To simultaneously identify consumer segments based on individual-level consumption and community-level food retail environment data and to investigate whether the segments are associated with BMI and dietary knowledge in China.

A multilevel latent class cluster model was applied to identify consumer segments based not only on their individual preferences for fast food, salty snack foods, and soft drinks and sugared fruit drinks, but also on the food retail environment at the community level.

The data came from the China Health and Nutrition Survey (CHNS) conducted in 2006 and two questionnaires for adults and communities were used.

A total sample of 9788 adults living in 218 communities participated in the CHNS.

We successfully identified four consumer segments. These four segments were embedded in two types of food retail environment: the saturated food retail environment and the deprived food retail environment. A three-factor solution was found for consumers’ dietary knowledge. The four consumer segments were highly associated with consumers’ dietary knowledge and a number of sociodemographic variables.

The widespread discussion about the relationships between fast-food consumption and overweight/obesity is irrelevant for Chinese segments that do not have access to fast food. Factors that are most associated with segments with a higher BMI are consumers’ (incorrect) dietary knowledge, the food retail environment and sociodemographics. The results provide valuable insight for policy interventions on reducing overweight/obesity in China. This study also indicates that despite the breathtaking changes in modern China, the impact of ‘obesogenic’ environments should not be assessed too strictly from a ‘Western’ perspective.

To assess the prevalence of enlarged thyroid volume (Tvol) in Saharawi refugee children, and their urinary iodine concentration (UIC), and to identify possible sources of excess iodine intake.

A cross-sectional survey was performed during January–February 2007. Tvol was measured by ultrasound and iodine concentration was analysed in casual urine samples, in household drinking water and in milk samples from household livestock.

The study was undertaken in four refugee camps in the Algerian desert.

The subjects were 421 Saharawi children, 6–14 years old.

Enlarged Tvol was found in 56 % (Tvol-for-age) and 86 % (Tvol-for-body-surface-area) of the children. The median (25th percentile–75th percentile, P25–P75) UIC was 565 (357–887) μg/l. The median (P25–P75) iodine concentration in household drinking water was 108 (77–297) μg/l. None of the children had UIC below 100 μg/l, 16 % had UIC between 100 and 299 μg/l, and 84 % had UIC above 300 μg/l. There was a positive association between Tvol and whether the household possessed livestock.

The children are suffering from endemic goitre and high UIC caused probably by an excessive intake of iodine. The excessive iodine intakes probably originate from drinking water and milk.

To investigate whether the socio-economic status (SES) of elderly eastern Mediterranean islanders is associated with their dietary habits, particularly with adherence to the traditional Mediterranean diet.

Cross-sectional.

Adherence to the Mediterranean diet was measured by the MedDietScore (range: 0–55), whereas SES was estimated using education and financial status.

During 2005–2007, 300 men and women from Cyprus, 100 from Samothraki, 142 from Mitilini, 114 from Kefalonia, 131 from Crete, 150 from Lemnos, 150 from Corfu and 103 from Zakynthos (aged 65–100 years), free of known chronic diseases, participated in the survey.

Multiple linear regression analysis revealed that belonging to the highest SES was associated with a higher MedDietScore (P < 0·01), after adjusting for potential sociodemographic, lifestyle, dietary and clinical confounders. A significant positive association was also found between MedDietScore and years of school (P = 0·004), as well as financial status (P = 0·001).

Older Greek people of higher SES seem to follow a relatively healthier diet. Both education and income seem to play a role in this issue. Thus, public health policy makers should focus on people with low SES in order to improve their quality of diet and, consequently, their health status.

To evaluate the relationship between egg consumption and CHD and stroke mortality using the Third National Health and Nutrition Examination Survey 1988–1994 (NHANES III) and follow-up survey.

A cross-sectional survey using a stratified, multi-stage probability sample was analysed, adjusting for survey design. Egg consumption was obtained from the FFQ and separated into categories of egg intake. Hazard ratios (HR) were calculated for CHD and stroke mortality using multivariate Cox regression models.

