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 compare methods used to assess the validity of nutrient intake data obtained from a food-frequency questionnaire (FFQ), using folate and vitamin B12 as nutrient examples.

Cross-sectional sample from a population cohort.

Two postcode areas west of Sydney, Australia.

In total, 2895 people aged 49 years and older provided dietary data using a semi-quantitative FFQ (79% of 3654 subjects examined). The validity of the FFQ was assessed against three 4-day weighed food records (WFRs) completed by 78 people (mean age 70 years).

Folate and vitamin B12 validity data were assessed using different methods. The Spearman ranked correlations (energy-adjusted) were 0.66 for folate and 0.38 for vitamin B12. Using the Bland–Altman method, following loge transformation, no linear trend existed between the differences and means for folate and vitamin B12. Large differences existed between the FFQ and WFR in individual cases, particularly for vitamin B12. Finally, data were divided into quintile categories for the test and reference method: 79% classified folate within one quintile, 65% classified vitamin B12 within one quintile; there was no gross misclassification for folate and only 3% misclassification for vitamin B12.

Different methods of analysis provided different information about the validity of the FFQ. Correlation coefficients should not be used alone to assess the validity of nutrient data, but should be used in conjunction with Bland–Altman analyses. Depending on the use of the data, additional assessment of classification categories is recommended. This worked example demonstrates that absolute intakes of folate and vitamin B12 should be used with caution.

The objective of the present study was to explore the influence of participation in community-supported agriculture (CSA) on vegetable exposure, vegetable intake during and after the CSA season, and preference related to locally produced vegetables acquired directly from CSA growers.

Quantitative surveys were administered at three time points in two harvest seasons to four groups of CSA participants: new full-paying, returning full-paying, new subsidized and returning subsidized members. Questionnaires included a vegetable frequency measure and measures of new and changed vegetable preference. Comparisons were made between new and returning CSA members and between those receiving subsidies and full-paying members.

The research was conducted in a rural county in New York, USA.

CSA members who agreed to participate in the study.

Analysis was based on 151 usable questionnaires. CSA participants reported higher intake of eleven different vegetables during the CSA season, with a sustained increase in some winter vegetables. Over half of the respondents reported trying at least one, and up to eleven, new vegetables. Sustained preferences for CSA items were reported.

While those who choose to join a CSA may be more likely to acquire new and expanded vegetable preferences than those who do not, the CSA experience has the potential to enhance vegetable exposure, augment vegetable preference and increase overall vegetable consumption. Dietary patterns encouraged through CSA participation can promote preferences and consumer demand that support local production and seasonal availability. Emphasis on fresh and fresh stored locally produced vegetables is consistent with sustainable community-based food systems.

To assess how diet quality, physical activity and body weight are related to health-related quality of life (HRQOL) among children in the Canadian province of Alberta.

In 2008, we surveyed 3421 grade 5 students and their parents from 148 randomly selected schools. Students completed the Harvard Food Frequency Questionnaire, questions on physical activities, and had their height and weight measured. The HRQOL of the students was assessed using the EQ-5D-Y. Parents completed questions on socio-economic background and children's lifestyle. We applied multilevel regression methods to examine the importance of children's diet quality, physical activity and weight status for the EQ-5D-Y Visual Analogue Scale and for the EQ-5D-Y dimensions.

The province of Alberta, Canada.

Grade 5 students.

Students with better diet quality, higher physical activity levels and normal body weights were statistically significantly more likely to report better HRQOL than students who ate less healthily, were less active or were overweight or obese.

The importance of diet quality, physical activity and body weight status for HRQOL may help justify broader implementation of school health programmes that promote healthy eating and active living, as these programmes will help reduce the burden of childhood obesity and improve quality of life.

Data-driven approaches to dietary patterns are under-utilized; latent class analyses (LCA) are particularly rare. The present study used an LCA to identify subgroups of people with similar dietary patterns, explore changes in dietary patterns over a 10-year period and relate these dynamics to sociodemographic factors and health outcomes.

The 1998 baseline and 2008 follow-up of the Cork and Kerry Diabetes and Heart Disease Study. Diets were assessed with a standard FFQ. LCA, under the assumption of conditional independence, was used to identify mutually exclusive subgroups with different dietary patterns, based on food group consumption.

Republic of Ireland.

