 2000–2003.

The Northern European group was the only one that registered an increase in MAI, although this was not statistically significant.

Many countries in the Mediterranean basin are drifting away from the Mediterranean dietary pattern (MDP). However, countries in Northern Europe and some other countries around the world are taking on a Mediterranean-like dietary pattern. The Other Mediterranean countries have the closest adherence to the MDP, currently and in the 1960s. Nutrition policy actions to tackle dietary westernisation and preserve the healthy prudent MDP are required.

To evaluate the reproducibility of, and to compare and calibrate, diet measures by the Northern Sweden 84-item food-frequency questionnaire (FFQ) with measures from 24-hour diet recalls (24-HDR).

Randomly selected respondents (n=246) from the EPIC (diet-cancer) and MONICA (diet-cardiovascular disease) study cohort in Northern Sweden were invited to answer the FFQ twice over a one-year interval (FFQ1 and FFQ2), and to complete ten 24-hour recalls (reference method) in the months between. Plasma β-carotene concentrations were determined from a subset of 47 participants.

Vasterbotten and Norrbotten, Northern Sweden.

Ninety-six men and 99 women, who completed the study.

The reproducibility of the FFQ was high in terms of both mean energy and nutrient intakes and relative ranking of participants by intake levels (median Pearson correlation of 0.68). Moderately higher food intake frequencies were recorded by FFQ1 compared with 24-hour recalls for dairy products, bread/cereals, vegetables, fruits and potato/rice/pasta, whereas meat, fish, sweet snacks and alcoholic beverage intakes were lower. The median Spearman coefficient of correlation between FFQ1 and the average of ten 24-HDR measurements was 0.50. Daily energy and nutrient intakes were similar for FFQ1 and 24-HDR measurements, except for fibre, vitamin C, β-carotene and retinol (FFQ1<24-HDR) and sucrose and cholesterol (FFQ1>4-HDR). Pearson coefficients of correlation between FFQ1 and 24-HDR corrected for attenuation due to residual day-to-day variation in the 24-HDR measurements ranged from 0.36 to 0.79 (median 0.54). Adjustment for energy had only very moderate effects on the correlation estimates. Calibration coefficients estimated by linear regression of the 24-HDR on the FFQ1 measurements varied between 0.30 and 0.59 for all nutrients except alcohol, which had calibration coefficients close to 1.0. These low calibration coefficients indicate that relative risk estimates corresponding to an absolute difference in dietary intake levels measured by the FFQ will generally be biased towards 1.0. Plasma β-carotene levels had a Pearson coefficient of correlation of 0.47 with the 24-HDR measurements, and of 0.23 with FFQ1 measurements.

The Northern Sweden FFQ measurements have good reproducibility and an estimated level of validity similar to that of FFQ measurements in other prospective cohort studies. The results from this study will form the basis for the correction of attenuation and regression dilution biases in relative risk estimates, in future studies relating FFQ measurements to disease outcomes.

To describe anthropometric characteristics of participants of the European Prospective Investigation into Cancer and Nutrition (EPIC).

A cross-sectional analysis of baseline data of a European prospective cohort study.

This analysis includes study populations from 25 centres in nine European countries. The British populations comprised both a population-based and a ‘health-conscious’ group. The analysis was restricted to 83 178 men and 163 851 women aged 50–64 years, this group being represented in all centres.

Anthropometric examinations were undertaken by trained observers using standardised methods and included measurements of weight, height, and waist and hip circumferences. In the ‘health-conscious’ group (UK), anthropometric measures were predicted from self-reports.

Except in the ‘health-conscious’ group (UK) and in the French centres, mean body mass index (BMI) exceeded 25.0 kg m-2. The prevalence of obesity (BMI≥30 kg m-2) varied from 8% to 40% in men, and from 5% to 53% in women, with high prevalences (>25%) in the centres from Spain, Greece, Ragusa and Naples (Italy) and the lowest prevalences (<10%) in the French centres and the ‘health-conscious’ group (UK). The prevalence of a large waist circumference or a high waist-to-hip ratio was high in centres from Spain, Greece, Ragusa and Naples (Italy) and among women from centres in Germany and Bilthoven (The Netherlands).

Anthropometric measures varied considerably within the EPIC population. These data provide a strong base for further investigation of anthropometric measures in relation to the risk of chronic diseases, especially cancer.

To review the epidemiological evidence for vegetarian diets, low-meat dietary patterns and their association with health status in adults.

Published literature review focusing primarily on prospective studies and meta-analyses examining the association between vegetarian diets and health outcomes.

