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.

The US Food and Drug Administration (FDA) proposes to establish standardized and mandatory criteria upon which front-of-pack (FOP) nutrition labelling must be based. The present study aimed to estimate the relative contribution of declared amounts of different nutrients to the perception of the overall ‘healthfulness’ of foods by the consumer.

Protein, fibre, vitamin A, vitamin C, calcium and iron were nutrients to encourage. Total fat, saturated fat, cholesterol, total and added sugar, and sodium were the nutrients to limit. Two content claims per nutrient used the FDA-approved language. An online consumer panel (n 320) exposed to multiple messages (n 48) rated the healthfulness of each hypothetical food product. Utility functions were constructed using conjoint analysis, based on multiple logistic regression and maximum likelihood estimation.

Consumer perception of healthfulness was most strongly driven by the declared presence of protein, fibre, calcium and vitamin C and by the declared total absence of saturated fat and sodium. For this adult panel, total and added sugar had lower utilities and contributed less to the perception of healthfulness. There were major differences between women and men.

Conjoint analysis can lead to a better understanding of how consumers process information about the full nutrition profile of a product, and is a powerful tool for the testing of nutrient content claims. Such studies can help the FDA develop science-based criteria for nutrient profiling that underlies FOP and shelf labelling.

To examine the association of both perceived and geographic neighbourhood food access with food security status among households with children.

This was a cross-sectional study in which participants’ perceptions of neighbourhood food access were assessed by a standard survey instrument, and geographic food access was evaluated by distance to the nearest supermarket. Multinomial logistic regression models were used to examine the associations.

The Midlands Family Study included 544 households with children in eight counties in South Carolina, USA. Food security status among participants was classified into three categories: food secure (FS), food insecure (FI) and very low food security among children (VLFS-C).

Compared with FS households, VLFS-C households had lower odds of reporting easy access to adequate food shopping. VLFS-C households also had lower odds of reporting neighbourhood access to affordable fruits and vegetables compared with FS households and reported worse selection of fruits and vegetables, quality of fruits and vegetables, and selection of low-fat products. FI households had lower odds of reporting fewer opportunities to purchase fast food. None of the geographic access measures was significantly associated with food security status.

Caregivers with children who experienced hunger perceived that they had less access to healthy affordable food in their community, even though grocery stores were present. Approaches to improve perceived access to healthy affordable food should be considered as part of the overall approach to improving food security and eliminating child hunger.

To report on the prevalence of overweight and obesity among pre-school children in Kenya and examine the associations between childhood overweight and selected maternal and child-related factors.

Demographic Health Survey data, multistage stratified cluster sampling methodology.

Rural and urban areas of Kenya.

A total of 1495 children between the ages of 3 and 5 years in Kenya.

Over 30 % of the children were stunted, approximately 16 % were underweight, 4 % were wasted, approximately 18 % were overweight and 4 % were obese; 8 % were both overweight/obese and stunted. Maternal overweight and obesity, higher levels of maternal education, being a large or very large child at birth, and being stunted were each associated with higher odds of overweight and obesity among Kenyan children. Older children and large household size were each associated with lower odds of overweight and obesity among Kenyan children.

The analysis demonstrates the presence of under- and overnutrition among Kenyan pre-school children and the importance of focusing on expanding efforts to prevent and treat malnutrition within this population. It also identifies some of the modifiable factors that can be targeted in these efforts.

Adequate fruit and vegetable intake is important in the prevention of chronic disease. Health literacy is associated with health outcomes but its role in dietary behaviour has received little attention. The present study investigated the association between a multidimensional measure of health literacy, sociodemographic characteristics, and fruit and vegetable intake in rural Australia.

A cross-sectional survey on intake of fruits and vegetables (servings/d), demographic characteristics and health literacy profile using a nine-scale Health Literacy Questionnaire (HLQ). Associations between health literacy and fruit and vegetable intake were assessed using logistic regression.

A large rural area of Victoria.

Adults residing in the Grampians region (n 1154; 61 % female, mean age 52 (sd 17) years).

