To determine the effectiveness of nutrition education intervention based on Pender's Health Promotion Model in improving the frequency and nutrient intake of breakfast consumption among female Iranian students.

The quasi-experimental study based on Pender's Health Promotion Model was conducted during April–June 2011. Information (data) was collected by self-administered questionnaire. In addition, a 3 d breakfast record was analysed. P < 0·05 was considered significant.

Two middle schools in average-income areas of Qom, Iran.

One hundred female middle-school students.

There was a significant reduction in immediate competing demands and preferences, perceived barriers and negative activity-related affect constructs in the experimental group after education compared with the control group. In addition, perceived benefit, perceived self-efficacy, positive activity-related affect, interpersonal influences, situational influences, commitment to a plan of action, frequency and intakes of macronutrients and most micronutrients of breakfast consumption were also significantly higher in the experimental group compared with the control group after the nutrition education intervention.

Constructs of Pender's Health Promotion Model provide a suitable source for designing strategies and content of a nutrition education intervention for improving the frequency and nutrient intake of breakfast consumption among female students.

The aim of the present study was to evaluate the effects of a 1-year family-based healthy lifestyle intervention implemented through day-care centres on toddlers’ BMI Z-scores and reported activity- and dietary-related behaviours.

Pilot cluster-randomized controlled trial.

Seventy child-care centres in three different intervention communities and three paired-matched control communities in Flanders, Belgium.

A sample of 203 Belgian toddlers aged 9–24 months was included in the study. Objectively assessed weight and height were used to calculate BMI Z-scores. A parental-report questionnaire was used to assess children's lifestyle behaviours.

Positive intervention effects were found on BMI Z-score. No intervention effects were found for activity- and dietary-related behaviours targeted by the intervention. In both intervention and control groups, daily consumption of water, soft drinks, sweets and savoury snacks increased while daily consumption of fruit and vegetables decreased over 1 year. Daily physical activity remained stable but screen-time behaviour increased in both groups over time.

The study showed that a family-based healthy lifestyle intervention implemented through day-care centres can lead to healthier weight outcomes in toddlers. In both groups, an unhealthier lifestyle pattern was observed over 1 year which underlines the importance of the early childhood period as the focus of future behavioural interventions.

To identify the association of household food insecurity (HFI) with anthropometric status, the risk of vitamin A deficiency and anaemia, morbidities such as cough and fever, and hospitalizations for diarrhoea and pneumonia in children under 5 years old.

Cross-sectional study using data from the 2006 Brazilian Demographic and Health Survey. HFI was measured with the Brazilian Food Insecurity Measurement Scale (EBIA). Vitamin A deficiency and anaemia were assessed in blood samples. Child morbidities were reported by the child’s mother and included cough, fever, and hospitalizations for diarrhoea and pneumonia. Regression results were expressed as unadjusted and adjusted OR and corresponding 95 % CI for severe food insecurity, with statistical significance set at P<0·05.

Nationally representative survey.

Children (n 4064) under 5 years old.

There was no association between HFI and vitamin A deficiency, pneumonia, wasting or overweight. The prevalence of cough, fever, hospitalization for diarrhoea and stunting were associated with degree of HFI severity. There was a significant association of morbidities and stunting with severe food insecurity (v. food secure). After controlling for confounders, the association between severe food insecurity (v. food secure/rest of food insecurity categories) and the prevalence of common morbidities remained strong, showing that severely food-insecure children had a greater likelihood of experiencing cough (adjusted OR=1·79) and of being hospitalized for diarrhoea (adjusted OR=2·55).

Severe HFI was associated with cough and severe diarrhoea among Brazilian children.

Pregnancy is accompanied by profound alterations in thyroid economy and relative iodine deficiency. The aim of this study was to evaluate urinary iodine excretion of pregnant women in cities with adequate and more than adequate iodine intake.

