Most children do not meet the recommended intake of vegetables. Variety was identified as a potential factor to increase children's intake of these foods, as it was shown that variety was effective in improving meal composition in adults. Because younger children are suggested to be more responsive to internal satiation signals than to external food-related cues compared with adults, it is not clear whether variety is effective to improve meal composition in 7- to 10-year-old children.

Experiment.

Children were assigned one of three different fake food buffets containing pasta, chicken, and either one vegetable (carrots or beans) or two vegetables (carrots and beans). The children were asked to serve themselves a meal that they would like to eat for lunch from the given selection.

One hundred children (fifty-two boys; mean age 8·8 (sd 1·1) years).

Children given the two-vegetable choice served themselves significantly more energy from vegetables (mean 64 (sd 51) kJ, 10·9 (sd 9·4) %) compared with children who were offered only either carrots (mean 37 (sd 25) kJ, 5·9 (sd 6·5) %) or beans (mean 38 (sd 34) kJ, 5·6 (sd 6·3) %). The total energy of the meal was not increased, indicating that children chose a more balanced lunch when offered more vegetables.

School-aged children are responsive to food-related cues and variety is effective in increasing their vegetable choice. Serving an assortment of vegetables in school cafeterias might be a simple and effective strategy to improve children's nutrition.

To examine the opinions of stakeholders on strategies to improve dietary quality of Supplemental Nutrition Assistance Program (SNAP) participants.

Participants answered a thirty-eight-item web-based survey assessing opinions and perceptions of SNAP and programme policy changes.

USA.

Survey of 522 individuals with stakeholder interest in SNAP, conducted in October through December 2011.

The top three barriers to improving dietary quality identified were: (i) unhealthy foods marketed in low-income communities; (ii) the high cost of healthy foods; and (iii) lifestyle challenges faced by low-income individuals. Many respondents (70 %) also disagreed that current SNAP benefit levels were adequate to maintain a healthy diet. Stakeholders believed that vouchers, coupons or monetary incentives for purchasing healthful foods might have the greatest potential for improving the diets of SNAP participants. Many respondents (78 %) agreed that sodas should not be eligible for purchases with SNAP benefits. More than half (55 %) believed retailers could easily implement such restrictions. A majority of respondents (58 %) agreed that stores should stock a minimum quantity of healthful foods in order to be certified as a SNAP retailer, and most respondents (83 %) believed that the US Department of Agriculture should collect data on the foods purchased with SNAP benefits.

Results suggest that there is broad stakeholder support for policies that align SNAP purchase eligibility with national public health goals of reducing food insecurity, improving nutrition and preventing obesity.

Dietary questionnaires for assessing dietary intakes among populations of individuals aged 80 years or older (the very old) are very limited. We examined the relative validity of forty-three nutrients and twenty-seven food groups estimated by a brief-type self-administered diet history questionnaire (BDHQ) targeting very old Japanese, using semi-weighed dietary records (DR) as a reference.

Between June and August 2012 and between June 2015 and February 2016, a three-day non-consecutive DR (at two-week intervals) and a BDHQ were completed.

Tokyo, the capital prefecture of Japan.

Eighty very old Japanese (thirty-six men and forty-four women) aged 82–94 years.

The median intakes of 40–70 % of the crude and energy-adjusted nutrients estimated by the BDHQ were significantly different from those estimated by the DR. The median Spearman’s correlation coefficient of nutrient intakes between the BDHQ and the DR was 0·39–0·46. About half (48–56 %) of the food groups were significantly different in terms of the median intakes estimated by the BDHQ and the DR in crude and energy-adjusted values. The median Spearman’s correlation coefficient between the BDHQ and the DR was 0·45–0·48.

Acceptable Spearman’s correlations (≥0·3) were obtained for many dietary intakes among the very old Japanese population. The BDHQ is a good candidate for epidemiological studies among very old Japanese, although, for some nutrients and food groups, the difficulty of estimating accurate median intakes is one of the limitations for the tool. Further efforts to enhance the validity of the BDHQ for very old populations are needed.

The purpose of this impact evaluation was to measure the influence of a government of Ontario, Canada health promotion initiative, the Northern Fruit and Vegetable Pilot Programme (NFVPP), on elementary school-aged children’s psychosocial variables regarding fruit and vegetables, and fruit and vegetable consumption patterns.

