To assess whether higher adherence to the traditional Mediterranean diet (MedDiet) was associated with lower consumption of ultra-processed foods (UPF) and lower free sugar intake.

Cross-sectional analysis of baseline information among participants in the SENDO project, a Spanish paediatric cohort. Dietary information was collected through a semi-quantitative FFQ. Food items were classified according to the NOVA classification. Adherence to the MedDiet was evaluated through the KIDMED index.

Spain.

Three hundred eight-six children (52 % boys) with a mean age of 5·3 years old (sd 1·0) were included in the analysis.

74·4 % of the children had moderate adherence to the MedDiet (mean KIDMED score: 5·9 points; sd 1·7) and overall, 32·2 % of the total energy intake came from UPF. Each two additional points in the KIDMED score was associated with 3·1 % (95 % CI 2·1, 4·0) lower energy intake from UPF. Compared to those with low adherence to the MedDiet, children with medium and high adherence reported 5·0 % (95 % CI 2·2, 7·7) and 8·5 % (95 % CI 5·2, 11·9) lower energy intake from UPF, respectively. We also found that 71·6 % of the variability in free sugar intake was explained by the variability in UPF consumption.

Adherence to the traditional MedDiet was inversely associated with energy intake from UPF. Furthermore, most of the variability in free sugar intake was explained by the variability of UPF consumption. Public health strategies are needed to strengthen the adherence to the MedDiet in pre-schoolers while regulating the production, marketing and advertising of UPF.

Diet-related diseases are the leading cause of morbidity and mortality in the USA. While the critical aspects of a healthy diet are well known, the relationship between community-based, teaching kitchen education and dietary behaviours is unclear. We examined the effect of a novel culinary medicine education programme on Mediterranean diet adherence and food cost savings.

Families were randomised to a hands-on, teaching kitchen culinary education class (n = 18) or non-kitchen-based dietary counselling (n = 23) for 6 weeks. The primary outcome was adherence to the validated nine-point Mediterranean diet score, and the secondary outcome was food cost savings per family.

The Goldring Center for Culinary Medicine, a community teaching kitchen in New Orleans.

Families (n = 41) of at least one child and one parent.

Compared with families receiving traditional dietary counselling, those participating in hands-on, kitchen-based nutrition education were nearly three times as likely to follow a Mediterranean dietary pattern (OR 2·93, 95% CI 1·73, 4·95; P  <  0·001), experiencing a 0·43-point increase in Mediterranean diet adherence after 6 weeks (B  =  0·43; P  <  0·001). Kitchen-based nutrition education projects to save families $US 21·70 per week compared with standard dietary counselling by increasing the likelihood of consuming home-prepared v. commercially-prepared meals (OR 1·56, 95% CI 1·08, 2·25; P  =  0·018).

Community-based culinary medicine education improves Mediterranean diet adherence and associates with food cost savings among a diverse sample of families. Hands-on culinary medicine education may be a novel evidence-based tool to teach healthful dietary habits and prevent chronic disease.

To identify scientific publications that result from food industry-funded projects on human health and to characterize their research topics to assess the potential for bias in the research agenda.

Cross-sectional analysis.

Food industry-supported projects related to human health were identified from food company websites; publications resulting from the food industry-sponsored projects were identified through a PubMed search.

Of ten companies analysed, only two (Coca-Cola and the Mars Center for Cocoa Health Science) provided a list of research projects with sufficient detail for analysis. Among the 204 publications resulting from thirty-seven disclosed research projects, the most common topic was physical activity (40·7 %), while highly processed foods were analysed in 10·8 % of the publications. Twenty-two publications (10·8 %) focused on research integrity or research methods.

Publications resulting from Coca-Cola- and Mars-sponsored research appear to skew the evidence towards solutions that favour industry interests by focusing on food components that can be manipulated and marketed by food companies. These food industry-funded publications can also distract from nutrition as a health issue by diverting public and policy attention to physical activity. Shaping the debate around scientific methods can be another strategy that corporations use for their benefit to raise doubts about the methods used in non-industry sponsored research.

To develop an index that assesses the degree of adherence to existing diet–lifestyle recommendations for preschoolers (Preschoolers Diet–Lifestyle Index (PDL-Index)) and to investigate its association with obesity.

