The present study sought to explore the factors that influence registration for free school meals and the subsequent take-up following registration in England.

The research design consisted of two phases, a qualitative research phase followed by an intervention phase. Findings are presented from the qualitative research phase, which comprised interviews with head teachers, school administrators, parents and focus groups with pupils.

The study took place in four primary schools and four secondary schools in Leeds, UK.

Participants included head teachers, school administrators, parents and pupils.

Findings suggested that parents felt the registration process to be relatively straightforward although many secondary schools were not proactive in promoting free school meals. Quality and choice of food were regarded by both pupils and parents as significant in determining school meal choices, with stigma being less of an issue than originally anticipated.

Schools should develop proactive approaches to promoting free school meals and attention should be given not only to the quality and availability of food, but also to the social, cultural and environmental aspects of dining. Processes to maintain pupils’ anonymity should be considered to allay parents’ fear of stigma.

To determine if dietary, supplemental and total vitamin D intakes in the USA are influenced by income, race/ethnicity or gender.

Cross-sectional. US vitamin D intakes were estimated by poverty income ratio (PIR), race/ethnicity and gender using 24 h dietary intake recalls and dietary supplement use questionnaires. Statistical analyses of weighted data were performed using SAS (version 9·2) to estimate means and their standard errors. Race and ethnic intake differences controlling for PIR, gender and age were assessed by ANCOVA.

Adults aged ≥19 years.

The 2007–2010 National Health and Nutrition Examination Survey, USA.

Total (dietary and supplement) vitamin D intake was greater in the high (10·0 (se 0·30) μg/d) v. the medium (7·9 (se 0·3) μg/d) or the low (8·0 (se 0·3) μg/d) PIR categories. Total vitamin D intake of non-Hispanic Whites (10·6 (se 0·4) μg/d) was greater than that of Hispanics (8·1 (se 0·3) μg/d) and non-Hispanic Blacks (7·1 (se 0·3) μg/d). Supplemental vitamin D intake was greater by females (5·3 (se 0·2) μg/d) than by males (3·3 (se 0·2) μg/d). Participants with high income were more likely to be vitamin D supplement users (33·0 %) than those with medium (22·5 %) or low (17·6 %) income. High-income non-Hispanic Whites had the lowest percentage (57 %) not meeting the Estimated Average Requirement for vitamin D. Fortified milk and milk products provided 43·7 % of the dietary vitamin D intake.

Public health efforts should expand the number of vitamin D-fortified foods and encourage the consumption of foods high in vitamin D and use of supplements.

To evaluate patterns of water consumption from plain water, beverages and foods among Mexican children and adolescents and to compare actual patterns of total daily water intake with the Dietary Reference Intakes (DRI).

We analysed one 24 h dietary recall from Mexican children and adolescents. We calculated intakes of total daily water and water from foods and from beverages. Actual total water intake per capita was subtracted from the DRI for water to calculate the shortfall.

Mexican National Health and Nutrition Survey in 2012.

Mexican children and adolescents (n 6867) aged 1–18 years.

Approximately 73 % of children and adolescents aged 1–18 years reported drinking plain water. Beverages and plain water represented 65·5 % and 26·5 % of total daily water intake, respectively. Among 1–3-year-olds, the top three main sources of water were from foods, plain water and water from plain milk. Among 4–8- and 9–13-year-olds, the main sources were from foods, plain water and agua fresca (fruit water). Among 14–18-year-olds, the main sources of water were plain water, water from foods and soda. A higher proportion of 1–3-year-olds and 4–8-year-olds met the DRI for water (38 % and 29 %, respectively). Among 9–13-year-olds and 14–18-year-olds, 13–19 % of children met the DRI for water.

Total daily water intakes remain below DRI levels in all age groups. Although plain water still contributes the greatest proportion to daily water intake among fluids, caloric beverages are currently major sources of water especially among older children and adolescents.

Dietary protein plays a role in counteracting age-related muscle loss. However, limited long-term data exist on protein intake and markers of cardiometabolic health, which tend to deteriorate with age.

