The present study investigated parents’ understanding and approaches to providing energy-dense and nutrient-poor ‘extra foods’ to pre-school children and explored variation between parents of low and high socio-economic status in relation to these issues.

We conducted thirteen focus groups. Data were subject to framework analysis.

Child-care centres in distinctly socially disadvantaged and socially advantaged areas.

Eighty-eight parents of children aged 3–5 years.

The three most common terms parents identified to describe foods that are not ‘everyday foods’ were ‘treats’, ‘sometimes foods’ and ‘junk’. Parents’ perceptions regarding what influences them in providing food to their children included seven sub-themes: (i) the influence of the child; (ii) food-related parenting practices; (iii) health considerations; (iv) food costs and convenience; (v) external factors perceived as influencing their child; (vi) factors related to child care; and (vii) social influences and occasions. Parents’ decision-making processes regarding provision of ‘extra foods’ related to moderation and balance. Parents generally expressed the position that as long as a child is eating healthy foods, then treats are appropriate; and for many parents, this might apply frequently. All groups described the health of their child as an influence, but parents in low socio-economic groups were more likely to describe immediate concerns (dental health, behaviour) in relation to avoiding sugar-dense food or drink.

The belief that provision of ‘extra foods’ can be frequent as long as children are eating a healthy balance of foods is factored into parents’ decision making. Challenging this belief may be important for reducing the consumption of ‘extra foods’ by young children.

To examine the influence of eating location on the quality of the diets of Irish children and to compare intakes at home with intakes at other people's homes and intakes outside the home, and to compare intakes at various locations outside the home.

Food intake was measured using a 7-day weighed diary in 594 children from the Republic of Ireland (aged 5–12 years). Details of where the food was prepared or obtained were also recorded.

Eighty-nine per cent of all eating occasions occurred at home; < 6% occurred at both other people's homes and outside the home (takeaway, restaurant, shop, other). The percentage of food energy from fat was above the recommended 35% at other people's homes and outside the home, specifically at takeaways and restaurants. Fibre and micronutrient intakes (per 10 MJ) were significantly higher at home than at the other locations (P < 0.05). Within the ‘out’ locations, fibre and micronutrient intakes were generally higher at restaurants and lower at shops. High consumers of foods outside the home had a statistically significant, but relatively small decline in nutrient intakes compared with non- or low consumers. Chips and processed potatoes, meat products, savouries, sugars and confectionery, and savoury snacks made the greatest contribution to foods consumed outside the home.

The main focus of nutrition policies to improve the diets of Irish children should be the home environment rather than the food service sector. However, guidelines could call for better food choices outside the home to improve nutrient intakes.

To examine the associations between the consumption of fruit and vegetables and other markers of cancer risk.

A cross-sectional survey within the population-based prospective Malmö Diet and Cancer (MDC) Study. Information on food habits was collected through the modified diet history method designed and validated for the MDC Study. Data on smoking and alcohol habits, leisure time physical activity, birth country, education, socioeconomic status and cohabitation status were collected through a questionnaire.

Malmö, the third largest city in Sweden.

All subjects who entered the MDC Study during winter 1991 to summer 1994 (men and women living in Malmö, aged between 46 and 68 years), with a total of 15 173.

Women consumed more fruit and vegetables than men. Low consumption of both fruits and vegetables was associated with unfavourable nutrient profiles: higher percentage of energy from fat and lower intakes of antioxidant nutrients and dietary fibre. Low consumption was also associated with smoking, low leisure time physical activity, low education and being born in Sweden. High age was associated with low vegetable consumption in both genders. Alcohol intake was positively associated with vegetable consumption in both genders, while both zero and high alcohol consumers had low fruit consumption. Men residing without a partner consumed less fruits and vegetables than other men. There were very weak or no independent associations between socioeconomic status and fruit/vegetable consumption.

This study indicates that several established risk markers and risk factors of cancer may be independently associated with low fruit and vegetable consumption. The findings suggest that the adverse effects of factors such as smoking, low physical activity and a high-fat diet could partly be explained by low consumption of fruit or vegetables. The implied health benefits of a low or moderate alcohol consumption may be similarly confounded by high consumption of fruit or vegetables.