The PDL-Index was constructed using eleven components (i.e. questions regarding the frequency of consumption of selected foods/food groups, time spent on television watching and on moderate-to-vigorous physical activities).

Scores from 0 to 4 were assigned to all components of the index. The PDL-Index total score ranged from 0 to 44. Higher values of the PDL-Index indicate greater adherence to dietary and lifestyle recommendations for preschoolers or otherwise greater adherence to healthier dietary–lifestyle patterns.

As a validation procedure, a sample of 2287 preschoolers from Greece (GENESIS study) was used.

The participants following healthier diet–lifestyle patterns (third tertile of PDL-Index) were less likely to be obese or overweight/obese compared to those following unhealthy diet–lifestyle patterns (first tertile of PDL-Index). It was observed that a 1/44 unit increase in the score of the PDL-Index was associated with approximately 5 % and 3 % lower odds of being obese and overweight/obese, respectively. Statistically significant results were observed after adjusting for potential confounders.

The suggested PDL-Index could help public health policy makers in identifying vulnerable population subgroups and developing cost-effective, targeted intervention actions both in family and preschool settings. In addition, health-care professionals can use the PDL-Index to evaluate diet quality, lifestyle and risk for overweight/obesity at an individual level and counsel parents accordingly.

Sociodemographic factors may affect adherence to specific dietary patterns during pregnancy. The present study aimed to identify dietary patterns during pregnancy and associated factors among Brazilian pregnant women.

A cross-sectional analysis. Dietary intake was evaluated with a semi-quantitative FFQ during the first postpartum week; the time frame included the second and third gestational trimesters. Principal component analysis was used to identify dietary patterns during pregnancy. Sociodemographic data were obtained using a structured questionnaire. Multiple linear regressions were applied to test the associations between the sociodemographic factors and dietary patterns.

Mesquita, Rio de Janeiro, Brazil, 2011.

Postpartum women (n 327) who were 18–45 years of age and Mesquita residents.

Three different dietary patterns were identified: ‘healthy’ (mainly comprising legumes, vegetables and fruits), ‘mixed’ (mainly comprising candy, butter and margarine, and snacks) and ‘traditional’ (mainly comprising beans and rice). Women with a higher monthly per capita family income (β=0·0006; 95 % CI 0·0001, 0·001; P=0·011) and women of older age (β=0·021; 95 % CI −0·001, 0·042; P=0·058) were more likely to adhere to the ‘healthy’ dietary pattern. Women with higher parity were less likely to adhere to the ‘healthy’ pattern (β=−0·097; 95 % CI −0·184, −0·009; P=0·030) and were more likely to adhere to the ‘traditional’ pattern (β=0·098; 95 % CI 0·021, 0·175; P=0·012). Although not statistically significant, older women were less likely to adhere to the ‘mixed’ (β=−0·017; 95 % CI −0·037, 0·003; P=0·075) and ‘traditional’ (β=−0·018; 95 % CI −0·037, 0·001; P=0·061) dietary patterns.

Monthly per capita family income, parity and maternal age were factors associated with adherence to a healthy diet during pregnancy.

To investigate evolving food retail systems in Thailand.

Rapid assessment procedures based on qualitative research methods including interviews, focus groups discussions and site visits.

Seven fresh markets located in the four main regions of Thailand.

Managers, food specialists, vendors and shoppers from seven fresh markets who participated in interviews and focus group discussions.

Fresh markets are under economic pressure and are declining in number. They are attempting to resist the competition from supermarkets by improving convenience, food diversity, quality and safety.

Obesity has increased in Thailand at the same time as rapid growth of modern food retail formats has occurred. As fresh markets are overtaken by supermarkets there is a likely loss of fresh, healthy, affordable food for poorer Thais, and a diminution of regional culinary culture, women's jobs and social capital, with implications for the health and nutrition transition in Thailand.

To assess the intake frequency of fruit and vegetables, serving sizes, reasons for and barriers to consumption, and the potential for increasing fruit and vegetable intake.

A nationwide postal questionnaire survey was conducted in 2006 over all four seasons. The participants were stratified according to occupation and sex. The response rate for 5130 questionnaires sent out was 52·7 %.

Austria.

Austrian adults, aged 19–64 years.