A health and nutrition survey conducted in the USA from 1988 to 1994 with follow-up through 31 December 2000.

The study population included men and women who were free of CVD and had completed a FFQ at baseline.

Multivariate models adjusting for health, lifestyle and dietary factors indicated that ‘high’ egg consumption (≥7 times/week v. <1 time/week) was not associated with significantly increased CHD mortality (HR = 1·13, 95 % CI 0·61, 2·11 (men); HR = 0·92, 95 % CI 0·27, 3·11 (women)). There was a statistically significant inverse association between ‘high’ egg consumption and stroke mortality among men (HR = 0·27, 95 % CI 0·10, 0·73), but the estimate was imprecise because of sparse data. We did not observe a statistically significant positive association between ‘high’ egg consumption and CHD or stroke mortality in analyses restricted to individuals with diabetes, but these analyses may be limited due to the small number of diabetics.

We did not find a significant positive association between egg consumption and increased risk of mortality from CHD or stroke in the US population. These results corroborate the findings of previous studies.

To develop a method to make use of incomplete 24-hour urinary samples in nutritional epidemiology, especially when validating the dietary intake of nitrogen (protein), sodium and potassium.

Urinary data for men and women collected in three different studies were evaluated. The concentration of para-aminobenzoic acid (PABA) in one 24-hour urine sample per person was compared with the concentrations of nitrogen, sodium, potassium and creatinine.

Men and women living in Cambridge, UK and women living in the town of Varberg, Sweden.

In total, this study consists of data from 73 Swedish women (20–50 years of age), 165 UK women (50–65 years) and 75 UK men (55–88 years).

On average four out of 10 people in this study had a PABA recovery below 85%. The linear regression equations for urinary excretion of nitrogen, sodium and potassium in relation to PABA recovery were y = 2.3 + 0.088 * x (r = 0.99), y = 45 + 0.82 * x (r = 0.87) and y = 19 + 0.60 * x (r = 0.93), respectively.

The linear regression equations can be used for adjusting urinary nitrogen, sodium and potassium in urinary collections in cases where the PABA recovery is below 85%. Since it is common to obtain 24-hour urine collections with a PABA recovery below 85%, this method should increase the usefulness of biological markers of food intake in nutritional epidemiological studies and also increase the possibilities to study people that previously have been part of the drop-out group or the group with low motivation and cooperation. It is important to stress that we have not studied the relationship between PABA recovery and various urinary variables below the PABA recovery of 50%. Thus, in a case of PABA recovery below 50%, we do not recommend the use of this method to compensate for incomplete collections.

To examine the association between diet quality and the diagnosis of an internalizing disorder in children and adolescents.

A prospective study examining the relationship between diet quality and mental health. FFQ responses of 3757 children were used to calculate a composite score for diet quality and its four components: variety, adequacy, moderation and balance. Physicians’ diagnoses on internalizing disorders were obtained by linking the children's dietary information to administrative health data. Negative binomial regression models were used to examine the association between diet quality and diagnosis of an internalizing disorder.

The Canadian province of Nova Scotia.

A provincially representative sample of grade 5 students (age 10–11 years).

Diet quality was not found to be associated with internalizing disorder in a statistically significant manner (incidence rate ratio = 1·09; 95 % CI 0·73, 1·63). However, relative to children with little variety in their diets, children with greater variety in their diet had statistically significant lower rates of internalizing disorder in subsequent years (incidence rate ratio = 0·45; 95 % CI 0·25, 0·82).

These findings suggest the importance of variety in children's diet and opportunities in the prevention of adolescent depression and anxiety.

Dietary sodium reduction is a cost-effective public health intervention to reduce chronic disease. In response to calls for further research into front-of-pack labelling systems, we examined how alternative sodium nutrition label formats and nutrition claims influenced consumers’ choice behaviour and whether consumers with or without a diagnosis of hypertension differed in their choice patterns.

