Nitrate and nitrite are probable human carcinogens when ingested under conditions that increase the formation of N-nitroso compounds. There have been limited efforts to develop US databases of dietary nitrate and nitrite for standard FFQ. Here we describe the development of a dietary nitrate and nitrite database and its calibration.

We analysed data from a calibration study of 1942 members of the NIH–AARP (NIH–AARP, National Institutes of Health–AARP) Diet and Health Study who reported all foods and beverages consumed on the preceding day in two non-consecutive 24 h dietary recalls (24HR) and completed an FFQ. Based on a literature review, we developed a database of nitrate and nitrite contents for foods reported on these 24HR and for food category line items on the FFQ. We calculated daily nitrate and nitrite intakes for both instruments, and used a measurement error model to compute correlation coefficients and attenuation factors for the FFQ-based intake estimates using 24HR-based values as reference data.

FFQ-based median nitrate intake was 68·9 and 74·1 mg/d, and nitrite intake was 1·3 and 1·0 mg/d, in men and women, respectively. These values were similar to 24HR-based intake estimates. Energy-adjusted correlation coefficients between FFQ- and 24HR-based values for men and women respectively were 0·59 and 0·57 for nitrate and 0·59 and 0·58 for nitrite; energy-adjusted attenuation factors were 0·59 and 0·57 for nitrate and 0·47 and 0·38 for nitrite.

The performance of the FFQ in assessing dietary nitrate and nitrite intakes is comparable to that for many other macro- and micronutrients.

To identify child hunger and examine its association with family factors, receipt of benefits, housing conditions and social support among recently arrived refugee families with young children.

Structured and semi-structured questionnaire administered to a service-based, purposive sample of caregivers.

East London, United Kingdom.

Thirty households with children <5 years old, resident in the UK for <2 years.

All households sampled were food-insecure, and 60% of index children were experiencing hunger as defined on the Radimer/Cornell scale. Child hunger was significantly associated with recent arrival, marginally significantly associated with receipt of fewer benefits and younger parenthood, and not associated with maternal education or self-efficacy score, household size or composition, or measures of social support.

A community-based, participatory approach for rapid assessment of the prevalence, extent and causes of child hunger among newly arrived asylum seekers recently arrived in Britain is feasible, and preliminary results suggest a programmatic need for a broader, population-based assessment of food insecurity in this rapidly growing population group.

To examine the relationship between sweetened beverage consumption and components of the metabolic syndrome in a Mexican population.

We performed a cross-sectional analysis of data from selected adults participating in the baseline assessment of the Health Workers Cohort Study. Information on participants’ sociodemographic characteristics, dietary patterns and physical activity were collected via self-administered questionnaires. Sweetened beverage consumption was evaluated through a validated semi-quantitative FFQ. Anthropometric and clinical measures were assessed with standardized procedures. The definition of metabolic syndrome was determined using criteria from the National Cholesterol Education Program Adult Treatment Panel III. The associations of interest were evaluated by means of linear and logistic regression models.

The Mexican states of Morelos and Mexico.

A total of 5240 individuals aged 20 to 70 years (mean 39·4 (sd 11·5) years) were evaluated.

Overweight/obesity prevalence was 56·6 %. The prevalence of metabolic syndrome in this sample was 26·6 %. We found that for each additional daily sweetened beverage serving consumed, participants experienced an average increase of 0·49 mmol/l in TAG and a decrease in HDL cholesterol of 0·31 mmol/l. Subjects consuming more than two servings of sweetened beverages daily were at 2·0 times greater risk of metabolic syndrome than those who did not consume sweetened beverages. We also observed that higher sweetened beverage consumption increased the risk of all components of the metabolic syndrome.

Our data support the hypothesis that sweetened beverage consumption increases the risk of metabolic syndrome in Mexican adults, possibly by providing excess energy and large amounts of rapidly absorbable sugars.

To explore socio-economic factors associated with rising rates of overweight among Vietnamese adults.

The study was based on three national surveys of socio-economic factors and health conducted over a 10-year period. The studies were: the Vietnamese Living Standard Survey 1992–1993 (11 982 participants); the Vietnamese Living Standard Survey 1997–1998 (15 975 participants); and the Vietnamese National Health Survey 2001–2002 (94 656 participants).

