To evaluate the accuracy of a simplified inventory procedure for assessing nutrient intake from vitamin and mineral supplements.

Participants brought their supplements to a clinic. An interviewer conducted the supplement inventory procedure, which consisted of recording data on the type of multiple vitamin and single supplements used. For the multiple vitamins, the interviewer recorded the exact dose for a subset of nutrients (vitamin C, calcium, selenium). For other nutrients, we imputed the dose in multiple vitamins. The dose of all single supplements was recorded. Labels of the supplements were photocopied and we transcribed the exact nutrient label data for the criterion measure. Spearman correlation coefficients were used to assess precision of nutrient intakes from the simplified inventory compared to the criterion measure.

Data are from 104 adult vitamin supplement users in Washington state.

Correlation coefficients between nutrient intake estimated from the simplified inventory compared to the criterion measure were high (0.8–1.0) for those nutrients (vitamin C, calcium, selenium) for which the interviewer recorded the exact dose contained in multiple vitamins. However, for nutrients for which imputations were made regarding dose in multiple vitamins, correlation coefficients ranged from good (0.8 for vitamin E) to poor (0.3 for iron).

The simplified inventory is rapid (4–5 min) and practical for large-scale studies. The precision of nutrient estimates using this procedure was variable, although excellent for the subset of nutrients for which the dose was recorded exactly. This study illustrates many of the challenges of collecting high quality supplement data.

The prevalence of obesity has reached epidemic proportions, and in terms of the extent of its negative impact on the health has been compared to those of tobacco and alcohol. One of the first medical consequences of obesity to be recognised was cardiovascular disease (CVD). Obesity, particularly abdominal obesity, predisposes a person to a number of other cardiovascular risk factors, and is an independent predictor of clinical CVD including coronary death, coronary heart disease, heart failure and stroke.

A Medline search using the following keywords (obesity, cardiovascular disease, body mass index, cardiovascular risk factors, type 2 diabetes, metabolic syndrome) was performed looking for high impact factor English-written references.

Ninety-nine (N=99) relevant articles published in the last 15 years were selected and commented. As detailed throughout the text, current therapies available for weight management can improve or prevent many of these obesity-related risk factors for CVD. However, there is some controversy as to whether weight loss is beneficial for health, and large clinical outcome trials such as the Look-AHEAD (Action for Health in Diabetes) trial or the SCOUT (Sibutramine Cardiovascular Outcomes Trial) study are currently ongoing.

In the present review, we summarise the effects of obesity as well as the efficacy of weight-loss interventions on cardiovascular risk factors and CVD.

Breast cancer is the most common type of cancer in women worldwide. Several studies have examined the role of single nutrients and food groups in breast cancer pathogenesis but fewer investigations have addressed the role of dietary patterns. Our main objective was to identify the relationship between major dietary patterns and breast cancer risk among Iranian women.

Hospital-based case–control study.

Shohada Teaching Hospital, Tehran, Iran.

Overall, 100 female patients aged 30–65 years with breast cancer and 174 female hospital controls were included in the present study. Dietary intake was assessed using a valid and reliable semi-quantitative FFQ consisting of 168 food items.

Two dietary patterns were identified explaining 24·31 % of dietary variation in the study population. The ‘healthy’ food pattern was characterized by the consumption of vegetables, fruits, low-fat dairy products, legumes, olive and vegetable oils, fish, condiments, organ meat, poultry, pickles, soya and whole grains; while the ‘unhealthy’ food pattern was characterized by the consumption of soft drinks, sugars, tea and coffee, French fries and potato chips, salt, sweets and desserts, hydrogenated fats, nuts, industrial juice, refined grains, and red and processed meat. Compared with the lowest tertile, women in the highest tertile of the ‘healthy’ dietary pattern score had 75 % decreased risk of breast cancer (OR = 0·25, 95 % CI 0·08, 0·78), whereas women in the highest tertile of the ‘unhealthy’ dietary pattern had a significantly increased breast cancer risk (OR = 7·78, 95 % CI 2·31, 26·22).

A healthy dietary pattern may be negatively associated with breast cancer risk, while an unhealthy dietary pattern is likely to increase the risk among Iranian women.

To document changes in consumption of food away from home (FAFH) and intakes of selected nutrients by working-age adults between 2005–06 and 2013–14, covering the most recent recessionary period and recovery.

Means were compared across survey rounds relative to 2005–06. Multivariate regression was used to account for changes in demographic characteristics over time.

