To evaluate prevalence of vitamin D deficiency and its associated factors in southern Iranian children.

Cross-sectional study. Anthropometric and pubertal characteristics were assessed by a trained physician. Physical activity and sun exposure were evaluated using standard questionnaires. Body composition measurements were performed using dual-energy X-ray absorptiometry. Serum Ca, P alkaline phosphatase and 25-hydroxyvitamin D (25(OH)D) were assessed in all children. Statistical analysis was done using the statistical software package IBM SPSS Statistics 18·0.

Iranian children (n 477) aged 9–18 years.

Fars Province, Iran, 2011.

Of the children, 81·3 % were 25(OH)D deficient. There was no significant difference in 25(OH)D concentration between boys and girls (P=0·3). 25(OH)D concentration was associated with BMI (r=−0·1, P=0·02), pubertal status (r=−0·08, P=0·04) and sun exposure (r=0·10, P=0·04). Fat mass index was associated with 25(OH)D concentration (r=−0·13, P=0·03), but not lean mass index (P=0·86). In multiple regression analysis with adjustment for confounding factors, age and puberty were found to be independently associated with 25(OH)D concentration (P=0·008 and P=0·006); there was a significant correlation between exercise and 25(OH)D concentration after adjustment for either BMI (P=0·01) or fat mass index (P=0·02).

25(OH)D deficiency is highly prevalent among children in the south of Iran. It is related to insufficient sun exposure, low physical activity, advancing age and pubertal stage. Measures should be taken to improve the health of southern Iranian children in this critical age group by preventing 25(OH)D deficiency.

To describe self-reported physical activity (PA) patterns in the various domains (school, home, transport, leisure time) and intensity categories (walking, moderate PA, vigorous PA) in European adolescents. Furthermore, self-reported PA patterns were evaluated in relation to gender, age category, weight status category and socio-economic status (SES).

Cross-sectional study.

Ten European cities.

In total, 3051 adolescents (47·6 % boys, mean age 14·8 (sd 1·2) years) completed an adolescent-adapted version of the validated International Physical Activity Questionnaire.

The total sample reported most PA during leisure time (485 min/week) and least PA at home (140 min/week). Boys reported significantly more school-based PA (P < 0·001), leisure-time PA (P = 0·003), vigorous PA (P < 0·001) and total PA (P = 0·002) than girls, while girls reported more home-based PA (P < 0·001) and walking (P = 0·002) than boys. Self-reported PA at school (P < 0·001), moderate PA (P < 0·001), vigorous PA (P < 0·001) and total PA (P < 0·001) were significantly higher in younger age groups than in older groups. Groups based on weight status differed significantly only in leisure-time PA (P = 0·004) and total PA (P = 0·003), while groups based on SES differed in all PA domains and intensities except transport-related PA and total PA.

The total sample of adolescents reported different scores for the different PA domains and intensity categories. Furthermore, patterns were different according the adolescents’ gender, age, weight status and SES.

To investigate underlying causes for food and nutrition insecurity in black South African households and to gain understanding of the factors contributing to better nutrition security, with emphasis on household organisation, gender and intra-household dynamics and social networks.

Within a larger cross-sectional survey that investigated the impact of urbanisation on the health of black South Africans, 166 people, mostly women, were interviewed on household food security. Methods used were structured face-to-face interviews, in-depth interviews, observation, interviews with key informants and a sociodemographic questionnaire. Information was collected from 1998 to 2000 in 15 rural and urban areas of the North West Province, South Africa.

Three-quarters of households in this sample are chronically food-insecure. Families are disrupted, due to migrant work, poverty and increasing societal violence, and half of households are female-headed. Certain categories of female-headed households and households based on partnership relationships, despite more limited resources, achieve a better or an equal economic status and better nutrition security than those households led by men, with the latter often being considered an economic liability. The reliance on and fostering of social ties and networks appear to be of central significance.

Gender and intra-household relations, as well as social networks and income from informal sector activities, are often not uncovered by conventional statistical methods. Qualitative research can reveal the unexpected and furthermore empowers people, as their voices are heard.

