A number of individual risk factors for childhood obesity have been identified, but only some of these are amenable to prevention. To assess the amount of cases in a general population attributable to these risk factors, adjusted population-attributable fractions were estimated.

Cross-sectional study.

Obligatory school entry examination in 2001/2002 in six Bavarian communities (Germany).

5472 children at age 5–6 years.

Anthropometric measures were ascertained by public health nurses, and measures concerning sociodemographics, lifestyle and child behaviour such as child's daily meal frequency were obtained with self-administered parental questionnaires. Obesity was defined according to sex- and age-specific body mass index cut-off points proposed by the International Obesity Task Force. Adjusted population-attributable fractions were calculated based on logistic regression.

A combination of the risk factors low meal frequency, decreased physical activity, watching television >1 h day− 1, formula feeding and smoking in pregnancy accounted for 48.2% of obese children. This combination yielded a maximal achievable prevalence reduction of 1.5% for obesity (3.2% observed prevalence).

A modification of five known risk factors for childhood overweight and obesity could reasonably lower obesity prevalences at school entry. These risk factors should be particularly considered in decision making on preventive measures.

To examine the efficiency of the Bangladesh Integrated Nutritional Program (BINP) in identifying which infants should be supplemented, whether full supplementation was given for the stipulated period of time, and whether the correct exit criteria from the supplementation programme were used. To test whether targeted food supplementation of infants between 6–12 months of age resulted in enhanced weight gain.

Mallickbari Union, Bhaluka, a rural area located about 100 km north of Dhaka, Bangladesh.

Five hundred and twenty-six infants followed for 6 to 12 months.

Of the 526 infants studied, 368 should have received supplementation based on BINP criteria but only 111 infants (30%) did so, while a further 13% were incorrectly given supplementation. So in total over half (52.8%) of the sample was incorrectly identified for supplementation. In addition, less than a quarter of the infants received the full 90 days of supplementation and close to half of the infants exited the programme without the requisite weight gain. Infants were assigned to one of four groups: correctly supplemented, correctly non-supplemented, incorrectly supplemented or incorrectly non-supplemented. This classification provided natural controls; the correctly supplemented infants versus the incorrectly non-supplemented infants, and the correctly non-supplemented infants versus the incorrectly supplemented infants. There were no significant differences in weight gain between the correctly supplemented group and the incorrectly non-supplemented group or between the correctly non-supplemented and the incorrectly supplemented groups, nor was there any evidence of growth faltering in the incorrectly non-supplemented group.

This study found serious programmatic deficiencies – inability to identify growth faltering in infants, failure to supplement for the full time period and incorrect exit procedures. There was no evidence that food supplementation had any impact on improving infant weight gain.

To examine the associations of adiposity, dietary restraint and other personal characteristics with energy reporting quality.

Secondary analysis of 230 women and 158 men from the 1997/98 Ontario Food Survey.

Energy reporting quality was estimated by ratios of energy intake (EI) to both basal metabolic rate (BMR) and total energy expenditure (TEE). Multivariate regression analyses were conducted to examine energy reporting quality between two dietary recalls and in relation to body mass index (BMI) with adjustment for potential confounders. Energy reporting quality was explored across categories of age, BMI, income, education, dieting status and food insecurity through analysis of variance (ANOVA).

From the ANOVA, energy reporting quality was associated with BMI group, age category and weight loss for men and women, as well as with education among women (P < 0.05). The multivariate regression analyses indicated that energy reporting quality was positively associated with education and inversely associated with obesity and dieting. No associations were observed in relation to food insecurity or income (P>0.05). EI:BMR and EI:TEE on the first and second 24-hour recalls were positively related (P < 0.0001 for men and women). A higher proportion of variance in energy reporting quality was explained for women than for men (R2 = 0.19 and 0.14, respectively).

Studies of diet and adiposity are probably hindered to some extent by BMI-related variation in energy reporting quality. Methods to address this issue are urgently needed if population surveys will continue to serve as the primary source of dietary intake data.

To examine longitudinal associations of parental report of household food availability and parent intakes of fruits, vegetables and dairy foods with adolescent intakes of the same foods. This study expands upon the limited research of longitudinal studies examining the role of parents and household food availability in adolescent dietary intakes.

Longitudinal study. Project EAT-II followed an ethnically and socio-economically diverse sample of adolescents from 1999 (time 1) to 2004 (time 2). In addition to the Project EAT survey, adolescents completed the Youth Adolescent Food-Frequency Questionnaire in both time periods, and parents of adolescents completed a telephone survey at time 1. General linear modelling was used to examine the relationship between parent intake and home availability and adolescent intake, adjusting for time 1 adolescent intakes. Associations were examined separately for the high school and young adult cohorts and separately for males and females in combined cohorts.

