To characterise plasma and red-blood-cell (RBC) folate status among pregnant women in an area with an extremely high prevalence of neural tube defects, and to compare them with those of women from a low prevalence area.

A cross-sectional survey conducted in 2003.

One county and one city from each of the high prevalence area and the low prevalence area in China.

Five hundred and sixty-two women in their first trimester of pregnancy in the high prevalence area and 695 pregnant women in the low prevalence area.

Women in the high prevalence area had less than half the plasma and RBC folate concentrations (12.2 and 440.0 nmol l− 1, respectively) of women in the low prevalence area (33.5 and 910.4 nmol l− 1, respectively). In the high prevalence area, 40% of rural women were deficient in RBC folate and 50% were deficient in plasma folate; 20% of urban women were deficient in RBC folate and 30% deficient in plasma folate. In contrast, only 4% (RBC folate) and 6% (plasma folate) of rural women, and 2% (RBC folate) and 1% (plasma folate) of urban women, were folate-deficient in the low prevalence area. Less than 10% of rural and about 26% of urban women in the high prevalence area took folic acid periconceptionally, compared with 70% and 60% of women in the low prevalence area.

Blood folate deficiency is highly prevalent among pregnant women in an area of China with a very high prevalence of neural tube defects.

To assess factors influencing dietary behaviours of adolescents in Addis Ababa, Ethiopia.

Using the qualitative participatory method Photovoice, participants received training on the basics of Photovoice and took photographs related to (un)healthy eating in their environment. Transcripts of individual interviews, focus group discussions and photographs were coded for thematic analysis.

One private and one public school located in the same, central neighbourhood in Addis Ababa, Ethiopia to explore how school populations of different socio-economic status experience the same neighbourhood environment.

Twenty-six adolescents aged 14–19 years old, of which there were seventeen girls and nine boys.

Findings from the current study indicate that food safety concerns appear to be the major influencing factors for adolescents’ dietary choices. Unhealthy and unsafe foods appear to be widely available and/or affordable in adolescents’ neighbourhoods and almost half of the photographs taken by adolescents depicted poor hygiene conditions related to food vendors. Participants considered foods available in their environments as generally unsafe, calling for more packaged food.

Concerns for food safety, hygiene and affordability are the dominating factors for adolescents’ food choices. These concerns, together with limited nutrition knowledge and preference for packaged foods, could make cheap, ultra-processed packaged foods more desirable.

To describe homeless youths’ experiences of food insecurity and examine the relation between chronic food deprivation and food acquisition practices.

A cross-sectional survey of homeless youths was conducted in 2003 to assess their nutritional vulnerability and describe their food acquisition practices.

Toronto, Canada.

Two hundred and sixty-one youths, aged 16–24 years, who had spent ten or more of the past thirty nights sleeping in a temporary shelter, public space or friend’s place, because they had no place of their own. Most participant recruitment (70 %) occurred outdoors, but 30 % were recruited in drop-in centres.

Over the past 30 d, 28 % of males and 43 % of females experienced chronic food deprivation (i.e. reduced food intake for ≥10 d), and 32 % of females and 48 % of males reported problems obtaining water to drink. Most youths routinely obtained meals at charitable programmes and panhandled for money for food, and many routinely stole food or ate day-old food obtained from restaurants. In contrast, eating food discarded by others and postponing debt payments were strategies of desperation, more common among youths experiencing chronic food deprivation. Additionally, for males, deliberately seeking the company of friends, relatives or acquaintances to obtain food, and for females, borrowing money or trading sex for food, were associated with chronic food deprivation.

The pervasiveness and severity of food insecurity experienced by the youths and their desperate means of food acquisition highlight the need for more effective responses to the plight of homeless youths in Canadian cities.

To compare dietary patterns and food and macronutrient intakes among adults in three ethnic groups in rural Kenya.

In the present cross-sectional study, dietary intake was estimated in adult volunteers using two non-consecutive interactive 24 h recalls. Dietary patterns were assessed from the number of meals and snacks per day and from the food items and major food groups registered, and their contribution to energy intake (EI) was calculated. Anthropometric values were measured and sociodemographic data obtained using a questionnaire.

