To validate the general nutrition knowledge questionnaire developed by Parmenter and Wardle (1999) in a Turkish student sample.

The original questionnaire of Parmenter and Wardle (1999) was modified and translated into Turkish. The modified questionnaire was administered to second year undergraduate students. Some students completed the questionnaire twice for the measurement of test–retest reliability. Statistical analysis was performed on the responses to measure the internal reliability, test–retest reliability and construct validity.

Students completed the questionnaire under supervision. The questionnaire was completed at the end of lectures. Retest was carried out two weeks after first administration of the test.

A total of 195 undergraduate students studying either nutrition and dietetics (n 90) or engineering (n 105) participated in the study. Of these, 125 students completed the questionnaire on two occasions.

Overall internal reliability (Cronbach's α = 0·89) and test–retest reliability (0·86) were high. Significant differences between the scores of the two groups of students indicated that the questionnaire had satisfactory construct validity.

The modified version of the general nutrition knowledge questionnaire can be used as a tool to examine the nutrition knowledge of adults in Turkey. In the next stage of the study, some adjustments need to be made to the items that led to low reliability values so that these items will be more applicable to the eating habits and patterns of Turkish people.

To determine the prevalence of vitamin A deficiency, infection and adequacy of vitamin A intakes among Zambian children, and the contribution of dietary vitamin A and infection to vitamin A status.

A cross-sectional survey of vitamin A intakes by the 24 h recall method, vitamin A status by plasma retinol and the modified relative dose-response test, and infection by acute-phase proteins.

Rural communities in Central and Eastern Provinces of Zambia.

Children 2–5 years of age.

The prevalence of vitamin A deficiency was 56 % by plasma retinol, 48 % with infection-adjusted plasma retinol and 22 % by the modified relative dose-response test. The majority of children (61 %) had a current infection. Vitamin A intakes were relatively high (331 to 585 μg retinol activity equivalents/d in the harvest/early post-harvest and late post-harvest seasons, respectively) and the prevalence of inadequate intakes was <1 % when compared with the Estimated Average Requirement (210 and 275 μg retinol activity equivalents/d for children aged 1–3 and 4–8 years, respectively). Elevated α-1-acid glycoprotein was negatively associated with plasma retinol (P < 0·0 0 1) and vitamin A intake was positively associated with plasma retinol (P < 0·05), but only when estimated assuming a 26:1 retinol equivalence for provitamin A from green and yellow vegetables.

Infection and vitamin A intakes were significant determinants of plasma retinol. We cannot conclude which indicator more accurately represents the true vitamin A status of the population. Reasons for the persistent high prevalence of vitamin A deficiency in the presence of adequate vitamin A intakes are unclear, but the high rates of infection may play a role.

To investigate the impact of eating behaviour traits on central obesity, prediabetes and associated major dietary food patterns.

Assessment of eating behaviour was based on the revised German version of the Three-Eating Factor Questionnaire using cross-sectional and longitudinal data of a feasibility study in employees. Data on lifestyle and nutrition were obtained by validated self-administered questionnaires. Baseline characteristics were analysed by the univariate χ2 test or the Mann–Whitney test. To quantify correlations linear regression analysis was used.

The Delay of Impaired Glucose Tolerance by a Healthy Lifestyle Trial (DELIGHT), which investigated measures to prevent type 2 diabetes mellitus in 2004–2008.

Employees (21–64 years, 127 men, 157 women) with elevated waist circumference (men ≥94 cm, women ≥80 cm) of five medium-sized companies in northern Germany.

At baseline (T0), BMI but particularly waist circumference showed a strong inverse correlation with flexible control (P < 0·0001) and a positive correlation with disinhibition (P < 0·0001) and rigid control (P = 0·063). Flexible control was also significantly inversely related to fasting plasma glucose (P = 0·040), energy intake (P < 0·0001), intake of meat and meat products (P = 0·0001), and positively associated with intake of fruit and vegetables (P < 0·0001) at baseline (T0). Changes in flexible control within the first year of intervention (T1 v. T0) predicted changes in central obesity (P < 0·0001) and fasting plasma glucose (P = 0·025).

DELIGHT shows that flexible control characterizes individuals with a higher dietary quality, a lower waist circumference and a lower glucose level. Enhancing flexible control more than rigid control, and decreasing disinhibition, seems beneficial in terms of central adiposity and glucose levels.

To simultaneously identify consumer segments based on individual-level consumption and community-level food retail environment data and to investigate whether the segments are associated with BMI and dietary knowledge in China.

A multilevel latent class cluster model was applied to identify consumer segments based not only on their individual preferences for fast food, salty snack foods, and soft drinks and sugared fruit drinks, but also on the food retail environment at the community level.

The data came from the China Health and Nutrition Survey (CHNS) conducted in 2006 and two questionnaires for adults and communities were used.

A total sample of 9788 adults living in 218 communities participated in the CHNS.

We successfully identified four consumer segments. These four segments were embedded in two types of food retail environment: the saturated food retail environment and the deprived food retail environment. A three-factor solution was found for consumers’ dietary knowledge. The four consumer segments were highly associated with consumers’ dietary knowledge and a number of sociodemographic variables.

