To investigate the beverage intake patterns of Canadian adults and explore characteristics of participants in different beverage clusters.

Analyses of nationally representative data with cross-sectional complex stratified design.

Canadian Community Health Survey, Cycle 2·2 (2004).

A total of 14 277 participants aged 19–65 years, in whom dietary intake was assessed using a single 24 h recall, were included in the study. After determining total intake and the contribution of beverages to total energy intake among age/sex groups, cluster analysis (K-means method) was used to classify males and females into distinct clusters based on the dominant pattern of beverage intakes. To test differences across clusters, χ2 tests and 95 % confidence intervals of the mean intakes were used.

Six beverage clusters in women and seven beverage clusters in men were identified. ‘Sugar-sweetened’ beverage clusters – regular soft drinks and fruit drinks – as well as a ‘beer’ cluster, appeared for both men and women. No ‘milk’ cluster appeared among women. The mean consumption of the dominant beverage in each cluster was higher among men than women. The ‘soft drink’ cluster in men had the lowest proportion of the higher levels of education, and in women the highest proportion of inactivity, compared with other beverage clusters.

Patterns of beverage intake in Canadian women indicate high consumption of sugar-sweetened beverages particularly fruit drinks, low intake of milk and high intake of beer. These patterns in women have implications for poor bone health, risk of obesity and other morbidities.

There are no percentile curves for BMI, waist circumference (WC) or waist-to-height ratio (WHtR) available for Portuguese children and adolescents. The purpose of the present study was to develop age- and sex-specific BMI, WC and WHtR percentile curves for a representative sample of adolescents living in the Portuguese islands of Azores, one of the poorest regions of Europe, and to compare them with those from other countries.

Cross-sectional school-based study. Weight, height and WC were objectively measured according to standard procedures. Smoothed percentile curves were estimated using Cole's LMS method.

Azores, Portugal.

Proportionate stratified random sample of 1500 adolescents, aged 15–18 years.

Results showed some sex differences in the shape of the BMI curves: in girls, the upper percentile values tend to decrease by the age of 16 and 17 years; whereas in boys, the upper percentiles tend to be flat between 15 and 16 years and then increase until the age of 18 years. In both sexes, the upper percentile values of both WC and WHtR decreased slightly by the age of 16 years and then increased steeply. In both sexes, the Azorean values for the 50th and 90th WC percentiles were higher than those reported for adolescents from the majority of other countries.

The reference curves presented herein provide baseline data for the long-term surveillance of Azorean adolescents, as well as for national and international comparisons.

According to the 2007–2008 National Health and Nutrition Examination Survey, the prevalence of obesity in the US population was 33·8 %; 34·3 % and 38·2 %, respectively, in middle-aged men and women. We asked whether available blood donor data could be used for obesity surveillance.

Cross-sectional study of BMI and obesity, defined as BMI ≥ 30·0 kg/m2. Adjusted odds ratios (aOR) were calculated with logistic regression.

A network of six US blood centres.

Existing data on self-reported height and weight from blood donors, excluding persons deferred for very low body weight.

Among 1 042 817 donors between January 2007 and December 2008, the prevalence of obesity was 25·1 %; 25·7 % in men and 24·4 % in women. Obesity was associated with middle age (age 50–59 years v. <20 years: aOR = 1·92 for men and 1·81 for women), black (aOR = 1·57 for men and 2·35 for women) and Hispanic (aOR = 1·47 for men and 1·49 for women) race/ethnicity compared with white race/ethnicity, and inversely associated with higher educational attainment (college degree v. high school or lower: aOR = 0·56 for men and 0·48 for women) and double red cell donation and platelet donation.

Obesity is common among US blood donors, although of modestly lower prevalence than in the general population, and is associated with recognized demographic factors. Blood donors with higher BMI are specifically recruited for certain blood collection procedures. Blood centres can play a public health role in obesity surveillance and interventions.