A cross-sectional study was performed on schoolchildren and pregnant women in four cities in the Islamic Republic of Iran. Urinary iodine excretion was measured for 438 schoolchildren and 403 pregnant women. In addition, in Isfahan City, thyroid volume was measured by sonography for 30 pregnant women in each trimester of pregnancy and for 90 non-pregnant women who also had urinary iodine measurement.

Median urinary iodine of schoolchildren was 31.2, 25.0, 20.2 and 19.3 μg/dl in Rasht, Isfahan, Ilam and Tehran, respectively. Corresponding values for pregnant women were 33.8, 21.2, 19.0 and 18.6μg/dl. The percentage of pregnant women with urinary iodine below 20μg/dl was 16, 45, 55 and 54, and below 10μg/dl was 1, 7, 7 and 13, in Rasht, Isfahan, Ilam and Tehran, respectively. In Isfahan, urinary iodine was significantly decreased in the third trimester of pregnancy, compared with controls. Mean thyroid volume was 7.8±3.1 ml and 7.8±2.8 ml in pregnant and non-pregnant women, respectively.

Recommended values for dietary iodine through universal salt iodisation may not be adequate for pregnant women, and the specific problem of iodine and pregnancy should be considered further in the light of the latest recommendations.

The relationship of socio-economic status and vegetable consumption is examined in nine European countries. The aim is to analyse whether the pattern of socio-economic variation with regard to vegetable consumption is similar in all studied countries with high v. low vegetable availability and affordability, and whether education has an independent effect on vegetable consumption once the effects of other socio-economic factors have been taken into account.

The data for the study were obtained from national surveys conducted in Finland, Denmark, Germany, Estonia, Latvia, Lithuania, France, Italy and Spain, in 1998 or later. These surveys included data on the frequency of use of vegetables. Food Balance Sheets indicated that the availability of vegetables was best in the Mediterranean countries. The prices of vegetables were lowest in the Mediterranean countries and Germany.

Educational level was positively associated with vegetable consumption in the Nordic and Baltic countries. In the Mediterranean countries, education was not directly associated with the use of vegetables but, after adjusting for place of residence and occupation, it was found that those with a lower educational level consumed vegetables slightly more often. Manual workers consumed vegetables less often than non-manual workers, but otherwise there was no systematic association with occupation.

The Mediterranean countries did not show a positive association between educational level and vegetable consumption. The positive association found in the Northern European countries is linked to the lower availability and affordability of vegetables there and their everyday cooking habits with no long-standing cultural tradition of using vegetables.

To estimate the prevalence of and risk factors for vitamin D deficiency in young urban children in Auckland, New Zealand, where there is no routine vitamin D supplementation.

A random sample of urban children. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D <27·5 nmol/l (<11 ng/ml). Logistic regression analysis was used to calculate odds ratios and, from these, relative risks (RR) and 95 % confidence intervals were estimated.

Auckland, New Zealand (36°52′S), where the daily vitamin D production by solar irradiation varies between summer and winter at least 10-fold.

Children aged 6 to 23 months enrolled from 1999 to 2002.

Vitamin D deficiency was present in forty-six of 353 (10 %; 95 % CI 7, 13 %). In a multivariate model there was an increased risk of vitamin D deficiency associated with measurement in winter or spring (RR = 7·24, 95 % CI 1·55, 23·58), Pacific ethnicity (RR = 7·60, 95 % CI 1·80, 20·11), not receiving any infant or follow-on formula (RR = 5·69, 95 % CI 2·66, 10·16), not currently receiving vitamin supplements (RR = 5·32, 95 % CI 2·04, 11·85) and living in a more crowded household (RR = 2·36, 95 % CI 1·04, 4·88).

Vitamin D deficiency is prevalent in early childhood in New Zealand. Prevalence varies with season and ethnicity. Dietary factors are important determinants of vitamin D status in this age group. Vitamin D supplementation should be considered as part of New Zealand’s child health policy.

To develop a diet quality index (DQI) that assesses adherence to the Swedish nutrition recommendations (SNR) and the Swedish dietary guidelines (SDG).

