The relationship between a child's environment and nutritional status is difficult to examine yet could offer an important guide to policy. The objective of the present work was to examine individual and environmental correlates with childhood height-for-age in Ghana.

Data were derived from the 2008 MEASURE Demographic and Health Survey in Ghana, the 2000 Ghana Population and Housing Census, and the World Wide Fund for Nature's eco-regions database. A generalized linear mixed regression model was used to estimate the effects of individual and environmental correlates on height-for-age.

The study examined 2225 Ghanaian children aged 0–59 months.

The setting was all districts in Ghana for the year 2008.

After accounting for individual characteristics of children, mothers and households, height-for-age was significantly associated with population density. Other significantly associated variables in the final model were the age of the child, vaccination status, the size of the child at birth, months of breast-feeding, mother's BMI, whether the child's mother had health insurance and wealth quintile.

In addition to a number of characteristics of the children and their households, the social milieu is important to understanding differences in height-for-age among children in Ghana. The biophysical environment was not associated with height-for-age.

The US Food and Drug Administration and Institute of Medicine are currently investigating front-of-package (FOP) food labelling systems to provide science-based guidance to the food industry. The present paper reviews the literature on FOP labelling and supermarket shelf-labelling systems published or under review by February 2011 to inform current investigations and identify areas of future research.

A structured search was undertaken of research studies on consumer use, understanding of, preference for, perception of and behaviours relating to FOP/shelf labelling published between January 2004 and February 2011.

Twenty-eight studies from a structured search met inclusion criteria. Reviewed studies examined consumer preferences, understanding and use of different labelling systems as well as label impact on purchasing patterns and industry product reformulation.

The findings indicate that the Multiple Traffic Light system has most consistently helped consumers identify healthier products; however, additional research on different labelling systems’ abilities to influence consumer behaviour is needed.

To test a surveillance system on diet and physical activity based on data gathered at well-child visits.

Cross-sectional data collection on growth, diet, physical activity and sociodemographic variables.

Offices of 179 paediatricians in three Italian regions.

26 898 children for a total of 32 915 well-child visits at 1, 3, 5–6, 8–9, 12, 18, 24, 36 and 60–72 months of age.

The BMI Z-score was lower than the WHO standard at 1 and 3 months but higher from 8–9 months onwards. The rates of breast-feeding at 1, 3, 5–6, 8–9 and 12 months were 88 %, 75 %, 64 %, 52 % and 32 %, respectively, with 5 % and 3 % continuing up to 24 and 36 months. Exclusive breast-feeding was 64 %, 54 % and 20 % at 1, 3 and 5–6 months, respectively; 57 % at 5 months and 85 % at 6 months were given complementary foods. Only 8 % and 10 % of children were taking five portions of fruit and vegetables daily, while 47 % and 51 % were consuming sugar-sweetened beverages at 36 and 60–72 months, respectively. At 60–72 months, less than 10 % reported at least 1 h of moderate-to-vigorous physical activity on 5–7 d/week, and 32 % watched television or played videogames for more than 2 h/d, every day. The majority of paediatricians rated the surveillance system as reliable and feasible.

Surveillance for diet and physical activity in pre-school children, with data gathered during well-child visits, is feasible and potentially useful to plan and evaluate activities for the prevention of obesity.

The present study investigated how trans-fat is reported on the packaging of foods sold in a Brazilian supermarket.

The present descriptive, cross-sectional study analysed the ingredient list, nutrition facts label and claims of no trans-fat on the packaging.

A large supermarket in Florianópolis, Brazil.

All food products available at the supermarket.

Of the 2327 study products, more than half had components containing trans-fat in the ingredient list, especially hydrogenated vegetable fat and its alternative names. A small percentage of food products reported some trans-fat content on the nutrition facts label and roughly a quarter of the food products claimed to contain no trans-fat on the front of the packaging. There was very low agreement among the trans-fat content reported in the nutrition facts label, claims of no trans-fat made on the packaging and the ingredient list.

There was low agreement among the different ways of reporting trans-fat, suggesting that it is not possible to rely on the nutrition facts label or no trans-fat claims printed on the packaging of Brazilian food products. Hence, the Brazilian legislation on food labels needs to change to improve the reliability of food labels and to help control the trans-fat intake of the population.