To examine whether involvement in food preparation tracks over time, between adolescence (15–18 years), emerging adulthood (19–23 years) and the mid-to-late twenties (24–28 years), as well as 10-year longitudinal associations between home food preparation, dietary quality and meal patterning.

Population-based, longitudinal cohort study.

Participants were originally sampled from Minnesota public secondary schools (USA).

Participants enrolled in Project EAT (Eating Among Teens and Young Adults)-I, EAT-II and EAT-III (n 1321).

Most participants in their mid-to-late twenties reported an enjoyment of cooking (73 % of males, 80 % of females); however, few prepared meals including vegetables most days of the week (24 % of males, 41 % of females). Participants in their mid-to-late twenties who enjoyed cooking were more likely to have engaged in food preparation as adolescents and emerging adults (P < 0·01); those who frequently prepared meals including vegetables were more likely to have engaged in food preparation as emerging adults (P < 0·001), but not as adolescents. Emerging adult food preparation predicted better dietary quality five years later in the mid-to-late twenties, including higher intakes of fruit, vegetables and dark green/orange vegetables, and less sugar-sweetened beverage and fast-food consumption. Associations between adolescent food preparation and later dietary quality yielded few significant results.

Food preparation behaviours appeared to track over time and engagement in food preparation during emerging adulthood, but not adolescence, was associated with healthier dietary intake during the mid-to-late twenties. Intervention studies are needed to understand whether promoting healthy food preparation results in improvements in eating patterns during the transition to adulthood.

As a means of empowering consumers, nutrition labelling has become a widely discussed topic. Simplicity and uniformity of labelling systems are regarded as the prevailing demands from the consumer side. In the present study, we analyse the effects of the traffic light signposting scheme on consumers’ food choices.

In an online survey, respondents first rated the understandability of the traffic light signposting scheme. In a following conjoint experiment, they indicated which products they would select as the healthiest of the presented products, based on the nutritive information provided by the traffic light signposting scheme.

A major German university.

In total 2002 undergraduate students participated in the survey. Two-thirds (69 %) of the respondents were female and the majority of the respondents (70 %) were between 18 and 24 years old. Seventy-seven per cent of the participants indicated that they had a higher level of education.

Overall, the participants rated the understandability of the traffic light nutrition signposting scheme fairly high (5·9 out of 7). Sugar and fat were found to be the most important attributes of the scheme. Participants placed greater emphases on a change in a product's nutrient characteristic from ‘amber to ‘red’ compared with a change from ‘green’ to ‘amber’.

Our results confirm the signalling effect of colour coding as it helps reduce the complexity of decision making. Our findings shed new light on the ongoing discussion concerning appropriate and efficient nutrition labelling and provide interesting insights for further research as well as implications for public policy making.

To assess and develop a consensus among a European panel of public health nutrition workforce stakeholders (academics and employers) regarding core functions required for effective public health nutrition practice.

A modified Delphi study involving data from two rounds of questionnaires administered among a panel of public health nutrition workforce stakeholders.

Europe.

A panel of fifty-three public health nutrition development stakeholders, including thirty-three academics and twenty employers, sampled from eighteen European countries.

Panellists rated 50 % (19/38) of the initially listed functions as core (i.e. without which public health capacity is limited), using a majority cut-off (>50 %). Out of the nineteen core functions seven were categorised under the heading Intervention management, emphasising high agreement on the importance of managing interventions in public health nutrition work. Only one of the identified core public health nutrition functions was rated differently between academics and employers, suggesting consistent identification of core functions between stakeholder groups.

This consensus on core functions of the public health nutrition workforce in Europe can be used to promote a consistent understanding of the role and value of public health nutritionists as a discrete disciplinary sub-specialty of the public health workforce. The convergence of opinions of academics and employers, as well as comparison with previous international studies, indicates that there is a set of core public health nutrition functions transferable between countries that can be used as a benchmark to guide further development of the public health nutrition workforce in Europe.

To identify sociodemographic and environmental correlates of sweetened beverages (regular soft drinks, fruit juice) among children of pre-school age.