A cross-sectional study within the Malmö Diet and Cancer (MDC) cohort. A diet history method collected dietary data, a structured questionnaire lifestyle and socio-economic information, and anthropometric data were collected by direct measurements. The index (DQI-SNR) included six components: SFA, PUFA, fish and shellfish, dietary fibre, fruit and vegetables, and sucrose.

Malmö, Sweden.

Men (n 4525) and women (n 8491) of the MDC cohort enrolled from September 1994 to October 1996.

For participants with high DQI-SNR scores, nutrient and food intakes were close to recommendations. However, most of the study population exceeded the recommended intake for SFA (98 %) and few reached recommended intakes for dietary fibre (24 %), fruit and vegetables (32 %), vitamin D (18 %) and folate (2 %). A high DQI-SNR score was positively associated with age, physical activity, not smoking, past food habit change, education and socio-economic status. Individuals with high scores were more likely to have a diabetes diagnosis or experienced a cardiovascular event.

Results suggest that the DQI-SNR is a useful tool for assessing adherence to the SNR 2005 and the SDG in the MDC cohort. No index has previously been developed with the aim of evaluating adherence to the current dietary recommendations in Sweden. Further validation of the DQI-SNR, and evaluation of its utility, is needed.

Pregnancy and postpartum iron status is of great public health importance, yet few studies have examined predictors of haemoglobin (Hb) concentration during this time. We identified predictors of Hb from 24 weeks' gestation until delivery and from 4 to 25 weeks postpartum.

Blood was drawn as many as four times during care: at the initial visit, at 24–29 weeks' gestation, at delivery and postpartum. A longitudinal, multivariable linear regression model was used to predict Hb concentration.

A public health clinic in Raleigh, North Carolina.

n = 520 women who participated in the Iron Supplementation Study.

Hb concentration at the previous blood draw, short stature, non-Hispanic white ethnicity/race, > 12 years of education and smoking were positive predictors of pregnancy and postpartum Hb concentrations. Iron supplement use was a positive predictor, while inadequate weight gain and severe nausea/vomiting were negative predictors of gestational Hb. A high infant birth weight and postpartum haemorrhage were negative predictors of postpartum Hb. Pre-pregnancy body mass index had a slight positive relationship with gestational Hb, but had a strong negative relationship with postpartum Hb. The longitudinal model also confirmed the typical pattern of gestational Hb concentration. As the number of weeks between the initial visit and the 24- to 29-week visit increased, Hb at 24–29 weeks' gestation decreased. As gestational age increased from 24 weeks until delivery, Hb concentration increased as well.

The predictors identified here could be used in clinical settings to target high–risk women for intervention.

To analyse the 5-year sustainability of a worksite canteen intervention of serving more fruit and vegetables (F&V).

Average F&V consumption per customer per meal per day was assessed in five worksite canteens by weighing F&V served and subtracting waste. Data were collected by the canteen staff during a 3-week continuous period and compared to data from the same five canteens measured at baseline, at end point and at 1-year follow-up. The intervention used a participatory and empowering approach, self-monitoring and networking among the canteen staff, management and a consultant. The method focused on providing ideas for increased F&V for lunch, making environmental changes in the canteens by giving access to tasteful and healthy food choices and reducing the availability of unhealthy options.

Five Danish worksites serving from 50 to 500 meals a day: a military base, an electronic component distributor, a bank, a town hall and a waste-handling facility.

Worksite canteen managers, canteen staff.

Four of the five worksite canteens were able to either maintain the intervention or even increase the consumption of F&V. The average increase from baseline to 5-year follow-up was 95 g per customer per meal per day (18, 144, 66, 105 and 141 g, respectively). On average, the five canteens at the long-term follow-up had an F&V consumption of 208 g/meal per customer.

The present study indicates that sustainability of F&V is possible in worksites where the participatory and empowering approach, self-monitoring, environmental change, dialogue with suppliers and networking among worksite canteens are applied.

