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.

The present study aimed to compare two situations of endemic malnutrition among <5-year-old African children and to estimate the incidence, the duration and the case fatality of severe wasting episodes.

Secondary analysis of longitudinal studies, conducted several years ago, which allowed incidence and duration to be calculated from transition rates. The first site was Niakhar in Senegal, an area under demographic surveillance, where we followed a cohort of children in 1983–5. The second site was Bwamanda in the Democratic Republic of Congo, where we followed a cohort of children in 1989–92. Both studies enrolled about 5000 children, who were followed by routine visits and systematic anthropometric assessment, every 6 months in the first case and every 3 months in the second case.

Niakhar had less stunting, more wasting and higher death rates than Bwamanda. Differences in cause-specific mortality included more diarrhoeal diseases, more marasmus, but less malaria and severe anaemia in Niakhar. Severe wasting had a higher incidence, a higher prevalence and a more marked age profile in Niakhar. However, despite the differences, the estimated mean durations of episodes of severe wasting, calculated by multi-state life table, were similar in the two studies (7·5 months). Noteworthy were the differences in the prevalence and incidence of severe wasting depending on the anthropometric indicator (weight-for-height Z-score ≤–3.0 or mid upper-arm circumference <110 mm) and the reference system (National Center for Health Statistics 1977, Centers for Disease Control and Prevention 2000 or Multicentre Growth Reference Study 2006).

Severe wasting appeared as one of the leading cause of death among under-fives: it had a high incidence (about 2 % per child-semester), long duration of episodes and high case fatality rates (6 to 12 %).

To estimate the burden of disease attributable to low fruit and vegetable intake in the 15 countries that were members of the European Union (EU) before May 2004 (EU-15) and the 10 countries that then joined it (EU-10).

Data on fruit and vegetable intake, target levels of intake and estimates of relative risks, deaths and disability were combined to obtain the burden of ischaemic heart disease, ischaemic stroke and four types of cancer (lung/bronchus/trachea, stomach, oesophagus, and colon/rectum) attributable to low fruit and vegetable consumption.

EU-15 and EU-10 Member States.

The number of lives potentially saved annually from the selected outcomes if fruit and vegetable intake increased to 600 g person−1 day−1 reached 892 000 and 423 000 in the EU-15 and EU-10, respectively; total disease burden could decrease by 1.9% and 3.6%, respectively. The burden of ischaemic heart disease and stroke could be reduced by up to 17% and 10%, respectively, in the EU-15 and by 24% and 15%, respectively, in the EU-10; potential reductions for the selected cancers varied from 1% to 12% in the EU-15 and from 2% to 17% in the EU-10.

The potential health gain of increased fruit and vegetable intake is particularly large in the new Member States, and particularly high for cardiovascular diseases, a main cause of health divide in Europe. This stresses the need for better nutrition programmes and policies that take account of economic, social and cultural specificities.

To describe the current use of nutritional supplements and their contribution to micronutrient intakes in a representative sample of Irish adults, to evaluate the impact of supplement use on the adequacy of micronutrient intakes and to assess the risk to supplement users of exceeding tolerable upper intake levels (UL).

Food intake data were collected in 1379 (662 male and 717 female) randomly selected Irish adults aged 18 to 64 years using a 7-day food diary. The current use of nutritional supplements was assessed using a selfadministered questionnaire and respondents entered each supplement as it was consumed into the food diary.

Twenty-three per cent of respondents regularly used nutritional supplements. Twice as many women used supplements as men. The intakes of micronutrients were significantly higher (P < 0.001) in supplement users than in non-users. Micronutrient intakes from food sources were similar in male users and non-users of supplements, but were significantly higher (P < 0.01) in female users, by 3 to 13%, for Fe, Mg, Mn, vitamins C and E and niacin than in non-users. The percentage of female users between 18 and 50 years who had mean Fe intakes below the average requirement (AR) (10 mg) decreased from 50 to 25 when the contribution from supplements was included. The use of supplements reduced the percentage of men who had mean intakes below the AR for Zn from 19 to 13, for riboflavin from 14 to 6 and for vitamin A from 20 to 5, and reduced the percentage of women with intakes below the AR for Ca from 23 to 16 and for riboflavin from 23 to 14. Twenty-one women out of 80 aged between 18 and 50 years, who consumed supplemental folate, achieved the intake of 600 |xg recommended to prevent neural tube defects. Twenty-two per cent of the women who took iron and 15% of the women who took vitamin B$ in supplemental form had mean daily intakes that exceeded that UL for these nutrients. Supplement users did not exceed the UL for the other micronutrients.