The HLQ scale ‘Actively managing my health’ predicted (OR; 95 % CI) fruit (2·31; 1·87, 2·84) and vegetable (1·81; 1·45, 2·26) intake. The scales ‘Appraisal of health information’ (fruits: 1·73; 1·41, 2·13; vegetables: 1·49; 1·20, 1·86), ‘Social support for health’ (fruits: 1·31; 1·06, 1·63; vegetables: 1·40; 1·10, 1·76) and ‘Ability to find good health information’ (fruits: 1·25; 1·05, 1·48; vegetables: 1·36; CI 1·13, 1·63) also predicted fruit and vegetable intake. These associations remained significant after adjusting for age, gender, educational attainment and having private health insurance.

Health literacy, particularly being proactive, appraising information and having social support for health, is associated with greater fruit and vegetable intake. Future interventions should consider the health literacy needs of the community to improve fruit and vegetable intake.

The aim of the study was to determine the association between dietary outcomes and the neighbourhood food environment (street network distance from home to stores) and consumer food environment (Nutrition Environment Measurement Survey-Stores (NEMS-S) audit).

The neighbourhood food environment was captured by creating 0·5-mile and 1-mile network distance (street distance) around each participant's home and the nearest food venue (convenience store, grocery store, supermarket, farmers' market and produce stand). The consumer food environment was captured by conducting NEMS-S in all grocery stores/supermarkets within 0·5 and 1 mile of participants’ homes.

Fayette County, KY, USA.

Supplemental Nutrition Assessment Program (SNAP) participants, n 147.

SNAP participants who lived within 0·5 mile of at least one farmers’ market/produce stand had higher odds of consuming one serving or more of vegetables (OR = 6·92; 95 % CI 4·09, 11·69), five servings or more of grains (OR = 1·76; 95 % CI 1·01, 3·05) and one serving or more of milk (OR = 3·79; 95 % CI 2·14, 6·71) on a daily basis. SNAP participants who lived within 0·5 mile of stores receiving a high score on the NEMS-S audit reported higher odds of consuming at least one serving of vegetables daily (OR = 3·07; 95 % CI 1·78, 5·31).

Taken together, both the neighbourhood food environment and the consumer food environment are associated with a healthy dietary intake among SNAP participants.

We aimed to use the meta-analysis method to assess the relationship between coffee drinking and all-cause mortality.

Categorical and dose–response meta-analyses were conducted using random-effects models.

We systematically searched and identified eligible literature in the PubMed and Scopus databases.

Seventeen studies including 1 054 571 participants and 131 212 death events from all causes were included in the present study.

Seventeen studies were included and evaluated in the meta-analysis. A U-shaped dose–response relationship was found between coffee consumption and all-cause mortality (P for non-linearity <0·001). Compared with non/occasional coffee drinkers, the relative risks for all-cause mortality were 0·89 (95 % CI 0·85, 0·93) for 1–<3 cups/d, 0·87 (95 % CI 0·83, 0·91) for 3–<5 cups/d and 0·90 (95 % CI 0·87, 0·94) for ≥5 cups/d, and the relationship was more marked in females than in males.

The present meta-analysis of prospective cohort studies indicated that light to moderate coffee intake is associated with a reduced risk of death from all causes, particularly in women.

The aim of the present study was to investigate vitamin D status among female out-patients in Saudi Arabia during the summer and winter seasons.

Data were retrospectively collected using medical record abstraction.

A multidisciplinary hospital in Riyadh between January and December 2009.

Saudi females (age ≥19 years; n 1556) attending out-patient clinics for various complaints comprised the studied population. The population was subdivided into two groups depending on the date of their visit where blood samples were collected: summer (n 659) and winter groups (n 897). The summer group was further subdivided into premenopausal (age 19–49 years; n 425) and postmenopausal subgroups (age ≥50 years; n 234). Similarly, the winter group was subdivided into premenopausal (n 543) and postmenopausal subgroups (n 354). Serum levels of 25-hydroxyvitamin D (25(OH)D) were measured using HPLC.

The prevalence of vitamin D deficiency (25(OH)D <50 nmol/l) was high in both premenopausal and postmenopausal groups (80 % and 68 %, respectively) during the summer, as well as during the winter (85 % and 76 %, respectively).