Prospective cohort study. FFQ-derived protein intake (g/d) and cardiometabolic markers were assessed up to five times across 20 years. Markers included systolic (SBP) and diastolic (DBP) blood pressures, circulating lipids (total, HDL and LDL cholesterol; TAG), estimated glomerular filtration rate (eGFR), fasting glucose (FG), weight and waist circumference (WC). Mixed models accounting for repeated measures were used to estimate adjusted mean annualized changes in outcomes per quartile category of protein.

Framingham Heart Study Offspring cohort, USA.

Participants (n 3066) with 12 333 unique observations, baseline (mean (sd)) age=54·0 (9·7) years, BMI=27·4 (4·9) kg/m2, 53·5 % female.

In fully adjusted models, there were favourable associations (mean (se)) of total protein with annualized changes in SBP (lowest v. highest intake: 0·34 (0·06) v. 0·04 (0·06) mmHg, P trend=0·001) and eGFR (−1·03 (0·06) v. −0·87 (0·05) ml/min per 1·73 m2, P trend=0·046), unfavourable associations with changes in FG (0·013 (0·004) v. 0·028 (0·004) mmol/l, P trend=0·004) and no associations with weight, WC, DBP or lipids. Animal protein was favourably associated with SBP and unfavourably with FG and WC; plant protein was favourably associated with FG and WC.

The present study provides evidence that protein intake may influence changes in cardiometabolic health independent of change in weight in healthy adults and that protein’s role in cardiometabolic health may depend on the protein source.

To evaluate the prevalence and identify some predictors of misreporting in an elderly Belgian population and to assess the effect of underreporting on estimated intakes of macronutrients and foods.

A 1-day food record was completed by 2083 adult men and women aged 65 years or more. Individuals whose energy intake was lower than 0.90 × BMR (basal metabolic rate) were defined as underreporters. Overreporting was defined as energy intake greater than 2 × BMR.

Underreporting and overreporting occurred in 13.6% and 7.9% of food records, respectively. Results from logistic regression models indicated that gender and body mass index (BMI) were predictors of misreporting. Whereas women were more likely to underreport energy intake, the prevalence of overreporting was higher in men. Underreporting was more prevalent among obese people and overreporting more prevalent in normal-weight subjects. Smoking status and education level did not predict underreporting; however, overreporting was more likely to occur in more highly educated subjects. A cultural difference in reporting of nutrient intakes was also found, with the percentage of underreporters being higher among Walloons compared with Flemish.

BMI seemed to be one of the most important factors in misreporting. This calls for special attention when dietary surveys are performed on obese or lean people.

Studies examining the association of dairy consumption with incident CHD have yielded inconsistent results. The current prospective study examined the association between dairy consumption and CHD in a population-based sample of older community-dwelling adults.

Baseline CHD risk factors were assessed and an FFQ was self-administered. Participants were followed for morbidity and mortality with periodic clinic visits and annual mailed questionnaires for an average of 16·2 years, with a 96 % follow-up rate for fatal and non-fatal CHD.

Community.

Participants were 751 men and 1008 women aged 50–93 years who attended a clinic visit in 1984–1987.

At baseline the mean age was 70·6 (sd 9·8) years for men and 70·1 (sd 9·3) years for women. Participants who developed CHD during follow-up were significantly older (P < 0·001), had higher BMI (P = 0·035) and higher total cholesterol (P = 0·050), and were more likely to be male (P < 0·001), diabetic (P = 0·011) and hypertensive (P < 0·001), than those who did not develop CHD. Multivariate regression analyses adjusting for age, BMI, diabetes, hypertension, LDL-cholesterol and oestrogen use (in women) indicated that women who consumed low-fat cheese ‘sometimes/often’ and women who consumed non-fat milk ‘sometimes/often’ had an increased risk of incident CHD (hazard ratio = 2·32; 95 % CI 1·57, 3·41) and CHD (hazard ratio = 1·48; 95 % CI 1·02, 2·16) compared with women who ‘never/rarely’ ate these dairy products.

Woman with higher intake of low-fat cheese and non-fat milk seem to have a higher risk of incident CHD. This needs further investigation considering recent evidence of cardiovascular benefits from certain dairy fat.