A cross-sectional study was conducted in the Bondo, Kitui and Transmara districts of rural Kenya. A high prevalence of food insecurity in Kenya underlines the importance of describing the dietary patterns and intakes in different Kenyan ethnic groups.

A total of 1163 (61 % women) adult Luo, Kamba and Maasai, with a mean age of 38·6 (range: 18–68) years, volunteered to participate.

Dietary patterns and food groups contributing to EI differed significantly among the ethnic groups. Mean EI ranged from 5·8 to 8·6 MJ/d among women and from 7·2 to 10·5 MJ/d among men, with carbohydrates contributing between 55·7 % and 74·2 % and fat contributing between 14·5 % and 30·2 % of total EI. Mean protein intake ranged from 0·72 to 1·3 g/kg per d, and EI:BMR ratio ranged between 1·1 and 1·6 in both sexes, and was highest among the Luo. Prevalence of underweight (BMI < 18·5 kg/m2) was 13·7 %, 20·5 % and 24·2 % in the Luo, Kamba and Maasai, respectively.

The degree of food insecurity measured as a degree of undernutrition and as dietary patterns differed considerably among the ethnic groups. The Maasai and Kamba in particular were exposed to food insecurity.

As misreporting, mostly under-reporting, of dietary intake is a generally known problem in nutritional research, we aimed to analyse the association between selected determinants and the extent of misreporting by the duplicate portion method (DP), 24 h recall (24hR) and FFQ by linear regression analysis using the biomarker values as unbiased estimates.

For each individual, two DP, two 24hR, two FFQ and two 24 h urinary biomarkers were collected within 1·5 years. Also, for sixty-nine individuals one or two doubly labelled water measurements were obtained. The associations of basic determinants (BMI, gender, age and level of education) with misreporting of energy, protein and K intake of the DP, 24hR and FFQ were evaluated using linear regression analysis. Additionally, associations between other determinants, such as physical activity and smoking habits, and misreporting were investigated.

The Netherlands.

One hundred and ninety-seven individuals aged 20–70 years.

Higher BMI was associated with under-reporting of dietary intake assessed by the different dietary assessment methods for energy, protein and K, except for K by DP. Men tended to under-report protein by the DP, FFQ and 24hR, and persons of older age under-reported K but only by the 24hR and FFQ. When adjusted for the basic determinants, the other determinants did not show a consistent association with misreporting of energy or nutrients and by the different dietary assessment methods.

As BMI was the only consistent determinant of misreporting, we conclude that BMI should always be taken into account when assessing and correcting dietary intake.

To determine key points of intervention in urban food systems to improve the climate resilience, equity and healthfulness of the whole system.

The paper brings together evidence from a 3-year, Australia-based mixed-methods research project focused on climate change adaptation, cities, food systems and health. In an integrated analysis of the three research domains – encompassing the production, distribution and consumption sectors of the food chain – the paper examines the efficacy of various food subsystems (industrial, alternative commercial and civic) in achieving climate resilience and good nutrition.

Greater Western Sydney, Australia.

Primary producers, retailers and consumers in Western Sydney.

This overarching analysis of the tripartite study found that: (i) industrial food production systems can be more environmentally sustainable than alternative systems, indicating the importance of multiple food subsystems for food security; (ii) a variety of food distributors stocking healthy and sustainable items is required to ensure that these items are accessible, affordable and available to all; and (iii) it is not enough that healthy and sustainable foods are produced or sold, consumers must also want to consume them. In summary, a resilient urban food system requires that healthy and sustainable food items are produced, that consumers can attain them and that they actually wish to purchase them.

This capstone paper found that the interconnected nature of the different sectors in the food system means that to improve environmental sustainability, equity and population health outcomes, action should focus on the system as a whole and not just on any one sector.

To summarise the findings from this supplemental issue on the distribution of malnutrition (stunting/short stature, anaemia and overweight) by wealth, education and ethnicity within and between ten Latin American countries.

We retrieved information from each country’s article and estimated the average difference in the prevalence of malnutrition between groups. We estimated the associations between countries’ malnutrition prevalence and GDP, percentage of women with high education and percentage of non-indigenous ethnicity.

Nationally representative surveys from ten Latin American countries conducted between 2005 and 2017.