A cluster-randomised controlled trial design was used. The NFVPP consisted of three intervention arms: (i) Intervention I: Free Fruit and Vegetable Snack (FFVS) + Enhanced Nutrition Education; (ii) Intervention II: FFVS-alone; and (iii) Control group. Using the Pro-Children Questionnaire, the primary outcome measure was children’s fruit and vegetable consumption, and the secondary outcome measures included differences in children’s awareness, knowledge, self-efficacy, preference, intention and willingness to increase fruit and vegetable consumption.

Twenty-six elementary schools in a defined area of Northern Ontario were eligible to participate in the impact evaluation. A final sample size of 1277 students in grades five to eight was achieved.

Intervention I students consumed more fruit and vegetables at school than their Control counterparts by 0·49 serving/d (P < 0·05). Similarly, Intervention II students consumed more fruit and vegetables at school than Control students by 0·42 serving/d, although this difference was not statistically significant. Among students in both intervention groups, preferences for certain fruit and vegetables shifted from ‘never tried it’ towards ‘like it’.

The NFVPP resulted in positive changes in elementary school-aged children’s fruit and vegetable consumption at school, and favourable preference changes for certain fruit and vegetables.

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.

To investigate barriers to increasing fruit and vegetable (f + v) intakes in a large sample of the older population of Northern Ireland (NI), in relation to current intakes.

The study was conducted using a telephone survey assessing f + v intakes, barriers to increasing intakes and various demographic and lifestyle characteristics. Barriers to increasing intakes were investigated using twenty-two closed-response items and one open-response item.

NI.

Four hundred and twenty-six older people from NI, representative of the older population of NI.

Principal component analysis of the twenty-two closed-response items revealed five factors affecting f + v consumption. Significant associations with current intakes were found where greater f + v consumption was associated with greater ‘liking’ for f + v (B = 0·675, P < 0·01), greater ‘awareness of current recommendations’ for consumption (B = 0·197, P < 0·01) and greater ‘willingness to change’ (B = 0·281, P < 0·01). ‘Ease of consumption’ and ‘difficulties in achieving consumption’ were not associated with f + v intakes. Similar associations between f + v intakes and ‘liking’ and ‘awareness’ were also found in those consuming low intakes of f + v or those at risk of consuming low intakes. Low awareness and knowledge of recommendations were also found in response to the open-ended question in all groups, although some weight was also given here to environmental difficulties, such as cost and access.

These findings suggest that interventions aiming to increase f + v intakes in the older population of NI should focus predominantly on improving liking and improving knowledge and awareness of current recommendations.

To measure the occurrence and correlates of food insufficiency among HIV-infected crack-cocaine users in Atlanta and Miami, USA.

Non-probability cross-sectional sample.

Inner-city hospitals in Atlanta and Miami.

Two hundred and eighty-seven HIV-infected crack users.

One-third (34 %) of respondents experienced food insufficiency within 30 d of interview. Increased odds of food insufficiency was associated with current homelessness (adjusted OR = 3·78, 95 % CI 1·70, 8·41), living alone (adjusted OR = 2·85, 95 % CI 1·36, 5·98), religious service attendance (adjusted OR = 2·34, 95 % CI 1·02, 5·38) and presence of health insurance (adjusted OR = 2·41, 95 % CI 1·06, 5·54). Monthly income greater than $US 600 (adjusted OR = 0·19, 95 % CI 0·06, 0·58) was associated with decreased odds of food insufficiency, and less than weekly crack use was marginally associated with decreased odds of food insufficiency (adjusted OR = 0·39, 95 % CI 0·13, 1·08).

Food insufficiency is very prevalent among HIV-infected urban crack-cocaine users in Atlanta and Miami. Correlates of food insufficiency confirm the social vulnerability of these individuals. Routine assessment for food insecurity should become a routine component of treatment and prevention programmes in at-risk populations.

To explore consumer trust in food, especially people’s experiences that support or diminish trust in the food supply; consumer practices to strengthen trust in food; and views on how trust in the food supply could be increased.

Adelaide, South Australia.

In-depth qualitative research interviews and focus groups.

Women and men who are primary food providers in families (n = 24).

Media coverage of food scares and scandals and personal experience of food-borne illness challenged respondents’ trust in the food system. Poor retail food handling practices and questionable marketing ploys by food manufacturers also decreased trust. Buying ‘Made-in-Australia’ produce and following food safety procedures at home were important practices to strengthen food trust. Knowledge of procedures for local food inspection and for national food regulation to keep food safe was scanty. Having a strong regulatory environment governing food safety and quality was considered by respondents to be of prime importance for trust building.