The aims were to collect data on consumption of different food supplements in a sample of the adult Italian population and to characterize users by demographic, physical and health-related characteristics, lifestyle and behaviour.

Cross-sectional survey.

The study was conducted in 2008 in ten towns of Italy (two towns from each of the five macro-areas: Northwest, Northeast, Centre, South and Islands).

Adults (n 10 000) aged ≥18 years were randomly selected and asked to fill in a self-administered questionnaire regarding their use of food supplements and the above variables. The effect of these variables on food supplement use was evaluated by univariate and multivariate logistic regression.

Of the 1723 individuals who returned the questionnaire, 49 % were users of food supplements. A large proportion (54 %) of users used more than one category of food supplement: vitamin and/or mineral supplements were the most used (61 %), followed by supplements with botanicals and botanical extracts (28 %). The results obtained by logistic regression showed that gender, town size, education level, sports practice, regular use of wholemeal cereal-based foods and presence of a low stress level were determinants for the use of food supplements in the examined population. However, these determinants were not shared by all categories of supplements.

The results of this preliminary study highlight that associations between demographic, dietary and lifestyle factors and use of different categories of food supplements differ according to products, and cannot be accounted for simply by dichotomizing individuals as users or non-users.

To develop meal plans using grain-based foods demonstrating how to incorporate wholegrain foods into a balanced diet for weight maintenance for different cuisines. The present study examines the ability of meal plans with ≥4 grain-based servings daily to meet nutrient recommendations using lacto-ovo vegetarian and rice-based cuisines.

Eighteen plans from each cuisine for three age brackets for both genders were developed. Plans aimed for ≥4 servings of grain-based foods daily, with separate plans for all wholegrain, all refined-grain and half wholegrain–half refined-grain foods. Meal plans followed an isoenergetic approach and were designed to meet specific Australian nutrient reference values and serving sizes.

All plans met the Recommended Dietary Intake or Adequate Intake for targeted nutrients except for Fe in the rice-based meal plan for females aged ≥19 years (17 mg). In the plans for 14–18 year and ≥19 year age groups, four servings of grain-based foods could be accommodated. In the plans for 9–13 years, increasing the number of grain-based food servings to four reduced micronutrients levels delivered by the total diet. Specific food choices were made to ensure nutrient targets were met across each category for wholegrain and refined-grain plans. The major difference in nutrients between wholegrain and refined-grain foods was found in the vegetarian cuisine, where the meal plans containing whole grains produced on average 30 % higher fibre (38–53 g) levels than those with refined grains (27–40 g).

With careful food selection, meal plans with ≥4 servings of grain-based foods daily can meet nutrient reference values for lacto-ovo vegetarian and rice-based cuisines.

The present store-based intervention was designed to promote sales of fruits and vegetables (F&V) to increase intake among store customers – specifically customers of tiendas, small-to-medium-sized Latino food stores.

Four tiendas were randomized to a 2-month environmental change intervention or a delayed treatment control condition. Employees and managers were trained to promote F&V sales, including how to implement a food marketing campaign and installing store equipment to promote fresh fruits and vegetables. The primary outcome was self-reported daily intake of F&V among a convenience sample of customers (at least forty per store) collected at baseline prior to randomization and then 4 months later. In addition, changes in availability of F&V in the tiendas, using unobtrusive observational methods, provided evidence of intervention fidelity.

Tiendas in central North Carolina.

Participants included 179 customers who were recent immigrants from Mexico and Central America.

A group-by-time interaction approached significance on daily servings of F&V; intervention customers reported an increase in F&V intake over time and as a function of the intervention (P ≤ 0·06). Unexpectedly, self-efficacy for consuming more fruits (P ≤ 0·01) and more vegetables (P ≤ 0·06) decreased. In our store-level analyses, a group-by-time interaction was observed for availability of fresh and canned vegetables; the intervention increased availability of vegetables but not fruit.

Environmental change strategies to promote healthy eating are needed given the rates of obesity and diabetes in the Latino population. A store-based intervention was moderately effective at increasing customers’ reported F&V intake. Such strategies can have a public health impact on underserved populations.

To investigate the association of family income at birth with BMI among young adults who have been followed since birth.

A birth cohort study.