Supplementation appears to be beneficial in promoting adequate intakes of some micronutrients, particularly Fe and folate in women aged 18–50 years and vitamin A in men. There appears to be little risk to supplement users of experiencing adverse side effects due to excessive intakes of micronutrients.

Schools have been recognised as a potential setting for improving young peoples’ food and beverage choices; however, many schools fail to adhere to healthy food and beverage policy standards. The current study aimed to explore the enablers and barriers to effective implementation of and compliance with school-based food and beverage policies.

Systematic review and meta-synthesis. Eight electronic databases were searched for articles in June 2019. Studies were eligible for inclusion if they reported on implementation and/or compliance of school-based food and/or beverage policies with outcomes relating to enablers and/or barriers. This review had no restrictions on study design, year of publication or language. Seventy-two full-text articles were assessed for eligibility, of which twenty-eight were included in this review.

Studies conducted globally that focused on schools.

School-based healthy food and beverage policies.

Financial (cost of policy-compliant foods, decreased profit and revenue), physical (availability of policy-compliant foods, close geographical proximity to unhealthy food outlets) and social (poor knowledge, understanding, and negative stakeholders’ attitudes towards policy) factors were the most frequently reported barriers for policy implementation. Sufficient funding, effective policy communication and management, and positive stakeholders’ attitudes were the most frequently reported enablers for policy implementation.

There is a need for better communication strategies, financial and social support prior to school-based food policy implementation. Findings of this review contribute to a thorough understanding of factors that underpin best practice recommendations for the implementation of school-based food policy, and inform those responsible for improving public health nutrition.

To determine and compare the effect of two interventions in reducing the plate waste of school lunches.

A between-group analysis was conducted among children from three primary schools: (i) a group receiving intervention A, designed for children and focusing on nutrition education and food waste; (ii) a group receiving intervention B, intended for teachers and focusing on the causes and consequences of food waste; and (iii) a control group with no intervention. For each child, physical weighing of individual meals and leftovers was performed on three non-consecutive weeks at baseline (T0), 1 week (T1, short term) and 3 months (T2, medium term) following the intervention. Plate waste was recorded for a total of 1742 lunches during 14 d over eight different menus.

Portuguese public primary schools in the city of Porto.

All fourth-grade children (n 212) attending the three preselected schools.

After intervention A focusing on nutrition education designed for children, a decrease in soup waste was observed compared with the control group. The effect was greater at T1 (−11·9 (se 2·8) %; P<0·001) than at T2 (−5·8 (se 4·4) %; P=0·103). The plate waste of identical main dishes decreased strongly at T1 (−33·9 (se 4·8) %; P<0·001). However, this effect was not found at T2 (−13·7 (se 3·2) %; P<0·001). After intervention B involving teachers, plate waste decreased at T2 (−5·5 (se 1·9) % for soup; −5·4 (se 2·4) % for identical main dishes).

Nutrition education designed for children was more effective in the short than the medium term. Thus, this kind of intervention was not effective in reducing food waste in the medium term. In contrast, an intervention focusing on teachers revealed better results in the medium term than in the short term.

To focus on factors that play a major role in our rapid, global nutritional changes.

A range of studies are summarised: these show how an understanding of social, economic and technological change at the global, national and community levels affects diet, activity, and body composition patterns and trends. These studies are used to demonstrate the value of the key global, national, community, household and individual factors that should define the field of nutrition.

The focus is global.

Large shifts have occurred in diet and in physical activity patterns – particularly in the last one or two decades of the twentieth century. These changes are reflected in nutritional outcomes such as changes in average stature, body composition and morbidity. Understanding the rapidity of these changes and the underlying factors at the global, national and community levels is critical for creating a science of nutrition that can prevent disease and sustain the health and integrity of humans.

The vision of the nutrition field is one where scholars who work on many levels will intersect; equal weight in the nutrition profession will be provided to all dimensions as they are welcomed into the field of nutrition – particularly those that will directly or indirectly affect dietary patterns, physical activity patterns, and energetics. This vision of the nutrition field is one where scholars from a range of disciplines and perspectives meet to work together with the goal being a focus on improving nutritional status and the human condition.

The European Youth Heart Study (EYHS) is a cross-sectional, school-based population study on risk factors for future cardiovascular disease in children, with an overall participation rate in Sweden of about 50%. To study the representativeness of the participants in the Swedish part of EYHS, a comprehensive non-participant follow-up study was carried out.