To decrease the intake of sucrose, increase the intake of fibre and the consumption of fruit and vegetables among secondary-school pupils.

Intervention study among eighth grade pupils during one school year. Data were collected by questionnaires and from a subgroup of pupils by 48 h dietary recall at baseline in spring 2007 and after the intervention in 2008.

Twelve secondary schools were randomly allocated to intervention (IS) and control schools (CS) within three cities. Intervention included nutrition education and improvement of the food environment focusing particularly on the quality of snacks at school.

A total of 659 pupils completed the questionnaires and the dietary recall was obtained from 287 pupils both at baseline and follow-up.

The frequency of consumption of rye bread increased (P = 0·03) and that of sweets decreased (P = 0·006) among girls in the IS. The intake of sucrose fell among IS pupils, from 12·8 % to 10·5 % of the total energy intake (P = 0·01). Intake of fruit (g/MJ) remained the same in IS, whereas it decreased in CS (P = 0·04).

Sugar intake can be lowered by improving the quality of snacks, but it is more difficult to increase fibre intake and fruit and vegetable consumption unless the content of school lunches can be modified. It is the responsibility of the adults working in schools to create a healthy environment and to make healthy choices easy for pupils.

To determine how much of the variation in nutritional status of Bangladeshi children under 5 years old can be attributed to the socio-economic status of the family.

Nutritional status used reference Z-scores of weight-for-age (WAZ), height-for-age (HAZ) and weight-for-height (WHZ). A ‘possession score’ was generated based on ownership of a radio, television, bicycle, motorcycle and telephone, and the availability of electricity, with categories of 0 to 4+ possessions. A five-point (quintile) ‘poverty index’ was created using principal component analysis.

The Bangladesh Demographic and Health Survey 2004 was the source of data.

A sample of 4891 children aged <5 years was obtained.

Some 57·8 % of the sample was either stunted, wasted or underweight (7·7 % were stunted, wasted and underweight). Of those stunted (48·4 %), 25·7 % were also underweight. Underweight and wasting prevalences were 40·7 % and 14·3 %, respectively. Mean WAZ, HAZ and WHZ did not differ by sex. Children of mothers with no education or no possessions were, on average, about 1 sd more underweight and stunted than those with higher educated mothers or with 4+ possessions. The possession score provided much greater discrimination of undernutrition than the poverty index. Nearly 50 % of children from households with no possessions were stunted, wasted or underweight (only 27 % in the poorest quintile), compared with only 3–6 % of children from households with 4+ possessions (over 13 % in the richest quintile).

Maternal education and possession score were the main predictors of a child’s nutritional status. Possession score was a much better indicator of undernutrition than the poverty index.

Menstrual disorders are common in young women, and heavy menstrual blood losses (MBL) are an important cause of anaemia. Menstrual morbidity normally goes untreated in developing countries where cultural barriers also serve to mask the problems. We investigated the prevalence of menstrual morbidity, and measured MBL and its relationship to iron deficiency in a rural adolescent population. The rationale was to assess whether or not reducing heavy MBL could be part of a strategy to reduce iron deficiency anaemia.

Rural village in south-east Nigeria.

Cross-sectional survey.

The study included all non-pregnant, unmarried nulliparous girls (< 20 years) who had menstruated, and who lived in K'Dere village.

A field worker allocated to each girl completed a questionnaire, and supervised recovery and collection of soiled pads and ensured blood sampling. MBL was measured using the standard alkaline haematin method. Haemoglobin (Hb), serum iron, transferrin saturation and protoporphyrin levels (ZPP) were also measured.

307 girls completed MBL measurements; 11.9% refused to participate. 12.1% had menorrhagia (> 80 ml); median MBL was 33.1 ml. Menorrhagia was more frequent in girls who had menstruated for > 2 years (P = 0.048), and had longer duration of menses (P < 0.001). Iron status as measured by haematocrit, serum iron, transferrin saturation and ZPP values was inversely related to MBL. Neither height nor body mass index for age was associated with current iron status.

The level of menorrhagia detected (12%) may be an ‘expected’ level for a condition which often has no underlying pathology. Heavy MBL is one of the most important factors contributing to iron deficiency anaemia. Measures are needed to alleviate menstrual disorders, and improve iron status. Oral contraceptives can be part of a strategy to reduce anaemia, particularly for adolescents at high risk of unwanted pregnancies.