The sample included 509 pairs of parents/guardians and adolescents.

Vegetables served at dinner significantly predicted adolescent intakes of vegetables for males (P = 0.037), females (P = 0.009), high school (P = 0.033) and young adults (P = 0.05) at 5-year follow-up. Among young adults, serving milk at dinner predicted dairy intake (P = 0.002). Time 1 parental intakes significantly predicted intakes of young adults for fruit (P = 0.044), vegetables (P = 0.041) and dairy foods (P = 0.008). Parental intake predicted intake of dairy for females (P = 0.02).

The findings suggest the importance of providing parents of adolescents with knowledge and skills to enhance the home food environment and improve their own eating behaviours.

To examine the pattern of intake of key foods and beverages of children aged 4–12 years and the association with weight status.

A computer-assisted telephone interview was used to determine the intake of fruit, vegetables, packaged snacks, fast foods and sweetened drinks ‘yesterday’ and ‘usually’ as reported by parents/guardians of a representative sample of 2184 children from the Barwon South-Western region of Victoria, Australia.

Children who consumed >2–3, >3–4 and >4 servings of fruit juice/drinks ‘yesterday’ were, respectively, 1.7 (95% confidence interval (CI) 1.2–2.2), 1.7 (95% CI 1.2–2.5) and 2.1 (95% CI 1.5–2.9) times more likely to be overweight/obese compared with those who had no servings of fruit juice/drink ‘yesterday’, adjusted for age, gender and socio-economic status (SES). Further, children who had ≥ 3 servings of soft drink ‘yesterday’ were 2.2 (95% CI 1.3–3.9) times more likely to be overweight/obese compared with those who had no servings of soft drink ‘yesterday’, adjusted for age, gender and SES. In addition, children who ‘usually’ drank fruit juice/drinks twice or more per day were 1.7 (95% CI 1.2–2.4) times more likely to be overweight/obese compared with those who drank these beverages once or less per week, adjusted for age, gender and SES. Although fast foods and packaged snacks were regularly eaten, there were no associations between weight status and consumption of these foods.

Intake of sweetened beverages was associated with overweight and obesity in this population of Australian schoolchildren and should be a target for intervention programmes aimed at preventing unhealthy weight gain in children.

To understand the periconceptional use of folic acid and its association with selected characteristics in northern China.

As part of a population-based case–control study on external structural birth defects, we analysed periconceptional use of folic acid among control mothers.

The study was conducted in four counties (Pingding, Xiyang, Taigu and Zezhou) in Shanxi Province of northern China.

The subjects in this study were the control mothers, who were interviewed between January 2003 and May 2005.

Of the 480 respondent mothers, 49 women (10.2%) reported ever using folic acid supplements, and only 16 women (3.3%) used it periconceptionally. The rates of any use and periconceptional use did not change significantly with study year. Periconceptional use of folic acid was significantly increased among women with more than high school education (odds ratio (OR) = 4.57, P < 0.10), women who were not farmers (OR = 4.72, P < 0.05), women with a history of birth-defect-affected pregnancy (OR = 32.73, P < 0.05) and women who planned their pregnancy (OR = 7.88, P < 0.10).

The rate of periconceptional folic acid use was among the lowest of those reported from other countries. More work should be done to improve preconceptional use of folic acid with special attention on less educated women and women farmers.

To examine associations of various psychosocial factors with fruit andvegetable intake in African-American adults.

A cross-sectional survey of a population-based sample of 658African-Americans, aged 18–70 years, in North Carolina.Information was collected on diet-related psychosocial (predisposing,reinforcing and enabling) factors based on the PRECEDE (Predisposing,Reinforcing, and Enabling Constructs in Educational Diagnosis andEvaluation) planning framework; demographic, lifestyle and behaviouralcharacteristics, and fruit and vegetable intake.

The mean participant age was 43.9 years (standard deviation 11.6), 57% werefemale and 76% were overweight/obese. Participants expressed healthy beliefsregarding many of, but not all, the psychosocial factors. For example,although half of the respondents believed it is important to eat a diet highin fruits/vegetables, only 26% knew that ≥ 5 dailyservings are recommended. The strongest associations of the psychosocialfactors with fruit/vegetable intake were for predisposing factors (e.g.belief in the importance of a high fruit/vegetable diet and knowledge offruit/vegetable recommendations) and one reinforcing factor (socialsupport), with differences between the healthiest and least healthyresponses of 0.5–1.0 servings per day. There was evidence ofeffect modification by gender in associations between psychosocial factorsand fruit/vegetable consumption (e.g. self-efficacy was only significant inwomen), with higher intakes and generally healthier responses to thepsychosocial variables in women than men.