Children (<5 years), adolescent women (11–19 years) and adult women (20–49 years).

Socially disadvantaged groups (low wealth, low education and indigenous ethnicity) had on average 15–21 (range across indicators and age groups) percentage points (pp) higher prevalence of stunting/short stature and 3–11 pp higher prevalence of anaemia. For overweight or obesity, adult women with low education had a 17 pp higher prevalence; differences were small among children <5 years, and results varied by country for adolescents by education, and for adults and adolescents by wealth and ethnicity. A moderate and strong correlation (–0·58 and –0·71) was only found between stunting/short stature prevalence and countries’ GDP per capita and percentage of non-indigenous households.

Overweight was equally distributed among children; findings were mixed for ethnicity and wealth, whereas education was a protective factor among adult women. There is an urgent need to address the deep inequalities in undernutrition and prevent the emerging inequalities in excess weight from developing further.

We conducted a meta-analysis to evaluate the relationship between vitamin E and age-related cataract (ARC).

The fixed- or random-effect model was selected based on heterogeneity. Meta-regression was used to explore potential sources of between-study heterogeneity. Publication bias was evaluated using Begg’s test. The dose–response relationship was assessed by a restricted cubic spline model.

Relevant studies were identified by a search of PubMed and the Cochrane Library to May 2014, without language restrictions.

Studies involved samples of people of all ages.

Dietary vitamin E intake, dietary and supplemental vitamin E intake, and high serum tocopherol levels were significantly associated with decreased risk of ARC, the pooled relative risk was 0·73 (95 % CI 0·58, 0·92), 0·86 (95 % CI 0·75, 0·99) and 0·77 (95 % CI 0·66, 0·91), respectively. Supplemental vitamin E intake was non-significantly associated with ARC risk (relative risk=0·92; 95 % CI 0·78, 1·07). The findings from dose–response analysis showed evidence of a non-linear association between dietary vitamin E intake and ARC. The risk of ARC decreased with dietary vitamin E intake from 7 mg/d (relative risk=0·94; 95 % CI 0·90, 0·97).

The findings of the meta-analysis indicated that dietary vitamin E intake, dietary and supplemental vitamin E intake, and high level of serum tocopherol might be significantly associated with reduced ARC risk.

The present analysis evaluates the overall appreciation and implementation of an intervention, Project Tomato, designed to maintain fruit and vegetable intake in children aged 8–9 years.

A random sample of fifty-four English primary schools (658 children) were randomised to either the intervention group or the control. The intervention group received a multi-component programme delivered in school by teachers and items sent home for parents/children. Dietary measurements were collected at baseline and follow-up. The intervention participants completed questionnaires on the intervention materials, to identify implementation and appreciation of the intervention, and other environmental mechanisms.

Fifty-four primary schools were randomly selected, with twenty-seven schools allocated to the intervention group.

A total of 311 children received the intervention.

Implementation of the intervention was low, 21·3 % of school items and 56·0 % of home items were implemented. The intervention materials were well received by teachers, parents and children. Other mechanisms that may affect fruit and vegetable intake were explored. Children who ate their main meal with their parents 3–7 nights/week on average consumed 37·6 (95 % CI 9·8, 65·4) g more fruit and vegetables than children who ate with their parents 0–2 times/week.

Implementation of the trial components was poor. However, the results identified the importance of parental environment and mealtime structure on children's fruit and vegetable intake.

This study explores the factors that influence eating patterns in a nationally representative sample of the English population.

Subjects were interviewed in 1993; questions covered basic demographic details, attitudes about nutrition, and they completed a short food frequency questionnaire that had previously been validated. Cluster analysis was used to summarize dietary intake into more or less healthy clusters.

A random sample ofthe English population.

A cross-sectional survey of 5553 men and women (response rate 70%) aged between 16 and 74 years.