The dimensions of trust found in this study are consistent with key theoretical aspects of trust. The need for trust in highly complex environments, in this case the food supply, was evident. Trust was found to be integral to food choice, and negative media reports, the sources of which themselves enjoy various levels of dependability, were found to easily damage trust relationships. The lack of visibility of authoritative monitoring and surveillance, misleading food advertising, and poor retail food handling practices were identified as areas that decreased consumer trust. Respondents also questioned the probity of food labelling, especially health claims and other mechanisms designed to guide food choice. The research highlights the role trust plays in food choice. It also emphasises the importance of a visible authoritative presence in the food system to strengthen trust and provide reassurance to consumers.

To compare vitamin B6 status indices with each other and with potential confounding factors, in the datasets from two national British surveys and associated studies.

Vitamin B6 status was measured by plasma pyridoxal phosphate (PLP) and plasma pyridoxic acid (PA) in both surveys, and also by erythrocyte aspartate aminotransferase activation coefficient (EAATAC) in one of the surveys. Plasma α1-antichymotrypsin was measured as an index of acute phase status; plasma creatinine was measured as an index of renal function; and plasma total alkaline phosphatase activity was measured as a proxy for PLP hydrolase activity.

The survey of people aged 65 years and over was carried out in 80 postcode sectors across mainland Britain during 1994–95 and the survey of young people was carried out in 132 postcode sectors across mainland Britain during 1997.

Blood samples from c. 1000 subjects of both sexes in each survey permitted measurements of plasma PLP and PA. There were also measurements of EAATAC in the young people's survey.

According to published limits of normality, only 5% or less of the young people had unacceptable vitamin B6 status as measured by plasma PLP. About half had apparently unacceptable status by EAATAC, but this observation is difficult to interpret. The young people had considerably higher plasma concentrations of PLP and lower concentrations of PA than the older people. In both surveys, plasma PLP was strongly correlated with plasma PA and in the young persons’ survey it was also correlated, although much less strongly, with the basal activity and activation coefficient of aspartate aminotransferase. Both plasma PLP and EAATAC (but not PA nor basal aspartate aminotransferase activity) were influenced by acute phase status in young people, as indicated by significant correlations with α1-antichymotrypsin. In people aged 65 years and over, PA (but not PLP) was correlated with renal function, as indicated by its relation with plasma creatinine; however PLP (but not PA) was correlated with plasma alkaline phosphatase activity.

Several potential confounders — acute phase reaction, kidney malfunction and hydrolase activity — may influence vitamin B6 status indices, although differently for different indices and different age groups. Since older people have relatively poor vitamin B6 status, which may have important health implications for them, more reliable vitamin B6 status indices are needed.

To assess the consumption of ultra-processed foods and its association with the overall dietary content of nutrients related to non-communicable diseases (NCD) in the Chilean diet and to estimate the population attributable fraction of ultra-processed food consumption on the unhealthy nutrient content.

Cross-sectional analysis of dietary data collected through a national survey (2010).

Chile.

Chilean population aged ≥2 years (n 4920).

In Chile, ultra-processed foods represented 28·6 % of the total energy intake. A significant positive association was found between the dietary share of ultra-processed foods and NCD-promoting nutrients such as dietary energy density (standardised regression coefficient (β) = 0·22), content of free sugars (β = 0·45), total fats (β = 0·26), saturated fats (β = 0·19), trans fats (β = 0·09) and Na:K ratio (β = 0·04), while a significant negative association was found with the content of NCD-protective nutrients such as K (β = –0·19) and fibre (β = –0·31). The content of Na (β = 0·02) presented no significant association. Except for Na, the prevalence of inadequate intake of all nutrients (WHO recommendations) increased across quintiles of the dietary share of ultra-processed foods. With the reduction of ultra-processed foods consumption to the level seen among the 20 % lowest consumers (3·8 % (0–9·3 %) of the total energy from ultra-processed foods), the prevalence of nutrient inadequacy would be reduced in almost three-fourths for trans fats; in half for energy density (foods); in around one-third for saturated fats, energy density (beverages), free sugars and total fats; in near 20 % for fibre and Na:K ratio and in 13 % for K.

In Chile, decreasing the consumption of ultra-processed foods is a potentially effective way to achieve the WHO nutrient goals for the prevention of diet-related NCD.

To determine risk factors for anaemia in preschool children.

A cross-sectional study.

Tigray province, northern Ethiopia.

2080 of 2373 children aged 6–60 months provided blood to assess anaemia.