Daily fruit consumption was reported by 57·1 % of the participants and daily vegetable consumption by 36·2 %. On average, 2·1 (sd 1·9) servings (250 (sd 225) g) of fruit and 1·7 (sd 1·3) servings (198 (sd 159) g) of vegetables were consumed daily. Women ate fruit and vegetables both more frequently and in greater quantities than men. Both intake frequency and the number of fruit and vegetable servings were largely independent of seasonal fluctuations. The primary reason for the consumption of both fruit and vegetables was taste. The greatest barrier to higher intake was the perception that current individual consumption was already sufficient. Price did not constitute a relevant barrier in Austria. At present, the potential for increasing fruit and vegetable intake can be estimated at two servings.

Austrian adults still consume less fruit and vegetables than recommended. Strategies to increase intake should pay more attention to the taste instead of the various health aspects.

To develop and test a quantitative, interviewer-administered food frequency questionnaire (FFQ) to ascertain nutrient intakes of individuals in northern India.

A 92-item FFQ was developed based on food use and market surveys of the study area. A validation study was conducted consisting of 24-h diet recalls (24HR) administered on 6 randomly selected days over 1 year. Two FFQs were administered, one each at the beginning and end of the 1-year period. FFQ and 24HR-derived nutrient scores were compared using correlation and regression analyses and by computing differences between nutrient intakes estimated by the two methods.

Rural villages in Bhavnagar District, Gujarat, North India.

60 individuals who agreed to provide all necessary data.

Pearson (parametric) correlation coefficients averaged 0.69 in comparing nutrient scores derived from the 24HR with those from the first FFQ and 0.72 in comparing the second FFQ (P < 0.0001). Spearman correlation coefficients were virtually identical to the Pearson correlations, averaging 0.68 and 0.72, respectively. In regression analyses, most coefficients were close to 1.0 (perfect linear association). Nutrient scores were significantly and consistently higher on both FFQs relative to the 24HR.

This FFQ produces results broadly comparable, and superior in some respects, to those commonly used in the West. Higher than average measures of association indicate its suitability for comparing exposures within this study population in reference to health-related endpoints.

To evaluate vitamin D deficiency prevalence and risk factors among pregnant Chinese women.

A descriptive cross-sectional analysis.

China National Nutrition and Health Survey (CNNHS) 2010–2013.

A total of 1985 healthy pregnant women participated. Possible predictors of vitamin D deficiency were evaluated via multiple logistic regression analyses.

The median serum 25-hydroxyvitamin D level was 15·5 (interquartile range 11·9–20·0, range 3·0–51·5) ng/ml, with 74·9 (95 % CI 73·0, 76·7) % of participants being vitamin D deficient (25-hydroxyvitamin D <20 ng/ml). According to the multivariate logistic regression analyses, vitamin D deficiency was positively correlated with Hui ethnicity (P=0·016), lack of vitamin D supplement use (P=0·021) and low ambient UVB level (P<0·001). In the autumn months, vitamin D deficiency was related to Hui ethnicity (P=0·012) and low ambient UVB level (P<0·001). In the winter months, vitamin D deficiency was correlated with younger age (P=0·050), later gestational age (P=0·035), higher pre-pregnancy BMI (P=0·019), low ambient UVB level (P<0·001) and lack of vitamin D supplement use (P=0·007).

Vitamin D deficiency is prevalent among pregnant Chinese women. Residing in areas with low ambient UVB levels increases the risk of vitamin D deficiency, especially for women experiencing advanced stages of gestation, for younger pregnant women and for women of Hui ethnicity; therefore, vitamin D supplementation and sensible sun exposure should be encouraged, especially in the winter months. Further studies must determine optimal vitamin D intake and sun exposure levels for maintaining sufficient vitamin D levels in pregnant Chinese women.

To examine the effect of the new Canadian labelling regulations on the fat composition and prices of margarines.

A survey of all margarines sold in major supermarkets in the Greater Toronto area was conducted in 2006, and results were compared with those of a similar survey conducted in 2002. Average fat composition, proportion of ‘trans fat-free’ margarines and average prices of margarines were compared. A general linear model procedure was used to compare the relationship between price and fat composition in 2002 and 2006.