To examine the relationship between cigarette smoking and a range of nutrient intakes and blood status indices in older people.

National Diet and Nutrition Survey: cross-sectional survey of nationally representative sample of people aged 65 years and over.

Mainland Britain during 1994/95.

1191 people (619 male, 572 female) aged 65 years and over, of whom 920 were living in private households and 271 were living in institutions.

Cigarette smoking was inversely correlated with intakes of antioxidants and other micronutrients after adjustment for age, sex and domicile. Cigarette smoking was also inversely correlated with a number of antioxidant micronutrient status indices including plasma vitamin C and the carotenoids (but not vitamin E status indices), and with other micronutrient status indices, including plasma pyridoxal phosphate, red cell and serum folate, after adjustment for age, sex, domicile and the corresponding nutrient intake. Previous cigarette smoking or cigar/pipe smoking was not generally associated with lower nutrient intakes or status indices, however, both current and previous cigarette smoking was associated with increased concentrations of acute phase indicators. Further adjustment for total energy intake and/or sociodemographic, health and drug usage variables attenuated only a few of the associations observed.

Older people who smoke cigarettes are at increased risk of suboptimal antioxidant and other micronutrient intakes and status, but the lower intakes found in cigarette smokers only partly explain their reduced blood indices.

To evaluate the Canadian Diet History Questionnaire I (C-DHQ I) food list and to adapt the US DHQ II for Canada using Canadian dietary survey data.

Twenty-four-hour dietary recalls reported by adults in a national Canadian survey were analysed to create a food list corresponding to C-DHQ I food questions. The percentage contribution of the food list to the total survey intake of seventeen nutrients was used as the criterion to evaluate the suitability of the C-DHQ I to capture food intake in Canadian populations. The data were also analysed to identify foods and to modify portion sizes for the C-DHQ II.

The Canadian Community Health Survey (CCHS) – Cycle 2.2 Nutrition (2004).

Adults (n 20 159) who completed 24 h dietary recalls during in-person interviews.

Four thousand five hundred and thirty-three foods and recipes were grouped into 268 Food Groups, of which 212 corresponded to questions on the C-DHQ I. Nutrient intakes captured by the C-DHQ I ranged from 79 % for fat to 100 % for alcohol. For the new C-DHQ II, some food questions were retained from the original US DHQ II while others were added based on foods reported in CCHS and foods available on the Canadian market since 2004. Of 153 questions, 143 were associated with portion sizes of which fifty-three were modified from US values. Sex-specific nutrient profiles for the C-DHQ II nutrient database were derived using CCHS data.

The C-DHQ I and II are designed to optimize the capture of foods consumed by Canadian populations.

To develop an artificial intelligence (AI)-based algorithm which can automatically detect food items from images acquired by an egocentric wearable camera for dietary assessment.

To study human diet and lifestyle, large sets of egocentric images were acquired using a wearable device, called eButton, from free-living individuals. Three thousand nine hundred images containing real-world activities, which formed eButton data set 1, were manually selected from thirty subjects. eButton data set 2 contained 29 515 images acquired from a research participant in a week-long unrestricted recording. They included both food- and non-food-related real-life activities, such as dining at both home and restaurants, cooking, shopping, gardening, housekeeping chores, taking classes, gym exercise, etc. All images in these data sets were classified as food/non-food images based on their tags generated by a convolutional neural network.

A cross data-set test was conducted on eButton data set 1. The overall accuracy of food detection was 91·5 and 86·4 %, respectively, when one-half of data set 1 was used for training and the other half for testing. For eButton data set 2, 74·0 % sensitivity and 87·0 % specificity were obtained if both ‘food’ and ‘drink’ were considered as food images. Alternatively, if only ‘food’ items were considered, the sensitivity and specificity reached 85·0 and 85·8 %, respectively.

The AI technology can automatically detect foods from low-quality, wearable camera-acquired real-world egocentric images with reasonable accuracy, reducing both the burden of data processing and privacy concerns.

There is strong evidence that what we eat and how it is produced affects climate change.

The present paper examines coverage of food system contributions to climate change in top US newspapers.