As defined from the cluster analysis about half the sample were currently reporting a more healthy diet; respondents in the better educated middle-aged demographic cluster were more likely to report eating a more healthy diet than respondents in the younger lower-income family cluster. About three-quarters of all respondents believed that they either already ate a healthy diet or had changed to a healthy diet in the last 3 years. For those respondents who said they were eating a healthy diet about half of them were eating a more healthy diet. Respondents who had not changed their diet were more likely than those who had to believe that healthy foods were just another fashion (men 34% v. 13%; women 30% v. 12%). or expensive (men 50% v. 35%; women 53% v. 40%); they were less likely to care about what they ate (men 45% v. 13%; women 27% v. 7%). Nearly three-quarters of all respondents agreed that experts never agree about what foods are good for you. Younger, low-income families, and those who smoked, were the group least likely to be eating a more healthy diet.

The results of this study suggest that about half of the population has reported a change to a healthier diet over the last 3 years and that overall about half of the population report eating a healthy diet. Those who had not made any change and were currently reporting a less healthy diet were more likely to smoke and come from the 'worse off' group in the survey; they were also more likely to hold negative attitudes about healthy eating. A more focused and integrated approach to promoting Dietary change healthy lifestyle in general is required, while at the same time ensuring that there is healthy eating continued support for the majority of the population who have made healthy dietary Cluster analysis changes.

To determine the association of beverage consumption with obesity in Mexican American school-aged children.

Cross-sectional study using the baseline data from a cohort study. Mothers and children answered questions about the frequency and quantity of the child's consumption of soda, diet soda, other sugar-sweetened beverages, 100 % fruit juice, milk and water. The questions were adapted from the Youth/Adolescent FFQ. Children were weighed and measured. Data were collected on the following potential confounders: maternal BMI, household income, maternal education, maternal occupational status, maternal acculturation, child physical activity, child screen time and child fast-food consumption. Logistic regression was used to examine the association between servings (240 ml) of each beverage per week and obesity (BMI ≥ 95th percentile).

Participants were recruited from among enrolees of the Kaiser Permanente Health Plan of Northern California. Data were collected via an in-home assessment.

Mexican American children (n 319) aged 8–10 years.

Among participants, 20 % were overweight and 31 % were obese. After controlling for potential confounders, consuming more servings of soda was associated with increased odds of obesity (OR = 1·29; P < 0·001). Consuming more servings of flavoured milk per week was associated with lower odds of obesity (OR = 0·88; P = 0·004). Consumption of other beverages was not associated with obesity in the multivariate model.

Discouraging soda consumption among Mexican American children may help reduce the high obesity rates in this population.

To assess food insecurity and its association with changes in nutritional habits among Belgian adults during confinement due to COVID-19.

Three cross-sectional online health surveys were conducted during March–May 2020. Multinomial logistic regression models were used to determine associations between self-reported changes in fruit, vegetable, soft drink and sweet and salted snack consumption or weight as dependent variables and food insecurity indicators as independent variables, adjusted for gender, household composition, educational attainment and household income.

Belgium.

In total, 8640 adults recruited by convenience sampling.

About 10·4 % of Belgians often or sometimes feared food shortages, 5·0 % were often or sometimes short of food without money to buy more and 10·3 % often or sometimes could not afford to eat a healthy diet during confinement. These percentages were highest among single-parent families (26·7, 14·4 and 23·4 %, respectively). Adults who often or sometimes feared that food would run out during confinement had significantly higher odds of decreased v. unchanged fruits (3·53; 95 % CI = 2·06, 6·05) and vegetables (5·42; 95 % CI = 2·90, 10·11) consumption and significantly higher odds of increased v. unchanged soft drink consumption (3·79; 95 % CI = 2·20, 6·54). Similar results were found for adults who often or sometimes ran out of food and for adults who often or sometimes were not able to afford a healthy diet.

Food insecurity during the COVID-19 confinement measures in Belgium was associated with adverse changes in most dietary behaviours. A strong government response is needed to tackle malnutrition and food insecurity to protect public health from ongoing and future pandemics.

Tea has been reported to reduce cardiovascular mortality, but the underlying mechanisms are largely unknown. The aim of the current project was to investigate the effect of green tea (Japanese Sencha), black tea (Indian Assam B.O.P.) and Rooibos tea (South Africa) on angiotensin-converting enzyme (ACE) and nitric oxide (NO).