Average amounts of trans fatty acids (TFA) and MUFA decreased, while average amounts of PUFA increased significantly from 2002 to 2006. The proportion of margarines with less than 0·2 g TFA/10 g serving rose significantly from 31 % in 2002 to 69 % in 2006. Margarines lower in TFA on average cost significantly more than margarines with greater amounts of these fats, and this relationship appeared stronger in 2006 relative to 2002.

There is evidence of reductions in TFA in margarines since new labelling regulations came into effect in Canada; however, TFA reductions appeared to be restricted to higher-priced margarines. Results suggest that voluntary approaches (i.e. manufacturer incentives via labelling) to reduce population intakes of TFA will yield little changes in TFA content of low-cost products and thus may have limited benefit for lower-income groups, who are at higher risk of heart disease.

Paternal smoking is highly prevalent in Asia, and tobacco may account for a large proportion of household expenditures among poor families. We sought to characterise the relationship between paternal smoking, child malnutrition and food expenditures.

Data on smoking, household expenditures and child malnutrition were examined in a stratified multistage cluster sample of households in the Indonesia nutrition surveillance system. Main outcome measures were child wasting (weight-for-height Z-score < − 2), underweight (weight-for-age Z-score < − 2) and stunting (height-for-age Z-score < − 2), and severe wasting, underweight and stunting (defined by respective Z-scores < − 3).

In total, 175 583 households from urban slum areas in Indonesia.

Children 0–59 months of age.

The prevalence of paternal smoking was 73.8%. After adjusting for child gender and age, maternal age and education, and weekly per capita household expenditures, paternal smoking was associated with child stunting (odds ratio (OR) = 1.11, 95% confidence interval (CI) 1.08–1.14, P < 0.0001), severe wasting (OR = 1.17, 95% CI 1.03–1.33, P = 0.018) and severe stunting (OR = 1.09, 95% CI 1.04–1.15, P < 0.001). In households where the father was a smoker, tobacco accounted for 22% of weekly per capita household expenditures, with less money spent on food compared with households in which the father was a non-smoker.

Among poor families in urban slum areas of Indonesia, paternal smoking diverts household money from food to tobacco and exacerbates child malnutrition.

In life-cycle assessment, the functional unit defines the unit for calculation of environmental indicators. The objective of the present study was to assess the influence of two functional units, 100 g and 100 kcal (420 kJ), on the associations between three dimensions for identifying sustainable foods, namely environmental impact (via greenhouse gas emissions (GHGE)), nutritional quality (using two distinct nutrient profiling systems) and price.

GHGE and price data were collected for individual foods, and were each expressed per 100 g and per 100 kcal. Two nutrient profiling models, SAIN,LIM and UK Ofcom, were used to assess foods’ nutritional quality. Spearman correlations were used to assess associations between variables. Sustainable foods were identified as those having more favourable values for all three dimensions.

The French Individual and National Dietary Survey (INCA2), 2006–2007.

Three hundred and seventy-three foods highly consumed in INCA2, covering 65 % of total energy intake of adult participants.

When GHGE and price were expressed per 100 g, low-GHGE foods had a lower price and higher SAIN,LIM and Ofcom scores (r=0·59, −0·34 and −0·43, respectively), suggesting a compatibility between the three dimensions; 101 and 100 sustainable foods were identified with SAIN,LIM and Ofcom, respectively. When GHGE and price were expressed per 100 kcal, low-GHGE foods had a lower price but also lower SAIN,LIM and Ofcom scores (r=0·67, 0·51 and 0·47, respectively), suggesting that more environment-friendly foods were less expensive but also less healthy; thirty-four sustainable foods were identified with both SAIN,LIM and Ofcom.

The choice of functional unit strongly influenced the compatibility between the sustainability dimensions and the identification of sustainable foods.

To identify child and parental factors associated with screen time in 3-year-old children.

Observational study.

Participants were recruited from a large primary-care paediatric group practice in Toronto, Canada.

Healthy 3-year-old children were included. A questionnaire was completed by their parents on screen time. Descriptive statistics and linear regression models were used to assess associations between child screen time and selected factors. Multivariable models included factors from the univariate analysis with P < 0·1. Estimated effects and 95 % CI are reported.