In 1982, all children born in Pelotas, southern Brazil, were included in a perinatal survey and visited at ages 1, 2, 4, 15, 18–19 and 23 years.

Cohort members (n 4297) were traced and interviewed in 2004–2005. In all follow-ups, participants were weighed and measured, and BMI and prevalence of obesity were calculated for each age. Family income was obtained in minimum wages in 1982 and as a continuous variable, in reais, in later follow-ups. Skin colour was self-reported in 2004–2005.

Mean BMI and prevalence of obesity differed between males and females. In males, a direct relationship was found throughout life and among females this relationship was modified by age. During childhood, BMI was higher among girls from higher income groups and this association was inversed at age 23 years. At this same age, mean BMI among black women was 1·3 kg/m2 higher than among white women, even after adjustment for current family income.

The findings show in men that the relationship between income and BMI is similar to that seen in less developed areas, whereas among adult women the relationship is similar to that observed in developed countries. In addition to the effect of socio-economic status, skin colour also has an influence on the BMI of adult women.

To provide an overview of the status of monitoring and evaluation (M&E) of school feeding across sub-Saharan Africa and to reflect on the experience on strengthening M&E systems to influence policy making in low-income countries.

Literature review on the M&E of school feeding programmes as well as data from World Food Programme surveys.

Sub-Saharan Africa.

Countries implementing school feeding.

Only two randomized controlled impact evaluations have been implemented in sub-Saharan Africa. Where M&E data collection is underway, the focus is on process and service delivery and not on child outcomes. M&E systems generally operate under the Ministry of Education, with other Ministries represented within technical steering groups supporting implementation. There is no internationally accepted standardized framework for the M&E of school feeding. There have been examples where evidence of programme performance has influenced policy: considering the popularity of school feeding these cases though are anecdotal, highlighting the opportunity for systemic changes.

There is strong buy-in on school feeding from governments in sub-Saharan Africa. In response to this demand, development partners have been harmonizing their support to strengthen national programmes, with a focus on M&E. However, policy processes are complex and can be influenced by a number of factors. A comprehensive but simple approach is needed where the first step is to ensure a valid mandate to intervene, legitimizing the interaction with key stakeholders, involving them in the problem definition and problem solving. This process has been facilitated through the provision of technical assistance and exposure to successful experiences through South–South cooperation and knowledge exchange.

Little is known about how public entities can partner with industry to achieve public health goals. We investigated industry's perspective of factors that influenced their adoption and implementation of voluntary, government-issued nutrition guidelines (Alberta Nutrition Guidelines for Children and Youth, ANGCY) in recreational facilities.

In-depth semi-structured interviews were conducted. Data were analysed using directed content analysis.

Food services in recreational facilities.

Seven managers from industry participated; five from companies that had adopted and implemented the ANGCY (adopters) in recreational facilities and two from companies that had not (non-adopters).

Industry views nutrition guidelines through the lens of profitability. Non-adopters were unwilling to implement the ANGCY for fear of sacrificing short-term profitability, whereas adopters adhered to them in an attempt to position themselves for long-term profitability. Adopters faced barriers including few resources, no training, complex guidelines, low availability of and demand for ANGCY-compliant products, competitive pressures and substantial declines in revenue. Managers believed widespread voluntary adoption of the ANGCY was unlikely without government incentives and/or a mandate, as the environmental context for voluntary action was poor. All managers supported government-mandated implementation of the ANGCY to level the playing field upon which companies compete.

Public–private partnerships in recreational facilities can embrace public health goals in the short term, provided industry perceives potential for long-term financial gain. Widespread uptake of voluntary nutrition guidelines in this setting is unlikely, however, as market mechanisms do not encourage industry to sell and promote healthier options. Government legislation may therefore be warranted.

An increasing focus on legislation, policy and guidance on the nutritional content of school food has in part been in response to the limited impact of more behavioural or educational approaches. However, there is a risk that a sole focus on policy-level action may lead to neglect of the important contribution that more behavioural approaches can make as components of effective, coordinated, multilevel action to improve the dietary intake of schoolchildren. The current paper aims to highlight the potential importance of viewing alternative approaches as complementary or synergistic, rather than competing.

The socio-ecological and RE-AIM frameworks are used to provide a theoretical rationale and demonstrate the importance of explicitly identifying the interdependence of policies, interventions and contextual structures and processes. School food case study evidence is used to exemplify how understanding and exploiting these interdependencies can maximise impact on dietary outcomes.