Children's dietary intake, food behaviours and screen time were measured by parental report. A Geographic Informational System was used to assess the number of grocery stores and fast-food restaurants available within 1 km of the children's residence. Multivariate log-binomial regression models were constructed to determine correlates of drinking soft drinks during the previous week.

Edmonton region, Canada.

Children aged 4 and 5 years (n 2114) attending a public health unit for immunization were recruited for a cohort study on determinants of childhood obesity, between 2005 and 2007.

Children from neighbourhoods with low socio-economic status (relative risk (RR) = 1·17, 95 % CI 0·98, 1·40) or who participated in >2 h of screen time daily (RR = 1·28, 95 % CI 1·13, 1·45) were significantly more likely to have consumed regular soft drinks within the last week. Those who lived within 1 km of a grocery store were significantly less likely to consume regular soft drinks (RR = 0·84, 95 % CI 0·73, 0·96). Children who participated in >2 h of screen time daily (RR = 1·16, 95 % CI 1·06, 1·27) were more likely to exceed the recommended weekly number of servings of fruit juice.

Socio-economic and built environment factors are associated with soft drink consumption in children of pre-school age. These findings may help health professionals to advocate for policies that reduce soft drink consumption among children.

To estimate the frequency of anaemia in pregnant women before and after the fortification of flours with Fe.

Retrospective study developed from secondary data obtained from medical records.

Two health units in Rio de Janeiro, Brazil.

Socio-economic, demographic, obstetric and Hb concentration data were collected of 778 pregnant women attending prenatal care. Two study groups were created: the first referred to the period before fortification (G1, n 391), including women whose parturition happened before June 2004; and the second referred to the period after fortification (G2, n 387), including women whose last menstrual cycle happened after June 2005. The Hb cut-off point adopted for anaemia diagnosis was <11·0 g/dl.

In linear regression models, when Hb concentration was expressed as a dependent variable, women in G2 presented Hb concentration 0·26 g/dl and 0·36 g/dl higher during the second and third trimesters of pregnancy, respectively, compared with G1. In logistic regression models where the dependent variable was anaemia during the second and third trimesters, it was verified that being a member of G2 was a protective factor against anaemia in the third trimester. Regarding the presence of anaemia at any gestational moment, it was verified that being a member of G2 represented a protective factor against anaemia during pregnancy.

Results indicate the protective effect of the fortification of flours with Fe in the fight against gestational anaemia, contributing to prevention and control of this nutritional disorder among pregnant women.

To determine whether a possession score or a poverty index best predicts undernutrition and anaemia in women of reproductive age (15–49 years; WRA) and children aged 6–59 months living in Côte d'Ivoire.

Anthropometric measurements were converted to Z-scores to assess stunting, wasting and underweight in children, and converted to BMI in WRA. A venous blood sample was drawn, and Hb concentration and Plasmodium spp. infection were determined. A possession score was generated with categories of zero to four possessions. A five-point (quintile) poverty index using household assets was created using principal component analysis. These socio-economic measures were compared for their ability to predict anaemia and malnutrition.

Data were from a nationally representative survey conducted in Côte d'Ivoire in 2007.

A sample of 768 WRA and 717 children aged 6–59 months was analysed.

Overall, 74·9 % of children and 50·2 % of WRA were anaemic; 39·5 % of the children were stunted, 28·1 % underweight and 12·8 % wasted, while 7·4 % of WRA had BMI < 18·5 kg/m2. In general, there were more stunted and underweight children and thin WRA in rural areas. The poverty index showed a stronger relationship with nutritional status than the possession score; mean Hb difference between the poorest and wealthiest quintiles in children and WRA was 8·2 g/l and 6·5 g/l, respectively (13·9 % and 19·8 % difference in anaemia, respectively; P < 0·001), and Z-scores and BMI were significantly better in the wealthiest quintile (P < 0·001).

The poverty index was generally a better predictor of undernutrition in WRA and pre-school children than the possession score.

To investigate whether awareness of the Japanese Food Guide (JFG) can promote changes in eating behaviour.