A total of 157 children were enrolled (91 % recruitment). The mean screen time per weekday was 104 min (similar for weekend day). In all, 10 % of children had a television (TV) in their bedroom; 59 % consumed at least one meal while watching TV; and 81 % of parents had household rules about screen time. Controlling for maternal education and age, eating lunch and dinner in front of the screen and mother being employed were associated with an increase in child weekday screen time of 96 (95 % CI 30, 192), 42 (95 % CI 12, 90) and 36 (95 % CI 6, 72) min/d, respectively. Eating lunch in front of the screen and an increase of 1 h of parental screen time were associated with an increase of 78 (95 % CI 36, 132) and 12 (95 % CI 6, 18) min/d in child weekend screen time. Family rules decreased child weekend screen time by 30 (95 % CI 6, 54) min/d.

Interventions that include these important parental factors should be evaluated for their effectiveness in reducing screen time.

To identify parents’ concerns and attitudes towards children’s diets, activity habits and weight status.

Computer-assisted telephone interviewing administration of a 37-item survey. Data were weighted for parental education level. Descriptive results are presented, and comparisons are made by the age, gender and parental characteristics of the child.

Online research panel of Australian parents.

A total of 1202 randomly selected parents of children aged 2–16 years, broadly representative of the Australian population.

Parents were concerned about their child’s education (reported by 35 % of respondents), child’s health and well-being (25 %), and violence, drugs and alcohol (20 %). Concern about nutrition was indicated by 14 % of respondents and concern about fitness/exercise was indicated by 3 % of the sample. Factors perceived as making a healthy diet difficult to achieve for their child were child resistance (89 %), the availability of healthy food (72 %), a busy lifestyle (67 %) and the influence of food advertising (63 %). Ninety-two per cent of parents thought that it was realistic for their child to be active for at least 1 h/d, with 75 % of parents feeling that it was realistic for their child to have less than 2 h recreational screen time per d. Despite this, common barriers to achieving the activity guidelines were lack of time, weather and keeping children occupied.

Insights into parental concerns from the current study may be useful in guiding development of interventions to improve children’s nutrition and physical activity habits by framing messages in a way that are most likely to resonate with parents.

The present work is aimed at meta-analysing validity studies of FFQ for adolescents, to investigate their overall accuracy and variables that can affect it negatively.

A meta-analysis of sixteen original articles was performed within the ASSO Project (Adolescents and Surveillance System in the Obesity prevention).

The articles assessed the validity of FFQ for adolescents, compared with food records or 24 h recalls, with regard to energy and nutrient intakes.

Pearson’s or Spearman’s correlation coefficients, means/standard deviations, kappa agreement, percentiles and mean differences/limits of agreement (Bland–Altman method) were extracted. Pooled estimates were calculated and heterogeneity tested for correlation coefficients and means/standard deviations. A subgroup analysis assessed variables influencing FFQ accuracy.

An overall fair/high correlation between FFQ and reference method was found; a good agreement, measured through the intake mean comparison for all nutrients except sugar, carotene and K, was observed. Kappa values showed fair/moderate agreement; an overall good ability to rank adolescents according to energy and nutrient intakes was evidenced by data of percentiles; absolute validity was not confirmed by mean differences/limits of agreement. Interviewer administration mode, consumption interval of the previous year/6 months and high number of food items are major contributors to heterogeneity and thus can reduce FFQ accuracy.

The meta-analysis shows that FFQ are accurate tools for collecting data and could be used for ranking adolescents in terms of energy and nutrient intakes. It suggests how the design and the validation of a new FFQ should be addressed.

To describe the consequences of systematic reporting bias by the obese for diet–disease relationships.

The present report used 24-hour urinary nitrogen and estimates of 24-hour energy expenditure to assess error in diet reporting, and examined the consequence of accounting for this error for associations between dietary fat intake and serum low-density lipoprotein (LDL)-cholesterol.

Sub-study to the Danish MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) project, carried out in 1987–1988.

A random sub-sample of the adult Danish male population (n = 152).

Correcting dietary fat for underreporting error weakened, rather than strengthened, the association between dietary fat intake and LDL-cholesterol by reducing the slope of the regression from β = 3.4, P = 0.02 to β = 2.7, P = 0.04.