The present study explored recipients’ perceptions of food charity and their suggested improvements in inner-city Perth, Western Australia.

In-depth interviews were conducted with charitable food service (CFS) recipients. Transcripts were thematically analysed using a phenomenological approach.

Interviews were conducted at two CFS in inner-city Perth.

Fourteen adults.

The recipients’ journeys to a reliance on CFS were varied and multifactorial, with poverty, medical issues and homelessness common. The length of time recipients had relied on food charity ranged from 8 months to over 40 years. Most were ‘grateful yet resigned’, appreciative of any food and resigned to the poor quality, monotony and their unmet individual preferences. They wanted healthier food, more variety and better quality. Accessing services was described as a ‘full-time job’ fraught with unreliable information and transport difficulties. They called for improved information and assistance with transport. ‘Eroded dignity’ resulted from being fed without any choice and queuing for food in public places, often in a volatile environment. ‘Food memories and inclusion’ reflected a desire for commensality. Recipients suggested services offer choice and promote independence, focusing on their needs both physical and social.

Although grateful, long-term CFS recipients described what constitutes a voluntary failure. Their service improvement recommendations can help meet their nutritional and social needs. A successful CFS provides a food service that prioritises nutritious, good-quality food and individual need, while promoting dignity and social inclusion, challenging in the current Australian context.

We aimed to assess the prevalence and associated factors of vitamin D deficiency in healthy adolescents and to determine parent–adolescent association in vitamin D status.

A cross-sectional study.

Data from the Korean National Health and Nutrition Examination Survey (KNHANES) 2008–2009. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured using 125I-labelled RIA kits. Vitamin D deficiency in adolescents was defined as 25(OH)D level <27·5 nmol/l, and 25(OH)D levels between 27·5 and <50 nmol/l were considered insufficient. For the parents, vitamin D deficiency was defined as 25(OH)D level <50 nmol/l.

The study population consisted of 2062 adolescents (1095 boys, 967 girls; aged 10–18 years) and their parents (1005 fathers, 1341 mothers).

Overall, 13·4 % of adolescents (boys 11·7 %, girls 15·4 %) were 25(OH)D deficient, 54·7 % were 25(OH)D insufficient. Prevalence of vitamin D deficiency increased with age (P < 0·0001). Parental vitamin D deficiency was more prevalent in vitamin D-deficient adolescents than in non-deficient adolescents (all P < 0·0001). In multivariate logistic regression analyses, predictors for vitamin D deficiency were senior high school students (OR = 3·45–4·33), winter/spring season (OR = 3·18–5·11/5·35–7·36) and parental vitamin D deficiency (OR = 1·78–4·88; all P < 0·05).

Vitamin D insufficiency is prevalent among healthy Korean adolescents and the parent–offspring association warrants vitamin D screening for family members of deficient individuals.

Evidence suggests that improvements to the childcare nutrition environment can have a positive impact on child dietary intake. The primary aim of the present study was to assess, relative to usual care, the effectiveness of a multi-strategy implementation intervention in improving childcare compliance with nutrition guidelines. As a secondary aim, the impact on child dietary intake was assessed.

Parallel-group, randomised controlled trial design. The 6-month intervention was designed to overcome barriers to implementation of the nutrition guidelines that had been identified by applying the theoretical domains framework.

Hunter New England region, New South Wales, Australia.

Forty-five centre-based childcare services.

There were no differences between groups in the proportion of services providing food servings (per child) compliant with nutrition guideline recommendations for all five (5/5) food groups at follow-up (i.e. full compliance). Relative to control services, intervention services were more likely to be compliant with guidelines (OR; 95 % CI) in provision of fruit (10·84; 1·19, 551·20; P=0·0024), meat and meat alternatives (8·83; 1·55, –; P=0·023), dairy (8·41; 1·60, 63·62; P=0·006) and discretionary foods (17·83; 2·15, 853·73; P=0·002). Children in intervention services consumed greater servings (adjusted difference; 95 % CI) of fruit (0·41; 0·09, 0·73; P=0·014) and vegetables (0·70; 0·33, 1·08; P<0·001).