An anonymous online experiment in which participants viewed ten choice sets featuring three fictitious brands of baked beans with varied label formats and nutritional profiles (high and low sodium) and indicated which brand in each set they would purchase if shopping for this product.

Participants were recruited from New Zealand's largest online nationwide research panel.

Five hundred people with self-reported hypertension and 191 people without hypertension aged 18 to 79 years.

The addition of a front-of-pack label increased both groups’ ability to discriminate between products with high and low sodium, while the Traffic Light label enabled better identification of the high-sodium product. Both front-of-pack formats enhanced discrimination in the presence of a reduced salt claim, but the Traffic Light label also performed better than the Percentage Daily Intake label in moderating the effect of the claim for the high-sodium product.

Front-of-pack labels, particularly those with simple visual cues, enhance consumers’ ability to discriminate between high- and low-sodium products, even when those products feature nutrition claims.

To assess the possible associations between physical activity, diet, social state and overweight in children.

Crossectional study on 1468 children aged between 5 and 7 years old in Kiel, northwest Germany.

Assessment of physical activity and social factors by a questionnaire, food frequency record, body composition analysis by anthropometrics and bioelectrical impedance analysis.

23% of our children were overweight or obese. Low levels of physical activity (as assessed by TV viewing time) were associated with increased body mass index and a higher prevalence of overweight. TV-viewing of more than 1 h per day was associated with a high consumption fast food, sweets, chips and pizza whereas fruits and vegetables were less frequently consumed. Overweight, inactivity and unhealthy eating habits were seen more frequently in families with a low social status.

In 5 to 7 years old children, overweight is associated with physical inactivity, unhealthy eating habits and a low social status. Primary prevention efforts should be directed to low income families.

To assess rates of initiation of breast-feeding and exclusive breast-feeding within 2 months after delivery and to determine the factors influencing exclusive breast-feeding.

A health worker-administered questionnaire survey was carried out during the time period 1 August–30 September 2005.

Immunisation clinics of Pokhara, a submetropolitan city in western Nepal.

Three hundred and eighty-five mothers who had delivered a child within the previous 2 months.

The rates of initiation within 1 h and within 24 h of delivery were 72.7 and 84.4%, respectively. Within 2 months after delivery, exclusive breast-feeding was practised by 82.3% of the mothers. Breast milk/colostrum was given as the first feed to 332 (86.2%) babies but 17.2% of them were either given expressed breast milk or were put to the breast of another lactating mother. Pre-lacteal feeds were given to 14% of the babies. The common pre-lacteal feeds given were formula feeds (6.2%), sugar water (5.9%) and cow's milk (2.8%). Complementary feeds were introduced by 12.7% of the mothers. By logistic regression analysis, friends' feeding practices, type of delivery and baby's first feed were the factors influencing exclusive breast-feeding practice of the mothers.

Despite the higher rates of initiation and exclusive breast-feeding, practices such as pre-lacteal feeds and premature introduction of complementary feeds are of great concern in this urban population. There is a need for promotion of good breast-feeding practices among expectant mothers and also the community, especially the families, taking into account the local traditions and customs.

Previous studies have shown that the Dietary Approaches to Stop Hypertension (DASH) diet might contribute to managing risk factors of non-alcoholic fatty liver disease (NAFLD), but evidence is limited. We examined the association of DASH diet score (DASH-DS) with NAFLD, as well as the intermediary effects of serum retinol-binding protein-4 (RBP4), serum high-sensitivity C-reactive protein (hs-CRP), serum TAG, homeostasis model assessment of insulin resistance (HOMA-IR) and BMI.

We performed a cross-sectional analysis of a population-based cohort study. Dietary data and lifestyle factors were assessed by face-to-face interviews and the DASH-DS was then calculated. We assessed serum RBP4, hs-CRP and TAG and calculated HOMA-IR. The presence and degree of NAFLD were determined by abdominal sonography.

