To assess total sugar (TS), added sugar (AS) and free sugar (FS) intakes, dietary sources, adherence to recommendations and determinants of consumption, in a Portuguese national sample.

Cross-sectional study. Dietary assessment was obtained by two food diaries in children aged <10 years and two non-consecutive 24 h recalls for other age groups. TS, AS and FS intakes were estimated by using SPADE software. TS content in food was estimated at the ingredient level. AS content in food was assessed through a systematic methodology and FS was based on the WHO definition.

National Food, Nutrition and Physical Activity Survey (IAN-AF 2015–2016), Portugal.

Representative sample from the Portuguese population, aged from 3 months to 84 years (n 5811).

Mean daily intake and contribution to total energy intake (E%) were 84·3 g/d (18·5 E%) for TS, 32·1 g/d (6·8 E%) for AS and 35·3 g/d (7·5 E%) for FS. Of the population, 76 % adhered to the FS recommendation (FS < 10 E%). The lowest adherence was in children (51·6 %) and adolescents (51·3 %). The main dietary source of TS was fruit across all ages, except in adolescents which was soft drinks. In children, the main dietary sources of FS were yoghurts and sweets, soft drinks in adolescents and table sugar in adults/elderly. FS intake was lower in children with more educated parents and in adults who practised physical activity regularly, and higher among smokers.

Interventions ought to be planned towards decreasing intakes of added and free sugars considering population-specific characteristics.

Data on the prevalence and predictors of breast-feeding remain scarce in Lebanon. Moreover, no study has previously addressed the effect of the paediatrician’s sex on breast-feeding. The present study aimed to assess the prevalence and predictors of breast-feeding at 1 and 4 months of infant age while exploring the potential role of the sex of the paediatrician.

Prospective cohort study. Predictors of breast-feeding significant at the bivariate level were tested at 1 and 4 months through two stepwise regression models.

Infants were enrolled through the clinics and dispensaries of 117 paediatricians located in Beirut, Lebanon, and its suburbs.

A total of 1320 healthy newborn infants born between August 2001 and February 2002 were prospectively followed during the first year.

Breast-feeding rates at 1 and 4 months were 56·3 % and 24·7 %, respectively. Early discharge, high parity and religion were significantly associated with higher breast-feeding rates at 1 and 4 months of age. Maternal age proved significant only at 1 month, while maternal working status and sex of the paediatrician were significant at 4 months. A novel finding of our study was the positive effect of female paediatricians on breast-feeding continuation until 4 months of age (OR = 1·49; 95 % CI 1·03, 2·15).

Breast-feeding rates are low at 1 and 4 months of infant age in Beirut. Further research to investigate the interactions between female physicians and lactating mothers in maintaining breast-feeding in other populations is warranted. The results constitute the basis for designing interventions targeting policy makers, health professionals and mothers.

To examine changes in periconceptional folic acid supplementation behaviour among Chinese women of reproductive age after the implementation of a folic acid supplementation programme.

Two cross-sectional surveys were conducted.

One survey was before (2002–2004) and the other was after (2011–2012) implementation of the programme, both were conducted in two areas of China with different prevalence of neural tube defects. Information on supplementation behaviours was collected in face-to-face interviews with women early in their pregnancy.

A total of 1257 and 1736 pregnant women participated before and after the programme, respectively.

The rate of periconceptional folic acid supplementation increased from 15 % to 85 % in the high-prevalence population and from 66 % to 92 % in the low-prevalence population. However, more than half of the women began taking the supplement after learning they were pregnant. The proportion of women who began taking folic acid before their last menstrual period decreased after the programme in rural areas with both a high and low prevalence of neural tube defects.

Although periconceptional folic acid supplementation among Chinese women increased substantially after the programme, supplementation was often initiated too late to be effective in preventing neural tube defects. Educational and promotional campaigns should focus on how to increase the rate of folic acid supplementation before pregnancy.

Wild edible plants (WEP) play the dual role of securing food diversity and promoting health in traditional societies. Current simplified dietary habits contribute to increasing population health risks. Since WEP are integral to the diet of traditional communities, identifying their significance as foods to people provides further evidence to conserve them and promote their consumption. Six species of WEP were identified as integral to the diet of rural Lebanese communities. We investigated their patterns of consumption and knowledge regarding their health and medicinal properties.