A longitudinal study was conducted in 2007 and 2009 by means of an Internet-based survey. Awareness status of the JFG and a sixteen-item scale for calculating eating behaviour scores were obtained.

Japan.

In total, 787 Japanese adults (20–59 years) who registered with an Internet research service organization were included in the study. The respondents were divided into three groups. The respondents who were aware of the JFG in 2007 were categorized into Group 1. Those who were not aware of the JFG in 2007 were categorized into either Group 2 or Group 3. Group 2 became aware of the JFG by 2009, and Group 3 was not aware of the JFG in 2009.

In Group 2, the eating behaviour score increased significantly by 0·8 points from 4·7 in 2007 to 5·5 in 2009 (P = 0·004). The eating behaviour score of Group 1 (6·5 points in 2007; 6·3 points in 2009) and Group 3 (3·8 points in 2007; 4·1 points in 2009) did not change significantly from 2007 to 2009.

Awareness of the JFG promoted eating behaviour change in the Japanese population. The results indicate that awareness of nutrition information from sources such as the JFG would promote healthy eating.

Little is known about the prevalence of nutritional supplement use in European adolescents. We conducted the present study to analyse the prevalence of nutritional supplement use and factors associated with this use among Slovenian adolescents.

The nutritional supplementation practices of 818 adolescents were studied using an anonymous questionnaire. Information was sought on the type of supplements used, frequency of use and sources of information.

The region of north-west Slovenia.

Schoolchildren from twenty primary schools and twelve secondary schools.

Some 19·3% of all adolescents reported using at least one nutritional supplement and the prevalence of use was significantly higher in adolescents who were members of sports clubs. Multivitamins were the most common nutritional supplement. Older adolescents were significantly more likely to be supplementing with iron, protein and minerals. Less than 16 % of supplement users in our study sought information from health-care professionals. Nearly 62 % obtained information from parents and coaches, and many adolescents appear to decide on nutritional supplementation themselves, without advice. Older adolescents were significantly more likely to combine supplements than younger adolescents.

One-fifth of Slovenian adolescents use nutritional supplements. There are clear differences in supplement use between younger (age 12 years) and older (age 17 years) adolescents. Multiple use of supplements, coupled with self-managed supplementation in older adolescents, is concerning. Hence, there is an urgent need to provide accurate information regarding nutritional supplements, which will help adolescents, their parents and coaches to make informed choices about their use.

To examine socio-economic differences in the frequency and types of takeaway foods consumed.

A cross-sectional postal survey.

Participants were asked about their usual consumption of overall takeaway food (<4 times/month or ≥4 times/month) and of twenty-two specific takeaway food items (<1 time/month or ≥1 time/month); these latter foods were grouped into ‘healthy’ and ‘less healthy’ choices. Socio-economic position was measured on the basis of educational level and equivalised household income, and differences in takeaway food consumption were assessed by calculating prevalence ratios using log binomial regression.

Adults aged 25–64 years from Brisbane, Australia, were randomly selected from the electoral roll (n 903; 63·7 % response rate).

Compared with their more educated counterparts, the least educated were more regular consumers of overall takeaway food and fruit or vegetable juice and less regular consumers of sushi. For the ‘less healthy’ items, the least educated more regularly consumed potato chips, savoury pies, fried chicken and non-diet soft drinks; however, the least educated were less likely to consume curry. Household income was not associated with overall takeaway consumption. The lowest-income group was a more regular consumer of fruit or vegetable juice compared with the highest-income group. Among the ‘less healthy’ items, the lowest-income group was a more regular consumer of fried fish, ice cream and milk shakes, whereas curry was consumed less regularly.

The frequency and types of takeaway foods consumed by socio-economically disadvantaged groups may contribute to inequalities in overweight or obesity and to chronic disease.

Increasing trends in the consumption of commercial sugar-sweetened beverages (SSB) have occurred in parallel with rising levels of obesity in Latin America, but data showing the relationship between these SSB and obesity are limited. The current study examined the association between commercial and traditional SSB and measures of adiposity in Costa Rica.