To describe breakfast habits at food group level in European adolescents and to investigate the associations between these habits and sociodemographic factors.

Cross-sectional study.

Secondary schools from nine European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Breakfast habits were assessed twice using a computer-based 24 h dietary recall. Adolescents who consumed breakfast on at least one recall day were classified as ‘breakfast consumers’ and adolescents who did not have anything for breakfast on either of the two recall days were considered ‘breakfast skippers’. A ‘breakfast quality index’ to describe breakfast quality was created based on the consumption or non-consumption of cereals/cereal products, dairy products and fruits/vegetables. The sociodemographic factors studied were sex, age, region of Europe, maternal and paternal education, family structure and family affluence.

Adolescents (n 2672, 53 % girls) aged 12–17 years.

The majority of the adolescents reported a breakfast that scored poorly on the breakfast quality index. Older adolescents, adolescents from the southern part of Europe and adolescents from families with low socio-economic status were more likely to consume a low-quality breakfast.

The study highlights the need to promote the consumption of a high-quality breakfast among adolescents, particularly in older adolescents, adolescents from southern Europe and adolescents from families with low socio-economic status, in order to improve public health.

To validate an Arabic version of the Eating Attitude Test (EAT-26) and identify factors (such as depression, stress, anxiety and body dissatisfaction) that might be associated with disordered eating among a sample of the Lebanese population.

Cross-sectional study.

All Lebanese governorates.

A total of 811 participants randomly selected participated in this 5-month study (January–May 2018).

The EAT-26 scale items converged over a solution of six factors that had an eigenvalue over 1, explaining a total of 60·07 % of the variance (Cronbach’s α = 0·895). The prevalence of disordered eating attitudes was 23·8 %. Higher EAT-26 scores (disordered eating attitudes) were significantly associated with higher depression (β = 0·325), higher emotional eating (β = 0·083), daily weighing (β = 3·430), higher physical activity (β = 0·05), starving to reduce weight (β = 4·94) and feeling pressure from TV/magazine to lose weight (β = 3·95).

The Arabic version of EAT-26 can be a useful instrument for screening and assessing disordered eating attitudes in clinical practice and research. Some factors seem to be associated with more disordered eating attitudes among participants for whom psychological counseling may be needed. Yet, our findings are considered preliminary, and further studies are warranted to confirm them.

Intake and status of carotenoids have been associated with chronic disease. The objectives of this study were to examine the association between carotenoid intakes as measured by two regional food-frequency questionnaires (FFQs) and their corresponding measures in serum, and to report on dietary food sources of carotenoids in Jackson Heart Study (JHS) participants.

Cross-sectional analysis of data for 402 African American men and women participating in the Diet and Physical Activity Sub-Study (DPASS) of the JHS.

Mean serum carotenoid concentrations and intakes in this population were comparable to those reported for the general US population. After adjustment for covariates, correlations between serum and dietary measures of each carotenoid, for the average of the recalls (deattenuated), the short FFQ and the long FFQ, respectively, were: 0·37, 0·35 and 0·21 for α-carotene; 0·35, 0·26 and 0·28 for total (diet plus supplements) β-carotene; 0·25, 0·17 and 0·20 for dietary β-carotene; 0·42, 0·34 and 0·26 for β-cryptoxanthin; 0·33, 0·15 and 0·17 for lutein plus zeaxanthin; and 0·37, 0·19 and 0·14 for lycopene. Major dietary sources of α-carotene were orange vegetables; of β-carotene and lutein plus zeaxanthin, mustard, turnip and collard greens; of β-cryptoxanthin, orange juice; and of lycopene, tomato juice.

On average, carotenoid intakes and serum concentrations are not lower in this southern African American population than the general US population. The two regional FFQs developed for a southern US population and used as dietary assessment tools in the JHS appear to provide reasonably valid information for most of these carotenoids.