Male and female adults >18 years old were stratified by gender, age group, area of residence, occupation, education and relative food expenditures. Overweight was defined using body mass index (BMI) ≥ 25 kg m− 2.

Overweight rates in Vietnam more than doubled between 1992 and 2002 (from 2.0 to 5.7%). Significant increases were observed for men and women, in urban and rural areas, and for all age groups. In univariate analyses, both age and higher socio-economic status were associated with higher rates of overweight. Using the most recent survey, urban populations were more likely to be overweight than rural ones (odds ratio (OR) = 1.79), white-collar workers were more likely to be overweight than manual labourers (OR = 1.95) and persons in the top level of food expenditures were more likely to be overweight than persons in the bottom level (OR = 4.96) after adjustment for other factors. Education was inversely associated with overweight after adjusting for covariates.

Economic growth and improved standard of living are associated with higher rates of overweight in nations in early stages of economic development. In Vietnam, higher rates of overweight were observed among the higher income and occupation groups.

The purpose of this study was to validate a quantitative food-frequency questionnaire (QFFQ) created for assessing the usual intake of foods and nutrients in the prevailing season in Western Mali.

Intake of foods and nutrients over the week preceding the interview was measured with a 69-item QFFQ. Intakes were compared with intakes as measured with 2-day combined weighed and recalled diet records.

A rural village in Western Mali, West Africa.

Twenty-seven men and 48 women (15–59 years of age) representing 18 households.

Spearman rank correlations between intake of food groups from the QFFQ and the diet record ranged from 0.09 (meat/fish) to 0.58 (tea/coffee). Median coefficient was 0.37. Median Spearman correlation coefficient for nutrient intake was 0.40. Men had higher median correlation coefficients than did women. The proportion of subjects being classified into the same quartile of food intake was on median 33%, while a median of 7% was misclassified into extreme quartiles. Correct classification into the same quartile for intake of nutrients was on median 34% while a median of 4% was grossly misclassified. Intakes of most food groups and nutrients as measured by the QFFQ were higher than those measured by the diet records. However, while men had higher estimated intakes for foods eaten in-between meals, women in general had higher intake of foods eaten in the main meals.

This QFFQ can be used for comparing the intake of foods and nutrients between groups within this study population. It therefore represents a useful tool in the surveillance of food intake in the population, both in identifying vulnerable groups and for tracking food intake over time. The differences between men and women in overestimating food intake need to be taken into account when using the method.

To analyse the association between family structure and adiposity in children.

Cross-sectional and longitudinal analysis of the IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) study cohort.

Primary schools and kindergartens.

Children (n 12 350; aged 7·9 (sd 1·8) years) for the cross-sectional analysis and children (n 5236; at baseline: normal weight, aged 5·9 (sd 1·8) years) for the longitudinal study underwent anthropometry. Family structure was analysed as (i) number and type of cohabiting adults and (ii) number of siblings.

In the cross-sectional analysis, after controlling for covariates, children living with grandparents had significantly higher BMI Z-score than those living with both parents (0·63; 95 % CI 0·33, 0·92 v. 0·19; 95 % CI 0·17, 0·22; P < 0·01); in addition, the higher the number of siblings, the lower the BMI Z-score (only child = 0·31; 95 % CI 0·24, 0·38; 1 sibling = 0·19; 95 % CI 0·16, 0·23; 2 siblings = 0·15; 95 % CI 0·09, 0·20; >2 siblings = 0·07, 95 % CI 0·04, 0·19; P < 0·001). Over the 2-year follow-up, differences in weight gain were observed across family-structure categories. Further, the risk of incidence of overweight/obesity was significantly lower the higher the number of siblings living in the household (v. only child: 1 sibling = 0·74, 95 % CI 0·57, 0·96; 2 siblings = 0·63, 95 % CI 0·45, 0·88; >2 siblings = 0·40, 95 % CI 0·21, 0·77), independently of confounders.

The study suggests that an independent association between family structure and childhood obesity exists.

Using data from the national micronutrients survey 2011–2012, the present study explored the determinants of Fe status and Hb levels in Bangladesh with a particular focus on groundwater Fe.

Cross-sectional study conducted at the nationwide scale.

The survey was conducted in 150 clusters, fifty in each of the three strata of rural, urban and slum.

Three population groups: pre-school age children (6–59 months; PSAC), school age children (6–14 years; SAC) and non-pregnant non-lactating women (15–49 years; NPNLW).