Case studies of trials in schools in the UK (South West England and Wales) and Australia (Victoria).

Schoolchildren.

The case studies provide examples to support the hypothesis that the reach, effectiveness, adoption, implementation and maintenance of school food policies and interventions can be maximised by understanding and exploiting the interdependence between levels in the socio-ecological framework.

Rather than being seen as competing alternatives, diverse approaches to improving the diets of schoolchildren should be considered in terms of their potential to be complementary and synergistic, acting at multiple levels to improve acceptability, fidelity, effectiveness and sustainability.

FFQ are commonly used to rank individuals by their food and nutrient intakes in large epidemiological studies. The purpose of the present study was to develop and validate an FFQ to rank individuals participating in an ongoing Prospective Urban and Rural Epidemiological (PURE) study in Chile.

An FFQ and four 24 h dietary recalls were completed over 1 year. Pearson correlation coefficients, energy-adjusted and de-attenuated correlations and weighted kappa were computed between the dietary recalls and the FFQ. The level of agreement between the two dietary assessment methods was evaluated by Bland–Altman analysis.

Temuco, Chile.

Overall, 166 women and men enrolled in the present study. One hundred men and women participated in FFQ development and sixty-six individuals participated in FFQ validation.

The FFQ consisted of 109 food items. For nutrients, the crude correlation coefficients between the dietary recalls and FFQ varied from 0·14 (protein) to 0·44 (fat). Energy adjustment and de-attenuation improved correlation coefficients and almost all correlation coefficients exceeded 0·40. Similar correlation coefficients were observed for food groups; the highest de-attenuated energy-adjusted correlation coefficient was found for margarine and butter (0·75) and the lowest for potatoes (0·12).

The FFQ showed moderate to high agreement for most nutrients and food groups, and can be used to rank individuals based on energy, nutrient and food intakes. The validation study was conducted in a unique setting and indicated that the tool is valid for use by adults in Chile.

The purpose of the present study was to use a meta-analytic approach to examine the convergent validity of the International Physical Activity Questionnaire (IPAQ).

Systematic review by meta-analysis.

The relevant studies were surveyed from five electronic databases. Primary outcomes of interest were the product-moment correlation coefficients between IPAQ and other instruments. Five separate meta-analyses were performed for each physical activity (PA) category of IPAQ: walking, moderate PA (MPA), total moderate PA (TMPA), vigorous PA (VPA) and total PA (TPA). The corrected mean effect size (ESρ) unaffected by statistical artefacts (i.e. sampling error and reliability) was calculated for each PA category. Selected moderator variables were length of IPAQ (i.e. short and long form), reference period (i.e. last 7 d and usual week), mode of administration (i.e. interviewer and self-reported), language (i.e. English and translated) and instruments (i.e. accelerometer, pedometer and subjective measure).

A total of 152 ESρ across five PA categories were retrieved from twenty-one studies.

The results showed small- to medium-sized ESρ (0·27–0·49). The highest value was observed in VPA while the lowest value was found in MPA. The ESρ were differentiated by some of the moderator variables across PA categories.

The study shows the overall convergent validity of IPAQ within each PA category. Some differences in degree of convergent validity across PA categories and moderator variables imply that different research conditions should be taken into account prior to deciding on use of the appropriate type of IPAQ.

To evaluate the effect of fibre intake on the evolution of maternal BMI from pregnancy to postpartum and to identify dietary patterns associated with fibre intake.

Cohort study. Food intake was obtained using an FFQ. Focused principal component analysis was used focusing on the variables: postpartum weight retention and total dietary fibre intake. Poisson regression models with robust variance were built in order to measure the effect of fibre intake during the postpartum period on obesity risk.

Primary care clinics in southern Brazil.

Pregnant women (n 370) were followed until the 5th month postpartum.

The highest contribution to fibre intake came from the consumption of beans. Consumption of bread and rice indicated a common Brazilian food pattern along with beans. Participants retained a median of 4·4 (interquartile range 0·6, 7·9) kg of weight gained during pregnancy. Obesity risk, defined as an unfavourable evolution of BMI during pregnancy and postpartum, was present in 189 (55·1 %) women. Individual food items did not have an important effect on weight retention. In Poisson regression adjusting for maternal age, pre-pregnancy BMI and total gestational weight gain, inadequate postpartum fibre intake increased obesity risk by 24 % (relative risk = 1·24; 95 % CI 1·05, 1·47).