This example illustrates that systematic underreporting of dietary fat by high-risk groups such as the obese may produce an overestimated association. These results imply that previous epidemiological studies showing a positive association between percentage of energy from fat and other health outcomes, e.g. cancer and heart disease, may have overestimated the negative effects of a high-fat diet. If we were able to correctly assess dietary fat intake in general populations, recommendations for fat intake may be more liberal than the 30% suggested today. Improved assessment of fat intake in epidemiological studies is necessary for future development of evidence-based recommendations for diet and health.

To study pregnant women's diet at food and nutrient levels and how these match recommendations; to describe how factors such as education level, economy and folk dietetics influence the women's food choice; and to give suggestions for the improvement of nutrition education in the existing antenatal care systems.

Thirty pregnant women in the last trimester were interviewed three times using a 24-hour dietary recall with weighing of foods and recipes of dishes. Interviews regarding health, nutrition and socio-economic status, and measurements of weight and height of the women, were conducted.

Rural parts of Salem District, Tamil Nadu, South India.

The women's diet (without supplements) was insufficient in energy and all nutrients except fat, compared with the Indian recommendations. Aggravating low intakes of micronutrients were found which were reflected in low intakes of foods other than rice. Eating customs and economy appeared to influence the women's food choice negatively in relation to recommendations while factors such as education level, family type, pregnancy number and folk dietetics did not seem to have a negative effect. The amounts of foods recommended, especially green leafy vegetables, must be shown to the women. The nutrition advice given by all levels of health providers must be the same and based on cheap, local, commonly consumed foods.

To describe part of the results of the CALIPSO study, i.e. to provide seafood consumption data on high seafood consumers in France and its contribution to n-3 long-chain (LC) PUFA intake.

A total of 1011 individuals aged 18 years and over, who consumed fish and seafood at least twice weekly, were recruited. A consumption survey and a local ‘total diet study’ were performed to examine seafood consumption, fatty acids composition of seafood and to assess n-3 LC PUFA intake.

The CALIPSO survey was conducted in four French coastal regions (Le Havre, Lorient, La Rochelle and Toulon).

The subjects were questioned about their consumption habits, especially concerning fish and seafood, through a first validated FFQ. A sample of the most consumed seafood products (n 47) was analysed for each region for its fatty acid composition. Fatty acids and especially n-3 LC PUFA intakes in this population were then calculated.

The average consumption of fresh and frozen fish was found to be 633, 636·5 and 787·8 g/week among men aged 18–64 years, women aged 18–64 years and people over 65 years, respectively. In these population groups, the consumption of crustaceans and molluscs was 270·3, 259·9 and 279·3 g/week, respectively. The results show that, irrespective of the age group and gender, consumption of fish and seafood twice weekly without excluding oily fish allowed people to reach the national and international recommended n-3 LC PUFA intakes and demonstrates the validity of the French recommendations for fish consumption.

To compare physical activity (PA) reported through pedometer registrations (step counts) with PA reported in four different questionnaires; to compare step count thresholds (7500, 10 000 and 12 500 steps/d) with the PA guideline of 30 min of moderate to vigorous PA (MVPA) per day.

A sample of 310 healthy adults, mean age 38·7 (sd 11·9) years, volunteered to participate. Forty-seven per cent was male and 93 % of the sample was employed.

PA was assessed by interview (Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ)), three self-administered questionnaires (long version and short version of the International Physical Activity Questionnaire (long-form IPAQ, short-form IPAQ), Baecke questionnaire) and seven consecutive days of pedometer registration.

Step counts correlated positively with questionnaire-based PA. The strongest correlations were found between step counts and total PA reported in the long-form IPAQ (rs = 0·37), moderate PA reported in the short-form IPAQ (rs = 0·33), total and moderate PA reported in the MLTPAQ (rs = 0·32), and the total and leisure-time PA indices (excluding sport) reported in the Baecke questionnaire (rs = 0·44). According to step counts, 22·6 % of the participants were somewhat active, 18·7 % active and 39·4 % highly active. As assessed by the long-form IPAQ, short-form IPAQ and MLTPAQ, the guideline of 30 min MVPA/d was reached by respectively 85·4 %, 84·8 % and 68·0 % of participants.

Pedometer-based data offer adequate information to discriminate between levels of PA. Caution is needed when comparing active samples based on different PA recommendations.