Anaemia was highly prevalent (42%) and constituted an important nutritional problem in the region. In a sub-sample of 230 anaemic children, 56% had a low red blood cell (RBC) count, and 43% had a serum ferritin of less than 12 μg l−1 indicating that the anaemia was largely due to iron deficiency. Unlike other regions in developing countries, hookworm (0.4%) and malaria (0.0%) were rare and contributed little to the anaemia. Even though their diet lacked variety, the amount of iron consumed through cereal-based staple foods was adequate. However, the iron in these foods was not readily available and their diets were probably high in iron absorption inhibitors and low in enhancers. Dietary factors associated with anaemia included frequent consumption of inhibitors, such as fenugreek and coffee, and poor health in the child such as diarrhoea and stunting.

Underlying causes of anaemia were lack of safe water and inadequate human waste management, maternal illiteracy and mother being ill, and having no food reserves. The root cause of these factors was poverty. The optimal control strategy for iron deficiency anaemia should have a holistic approach which includes the alleviation of poverty, the empowerment of women and the provision of a safe environment.

Various indicators and assessment tools exist to measure diets and nutrition. Most studies eventually rely on one approach. Relatively little is known about how closely results match when different tools are used in the same context. The present study compares and correlates different indicators for the same households and individuals to better understand which indicators can be used as proxies for others.

A survey of households and individuals was carried out in Kenya in 2015. Seven-day food consumption and 24 h dietary recalls were administered at household and individual level, respectively. Individual height and weight measures were taken. Different indicators of food access (energy consumption, household dietary diversity scores), dietary quality (individual dietary diversity scores, micronutrient intakes) and nutrition (anthropometric indicators) were calculated and correlated to evaluate associations.

Rural farm households in western Kenya.

Data collected from 809 households and 1556 individuals living in these households (782 female adults, 479 male adults, 295 children aged 6–59 months).

All measures of food access and dietary quality were positively correlated at individual level. Household-level and individual-level dietary indicators were also positively correlated. Correlations between dietary indicators and anthropometric measures were small and mostly statistically insignificant.

Dietary indicators from 7d food consumption recalls at the household level can be used as proxies of individual dietary quality of children and male and female adults. Individual dietary diversity scores are good proxies of micronutrient intakes. However, neither household-level nor individual-level dietary indicators are good proxies of individual nutritional status in this setting.

To investigate the role of severe physical violence during pregnancy (SPVP) between intimate partners in early cessation of exclusive breast-feeding (EBF).

A health services survey. The revised Conflict Tactics Scale was used to characterize SPVP; premature breast-feeding cessation was identified using a current status data approach, which was based on the information reported from food recall during the preceding 7 d. The cumulative hazard function was estimated by complementary log–log transformation models, which allowed the ensuing estimation of early breast-feeding cessation rates in different age groups and the ratio of rates of weaning between women exposed and not exposed to violence.

Five large public primary health-care facilities of Rio de Janeiro, Brazil.

The sample comprised 811 randomly selected mothers of children under 5 months of age who were waiting to be consulted.

SPVP is an independent risk factor of cessation of EBF since, after controlling for socio-economic, demographic, reproductive and lifestyle variables, women exposed to violence presented an incidence density that was 31 % higher than those who were not exposed (hazard ratio = 1·30, 95 % CI 1·01, 1·69).

The findings corroborate the hypothesis that SPVP is an important risk factor for EBF. This indicates the need for incentives to adequately train health-care personnel in dealing with lactating women in order to gain a broader view of breast-feeding beyond the biological aspects of lactation, including the maternal psychological dimension.

To examine the association between cardiovascular risk and childhood overweight and obesity using the BMI cut-offs recommended by the WHO.

Children were classified as normal weight, overweight and obese according to the WHO BMI-for-age reference. Blood pressure, lipids, glucose, insulin, homeostasis model assessment–insulin resistance (HOMA-IR) and uric acid levels were compared across BMI groups. ANOVA and tests of linearity were used to assess overall mean differences across groups. Crude and adjusted odds ratios were calculated for adverse plasma levels of biochemical variables.

Paediatric care centres.

Children (n 149) aged 8–18 years.

About 37 %, 22 % and 41 % of children were classified respectively as normal weight, overweight and obese. There were significant linear mean differences between BMI groups in systolic blood pressure, HDL-cholesterol, TAG, insulin, HOMA-IR and uric acid. Obese children were 10·6 times more likely than normal-weight children to have hypertension; OR for other associations were 60·2 (high insulin), 39·5 (HOMA-IR), 27·9 (TAG), 16·0 (HDL-cholesterol), 4·3 (LDL-cholesterol) and 3·6 (uric acid). Overweight children were more likely than normal-weight children to have hypertension (OR = 3·5), high insulin (OR = 28·2), high HOMA-IR (OR = 23·3) and high TAG (OR = 16·1). Nearly 92 % and 57 % of the obese and overweight children, respectively, had one or more risk factor.