National prevalence of Fe deficiency was 10·7 %, 7·1 % and 3·9–9·5 % in PSAC, NPNLW and SAC, respectively. Prevalence of anaemia was 33·1 % (PSAC), 26·0 % (NPNLW) and 17·1–19·1 % (SAC). Multivariate regression analyses showed that the area with ‘predominantly high groundwater Fe’ was a determinant of higher serum ferritin levels in NPNLW (standardized β=0·19; P=0·03), SAC (standardized β=0·22; P=0·01) and PSAC (standardized β=0·20; P=0·03). This area also determined higher levels of Hb in PSAC (standardized β=0·14; P=0·01).

National prevalence of Fe deficiency in Bangladesh is low, contrary to the widely held assumption. High Fe level in groundwater is associated with higher Fe status (all populations) and higher Hb level (PSAC).

We aimed to assess dietary profiles of adults from the NutriNet-Santé cohort according to different levels of organic food consumption using detailed self-reported data on organic food intakes.

Food intakes were obtained using an organic food frequency questionnaire (Org-FFQ). The participants were ranked into five groups (quintiles, Q) according to the proportion of organic foods in their diet. To determine diet quality, two scores were computed reflecting adherence to food-based recommendations (mPNNS-GS) and the probability of adequate nutrient intake (PANDiet). Relationships between levels of organic food consumption and dietary characteristics were assessed using multivariable-adjusted ANCOVA models.

The NutriNet-Santé Study.

French adults from the NutriNet-Santé Study (n 28 245).

Intakes of foods of plant origin increased along with the contribution of organic foods to the diet while a reverse trend was identified for dairy products, cookies and soda (P-trend<0·0001). The diet quality scores increased from Q1 (mPNNS-GS, 7·89 (se 0·02); PANDiet: 63·04 (se 0·11)) to Q5 (mPNNS-GS, 8·78 (se 0·02); PANDiet, 69·37 (se 0·10)). Overall, high organic food consumers exhibited better diet quality, although intermediate organic food consumers showed better adherence to specific nutritional recommendations related to animal products.

The study provides new insights into the understanding of organic food consumption as a part of a healthy diet and sheds some light on the dietary profiles of different categories of organic food consumers. These results underline strong dietary behaviour correlates associated with organic food consumption that should be controlled for in future aetiological studies on organic foods and health.

We compared the dietary behaviour of three different household types and explored developmental trends in food choices following a life event.

The study is based on data from three Swiss Food Panel survey periods. A cross-sectional comparison between household types was conducted by using a one-way independent ANOVA. Repeated measures were analysed with a mixed ANCOVA to examine changes in dietary behaviour following a life event.

Participants in the survey filled in a questionnaire in the years 2010, 2011 and 2012.

The final sample consisted of 3559 persons with a mean age of 56 years (range 22–94 years; 46 % men). Seventy-two people moved in with their partner and sixty-five people reported the birth of their first child.

Cross-sectional evidence confirmed that women living in households with a partner reported higher consumption frequencies for meat and processed meats compared with those living alone. Men living in cohabitation had a higher vegetable intake. The transitional effect of moving in with a partner, however, resulted in a higher intake of processed meats for both genders and a higher intake of pork and savoury items for men. Transition to motherhood was linked to an increase in vegetable consumption, while the transition to fatherhood did not change consumption patterns significantly.

Individuals in life-stage transitions are more likely to change their nutritional strategies and life events can be a window of opportunity for changes towards better food choices.

To identify the magnitude of anaemia and deficiencies of Fe (ID) and vitamin A (VAD) and their associated factors among rural women and children.

Cross-sectional, comprising a household, health and nutrition survey and determination of Hb, biochemical (serum concentrations of ferritin, retinol, C-reactive protein and α1-acid glycoprotein) and anthropometric parameters. Multivariate logistic regression examined associations of various factors with anaemia and micronutrient deficiencies.

Kalalé district, northern Benin.

Mother–child pairs (n 767): non-pregnant women of reproductive age (15–49 years) and children 6–59 months old.