A high prevalence of vitamin D deficiency among Saudi female out-patients was observed throughout the year despite the routine supplementation with 10–20 μg vitamin D3 for postmenopausal women. Clinicians should seriously consider determining the vitamin D status of Saudi females routinely and prescribing them proper supplementation.

To compare micronutrient intakes and status in Central and Eastern Europe (CEE) with those in other European countries and with reference values.

Review of the micronutrient intake/status data from open access and grey literature sources from CEE.

Micronutrients studied were folate, iodine, Fe, vitamin B12 and Zn (for intake and status) and Ca, Cu, Se, vitamin C and vitamin D (for intake). Intake data were based on validated dietary assessment methods; mean intakes were compared with average nutrient requirements set by the Nordic countries or the US Institute of Medicine. Nutritional status was assessed using the status biomarkers and cut-off levels recommended primarily by the WHO.

For all population groups in CEE, the mean intake and mean/median status levels were compared between countries and regions: CEE, Scandinavia, Western Europe and Mediterranean.

Mean micronutrient intakes of adults in the CEE region were in the same range as those from other European regions, with exception of Ca (lower in CEE). CEE children and adolescents had poorer iodine status, and intakes of Ca, folate and vitamin D were below the reference values.

CEE countries are lacking comparable studies on micronutrient intake/status across all age ranges, especially in children. Available evidence showed no differences in micronutrient intake/status in CEE populations in comparison with other European regions, except for Ca intake in adults and iodine and Fe status in children. The identified knowledge gaps urge further research on micronutrient intake/status of CEE populations to make a basis for evidence-based nutrition policy.

Attitudes towards food varied markedly between children and their mothers. Children viewed food primarily as a necessity of life, whereas mothers viewed food primarily as a pleasure for their child, with necessity and nutrition given a lower importance. Contrary to popular belief children's enjoyment of [unhealthy] and [healthy] foods was similar. French-fries were the favourite food for 92% of children, closely followed by pasta (89%). Fruit and candy received similar scores (82% and 81% respectively), suggesting that external factors such as convenience are the prime barrier to fruit consumption rather than the enjoyment factor. Over the three surveys a strong persistence of the traditional French meal pattern has been demonstrated, with breakfast, lunch and evening meals eaten by 97%, 96% and 99% of children respectively. One increasing occurrence is the viewing of television during meal times with 25% of breakfasts, 46% of afternoon snacks and 41% of evening meals consumed in front of the television. Children's attitudes towards food demonstrated an overwhelming trust of their mother and her ability to provide them with nourishing foods. Mothers often found it difficult to reconcile the demands of family life, employment, healthy eating and the maintenance of a pleasurable atmosphere at mealtimes.

Overall, children and mothers appeared to have divergent attitudes towards food. An understanding of children's enjoyment of foods considered more 'healthy' or less [healthy] enables effective nutrition messages to be developed for children. However, further work is needed to explore the long-term impact of mothers' attitudes towards food and mealtimes on a child's relationship to food and eating habits during adolescence through to adulthood.

To examine whether home availability of energy-dense snack foods mediates the association between television (TV) viewing and energy-dense snack consumption among adolescents.

Cross-sectional.

Secondary schools in Victoria, Australia.

Adolescents (n 2984) from Years 7 and 9 of secondary school completed a web-based survey, between September 2004 and July 2005, assessing their energy-dense snack food consumption, school-day and weekend-day TV viewing and home availability of energy-dense snack foods.

School-day and weekend-day TV viewing were positively associated with energy-dense snack consumption among adolescent boys (β = 0·003, P < 0·001) and girls (β = 0·03, P < 0·001). Furthermore, TV viewing (school day and weekend day) were positively associated with home availability of energy-dense snack foods among adolescent boys and girls and home availability of energy-dense snack foods was positively associated with energy-dense snack food consumption among boys (β = 0·26, P < 0·001) and girls (β = 0·28, P < 0·001). Home availability partly mediated the association between TV viewing and energy-dense snack consumption.

The results of the present study suggest that TV viewing has a significant role to play in adolescent unhealthy eating behaviours. Future research should assess the efficacy of methods to reduce adolescent energy-dense snack food consumption by targeting parents to reduce home availability of energy-dense foods and by reducing TV viewing behaviours of adolescents.