A cross-sectional analysis was conducted in which the exposure, SSB intake, was defined as frequency of daily servings of ‘fresco’ (a traditional home-made beverage), fruit drink (commercially available SSB), soda and fruit juice (made from fruits at home). Multivariate linear regression was used to estimate associations between SSB intake and BMI, waist-to-hip ratio and skinfold thickness.

Central Valley, Costa Rica.

Controls (n 2045) of a case–control study on diet and heart disease in Costa Rica.

Fresco, fruit drink, soda and fruit juice were consumed ≥1 time/d by 47 %, 14 %, 4 % and 14 % of the population, respectively. One serving/d of soda, fruit drink and fresco was associated with 0·89, 0·49 and 0·21 kg/m2 higher BMI, respectively (all P < 0·05). Fruit drink (≥1 serving/d) was associated with higher waist-to-hip ratio (P = 0·004), while soda and fresco were associated with higher skinfold thickness (P = 0·02 and 0·01, respectively). Associations with fruit juice intake were modest and not statistically significant. Other factors associated with higher BMI were higher income and less education, smoking and physical inactivity (all P < 0·05).

Increasing intake of commercially available SSB could be in part responsible for the high prevalence of obesity among Hispanic adults.

To evaluate the implementation of a controlled, 6-week, environmental and educational intervention to improve dietary intake and body composition, and to study the association of implementation fidelity with diet and body composition outcomes.

A process evaluation documented participation, dose of nutrition education delivered, participant satisfaction, fidelity and completeness of the food environment intervention implementation, and context through observations and interviews with staff and residents. Intervention sites were scored and categorized as high or low participation and implementation and compared on essential elements of the food environment and on diet and body composition outcomes.

Six urban residential drug-treatment facilities in Upstate New York.

Fifty-five primarily black and white men in residential drug-treatment programmes.

Participants were exposed to 94 % and 69 % of the educational and environmental elements, respectively. High implementation sites were significantly more likely to provide water and 100 % juice, offer fruit or vegetable salad, offer choices of fruits and vegetables, and limit fried foods. Mixed-model analysis of covariance revealed that participants in the high participation and implementation sites reported greater reductions in total energy, percentage of energy from sweets, daily servings of fats, oils and sweets, and BMI over the intervention period. Participants in low participation and implementation sites reported greater reductions in percentage of energy from fat. Differential implementation of environmental elements limited the intervention impact.

These findings document the contribution of changes in eating environments to facilitate dietary behaviour change in community residential substance-abuse settings.

To test the feasibility of a pan-European professional recognition system for public health nutrition.

A multistage consultation process was used to test the feasibility of a model system for public health nutritionist certification. A review of existing national-level systems for professional quality assurance was conducted via literature review and a web-based search, followed by direct inquiries among stakeholders. This information was used to construct a consultation document circulated to key stakeholders summarising the rationale of the proposed system and inviting feedback about the feasibility of the system. Two consultation workshops were also held. The qualitative data gathered through the consultation were collated and thematically analysed.

Europe.

Public health nutrition workforce stakeholders across twenty-nine countries in the European Union.

One hundred and forty-five contacts/experts representing twenty-nine countries were contacted with responses received from a total of twenty-eight countries. The system proposed involved a certification system of professional peer review of an applicant's professional practice portfolio, utilising systems supported by information technology for document management and distribution similar to peer-review journals. Through the consultation process it was clear that there was overall agreement with the model proposed although some points of caution and concern were raised, including the need for a robust quality assurance framework that ensures transparency and is open to scrutiny.

The consultation process suggested that the added value of such a system goes beyond workforce development to enhancing recognition of the important role of public health nutrition as a professional discipline in the European public health workforce.

To investigate the impact of fortification by comparing food records and selected biochemical indicators of nutritional status pre- and post-fortification.