Interventions to increase fruit/vegetable intake in African-Americans may bemore effective if they focus primarily on predisposing factors, such asknowledge, self-efficacy and attitudes, but not to the exclusion ofreinforcing and enabling factors. The psychosocial factors that are targetedmay also need to be somewhat different for African-American men andwomen.

To examine school-level relationships between deprivation and breakfast eating behaviours (breakfast skipping and the healthfulness of foods consumed) in 9–11-year-old schoolchildren and to examine whether attitudes towards eating breakfast mediated these relationships.

Cross-sectional survey.

One hundred and eleven primary schools in Wales.

Year 5 and 6 pupils within the 111 primary schools. Measures were completed by 4314 children. Analysis was conducted at the group (school) level, with each school representing one group.

Deprivation was positively associated with breakfast skipping and consumption of ‘unhealthy’ items (i.e. sweet snacks, crisps) for breakfast. A significant negative association was found between deprivation and consumption of ‘healthy’ items (i.e. fruit, bread, cereal, milk). Deprivation was significantly inversely associated with attitudes towards eating breakfast. The relationships between deprivation and (1) breakfast skipping and (2) consumption of ‘healthy’ items for breakfast were mediated by attitudes towards eating breakfast. The hypothesis that attitudes mediated the relationship between deprivation and consumption of ‘unhealthy’ breakfast items was unsupported.

Deprivation is associated with adverse breakfast eating behaviours amongst children aged 9–11 years, in terms of breakfast skipping and the quality of breakfasts consumed. Socio-economic differences in attitudes towards eating breakfast are apparent amongst this age group, and appear to relate to social gradients in breakfast eating behaviours. Research is needed to examine the causal nature of these trends and to elucidate factors underlying the development of socio-economic differences in eating-related cognitions.

The prevalence of obesity has reached epidemic proportions, and in terms of the extent of its negative impact on the health has been compared to those of tobacco and alcohol. One of the first medical consequences of obesity to be recognised was cardiovascular disease (CVD). Obesity, particularly abdominal obesity, predisposes a person to a number of other cardiovascular risk factors, and is an independent predictor of clinical CVD including coronary death, coronary heart disease, heart failure and stroke.

A Medline search using the following keywords (obesity, cardiovascular disease, body mass index, cardiovascular risk factors, type 2 diabetes, metabolic syndrome) was performed looking for high impact factor English-written references.

Ninety-nine (N=99) relevant articles published in the last 15 years were selected and commented. As detailed throughout the text, current therapies available for weight management can improve or prevent many of these obesity-related risk factors for CVD. However, there is some controversy as to whether weight loss is beneficial for health, and large clinical outcome trials such as the Look-AHEAD (Action for Health in Diabetes) trial or the SCOUT (Sibutramine Cardiovascular Outcomes Trial) study are currently ongoing.

In the present review, we summarise the effects of obesity as well as the efficacy of weight-loss interventions on cardiovascular risk factors and CVD.

Food insecurity and undernutrition remain particularly severe in developing countries where improvements in economic conditions have tended to benefit the advantaged groups and resulted in widespread inequalities in health. This study examined how economic inequality is associated with chronic childhood undernutrition.

A child was defined as chronically undernourished (stunted) if his or her height-for-age index was more than two standard deviations below the reference median. Household economic status was measured by an index based on household ownership of durable assets. Bivariate and multivariate analyses were used to estimate the effects of household economic status on stunting.

A nationally representative sample of 6251 household interviews in Ghana.

A total of 3077 children aged 0–59 months included in the 2003 Ghana Demographic and Health Survey.

Children in the poorest 20% of households are more than twice as likely to suffer from stunting as children in the richest 20% of households independent of the child's age, sex, birth order, breast-feeding duration, birth weight; mother's age at childbirth, body mass index, education; and household access to safe drinking water, hygienic toilet facilities, residence and geographic region (odds ratio = 2.3; 95% confidence interval 1.4–3.7). Also children in the next poorest and in the middle quintiles are significant more likely to be chronically undernourished than children in the richest 20% of households.

This study concludes that economic inequality is strongly associated with chronic childhood undernutrition; and reducing economic inequalities and making services more accessible to the poor will be key to improving the health and nutritional status of children in Ghana.