A structured multilevel analysis model was developed, addressing each level in the sampling procedure. The income, educational and occupational categories of the geographical regions of the study (level I), school catchment areas (level II) and parents (level III) were compared with official data. Participating and non-participating pupils (level IV) were compared through a questionnaire.

Thirty-seven state schools in two regions of Central Sweden (Örebro and southern Stockholm) were visited during the school year 1998/1999.

Boys and girls aged 9 and 15 years were randomly sampled through a multiphase sampling procedure.

Data for socio-economic status for levels I and II corresponded well to national and regional official data. At level III, non-manually working parents were slightly over-represented among parents of participating children. At level IV, non-participating subjects corresponded in most respects to participants with a few exceptions – mainly more interest in physical exercise among participants.

Based on the knowledge from the non-participant study, we do not foresee problems regarding interpretation of the outcomes in the EYHS, despite the low participation rate.

In 1976, the Royal College of Physicians and the British Cardiac Society recommended eating less fatty red meat and more poultry instead because it was lean. However, the situation has changed since that time, with a striking increase in fat content of the standard broiler chicken. The aim of the present study was to report a snapshot of data on fat in chickens now sold to the public.

Samples were obtained randomly between 2004 and 2008 from UK supermarkets, farm shops and a football club. The amount of chicken fat was estimated by emulsification and chloroform/methanol extraction.

Food sold in supermarkets and farms in England.

Chicken samples.

The fat energy exceeded that of protein. There has been a loss of n-3 fatty acids. The n-6:n-3 ratio was found to be as high as 9:1, as opposed to the recommendation of about 2:1. Moreover, the TAG level in the meat and whole bird mostly exceeded the proportion of phospholipids, which should be the higher for muscle function. The n-3 fatty acid docosapentaenoic acid (DPA, 22 : 5n-3) was in excess of DHA (22 : 6n-3). Previous analyses had, as usual for birds, more DHA than DPA.

Traditional poultry and eggs were one of the few land-based sources of long-chain n-3 fatty acids, especially DHA, which is synthesized from its parent precursor in the green food chain. In view of the obesity epidemic, chickens that provide several times the fat energy compared with protein seem illogical. This type of chicken husbandry needs to be reviewed with regard to its implications for animal welfare and human nutrition.

To study the relationship between dietary intake and the development of type 2 diabetes among Chinese adults.

A prospective cohort study. Dietary assessment was carried out using a validated FFQ. Principal component analysis was used to identify dietary patterns. Dietary glycaemic load and variety of snacks were also calculated.

A hospital-based centre at the Queen Mary Hospital in Hong Kong SAR, China.

A total of 1010 Chinese adults aged 25–74 years who participated in a territory-wide dietary and cardiovascular risk factor prevalence survey in 1995–1996 were followed up for 9–14 years for the development of diabetes.

A total of 690 (68·3 %) individuals completed follow-up during 2005–2008 and seventy-four cases of diabetes were identified over the follow-up period. Four dietary patterns were identified (‘more snacks and drinks’, ‘more vegetables, fruits and fish’, ‘more meat and milk products’ and ‘more refined grains’). After adjustment for age, sex, BMI, waist-to-hip ratio, smoking, alcohol intake, participation in exercise/sports and family history of diabetes, the more vegetables, fruits and fish pattern was associated with a 14 % lower risk (OR per 1 sd increase in score = 0·76; 95 % CI 0·58, 0·99), whereas the more meat and milk products pattern was associated with a 39 % greater risk of diabetes (OR per 1 sd increase in score = 1·39; 95 % CI 1·04, 1·84). Dietary glycaemic load, rice intake, snack intake and variety of snacks were not independently associated with diabetes.

The more vegetables, fruits and fish pattern was associated with reduced risk and the more meat and milk products pattern was associated with an increased risk of diabetes.

Consuming a variety of fruit and vegetables provides many different micronutrients and bioactive compounds. Whether this contributes to the beneficial association between fruit and vegetables and incident CHD and stroke is unknown.

Prospective population-based cohort study.

The Netherlands.

Men and women (n 20 069) aged 20–65 years. Participants completed a validated 178-item FFQ, including nine fruit and thirteen vegetable items. Variety in fruit and vegetables was defined as the sum of different items consumed at least once per 2 weeks over the previous year. Hazard ratios (HR) for variety in relation to incident CHD and stroke were calculated using multivariable Cox proportional hazards models additionally adjusted for quantity of fruit and vegetables.