Obesity and overweight defined using the WHO BMI-for-age cut-offs identified children with higher metabolic and vascular risk. These results emphasize the importance of prevention of overweight and obesity in childhood to reduce cardiovascular risk.

To compare non-ethnically based supermarkets and Latino grocery stores (tiendas) in a lower-income region with regard to the availability, quality and cost of several healthy v. unhealthy food items.

A cross-sectional study conducted by three independent observers to audit twenty-five grocery stores identified as the main source of groceries for 80 % of Latino families enrolled in a childhood obesity study. Stores were classified as supermarkets and tiendas on the basis of key characteristics.

South San Diego County.

Ten tiendas and fifteen supermarkets.

Tiendas were smaller than supermarkets (five v. twelve aisles, P = 0·003). Availability of fresh produce did not differ by store type; quality differed for one fruit item. Price per unit (pound or piece) was lower in tiendas for most fresh produce. The cost of meeting the US Department of Agriculture's recommended weekly servings of produce based on an 8368 kJ (2000 kcal)/d diet was $US 3·00 lower in tiendas compared with supermarkets (P < 0·001). The cost of 1 gallon of skimmed milk was significantly higher in tiendas ($US 3·29 v. $US 2·69; P = 0·005) and lean (7 % fat) ground beef was available in only one tienda (10 %) compared with ten (67 %) supermarkets (P = 0·01).

Barriers remain in the ability to purchase healthier dairy and meat options in tiendas; the same is not true for produce. These results highlight the potential that tiendas have in improving access to quality, fresh produce within lower-income communities. However, efforts are needed to increase the access and affordability of healthy dairy and meat products.

With the upsurge in online dietary modification programmes, online dietary assessment tools are needed to capture food intake. Although the DASH (Dietary Approaches to Stop Hypertension) diet is recommended by the US Department of Agriculture, there are no online instruments that capture DASH food servings. Our objective was to assess the validity of a new, short, online dietary questionnaire developed to capture intake of DASH food servings. The DASH Online Questionnaire (OLQ) was validated against the well-known Block Food Frequency Questionnaire (FFQ).

This was a cross-sectional validation of the DASH OLQ, which contained eleven food groups (breakfast cereals; dairy; drinks; fats and oils; fruits; grains and snacks; meat, fish and poultry; mixed dishes; sweets; vegetables; and nuts, seeds and legumes). Each subject completed a DASH OLQ once weekly for four weeks and one 98.2 Block FFQ (110 questions) between weeks 2 and 4. DASH OLQ were averaged and then compared with the Block FFQ for nutrient intakes as well as intakes of DASH food groups.

Boston University Medical Center, Boston, Massachusetts.

One hundred and ninety-one faculty and staff at Boston University Medical Center aged 20–70 years.

There were significant positive correlations between the Block FFQ and the DASH OLQ for all food groups ranging from r = 0·8 for the nuts/seeds/legumes category to r = 0·3 for vegetables and mixed dishes. A comparison of nutrient intakes found strong positive correlations in all nutrient categories. Of particular interest in the DASH diet and the web-based nutrition and physical activity programme were total fat (r = 0·62), total carbohydrate (r = 0·67), total K (r = 0·68), total Ca (r = 0·69), total vitamin C (r = 0·60) and total energy intake (r = 0·68).

The DASH OLQ captures food and nutrient intake well in relation to the more established Block FFQ.

Online food delivery (OFD) platforms offer consumers a convenient and fast delivery service of foods and drinks sourced from foodservice partners (e.g. restaurants, quick service restaurants). There is a need to assess the impact of this emergent segment of the foodservice sector on diet and diet-related health. The aim of this narrative review was to describe the OFD sector in Australia, its use and identify potential ways to include OFD platforms in existing public health nutrition policy.

A search was conducted in peer-reviewed and grey literature. Sources were analysed and synthesised to report the characteristics of OFD platforms, delivery process, users and potential drivers of usage. The aim and scope of public health nutrition policies were analysed to identify ways of including OFD platforms.

Australia.

General population.