Guangzhou, China.

Guangzhou Nutrition and Health Study participants, aged 40–75 years at baseline (n 3051).

After adjusting for potential covariates, we found an inverse association between DASH-DS and the presence of NAFLD (Ptrend = 0·009). The OR (95 % CI) of NAFLD for quintiles 2–5 were 0·78 (0·62, 0·98), 0·74 (0·59, 0·94), 0·69 (0·55, 0·86) and 0·77 (0·61, 0·97), respectively. Path analyses indicated that a higher DASH-DS was associated with lower serum RBP4, hs-CRP, TAG, HOMA-IR and BMI, which were positively associated with the degree of NAFLD.

Adherence to the DASH diet was independently associated with a marked lower prevalence of NAFLD in Chinese adults, especially in women and those without abdominal obesity, and might be mediated by reducing RBP4, hs-CRP, TAG, HOMA-IR and BMI.

To evaluate red and processed meat intake, and the impact meat consumption has on diet quality and the environment.

A large cross-sectional health survey performed in São Paulo, Brazil.

Diet was assessed by two 24 h dietary recalls. Usual intakes were calculated using the Multiple Source Method. The World Cancer Research Fund recommendation of an average of 71·4 g/d was used as the cut-off point to estimate excessive red and processed meat consumption. To investigate the relationship between meat consumption and diet quality we used the Brazilian Healthy Eating Index Revised. The environmental impact was analysed according to estimates of CO2 equivalent emissions from meat consumption.

Brazilians (n 1677) aged 19 years and older were studied.

The mean red and processed meat intake was 138 g/d for men and 81 g/d for women. About 81 % of men and 58 % of women consumed more meat than recommended. Diet quality was inversely associated with excessive meat intake in men. In Brazil alone, greenhouse gas emissions from meat consumption, in 2003, were estimated at approximately 18 071 988 tonnes of CO2 equivalents, representing about 4 % of the total CO2 emitted by agriculture.

The excessive meat intake, associated with poorer diet quality observed, support initiatives and policies advising to reduce red and processed meat intake to within the recommended amounts, as part of a healthy and environmentally sustainable diet.

Folate and vitamin B12 are two vital regulators in the metabolic process of homocysteine, which is a risk factor of atherothrombotic events. Low folate intake or low plasma folate concentration is associated with increased stroke risk. Previous randomized controlled trials presented discordant findings in the effect of folic acid supplementation-based homocysteine lowering on stroke risk. The aim of the present review was to perform a meta-analysis of relevant randomized controlled trials to check the how different folate fortification status might affect the effects of folic acid supplementation in lowering homocysteine and reducing stroke risk.

Relevant randomized controlled trials were identified through formal literature search. Homocysteine reduction was compared in subgroups stratified by folate fortification status. Relative risks with 95 % confidence intervals were used as a measure to assess the association between folic acid supplementation and stroke risk.

The meta-analysis included fourteen randomized controlled trials,

A total of 39 420 patients.

Homocysteine reductions were 26·99 (sd 1·91) %, 18·38 (sd 3·82) % and 21·30 (sd 1·98) %, respectively, in the subgroups without folate fortification, with folate fortification and with partial folate fortification. Significant difference was observed between the subgroups with folate fortification and without folate fortification (P=0·05). The relative risk of stroke was 0·88 (95 % CI 0·77, 1·00, P=0·05) in the subgroup without folate fortification, 0·94 (95 % CI 0·58, 1·54, P=0·82) in the subgroup with folate fortification and 0·91 (95 % CI 0·82, 1·01, P=0·09) in the subgroup with partial folate fortification.

Folic acid supplementation might have a modest benefit on stroke prevention in regions without folate fortification.

To examine the association between calculated maternal dietary exposure to Hg in pregnancy and infant birth weight in the Norwegian Mother and Child Cohort Study (MoBa).