Men and women aged 50–69 years at baseline (n 923) and at 10-year follow-up (n 320).

Three dietary classes emerged: Western, Healthy and Low-Energy. Significant differences in demographic, lifestyle and health outcomes were associated with class membership. Between baseline and follow-up most people remained ‘stable’ in their dietary class. Most of those who changed class moved to the Healthy class. Higher education was associated with transition to a healthy diet; lower education was associated with stability in an unhealthy pattern. Transition to a healthy diet was associated with higher CVD risk factors at baseline: respondents were significantly more likely to be smokers, centrally obese and to have hypertension (non-significant).

LCA is useful for exploring dietary patterns transitions. Understanding the predictors of longitudinal stability/transitions in dietary patterns will help target public health initiatives by identifying subgroups most/least likely to change and most/least likely to sustain a change.

To identify the information that adult consumers use on food labels, the difficulties they experience when using food labels and their reasons for not always using food labels. The relationship between their understanding of the information on the food label and their ability to make informed food choices was also investigated by means of their being required to perform labelling tasks.

A cross-sectional and descriptive research approach was followed. Data were collected by means of the administration of questionnaires.

Selected supermarkets in Potchefstroom and Klerksdorp in the North West Province, South Africa.

Questionnaires were administered to 174 consumers of African descent and Caucasians, ≥18 years of age, who were involved in purchasing household food products.

The information that is mostly used on food labels includes the expiry date, the list of ingredients and nutritional information, such as fat and cholesterol content. The difficulties associated with food labels were indicated mainly as being the font size of the print, whereas the reasons for not reading food labels were related to product attributes (‘taste and price are more important than is the nutritional content of the food product’), demographic characteristics (‘lack of education and nutritional knowledge’) and situational factors (‘experiencing time constraints’).

Results from the present study indicated that the expiry date was the most important information on a food label used by consumers. Scores from the labelling tasks showed that the respondents did not always understand how to use the information on food labels in order to make informed food choices. Barriers to consumer understanding and the use of food labels are highlighted. Improvements on current food labels in South Africa are suggested. Guidelines for consumer education regarding the use of food labels are also provided.

The present study was undertaken to assess the impact of drought on the nutritional status of pre-school children aged 0–5 years from a rural population in a desert area facing drought conditions very frequently.

The sampling design for assessment was the three-stage sampling technique.

The study was carried out in 24 villages belonging to six tehsils (sub-units of district) of Jodhpur District, a drought-affected desert district of western Rajasthan, during a drought in 2003.

A total of 914 children were examined at household level, with nutritional status assessed by anthropometry, dietary intake and clinical signs of nutritional deficiency.

The results revealed growth retardation. Stunting (malnutrition of long duration) was observed in 53% of children and underweight in 60%. Wasting, an indicator of short-duration malnutrition, was present in 28% of children. The extent of malnutrition was significantly higher in girls than boys (P < 0.05). Vitamin A and B complex deficiencies were found in 0.7 and 3.0% of children, respectively. Prevalence of marasmus (protein–energy malnutrition, PEM) was 1.7% (2.3% in boys and 1.1% in girls). Overall deficits in mean energy and protein intakes were very high (76 and 54%, respectively). Comparison of the present drought results with earlier studies in desert normal and desert drought conditions showed higher prevalence of PEM and higher dietary energy and protein deficiencies.

The prevalence of wasting was high, greater than the cut-off point of 15% stated by the World Health Organization to indicate that the severity of malnutrition is critical. PEM, vitamin A and B complex deficiencies and anaemia, along with dietary deficits of energy and protein, were observed to be higher than in non-desert areas. This may be due to the harsh environmental conditions in desert areas where drought occurs quite frequently and adversely affects the economy, largely by eroding the coping capacity and economic potential of the people as a result of heavy livestock losses and reduced harvests, leading to increased poverty and poor food intake of the inhabitants. Due to inadequate consumption of daily food the children were suffering from wasting and PEM. Efforts should be made to incorporate measures, such as ensuring the supply of adequate energy and protein to all age groups and especially pre-school children, into ongoing nutrition programmes in order to improve the food security of local inhabitants in this area.

High-glycaemic-load diets may increase endometrial cancer risk by increasing circulating insulin levels and, as a consequence, circulating oestrogen levels. Given the paucity of epidemiological data regarding the relationship between dietary glycaemic index and glycaemic load and endometrial cancer risk, we sought to examine these associations using data from a prospective cohort study.