In women, the overall prevalence of anaemia, ID, Fe-deficiency anaemia (IDA) and VAD was 47·7, 18·3, 11·3 and 17·7 %, respectively. A similar pattern for anaemia (82·4 %), ID (23·6 %) and IDA (21·2 %) was observed among children, while VAD was greater at 33·6 %. Greater risk of anaemia, ID and VAD was found for low maternal education, maternal farming activity, maternal health status, low food diversity, lack of fruits and vegetables consumption, low protein foods consumption, high infection, anthropometric deficits, large family size, poor sanitary conditions and low socio-economic status. Strong differences were also observed by ethnicity, women’s group participation and source of information. Finally, age had a significant effect in children, with those aged 6–23 months having the highest risk for anaemia and those aged 12–23 months at risk for ID and IDA.

Anaemia, ID and VAD were high among rural women and their children in northern Benin, although ID accounted for a small proportion of anaemia. Multicentre studies in various parts of the country are needed to substantiate the present results, so that appropriate and beneficial strategies for micronutrient supplementation and interventions to improve food diversity and quality can be planned.

The present study was designed to assess the effects of Ca+vitamin D supplementation on pregnancy outcomes in women with gestational diabetes mellitus (GDM).

A randomized, double-blind, placebo-controlled trial was conducted among sixty women with GDM. Participants were divided into two groups to receive Ca+vitamin D supplements or placebo. Individuals in the Ca+vitamin D group (n 30) received 1000 mg Ca/d and two pearls containing 1250 µg (50 000 IU) of cholecalciferol (vitamin D3) during the intervention (one at study baseline and another at day 21 of the intervention); those in the placebo group (n 30) received two placebos of vitamin D at the mentioned times and placebos of Ca every day for 6 weeks. Pregnancy outcomes were determined.

A urban community setting in Arak, Iran.

Sixty women with GDM and their newborns, living in Arak, Iran were enrolled.

Women treated with Ca+vitamin D had a significant decrease in caesarean section rate (23·3 % v. 63·3 %, P=0·002) and maternal hospitalization (0 v. 13·3 %, P=0·03) compared with those receiving placebo. In addition, newborns of GDM women randomized to Ca+vitamin D had no case of macrosomia, while the prevalence of macrosomia among those randomized to placebo was 13·3 % (P=0·03). Lower rates of hyperbilirubinaemia (20·0 % v. 56·7 %, P=0·03) and hospitalization (20·0 % v. 56·7 %, P=0·03) were also seen in the supplemented group of newborns than in the placebo group.

Ca+vitamin D supplementation for 6 weeks among pregnant women with GDM led to decreased caesarean section rate and maternal hospitalization, and decreased macrosomia, hyperbilirubinaemia and hospitalization in newborns.

To assess whether alcoholic and caffeinated beverages are associated with risk of fractures in women.

Population-based sample surveyed by post.

A total of 34703 postmenopausal Iowan women aged 55–69 years were surveyed.

A cohort of women reported alcoholic and caffeinated beverage intake and were followed for 6.5 years for fracture occurrence. Relative risks (RR) and 95% confidence intervals (CI) were computed using Cox proportional hazards regression. Covariates included age, tobacco use, physical activity, body mass index (BMI), waist to hip ratio (WHR), oestrogen use and calcium intake.

At least one fracture was reported by 4378 women (389 upper arm, 288 forearm, 1128 wrist, 275 hip, 416 vertebral and 2920 other fractures). The adjusted RR for highest versus lowest caffeine intake quintiles was 1.09 (95% CI 0.99–1.21) for combined fracture sites. Wrist fractures were associated positively (RR for extreme quintiles 1.37, 95% CI 1.11–1.69) and upper arm fractures were negatively associated (RR 0.67, 95% CI 0.48–0.94) with caffeine intake. The age-adjusted RR of total fractures for highest versus lowest frequency of beer usage was 1.55 (95% CI 1.25–1.92) and for liquor was 1.25 (95% CI 1.03–1.54). No other association was found between any specific fracture site and alcohol intake.

We found a modest increase in fracture risk associated with highest caffeine intake, varying by site. Alcohol intake was low, but it also showed a weak positive association with fracture risk.

It is likely that there are substantial subconscious effects of organizations’ efforts to associate their products with sport via sponsorships, but most research methods are unable to capture these effects. The present study employed a novel projective technique to explore children's implicit associations between popular sports and a range of sports sponsors.

Children participated in an activity using magnets bearing the logos of numerous sports and sponsors. They were invited to arrange the magnets on a whiteboard without being advised that the activity related to sponsorship.

Perth, Western Australia.