National Health and Nutrition Examination Survey (NHANES), 2005–2014.

Working-age adults born in 1951–80 (n 12 129) and adolescents and young adults born in 1981–90 (n 5197) who reported day 1 dietary intake data.

Approximately 34 % of energy consumed by working-age adults came from FAFH (14 % from fast foods) in 2005–06. Levels of FAFH consumption were lowest in 2009–10, at 28 and 11 % of energy from FAFH and fast foods, respectively. Percentage of energy from fast foods was 1·9 percentage points higher in 2013–14. Percentage of energy from saturated fat and total mg of cholesterol consumed were lower in 2009–14, while intake of fibre was higher in 2011–14. At-home foods had less saturated fat and more fibre in 2009–14. The greater the percentage of energy from FAFH in the day, the greater the intakes of fat and cholesterol. Percentage of energy from FAFH was highest among those born in 1981–90 and lowest among those born in 1951–60.

FAFH is a significant source of energy, fat and cholesterol among working-age adults. Menu labelling may lower FAFH’s energy content and make it easier for consumers to choose more healthful items.

To develop a policy formulation tool for strategically informing food and nutrition policy activities to promote healthy and sustainable diets (HSD).

A policy formulation tool consisting of two complementary components was developed. First, a conceptual framework of the environment–public health nutrition relationship was constructed to characterise and conceptualise the food system problem. Second, an ‘Orders of Food Systems Change’ schema drawing on systems dynamics thinking was developed to identify, assess and propose policy options to redesign food systems.

Food and nutrition policy activities to promote HSD have been politicised, fragmented and lacking a coherent conceptual and strategic focus to tackle complex food system challenges.

The tool’s conceptual framework component comprises three integrated dimensions: (i) a structure built around the environment and public health nutrition relationship that is mediated via the food system; (ii) internal mechanisms that operate through system dynamics; and (iii) external interactions that frame its nature and a scope within ecological parameters. The accompanying schema is structured around three orders of change distinguished by contrasting ideological perspectives on the type and extent of change needed to ‘solve’ the HSD problem.

The conceptual framework’s systems analysis of the environment–public health nutrition relationship sets out the food system challenges for HSD. The schema helps account for political realities in policy making and is a key link to operationalise the framework’s concepts to actions aimed at redesigning food systems. In combination they provide a policy formulation tool to strategically inform policy activities to redesign food systems and promote HSD.

Adjustment for body weight and physical activity has been suggested as an alternative to adjusting for reported energy intake in nutritional epidemiology. We examined which of these approaches would yield stronger correlations between nutrients and their biomarkers.

A cross-sectional study in which dietary fatty acids, carotenoids and retinol were adjusted for reported energy intake and, separately, for weight and physical activity using the residual method. Correlations between adjusted nutrients and their biomarkers were examined.

USA.

Cases and controls from a nested case–control study of erythrocyte fatty acids and CHD (n 442) and of plasma carotenoids and retinol and breast cancer (n 1254).

Correlations between intakes and plasma levels of trans-fatty acids were 0·30 (energy-adjusted) and 0·16 (weight- and activity-adjusted); for erythrocyte levels, the corresponding correlations were 0·37 and 0·25. Energy-adjusted intakes of linoleic acid and α-linolenic acid were more strongly correlated with their respective biomarkers than weight- and activity-adjusted intakes, but the differences were not significant except for linoleic acid (erythrocyte). Weight- and activity-adjusted DHA intake was slightly more strongly correlated with its plasma biomarker than energy-adjusted intake (0·37 v. 0·34). Neither method made a difference for DHA (erythrocyte), carotenoids and retinol.

The effect of energy adjustment depends on the nutrient under investigation, and adjustment for energy calculated from the same questionnaire used to estimate nutrient intakes improves the correlation of some nutrients with their biomarkers appreciably. For the nutrients examined, adjustment using weight and physical activity had at most a small effect on these correlations.

There is increasing evidence for a significant effect of processed meat (PM) intake on cancer risk. However, refined knowledge on how components of this heterogeneous food group are associated with cancer risk is still missing. Here, actual data on the intake of PM subcategories is given; within a food-based approach we considered preservation methods, cooking methods and nutrient content for stratification, in order to address most of the aetiologically relevant hypotheses.

Standardised computerised 24-hour diet recall interviews were collected within the framework of the European Prospective Investigation into Cancer and Nutrition (EPIC), a prospective cohort study in 27 centres across 10 European countries.

Subjects were 22 924 women and 13 031 men aged 35–74 years.