The widespread discussion about the relationships between fast-food consumption and overweight/obesity is irrelevant for Chinese segments that do not have access to fast food. Factors that are most associated with segments with a higher BMI are consumers’ (incorrect) dietary knowledge, the food retail environment and sociodemographics. The results provide valuable insight for policy interventions on reducing overweight/obesity in China. This study also indicates that despite the breathtaking changes in modern China, the impact of ‘obesogenic’ environments should not be assessed too strictly from a ‘Western’ perspective.

California Assembly Bill 1535 awarded $US 15 million to California public schools to promote, develop and sustain instructional school gardens through the California Instructional School Garden Program (CISGP). The present study was designed to assess the effectiveness of the CISGP at assisting schools in implementing, maintaining and sustaining an academic school garden programme, determine how schools utilized the funding they received and assess the impact of the California state budget crisis on the CISGP.

A mid-term evaluation was used to assess the degree to which schools achieved their instructional garden-related goals.

California.

Only schools that applied for the CIGSP grant as part of a school district and also provided a contact email and had a unique contact person were included in the study (n 3103, 80·6 %).

In general, many schools reported not achieving their predicted goals with regard to the CISGP grant. Only 39·4 % of schools reported accomplishing all of their garden-related goals. Over one-third (37·8 %) of schools reported that their school gardens were negatively affected by the California budget deficit.

The difference between predicted and actual utilization of the CISGP grants may be due to a combination of the effects of budget shortfall and insufficiency of the grant award amount.

To determine the extent to which weight gain and eating behaviours in infancy predict later adiposity.

Population-based, prospective, longitudinal birth cohort study. Weights collected in infancy were used to calculate Z-scores for weight gain to age 1 year conditional on birth weight (CWG). To avoid multiple significance tests, variables from the parent questionnaire completed at age 1 year describing eating avidity were combined using general linear modelling to create an infancy avidity score. Anthropometry, skinfold thicknesses and bioelectrical impedance data collected at age 7–8 years were combined using factor analysis, to create an adiposity index.

Gateshead, UK.

Members of the Gateshead Millennium Study cohort with data at both time points (n 561).

CWG in infancy significantly predicted adiposity at age 7 years, but related more strongly to length and lean mass. High adiposity (> 90th internal percentile) at age 7 years was significantly associated with high CWG (relative risk 2·76; 95 % CI 1·5, 5·1) in infancy, but less so with raised (> 74th internal percentile) eating avidity in infancy (relative risk 1·87; 95 % CI 0·9, 3·7). However, the majority of children with high weight gain (77·6 %) or avidity (85·5 %) in infancy did not go on to have high adiposity at age 7 years.

Rapid weight gain in infancy and the eating behaviours which relate to it do predict later adiposity, but are more strongly predictive of later stature and lean mass.

To describe breakfast habits at food group level in European adolescents and to investigate the associations between these habits and sociodemographic factors.

Cross-sectional study.

Secondary schools from nine European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Breakfast habits were assessed twice using a computer-based 24 h dietary recall. Adolescents who consumed breakfast on at least one recall day were classified as ‘breakfast consumers’ and adolescents who did not have anything for breakfast on either of the two recall days were considered ‘breakfast skippers’. A ‘breakfast quality index’ to describe breakfast quality was created based on the consumption or non-consumption of cereals/cereal products, dairy products and fruits/vegetables. The sociodemographic factors studied were sex, age, region of Europe, maternal and paternal education, family structure and family affluence.

Adolescents (n 2672, 53 % girls) aged 12–17 years.

The majority of the adolescents reported a breakfast that scored poorly on the breakfast quality index. Older adolescents, adolescents from the southern part of Europe and adolescents from families with low socio-economic status were more likely to consume a low-quality breakfast.

The study highlights the need to promote the consumption of a high-quality breakfast among adolescents, particularly in older adolescents, adolescents from southern Europe and adolescents from families with low socio-economic status, in order to improve public health.

To study the awareness of the Heart Symbol in different age and educational groups, and changes in the awareness over a 9-year period. In addition, the reported use of products with the symbol was examined.

A series of annual cross-sectional postal surveys on Health Behaviour and Health among the Finnish Adult Population.

A random sample (n 5000 per annum) from the Finnish population aged 15–64 years, drawn from the National Population Register, received a questionnaire.

Men and women (n 29 378) participating in the surveys in 2000–2009.

At the early 2000s, 48 % of men and 73 % of women reported to be familiar with the symbol. The corresponding rates were 66 % for men and 91 % for women in 2009. The reported use of products with the symbol increased from 29 % to 52 % in men and from 40 % to 72 % in women. In men, the awareness did not vary by age, whereas older women (45–64 years) were less likely to be aware of the symbol compared with younger women (25–34 years). Men and women with the highest education were best aware of the symbol and more likely to use the products in the early 2000s. The educational differences diminished or disappeared during the study period.