To assess changes in carotenoid intake based on the variations in the consumption of fresh fruit and vegetables in the Spanish population over the period 1964–2004.

Consumption data of fresh fruit and vegetables from Family Budget Surveys carried out in 1964, 1980, 1990 and 2004. Consumption data (g per person per day) accounted for >90% of fruit and vegetable consumption at each time point. Quality controlled high-performance liquid chromatography analysis of the carotenoid composition of Spanish fruit and vegetable was used.

Randomly selected, private households throughout Spain (20 800 households in 1964, 30 311 households in 1980, 21 155 households in 1990 and 6000 households in 2004). Twelve vegetables and 16 fruits representing 89–96% of the total consumption of fresh fruit and vegetables were used.

Individual consumption of fruit and vegetables has changed over this period, altering the total and individual intake of carotenoids. Total carotenoid intake increased from 2.5 mg per person per day in 1964 to 4.1 mg per person per day in 1990, with a decrease to 3.3 mg per person per day in 2004. These increments are due to an increase in lycopene, α- and β-carotene, while a decrease in lutein and zeaxanthin is observed during the last decade. A continuous and consistent decrease in the relative contribution of lutein in the diet is observed over the period studied.

Although the consumption of fruit and vegetables is still consistent with a Mediterranean-type pattern, modifications in the consumption of individual fruits and vegetables have provoked changes in total and specific carotenoid intake with potential relevance in human health.

A number of studies have pointed to the pressure that housing costs can exert on the resources available for food. The objectives of the present study were to characterise the relationship between the proportion of income absorbed by housing and the adequacy of household food expenditures across the Canadian population and within income quintiles; and to elucidate the impact of receipt of a housing subsidy on adequacy of food expenditures among low-income tenant households.

The 2001 Survey of Household Spending, conducted by Statistics Canada, was a national cross-sectional survey that collected detailed information on expenditures on goods and services. The adequacy of food spending was assessed in relation to the cost of a basic nutritious diet.

Canada.

The person with primary responsibility for financial maintenance from 15 535 households from all provinces and territories.

As the proportion of income allocated to housing increased, food spending adequacy declined significantly among households in the three lowest income quintiles. After accounting for household income and composition, receipt of a housing subsidy was associated with an improvement in adequacy of food spending among low-income tenant households, but still mean food spending fell below the cost of a basic nutritious diet even among subsidised households.

This study indicates that housing costs compromise the food access of some low-income households and speaks to the need to re-examine policies related to housing affordability and income adequacy.

To examine associations between shopping, food preparation, meal and eating behaviours and fruit and vegetable intake among women.

Cross-sectional survey.

Community-based sample from metropolitan Melbourne, Australia.

A sample of 1136 women aged 18–65 years, randomly selected from the electoral roll.

Food-related behaviours reflecting organisation and forward-planning, as well as enjoyment of and high perceived value of meal shopping, preparation and consumption were associated with healthier intakes of fruits and vegetables. For example, women who more frequently planned meals before they went shopping, wrote a shopping list, enjoyed food shopping, planned in the morning what they will eat for dinner that night, planned what they will eat for lunch, reported they enjoy cooking, liked trying new recipes and who reported they sometimes prepare dishes ahead of time were more likely to consume two or more servings of vegetables daily. Conversely, women who frequently found cooking a chore, spent less than 15 minutes preparing dinner, decided on the night what they will eat for dinner, ate in a fast-food restaurant, ate takeaway meals from a fast-food restaurant, ate dinner and snacks while watching television and who frequently ate on the run were less likely to eat two or more servings of vegetables daily.

Practical strategies based on these behavioural characteristics could be trialled in interventions aimed at promoting fruit and vegetable consumption among women.

Recent reports suggest persistence of health disparities related to socio-economic position (SEP). To understand if diet may be a contributor to these trends, we examined secular trends in the association of diet and indicators of SEP from 1971–1975 to 1999–2002.

We used data from the National Health and Nutrition Examination Surveys (NHANES) I (1971–1975), II (1976–1980), III (1988–1994) and 1999–2002 to examine the independent associations of poverty income ratio (PIR) and education with diet and biomarkers of diet and disease in 25–74-year-olds (n = 36 600). We used logistic and linear regression methods to adjust for multiple covariates and survey design to examine these associations.