Despite the importance of cooking in modern life, public perceptions about what it means to cook are unknown. We aimed to examine perceptions of cooking and their association with cooking confidence, attitudes and behaviours in the USA.

We designed and fielded a nationally representative survey among US adults (n 1112) in April 2015. We used factor analysis to identify perceptions about cooking and multivariate ordered logit and Poisson models to explore associations between those perceptions and cooking confidence, attitudes and behaviours.

Nationally representative web-based survey of US adults.

US adults aged ≥18 years.

Americans conceptualized cooking in three ways: the use of scratch ingredients, convenience foods and not using heat. Respondents who perceived cooking as including convenience foods were less confident in their ability to cook from scratch (OR=0·52, P<0·001) and less likely to enjoy cooking (OR=0·68, P=0·01) than those who did not. Although individuals who perceived cooking as including only scratch ingredients reported cooking dinner (4·31 times/week) and using packaged/boxed products (0·95 times/week) the least frequently, few notable differences in the frequency of cooking meals were observed.

Cooking frequency is similar among US adults regardless of how they perceive cooking, but cooking confidence and enjoyment are lowest among Americans who perceive cooking as including the use of convenience foods. These insights should inform the development of more specific measures of cooking behaviour as well as meaningful and targeted public health messages to encourage healthier cooking.

Public health messages to reduce Hg exposure for pregnant women have focused exclusively on advice on fish consumption to limit Hg exposure, with little account being taken of the positive contribution of fish to nutritional quality. The aim of the present review was to compare and contrast the content and presentation of national guidelines on fish consumption in pregnancy, and comment on their evidence base and impact on consumption.

We searched for national and international guidelines on fish consumption in pregnancy using Internet search strategies. The detailed content and style of presentation of the guidelines were compared. The evidence base for the guidelines, and evidence for the impact of the guidelines on fish consumption levels, were assessed.

We identified nineteen national guidelines and three international guidelines. There was great variation in the content, complexity and presentation style. The guidelines were based largely on the Hg content of fish with far less consideration being given to the positive beneficial effects of nutrients provided by fish. The complexity of the guidelines may lead to pregnant women reducing their fish intake, or not eating fish at all.

Guidelines on fish consumption in pregnancy should take the beneficial effects of fish into account. Guidelines need to be clear and memorable, and appropriately disseminated, to achieve impact. Guidelines could include visual rather than narrative content. Use of technology, for example apps, could enable women to record their fish consumption in real time and log compliance with guidance over a week or other time period.

To assess the impact of a food-based intervention on blood pressure (BP) in free-living South African men and women aged 50–75 years, with drug-treated mild-to-moderate hypertension.

A double-blind controlled trial was undertaken in eighty drug-treated mild-to-moderate hypertensive subjects randomised to an intervention (n 40) or control (n 40) arm. The intervention was 8-week provision of six food items with a modified cation content (salt replacement (SOLO™), bread, margarine, stock cubes, soup mix and a flavour enhancer) and 500 ml of maas (fermented milk)/d. The control diet provided the same quantities of the targeted foods but of standard commercial composition and 500 ml/d of artificially sweetened cooldrink.

The intervention effect estimated as the contrast of the within-diet group changes in BP from baseline to post-intervention was a significant reduction of 6·2 mmHg (95 % CI 0·9, 11·4) for systolic BP. The largest intervention effect in 24 h BP was for wake systolic BP with a reduction of 5·1 mmHg (95 % CI 0·4, 9·9). For wake diastolic BP the reduction was 2·7 mmHg (95 % CI −0·2, 5·6).

Modification of the cation content of a limited number of commonly consumed foods lowers BP by a clinically significant magnitude in treated South African hypertensive patients of low socio-economic status. The magnitude of BP reduction provides motivation for a public health strategy that could be adopted through lobbying of the food industry by consumer and health agencies.

The present study aimed to evaluate the relationship between the consumption of selected food groups and insulin resistance, with an emphasis on sugar-sweetened beverages (SSB).