Seventeen healthy volunteers received a single oral dose of 400 ml green tea, black tea or Rooibos tea in a randomized, three-phase, crossover study. ACE activity and NO concentration were measured (at 0, 30, 60 and 180 min) in all phases. ACE activity was analysed by means of a commercial radioenzymatic assay. Nitrite was analysed as a marker of NO concentration. In addition, ACE genotype was determined using a PCR method.

Oral intake of a single dose of Rooibos tea significantly inhibited ACE activity after 30 min (P < 0·01) and after 60 min (P < 0·05). A significant inhibition of ACE activity was seen with green tea for the ACE II genotype 30 min after intake of the tea (P < 0·05) and for the ACE ID genotype 60 min after intake (P < 0·05). A significant inhibition of ACE activity was also seen with Rooibos tea for the ACE II genotype 60 min after intake (P < 0·05). No significant effect on NO concentration was seen.

These results suggest that green tea and Rooibos tea may have cardiovascular effects through inhibition of ACE activity.

To investigate food insecurity (FI) prevalence in two favelas in Brazil in the early weeks of the social distancing policy, from 27 March 2020 to 1 June 2020.

A cross-sectional study using an online questionnaire to elicit information on socio-economic and demographic characteristics, the types of stores visited to buy food, and FI screening. The FI experience was evaluated according to the Brazilian Food Insecurity Scale. Factors associated with moderate or severe FI were investigated using the logistic regression model.

São Paulo city, Brazil.

Totally, 909 householders.

Eighty-eight per cent of the households included young women working as cleaners or kitchen assistants and in sales services. One-fifth of the participants were involved in the federal cash transfer programme, called Bolsa Família. There were 92 % households with children. The most frequent experience reported was uncertainty about food acquisition or receiving more (89 %), eating less than one should (64 %), not being able to eat healthy and nutritious food (46 %), and skipping a meal (39 %). Forty-seven per cent of the participants experienced moderate or severe FI. Factors associated with moderate and severe FI were low income, being a Bolsa Família recipient, having a low level of education and living in a household without children.

Half of the participants experienced moderate or severe FI, and almost 10 % experienced hunger. Our data suggest that families with children were at a lower risk of moderate to severe FI. It is possible that nationally established social programmes such as Bolsa Família were protecting those families.

To examine the characteristics of supporters and opponents of a sugar-sweetened beverage (SSB) tax and to identify pro-tax messages that resonate with the public.

A survey was administered by telephone in February 2013 to assess public opinion about a penny-per-ounce tax on SSB. Support was also examined for SSB consumption reduction and pro-tax messages. Individual characteristics including sociodemographics, political affiliation, SSB consumption behaviours and beliefs were explored as predictors of support using logistic regression.

A representative sample of voters was recruited from a Mid-Atlantic US state.

The sample included 1000 registered voters.

Findings indicate considerable support (50 %) for an SSB tax. Support was stronger among Democrats, those who believe SSB are a major cause of childhood obesity and those who believe childhood obesity warrants a societal intervention. Belief that a tax would be effective in lowering obesity rates was associated with support for the tax and pro-tax messages. Respondents reporting that a health-care provider had recommended they lose weight were less convinced by pro-tax messages. Women, Independents and those concerned about childhood obesity were more convinced by the SSB reduction messages. Overall, the most popular messages focused on the importance of reducing consumption among children without mentioning the tax.

Understanding who supports and opposes SSB tax measures can assist advocates in developing strategies to maximize support for this type of intervention. Messages that focus on the effect of consumption on children may be useful in framing the discussion around SSB tax proposals.

The objective of this study was to identify the determinants of anaemia in Lebanese women of childbearing age attending health centres in Lebanon.

Cross-sectional study carried out between May and December 2003. Anthropometric measurements as well as sociodemographic, health and dietary intake data were collected using a questionnaire. Haemoglobin (Hb), plasma ferritin, plasma folate and vitamin B12 were assessed using standard laboratory methods.

Governmental health centres in Lebanon.

Four hundred and seventy non-pregnant Lebanese women aged 15–45 years.