Findings indicate that service-level changes to menus in line with dietary guidelines can result in improvements to children’s dietary intake. The study provides evidence to advance implementation research in the setting as a means of enhancing child public health nutrition.

Universal interventions may widen or narrow inequalities if disproportionately effective among higher or lower socio-economic groups. The present paper examines impacts of the Primary School Free Breakfast Initiative in Wales on inequalities in children's dietary behaviours and cognitive functioning.

Cluster-randomised controlled trial. Responses were linked to free school meal (FSM) entitlement via the Secure Anonymised Information Linkage databank. Impacts on inequalities were evaluated using weighted school-level regression models with interaction terms for intervention × whole-school percentage FSM entitlement and intervention × aggregated individual FSM entitlement. Individual-level regression models included interaction terms for intervention × individual FSM entitlement.

Fifty-five intervention and fifty-six wait-list control primary schools.

Approximately 4500 children completed measures of dietary behaviours and cognitive tests at baseline and 12-month follow-up.

School-level models indicated that children in intervention schools ate a greater number of healthy items for breakfast than children in control schools (b = 0·25; 95 % CI 0·07, 0·44), with larger increases observed in more deprived schools (interaction term b = 1·76; 95 % CI 0·36, 3·16). An interaction between intervention and household-level deprivation was not significant. Despite no main effects on breakfast skipping, a significant interaction was observed, indicating declines in breakfast skipping in more deprived schools (interaction term b = −0·07; 95 % CI −0·15, −0·00) and households (OR = 0·67; 95 % CI 0·46, 0·98). No significant influence on inequality was observed for the remaining outcomes.

Universal breakfast provision may reduce socio-economic inequalities in consumption of healthy breakfast items and breakfast skipping. There was no evidence of intervention-generated inequalities in any outcomes.

To examine dietary change that has occurred over 5 to 6 years.

A cohort of Scottish women (n=898) with a mean age of 47.5 years (range 45–54 years) at baseline.

Dietary intake was assessed by validated food-frequency questionnaire (FFQ) and analysed using the UK Composition of Foods database.

Since the first dietary assessment, mean daily energy intake had decreased from 8.2±2.3 to 7.9±2.2 MJ. The degree of low energy reporting (defined as ratio of energy intake to basal metabolic rate >1.1) had increased from 18.7% at baseline to 25.6% at follow-up. Low energy reporters were significantly heavier than ‘normal’ energy reporters (mean weight at follow-up, 68.9±12.6 vs. 66.8±11.3 kg) and could be deliberately restricting intake rather than underreporting. Overall there were decreases in intakes of red meat, processed meat and cheese, but increases in poultry and non-oily fish consumption. Consumption of bread, biscuits and cakes had gone down and there was an increase in cereal and rice/pasta consumption. Intake of potatoes had decreased whereas fruit intake had increased. There were small but statistically significant differences in intakes for most nutrients (>8% change). Nutrient intakes at both visits were similar across menopausal status and usage groups of hormone replacement therapy. Modifications to the computer version of the McCance and Widdowson nutrient database, which differed from the published version, were noted. These changes altered the original baseline values for our study.

The menopause per se is not a period of marked change in nutrient intake. Caution is advised when using computer databases of food compositions for longitudinal studies.

To develop policy and public health recommendations for implementation at all levels by individuals and organisations working in, or related to, the field of breast-feeding promotion in developed country settings, where breast-feeding rates remain low.

Two research phases, comprising (i) an assessment of the formal evidence base in developed country settings and (ii) a consultation with UK-based practitioners, service managers and commissioners, and representatives of service users. The evidence base included three systematic reviews and an Evidence Briefing. One hundred and ten studies evaluating an intervention in developed country settings were assessed for quality and awarded an overall quality rating. Studies with a poor quality rating were excluded. The resulting seventy studies examined twenty-five types of intervention for breast-feeding promotion. These formed the basis of the second consultation phase to develop the evidence-based interventions into recommendations for practice, which comprised (i) pilot consultation, (ii) electronic consultation, (iii) fieldwork meetings and (iv) workshops. Draft findings were synthesised for two rounds of stakeholder review conducted by the National Institute for Health and Clinical Excellence.