We aimed to identify sociodemographic, lifestyle and behavioural determinants of consumption of sugar-sweetened beverages (SSB) and artificially sweetened beverages (ASB) among adults in Cambridgeshire, UK.

Cross-sectional data were obtained from a cohort of 9991 adults born between 1950 and 1975. An FFQ was used to assess consumption of beverages and other dietary factors. Multivariable logistic regression was used to examine potential determinants of consuming SSB and ASB (≥1 serving/d).

Recruitment from general practice surgeries to participate in the ongoing population-based Fenland Study.

Adults (n 9991) aged 30–64 years from three areas of Cambridgeshire, UK.

Prevalence estimates for daily SSB and ASB consumption were 20·4 % (n 2041) and 8·9 % (n 893), respectively. SSB consumption (OR; 95 % CI) was more common in men than women (1·33; CI 1·17, 1·50) and among those reporting lower income (<£20 000/year) than those reporting higher income (>£40 000/year; 1·31; 1·09, 1·58). In contrast, daily ASB consumption was more common among women than men (1·62; 1·34, 1·96), those on weight-loss diets than those who were not (2·58; 2·05, 3·24) and those reporting higher income than lower income (1·53; 1·16, 2·00). Factors associated with higher consumption of each of SSB and ASB included being a younger adult, being overweight/obese, having shorter education, eating meals or snack foods while watching television, and skipping breakfast (P<0·05 each).

Frequent consumers of SSB and ASB differ by several sociodemographic characteristics. However, increased BMI, younger age and unhealthy eating behaviours are common to both groups.

Strategies are needed to address the shortfall in children's dairy food and Ca intakes. The present review identified interventions targeting an increase in children's dairy food or Ca intakes, and determined characteristics associated with successful intervention.

A systematic literature search identified fourteen intervention studies, published in English, between 1990 and 2010. Studies were evaluated for study population, setting and mode of delivery, dietary targets and outcome measures, measures of intervention intensity, intervention description, the use of behaviour change techniques and intervention effectiveness.

Interventions targeting an increase in dairy food or Ca intake.

Children aged 5–12 years.

Ten of the fourteen studies were considered to be effective. Studies focusing on encouraging intake of dairy foods or Ca alone were all effective, compared with 55 % of studies promoting dairy within the context of a healthy diet. Effective interventions tended to be higher in intensity, provide dairy foods and were delivered across a variety of settings to a range of primary targets. The number of behaviour change techniques used did not differentiate effective and ineffective interventions, but the use of taste exposure and prompting practice appeared to be important for effective intervention.

Interventions that target an increase in children's dairy food or Ca intake could potentially increase children's dairy food intake by about one serving daily. Research conducted outside the USA is needed. The review has identified some promising strategies likely to be part of effective interventions for improving dairy and Ca intakes in countries where children's intake is insufficient.

The present study was designed to determine household food security status and factors associated with food insecurity among high-school students in Esfahan, Iran.

Cross-sectional surveys.

The present study was conducted in autumn 2008 in Esfahan, Iran. The samples were selected using systematic cluster sampling. Socio-economic questionnaires, food security questionnaires and FFQ were filled out during face-to-face interviews. In addition, data on participants’ weights and heights were collected.

A total of 580 students (261 boys and 319 girls) aged 14–17 years from forty high schools in Esfahan, Iran, were selected.

The prevalence of household food insecurity according to the US Department of Agriculture food security questionnaire was 36·6 % (95 % CI 0·33, 0·40). Food insecurity was positively associated with number of members in the household (P < 0·05) and negatively associated with parental education level and job status and household economic status (P < 0·05). Moreover, students living in food-insecure households more frequently consumed bread, macaroni, potato and egg (P < 0·05), while they less frequently consumed rice, red meat, sausage and hamburger, poultry, fish, green vegetables, root and bulb (coloured) vegetables, melons, apples and oranges, milk and yoghurt (P < 0·05).

Food insecurity was prevalent among households in Esfahan, Iran, and food security status was associated with socio-economic factors. Students who belonged to food-secure households more frequently consumed healthy foods (except sausage and hamburger), whereas those living in food-insecure households more frequently consumed cheap foods containing high energy per kilogram. The present study suggests that intervention programmes be designed and carried out.