Children (n 164) aged 5–12 years.

Three-quarters (76 %) of the children aligned at least one correct sponsor magnet with the relevant sport. Just over half the children (54 %) correctly matched the most popular sport (an Australian Football League team) with its relevant sponsor (a fast-food chain).

Given the unstructured nature of the projective task, the results provide some support for the argument that sports sponsorship can effectively reach child audiences. This is of concern given the current extent of sponsorship by alcohol and fast-food companies.

To identify dietary transition stages based on dietary patterns of adult Haitians having lived in Montreal for various lengths of time, and to assess associated dietary quality.

One hundred and eighty-one Haitians aged 25–60 years were recruited by the modified random digit dialling method.

Socio-economic, diet and lifestyle variables were documented by questionnaire. Three non-consecutive 24-hour dietary recalls were conducted over a 3-month period. Dietary patterns were studied using cluster analysis, and their association with proportion of lifetime in Canada and with socio-economic status (SES) was examined. Diet quality criteria were micronutrient adequacy and healthfulness based on dietary recommendations of the World Health Organization.

Four dietary phenotypes were identified which could roughly represent stages of dietary transition or acculturation (Traditional, Pre-Western, Western and Modern). Subjects in the ‘Traditional’ cluster were older and had lived for a significantly lower proportion of their lifetime in Canada; they also tended to be of lower SES. Diet quality was significantly higher in the ‘Traditional’ than the ‘Western’ type, particularly with respect to healthfulness. A significantly lower proportion of subjects complying with limited intake of total fat ( < 30%) and cholesterol ( < 45%) was observed in the ‘Western’ compared with other diet phenotypes. Less than 15% of all subjects consumed enough dietary fibre, irrespective of diet type.

Dietary transition stages could be identified on the basis of food patterns of Haitians according to the proportion of their lifetime in Canada. Encouraging the youth to retain the traditional food culture in its positive aspects would appear relevant.

This study aimed to determine the accuracy with which children aged 5 to 7 years were able to report the food eaten at a school lunch.

Two hundred and three children (103 boys, 100 girls) aged 5–7 years were recruited from three primary schools in Oxford.

Trained investigators made observational records of the school dinner and packed lunch intakes of four or five children per session. Children were interviewed within two hours of finishing the lunchtime meal and asked to provide a free recall of their meal. When the child had completed the recall, non-directive prompts were used to assess if the child was able to remember anything else. Foods recalled were classified as matches (recalled food agreed with observation), omissions (failed to report a food observed) or phantoms (recalled food was not observed).

The percentage of accurate recall was significantly higher (P<0.01) in children eating packed lunch (mean 70±29%) than in children consuming school dinners (mean 58±27%). This difference may have been due to increased familiarity of foods in packed lunches. Leftovers were not readily reported in this age group. Prompts and cues enhanced recall by all children.

This study indicated that there was a wide range in the ability of children aged 5–7 years to recall intake from a packed lunch and/or school dinner. This dietary assessment method is unlikely to be suitable at an individual level. Investigators using dietary recall to estimate food intake in children aged 5–7 years need to be aware of the limitations of this method.

To identify consumer perceptions of whole milk, reduced-fat milk and soy milk, and to investigate demographic influences on perceptions and types of milk consumption.

Questionnaires covering nutritional and sensory perceptions of three types of milk.

Three hundred and sixty-one randomly selected shoppers in Melbourne, Australia.

Generally, respondents held positive perceptions about milk. Milk was considered as having good sensory properties, providing a good source of nutrients, and being a convenient and safe product. However, despite these findings, misperceptions and unawareness about the nutrient content of milk were prevalent. Negative perceptions were most common for whole milk and were mostly related to its perceived high fat, cholesterol and energy contents. Soy milk received lower ratings on sensory quality and convenience than dairy milk. There were few sociodemographic differences in consumers' perceptions. Although reduced-fat milk consumption was more frequent among elderly people and type of milk consumption was related to parenthood, no other significant effects of demographic variables were found on the consumption of specific milk types.

Although positive perceptions were common, negative perceptions and misperceptions appear to be prevalent, presenting a challenge for nutrition education. Sociodemographic factors were not shown to be important predictors of perceptions and type of milk consumption.

To measure dietary salt intake in a Swedish population.