The present research is a large multicentre European study in adolescents, the HELENA-CSS (Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study).

Homeostasis model assessment–insulin resistance index (HOMA-IR) was calculated. Several anthropometric and lifestyle characteristics were recorded. Dietary assessment was conducted by using a short FFQ.

The participants were a subset of the original sample (n 546) with complete data on glucose, insulin and FFQ. All participants were recruited at schools.

Median (25th, 75th percentile) HOMA-IR was 0·62 (0·44, 0·87). Mean HOMA-IR was significantly higher among adolescents consuming brown bread ≤1 time/week than among those consuming 2–6 times/week (P = 0·011). Mean values of HOMA-IR were also higher in adolescents consuming SSB >5 times/week compared with those consuming less frequently, although a statistically significant difference was detected between those consuming SSB 5–6 times/week and 2–4 times/week (P = 0·049). Multiple linear regression analysis showed that only the frequency of SSB consumption was significantly associated with HOMA-IR after controlling for potential confounders. In particular, it was found that HOMA-IR levels were higher among adolescents consuming SSB 5–6 times/week and ≥1 time/d compared with those consuming ≤1 time/week by 0·281 and 0·191 units, respectively (P = 0·009 and 0·046, respectively).

The present study revealed that daily consumption of SSB was related with increased HOMA-IR in adolescents.

To measure the occurrence and correlates of hunger and to evaluate the association between hunger and three health indicators among undocumented Mexican immigrants.

Non-probability cross-sectional sample.

Neighbourhoods within New York City.

Four hundred and thirty-one undocumented Mexican immigrants living in the USA.

Hunger was indicated by approximately 28% of respondents. In a multivariate model, working as a day labourer was associated with hunger (odds ratio (OR) 3.33, 95% confidence interval (CI) 1.83–6.06) while receiving public assistance protected against hunger (OR 0.23, 95% CI 0.06–0.88). In multivariate models, respondents who reported experiencing hunger also reported poorer overall health (OR 1.69, 95% CI 0.95–3.02) and more days of poor mental (P = 0.045) and physical health (P < 0.0001). Greater amount of time lived in the USA was also associated with worse overall health (P = 0.054) and more days of poor mental and physical health (P < 0.01).

The present study shows that food insecurity and hunger may be problems among undocumented migrants living in the USA. Uncertain and unpredictable work schedules and limited access to public assistance may contribute to high levels of hunger, which in turn may also negatively affect mental and physical health. Increasing amount of time lived in the USA is also associated with poorer health indicators. Programmes that provide undocumented migrants with emergency access to resources may reduce food insecurity and lead to improved health outcomes among this vulnerable population.

Weight gained during pregnancy and postpartum weight retention might contribute to obesity in women of childbearing age. Whether breast-feeding (BF) may decrease postpartum weight retention (PPWR) is still controversial. The purpose of our systematic review and meta-analysis was to investigate the relationship between BF and PPWR.

Three databases were systematically reviewed and the reference lists of relevant articles were checked. Meta-analysis was performed to quantify the pooled standardized mean differences (SMD) of BF on PPWR by using a random-effect model. Heterogeneity was tested using the χ2 test and I2 statistics. Publication bias was estimated from Egger’s test (linear regression method) or Begg’s test (rank correlation method).

Among 349 search hits, eleven studies met the inclusion criteria for the meta-analysis. Seven studies were conducted in the USA, one in Brazil, one in France, one in Georgia and one in Croatia. Compared with formula-feeding, BF for 3 to ≤6 months seemed to have a negative influence on PPWR and if BF continued for >6 months had little or no influence on PPWR. In a subgroup meta-analysis, the results did not change substantially after the analysis had been classified by available confounding factors. There was no indication of a publication bias from the result of either Egger’s test or Begg’s test.

Although the available evidence held belief that BF decreases PPWR, more robust studies are needed to reliably assess the impact of patterns and duration of BF on PPWR.