Both vegetarian diets and prudent diets allowing small amounts of red meat are associated with reduced risk of diseases, particularly CHD and type 2 diabetes. There is limited evidence of an association between vegetarian diets and cancer prevention. Evidence linking red meat intake, particularly processed meat, and increased risk of CHD, cancer and type 2 diabetes is convincing and provides indirect support for consumption of a plant-based diet.

The health benefits of vegetarian diets are not unique. Prudent plant-based dietary patterns which also allow small intakes of red meat, fish and dairy products have demonstrated significant improvements in health status as well. At this time an optimal dietary intake for health status is unknown. Plant-based diets contain a host of food and nutrients known to have independent health benefits. While vegetarian diets have not shown any adverse effects on health, restrictive and monotonous vegetarian diets may result in nutrient deficiencies with deleterious effects on health. For this reason, appropriate advice is important to ensure a vegetarian diet is nutritionally adequate especially for vulnerable groups.

The objective of this paper is to characterise the epidemiological and nutritional transition and their determinants in Mexico.

Age-adjusted standardised mortality rates (SMRs) due to acute myocardial infarction (AMI), diabetes mellitus and hypertension were calculated for 1980–1998. Changes in the prevalences of overweight and obesity in women and children and of dietary intake from 1988 to 1999 were also used in the analysis. Quantities of food groups purchased by adult equivalent (AE) and food expenditures away from home between 1984 and 1989 were used to assess trends. All information was analysed at the national and regional levels, and by urban and rural areas.

SMR for diabetes, AMI and hypertension increased dramatically parallel to obesity at the national and regional levels. Fat intake in women and the purchase of refined carbohydrates, including soda, also increased.

The results suggest that obesity is playing a role in the increased SMRs of diabetes, AMI and hypertension in Mexico. Total energy dietary intake and food purchase data could not explain the rise in the prevalence of obesity. The increases in fat intake and the purchase of refined carbohydrates may be risk factors for increased mortality. Information on physical activity was not available.

SMRs due to diabetes, hypertension and AMI have increased dramatically in parallel with the prevalence of obesity; therefore actions should be taken for the prevention of obesity. Reliable information about food consumption and physical activity is required to assess their specific roles in the aetiology of obesity.

The overall objective of this study was to evaluate and provide evidence and recommendations on current published literature about diet and lifestyle in the prevention of type 2 diabetes.

Epidemiological and experimental studies, focusing on nutritional intervention in the prevention of type 2 diabetes are used to make disease-specific recommendations. Long-term cohort studies are given the most weight as to strength of evidence available.

Numerous clinical trials and cohort studies in low, middle and high income countries are evaluated regarding recommendations for dietary prevention of type 2 diabetes. These include, among others, the Finnish Diabetes Prevention Study, US Diabetes Prevention Program, Da Qing Study; Pima Indian Study; Iowa Women's Health Study; and the study of the US Male Physicians.

There is convincing evidence for a decreased risk of diabetes in adults who are physically active and maintain a normal body mass index (BMI) throughout adulthood, and in overweight adults with impaired glucose tolerance who lose weight voluntarily. An increased risk for developing type 2 diabetes is associated with overweight and obesity; abdominal obesity; physical inactivity; and maternal diabetes. It is probable that a high intake of saturated fats and intrauterine growth retardation also contribute to an increased risk, while non-starch polysaccharides are likely to be associated with a decreased risk. From existing evidence it is also possible that omega-3 fatty acids, low glycaemic index foods and exclusive breastfeeding may play a protective role, and that total fat intake and trans fatty acids may contribute to the risk. However, insufficient evidence is currently available to provide convincing proof.

Based on the strength of available evidence regarding diet and lifestyle in the prevention of type 2 diabetes, it is recommended that a normal weight status in the lower BMI range (BMI 21–23) and regular physical activity be maintained throughout adulthood; abdominal obesity be prevented; and saturated fat intake be less than 7% of the total energy intake.

Public health professionals continue to see the benefits of fruit and vegetable consumption on population health. While studies that evaluate the availability of produce are sparse in the medical literature, disparities in availability may explain the disproportional intake of produce for some people. Therefore, the purpose of this study was to evaluate the availability and variety of produce located in two racially and economically diverse urban neighbourhoods.

A cross-sectional study was conducted in which 50% of the supermarkets, small grocery stores, delicatessens, and fruit and vegetable markets located in specific neighbourhoods were randomly sampled and surveyed between September 2004 and July 2005. Food stores were evaluated for the availability of 20 types of fresh fruits and 19 types of fresh vegetables, as well as their varieties and whether they were canned, frozen or previously prepared. 2000 US Census information was used to determine characteristics of the geo-coded census tracts where the food stores were located.