A large PIR differential in the likelihood of reporting a fruit or all five food groups and vitamin C intake, and an education differential in likelihood of obesity and carbohydrate intake, was noted in 1971–1975 but narrowed in 1999–2002 (P < 0.007). The positive association of education with intake of a fruit, vegetable or all five food groups, vitamins A and C, calcium and potassium intake remained unchanged across surveys (P < 0.001). Similarly, the positive association of PIR with the amount of foods and intakes of energy and potassium remained unchanged over three decades (P < 0.001). The education and the PIR differential in energy density, and the PIR differential in the likelihood of obesity, persisted over the period of the four surveys (P < 0.001).

Persistence of unfavourable dietary and biomarker profiles in Americans with low income and education suggests continued need for improvement in the quality of diets of these high-risk groups.

To measure dietary intakes of young children aged 12–24 months and to determine the impact of poor diets on stunting.

A quantitative food-frequency questionnaire was adapted, tested and standardised. Trained enumerators conducted in-depth interviews with the mothers/caregivers of the children. Forty stunted children in urban informal settlements and 30 stunted children in rural areas were selected and pair-matched with controls. The data were captured on the Food Finder Program of the Medical Research Council.

In both urban and rural areas, the diet of stunted and non-stunted groups did differ significantly and all diets were of poor nutritional quality.

Diets in both areas resembled the recommended prudent diet, i.e. low in fat and high in carbohydrates. Poor quality diets were not the primary cause of stunting.

To investigate the association of a posteriori dietary patterns with overall survival of older Europeans.

This is a multi-centre cohort study. Cox regression analysis was used to investigate the association of the prevailing, a posteriori-derived, plant-based dietary pattern with all-cause mortality in a population of subjects who were 60 years or older at recruitment to the European Prospective Investigation into Cancer and Nutrition (EPIC-Elderly cohort). Analyses controlled for all known potential risk factors.

In total, 74 607 men and women, 60 years or older at enrolment and without previous coronary heart disease, stroke or cancer, with complete information about dietary intakes and potentially confounding variables, and with known survival status as of December 2003, were included in the analysis.

An increase in the score which measures the adherence to the plant-based diet was associated with a lower overall mortality, a one standard deviation increment corresponding to a statistically significant reduction of 14% (95% confidence interval 5–23%). In country-specific analyses the apparent association was stronger in Greece, Spain, Denmark and The Netherlands, and absent in the UK and Germany.

Greater adherence to the plant-based diet that was defined a posteriori in this population of European elders is associated with lower all-cause mortality. This dietary score is moderately positively correlated with the Modified Mediterranean Diet Score that has been constructed a priori and was also shown to be beneficial for the survival of the same EPIC-Elderly cohort.

While adult populations have been well described in terms of nutritional status, such as the concentration of nutrient biomarkers, little work has been done in healthy paediatric populations.

The primary objective of this analysis was to explore the determinants of plasma micronutrients in a group of healthy infants and children.

The Diabetes Autoimmunity Study in the Young (DAISY) has enrolled 1433 newborns at increased risk for type 1 diabetes in Denver, Colorado. A representative random sample of 257 children from the DAISY cohort between the ages of 9 months and 8 years with a total of 815 clinic visits over time was used in this analysis. Annual dietary intake was assessed over time with Willett food-frequency questionnaires that were validated in this population. Environmental tobacco smoke (ETS) was assessed using a validated survey. Plasma samples were tested for vitamins, carotenoids and total lipids. Predictors of plasma micronutrients were evaluated using mixed models for longitudinal data, while adjusting for age, human leukocyte antigen genotype, type 1 diabetes family history and other potential confounders and covariates.

Increased micronutrient intake was associated with increased levels of their respective plasma nutrient, with the exception of γ-tocopherol. Independent of dietary intake, levels of α- and β-carotene and β-cryptoxanthin were significantly lower, and γ-tocopherol was significantly higher, in children who were exposed to ETS.

Dietary intake predicts plasma micronutrient levels. Exposure to ETS potentially could have negative health effects in this young population.

To quantify the potential effect of iron defortification in the USA on iron-deficiency anaemia (IDA).

Monte Carlo models were built to simulate iron nutrition in the US population. A hypothetical cohort of 15 000 persons from the general population was used in 15-year simulations to compare the prevalence of IDA with and without fortification.

With iron fortification, the prevalence of IDA was 2.4% for children aged 3–5 years, 5.4% for women aged 20–49 years, and 0.14% for men aged 20–49 years. The corresponding IDA estimates under iron defortification were 4.5%, 8.2% and 0.46%, respectively. Defortification had little effect on the distribution of iron indicators at or above the 50th percentile within each of these three groups and little effect on the distributions of iron indicators among adult men.

Iron defortification is likely to increase IDA among children and women of reproductive age, but is not likely to have meaningful effects on the iron status of men or the majority of women and children.