Variety and quantity in fruit and vegetables were highly correlated (r = 0·81). Variety was not associated with total energy intake (r = −0·01) and positively associated with nutrient intakes, particularly vitamin C (r = 0·70). During 10 years of follow-up, 245 cases of CHD and 233 cases of stroke occurred. Variety in vegetables (HR per 2 items = 1·05; 95 % CI 0·94, 1·17) and in fruit (HR per 2 items = 1·00; 95 % CI 0·87, 1·15) were not related to incident CHD. Variety in vegetables (HR per 2 items = 0·93; 95 % CI 0·83, 1·04) and in fruit (HR per 2 items = 1·03; 95 % CI 0·89, 1·18) were also not related to incident stroke.

More variety in fruit and vegetable consumption was associated with higher intakes of fruit and vegetables and micronutrients. Independently of quantity, variety in fruit and vegetables was related neither to incident CHD nor to incident stroke.

The purpose was to update the Healthy Eating Index-C (HEI-C) with Canada’s new food guide recommendations (HEIC-2009) and compare scores and ratings among a small sample of grade 6 students.

Updates to the HEI-C were completed with Canada’s new food guide recommendations for daily number of servings. HEI-C and HEIC-2009 scores were computed for a small sample (n 405) of grade 6 students utilizing nutrition data that were collected using the Food Behaviour Questionnaire, a validated web-based dietary assessment tool (including a 24 h dietary recall, FFQ, and food and physical activity behavioural questions).

Data were collected in fifteen schools in the Region of Waterloo District School Board, Ontario, Canada.

A total of 405 students (48 % males and 52 % females) from grade 6 classrooms completed the web-based survey.

The index scores revealed that participants scored higher (74·5 v. 69·6, P < 0·001) using the HEIC-2009 compared with the HEI-C, even though both index scores are rated in the ‘needs improvement’ category (HEIC-2009, 75 %; HEI-C, 71 %). A small group of participants (n 14), who were previously rated (using the HEI-C) in the ‘poor’ category, were rated in the ‘needs improvement’ category using the HEIC-2009 (χ2 = 589·647, df = 4, P < 0·001).

The HEIC-2009 has the potential to be used as a population-level diet quality index in Canada.

The aim of the present work was to determine what dietary assessment method can provide a valid and accurate estimate of nutrient intake by comparison with the gold standard.

A MEDLINE, EMBASE, ISI Web of Science, Cochrane and related references literature review was conducted on dietary assessment methods for adolescents reporting the validity and/or reproducibility values. A study quality assessment on the retrieved FFQ was carried out according to two different scoring systems, judging respectively the quality of FFQ nutrition information and of FFQ validation and calibration.

The present review considered adolescents attending high schools and recruited in hospitals or at home.

The target of the review was the healthy adolescent population in the age range 13–17 years.

Thirty-two eligible papers were included and analysed separately as ‘original articles’ (n 20) and ‘reviews’ (n 12). The majority (n 17) assessed the validation and reproducibility of FFQ. Almost all studies found the questionnaires to be valid and reproducible (r > 0·4), except for some food groups and nutrients. Different design and validation issues were highlighted, such as portion-size estimation, number of food items and statistics used.

The present review offers new insights in relation to the characteristics of assessment methods for dietary intake in adolescents. Further meta-analysis is required although the current review provides important indications on the development of a new FFQ, addressing the need for a valid, reproducible, user-friendly, cost-effective method of accurately assessing nutrient intakes in adolescents.

To assess to what extent the observed dietary changes and increased use of lipid-lowering medication can explain the almost 20 % decline in serum cholesterol (referring to serum total cholesterol) level observed from 1982 to 2007 in Finland.

Predicted changes of serum cholesterol were calculated by the Keys’ equation assuming the effect of trans fatty acids to be similar to SFA and using the dietary intake data of the national dietary surveys between 1982 and 2007. The effect of medication was estimated based on the information on use of lipid-lowering medication among survey participants. The predicted serum cholesterol levels were compared with observed changes in analysed serum cholesterol levels.

Four cross-sectional population surveys, in 1982, 1992, 2002 and 2007, in the provinces of North Karelia, Northern Savo and Southwestern Finland.

A total of 2325 men and 2638 women aged 26–64 years selected randomly from the national population register for the four surveys.