Exposure was calculated with use of a constructed database of Hg in food items and reported dietary intake during pregnancy. Multivariable regression models were used to explore the association between maternal Hg exposure and infant birth weight, and to model associations with small-for-gestational-age offspring.

The study is based on data from MoBa.

The study sample consisted of 62 941 women who answered a validated FFQ which covered the habitual diet during the first five months of pregnancy.

Median exposure to Hg was 0·15 μg/kg body weight per week and the contribution from seafood intake was 88 % of total Hg exposure. Women in the highest quintile compared with the lowest quintile of Hg exposure delivered offspring with 34 g lower birth weight (95 % CI −46 g, −22 g) and had an increased risk of giving birth to small-for-gestational-age offspring, adjusted OR = 1·19 (95 % CI 1·08, 1·30). Although seafood intake was positively associated with increased birth weight, stratified analyses showed negative associations between Hg exposure and birth weight within strata of seafood intake.

Although seafood intake in pregnancy is positively associated with birth weight, Hg exposure is negatively associated with birth weight. Seafood consumption during pregnancy should not be avoided, but clarification is needed to identify at what level of Hg exposure this risk might exceed the benefits of seafood.

To evaluate the relative validity of an FFQ for assessing nutrient intakes in 12-month-old infants.

The FFQ was developed to assess the diets of infants born to women in the Southampton Women’s Survey (SWS), a population-based survey of young women and their offspring. The energy and nutrient intakes obtained from an interviewer-administered FFQ were compared with those obtained from 4d weighed diaries (WD).

A sub-sample of fifty infants (aged 1 year) from the SWS had their diets assessed by both methods. The FFQ recorded the frequencies and amounts of foods and drinks consumed by the infants over the previous 28 d; milk consumption was recorded separately. The WD recorded the weights of all foods and drinks consumed by the infants on 4 d following the FFQ completion.

The Spearman rank correlation coefficients for intakes of energy, macronutrients and eighteen micronutrients, determined by the two methods, ranged from r = 0·25 to 0·66. Bland–Altman statistics showed that mean differences between methods were in the range +5 % to +60 % except for vitamin D (+106 %). Differences in micronutrient intake were partly explained by changes in patterns of milk consumption between the two assessments.

Although there were differences in absolute energy and nutrient intakes between methods, there was reasonable agreement in the ranking of intakes. The FFQ is a useful tool for assessing energy and nutrient intakes of healthy infants aged around 12 months.

In the vast majority of surveys and research in humans, dietary data are obtained from self-reports: recalls; records; or historical methods, usually food frequency questionnaires (FFQ). This study provides a rare opportunity to compare data derived from all three methods.

A crossover study of dietary fat in which data were collected using an average of 11.4 food records and 11.7 24-h diet recalls. Using simple subtraction and correlation, energy and nutrient intakes derived from the three methods were compared to each other and with those derived from a single FFQ. Analysis of variance was used to evaluate sources of variability in nutrient intakes estimated from the individual days of records and recalls.

An independent, free-standing medical research institute.

13 men who were compliant with study procedures.

FFQ-derived estimates of energy and nutrient intake were highest (e.g. 1967 kcal versus 1858 kcal and 1936 kcal for the records and recalls, respectively). Mean differences in energy and nutrient intakes and their variances were lowest and correlation coefficients highest in comparing the records and recalls (e.g. for fat the mean difference was 5.0 g, and r=0.85). Analysis of variance of individual days of record- and recall-derived datd (n=300) revealed that there was no effect due to either method (record or recall) or the sequence of administration.

Results of this study indicate that the FFQ overestimated dietary intake. Energy and nutrient results obtained from the records and recalls were interchangeable. However, based on smaller SDs around the means, it appears that the recalls may perform slightly better in estimating dietary intake in groups such as these well-educated, highly compliant men.

To highlight the differences between the food list required in a food-frequency questionnaire (FFQ) to rank people by their intake and the food items that contribute to absolute intake, and to discuss possible applications.