Important maternal weight retention occurred in these women. Adequate fibre intake may reduce obesity risk in the period following childbirth.

Proposed Australian regulation of claims on food labels includes requirements for products carrying a health claim to meet nutrient profiling criteria. This would not apply to nutrition content claims. The present study investigated the number and healthiness of products carrying claims and the impact of the proposed regulation.

Observational survey of claims on food packages across three categories: non-alcoholic beverages, breakfast cereals and cereal bars. Nutrient profiling was applied to products carrying claims to determine their eligibility to carry health claims under the proposed regulation.

Three large metropolitan stores from the three major supermarket chains in Sydney, Australia were surveyed in August 2011.

All claims on 1028 products were recorded. Nutrition composition and ingredients were collected from the packaging, enabling nutrient profiling. The proportion of products in each category carrying claims and the proportion of these that did not meet the nutrient profiling criteria were calculated.

Two-thirds of products in the three categories (ranging from 18 to 78 %) carried at least one claim. Of those carrying health claims, 31 % did not meet the nutrient profiling criteria. These would be ineligible to carry these claims under the proposed regulation. Additionally, 29 % of products carrying nutrition content claims did not meet the nutrient profiling criteria.

The number of products carrying nutrition content claims that did not meet the nutrient profiling criteria suggests that comprehensive regulation is warranted. Promotion of unhealthy foods using claims is potentially misleading for consumers and hinders their ability to select healthier foods. Implementation of the proposed regulation represents an improvement to current practice.

To examine the prospective association of television (TV) watching from adolescence to young adulthood with BMI, waist circumference (WC), waist-to-hip ratio (WHR) and obesity.

A community-based longitudinal cohort study.

Mater–University of Queensland Study of Pregnancy (MUSP) Cohort, Brisbane, Australia.

A sub-sample of 2439 children was followed up at ages 14 years and 21 years as part of a population-based birth cohort. Offspring reported the number of TV viewing hours each day at 14 and 21 years. BMI, WC and WHR were measured at 21 years.

In the adjusted model, offspring who watched TV for <3 h/d at 14 years but for ≥3 h/d at 21 years, or who watched TV for ≥3 h/d at 14 and 21 years, had greater BMI, WC and WHR at 21 years. Offspring who watched TV for ≥3 h/d at 14 years but for <3 h/d at 21 years had similar mean BMI, WC and WHR at 21 years to those who watched TV for <3 h/d at 14 and 21 years. Those offspring who reduced their TV watching hours to <3 h/d during the transition from adolescence into young adulthood were at less risk of becoming obese and those who continued or increased their TV watching to ≥3 h/d were at greater risk of becoming obese. This association remained independent of the potential confounding factors considered.

The present findings suggest that our efforts to decrease obesity by reducing TV watching hours among adults should consider interventions to reduce TV time among adolescents.

To determine if localised programmes that are successful in engaging the community can add value to larger fruit and vegetable mass-media campaigns by evaluating the results of the Eat It To Beat It programme.

The Eat It To Beat It programme is a multi-strategy intervention that uses community-based education and ‘below the line’ social marketing to increase fruit and vegetable consumption in parents. This programme was evaluated by a controlled before-and-after study with repeat cross-sectional data collected via computer-assisted telephone interviews with 1403 parents before the intervention (2008) and 1401 following intervention delivery (2011).

The intervention area was the Hunter region and the control area was the New England region of New South Wales, Australia.

Parents of primary school-aged children (Kindergarten to Year 6).

The programme achieved improvements in knowledge of recommended intakes for fruit and vegetables and some positive changes in knowledge of serving size for vegetables. Exposure to the programme resulted in a net increase of 0·5 servings of fruit and vegetables daily for those who recalled the programme compared with those who did not (P = 0·004). Increased intake of fruit and vegetables was significantly associated with increasing exposure to programme strategies.

The Eat It To Beat It programme demonstrates that an increase in consumption of fruit and vegetables can be achieved by programmes that build on the successes of larger mass-media and social-marketing campaigns. This suggests that funding for localised, community-based programmes should be increased.