An ethnobotanical survey, employing a qualitative questionnaire, was conducted among thirty informants. The identified species were Cichorium intybus, Eryngium creticum, Foeniculum vulgare, Malva sylvestris, Thymus syriacus and Gundelia tournifortii.

Most informants consumed the six plants as a regular part of their diet. Seasonal variability in consumption was evident. C. intybus was renowned for its digestive and blood strengthening properties. F. vulgare was used as a digestive stimulant. M. sylvestris was distinguished for its anti-inflammatory qualities. T. syriacus was popular for its digestive and anti-poisonous properties. E. creticum was attributed less pronounced health benefits. G. tournifortii was considered a nutritious food.

All six species were popular for their edible uses as well as their health and/or medicinal benefits. These properties are supported by scientific evidence. Our results highlight the importance of these plants for local people and support efforts for their conservation. However, we noticed a decline in indigenous knowledge. We encourage efforts to record it for other plants and in other communities.

Water is an essential nutrient overlooked in many cross-cultural studies of human nutrition. The present article describes dietary water intake patterns among forager-horticulturalist adults in lowland Bolivia, compares daily intake with international references and examines if variation in how people acquire water relates to gastrointestinal illness.

Cross-sectional observational study used survey, anthropometric and qualitative methods with Tsimane’ adults selected by age and sex stratification sampling in one community.

Research occurred in one Tsimane’ village in the Beni department, Bolivia with limited access to clean water. The 24 h diet and health recalls were conducted in July–August 2012 and qualitative interviews/ethnographic observation in September–October 2013.

Forty-five Tsimane’ household heads (49 % men) took part in the first data collection and twenty-two Tsimane’ (55 % men) were included in the follow-up interviews.

Men and women reported consuming 4·9 litres and 4·4 litres of water daily from all dietary sources, respectively. On average, water from foods represented 50 % of total water intake. Thirteen per cent of participants reported symptoms of gastrointestinal illness. In a logistic regression model adjusted for age, BMI, sex and raw water consumed, each percentage increase in water obtained from foods was associated with a reduced risk of gastrointestinal illness (OR=0·92; 95 % CI 0·85, 0·99).

Both total water intake and percentage of water from foods were higher than averages in industrialized countries. These findings suggest that people without access to clean water may rely on water-rich foods as a dietary adaptation to reduce pathogen exposures.

Currently 67 % of the US population is overweight or obese and obesity is associated with several chronic medical conditions. Geographic areas where individuals lack access to healthy foods have been termed ‘food deserts’. The study aim was to examine if area of residence within Metro Detroit was associated with dietary intake, food and shopping behaviours, and BMI.

Cross-sectional study.

Participants were recruited in the waiting area of four primary-care clinics.

Individuals (n 1004) completed a questionnaire comprising four sections: demographics; personal health status including self-reported height and weight; a modified diet, transportation and shopping survey; and a subscale from the Diet and Health Knowledge Survey.

Seventy-four per cent of participants were female and the mean age was 46·7 (sd 15·0) years. In univariate analyses, living in Detroit was associated with being African American, unemployment, less education, no regular exercise, worse health self-rating and obesity (P < 0·0005 for all). Participants living in Detroit had a 3·06 (95 % CI 1·91, 4·21) kg/m2 larger BMI compared with people living outside the city (P < 0·0005) in univariate analyses, but the effect was attenuated when adjusted for demographics, disease status, shopping and eating behaviours, dietary intakes and diet knowledge (β = −0·46 kg/m2, 95 % CI −2·23, 1·30 kg/m2, P = 0·60).

Overweight and obesity are highly prevalent both inside (82·9 %) and outside (72·8 %) the city of Detroit, presenting a major public health problem. However, living in this food desert was not significantly associated with BMI after potential covariates were considered.

The indigenous food environment, dietary intake and nutritional status of women in the Santhal tribal community of Jharkhand were assessed. Contribution of indigenous foods to nutritional status and nutrient intakes was explored.

Exploratory cross-sectional study with a longitudinal dietary intake assessment component. Household and dietary surveys were conducted to elicit information on socio-economic and demographic profile and food consumption patterns at household level. A 24 h dietary recall for two consecutive days (repeat surveys in two more seasons) and anthropometric assessments were carried out on one woman per household.

