To investigate what factors relate most strongly to breast-feeding duration in order to successfully support breast-feeding mothers.

Prospective birth cohort study using questionnaires, routinely collected weights and health check at age 13 months.

Gateshead, UK.

Parents of 923 term infants born in a defined geographical area and recruited shortly after birth, 50% of whom were breast-feeding initially.

Only 225 (24%) infants were still breast-fed at 6 weeks, although 136 (15%) continued beyond 4 months. Infants in the most affluent quintile were three times more likely to be initially breast-fed (P < 0.001) and five times more likely to still be feeding at 4 months (P = 0.001) compared with infants in the most deprived quintile. A third of breast-fed infants were given supplementary feeds in the maternity unit and this was associated with a 10-fold increase in odds of giving up breast-feeding by discharge (P = 0.001). Frequent feeding was reported as a reason for giving up in 70% of mothers at 6 weeks and 55% at 4 months. Those infants who stopped breast-feeding earliest showed the most rapid weight gain and were tallest at age 13 months. Non-breast-fed infants had 50% more family doctor contacts up to age 4 months (P = 0.005).

Initiation of breast-feeding in urban Britain remains strongly determined by socio-economic background and early cessation seems to be related to frequent feeding and rapid growth as well as a continuing failure to eradicate health practices that undermine breast-feeding. Those infants not receiving breast milk suffered increased morbidity, but the apparent association between breast-feeding duration and growth probably reflects reverse causation.

To identify predominant dietary patterns among Hispanic women and to determine whether adherence to dietary patterns is predicted by neighbourhood-level factors: linguistic isolation, poverty rate and the retail food environment.

Cross-sectional analyses of predictors of adherence to dietary patterns identified from principal component analysis of data collected using the Study of Women's Health Across the Nation FFQ. Census data were used to measure poverty rates and the percentage of Spanish-speaking families in the neighbourhood in which no person aged ≥14 years spoke English very well (linguistic isolation) and the retail food environment was measured using business listings data.

New York City.

A total of 345 Hispanic women.

Two major dietary patterns were identified: a healthy dietary pattern loading high for vegetables, legumes, potatoes, fish and other seafood, which explained 17 % of the variance in the FFQ data and an energy-dense dietary pattern loading high for red meat, poultry, pizza, french fries and high-energy drinks, which explained 9 % of the variance in the FFQ data. Adherence to the healthy dietary pattern was positively associated with neighbourhood linguistic isolation and negatively associated with neighbourhood poverty. Presence of more fast-food restaurants per square kilometre in the neighbourhood was significantly associated with lower adherence to the healthy diet. Adherence to the energy-dense dietary pattern was inversely, but not significantly, associated with neighbourhood linguistic isolation.

These results are consistent with the hypothesis that living in immigrant enclaves is associated with healthy dietary patterns among Hispanics.

The present study evaluated the impact of a national school programme of universal free healthy breakfast provision in Wales, UK.

A cluster randomised controlled trial with repeated cross-sectional design and a 12-month follow-up. Primary outcomes were breakfast skipping, breakfast diet and episodic memory. Secondary outcomes were frequency of eating breakfast at home and at school, breakfast attitudes, rest-of-day diet and class behaviour.

Primary schools in nine local education authority areas.

A total of 4350 students (aged 9–11 years) at baseline and 4472 at follow-up in 111 schools.

Students in intervention schools reported significantly higher numbers of healthy food items consumed at breakfast and more positive attitudes towards breakfast eating at 12 months. Parents in intervention schools reported significantly higher rates of consumption of breakfast at school and correspondingly lower rates of breakfast consumption at home. No other significant differences were found.

The intervention did not reduce breakfast skipping; rather, pupils substituted breakfast at home for breakfast at school. However, there were improvements in children’s nutritional intake at breakfast time, if not the rest of the day, and more positive attitudes to breakfast, which may have implications for life-course dietary behaviours. There was no impact on episodic memory or classroom behaviour, which may require targeting breakfast skippers.

To investigate the associations and relative impact of illness, socio-economic and social indicators for nutritional status among elderly persons in rural Bangladesh.

A multidisciplinary, cross-sectional study employing home interviews to collect information on demographic, socio-economic and social status; clinical examination to classify medical diagnoses; and Mini Nutritional Assessment (MNA) to assess the nutritional status of each participant.

Matlab, Bangladesh.

A total of 625 randomly selected individuals (≥60 years of age) participated in home interviews and 473 underwent clinical examination. Complete information on nutritional status was available for 457 individuals, median age 68 years, 55 % women.