Except for the so-called ‘health-conscious’ cohort in the UK, energy-adjusted total PM intake ranged between 11.1 and 47.9 g day−1 in women and 18.8 and 88.5 g day−1 in men. Ham, salami-type sausages and heated sausages contributed most to the overall PM intake. The intake of cured (addition of nitrate/nitrite) PM was highest in the German, Dutch and northern European EPIC centres, with up to 68.8 g day−1 in men. The same was true for smoked PM (up to 51.8 g day−1). However, due to the different manufacturing practice, the highest average intake of NaNO2 through PM consumption was found for the Spanish centres (5.4 mg day−1 in men) as compared with German and British centres. Spanish centres also showed the highest intake of NaCl-rich types of PM; most cholesterol- and iron-rich PM was consumed in central and northern European centres. Possibly hazardous cooking methods were more often used for PM preparation in central and northern European centres.

We applied a food-based categorisation of PM that addresses aetiologically relevant mechanisms for cancer development and found distinct differences in dietary intake of these categories of PM across European cohorts. This predisposes EPIC to further investigate the role of PM in cancer aetiology.

Education is a crucial social determinant of health. Food insecurity can be detrimental to children’s academic achievement, potentially perpetuating a cycle of poverty and food insecurity. We aimed to assess the relationship between food insecurity and academic achievement in Canadian school-aged children.

Cross-sectional study of children and parents. Parents completed the short-form Household Food Security Survey Module and questions about income and education level (socio-economic status). Children completed FFQ. Data were prospectively linked to children’s performance on standardized exams written one year later. Mixed-effect logistic regression was employed to assess the relationship between food insecurity and likelihood of meeting academic expectations adjusting for socio-economic status, diet quality and potential confounders.

Nova Scotia, Canada in 2011–2012.

Students (n 4105) in grade 5 (10–11 years; 2167 girls) and their parents.

Low food security was reported by 9·8 % of households; very low food security by 7·1 % of households. Students from low-income households and reporting poor diet quality were less likely to do well in school. Children who lived in households reporting very low food security had 0·65 times the odds (OR=0·65; 95 % CI 0·44, 0·96) of meeting expectations for reading and 0·62 times the odds (OR=0·62; 95 % CI 0·45, 0·86) of meeting expectations for mathematics.

Very low household insecurity is associated with poor academic achievement among children in Nova Scotia.

To develop and evaluate a pictorial, web-based version of the NCI diet history questionnaire (Web-PDHQ).

The Web-PDHQ and paper version of the DHQ (Paper-DHQ) were administered 4 weeks apart with 218 participants randomised to order. Dietary data from the Web-PDHQ and Paper-DHQ were validated using a randomly selected 4 d food record recording period (including a weekend day) and two randomly selected 24 h dietary recalls during the 4 weeks intervening between these two diet history administrations.

Research office in Reston, VA, USA.

Computer-literate men and women recruited through newspaper advertisements.

Mean correlation of energy and the twenty-five examined nutrients between the Web-PDHQ and Paper-DHQ was 0·71 and 0·51, unadjusted and energy-adjusted by the residual method, respectively. Moderate mean correlations (unadjusted 0·41 and 0·38; energy-adjusted 0·41 and 0·34) were obtained between both the Web-PDHQ and Paper-DHQ with the 4 d food record on energy and nutrients, but the correlations between the Web-PDHQ and Paper-DHQ with the 24 h recalls were modest (unadjusted 0·31 and 0·29; energy-adjusted 0·37 and 0·26). A subset of participants (n 48) completing the Web-PDHQ at the initial visit performed a retest on the same questionnaire 1 week later to determine repeatability, and the unadjusted mean correlation was 0·82.

These data indicate that the Web-PDHQ has comparable repeatability and validity to the Paper-DHQ but did not improve the relationship of the DHQ to other food intake measures (e.g. food records, 24 h recall).

To investigate the predictors of wasting, stunting and low mid-upper arm circumference among children aged 6–59 months in Somalia using data from household cross-sectional surveys from 2007 to 2010 in order to help inform better targeting of nutritional interventions.

Cross-sectional nutritional assessment surveys using structured interviews were conducted among communities in Somalia each year from 2007 to 2010. A two-stage cluster sampling methodology was used to select children aged 6–59 months from households across three livelihood zones (pastoral, agro-pastoral and riverine). Predictors of three anthropometric measures, weight-for-height (wasting), height-for-age (stunting) and mid-upper arm circumference, were analysed using Bayesian binomial regression, controlling for both spatial and temporal dependence in the data.