Households (n 151) with at least one woman of reproductive age in four villages of Godda district of Jharkhand, India.

Women aged 15–49 years.

Almost all households owned agricultural land and grew fruits and vegetables in backyards for household consumption. A wide variety of indigenous foods were reported but dietary recalls revealed low intake. Women consumed adequate energy and protein but micronutrient intake was inadequate (less than 66 % of recommended) in the majority (more than 50 %) for Ca, Fe, vitamin B2, folate and vitamin B12. Women consuming indigenous foods in the past 2 d had significantly higher intakes of Ca (P=0·008) and Fe (P=0·010) than those who did not. Varying degrees of underweight were observed in 50 % of women with no significant association between underweight and consumption of indigenous foods.

Promotion of preferential cultivation of nutrient-dense indigenous food sources and effective nutrition education on their importance may facilitate better micronutrient intakes among women in Santhal community of Jharkhand.

To investigate food sources and intakes of iron, and dietary factors associated with serum ferritin levels in 6–24-month-old children.

A cross-sectional survey employing proportionate cluster sampling was conducted in 1998/1999. Dietary intakes were assessed using a non-consecutive 3-day weighed food record. Serum ferritin and C-reactive protein were analysed from non-fasting venepuncture blood samples and general sociodemographic data were collected.

Cities of Christchurch, Dunedin and Invercargill, New Zealand.

Randomly selected healthy 6–24-month-old non-breast-feeding children (n=226).

Total iron intakes (±standard deviation (SD)) among non-breast-feeding infants (<12 months old; n=42) and toddlers (≥12 months old; n=184) were 8.4±2.9 mg day−1 and 5.0±2.5 mg day−1, respectively. Fifteen per cent of infants and 66% of toddlers were at risk of inadequate iron intakes. Main sources of dietary iron were infant formula (60%) for infants and cereals (31%) for toddlers. Meat contributed on average 2% and 10% of dietary iron in the infant and toddler diets, respectively. Dietary factors positively associated with serum ferritin were intakes of iron and vitamin C, whereas intakes of calcium and dietary fibre were negatively associated. For each 1% increase in percentage of energy from iron-fortified formula concomitant with a 1% decrease from dairy products, there was a 4.2% increased odds of replete iron stores (ferritin ≥20 μg l−1).

Toddlers were at higher risk of sub-optimal iron intakes than infants. Results suggest that a diet high in bioavailable iron is important for optimising the iron stores of young children in New Zealand.

There is limited knowledge on vitamin D status of children residing in the Andes and its association with undernutrition. We evaluated the vitamin D status of children residing in a low socio-economic status (SES) setting in the Ecuadorian Andes and assessed the association between vitamin D status, stunting and underweight. We hypothesized that children who were underweight would have lower serum 25-hydroxyvitamin D (25(OH)D) levels and lower 25(OH)D levels would be associated with a higher risk of stunting.

We conducted a cross-sectional secondary analysis of a randomized controlled trial, the Vitamin A, Zinc and Pneumonia study. Children had serum 25(OH)D concentrations measured. A sensitivity analysis was undertaken to determine a vitamin D cut-off specific for our endpoints. Associations between serum 25(OH)D and underweight (defined as weight-for-age Z-score≤−1) and stunting (defined as height-for-age Z-score≤−2) were assessed using multivariate logistic regression.

Children residing in five low-SES peri-urban neighbourhoods near Quito, Ecuador.

Children (n 516) aged 6–36 months.

Mean serum 25(OH)D concentration was 58·0 (sd 17·7) nmol/l. Sensitivity analysis revealed an undernutrition-specific 25(OH)D cut-off of <42·5 nmol/l; 18·6 % of children had serum 25(OH)D<42·5 nmol/l. Children who were underweight were more likely to have serum 25(OH)D<42·5 nmol/l (adjusted OR (aOR)=2·0; 95 % CI 1·2, 3·3). Children with low serum 25(OH)D levels were more likely to be stunted (aOR=2·8; 95 % CI 1·6, 4·7).

Low serum 25(OH)D levels were more common in underweight and stunted Ecuadorian children.

Consumption of cow’s milk, which is associated with diet and health benefits, has decreased in the USA. The simultaneous increase in demand for more costly organic milk suggests consumer concern about exposure to production-related contaminants may be contributing to this decline. We sought to determine if contaminant levels differ by the production method used.