To identify a high-sugar (HS) dietary pattern, a high-saturated-fat (HF) dietary pattern and a combined high-sugar and high-saturated-fat (HSHF) dietary pattern and to explore if these dietary patterns are associated with depressive symptoms.

We used data from the HELIUS (Healthy Life in an Urban Setting) study and included 4969 individuals aged 18–70 years. Diet was assessed using four ethnic-specific FFQ. Dietary patterns were derived using reduced rank regression with mono- and disaccharides, saturated fat and total fat as response variables. The nine-item Patient Health Questionnaire (PHQ-9) was used to assess depressive symptoms by using continuous scores and depressed mood (identified using the cut-off point: PHQ-9 sum score ≥10).

The Netherlands.

Three dietary patterns were identified; an HSHF dietary pattern (including chocolates, red meat, added sugars, high-fat dairy products, fried foods, creamy sauces), an HS dietary pattern (including sugar-sweetened beverages, added sugars, fruit (juices)) and an HF dietary pattern (including high-fat dairy products, butter). When comparing extreme quartiles, consumption of an HSHF dietary pattern was associated with more depressive symptoms (Q1 v. Q4: β=0·18, 95 % CI 0·07, 0·30, P=0·001) and with higher odds of depressed mood (Q1 v. Q4: OR=2·36, 95 % CI 1·19, 4·66, P=0·014). No associations were found between consumption of the remaining dietary patterns and depressive symptoms.

Higher consumption of an HSHF dietary pattern is associated with more depressive symptoms and with depressed mood. Our findings reinforce the idea that the focus should be on dietary patterns that are high in both sugar and saturated fat.

To evaluate the effectiveness of the peer counselling (PC) programme on breast-feeding initiation among participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Missouri, and to identify factors that facilitate breast-feeding initiation.

We used the data from the 2006 Missouri Pregnancy Nutrition Surveillance System, Missouri Live Birth Records and the Missouri WIC programme to compare breast-feeding initiation rates between PC and non-PC agencies. We used multilevel logistic regression, with individual participants being nested within agencies, to control for individual- and agency-level characteristics.

The breast-feeding initiation rate in PC agencies was significantly higher than in non-PC agencies among prenatal participants, but the difference was not significant among postpartum participants. After controlling for maternal sociodemographic characteristics, compared with prenatal cases in non-PC agencies, prenatal cases in PC agencies were more likely to initiate breast-feeding (OR = 1·21; 95 % CI 1·03, 1·43), whereas postpartum cases were less likely to initiate breast-feeding. Among prenatal participants in PC agencies, longer duration of prenatal WIC enrolment was associated with a higher rate of breast-feeding initiation. After adjusting for maternal sociodemographic characteristics and other agency-level characteristics, participants of PC agencies with an international board-certified lactation consultant were more likely to initiate breast-feeding than participants of PC agencies without such a consultant (OR = 1·21; 95 % CI 1·01, 1·45).

Prenatal participation in the WIC breast-feeding PC programme (especially participation early during pregnancy) was associated with an increased rate of breast-feeding initiation in Missouri.

To examine whether an FFQ can be used for assessing exposure to methylmercury (MeHg) by estimating MeHg intake from seafood consumption using the FFQ and confirming the accuracy of the estimated value.

Seafood consumption of pregnant women was assessed using the FFQ. Total mercury (T-Hg) concentrations of maternal red blood cells (RBC) and hair were measured as exposure indices of MeHg.

A prospective birth cohort study, the Tohoku Study of Child Development (TSCD), which has been ongoing since 2001.

The subjects were 609 pregnant Japanese women who were enrolled in the TSCD.

MeHg intake was estimated from seafood consumption determined using the FFQ and the MeHg concentrations in each type of seafood. The accuracy of the estimated value was confirmed by comparison with T-Hg in RBC and hair. Estimated MeHg intake was 42·3 μg/week, and 43·0 % of that was from large predatory fish. Compared with the Japanese tolerable weekly intake, in total 12·5 % of the subjects exceeded it. T-Hg concentrations in RBC and hair were significantly correlated with estimated MeHg intake: r = 0·325 (P < 0·0001) for RBC and r = 0·305 (P < 0·0001) for hair.