Using a sample of sixteen leading US newspapers from September 2005 to January 2008, two coders identified ‘food and climate change’ and ‘climate change’ articles based on specified criteria. Analyses examined variation across time and newspaper, the level of content relevant to food systems’ contributions to climate change, and how such content was framed.

There were 4582 ‘climate change’ articles in these newspapers during this period. Of these, 2·4 % mentioned food or agriculture contributions, with 0·4 % coded as substantially focused on the issue and 0·5 % mentioning food animal contributions. The level of content on food contributions to climate change increased across time. Articles initially addressed the issue primarily in individual terms, expanding to address business and government responsibility more in later articles.

US newspaper coverage of food systems’ effects on climate change during the study period increased, but still did not reflect the increasingly solid evidence of the importance of these effects. Increased coverage may lead to responses by individuals, industry and government. Based on co-benefits with nutritional public health messages and climate change’s food security threats, the public health nutrition community has an important role to play in elaborating and disseminating information about food and climate change for the US media.

Information about healthy and unhealthy nutrients is increasingly conveyed at the point of purchase. Many studies have investigated the effects of product health information on attitudes and intentions, but the empirical evidence becomes sketchier when the focus of research is actual purchase behaviour. The present paper provides an overview of empirical evidence on the effectiveness of product health information for food products at the point of purchase.

A systematic literature review was conducted.

Only studies were included that assessed the effect of product health information at the point of purchase on actual purchase behaviour, using data provided by stores’ sales records or obtained by investigating customer receipts as the primary outcome measure.

The included studies’ target group comprised supermarket clientele.

Several studies found no significant effects of product health information on actual purchase behaviour. Interventions were more likely to be effective when they lasted for a longer time, when they included additional intervention components, and when they targeted the absence of unhealthy nutrients instead of or in addition to the presence of healthy nutrients.

No strong evidence for the effectiveness of product health information was found. The effect of intervention duration, additional promotional activities and targeting of healthy v. unhealthy nutrients should be closely examined in future studies.

To assess the feasibility of combining short-term and long-term dietary assessment instruments as new concept for improving usual dietary intake assessment on the individual level.

Feasibility study of completing three 24 h dietary recalls (24-HDR) and a self-administered food propensity questionnaire (FPQ). The 24-HDR was conducted by monthly telephone interviews, using EPIC-SOFT software. The FPQ was completely standardized across cohorts and offered either as a web-based tool or in paper format.

Random sample derived from five ongoing European cohort studies (EPIC-San Sebastian, EPIC-Florence, EPIC-Potsdam, Estonia Genome Center (EGC) and Norwegian Women and Cancer study (NOWAC)).

A total of 400 participants.

Overall, the total participation rate for the present study was 65·3 % (n 261). On average, completion of the 24-HDR was highest for the first 24-HDR (63·0 %) and decreased slightly for the second (60·3 %) and third 24-HDR (56·3 %). The proportions of selecting the web-based FPQ varied among the study centres, with the highest in EGC (92·9 %) and NOWAC (70·0 %) and the lowest in EPIC-San Sebastian (25·5 %) and EPIC-Potsdam (33·9 %). Web users rarely requested support and were younger and more highly educated than those who completed the paper format.

The present study supports the feasibility of a combined application of three 24-HDR and an FPQ in culturally different populations. The varying acceptance of the web-based instrument across populations requires a flexible application of assessment instruments.

The incidence of osteoporosis increases with age and is most frequently observed in postmenopausal women. The objective of the present population-based cohort study was to assess the influence of Ca intake from dairy sources on hip bone mineral density and hip fracture incidence in a group of Polish women over 55 years of age.

The main outcome measures included: bone mineral density, the number of previous fractures and the reported Ca intake from dairy sources, assessed by a diet questionnaire.

The RAC-OST-POL Study was conducted in the District of Raciborz in the south of Poland.

The study was carried out in a group of 625 women, randomly recruited from the general population of women aged >55 years.

Median Ca intake from dairy products was lower in the group of women with femoral neck T-score ≤–2·5 than in the group with T-score >–2·5 (275 v. 383 mg/d; P = 0·0019). For total hip score, the difference was close to borderline significance (P = 0·0698). Median Ca intake from dairy products was lower in the group of women with previous fractures than in those without fracture history (336 v. 395 mg/d; P = 0·0254). The main dairy source of Ca in the analysed group included milk drinks, rennet cheese and milk.