Half-gallon containers of organic and conventional milk (four each) were collected by volunteers in each of nine US regions and shipped on ice for analysis. Pesticide, antibiotic and hormone (bovine growth hormone (bGH), bGH-associated insulin-like growth factor 1 (IGF-1)) residues were measured using liquid or gas chromatography coupled to mass or tandem mass spectrometry. Levels were compared against established federal limits and by production method.

Laboratory analysis of retail milk samples.

Current-use pesticides (5/15 tested) and antibiotics (5/13 tested) were detected in several conventional (26–60 %; n 35) but not in organic (n 34) samples. Among the conventional samples, residue levels exceeded federal limits for amoxicillin in one sample (3 %) and in multiple samples for sulfamethazine (37 %) and sulfathiazole (26 %). Median bGH and IGF-1 concentrations in conventional milk were 9·8 and 3·5 ng/ml, respectively, twenty and three times that in organic samples (P < 0·0001).

Current-use antibiotics and pesticides were undetectable in organic but prevalent in conventionally produced milk samples, with multiple samples exceeding federal limits. Higher bGH and IGF-1 levels in conventional milk suggest the presence of synthetic growth hormone. Further research is needed to understand the impact of these differences, if any, on consumers.

Measurements of length at birth, or in the neonatal period, are challenging to obtain and often discounted for lack of validity. Hence, classical ‘under-5’ stunting rates have been derived from surveys on children from 6 to 59 months of age. Guatemala has a high prevalence of stunting (49·8 %), but the age of onset of growth failure is not clearly defined. The objective of the study was to assess length-for-age within the first 1·5 months of life among Guatemalan infants.

As part of a cross-sectional observational study, supine length was measured in young infants. Mothers’ height was measured. Length-for-age Z-scores (HAZ) were generated and stunting was defined as HAZ <−2 using WHO growth standards.

Eight rural, indigenous Mam-Mayan villages (n 200, 100 % of Mayan indigenous origin) and an urban clinic of Quetzaltenango (n 106, 27 % of Mayan indigenous origin), Guatemala.

Three hundred and six newborns with a median age of 19 d.

The median rural HAZ was −1·56 and prevalence of stunting was 38 %; the respective urban values were −1·41 and 25 %. Linear regression revealed no relationship between infant age and HAZ (r=0·101, r2=0·010, P=0·077). Maternal height explained 3 % of the variability in HAZ (r=0·171, r2=0·029, P=0·003).

Stunting must be carried over from in utero growth retardation in short-stature Guatemalan mothers. As linear growth failure in this setting begins in utero, its prevention must be linked to maternal care strategies during gestation, or even before. A focus on maternal nutrition and health in an intergenerational dimension is needed to reduce its prevalence.

To review and synthesize existing national and state organizations’ policies related to the nutritional quality of snacks served in after-school programmes (ASP; 15.00–18.00 hours) in the USA.

Systematic review of websites and corresponding documentation describing national and state-level ASP organizations’ policies, standards, guidelines and/or recommendations for the nutritional quality of snacks served within the ASP setting.

ASP can play a critical role in a child's daily dietary intake. State and national organizations have developed policies to assist ASP in selecting nutritionally appropriate snacks, yet no widely accepted standards exist. By reviewing the extent of existing policies, recommendations for uniform policies can be made.

Policy documentation.

A total of seventeen organizations representing five unique snack policies comprised of thirteen different food items were identified. The most widely recognized snack policy, which the majority of state and national ASP organizations endorsed and upon which other snack policies were modelled, was the US Department of Agriculture reimbursement programmes. Consistently, policies endorsed serving fruits/vegetables, whole grains and milk/dairy products, and limiting foods high in fats/sugar/energy (calories). Two policies focused predominantly on total energy and macronutrient composition of snacks, a single policy suggested limits on sugar-sweetened beverages, and three endorsed serving water daily. A proposed set of general guidelines for ASP was developed based on uniformity in recommendations across policies.

The proposed set of nutritional guidelines will assist policy makers and ASP providers in selecting and serving nutritionally appropriate snacks that contribute to a child's overall healthful daily dietary intake.

To investigate the effect of public hospitals in Hong Kong not accepting free infant formula from manufacturers on in-hospital formula supplementation rates and breast-feeding duration.