Twenty-six per cent of the elderly participants were undernourished and 62 % were at risk of malnutrition according to MNA. More than three-quarters of the participants had acute infections, 66 % suffered from chronic illnesses, 36 % had sensory impairments and 81 % were suffering from gastrointestinal disorders. Acute infections (P < 0·001), gastrointestinal disorders (P < 0·01), depressive symptoms (P < 0·001) and impaired cognitive function (P < 0·01) were significantly and independently associated with poorer nutritional status. Moreover, female gender (P < 0·05), having no income (P < 0·01), being illiterate (P < 0·01) and not receiving regular financial support (P < 0·05) were also independently associated with poor nutritional status.

Malnutrition among elderly people in rural Bangladesh is associated with female gender, medical, psychological, socio-economic and social indicators. A multidimensional approach is probably needed to reduce undernutrition in older populations in low-income countries like Bangladesh.

To examine the fruit and vegetable consumption in Thailand, the percentage of Thais meeting recommended intakes and the association with sociodemographic factors.

Cross-sectional survey with a stratified, three-stage, cluster probability sampling design.

Community-dwelling men and women participating in the Thailand National Health Examination Survey III.

A total of 39 290 individuals aged ≥15 years were interviewed using a questionnaire to obtain information on sociodemographic characteristics and fruit and vegetable consumption. Daily fruit and vegetable consumption was estimated through the use of a short semi-qualitative FFQ.

Overall, participants had average frequencies of fruit and vegetable consumption equal to 4·56 and 5·97 d/week, respectively. Average daily number of servings of fruit, vegetables and fruit plus vegetables were 1·46, 1·78 and 3·24, respectively. Intake amounts of fruit, vegetables and fruit plus vegetables varied by marital status and region, and were lower among males (except for vegetable intake), those of older age, those with low educational attainment, those with low monthly household income and those living in a rural area. Only 1/3, 1/4 and 1/4 of the population consumed the recommended ≥2, ≥3 and ≥5 servings/d for fruit, vegetables and fruit plus vegetables. Sociodemographic factors related to meeting the recommended intake of ≥5 servings/d for fruit plus vegetables included being female (OR = 1·13) and household income ≥50 000 Baht/month (OR = 1·66).

The amounts of fruit and vegetables consumed by Thai participants were far below the level of current recommendations. Public education and campaigns on adequate consumption of fruits and vegetables should be targeted more towards low socio-economic groups.

To compare differences in children's diet quality on weekdays (Monday–Thursday), Fridays and weekend days.

A representative cross-sectional study in which participants completed a 7 d pre-coded food record. Mean intakes of energy, macronutrients and selected food items (g/10 MJ) as well as energy density were compared between weekdays, Fridays and weekend days for each gender in three age groups (4–6, 7–10 and 11–14 years) using Tobit analysis to account for zero intakes.

The Danish National Survey of Dietary Habits and Physical Activity 2003–2008.

Children (n 784; 49·9 % boys) aged 4–14 years.

For both genders in all age groups (P < 0·05), energy intake was higher during weekends than on weekdays, and intakes of sugar-sweetened beverages and white bread were higher, whereas intake of rye bread was lower. This contributed to a higher percentage of energy from added sugars, a lower fibre content and a higher energy density on weekend days v. weekdays. In children aged 4–6 and 7–10 years, the diet on weekend days was also characterized by higher intakes of sweets and chocolate and lower intakes of fruit and vegetables. Overall, the diet on Fridays appeared as a mix of the diets on weekdays and weekend days.

Significant differences and distinct characteristic patterns were found in children's diet quality during weekdays, Fridays and weekend days. The present study suggests that in prevention of childhood overweight and obesity, more attention should be paid to the higher energy intake, especially from sugar-rich foods and beverages, on Fridays and weekend days.

Proposed Australian regulation of claims on food labels includes requirements for products carrying a health claim to meet nutrient profiling criteria. This would not apply to nutrition content claims. The present study investigated the number and healthiness of products carrying claims and the impact of the proposed regulation.

Observational survey of claims on food packages across three categories: non-alcoholic beverages, breakfast cereals and cereal bars. Nutrient profiling was applied to products carrying claims to determine their eligibility to carry health claims under the proposed regulation.

Three large metropolitan stores from the three major supermarket chains in Sydney, Australia were surveyed in August 2011.