We conducted a nutritional survey among 1173 adults using an adapted 24-hour recall questionnaire.

To develop an FFQ, we analysed the 24-hour recall survey data by performing a stepwise multiple regression after grouping conceptually similar food items into 175 food groups.

In total, 126 food groups were included in the developed FFQ in order to explain at least 80% of the variance in the consumption of each of 27 nutrients. The nutrients that were explained by a few food groups were vitamin A (one food group), alcohol (two), β-carotene (two), vitamin E (three) and cholesterol (five). Nutrients that were explained by a large number of food groups were energy (37 food groups), potassium (31), magnesium (31), dietary fibre (30), phosphorus (31) and sodium (29). Using energy intake as an example, soft drinks were the best between-person energy classifiers, while providing only 2.4% of the total energy intake. Wine, seeds and nuts, which contributed highly to the variance, were minor energy contributors. In contrast, milk, sugar, fried chicken/turkey breast or whole chicken/turkey, which explained little of the variation in the population, were major energy contributors.

Developing an FFQ on the basis of common foods may not explain the between-person variation required for ranking individual intake in diet–disease studies. Producing lists of ‘discriminating items’ can be a useful application in developing mini-FFQs for selected nutrients.

To evaluate the effects of Chile’s 2016 regulation restricting child-directed marketing of products high in energy, saturated fats, sodium and sugars on reducing children’s exposure to ‘high-in’ television food advertising.

Television use by pre-schoolers and adolescents was assessed via surveys in the months prior to implementation and a year after implementation. Hours and channels of television use were linked with the amount of high-in food advertising observed in corresponding content analyses of food advertisements (ads) from popular broadcast and cable channels to estimate changes in exposure to food ads from these channels.

Middle-lower and lower-income neighbourhoods in Santiago, Chile.

Pre-schoolers (n 879; mothers reporting) and adolescents (n 753; self-reporting).

Pre-schoolers’ and adolescents’ exposure to high-in food advertising in total decreased significantly by an average of 44 and 58 %, respectively. Exposure to high-in food advertising with child-directed appeals, such as cartoon characters, decreased by 35 and 52 % for pre-schoolers and adolescents, respectively. Decreases were more pronounced for children who viewed more television. Products high in sugars were the most prevalent among the high-in ads seen by children after implementation.

Following Chile’s 2016 child-directed marketing regulation, children’s exposure to high-in food advertising on popular broadcast and cable television decreased significantly but was not eliminated from their viewing. Later stages of the regulation are expected to eliminate the majority of children’s exposure to high-in food advertising from television.

To determine adherence to nutritional guidelines by pregnant women in New Zealand and maternal characteristics associated with adherence.

A cohort of the pregnant women enrolled into New Zealand’s new birth cohort study, Growing Up in New Zealand.

Women residing within a North Island region of New Zealand, where one-third of the national population lives.

Pregnant women (n 5664) were interviewed during 2009–2010. An FFQ was administered during the face-to-face interview.

The recommended daily number of servings of vegetables and fruit (≥6) were met by 25 % of the women; of breads and cereals (≥6) by 26 %; of milk and milk products (≥3) by 58 %; and of lean meat, meat alternatives and eggs (≥2) by 21 %. One in four women did not meet the recommendations for any food group. Only 3 % met all four food group recommendations. Although adherence to recommendation for the vegetables/fruit group did not vary by ethnicity (P=0·38), it did vary for the breads/cereals, milk/milk products and meat/eggs groups (all P<0·001). Adherence to recommendations for the vegetables/fruit group was higher among older women (P=0·001); for the breads/cereals group was higher for women with previous children (P<0·001) and from lower-income households (P<0·001); and for the meat/eggs group was higher for women with previous children (P=0·003) and from lower-income households (P=0·004).

Most pregnant women in New Zealand do not adhere to nutritional guidelines in pregnancy, with only 3 % meeting the recommendations for all four food groups. Adherence varies more so with ethnicity than with other sociodemographic characteristics.