Anaemia (Hb <12 g dl−1) and iron deficiency (ferritin <15 μg l−1) were prevalent in 16.0 and 27.2% of the study sample, respectively. Of the total sample, 7.7% had iron-deficiency anaemia. The percentage of women with either Hb or ferritin deficiency or both was 35.6%. Plasma folate and vitamin B12 deficiency was reported in 25.1 and 39.4%, respectively, and 12.6% of the women had both folate and vitamin B12 deficiencies. Of the anaemic group, 48.0% of the women had iron deficiency. The intake of iron was lower in iron-deficient than in non-deficient women and a positive relationship was shown between folate intake and its corresponding serum levels. Regression analysis showed that ferritin, plasma folate and family history of anaemia were significant determinants of the anaemia in the sample of women.

Anaemia not related to iron deficiency was partly explained by plasma folate deficiency. Measures to control folate and iron deficiency should be considered.

To assess the effect on the haemoglobin concentrations of schoolchildren of weekly iron tablets administered by teachers.

Sixty schools were randomly assigned to two groups: in 30 schools children were given weekly for 10 weeks a tablet providing 65 mg of iron and 0.25 mg of folic acid; in the other 30 schools no iron tablets were given. All children were dewormed and given vitamin A before the study began. The haemoglobin concentration of up to 20 randomly selected children in each school was estimated before and 2 weeks after the end of treatment.

Rural community schools in Kolondieba district of Mali.

Some 1113 schoolchildren aged 6–19 years with a mean of 11.4 years.

The haemoglobin concentration of treated children rose on average by 1.8 g l-1 (P < 0.001) and the prevalence of anaemia fell by 8.2% (P < 0.001); in untreated children the haemoglobin concentration fell by an average of -2.7 g l-1 (P < 0.001) and the prevalence of anaemia rose by 9.4% (P < 0.001). The fall in haemoglobin concentration among untreated girls of -4.0 g l-1 was greater than in untreated boys (-0.3 g l-1, P < 0.001).

Weekly iron tablets given by teachers prevented a general fall in the haemoglobin concentrations of untreated children, and led to a small but statistically significant rise among treated children (P < 0.001). Young children benefited more than children aged ≥12 years, and girls benefited more than boys.

To assess which socio-economic indicator best predicts overweight in the European Union: educational attainment, occupational class or household income.

The prevalence of overweight is strongly related to socio-economic position. The relative importance of different socio-economic dimensions is uncertain, and might vary between countries.

Cross-sectional self-report data of the European Community Household Panel were obtained from nine countries (n 52 855; age 25–64 years). Uni- and multivariate regression analyses were employed to predict overweight (BMI ≥ 25 kg/m2) in relationship to socio-economic indicators. Occupational class was measured using the new European Socioeconomic Classification.

Large socio-economic differences in overweight were observed in all countries, especially for women. For both sexes, a low educational attainment was the strongest predictor of overweight. After controlling for education, overweight was negatively related to household income in women, but positively in men. Similar patterns were found for occupational class. For women, but not for men, educational inequalities in overweight were generally greater in Southern European countries. A similar pattern of inequalities in overweight was observed for all ages between 25 and 64 years.

Across Europe, overweight was more strongly and more consistently related to educational attainment than to occupational class or household income. People with lower educational attainment should be a specific target group for programmes and policies that aim to prevent overweight.

To examine the nature of the link between food advertising in UK magazines aimed at children and young people and Internet food marketing, to establish whether consideration should be given to tightening existing controls.

A review and descriptive analysis of food advertising found in a sample of the top five magazine titles aimed at a range of ages of children and young people between November 2004 and August 2005 and of the Internet food marketing sites to which readers were directed.

Food advertising appeared as ‘cover-mount’ free gifts and as part of the main bound issue. Children aged 6–10 years were the most frequent recipients of food-based free gifts, all of which were confectionery. No food advertising was found in magazines aimed at pre-school children and it formed a small percentage of total advertising in the magazines aimed at children of school age and above. Most food advertisements were for ‘less healthy’ foods, although advertisements for ‘healthier’ food products did appear infrequently. Almost half of food advertisements directed readers towards Internet food marketing sites. We found evidence that these sites are using at least some of the ‘marketing tricks’ which have been identified as a cause for concern.

Proposed restrictions on broadcast media may lead to more food advertising via other non-broadcast means. We suggest monitoring the effect of such changes in print and online advertising and that consideration be given to restricting marketing techniques used on websites aimed at children and young people.