Changes in dietary fat quality and cholesterol intake explain 0·70 mmol/l (65 %) of the decrease in men and 0·65 mmol/l (60 %) of the decrease in women in all subjects. Decline in dietary SFA intake is the main explanatory factor (47 % in men and 41 % in women) for the changes. The impact of lipid-lowering medication on observed cholesterol levels was found to be 16 % among men and 7 % among women.

The decrease in serum cholesterol levels in Finland can be explained mainly by dietary changes, especially changes in fat quality. The effect of lipid-lowering medication is less significant.

To describe scales that measure motivations for changing dietary behaviour, and to examine associations of these scales with current diet and dietary change.

A secondary analysis of a randomised trial of a self-help intervention to promote lower fat and higher fruit and vegetable consumption.

Participants and setting: Participants were 1205 adults selected at random from enrolees of a large Health Maintenance Organization. At baseline, data were collected on motives for changing diet, fruit and vegetable intake, fat-related dietary habits, and demographic characteristics. Participants were then randomised to receive the intervention or to receive no materials. A follow-up survey was administered at 12 months.

A majority of participants reported that it was very important to make dietary changes to feel better (72%) and to control an existing medical problem (57%), but very few (4%) were motivated by pressure from others. Factor analysis of the diet motivation items yielded two intrinsic (‘self-image’ and ‘personal health’) and one extrinsic (‘social pressure’) scales with fair internal consistency reliabilities (Cronbach's α = 0.59 to 0.68). Motivation scales were statistically significantly associated with demographic characteristics and baseline diet. For example, desire for a better self-image was a stronger motivator for changing diet among females, while personal health was more important to older persons and men (P < 0.001). Social pressure to change diet was statistically significantly associated with higher fat intake (r = 0.11) and self-image was associated with lower fat intake (r = −0.14, both P < 0.001). Motivation by social pressure and self-image were both significantly associated with greater fat reduction at 12 months post-intervention (P < 0.05).

The intrinsic and extrinsic motivation scales were weakly associated with current diet and predicted response to dietary intervention. More research is needed to better characterise and measure motives for dietary change, and to test whether tailoring interventions based on individuals' motives for dietary change would improve intervention effectiveness.

Several aspects of the diet characteristic of the Mediterranean countries are considered favourable not only on cardiovascular disease, but also on cancer risk. We considered some aspects of the Mediterranean diet (including, in particular, the consumption of olive oil and carbohydrates) on cancer risk.

Data were derived from a series of case-control studies, conducted in Italy since the early 1990s, on over 10 000 cases of thirteen cancer sites and over 17 000 controls.

Olive oil, and other mono- and unsaturated fats, appear to be favourable indicators of breast, ovarian, colorectal, but mostly of upper aero-digestive tract cancers. Whole grain foods are also related to reduced risk of upper aero-digestive tract and various other cancers. In contrast, refined grain intake and, consequently, glycaemic index and glycaemic load were associated to increased risk for several cancer sites. Fish, and hence a diet rich in n-3 polyunsaturated fatty acids, tended to be another favourable diet indicator, while frequent red meat intake was directly related to some common neoplasms. An a priori defined Mediterranean diet score was inversely related to upper digestive and respiratory tract cancers.

These data provide additional evidence that major characteristics of the Mediterranean diet favourably affect cancer risk.

To ascertain the breakfast habits of 10–15-year-old schoolchildren and to assess the quality of this meal as well as its relationship to the food consumption pattern for the full day.

Cross-sectional survey.

Eight hundred and two schoolchildren, boys and girls, aged 10–15 years, belonging to different urban schools located in Secunderabad, Andhra Pradesh, India.

The breakfast eating patterns of the children were studied and their impact on growth was assessed, using dietary recalls and anthropometric measurements.

Only 42.8% of the children ate breakfast regularly. Over half of the children skipped breakfast, ranging from daily to once in two weeks. The energy and protein composition of breakfasts eaten by the children indicated that those who did not skip breakfast met one-quarter to one-third of their total daily energy and protein requirements. Mean nutrient intakes calculated from 24-hour recalls revealed that the children's diets were inadequate compared with the recommended values for energy and protein. The inadequate energy intake was reflected in a high incidence of malnutrition in both boys and girls; 40.3% of the boys and 32.1% of the girls studied were found to be underweight. Protein intake was also inadequate among boys and girls, although a higher percentage of children met their protein requirements.

Over half of the schoolchildren studied skipped breakfast frequently, the main reason being getting up late. Children who consumed breakfast had higher daily intakes of energy and protein than children who skipped breakfast. These data confirm the importance of breakfast to overall dietary quality and adequacy in school-aged children.