Estimated MeHg intake based on the FFQ was significantly associated with T-Hg concentrations in RBC and hair. Although the estimated value involves uncertainties, the FFQ appears to be a useful tool for assessment of exposure to MeHg.

To adapt a scale to measure perceptions on food insecurity and hunger among households in urban and rural communities in Peru.

Qualitative and quantitative methodology including consultation with regional experts, key informant interviews and focus groups. A field survey trial was conducted in urban and rural communities using an adapted version of the US Department of Agriculture (USDA) Food Insecurity and Hunger Module (FIHM).

Five communities in three regions in Peru – Lima (coast), Ayacucho (Andean highlands) and San Martín (Amazon basin).

The qualitative component included forty intentionally selected people (fourteen key informants and twenty-six focus group participants). For the quantitative component 300 households that complied with selection criteria (poor or non-poor with at least one child below 12 years of age) were surveyed.

Qualitative research showed that concern about food availability and access was common among the three regions but its main cause varied across them. Participation in food aid programmes was a strategy to face constraints in food access. Mothers’ perceptions on the importance of balanced meals varied across households from different regions. Quantitative results showed robust findings for the reliability of the adapted FIHM’s fifteen-item scale (r > 0·863). In addition, descriptive results confirmed parallelism of item responses in the scale for variables such as farm ownership, family size and use of Communal Kitchens.

This mixed-method study allowed us to adapt the USDA module to assess food insecurity in Peru.

Convenience and cost impact on people’s meal decisions. Takeaway and pre-prepared foods save preparation time but may contribute to poorer-quality diets. Analysing the impact of time on relative cost differences between meals of varying convenience contributes to understanding the barrier of time to selecting healthy meals.

Six popular New Zealand takeaway meals were identified from two large national surveys and compared with similar, but healthier, home-made and home-assembled meals that met nutrition targets consistent with New Zealand Eating and Activity Guidelines. The cost of each complete meal, cost per kilogram, and confidence intervals of the cost of each meal type were calculated. The time-inclusive cost was calculated by adding waiting or preparation time cost at the minimum wage.

A large urban area in New Zealand.

For five of six popular meals, the mean cost of the home-made and home-assembled meals was cheaper than the takeaway meals. When the cost of time was added, all home-assembled meal options were the cheapest and half of the home-made meals were at least as expensive as the takeaway meals. The home-prepared meals were designed to provide less saturated fat and Na and more vegetables than their takeaway counterparts; however, the home-assembled meals provided more Na than the home-made meals.

Healthier home-made and home-assembled meals were, except one, cheaper options than takeaways. When the cost of time was added, either the home-made or the takeaway meal was the most expensive. This research questions whether takeaways are better value than home-prepared meals.

A diet rich in phyto-oestrogens has been suggested to protect against a variety of common diseases but UK intake data on phyto-oestrogens or their food sources are sparse. The present study estimates the average intakes of isoflavones, lignans, enterolignans and coumestrol from 7 d food diaries and provides data on total isoflavone, lignan and phyto-oestrogen consumption by food group.

Development of a food composition database for twelve phyto-oestrogens and analysis of soya food and phyto-oestrogen consumption in a population-based study.

Men and women, aged 40–79 years, from the general population participating in the Norfolk arm of the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk) between 1993 and 1997, with nutrient and food data from 7 d food diaries.

A subset of 20 437 participants.

The median daily phyto-oestrogen intake for all men was 1199 μg (interquartile range 934–1537 μg; mean 1504 μg, sd 1502 μg) and 888 μg for all women (interquartile range 710–1135 μg; mean 1205 μg, sd 1701 μg). In soya consumers, median daily intakes were higher: 2861 μg in men (interquartile range 1304–7269 μg; mean 5051 μg, sd 5031 μg) and 3142 μg in women (interquartile range 1089–7327 μg; mean 5396 μg, sd 6092 μg). In both men and women, bread made the greatest contribution to phyto-oestrogen intake – 40·8 % and 35·6 %, respectively. In soya consumers, vegetable dishes and soya/goat's/sheep's milks were the main contributors – 45·7 % and 21·3 % in men and 38·4 % and 33·7 % in women, respectively.

The ability to estimate phyto-oestrogen intake in Western populations more accurately will aid investigations into their suggested effects on health.