All claims on 1028 products were recorded. Nutrition composition and ingredients were collected from the packaging, enabling nutrient profiling. The proportion of products in each category carrying claims and the proportion of these that did not meet the nutrient profiling criteria were calculated.

Two-thirds of products in the three categories (ranging from 18 to 78 %) carried at least one claim. Of those carrying health claims, 31 % did not meet the nutrient profiling criteria. These would be ineligible to carry these claims under the proposed regulation. Additionally, 29 % of products carrying nutrition content claims did not meet the nutrient profiling criteria.

The number of products carrying nutrition content claims that did not meet the nutrient profiling criteria suggests that comprehensive regulation is warranted. Promotion of unhealthy foods using claims is potentially misleading for consumers and hinders their ability to select healthier foods. Implementation of the proposed regulation represents an improvement to current practice.

To evaluate the role of central adiposity, as evaluated by the measurement of waist circumference (WC), as an independent risk factor for hypertension and type 2 diabetes mellitus in the setting of a developing country.

Population-based, cross-sectional study.

A medium-sized town in southern Brazil.

One thousand and ninety-five non-pregnant women, 20 to 69 years old, recruited by cluster random sampling between 1999 and 2000. Their mean WC was 85.3 cm (standard deviation 13.9 cm) and 23.3% (n = 255) were obese (body mass index >30 kg m−2). The prevalence of hypertension and diabetes was 25.6% (n = 280) and 6.2% (n = 68), respectively.

The risks of hypertension and diabetes were directly related to WC measurement. Women with WC > 80 cm had increased risk of hypertension (odds ratio (OR) = 6.2, P < 0.001). The association remained significant (OR = 1.04 per cm increase in WC, P = 0.02) after adjusting for confounders. The effect of WC on diabetes was modified by age. The effect was stronger in women younger than 40 years old (OR = 12.7, P = 0.016) than in those over 40 years old (OR = 2.8, P = 0.013). In the multivariate analysis, the odds ratio was 5.7 (P = 0.12) in those under 40 years old and 2.8 (P = 0.008) in older women.

Waist circumference is an independent determinant for hypertension and diabetes in women in this population. The stronger association between WC and diabetes in younger women suggests that the validity of this indicator to assess abdominal adiposity is age-specific. Further studies should validate the usefulness of WC measurement in different age groups.

To assess the level of consensus amongst an international panel of public health nutrition leaders regarding the essential competencies required for effective public health nutrition practice.

A modified Delphi study involving three rounds of questionnaires.

A panel of 20 public health nutrition experts from seven countries in the European Union, the USA and Australia.

Expert panellists completed three rounds of the study relating to competencies. A literature review conducted as a prelude to the expert panel survey identified common competency units from the fields of public health, health promotion, nutrition and dietetics, and health education. These were categorised into seven competency areas including analytical, socio-cultural and political, public health service, communication, management and leadership, nutrition science and professional competency categories. There was strong initial agreement (≥90% of panellists at Round 1) that developing internationally recognised competencies for public health nutrition specialists was a priority. Twenty-six of an initial listing of 52 competency units were rated as essential competencies by ≥80% of the panellists after Round 1. Iteration rounds resulted in the addition of five extra competency units suggested by panellists after Round 1 and an increase by 13 in the number of competencies rated as essential to consensus levels. From a total of 57 competency units rated after the final survey round, 41 competency units were rated as essential competencies by ≥80% of the panellists (consensus), with 21 of these unanimously rated as essential competencies.

There is strong international agreement amongst public health nutrition leaders in Europe, the USA and Australia about a range of competencies required for effective public health nutrition practice. Essential competency units identified can be used to develop and review competency standards for public health nutrition.

Although dietary pattern approaches derived from dietary assessment questionnaires are widely used, only a few studies in Western countries have reported the validity of this approach. We examined the relative validity of dietary patterns derived from a self-administered diet history questionnaire (DHQ) among Japanese adults.

The DHQ, assessing diet during the preceding month, and 4 d dietary records (DR) were collected in each season over one year. To derive dietary patterns, 145 food items in the DHQ and 1259 in the DR were classified into thirty-three predefined food groups, and entered into a factor analysis.

Three areas in Japan; Osaka (urban), Nagano (rural inland) and Tottori (rural coastal).

A total of ninety-two Japanese women and ninety-two Japanese men aged 31–76 years.