Twenty-five recommendations emerged within three complementary and necessary categories, i.e. public health policy, mainstream clinical practice and local interventions.

The need for national policy directives was clearly identified as a priority to address many of the barriers experienced by practitioners when trying to work across sectors, organisations and professional groups. Routine implementation of the WHO/UNICEF Baby Friendly Initiative across hospital and community services was recommended as core to breast-feeding promotion in the UK. A local mix of complementary interventions is also required.

Little is known about the relationship of monetary diet costs to dietary intake and obesity, particularly in non-Western populations. This study examined monetary cost of dietary energy in relation to diet quality and body mass index (BMI) among young Japanese women.

Dietary intake was assessed by a validated, self-administered, diet history questionnaire. Diet costs were estimated using retail food prices. Monetary cost of dietary energy (Japanese yen 1000 kcal−1) was then calculated. BMI was computed from self-reported body weight and height.

A total of 3931 female Japanese dietetic students aged 18–20 years.

Monetary cost of dietary energy was positively associated with intakes of fruits, vegetables, fish and shellfish, and pulses; however, higher monetary cost of dietary energy was also associated with higher consumption of fat and oil, meat and energy-containing beverages, and lower consumption of cereals (rice, bread and noodles) (all P for trend <0.01). At the nutrient level, monetary cost of dietary energy was positively associated with intakes of dietary fibre and key vitamins and minerals, but also associated positively with intakes of fat, saturated fatty acids, cholesterol and sodium, and negatively with carbohydrate intake (all P for trend <0.0001). After adjustment for possible confounders, monetary cost of dietary energy was quite weakly but significantly negatively associated with BMI (P for trend = 0.0197).

Increasing monetary cost of dietary energy was associated with both favourable and unfavourable dietary intake patterns and a quite small decrease in BMI in young Japanese women.

To describe the burden, clinical characteristics and prognostic factors of severe malnutrition in children under the age of 5 years.

Retrospective study of hospital-based data systematically collected from January 2001 to December 2010.

Rural Mozambican district hospital.

All children aged <5 years admitted with severe malnutrition.

During the 10-year long study surveillance, 274 813 children belonging to Manhiça's Demographic Surveillance System were seen at out-patient clinics, almost half of whom (47 %) presented with some indication of malnutrition and 6 % (17 188/274 813) with severe malnutrition. Of these, only 15 % (2522/17 188) were eventually admitted. Case fatality rate of severe malnutrition was 7 % (162/2274). Bacteraemia, hypoglycaemia, oral candidiasis, prostration, oedema, pallor and acute diarrhoea were independently associated with an increased risk of in-hospital mortality, while malaria parasitaemia and breast-feeding were independently associated with a lower risk of a poor outcome. Overall minimum community-based incidence rate was 15 cases per 1000 child-years at risk and children aged 12–23 months had the highest incidence.

Severe malnutrition among admitted children in this Mozambican setting was common but frequently went undetected, despite being associated with a high risk of death. Measures to improve its recognition by clinicians responsible for the first evaluation of patients at the out-patient level are urgently needed so as to improve their likelihood of survival. Together with this, the rapid management of complications such as hypoglycaemia and concomitant co-infections such as bacteraemia, acute diarrhoea, oral candidiasis and HIV/AIDS may contribute to reverse the intolerable toll that malnutrition poses in the health of children in rural African settings.

Previous studies in China showed large sex differences in childhood overweight and obesity (OW/OB) rates. However, limited research has examined the cause of these sex differences. The present study aimed to examine individual and parental/familial factors associated with sex differences in childhood OW/OB rates in China.