The study was conducted in randomly sampled villages, representative of three livelihood zones in Somalia.

Children between the ages of 6 and 59 months in Somalia.

The estimated national prevalence of wasting, stunting and low mid-upper arm circumference in children aged 6–59 months was 21 %, 31 % and 36 %, respectively. Although fever, diarrhoea, sex and age of the child, household size and access to foods were significant predictors of malnutrition, the strongest association was observed between all three indicators of malnutrition and the enhanced vegetation index. A 1-unit increase in enhanced vegetation index was associated with a 38 %, 49 % and 59 % reduction in wasting, stunting and low mid-upper arm circumference, respectively.

Infection and climatic variations are likely to be key drivers of malnutrition in Somalia. Better health data and close monitoring and forecasting of droughts may provide valuable information for nutritional intervention planning in Somalia.

Childhood obesity is increasingly being recognized as a major public health problem in the Caribbean. The objective of the present study was to evaluate the effectiveness of a short-term, school-based, multi-component education intervention on improving the knowledge, attitudes and behaviour of primary-school children towards better dietary and activity habits.

The study was a randomized, controlled, school-based nutrition education and physical activity intervention. Participating schools were randomly assigned to the intervention (IVG) and non-intervention (NIVG) groups.

All primary schools in Sangre Grande, north-east Trinidad.

Five hundred and seventy-nine pupils in their sixth year of primary-school education were enrolled from twelve schools in Sangre Grande, north-east Trinidad.

Approximately 23 % of participants had BMI ≥ 85th percentile of the Centers for Disease Control and Prevention age- and gender-specific cut-off values. In multivariate regression equations controlling for age, gender, BMI and baseline value, intervention was associated with lower intake levels of fried foods, snack foods high in fat, sugar and salt (HFSS) and sodas (P < 0·05). In similar analyses, intervention was associated with higher knowledge scores (P < 0·01). Intervention was not significantly associated with physical activity and Children’s Eating Attitude Test-26 (ChEAT26) scores after controlling for age, gender, BMI and the relevant baseline values.

The intervention was associated with lower intake levels of fried foods, HFSS foods, sodas and higher knowledge scores independent of age, gender, BMI, ethnicity and the appropriate baseline value. Finally, the intervention was not associated with changes in physical activity behaviours in multivariate analyses.

To identify and assess healthy eating policies at national level which have been evaluated in terms of their impact on awareness of healthy eating, food consumption, health outcome or cost/benefit.

Review of policy documents and their evaluations when available.

European Member States.

One hundred and twenty-one policy documents revised, 107 retained.

Of the 107 selected interventions, twenty-two had been evaluated for their impact on awareness or knowledge and twenty-seven for their impact on consumption. Furthermore sixteen interventions provided an evaluation of health impact, while three actions specifically measured any cost/benefit ratio. The indicators used in these evaluations were in most cases not comparable. Evaluation was more often found for public information campaigns, regulation of meals at schools/canteens and nutrition education programmes.

The study highlights the need not only to develop harmonized and verifiable procedures but also indicators for measuring effectiveness and success and for comparing between interventions and countries. EU policies are recommended to provide a set of indicators that may be measured consistently and regularly in all countries. Furthermore, public information campaigns should be accompanied by other interventions, as evaluations may show an impact on awareness and intention, but rarely on consumption patterns and health outcome.

A high prevalence of food insecurity has persisted in the USA for the past two decades. Previous studies suggest that the association between food insecurity and obesity may vary by gender and race/ethnicity. We examined whether food insecurity was associated with BMI and obesity within gender and racial/ethnic groups in a large, diverse sample of low-income adults.

A cross-sectional analysis of a large population-based health survey. We compared the distribution of BMI and obesity by food security levels within gender and racial/ethnic categories.

Data were derived from the 2003–2009 waves of the California Health Interview Survey.

The study sample included 35 747 non-elderly adults with households ≤200 % of the federal poverty level.

Among Hispanic men, very low food security was associated with a 1·0 kg/m2 higher BMI (95 % CI 0·3, 1·7 kg/m2) and a 36 % higher prevalence of obesity (95 % CI 17, 58 %) after multivariate adjustment. Among Hispanic women, very low food security was associated with a 1·1 kg/m2 higher BMI (95 % CI 0·4, 1·9 kg/m2) and a 22 % higher prevalence of obesity (95 % CI 8, 38 %). Positive associations were also observed for Asian women and multi-racial men. No significant associations were observed for non-Hispanic whites, African Americans, Asian men or multi-racial women.