We examined the association between dietary glycaemic load and endometrial cancer risk in a cohort of 49 613 Canadian women aged between 40 and 59 years at baseline who completed self-administered food-frequency questionnaires between 1982 and 1985. Linkages to national mortality and cancer databases yielded data on deaths and cancer incidence, with follow-up ending between 1998 and 2000.

During a mean of 16.4 years of follow-up, we observed 426 incident cases of endometrial cancer. Hazard ratios for the highest versus the lowest quartile level of overall glycaemic index and glycaemic load were 1.47 (95% confidence interval (CI) = 0.90–2.41; P for trend = 0.14) and 1.36 (95% CI = 1.01–1.84; P for trend = 0.21), respectively. No association was observed between total carbohydrate or total sugar consumption and endometrial cancer risk. Among obese women (body mass index > 30 kg m−2) the hazard ratio for the highest versus the lowest quartile level of glycaemic load was 1.88 (95% CI = 1.08–3.29; P for trend = 0.54) and there was a 55% increased risk for the highest versus the lowest quartile level of glycaemic load among premenopausal women. There was also evidence to support a positive association between glycaemic load and endometrial cancer risk among postmenopausal women who had used hormone replacement therapy.

Our data suggest that diets with high glycaemic index or high glycaemic load may be associated with endometrial cancer risk overall, and particularly among obese women, premenopausal women and postmenopausal women who use hormone replacement therapy.

Using a national representative sample to identify groups within the UK male and female population over 65 years who report similar patterns of diet.

National representative dietary survey, using 4-day weighed dietary records of men and women aged over 65 years old and living in private households in Great Britain in 1994–1995. Cluster analysis was used to aggregate individuals into diet groups.

United Kingdom.

558 women and 539 men.

Consumption of predefined food groups, nutrient intakes, socio-economic, demographic and behavioural characteristics.

Three large clusters comprising 86% of the male population and three large clusters comprising 83% of the female population were identified. Among men, the most prevalent cluster was a ‘mixed diet’ with elements from a traditional diet and some elements from a healthy diet (48% of the male population); the second was a ‘healthy diet’ (21% of the male population); and the third was a ‘traditional diet high in alcohol’ (17% of the male population). Among women, the most prevalent diet was a ‘sweet traditional diet’ (33% of the female population); the second was a ‘healthy diet’ (32% of the female population); and the last was a ‘mixed diet’ with elements of the traditional diet and the healthy diet (18% of the female population). There were important differences in average nutrient intakes, socio-demographic and behavioural characteristics across these diet clusters.

Cluster analysis identified three diet groups among men and three among women. These differed not only in terms of reported dietary intake, but also with respect to their nutrient content, social and behavioural profile. The groups identified could provide a useful basis for health promotion based upon the diet clusters.

To describe how the time spent in food-related activities by Americans has changed over the past 30 years.

Data from four national time diary surveys, spanning 1975–2006, are used to construct estimates of trends in American adults’ time spent in food-related activities. Multivariate Tobits assess how food-related activities have changed over time controlling for sociodemographic and economic covariates.

Both bivariate and multivariate estimates reveal that between 1975 and 2006, American women’s time spent in food preparation declined substantially, whereas the time spent in these activities by American men changed very little. On the contrary, grocery shopping time increased modestly for both men and women. The primary eating time (i.e. time when eating/drinking was the respondent’s main focus) declined for both men and women over this historical period, and the composition of this time changed with less primary eating time being done alone. Concurrently, secondary eating time (i.e. time when something else had the respondent’s primary attention, but eating/drinking simultaneously occurred) rose precipitously for both women and men between 1975 and 1998.

The total time spent in eating (i.e. primary plus secondary eating time) has increased over the past 30 years, and the composition of this time has shifted from situations in which energy intake can be easily monitored to those in which energy intake may be more difficult to gauge. Less time is also being spent in food preparation and clean-up activities. Future research should explore possible links between these trends and Americans’ growing obesity risk.

The Mediterranean diet is rich in fat and starch, and hence may be related to overweight. We therefore investigated the relationship between adherence to a Mediterranean diet and body mass index (BMI) and waist-to-hip ratio (WHR).