Variables associated with child weight status, beliefs and behaviours, and obesity-related parenting practices were selected to examine their sex differences and association with a sex difference in child OW/OB outcomes using logistic regression analysis.

Cross-sectional data analysis using the 2011 China Health and Nutrition Survey.

Children aged 6–17 years (n 1544) and their parents.

Overall child OW/OB prevalence was 16·8 %. Adolescent boys (AB; 12–17 years) were about twice as likely to be overweight/obese as adolescent girls (AG; 15·5 v. 8·4 %, P<0·05). AB more likely had energy intake exceeding recommendations, self-perceived underweight, underestimated their body weight and were satisfied with their physical activity level than AG. AG more likely practised weight-loss management through diet and self-perceived overweight than AB. Mothers more likely identified AG’s weight accurately but underestimated AB’s weight. Stronger associations with risk of childhood OW/OB were found in boys than girls in dieting to lose weight (OR=6·7 in boys v. 2·6 in girls) and combined maternal and child perception of the child’s overweight (OR=35·4 in boys v. 14·2 in girls).

Large sex differences in childhood obesity may be related to the sex disparities in weight-related beliefs and behaviours among children and their parents in China.

To assess the relationship(s) between overall and within-food group diversity and several indices of dietary quality, such as dietary adequacy, moderation and balance, in Belgian adults. Dietary quality indices were derived from the food-based dietary guidelines (FBDG).

Information on food intake was collected with two 24 h recalls.

Average overall and within-food group diversity scores and dietary adequacy, moderation and balance scores were calculated.

A representative sample (n 3245) of the Belgian population at the age of 15 years and older was randomly selected from the National Register using a multistage stratified procedure.

For both men and women, total dietary diversity score increased with age and smokers had a significantly lower overall diversity score than non- or former smokers. A positive association was found between overall dietary diversity and both dietary adequacy and balance. For most food groups, especially bread and cereals, vegetables, dairy products and spreadable fats, within-food group dietary diversity was positively associated with the fulfilment of the specific recommendation for the intake of that food group. An inverse association was found between dietary diversity within the meat and the energy-dense, nutrient-poor food groups and dietary balance. Diversity within the dairy and spreadable fat group was responsible for the strongest increase in overall dietary adequacy and balance.

Overall dietary diversity is a useful indicator of dietary quality in Belgium. For some food groups, within-food group dietary diversity is a useful indicator of compliance with the specific FBDG for intake of that food group.

Despite widespread concern over exploitation of the European Union's fish stocks, dietary guidelines in the UK continue to recommend two portions of fish per week. The present study sought to investigate whether health and/or sustainability are motivating factors when purchasing and consuming fish and whether there are sociodemographic trends.

A structured, self-completion postal questionnaire exploring consumers’ attitudes towards purchasing fish, their dietary intake, stated purchasing behaviour and sociodemographic information.

Nottinghamshire, UK.

Adults from 842 households randomly selected from the electoral register.

Over half of the participants (57·0 %) were aware of the health benefits of fish consumption and reported health as a primary motivator for purchasing fish; however, only 26·8 % actively sought to purchase fish from a sustainable source (e.g. Marine Stewardship Council (MSC) certified fish). Only 30·6 % of participants met current dietary recommendations for fish intake. Older respondents (>60 years of age) were more likely to report purchasing fish for health reasons and to buy MSC fish. Participants were significantly less likely to report MSC purchases if they agreed with the statement ‘I am confused about which type of fish I should be eating to protect fish stocks’ (P < 0·001).

The number of consumers purchasing fish for health reasons was more than those seeking sustainably sourced fish; yet, they still failed to meet the recommended intake set by the Food Standards Agency. Dietary advice to the public to increase consumption of fish conflicts with the prevailing pressure on fish stocks. Clear advice should be communicated enabling consumers to meet nutritional needs while protecting fish stocks.