To compare an improved corn–soya blend (CSB+) with a ready-to-use supplementary food (RUSF) to test the hypothesis that satisfactory recovery rate will be achieved with CSB+ or RUSF when these foods provide 50 % of the child’s energy requirement, the 50 % remaining coming from usual diet.

A comparative efficacy trial study was conducted with moderately wasted children, using a controlled randomized design, with parallel assignment for RUSF or CSB+. Every child received a daily ration of 167 kJ (40 kcal)/kg body weight during 56 d with a follow-up performed every 14 d. Every caregiver received nutrition counselling at enrolment and at each follow-up visit.

Health districts of Mvog-Beti and Evodoula in the Centre region of Cameroon.

Eight hundred and thirty-three children aged 6–59 months were screened and eighty-one malnourished children (weight-for-height Z-score between −3 and −2) aged 25–59 months were selected.

Of children treated with CSB+ and RUSF, 73 % (95 % CI 59 %, 87 %) and 85 % (95 % CI 73 %, 97 %), respectively, recovered from moderate acute malnutrition, with no significant difference between groups. The mean duration of treatment required to achieve recovery was 44 d in the RUSF group and 51 d in the CSB+ group (log-rank test, P=0·0048).

There was no significant difference in recovery rate between the groups. Both CSB+ and RUSF were relatively successful for the treatment of moderate acute malnutrition in children. Despite the relatively low ration size provided, the recovery rates observed for both groups were comparable to or higher than those reported in previous studies, a probable effect of nutrition education.

The present qualitative study aimed to gain an in-depth understanding of participants’ attitudes, knowledge, perceived effectiveness (a person’s belief that his/her behaviour can contribute to environmental preservation) and behaviours relating to a sustainable eating pattern.

One-to-one interviews (either face-to-face or by telephone) were conducted following a structured interview schedule, audio-recorded, transcribed verbatim and analysed using inductive thematic analysis in NVivo 10.

Victorian (Australia) adult participants recruited via online advertisements, flyers on community advertisement boards and letterbox drops.

Twenty-four participants (mean age 40 years, range 19–69 years; thirteen female, eleven male) were interviewed.

Participants reported that environmental impact was not an important influence on their food choice. Participants displayed limited knowledge about a sustainable eating pattern, with most unaware of the environmental impact of food-related behaviours. Most participants believed sustainable eating would be only slightly beneficial to the environment. Participants reported undertaking limited sustainable food behaviours currently and were more willing to undertake a food behaviour if they perceived additional benefits, such as promoting health or supporting the local community.

The study suggests consumers need further information about a sustainable eating pattern and the environmental impact of food choice. The findings highlight some of the barriers that will need to be addressed when promoting this kind of eating pattern and that a range of interventions will be necessary.

Contributions of fish and other foods to variance of selenium and mercury status were studied in British adults.

Plasma and red-cell selenium and whole-blood mercury concentrations were measured during the National Diet and Nutrition Survey of Adults aged 19–64 years in mainland Britain, 2000–2001 (n = 1216). Food intake was weighed for seven consecutive days, and foods were combined in groups for data analysis. Four subsidiary groups characterised fish intakes: fried white fish, ‘other’ white fish, shellfish and oily fish.

Geometric means and 5–95% ranges were: for whole-blood mercury, 5.61 (1.30–22.2) nmol l− 1; for plasma selenium, 1.09 (0.83–1.43) μmol l− 1; for red-cell selenium, 1.64 (1.14–2.40) μmol l− 1. Twenty-eight per cent had no fish intake recorded during 7 days; the remaining 72% had a median intake of 237 g over the 7-day period, 5–95% range 45–780 g. Total fish intake was strongly and directly correlated with blood mercury, and moderately with red-cell and plasma selenium. Thus, sqrt(total fish intake) was correlated with: loge(blood Hg), t = +19.7; loge(plasma Se), t = +9.8; and loge(red-cell Se), t = +9.6, all P < 0.0001. All three biochemical (mercury and selenium) indices were strongly correlated with oily fish intake, and moderately correlated with shellfish and ‘other’ ( = non-fried) white fish, but none was significantly correlated with fried white fish. Blood mercury was strongly and directly correlated with red-cell and plasma selenium, and both increased with age.