To examine: (i) the association between home availability of fruit and vegetables and children's fruit and vegetable intake; (ii) the association between parental perception of the local food shopping environment and the home availability of fruit and vegetables; and (iii) whether the home availability of fruit and vegetables mediates the association between parental perception of the local food environment and children's fruit and vegetable consumption.

Cross-sectional study.

A total of ninety-one primary schools in the Netherlands.

In total 1501 primary caregivers completed a questionnaire to measure children's fruit and vegetable consumption, home availability of fruit and vegetables, parental perceptions of the local food shopping environment (price, quality and availability), the child's socio-economic status, the child's ethnicity and maternal height and weight.

The home availability of fruit and vegetables was positively associated with children's fruit and vegetable intake (P < 0·01 and P < 0·001, respectively). Negative parental perceptions of the local food shopping environment were associated with less fruit available at home (P < 0·05, P < 0·01 and P < 0·05 for price, quality and availability of fruit, respectively). No significant associations were found between parental perception of the local food shopping environment and children's fruit and vegetable consumption. We found no evidence that home availability of fruit and vegetables mediates the association between parental perception of the local food environment and children's fruit and vegetable intake.

Interventions focusing on improving the home availability of fruit and vegetables may help to increase children's fruit and vegetable consumption. However, more data are required on factors influencing the home availability of fruit and vegetables.

To examine the association between cardiovascular risk and childhood overweight and obesity using the BMI cut-offs recommended by the WHO.

Children were classified as normal weight, overweight and obese according to the WHO BMI-for-age reference. Blood pressure, lipids, glucose, insulin, homeostasis model assessment–insulin resistance (HOMA-IR) and uric acid levels were compared across BMI groups. ANOVA and tests of linearity were used to assess overall mean differences across groups. Crude and adjusted odds ratios were calculated for adverse plasma levels of biochemical variables.

Paediatric care centres.

Children (n 149) aged 8–18 years.

About 37 %, 22 % and 41 % of children were classified respectively as normal weight, overweight and obese. There were significant linear mean differences between BMI groups in systolic blood pressure, HDL-cholesterol, TAG, insulin, HOMA-IR and uric acid. Obese children were 10·6 times more likely than normal-weight children to have hypertension; OR for other associations were 60·2 (high insulin), 39·5 (HOMA-IR), 27·9 (TAG), 16·0 (HDL-cholesterol), 4·3 (LDL-cholesterol) and 3·6 (uric acid). Overweight children were more likely than normal-weight children to have hypertension (OR = 3·5), high insulin (OR = 28·2), high HOMA-IR (OR = 23·3) and high TAG (OR = 16·1). Nearly 92 % and 57 % of the obese and overweight children, respectively, had one or more risk factor.

Obesity and overweight defined using the WHO BMI-for-age cut-offs identified children with higher metabolic and vascular risk. These results emphasize the importance of prevention of overweight and obesity in childhood to reduce cardiovascular risk.

Mali is one of the poorest countries in Africa, with 72 % of its population surviving on less than $US 1·00 per day. Health and demographic indicators are bleak. With few exceptions, studies related to the health of women in Mali have largely been under-represented. In addition, in recent years a new type of malnutrition stemming from weight gain and obesity has been observed throughout Africa. The present study aimed to (i) describe geographic and health variations of women of reproductive age, (ii) describe geographic variations of household salt iodine levels and (iii) investigate potential factors associated with women's anthropometric status and use of adequately iodized salt among households in Mali.

Demographic and Health Survey data, multistage-stratified cluster sampling methodology.

Rural and urban areas of Mali.

Non-pregnant women (n 6015) between the ages of 19 and 44 years.

Nineteen per cent of the women were overweight or obese while 11 % were underweight. Seventy-eight per cent of the households utilized adequately iodized salt. Underweight women were more prevalent in southern Mali, while obesity was more frequent in the north-east and within the major urban areas. Households located within the southern parts of Mali were more likely to utilize adequately iodized salt. Education, age, modern contraceptive use, breast-feeding status at time of the survey and household wealth index were significantly associated with the women's BMI or households’ use of adequately iodized salt.

The combined use of statistical and geographic system analysis contributes to improve targeting of interventions among vulnerable populations.