Brooklyn, New York.

A supermarket was located in approximately every third census tract in predominantly white areas (prevalence = 0.33) and every fourth census tract in racially mixed areas (prevalence = 0.27). There were no supermarkets located in the predominantly black areas. With the exception of bananas, potatoes, okra and yucca, a lower proportion of predominantly black area stores carried fresh produce, while supermarkets carried the largest variety of produce types. Canned and frozen fruits and vegetables were found in the majority of stores, whereas prepared and organic produce was limited to predominantly white area stores.

These data demonstrate that the availability and variety of fresh produce is associated with neighbourhood racial composition and may be a factor contributing to differences in intake among residents.

This study employed a multilevel design to test the contribution of individual, social and environmental factors to mediating socio-economic status (SES) inequalities in fruit and vegetable consumption among women.

A cross-sectional survey was linked with objective environmental data.

A community sample involving 45 neighbourhoods.

In total, 1347 women from 45 neighbourhoods provided survey data on their SES (highest education level), nutrition knowledge, health considerations related to food purchasing, and social support for healthy eating. These data were linked with objective environmental data on the density of supermarkets and fruit and vegetable outlets in local neighbourhoods.

Multilevel modelling showed that individual and social factors partly mediated, but did not completely explain, SES variations in fruit and vegetable consumption. Store density did not mediate the relationship of SES with fruit or vegetable consumption.

Nutrition promotion interventions should focus on enhancing nutrition knowledge and health considerations underlying food purchasing in order to promote healthy eating, particularly among those who are socio-economically disadvantaged. Further investigation is required to identify additional potential mediators of SES–diet relationships, particularly at the environmental level.

To investigate the short- and long-term effectiveness and the predictors of weight loss in a mobile phone weight-loss programme among healthy overweight adults.

One hundred and twenty-five healthy, overweight (BMI = 26–36 kg/m2), 25–44-year-old, screened volunteers were randomized to an experimental group (n 62) to use a mobile phone-operated weight-loss programme or to a control group (n 63) with no intervention. Via text messaging, the programme instructed a staggered reduction of food intake and daily weight reporting with immediate tailored feedback. Assessments were at 0, 3, 6, 9 and 12 months for the experimental group; at 0 and 12 months for the control group. Main outcome variables were changes in body weight and waist circumference.

By 12 months the experimental group had lost significantly more weight than the control group (4·5 (sd 5·0) v. 1·1 (sd 5·8) kg; F(1,80) = 8·0, P = 0·006) and had a greater reduction in waist circumference (6·3 (sd 5·3) v. 2·4 (sd 5·4) cm; F(1,80) = 55·2, P = 0·0001). Early weight loss, self-efficacy, contact frequency, attitudes towards the medium, changes in work and family life and changes made in dietary habits were the strongest predictors of weight loss.

This mobile phone weight-loss programme was effective in short- and long-term weight loss. As a minimum-advice, maximal-contact programme, it offers ideas for future weight-loss programmes.

Vegetarians and vegans exclude certain food sources of vitamin D from their diet, but it is not clear to what extent this affects plasma concentrations of 25-hydroxyvitamin D (25(OH)D). The objective was to investigate differences in vitamin D intake and plasma concentrations of 25(OH)D among meat eaters, fish eaters, vegetarians and vegans.

A cross-sectional analysis.

United Kingdom.

Plasma 25(OH)D concentrations were measured in 2107 white men and women (1388 meat eaters, 210 fish eaters, 420 vegetarians and eighty-nine vegans) aged 20–76 years from the European Prospective Investigation into Cancer and Nutrition (EPIC)–Oxford cohort.

Plasma 25(OH)D concentrations reflected the degree of animal product exclusion and, hence, dietary intake of vitamin D; meat eaters had the highest mean intake of vitamin D (3·1 (95 % CI 3·0, 3·2) μg/d) and mean plasma 25(OH)D concentrations (77·0 (95 % CI 75·4, 78·8) nmol/l) and vegans the lowest (0·7 (95 % CI 0·6, 0·8) μg/d and 55·8 (95 % CI 51·0, 61·0) nmol/l, respectively). The magnitude of difference in 25(OH)D concentrations between meat eaters and vegans was smaller (20 %) among those participants who had a blood sample collected during the summer months (July–September) compared with the winter months (38 %; January–March). The prevalence of low plasma concentrations of 25(OH)D (<25 nmol/l) during the winter and spring ranged from <1 % to 8 % across the diet groups.

Plasma 25(OH)D concentrations were lower in vegetarians and vegans than in meat and fish eaters; diet is an important determinant of plasma 25(OH)D in this British population.