Data were obtained from the control group of a network of case–control studies on cancer conducted in major teaching and general hospitals in four Italian areas between 1991 and 2002. An interviewer-administered validated 78-item food-frequency questionnaire was used to obtain information on the subjects’ habitual diet. Information on socio-economic factors, lifestyle habits and anthropometric measures was also collected. A Mediterranean diet score (MDS) was derived on the basis of eight characteristics of the Mediterranean diet.

Subjects were 6619 patients (3090 men, 3529 women) admitted to hospital for a wide spectrum of acute, non-neoplastic conditions, unrelated to known risk factors for cancer and long-term modifications of diet.

In multiple linear regression models adjusted for age, study centre, education, tobacco smoking, occupational physical activity and total energy intake, the MDS was not related to BMI (β = 0.05 for men and −0.04 for women) or WHR (β = 0.000 and 0.001, respectively) in both sexes.

Adherence to the major characteristics of the Mediterranean diet is unrelated to BMI and WHR, confirming previous data from Greece and Spain.

Fe supplementation has been used to prevent anaemia in China; however, high Fe intake and body Fe stores may increase diabetes risk. The present study aimed to prospectively examine the association between Fe intake/stores and hyperglycaemia, and to assess the joint effects on anaemia.

We followed 1056 healthy adults aged 20 years and older from 2002 to 2007. Body Fe stores were measured. Dietary data were collected using a 3 d food record and FFQ. Hyperglycaemia was defined as fasting plasma glucose >5·6 mmol/l.

Of the participants, 28·8 % were anaemic at baseline. During the 5 years of follow-up, we documented 125 incident cases of hyperglycaemia, among them twenty-three were diabetic. Haem Fe intake was positively associated with the risk of hyperglycaemia in men and women: the OR (95 % CI) across increasing quartiles of haem Fe intake was 1·00 (referent), 1·49 (0·74, 3·01), 2·16 (1·06, 4·42) and 3·48 (1·71, 7·11), respectively (P for trend <0·001). Comparing the fourth quartile of serum ferritin with the others, the age- and gender-adjusted OR (95 % CI) was 1·54 (1·01, 2·34), P for trend = 0·043. The association between total Fe intake and the risk of hyperglycaemia was significant in men (P for trend = 0·002). Anaemia added additional risk of hyperglycaemia on haem Fe intake. Comparing extreme quartiles of haem Fe intake, the OR (95 % CI) was 5·67 (1·43, 22·49) and 3·44 (1·51, 7·85) for hyperglycaemia among anaemic and non-anaemic participants (P for trend = 0·008 and 0·010, respectively).

The present cohort study suggests that high haem Fe intake, anaemia and high ferritin are associated with an increased risk of hyperglycaemia in Chinese men and women. There was a joint effect between anaemia and haem Fe intake on the risk of hyperglycaemia.

To estimate the prevalence of malnutrition among free-living elderly in a rural population of south India.

Cross-sectional study. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) questionnaire, which is an eighteen-item nutritional screening instrument used in the elderly.

Kaniyambadi block, a rural development block in the state of Tamil Nadu, south India.

Community-dwelling elderly (aged 60 years and above).

As evaluated by the MNA, 14 % of the 227 subjects were malnourished and 49 % were at risk of malnourishment. No significant difference was found between men and women. The majority of the elderly were living with their children, had no income and consumed three meals per day. Older age (P < 0·001), decreased food intake (P < 0·001) and consuming fewer meals (P < 0·001) were independently associated with lower MNA scores.

More than 60 % of the subjects had low MNA scores (<23·5) indicating that deficient protein–energy intake is common among rural elderly of south India and requires more attention.

To investigate the sociodemographic determinants of diet quality of the elderly in four EU countries.

Cross-sectional study. For each country, a regression was performed of a multidimensional index of dietary quality v. sociodemographic variables.

In Finland, Finnish Household Budget Survey (1998 and 2006); in Sweden, SNAC-K (2001–2004); in the UK, Expenditure & Food Survey (2006–07); in Italy, Multi-purpose Survey of Daily Life (2009).

One- and two-person households of over-50s (Finland, n 2994; UK, n 4749); over-50 s living alone or in two-person households (Italy, n 7564); over-60 s (Sweden, n 2023).