Higher dairy Ca intake is recommended, since a number of the women analysed were unable to satisfy their Ca requirement exclusively from their diet.

The potential role of allium vegetables on endometrial cancer risk has been scarcely investigated and the results of previous Chinese studies are not easily applicable to Western populations. Therefore, we evaluated the relationship between onion and garlic intake and endometrial cancer, using data from an Italian case–control study.

We analysed data from a multi-centre case–control study of 454 endometrial cancer cases and 908 controls, admitted to the same hospitals for a wide spectrum of acute, non-neoplastic conditions. Information was collected by trained interviewers using a validated and reproducible FFQ. Multivariate odds ratios and 95 % confidence intervals were obtained after allowance for recognized confounding factors.

Compared with non-users, the OR of endometrial cancer for successive categories of onion intake were 0·94 (95 % CI 0·72, 1·21) for <2 portions/week and 0·40 (95 % CI 0·22, 0·72) for ≥2 portions/week, with a significant inverse trend in risk (P = 0·01). The OR for an increment of one portion (i.e. 80 g) of onions per week was 0·81 (95 % CI 0·70, 0·95). For garlic, the OR for successive categories of intake were 0·89 (95 % CI 0·68, 1·15) for intermediate use and 0·62 (95 % CI 0·42, 0·92) for high use, with a significant inverse trend in risk (P = 0·02).

Our study found a moderate protective role of allium vegetables on the risk of endometrial cancer.

To determine public attitudes towards federal spending on nutrition assistance programmes and support for policies to improve the nutritional impact of the Supplemental Nutrition Assistance Program (SNAP).

Participants answered survey questions by telephone assessing support for SNAP spending and proposed programme policy changes.

USA.

Survey of 3024 adults selected by random digit dialling conducted in April 2012, including 418 SNAP participants.

A majority (77 %; 95 % CI 75, 79 %) of all respondents supported maintaining or increasing SNAP benefits, with higher support among Democrats (88 %; 95 % CI 86, 90 %) than Republicans (61 %; 95 % CI 58, 65 %). The public supported policies to improve the nutritional impact of SNAP. Eighty-two per cent (95 % CI 80, 84 %) of respondents supported providing additional benefits to programme participants that can only be used on healthful foods. Sixty-nine per cent (95 % CI 67, 71 %) of respondents supported removing SNAP benefits for sugary drinks. A majority of SNAP participants (54 %; 95 % CI 48, 60 %) supported removing SNAP benefits for sugary drinks. Of the 46 % (95 % CI 40, 52 %) of SNAP participants who initially opposed removing sugary drinks, 45 % (95 % CI 36, 54 %) supported removing SNAP benefits for sugary drinks if the policy also included additional benefits to purchase healthful foods.

The US public broadly supports increasing or maintaining spending on SNAP. The majority of respondents, including SNAP participants, supported policies to improve the nutritional impact of SNAP by restricting the purchase of sugary drinks and incentivizing purchase of healthful foods with SNAP benefits.

The aims were to collect data on consumption of different food supplements in a sample of the adult Italian population and to characterize users by demographic, physical and health-related characteristics, lifestyle and behaviour.

Cross-sectional survey.

The study was conducted in 2008 in ten towns of Italy (two towns from each of the five macro-areas: Northwest, Northeast, Centre, South and Islands).

Adults (n 10 000) aged ≥18 years were randomly selected and asked to fill in a self-administered questionnaire regarding their use of food supplements and the above variables. The effect of these variables on food supplement use was evaluated by univariate and multivariate logistic regression.

Of the 1723 individuals who returned the questionnaire, 49 % were users of food supplements. A large proportion (54 %) of users used more than one category of food supplement: vitamin and/or mineral supplements were the most used (61 %), followed by supplements with botanicals and botanical extracts (28 %). The results obtained by logistic regression showed that gender, town size, education level, sports practice, regular use of wholemeal cereal-based foods and presence of a low stress level were determinants for the use of food supplements in the examined population. However, these determinants were not shared by all categories of supplements.