To review recent data on objectively measured overweight/obesity in national representative samples of European adolescents (aged 10–18 years), as well as availability of studies assessing trends in overweight/obesity in this target group. Attention was paid to the ability of the data to describe the obesity epidemic, especially in sociodemographic subgroups.

Data on prevalence and trends in overweight/obesity among adolescents in the twenty-seven European Community member states, Iceland, Norway and Switzerland, available as scientific publications as well as reports or unpublished data by the end of 2009, were retrieved. Reports on the most recent objectively measured data from national representative samples were selected and described with regard to the years of data collection, sample sizes, response rates, age ranges included, trends by age, type of measures of overweight/obesity, sociodemographic variables and the sources of information.

Objectively measured data on national representative samples were identified for only half of the countries, and the trend studies were mainly conducted applying subnational samples. Most studies used the criteria from the International Obesity Task Force (IOTF) to define overweight/obesity, but the age ranges studied and the years of data collection varied, and information on sample sizes and response rates were often not presented. Data on trends of overweight/obesity over time are increasing, and the most recent studies indicate that the prevalence rate of overweight/obesity has stabilized. Few studies reported data by sociodemographic subgroups other than gender and age.

Objectively measured data on national representative samples of adolescents appear scattered, and there is a large heterogeneity with respect to the quality and comparability of available data. Increasing use of the IOTF criteria for overweight/obesity contributes to improved comparability across studies. Data by sociodemographic subgroups, and in particular by socio-economic status, are scarce.

To determine the relative quantities of two hepatotoxic pyrrolizidine alkaloids, symphytine and echimidine, in teas prepared from comfrey leaves (Symphytum officinale), and to determine the potential contribution of the N-oxide forms of these alkaloids to levels of the parent alkaloids.

Comfrey leaves were purchased from three commercial sources and used to prepare tea in a manner consistent with the methods used by consumers. An extraction scheme was devised for extraction of the alkaloids, and a gas chromatographic method was developed to quantify the two major alkaloids, symphytine and echimidine. Recognising that the N-oxide derivatives of these alkaloids have also been identified in comfrey preparations, chemical reduction was applied to determine the total quantities of the alkaloids as free bases and as N-oxide derivatives.

The concentration of symphytine and echimidine varied considerably between teas prepared from leaves purchased from the different vendors of plant material. Moreover, a much higher concentration of symphytine was found in the tea when steps were included to reduce N-oxides prior to analysis. The treatment of pure symphytine with hot water did not generate the N-oxide derivative de novo.

Since the pyrrolizidine alkaloids are known to be hepatotoxic, consumption of herbal teas made from comfrey leaves may be ill-advised. The concentration of pyrrolizidine alkaloids in such teas may be underestimated substantially unless the concentration of N-oxides is taken into consideration.

To examine associations between availability of fast-food restaurants and convenience stores in the home and school neighbourhoods, considered separately and together, and adolescents’ fast-food and sugar-sweetened beverage (SSB) intakes.

Cross-sectional observational study.

East London, UK.

Adolescents (n 3089; aged 13–15 years) from the Olympic Regeneration in East London (ORiEL) Study self-reported their weekly frequency of fast-food and SSB consumption. We used food business addresses collected from local authority registers to derive absolute (counts) and relative (proportions) exposure measures to fast-food restaurants and convenience stores within 800 m from home, school, and home and school combined. Associations between absolute and relative measures of the food environment and fast-food and SSB intakes were assessed using Poisson regression models with robust standard errors.

Absolute exposure to fast-food restaurants or convenience stores in the home, school, or combined home and school neighbourhoods was not associated with any of the outcomes. High SSB intake was associated with relative exposure to convenience stores in the residential neighbourhood (risk ratio=1·45; 95 % CI 1·08, 1·96) and in the home and school neighbourhoods combined (risk ratio=1·69; 95 % CI 1·11, 2·57).

We found no evidence of an association between absolute exposure to fast-food restaurants and convenience stores around home and school and adolescents’ fast-food and SSB intakes. Relative exposure, which measures the local diversity of the neighbourhood food environment, was positively associated with SSB intake. Relative measures of the food environment may better capture the environmental risks for poor diet than absolute measures.