Our results suggest that the association of food insecurity and obesity is limited to individuals of certain low-income, minority racial/ethnic groups. Whether targeted interventions to address food insecurity in these individuals may also decrease obesity risk deserves further investigation.

Our physical environment influences our daily food choices unconsciously. Strategic changes in the food environment might therefore be potential measures to influence consumers’ food selection towards better nutrition, without affecting the consumers’ freedom of choice. The present study aimed to examine whether increased vegetable variety enhances healthy food choices and improves meal composition.

A randomised experiment.

Participants were instructed to serve themselves a lunch from a buffet of food replicas. Individuals were randomly assigned to one of three food combinations: condition A – cooked carrots, pasta and chicken; condition B – cooked green garden beans, pasta and chicken; condition AB – carrot sticks, green garden beans, pasta and chicken. Two one-vegetable conditions were compared with one two-vegetable condition. Data from Zurich, Switzerland, were analysed using one-way ANOVA.

Ninety-eight students (fifty-three men; mean age 22·8 (sd 2·2) years, minimum = 19 years, maximum = 29 years).

Participants who could choose from two vegetables derived significantly more energy (141 kJ) from vegetables compared with participants in the one-vegetable condition (104 and 84 kJ, respectively). Furthermore, in the two-vegetable condition, the relative energy of the meal derived from vegetables (10·9 %) increased significantly compared with the one-vegetable condition (8 % and 6·1 %, respectively). The total energy content of the meal (mean 1472 (sd 468) kJ) was not affected by the experimental manipulation.

Having a choice of vegetables increases a person's tendency to choose vegetables and leads to the selection of a more balanced meal. Serving an assortment of vegetables as side dishes might be a simple and effective strategy to improve food selection.

To assess the association of indicators of general and abdominal obesity with the prevalence of type 2 diabetes (T2DM) and intermediate hyperglycaemia (IHG) in the Chinese population.

We used data of 50 905 adults aged 18–79 years in the 2002 China National Nutrition and Health Survey. Recommended Chinese cut-off values were used for BMI (24 kg/m2) and waist circumference (WC; 85 cm in men, 80 cm in women). Optimal cut-offs for waist:height ratio (WHtR) were determined from analyses of receiver-operating characteristic (ROC) curves.

The prevalence of T2DM and IHG was 2·6 % and 1·9 % respectively. ROC curve analyses indicated 0·5 as the optimal cut-off value for WHtR in both sexes. High BMI, WC and WHtR were all associated with the prevalence of glucose tolerance abnormalities, with the highest prevalence ratio (PR) for high WHtR (men: PR = 2·85, 95 % CI 2·54, 3·21; women: PR = 3·10, 95 % CI 2·74, 3·51). When combining BMI and WHtR, in men either a high BMI or a high WHtR alone was associated with increased risk. Among women, a high BMI without a concomitant high WHtR was not associated with increased glucose tolerance abnormalities risk, whereas a high WHtR was associated with risk irrespective of BMI.

Among the Chinese adult population measures of central obesity are better predictors of glucose tolerance abnormalities prevalence than BMI. A WHtR cut-off point of 0·5 for both men and women can be considered as optimum for predicting (pre-) diabetes and may be a useful tool for screening and health education.

As a means to prevent neural tube defects (NTDs), women planning pregnancy in Denmark are recommended to take a dietary supplement of 400 μg folic acid daily during the periconceptional period. We examined compliance with this recommendation in a national survey.

Cohort study on pregnant women in Denmark.

The Danish National Birth Cohort (DNBC).

From November 2000 to February 2002, 22 000 pregnant women were recruited for DNBC. Use of dietary supplements was recorded at enrolment. Compliance with the recommendation was related to an information campaign that took place during the second half of 2001, and to lifestyle factors provided in a telephone interview by the end of the first trimester of pregnancy.

An increase was seen in the proportion of women complying with the recommendation in the study period and this coincided with the information campaign events. However, even at the end of the period, only 22.3% of the women who had planned their pregnancy fully complied with the recommendation. No increase at all was seen in periconceptional folic acid use among women with unplanned pregnancies. Young age, low education and smoking were identified as factors that determined non-compliance.

Alternative and more effective strategies are needed if the Danish population is to benefit fully from the knowledge that folic acid prevents NTDs. Future strategies should not only target vulnerable groups, such as the less educated and the young, but also women who get pregnant without planning this. The only possible way to reach the last group may be through fortification of foods with folic acid.