Prospective cohort study.

In-patient postnatal units of four public hospitals in Hong Kong.

Two cohorts of breast-feeding mother–infant pairs (n 2560). Cohort 1 (n 1320) was recruited before implementation of the policy to stop accepting free infant formula and cohort 2 (n 1240) was recruited after policy implementation. Participants were followed prospectively for 12 months or until they stopped breast-feeding.

The mean number of formula supplements given to infants in the first 24 h was 2·70 (sd 3·11) in cohort 1 and 1·17 (sd 1·94) in cohort 2 (P<0·001). The proportion of infants who were exclusively breast-fed during the hospital stay increased from 17·7 % in cohort 1 to 41·3 % in cohort 2 (P<0·001) and the risk of breast-feeding cessation was significantly lower in cohort 2 (hazard ratio=0·81; 95 % CI 0·73, 0·90). Participants who non-exclusively breast-fed during the hospital stay had a significantly higher risk of stopping any or exclusive breast-feeding. Higher levels of formula supplementation also increased the risk of breast-feeding cessation in a dose–response pattern.

After implementation of a hospital policy to pay market price for infant formula, rates of in-hospital formula supplementation were reduced and the rates of in-hospital exclusive breast-feeding and breast-feeding duration increased.

The goal of the present study was to use a methodology that accurately and reliably describes the availability, price and quality of healthy foods at both the store and community levels using the Nutrition Environment Measures Survey in Stores (NEMS-S), to propose a spatial methodology for integrating these store and community data into measures for defining objective food access.

Two hundred and sixty-five retail food stores in and within 2 miles (3·2 km) of Flint, Michigan, USA, were mapped using ArcGIS mapping software.

A survey based on the validated NEMS-S was conducted at each retail food store. Scores were assigned to each store based on a modified version of the NEMS-S scoring system and linked to the mapped locations of stores. Neighbourhood characteristics (race and socio-economic distress) were appended to each store. Finally, spatial and kernel density analyses were run on the mapped store scores to obtain healthy food density metrics.

Regression analyses revealed that neighbourhoods with higher socio-economic distress had significantly lower dairy sub-scores compared with their lower-distress counterparts (β coefficient=−1·3; P=0·04). Additionally, supermarkets were present only in neighbourhoods with <60 % African-American population and low socio-economic distress. Two areas in Flint had an overall NEMS-S score of 0.

By identifying areas with poor access to healthy foods via a validated metric, this research can be used help local government and organizations target interventions to high-need areas. Furthermore, the methodology used for the survey and the mapping exercise can be replicated in other cities to provide comparable results.

To investigate possible associations of lifestyle patterns with obesity and fat mass in children.

Cross-sectional epidemiological study. Principal component analysis was used to identify lifestyle patterns.

Primary schools from four regions in Greece.

A total of 2073 schoolchildren (aged 9–13 years).

Children in the fourth quartile of the lifestyle pattern combining higher dairy foods with more adequate breakfast consumption were 39·4 %, 45·2 % and 32·2 % less likely to be overweight/obese and in the highest quartile of sum of skinfold thicknesses and fat mass, respectively, than children in the first quartile of this pattern. Similarly, children in the fourth quartile of a lifestyle pattern comprising consumption of high-fibre foods, such as fruits, vegetables and wholegrain products, were 27·4 % less likely to be in the highest quartile of sum of skinfold thicknesses than children in the first lifestyle pattern quartile. Finally, children in the fourth quartile of a lifestyle pattern characterized by more time spent on moderate-to-vigorous physical activity and more frequent meals were 38·0 %, 26·3 % and 29·5 % less likely to be overweight, centrally obese and in the highest quartile of fat mass, respectively, than their peers in the first quartile of this lifestyle pattern (all P < 0·05).

The current study identified three lifestyle patterns (i.e. one pattern comprising higher dairy consumption with a more adequate breakfast; a second pattern characterized by increased consumption of high-fibre foods; and a third pattern combining higher physical activity levels with more frequent meals), which were all related with lower odds of obesity and/or increased fat mass levels. From a public health perspective, promotion of these patterns among children and their families should be considered as one of the components of any childhood obesity preventive initiative.

To validate a dietary assessment method, a 4-day food record together with a duplicate portion technique, with biological markers for food intake.