Dietary fish, especially oily fish, is a strong predictor of blood mercury and selenium in British adults.

To examine the effect of food insecurity during college on graduation and degree attainment.

Secondary analysis of longitudinal panel data. We measured food insecurity concurrent with college enrolment using the 18-question United States Department of Agriculture Household Food Security Survey Module. Educational attainment was measured in 2015–2017 via two questions about college completion and highest degree attained. Logistic and multinomial logit models adjusted for socio-demographic characteristics were estimated.

USA

A nationally representative, balanced panel of 1574 college students in the USA in 1999–2003 with follow-up through 2015–2017 from the Panel Study of Income Dynamics.

In 1999–2003, 14·5 % of college students were food-insecure and were more likely to be older, non-White and first-generation students. In adjusted models, food insecurity was associated with lower odds of college graduation (OR 0·57, 95 % CI: 0·37, 0·88, P = 0·01) and lower likelihood of obtaining a bachelor’s degree (relative risk ratio (RRR) 0·57 95 % CI: 0·35, 0·92, P = 0·02) or graduate/professional degree (RRR 0·39, 95 % CI: 0·17, 0·86, P = 0·022). These associations were more pronounced among first-generation students. And 47·2 % of first-generation students who experienced food insecurity graduated from college; food-insecure first-generation students were less likely to graduate compared to first-generation students who were food-secure (47·2 % v. 59·3 %, P = 0·020) and non-first-generation students who were food-insecure (47·2 % v. 65·2 %, P = 0·037).

Food insecurity during college is a barrier to graduation and higher-degree attainment, particularly for first-generation students. Existing policies and programmes that help mitigate food insecurity should be expanded and more accessible to the college student population.

The main purpose of the study was to investigate the feasibility of using workplaces to increase the fruit consumption of participants by increasing fruit availability and accessibility by a minimal fruit programme. Furthermore, it was investigated whether a potential increase in fruit intake would affect vegetable, total energy and nutrient intake.

A 5-month, controlled, workplace study where workplaces were divided into an intervention group (IG) and a control group (CG). At least one piece of free fruit was available per person per day in the IG. Total fruit and dietary intake was assessed, using two 24 h dietary recalls at baseline and at endpoint.

Eight Danish workplaces were enrolled in the study. Five workplaces were in the IG and three were in the CG.

One hundred and twenty-four (IG, n 68; CG, n 56) healthy, mainly normal-weight participants were recruited.

Mean daily fruit intake increased significantly from baseline to endpoint only in the IG by 112(se 35) g. In the IG, mean daily intake of added sugar decreased significantly by 10·7(se 4·4) g, whereas mean daily intake of dietary fibre increased significantly by 3·0(se 1·1) g. Vegetable, total energy and macronutrient intake remained unchanged through the intervention period for both groups.

The present study showed that it is feasible to increase the average fruit intake at workplaces by simply increasing fruit availability and accessibility. Increased fruit intake possibly substituted intake of foods containing added sugar. In this study population the increased fruit intake did not affect total energy intake.

Nutrition-related disorders, including vitamin A deficiency (VAD) and chronic diseases, are serious problems in the Federated States of Micronesia (FSM). Many suggest that these disorders are new problems related to dietary and lifestyle changes. In the past four decades, imported foods, such as white rice, flour, sugar, refined foods and fatty meats, have increasingly replaced local foods in the diet.

A literature review was conducted to understand underlying issues related to dietary change and obtain insights for nutrition research and interventions.

Published and unpublished papers from different disciplines were reviewed and collated for information on food and nutrition in FSM. Topics covered were historical background, local foods, infant and child feeding, dietary assessment, and nutritional status. Particular focus was on information and data relating to VAD, the primary topic that led to the review of the literature.

FSM, a tropical country of abundant agricultural resources, has suffered a great loss in production and consumption of local foods. Inconsistent external and internal government policies and food aid programmes have contributed to the problem. Further research on the nutrient content of local foods and factors affecting production, acquisition and consumption is needed, as well as a broad, well-planned, intersectoral intervention aimed at dietary improvement for all age groups in the population.