To analyse the prevalence of cardiovascular risk factors in healthy adolescents of low to middle socio-economic status and to study the influence of anthropometric, biological and lifestyle factors on the risk of metabolic syndrome (MetS).

Cross-sectional study. BMI, waist circumference, blood pressure, fat and lean mass (by dual-energy X-ray absorptiometry), TAG, HDL-cholesterol, glucose, insulin, homeostatic model assessment–insulin resistance index (HOMA-IR), food intake and physical activity were measured. Cardiovascular risk factors were defined using the International Diabetes Federation criteria and insulin resistance using HOMA-IR ≥2·6. Bivariate and multivariate regressions examined the associations between MetS and anthropometric, biological and lifestyle factors.

Observational cohort study including Chilean adolescents, who were part of a follow-up study beginning in infancy.

Adolescents aged 16–17 years (n 667).

In the sample, 16·2 % had obesity and 9·5 % had MetS. Low HDL-cholesterol (69·9 %), abdominal obesity (33·3 %) and fasting hyperglycaemia (8·7 %) were the most prevalent cardiovascular risk factors. In males, obesity (OR=3·7; 95 % CI 1·2, 10·8), insulin resistance (OR=3·0; 95 % CI 1·1, 8·2), physical inactivity (OR=2·9; 95 % CI 1·1, 7·7) and sarcopenia (OR=21·2; 95 % CI 4·2, 107·5) significantly increased the risk of MetS. In females, insulin resistance (OR=4·9; 95 % CI 1·9, 12·6) and sarcopenia (OR=3·6; 95 % CI 1·1, 11·9) were significantly associated with MetS.

High prevalences of obesity, abdominal obesity, dyslipidaemia, fasting hyperglycaemia and MetS were found in healthy adolescents. In both sexes, sarcopenia and insulin resistance were important risk factors of MetS. Promotion of active lifestyles at the school level and regulation of the sale of energy-dense foods are needed.

To explore and describe quantitatively the effect over time of unemployment on food purchase behaviour and diet composition.

Longitudinal data from 2008–2012, with monthly food purchase data aligned with register data on unemployment measured as a dichotomous indicator as well as a trend accounting for the duration.

A household panel which registers daily food purchases combined with detailed nutritional information and registration of the duration of unemployment at individual level. The structure of the data set facilitates the detection of effects or associations between duration of unemployment and diet composition, purchase behaviour in terms of food expenditure, and share of food purchased on offer and in discounters while controlling for important confounding factors.

Danish households of working age (n 3440) adjusted to household equivalents. We use fixed-effects econometric methods to control for unobserved heterogeneity.

In the short run, unemployment led to substitution in favour of discount stores and increases in food expenditure and in consumption of saturated fat, total fat and protein due to increased consumption of animal-based foods. In the medium run food expenditure declined together with consumption of fresh animal-based foods and saturated fat, total fat and protein. In the even longer run these nutrients were substituted by carbohydrates and added sugar.

Unemployment has a substantial influence on diet composition, but effects vary with duration of the unemployment period, which may have potential health implications. This ought to be taken into consideration in evaluations of existing reforms and in future reforms of welfare systems.

To examine the relationships between objectively measured sleep patterns (sleep duration, sleep efficiency and bedtime) and sugar-sweetened beverage (SSB) consumption (regular soft drinks, energy drinks, sports drinks and fruit juice) among children from all inhabited continents of the world.

Multinational, cross-sectional study.

The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE).

Children (n 5873) 9–11 years of age.

Sleep duration was 12 min per night shorter in children who reported consuming regular soft drinks ‘at least once a day’ compared with those who reported consuming ‘never’ or ‘less than once a week’. Children were more likely to sleep the recommended 9–11 h/night if they reported lower regular soft drink consumption or higher sports drinks consumption. Children who reported consuming energy drinks ‘once a week or more’ reported a 25-min earlier bedtime than those who reported never consuming energy drinks. Children who reported consuming sports drinks ‘2–4 d a week or more’ also reported a 25-min earlier bedtime compared with those who reported never consuming sports drinks. The associations between sleep efficiency and SSB consumption were not significant. Similar associations between sleep patterns and SSB consumption were observed across all twelve study sites.

Shorter sleep duration was associated with higher intake of regular soft drinks, while earlier bedtimes were associated with lower intake of regular soft drinks and higher intake of energy drinks and sports drinks in this international study of children. Future work is needed to establish causality and to investigate underlying mechanisms.