We identified three dietary patterns (‘healthy’, ‘Western’ and ‘Japanese traditional’) in women and two (‘healthy’ and ‘Western’) in men, which showed a relatively similar direction and magnitude of factor loadings of food groups across the first and mean of four DHQ (DHQ1 and mDHQ, respectively) and 16 d DR. The Pearson correlation coefficients between DHQ1 and 16 d DR for the healthy, Western and Japanese traditional patterns in women were 0·57, 0·36 and 0·44, and for the healthy and Western patterns in men were 0·62 and 0·56, respectively. When mDHQ was examined, the correlation coefficients improved for women (0·45–0·69).

Dietary patterns derived from the DHQ could be used for epidemiological studies as surrogates of those derived from DR.

To estimate mercury intake due to fish consumption among the individuals from Gipuzkoa participating in the European Prospective Investigation into Cancer (EPIC), and to validate the estimation of mercury exposure through diet, by measuring blood mercury level.

The population for the EPIC Gipuzkoa cohort was recruited from 1992 to 1995. Each individual's diet was assessed regarding habitual intake over the previous year, using the diet history method. Blood samples were taken at the time of the interview. The mercury content of the fish species consumed was supplied by the Food Chemical Surveillance Programme in the Basque Country.

For the estimation, 8417 volunteers, men and women, aged 35–65 years, of the EPIC cohort; for the validation, a random sample of 120 individuals stratified by fish intake was taken.

The validation study confirmed the relationship between fish consumption and mercury intake, as well as between fish consumption and mercury in erythrocytes. 99.9% of individuals have intakes below 75% of the Provisional Tolerable Weekly Intake (PTWI) of mercury established by the World Health Organization. But the limit dosage recommended by the United States Environmental Protection Agency, measured by the average risk index, would be exceeded often.

No individual from the cohort would exceed the PTWI of mercury. Nevertheless, owing to the amount of fish consumed, certain individuals would have mercury intakes approaching the recommended limits. With a view to the future, we believe mercury in fish must continue to be monitored closely in order to assess the risks for the population.

Children's fruit/vegetable intake is still below recommended levels. This study applied Internet-tailored advice for schoolchildren and Internet-supported brief dietary counselling (with child and parent) within preventive health care to promote fruit/vegetable intake.

The study involved 30 seventh-grade classes (16 in the intervention group and 14 in the control group) with a total of 675 children aged 9–12 years, of whom 495 were allowed to participate.

A cluster-randomised baseline–post-test experimental design was applied. During school hours, all children completed Internet-administered questionnaires on fruit/vegetable intake and related determinants. Children in the intervention group received immediate online individually tailored nutrition feedback. For each child in the intervention group, a nurse received information concerning the assessment of fruit/vegetable intake via the Internet to support a 5 min counselling protocol to promote fruit/vegetable intake. Children completed a similar post-test questionnaire 3 months after the first assessment. Intention-to-treat analyses were conducted using multilevel regression analyses.

A total of 486 children (98% of 495) participated (263 in the intervention group, 223 in the control group); 240 child–parent couples in the intervention group attended the counselling. Awareness of inadequate fruit intake (odds ratio (OR) = 3.0; 95% confidence interval (CI) = 1.8–5.3) and knowledge of recommended vegetable intake levels (OR = 2.7; 95% CI = 1.8–4.1) were significantly more likely at post-test in the intervention group than in the control group. No significant effects were found on intake or other determinants.

A compact, integrated two-component intervention can induce positive changes in knowledge and awareness of intake levels of fruit/vegetables among schoolchildren. To induce changes in intake levels, more comprehensive interventions may be needed.

To (i) evaluate the extent to which Coca-Cola’s ‘Transparency Lists’ of 218 researchers that it funds are comprehensive; (ii) map all scientific research acknowledging funding from Coca-Cola; (iii) identify those institutions, authors and research topics funded by Coca-Cola; and (iv) use Coca-Cola’s disclosure to gauge whether its funded researchers acknowledge the source of funding.

Using Web of Science Core Collection database, we retrieved all studies declaring receipt of direct funding from the Coca-Cola brand, published between 2008 and 2016. Using conservative eligibility criteria, we iteratively removed studies and recreated Coca-Cola’s transparency lists using our data. We used network analysis and structural topic modelling to assess the structure, organization and thematic focus of Coca-Cola’s research enterprise, and string matching to evaluate the completeness of Coca-Cola’s transparency lists.

Three hundred and eighty-nine articles, published in 169 different journals, and authored by 907 researchers, cite funding from The Coca-Cola Company. Of these, Coca-Cola acknowledges funding forty-two authors (<5 %). We observed that the funded research focuses mostly on nutrition and emphasizes the importance of physical activity and the concept of ‘energy balance’.