Four days of duplicate portions were collected in parallel with food recording. A 24-h urine sample and the faeces corresponding to the food intake (using a coloured marker) were collected. Completeness of urine and faeces collections was assessed using para-aminobenzoic acid (PABA) in urine and cadmium in faeces, respectively. Biomarkers of food intake (energy, protein, fibre, sodium, potassium, calcium) were measured in urine and faeces.

Swedish west coast.

Non-smoking Swedish women, 20–50 years of age, consuming a mixed diet (n=34), a mixed diet rich in shellfish (n=17) or a vegetarian/high-fibre diet (n=23).

The average ratio (food intake according to the dietary assessment methods/biological marker) for protein, sodium, potassium and calcium was 0.86. This indicates an underestimation of the food intake by approximately 15%. The ratio of stated fibre intake to biological marker was 1.20 for the mixed diet and the vegetarian diet group, indicating an overestimation by approximately 20%.

The underestimation of the intake of protein, sodium, potassium and calcium by all three groups and the overestimation of the fibre intake by two groups indicate that underreporting is selective to certain nutrients and foods and to various groups of people. The two dependent dietary assessment methods were equally good in measuring protein intake, which indicates that the women recorded what they actually duplicated.

To investigate the association between Helicobacter pylori infection and anaemia.

Six cross-sectional studies. H. pylori infection was assessed by the [13C]urea breath test using MS or IR analysis. Hb was measured for all countries. Ferritin and transferrin receptors were measured for Argentina, Bolivia, Mexico, and Venezuela.

Health services in Argentina, Brazil and Mexico or public schools in Bolivia, Cuba and Venezuela.

In Argentina, 307 children aged 4–17 years referred to a gastroenterology unit; in Bolivia, 424 randomly selected schoolchildren aged 5–8 years; in Brazil, 1007 adults (157 men, 850 women) aged 18–45 years attending thirty-one primary health-care units; in Cuba, 996 randomly selected schoolchildren aged 6–14 years; in Mexico, seventy-one pregnant women in their first trimester attending public health clinics; in Venezuela, 418 children aged 4–13 years attending public schools.

The lowest prevalence of H. pylori found was among children in Argentina (25·1 %) and the highest in Bolivia (74·0 %). In Bolivia, Cuba and Venezuela children showed similar prevalence of H. pylori infection as in Brazilian and Mexican adults (range 47·5 % to 81·8 %). Overall anaemia prevalence was 11·3 % in Argentina, 15·4 % in Bolivia, 20·6 % in Brazil, 10·5 % in Cuba and 8·9 % in Venezuela. Adjusted analyses allowing for confounding variables showed no association between H. pylori colonization and anaemia in any study. Hb, ferritin and transferrin receptor levels were also not associated with H. pylori infection in any country.

The present study showed no evidence to support the hypothesis that H. pylori contributes to anaemia in children, adolescents, adults or pregnant women in six Latin American countries.

Nutrient and food standards exist for school lunches in English primary schools although packed lunches brought from home are not regulated. The aim of the present study was to determine nutritional and dietary differences by lunch type.

A cross-sectional survey was carried out in 2007 assessing diet using the Child and Diet Evaluation Tool (CADET), a validated 24 h estimated food diary. The data were analysed to determine nutritional and dietary intakes over the whole day by school meal type: school meals and packed lunches.

Fifty-four primary schools across England.

Children (n 2709) aged 6–8 years.

Children having a packed lunch consumed on average 11·0 g more total sugars (95 % CI 6·6, 15·3 g) and 101 mg more Na (95 % CI 29, 173 mg) over the whole day. Conversely, children having a school meal consumed, on average, 4·0 g more protein (95 % CI 2·3, 5·7 g), 0·9 g more fibre (NSP; 95 % CI 0·5, 1·3 g) and 0·4 mg more Zn (95 % CI 0·1, 0·6 mg). There was no difference in daily energy intake by lunch type. Children having a packed lunch were more likely to consume snacks and sweetened drinks; while children having a school meal were more likely to consume different types of vegetables and drink water over the whole day.

Compared with children having a school meal, children taking a packed lunch to school consumed a lower-quality diet over the whole day, including higher levels of sugar and Na and fewer vegetables. These findings support the introduction of policies that increase school meal uptake.