There are three main operators with 9000–16 000 foodservice partners based predominantly in the main cities of Australia. OFD revenue has grown by 72 % in the last 5 years and is predicted to increase driven by usage by working adults with high disposable income who demand convenience. Current policies and initiatives aimed at manufacturers, retailers and foodservice outlets do not specifically regulate OFD platforms, although there is scope for these to be extended to such platforms.

OFD platforms are disruptors of the foodservice sector. Innovative and consistent health policy options that target the unique challenges and opportunities posed by OFD platforms are required to limit the potentially negative impact of OFD platforms on diet and diet-related health.

In the majority of exercise intervention studies, the aggregate reported weight loss is often small. The efficacy of exercise as a weight loss tool remains in question. The aim of the present study was to investigate the variability in appetite and body weight when participants engaged in a supervised and monitored exercise programme.

Fifty-eight obese men and women (BMI = 31·8 ± 4·5 kg/m2) were prescribed exercise to expend approximately 2092 kJ (500 kcal) per session, five times a week at an intensity of 70 % maximum heart rate for 12 weeks under supervised conditions in the research unit. Body weight and composition, total daily energy intake and various health markers were measured at weeks 0, 4, 8 and 12.

Mean reduction in body weight (3·2 ± 1·98 kg) was significant (P < 0·001); however, there was large individual variability (−14·7 to +2·7 kg). This large variability could be largely attributed to the differences in energy intake over the 12-week intervention. Those participants who failed to lose meaningful weight increased their food intake and reduced intake of fruits and vegetables.

These data have demonstrated that even when exercise energy expenditure is high, a healthy diet is still required for weight loss to occur in many people.

To determine the prevalence and sociodemographic factors related to vegetarians according to different definitions in Finland and to compare the consumption of selected foodstuffs and nutritional intakes among vegetarians and omnivores.

Information about subjects’ identification as vegetarians in a survey was used as a basis for self-defined vegetarianism. Foodstuffs consumed and their frequencies of consumption were obtained, and the reported consumption frequencies of meat, fish, milk and eggs or food portions containing these foodstuffs were used as a basis for an operationalized definition of different types of vegetarianism. Reported consumption was used to estimate foodstuff and nutritional intakes.

Three large nationwide surveys in Finland.

In total, 24 393 participants aged between 18 and 79 years were included.

The proportion of self-identified vegetarians was 3·3 % of the total population in Finland. According to responses to questions on consumption frequency, 1·4 % of the population were pesco-lacto-ovo-vegetarians, 0·43 % were vegans, lacto-vegetarians or lacto-ovo-vegetarians, and 0·18 % were vegans or lacto-vegetarians. Eighty per cent of the self-identified vegetarians did not follow a vegetarian diet according to the operationalized definition, but they consumed fewer meat products (P < 0·01).

Some self-defined vegetarians do consume red meat, poultry or fish, but they follow a healthier diet than self-defined omnivores. In the same sample self-identification indicated more than double the incidence of vegetarianism than the operationalized definition. Therefore self-identification is not a good method for observing the prevalence of vegetarianism.

To measure rates of hunger and food insecurity among young US-born Latino children with Mexican immigrant parents (Latinos) compared with a non-immigrant non-Latino population (non-Latinos) in a low-income clinic population.

A repeated cross-sectional survey of 4278 caregivers of children < 3 years of age in the paediatric clinic of an urban county hospital for a 5-year period from 1998 to 2003. A total of 1310 respondents had a US-born child with at least one parent born in Mexico. They were compared with a reference group comprised of non-Latino US-born participants (n = 1805). Child hunger and household food insecurity were determined with the US Household Food Security Scale.

Young Latino children had much higher rates of child hunger than non-Latinos, 6.8 versus 0.5%. Latino families also had higher rates of household food insecurity than non-Latinos, 53.1 versus 15.6%. Latino children remained much more likely to be hungry (odds ratio (OR) = 13.0, 95% confidence interval (CI) = 5.9–28.7, P < 0.01) and in household food-insecure households (OR = 6.6, 95% CI = 5.2–8.3, P < 0.01) than non-Latinos after controlling for the following variables in multivariate analysis: child's age, sex, maternal education level, single-headed household status, family size, young maternal age ( < 21 years), food stamp programme participation, TANF (Temporary Assistance to Needy Families, or ‘welfare’) programme participation and WIC (Women, Infants, and Children) usage, and reason for clinic visit (sick visit versus well-child).

Young children in Mexican immigrant families are at especially high risk for hunger and household food insecurity compared with non-immigrant, non-Latino patients in a low-income paediatric clinic.