Diet quality among the EU elderly is both low on average and heterogeneous across individuals. The regression models explained a small but significant part of the observed heterogeneity in diet quality. Resource availability was associated with diet quality either negatively (Finland and UK) or in a non-linear or non-statistically significant manner (Italy and Sweden), as was the preference for food parameter. Education, not living alone and female gender were characteristics positively associated with diet quality with consistency across the four countries, unlike socio-professional status, age and seasonality. Regional differences within countries persisted even after controlling for the other sociodemographic variables.

Poor dietary choices among the EU elderly were not caused by insufficient resources and informational measures could be successful in promoting healthy eating for healthy ageing. On the other hand, food habits appeared largely set in the latter part of life, with age and retirement having little influence on the healthiness of dietary choices.

There have been inconsistent results published regarding the relationship between dyslipidaemia and an increased risk of colorectal neoplasia (CRN), including colorectal adenoma (CRA) and colorectal cancer (CRC). We conducted a meta-analysis to explore the relationship between dyslipidaemia and CRN.

We identified studies by performing a literature search using PubMed, EMBASE and the Science Citation Index through October 2013.

We analysed thirty-three independent studies reporting the association between CRN and at least one of the selected lipid components, including total cholesterol (TC), TAG, HDL-cholesterol (HDL-C) and LDL-cholesterol (LDL-C).

CRN cases (n 21 809) were identified.

Overall, people with high levels of serum TAG (risk ratio (RR)=1·08; 95 % CI 1·05, 1·12, P<0·00001) and LDL-C (RR=1·07; 95 % CI 1·00, 1·14, P=0·04) presented an increased prevalence of CRN. Subgroup analyses revealed that high levels of serum TC (RR=1·04; 95 % CI 1·01, 1·09, P=0·02), TAG (RR=1·06; 95 % CI 1·03, 1·10, P=0·0009) and LDL-C (RR=1·11; 95 % CI 1·04, 1·19, P=0·003) increased the risk of CRA but not of CRC. No association between serum HDL-C and risk for CRN (including CRA and CRC) was observed.

Both TAG and LDL-C were significantly associated with an increasing prevalence of CRN. High levels of serum TC, TAG and LDL-C were positively associated with CRA but not with CRC. No significant association was observed between levels of serum HDL-C and CRN.

To describe the development and application of the School Food Environment Assessment Tools and a novel scoring system to assess the integration of healthy and environmentally sustainable food initiatives in elementary and secondary schools.

The cross-sectional study included direct observations of physical food environments and interviews with key school personnel regarding food-related programmes and policies. A five-point scoring system was then developed to assess actions across six domains: (i) food gardens; (ii) composting systems; (iii) food preparation activities; (iv) food-related teaching and learning activities; and availability of (v) healthy food; and (vi) environmentally sustainable food.

Vancouver, Canada.

A purposive sample of public schools (n 33) from all six sectors of the Vancouver Board of Education.

Schools scored highest in the areas of food garden and compost system development and use. Regular integration of food-related teaching and learning activities and hands-on food preparation experiences were also commonly reported. Most schools demonstrated rudimentary efforts to make healthy and environmentally sustainable food choices available, but in general scored lowest on these two domains. Moreover, no schools reported widespread initiatives fully supporting availability or integration of healthy or environmentally sustainable foods across campus.

More work is needed in all areas to fully integrate programmes and policies that support healthy, environmentally sustainable food systems in Vancouver schools. The assessment tools and proposed indicators offer a practical approach for researchers, policy makers and school stakeholders to assess school food system environments, identify priority areas for intervention and track relevant changes over time.

To determine the correlates of central adiposity.

Population-based cross-sectional study.

A total of 926 women (aged 40–60 years) from all districts of Tehran.

Demographic data were collected and anthropometric indices were measured according to standard protocols. Dietary intakes were assessed by means of a semi-quantitative food-frequency questionnaire. The suggested cut-off point for waist-to-hip ratio (WHR≥0.84) for Tehrani people, adjusted for their age group, was used to determine central adiposity. Logistic regression analysis was used to determine the correlates of WHR, which were adjusted for age, taking medications and body mass index (BMI). The components of dietary intake were determined by factor analysis. Pearson correlation was used to determine the association between the dietary components and WHR. Analysis of covariance was employed to compare the mean values of WHR in different lifestyle groups, with adjustment for BMI and age.