The results of this preliminary study highlight that associations between demographic, dietary and lifestyle factors and use of different categories of food supplements differ according to products, and cannot be accounted for simply by dichotomizing individuals as users or non-users.

To assess ultra-processed food (UPF) consumption and its socio-demographic, psychosocial and behavioural correlates in a general population of Italian children, adolescents and adults.

Cross-sectional telephone-based survey

Italy, 2010–2013.

In total, 9078 participants (5–97 years) from the Italian Nutrition & Health Survey. Dietary intakes were collected by a 1-d 24-h dietary recall. UPF was defined by the NOVA classification and expressed as percentage of total energies.

Average energy intake from UPF (95 % CI) was 17·3 % (17·1 %, 17·6 %) among adults and 25·9 % (24·8 %, 27·0 %) in children/adolescents. Top sources of UPF were processed meats (32·5 %) and bread substitutes (16·7 %). Among adults, age (β = −3·10; 95 % CI (−4·40, −1·80) for >65 years v. 20–40 years; βs are dimensionless) and residing in Southern Italy (β = −0·73; 95 % CI (−1·32, −0·14) v. Northern) inversely associated with UPF. Screen view during meals was directly linked to UPF, as well as poor self-rated health (β = 5·32; 95 % CI (2·66, 7·99)), adverse life events (β = 2·33; 95 % CI (1·48, 3·18)) and low sleep quality (β = 2·34; 95 % CI (1·45, 3·23)). Boys consumed two-point percent more UPF of the total energy than girls (β = 2·01; 95 % CI (0·20, 3·82)). For all ages, a Mediterranean diet was inversely associated with UPF (β = −4·86; 95 % CI (−5·53, −4·20) for good v. poor adherence in adults and (β = −5·08; 95 % CI (−8·38, −1·77) for kids).

UPF contributes a modest proportion of energy to the diets of Italian adults while being one-quarter of the total energies in children/adolescents. UPF was associated with several psychosocial factors and eating behaviours. Increased adherence to Mediterranean diet would possibly result in lower UPF consumption.

To provide an overview of methodological issues in the design, delivery and evaluation of childhood obesity prevention programmes.

Review of existing literature.

International.

Interventions have varied considerably with regard to their design, subject selection criteria, sample size, attrition rates, intervention components and duration of both the intervention and the follow-up phases. However, overall, there is only a limited body of consistent, high-quality evidence on which valid and generalisable conclusions can be drawn about best practices for the prevention of childhood obesity.

Although the rationale for targeting children and adolescents through primary prevention is now compelling, effective obesity prevention remains elusive. There is increasing consensus that prevention of childhood obesity necessitates multifaceted health promotion interventions based on population health principles. By definition, such interventions should have a range of outcome indicators of effectiveness, generalisability and sustainability, not just the traditional ones focused on individual lifestyle behaviour change. Given the complexity and intricacy of population-based intervention programmes, multiple methods of data collection which combine both qualitative and quantitative approaches will need to be fully exploited in order to move towards evidence-based practice in the future.

To compare dietary diversity scores measured over a 1-day and a 3-day period, and to assess their relationships with socio-economic characteristics and the nutritional status of rural African women.

A qualitative dietary recall allowed calculation of a dietary diversity score (DDS; number of food groups consumed out of a total of nine). Body mass index (BMI) and body fat percentage (BFP) were used to assess the nutritional status of women.

A representative sample of 550 mothers in north-east Burkina Faso.

The DDS increased from 3.5 to 4.4 when calculated from a 1-day or a 3-day recall (P < 0.0001), although for the latter the DDS was affected by memory bias. The DDS calculated from a 1-day recall was higher when a market day occurred during the recall period. Both scores were linked to the sociodemographic and economic characteristics of the women. Women in the lowest DDS tertile calculated from the 1-day recall had a mean BMI of 20.5 kg m− 2 and 17.7% of them were underweight, versus 21.6 kg m− 2 and 3.5% for those in the highest tertile (P = 0.0003 and 0.0007, respectively). The DDS calculated from the 1-day recall was also linked to mean BFP; all these links remained significant after adjustment for confounders. For the 3-day period, no such relationships were found to be significant after adjustment.

The DDS calculated from a 1-day dietary recall was sufficient to predict the women's nutritional status. In such a context attention should be paid to market days.