The prevalence of maternal anaemia remains unacceptably high in developing countries. At the same time, the percentage of women who consume one or more Fe+folic acid (IFA) tablets during pregnancy remains persistently low. The objective of the present study was to identify where, within antenatal care (ANC) programmes, pregnant women falter in obtaining and consuming an ideal minimum of 180 IFA tablets.

Data from Demographic and Health Surveys were used to develop a schematic which identifies four sequential ‘falter points’ to consuming 180 IFA tablets: ANC attendance, IFA receipt or purchase, IFA consumption and the number of tablets consumed.

Twenty-two countries with high burdens of undernutrition.

A sample of 162 958 women, 15 to 49 years of age, with a live birth in the past 5 years.

Across all countries, 83 % of all pregnant women had at least one ANC visit, 81 % of whom received IFA tablets. Of those receiving IFA tablets, 95 % consumed at least one. Overall adherence to the ideal supplementation regimen, however, was extremely low: only 8 % consumed 180 or more IFA tablets. There were only two countries in which the percentage of pregnant women consuming 180 or more tablets exceeded 30 %.

While most women receive and take some IFA tablets, few receive or take enough. The analysis identifies where ANC-based distribution of IFA falters in each country. It enables policy makers to design and prioritize follow-up activities to more precisely identify barriers, an essential next step to improving IFA distribution through ANC.

To evaluate the impact of a low-cost nutritional intervention in changing the lifestyle of adults.

Randomised clinical trial.

Primary health-care centre in São José do Rio Preto, São Paulo State, Brazil.

We randomly assigned 104 adults (83 women and 21 men aged 30–65 years, body mass index 24–35 kg m−2, non-diabetic) into two groups: nutrition counselling and control. Each subject in the intervention group received three individualised nutritional counselling sessions during the first 6 months aimed at increasing intakes of fruits, vegetables and olive oil, reducing saturated fat and improving physical activity. Body composition, biochemical indicators and lifestyle were assessed at baseline and at 6 months and 1 year in both groups.

After 6 months of follow-up, body weight, waist circumference, diastolic blood pressure, fasting blood glucose, total and low-density lipoprotein cholesterol, total and saturated fat, and dietary energy and cholesterol levels showed a more significant decrease among subjects in the intervention group than in the control group (P<05). Moreover, the intervention group showed significantly greater improvement in each intervention goal, such as reduced intake of saturated fat and increased intakes of fruits, vegetables, fibre and olive oil (P<0.05). After 12 months of follow-up, most of the outcomes were maintained.

The low-cost nutritional intervention programme improved serum lipids profile and weight control, and appeared to be feasible for use at a primary health-care centre in a developing country.

Little is known about customer purchases of foods and beverages from small and non-traditional food retailers (i.e. corner stores, gas-marts, dollar stores and pharmacies). The present study aimed to: (i) describe customer characteristics, shopping frequency and reasons for shopping at small and non-traditional food retailers; and (ii) describe food/beverage purchases and their nutritional quality, including differences across store type.

Data were collected through customer intercept interviews. Nutritional quality of food/beverage purchases was analysed; a Healthy Eating Index-2010 (HEI-2010) score for purchases was created by aggregating participant purchases at each store.

Small and non-traditional food stores that were not WIC-authorized in Minneapolis and St. Paul, MN, USA.

Customers (n 661) from 105 food retailers.

Among participants, 29 % shopped at the store at least once daily; an additional 44 % shopped there at least once weekly. Most participants (74 %) cited convenient location as the primary draw to the store. Customers purchased a median of 2262 kJ (540 kcal), which varied by store type (P=0·04). The amount of added sugar far surpassed national dietary recommendations. At dollar stores, participants purchased a median of 5302 kJ (1266 kcal) for a median value of $US 2·89. Sugar-sweetened beverages were the most common purchase. The mean HEI-2010 score across all stores was 36·4.

Small and non-traditional food stores contribute to the urban food environment. Given the poor nutritional quality of purchases, findings support the need for interventions that address customer decision making in these stores.

To determine the impact of contaminant iron and geophagy on iron intake and status of persons living in developing countries.