For proper interpretation of results from epidemiological studies that use food-frequency questionnaires (FFQs), it is necessary to know the relationship between reported intakes from the FFQ and true usual intake. In this paper, we report a calibration study conducted to investigate the performance of the FFQ used in a cohort study, the Canadian Study of Diet, Lifestyle and Health.

Over a 1-year period, 151 men and 159 women completed a full set of questionnaires including a self-administered baseline FFQ, three 24-hour diet recalls administered by telephone, and a second FFQ self-administered subsequently. The association between the nutrient estimates derived from the FFQs and the diet recalls was evaluated by calculating deattenuated Pearson's correlation coefficients.

The FFQs estimated mean daily nutrient intakes higher than the diet recalls. When the log-transformed and energy-adjusted nutrient intakes from the average of three 24-hour recalls were compared against the baseline FFQ, the following deattenuated correlations were obtained in men and women, respectively: total energy 0.44 and 0.32, total fat 0.64 and 0.68, saturated fat 0.68 and 0.70, dietary fibre 0.65 and 0.44, vitamin E 0.32 and 0.37, vitamin C 0.40 and 0.37, β-carotene 0.34 and 0.29, alcohol 0.74 and 0.67, caffeine 0.81 and 0.76, with a median correlation of 0.49 and 0.53. Correlations between the second FFQ and diet recalls were similar. The correlations between the two FFQs as a test of reliability had a median value 0.64 for men and 0.63 for women for selected nutrients.

The study suggests that the FFQ method gives acceptable levels of nutrients or food component estimates, as assessed by this calibration study against diet recalls, when limited to energy-adjusted and deattenuated values.

To investigate the degree of individual heterogeneity related to complex dietary behaviour and to further examine the associations of different dietary compositions with selected characteristics.

Latent class analysis was applied to data from the recent cross-sectional National Family Health Survey that collected information on the intake frequency of selected foods. Different responses regarding intake frequency were condensed into a set of five meaningful latent clusters representing different dietary patterns and these clusters were then labelled based on the reported degree of diet mixing.

Indian states.

In total, 90 180 women aged 15–49 years.

Three clusters were predominantly non-vegetarian and two were vegetarian. A very high or high mixed-diet pattern was observed particularly in the southern and a few north-eastern states. Many women in the very high mixed-diet cluster consumed mostly non-green/leafy vegetables on a daily basis, and fruits and other non-vegetarian diet on a weekly basis. In contrast, those in the low mixed-diet cluster consumed more than three-fifths of the major vegetarian diet ingredients alone on a daily basis. The affluent group that represented the low mixed-diet cluster were primarily vegetarians and those who represented the very high mixed-diet cluster were mostly non-vegetarians. The significant interrelationships of different characteristics highlight not only socio-economic, spatial and cultural disparities related to dietary practices, but also the substantial heterogeneity in diet mixing behaviour.

The results of this study confirmed our hypothesis of heterogeneous dietary behaviour of Indian women and yielded useful policy-oriented results which might be difficult to establish otherwise.

To compare food choices and nutrient intakes of pupils taking a school lunch or a packed lunch in eighty secondary schools in England, following the introduction of the food-based and nutrient-based standards for school food.

Cross-sectional data collected between October 2010 and April 2011. Pupils’ lunchtime food choices were recorded over five consecutive days.

Secondary schools, England.

A random selection of 5925 pupils having school lunches and 1805 pupils having a packed lunch in a nationally representative sample of eighty secondary schools in England.

The differences in the specific types of food and drink consumed by the two groups of pupils are typical of differences between a hot and cold meal. On average, school lunches as eaten contained significantly more energy, carbohydrate, protein, fibre, vitamin A, folate, Fe and Zn than packed lunches, and 8 % less Na.

Although neither school lunches nor packed lunches provided the balance of nutrients required to meet the nutrient-based standards (based on about one-third of daily energy and nutrient requirements), school lunches generally had a healthier nutrient profile, with lower Na and percentage of energy from fat, and higher fibre and micronutrient content. These differences were greater than those reported prior to the introduction of compulsory standards for school lunches. In order to ensure more pupils have a healthy lunch, schools could introduce and enforce a packed lunch policy or make school meals the only option at lunchtime.