Mean WHR was 0.82 ± 0.06. The possibility of being centrally obese was higher in women with light physical activity (odds ratio: 2.11; 95% confidence interval: 1.40–2.53), depressed women (1.36; 1.02–1.93), smokers (1.21; 1.02–1.56) and unemployed women (1.41; 1.13–1.72). Marriage (1.31; 1.10–1.82), menopause (1.22; 1.02–1.61), low vitamin C intake (2.31; 1.25–4.25) and low calcium intake (1.30; 1.07–3.78) were associated with central fat accumulation. Dairy consumption was inversely correlated with central fat accumulation (r = −0.2, P < 0.05).

Central adiposity is associated with poor lifestyle factors including low physical activity, depression, smoking, low intake of vitamin C, low intake of calcium and dairy products and high fat consumption. Thus lifestyle modifications should be encouraged to achieve a healthier body shape.

To identify factors potentially associated with weight retention measured 9 months after childbirth.

Prospective study with four follow-up waves in time (0.5, 2, 6 and 9 months postpartum).

Rio de Janeiro, Brazil.

Two hundred and sixty-six Brazilian women of childbearing age. Analysis was based on hierarchical logistic regression. The dependent variable was weight retention and was defined as the difference between weight at 9 months postpartum and pre-pregnancy weight, with a dichotomised cut-off at 7.5 kg. Covariates included demographic and socio-economic data, obstetric history, anthropometric data, and data on the infant. These data were grouped in blocks and ordered according to their influence on the dependent variable.

Of the women studied, 19.2% presented weight retention values ≥7.5 kg. According to the logistic regression analysis, the following variables remained associated with weight retention ≥7.5 kg: total family income, difficulty or inability to read a letter, age category ≥30 years, age at first childbirth <23 years, gestational weight gain ≥12 kg, body fat at baseline ≥30% and infant birth weight <3500 g. Infant hospitalisation was only marginally significant.

Determinant factors identified by the analysis highlight the need for nutritional intervention policies during pregnancy and in the first months postpartum as a way of minimising obesity and the diseases resulting from it.

To test whether diets achieving recommendations from the UK’s Scientific Advisory Committee on Nutrition (SACN) were associated with higher monetary costs in a nationally representative sample of UK adults.

A cross-sectional study linking 4 d diet diaries in the National Diet and Nutrition Survey (NDNS) to contemporaneous food price data from a market research firm. The monetary cost of diets was assessed in relation to whether or not they met eight food- and nutrient-based recommendations from SACN. Regression models adjusted for potential confounding factors. The primary outcome measure was individual dietary cost per day and per 2000 kcal (8368 kJ).

UK.

Adults (n 2045) sampled between 2008 and 2012 in the NDNS.

On an isoenergetic basis, diets that met the recommendations for fruit and vegetables, oily fish, non-milk extrinsic sugars, fat, saturated fat and salt were estimated to be between 3 and 17 % more expensive. Diets meeting the recommendation for red and processed meats were 4 % less expensive, while meeting the recommendation for fibre was cost-neutral. Meeting multiple targets was also associated with higher costs; on average, diets meeting six or more SACN recommendations were estimated to be 29 % more costly than isoenergetic diets that met no recommendations.

Food costs may be a population-level barrier limiting the adoption of dietary recommendations in the UK. Future research should focus on identifying systems- and individual-level strategies to enable consumers achieve dietary recommendations without increasing food costs. Such strategies may improve the uptake of healthy eating in the population.

To illustrate issues related to under-reporting in dietary surveys relevant for development of food-based dietary guidelines

Food and nutrient intakes in two national dietary surveys are analysed in relation to under-reporting using the concept of cut-off values for the ratio between energy intake and basal metabolic rate as well as biochemical markers of nutritional status.

Subjects with an implausibly low EI/BMR ratio had dietary patterns more close to recommended levels, e.g. lower fat intake and higher fibre intake, than those with acceptable energy intakes. Intakes of micronutrients were lower. This was due to both general and selective under-reporting of foods. Under-reporting was due to less frequent consumption, larger proportion of non consumers and smaller portion sizes. Low EI/BMR ratios did not influence the characterisation of protein and micronutrient intake of low and high consumers of fruit and vegetable intake.

Under-reporting can influence the usefulness of dietary data as a tool for developing food-based dietary guidelines, and the extent of under-reporting should be assessed using appropriate methods.