The Coca-Cola Company appears to have failed to declare a comprehensive list of its research activities. Further, several funded authors appear to have failed to declare receipt of funding. Most of Coca-Cola’s research support is directed towards physical activity and disregards the role of diet in obesity. Despite initiatives for greater transparency of research funding, the full scale of Coca-Cola’s involvement is still not known.

To examine UK country and ethnic variations in infant feeding practices.

Cohort study.

Infants enrolled in the Millennium Cohort Study, born between September 2000 and January 2002.

A total of 18 150 natural mothers (11 286 (8207 white) living in England) of singleton infants.

Breast-feeding initiation, breast-feeding discontinuation and introduction of solid foods before 4 months.

Maternal ethnic group, education and social class.

Seventy per cent of UK mothers started to breast-feed, of whom 62% stopped before 4 months. Median age at discontinuing breast-feeding was 14, 13, 10 and 6 weeks in Scotland, England, Wales and Northern Ireland, respectively. Thirty-six per cent of UK mothers (34% in England) introduced solids before 4 months. White mothers were more likely to discontinue breast-feeding (62%) and introduce solids early (37%) than most other ethnic minority groups; those stopping before 4 months were more likely to introduce solids early compared with those continuing to breast-feed beyond this age (adjusted rate ratio (95% confidence interval): 1.3 (1.1–1.2)). Educated mothers were less likely to stop breast-feeding before 4 months (white mothers, 0.8 (0.8–0.9); non-white mothers, 0.9 (0.8–1.0)) than those with no/minimal qualifications but, among ethnic minorities, were more likely to introduce solids early (1.3 (1.0–1.6)). Socio-economic status was positively associated with breast-feeding continuation among white women, and with age at introduction of solids among non-white women.

We have identified important geographic, ethnic and social inequalities in breast-feeding continuation and introduction of solids within the UK, many of which have not been reported previously. The factors mediating these associations are complex and merit further study to ensure that interventions proposed to promote maternal adherence to current infant feeding recommendations are appropriate and effective.

Our aim was to analyse the association of change patterns on TV-viewing and computer/tablet use and incidence of elevated consumption of ultra-processed food consumption and lower consumption of fruits and vegetables during the COVID-19 pandemic.

Data of 39 208 Brazilian adults from a Behaviour Web Survey were used. Unhealthy nutrition habits were eating fruits or vegetables for <5 d/week and ultra-processed food (sugary foods, snacks, ready-to-eat frozen foods and embedded foods) for ≥5 d/week. For incidence indicators, we only considered participants without unhealthy behaviour before the quarantine. We created four categories of change in TV-viewing and computer/tablet use, considering a cut-off point of 4 h/d for each behaviour (1 – consistently low, 2 – become low during the quarantine, 3 – become high during the quarantine or 4 – consistently high). Analyses were adjusted for sex, age group, highest academic achievement, per capita income, working status during the quarantine, skin colour and adherence to the quarantine.

Brazil.

Brazilian adults (nationally representative).

Logistic regression models revealed that high TV-viewing and computer/tablet use incidence were associated with higher odds for elevated frequency of ultra-processed food consumption (TV-viewing: OR 1·70; 95 % CI 1·37, 2·12; computer/tablet: OR 1·73; 95 % CI 1·31, 2·27) and low consumption of fruit and vegetables (TV-viewing: OR 1·70; 95 % CI 1·29, 2·23; computer/tablet: OR 1·53; 95 % CI 1·08, 2·17) incidence. Consistent high computer/tablet use also presented higher odds for incidence of elevated frequency of ultra-processed food consumption.

Participants with incidence of sedentary behaviours were also more likely to present incidence of unhealthy diet during the COVID-19 pandemic quarantine.

The aim of the study was to identify components of the COM-B (capability, opportunity, motivation and behaviour) model that influences behaviour to modify dietary patterns in 40–55-year-olds living in the UK, in order to influence the risk of cognitive decline in later life.

This is a qualitative study using the COM-B model and theoretical domains framework (TDF) to explore beliefs to adopting the Mediterranean-DASH Intervention for Neurodegenerative delay (MIND) diet.

Northern Ireland.

Twenty-five participants were recruited onto the study to take part in either a focus group or an interview. Participants were men and women aged between 40 and 55 years. Participants were recruited via email, Facebook and face to face.