Mean intake from 24 h recalls (n 142) was compared with the Estimated Average Requirement (EAR) to determine the proportion with inadequate intake. In a subsample (n 34), diet and serum retinol, folate, ferritin and Zn were compared pre- and post-fortification for fortified nutrients vitamin A, thiamin, riboflavin, niacin, folic acid, Fe and Zn.

South Africa.

Breast-feeding women (ninety-four HIV-infected, forty eight HIV-uninfected) measured at ∼6, 14, 24 weeks, and 9 and 12 months postpartum.

Pre-fortification, >80 % of women did not meet the EAR for vitamins A, C, D, thiamin, riboflavin, niacin, B6, B12 and folate and minerals Zn, iodine and Ca. Dietary intake post-fortification increased for all fortified nutrients. In post-fortification food records, >70 % did not meet the EAR for Zn and vitamins A, riboflavin and B6. Serum folate and Zn increased significantly post-fortification (P < 0·001 for both), with no change in ferritin and a reduction in retinol. Post-fortification marginal/deficient folate status was reduced (73·5 % pre v. 3·0 % post; P < 0·001), as was Zn deficiency (26·5 % pre v. 5·9 % post; P < 0·05). Pre- and post-fortification, >93 % were retinol replete. There was no change in Fe deficiency (16·7 % pre v. 19·4 % post; P = 0·728).

Micronutrient intake improved with fortification, but >70 % of lactating women did not meet the EAR for Zn, vitamins A, riboflavin and B6. Although 100 % exceeded the EAR for Fe after fortification, Fe status did not improve.

To evaluate a web-based nutritional knowledge questionnaire for primary-school children.

Children's nutritional knowledge was assessed in five domains: healthy choices (twenty-seven items), estimated recommended portions/servings (eight items), nutrient content (five items), main food function (five items) and categorization of food items (eight items).

The questionnaires were completed in school.

A convenience sample of 576 Belgian children (aged 7–12 years) from fourteen primary schools completed the questionnaire once, 386 completed the questionnaire twice.

Healthy choices could be answered correctly by 73 % of the children, nutrients by 59 %, food categorization by 49 %, main function by 38 % and portion estimation by 36 %. Children's test–retest intra-class correlations were 0·75 for healthy choices, 0·33 for nutrients, 0·61 for food categorization, 0·44 for main function, 0·47 for portion estimation and 0·76 for the total scale. The intra-class correlation was lower in the youngest age group (grade 2: 0·51, grade 4: 0·65, grade 6: 0·66). The total score was significantly lower in the retest. The instrument was in general positively evaluated by the children.

The instrument is a promising, practical, inexpensive tool with acceptable test–retest reliability in fourth and sixth graders.

Epidemiological studies have shown that adults tend to underestimate their weight and overestimate their height. This may lead to a misclassification of their BMI in studies based on self-reported data. The aim of the present study was to assess the validity of self-reported weight and height in Austrian adults.

Data on weight, height, health behaviour and sociodemographic characteristics of adults were collected in a standardized procedure via a self-filling questionnaire and a medical examination including measurements of weight and height.

A publicly accessible out-patient clinic in southern Austria.

Austrian residents (n 473) aged 18 years and older who attended a health check participated in the study.

The mean difference between reported and measured BMI was not significant in younger adults (<35 years: mean difference −0·21 kg/m2; P < 0·08) but increased significantly with age (≥55 years: mean difference −0·68 kg/m2; P < 0·001). The prevalence of normal weight (BMI = 18·5–24·9 kg/m2) and overweight (BMI = 25·0–29·9 kg/m2) was overestimated based on the self-reported data on BMI, while that for underweight (BMI < 18·5 kg/m2) and obesity (BMI ≥ 30·0 kg/m2) was underestimated (P < 0·001). The self-reported data showed an obesity prevalence of 12·5 %, while measurement showed a prevalence of 15·4 % (P < 0·001).

Our results indicate that prevalence rates of obesity are probably underestimated for Austrian adults when using self-reported weight and height information. The deviations from the measured data clearly increased with age. Analyses based on self-reported data should therefore be adjusted for the age dependency of the validity.