Literature for review was identified by searching Medline and Agricola, from appropriate other texts and from three reports from the Opportunities for Micronutrient Interventions (OMNI) Project of USAID.

The dietary intake of iron by people living in developing countries is generally high but iron deficiency remains prevalent. This apparent paradox is because the iron being consumed is predominantly in the non-haem form, which is poorly absorbed. Some of this non-haem iron is from contamination of food with iron from soil, dust and water; iron leaching into food during storage and cooking; contamination during food processing such as milling; and the practice of geophagy.

Although the contribution of contaminant iron to overall iron intake is well documented, its absorption and thus its impact on iron status is not. To be available for absorption, contaminant iron must join the common non-haem pool, i.e. be exchangeable. The absorption of exchangeable contaminant iron is subject to the same interactions with other constituents in the diet as the non-haem iron that is intrinsic to food. The limited available evidence suggests wide variation in exchangeability. In situations where a significant fraction of the contaminating iron joins the pool, the impact on iron status could be substantial. Without a simple method for predicting exchangeability, the impact of contaminant iron on iron status in any particular situation is uncertain.

Interventions known to increase the absorption of iron intrinsic to foods will also increase absorption of any contaminant iron that has joined the common pool. Any positive effect of geophagy resulting from an increased intake of iron is highly unlikely, due to inhibiting constituents contained in soils and clays. The efficacy of approaches designed to increase the intake of contaminant iron remains encouraging but uncertain. An approach using multiple interventions will continue to be essential to reduce iron deficiency anaemia.

Undernutrition and anaemia (the commonest micronutrient deficiency), continue to remain prevalent and persistent in sub-Saharan Africa (SSA) alongside a rising prevalence of overweight and obesity. However, there has been little research on the co-existence of all three conditions in the same household in recent years. The current study examines the co-existence and correlates of the different conditions of household burden of malnutrition in the same household across SSA.

The study involved twenty-three countries across SSA who conducted Demographic and Health Surveys between 2008 and 2017.

The analytical sample includes 145 020 households with valid data on the nutritional status of women and children pairs (i.e. women of reproductive age; 15–49 years and children under 5 years).

Logistic regression analyses were used to determine household correlates of household burden of malnutrition.

Anaemia was the most common form of household burden of malnutrition, affecting about seven out of ten households. Double and triple burden of malnutrition, though less common, was also found to be present in 8 and 5 % of the households, respectively. The age of the household head, location of the household, access to improved toilet facilities and household wealth status were found to be associated with various conditions of household burden of malnutrition.

The findings of the current study reveal that both double and triple burden of malnutrition is of public health concern in SSA, thus nutrition and health interventions in SSA must not be skewed towards addressing undernutrition only but also address overweight/obesity and anaemia.

To determine whether responses to simple dietary questions are associated with specific causes of death.

Self-reported frequency intakes of various classes of foods and data on confounding factors were collected at the baseline survey. Death notifications up to 31 December 1997 were ascertained from the Office for National Statistics. Relative risk (RR) of death and 95% confidence intervals (CI) associated with baseline dietary factors were calculated by Cox regression.

Prospective follow-up study based on five UK general practices.

Data were used from 11 090 men and women aged 35–64 years (81% of the eligible patient population) who responded to a postal questionnaire in 1989.

After 9 years of follow-up, 598 deaths were recorded, 514 of these among the 10 522 subjects with no previous history of angina. All-cause mortality was positively associated with age, smoking and low social class, as expected. Among the dietary variables, all-cause mortality was significantly reduced in participants who reported relatively high consumption of vegetables, puddings, cakes, biscuits and sweets, fresh or frozen red meat (but not processed meat), among those who reported using polyunsaturated spreads and among moderate alcohol drinkers. These associations were broadly similar for deaths from ischaemic heart disease (IHD), cancer and all other causes combined, and were not greatly attenuated by adjusting for potential confounding factors including social class.

Responses to simple questions about nutrition were associated with mortality. These findings must be interpreted with caution since residual confounding by dietary and lifestyle factors may underlie the associations.