Content analysis revealed that the main perceived barriers to the adoption of the MIND diet were time, work environment, taste preference and convenience. The main perceived facilitators reported were improved health, memory, planning and organisation, and access to good quality food.

This study provides insight into the personal, social and environmental factors that participants report as barriers and facilitators to the adoption of the MIND diet among middle-aged adults living in the UK. More barriers to healthy dietary change were found than facilitators. Future interventions that increase capability, opportunity and motivation may be beneficial. The results from this study will be used to design a behaviour change intervention using the subsequent steps from the Behaviour Change Wheel.

An exploratory qualitative investigation was done to determine the feeding and weaning practices, knowledge and attitudes towards nutrition of mothers/caregivers of children up to 3 years old attending baby clinics in the Moretele district (South Africa).

Qualitative data collection on six relevant nutrition topics was done using focus group interviews. Trained moderators, using a pre-tested, structured interview schedule, interviewed participants in six age groups. Focus group interviews were taped, transcribed and translated. Content analysis produced systematic data descriptions and ethnography provided descriptive data.

Breast-feeding was the choice feed and bottle-feeding was only given when breast-feeding was impossible. Solid food was introduced early (at 2–3 months) and a mixed family diet at 7–9 months. Milk feeds were stopped completely from 18–24 months. Weaning diets were compromised due to poor food choices, preparation practices and limited variety. The participant's nutrition knowledge regarding specific foods, their functions and recommended quantities was poor. The women adhered to their cultural beliefs regarding food choices and preparation practices.

The data analysis revealed that inadequate nutrition knowledge and adherence to cultural practices lead to poor-quality feeding practices. Cultural factors and taboos have a powerful influence on feeding practices and eating patterns. Young mothers often find it impossible to ignore their ill-informed elders or peer group. Nutrition knowledge needs to be changed in a first step towards implementing improved feeding practices. Facilitated group discussions could focus on possible solutions for the identified nutrition-related problems.

Assessing dietary exposure or nutrient intakes requires detailed dietary data. These data are collected in France by the cross-sectional Individual and National Studies on Food Consumption (INCA). In 2014–2015, the third survey (INCA3) was launched in the framework of the European harmonization process which introduced major methodological changes. The present paper describes the design of the INCA3 survey, its participation rate and the quality of its dietary data, and discusses the lessons learned from the methodological adaptations.

Two representative samples of adults (18–79 years old) and children (0–17 years old) living in mainland France were selected following a three-stage stratified random sampling method using the national census database.

Food consumption was collected through three non-consecutive 24 h recalls (15–79 years old) or records (0–14 years old), supplemented by an FFQ. Information on food supplement use, eating habits, physical activity and sedentary behaviours, health status and sociodemographic characteristics were gathered by questionnaires. Height and body weight were measured.

In total, 4114 individuals (2121 adults, 1993 children) completed the whole protocol.

Participation rate was 41·5% for adults and 49·8% for children. Mean energy intake was estimated as 8795 kJ/d (2102 kcal/d) in adults and 7222 kJ/d (1726 kcal/d) in children and the rate of energy intake under-reporters was 17·8 and 13·9%, respectively.

Following the European guidelines, the INCA3 survey collected detailed dietary data useful for food-related and nutritional risk assessments at national and European level. The impact of the methodological changes on the participation rate should be further studied.

To validate food photographs for food portion size estimation of frequently consumed dishes, to be used in a 24-hour recall food consumption study of pregnant women in a rural environment in Burkina Faso. This food intake study is part of an intervention evaluating the efficacy of prenatal micronutrient supplementation on birth outcomes.

Women of childbearing age (15–45 years).

A food photograph album containing four photographs of food portions per food item was compiled for eight selected food items. Subjects were presented two food items each in the morning and two in the afternoon. These foods were weighed to the exact weight of a food depicted in one of the photographs and were in the same receptacles. The next day another fieldworker presented the food photographs to the subjects to test their ability to choose the correct photograph.

The correct photograph out of the four proposed was chosen in 55% of 1028 estimations. For each food, proportions of underestimating and overestimating participants were balanced, except for rice and couscous. On a group level, mean differences between served and estimated portion sizes were between −8.4% and 6.3%. Subjects who attended school were almost twice as likely to choose the correct photograph. The portion size served (small vs. largest sizes) had a significant influence on the portion estimation ability.

The results from this study indicate that in a West African rural setting, food photographs can be a valuable tool for the quantification of food portion size on group level.