A cross-sectional study with measured 24 h urinary excretion of Na and K. Completeness of urine collection was assessed using p-aminobenzoic acid. The subjects were interviewed on their habitual food intake.

Sahlgrenska University Hospital, Gothenburg, Sweden.

Eighty-six young men (age 18–20 years), randomly selected from the population of Gothenburg. Seven men were excluded due to incomplete urine collection.

The mean excretion of Na and K over 24 h was 198 and 84 mmol, respectively (corresponding to 11·5 g NaCl and 3·3 g K). The mean 24 h excretion in the highest quartile of Na excretion was 297 mmol Na and 105 mmol K, and in the lowest quartile, 100 mmol Na and 68 mmol K. The mean Na:K ratio was 2·3, and respectively 3·2 and 1·8 in the highest and lowest Na excretion quartiles. Calculated energy intake did not differ between the highest and lowest quartiles of Na excretion, but body weight, BMI and the intake of certain foods known to be Na-rich did.

Salt intake in young men was alarming high and even subjects in the lowest quartile of Na excretion did not meet present recommendations to limit salt intake to 5–6 g/d. At this point we can only speculate what the consequences of the high salt intake may be for CVD and stroke later in life. Regulation of the salt content in processed and fast food and in snacks is advocated, to curtail the salt burden on society imposed by the food industry.

Exclusive breast-feeding is estimated to reduce infant mortality in low-income countries by up to 13 %. The aim of the present study was to determine the risk factors associated with suboptimal breast-feeding practices in Pakistan.

A cross-sectional study using data extracted from the multistage cluster sample survey of the Pakistan Demographic and Health Survey 2006–2007.

A nationally representative sample of households.

Last-born alive children aged 0–23 months (total weighted sample size 3103).

The prevalences of timely initiation of breast-feeding, bottle-feeding in children aged 0–23 months, exclusive breast-feeding and predominant breast-feeding in infants aged 0–5 months were 27·3 %, 32·1 %, 37·1 % and 18·7 %, respectively. Multivariate analysis indicated that working mothers (OR = 1·48, 95 % CI 1·16, 1·87; P = 0·001) and mothers who delivered by Caesarean section (OR = 1·95, 95 % CI 1·30, 2·90; P = 0·001) had significantly higher odds for no timely initiation of breast-feeding. Mothers from North West Frontier Province were significantly less likely (OR = 0·37, 95 % CI 0·23, 0·59; P < 0·001) not to breast-feed their babies exclusively. Mothers delivered by traditional birth attendants had significantly higher odds to predominantly breast-feed their babies (OR = 1·96, 95 % CI 1·18, 3·24; P = 0·009). The odds of being bottle-fed was significantly higher in infants whose mothers had four or more antenatal clinic visits (OR = 1·93, 95 % CI 1·46, 2·55; P < 0·001) and belonged to the richest wealth quintile (OR = 2·41, 95 % CI 1·62, 3·58; P < 0·001).

The majority of Pakistani mothers have suboptimal breast-feeding practices. To gain the full benefits of breast-feeding for child health and nutrition, there is an urgent need to develop interventions to improve the rates of exclusive breast-feeding.

Observational studies reported potential associations between different dietary patterns and the risk of metabolic syndrome (MetS); however, a consistent perspective has not been established to date. The current systematic review and meta-analysis aimed to evaluate the relationship between a posteriori dietary patterns and MetS by pooling available data.

MEDLINE and EMBASE databases were searched for relevant articles published up to July 2015 with no time restriction and with English language restriction. Two independent reviewers completed study selection and data extraction. Random-effects models (DerSimonian–Laird method) were used to pool effect sizes of eligible studies. The potential sources of heterogeneity were assessed using the I2 statistic.

Nineteen papers that identified dietary patterns using an a posteriori method were selected and included in the meta-analysis. The ‘Healthy/Prudent’ dietary pattern was inversely associated with risk of MetS (OR=0·89; 95 % CI 0·84, 0·94, P=0·002). In contrast, the ‘Unhealthy/Western’ dietary pattern had a significant positive association with risk of MetS (OR=1·16; 95 % CI 1·11, 1·22, P<0·001).

Our findings provide evidence that greater adherence to a healthy/prudent dietary pattern is associated with a lower risk of MetS, while an unhealthy/Western dietary pattern is associated with increased risk of MetS. These data suggest that a diet based on healthy food choices is also beneficial for prevention of MetS.