The majority of Finnish adults are familiar with the Heart Symbol, and the reported use of such products increased in all age and educational groups, especially among the less educated. The symbol may work as an effective measure to diminish nutrition-related health inequalities.

To examine the association between diet quality and the diagnosis of an internalizing disorder in children and adolescents.

A prospective study examining the relationship between diet quality and mental health. FFQ responses of 3757 children were used to calculate a composite score for diet quality and its four components: variety, adequacy, moderation and balance. Physicians’ diagnoses on internalizing disorders were obtained by linking the children's dietary information to administrative health data. Negative binomial regression models were used to examine the association between diet quality and diagnosis of an internalizing disorder.

The Canadian province of Nova Scotia.

A provincially representative sample of grade 5 students (age 10–11 years).

Diet quality was not found to be associated with internalizing disorder in a statistically significant manner (incidence rate ratio = 1·09; 95 % CI 0·73, 1·63). However, relative to children with little variety in their diets, children with greater variety in their diet had statistically significant lower rates of internalizing disorder in subsequent years (incidence rate ratio = 0·45; 95 % CI 0·25, 0·82).

These findings suggest the importance of variety in children's diet and opportunities in the prevention of adolescent depression and anxiety.

To compare estimates of underweight, stunting, wasting, overweight and obesity based on three growth charts.

Cross-sectional study to estimate weight-for-age, length/height-for-age and weight-for-height comparing the 2006 WHO Child Growth Standards (‘the WHO standards’), the 1977 National Center for Health Statistics (NCHS) international growth reference (‘the NCHS reference’) and the 1987 Argentine Pediatric Society Committee of Growth and Development reference (‘the APS reference’). Cut-off points were defined as mean values ±2 sd. Epi-Info software version 6·0 (Centers for Disease Control and Prevention) was used for statistical evaluations (χ2, P ≤ 0·05).

Greater La Plata conurbation, Buenos Aires, Argentina.

A total of 2644 healthy, full-term children from 0 to 5 years of age.

Prevalence of underweight was higher with the WHO standards than with the other references up to the first 6 months. For the rest of the ages, prevalence was lower with the WHO standards. Stunting prevalence was higher with the WHO standards at all ages. Prevalence of wasting was higher with the WHO standards compared with the NCHS reference up to the first 6 months and lower at 2–5 years of age. Overweight and obesity prevalences were higher with the WHO standards at all ages.

The new WHO standards appear to be a solid and reliable tool for diagnosis and treatment of nutritional diseases, also being the only one built with infants fed according to WHO recommendations. Therefore, our results support the decision of the National Ministry of Health about the utilization of the new WHO standards to monitor the nutritional status of Argentinean children aged less than 5 years.

To examine the roles of child cognitions and parental feeding practices in explaining child intentions and behaviour regarding fruit and vegetable consumption.

Cross-sectional surveys among pre-adolescent children and their parents.

The child questionnaire included measures of fruit and vegetable consumption and cognitions regarding fruit and vegetable consumption as postulated by the Attitude–Social Influence–Self-Efficacy (ASE) model. The parent questionnaire included measures of parental feeding practices derived from the Comprehensive Feeding Practices Questionnaire (CFPQ).

In total, 963 parents and 796 students in grades 5 and 6 from eighteen schools in the south-western part of Norway participated.

A large portion of child intention to eat fruit and child fruit consumption was explained by child cognitions (29 % and 25 %, respectively). This also applied to child intention to eat vegetables and child vegetable consumption (42 % and 27 %, respectively). Parent-reported feeding practices added another 3 % to the variance explained for child intention to eat fruit and 4 % to the variance explained for child vegetable consumption.

The results from the present study supported the application of the ASE model for explaining the variance in child intentions to eat fruit and vegetables and in child consumption of fruit and vegetables. Furthermore, our findings indicated that some parental feeding practices do have an influence on child intentions and behaviour regarding fruit and vegetable consumption. However, the role of parental feeding practices, and the pathways between feeding practices and child eating intentions and behaviour, needs to be further investigated.

To assess the association between dietary energy density and the prevalence of cardiometabolic risk factors among Iranian adult women.

Cross-sectional study.

Tehran, Islamic Republic of Iran.

We assessed habitual dietary intakes of 486 Iranian adult women by the use of a validated FFQ. Dietary energy density (DED) was calculated as each individual's reported daily energy intake (kJ/d, kcal/d) divided by the total weight of foods (excluding beverages) consumed (g/d). Fasting plasma glucose (FPG), lipid profiles and blood pressure were measured. Diabetes (FPG ≥ 126 mg/dl), dyslipidaemia (based on the National Cholesterol Education Program Adult Treatment Panel III) and hypertension (based on the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure) were determined. The presence of ‘at least one risk factor’ and ‘at least two risk factors’ of the three major risk factors for CVD (hypertension, dyslipidaemia and diabetes) was also evaluated. To explore the associations between DED and cardiometabolic risk factors, we obtained prevalence ratios in different models accounting for confounders.

Mean DED was 7·41 (sd 1·46) kJ/g (1·77 (sd 0·35) kcal/g). Consumption of energy-dense diets was associated with higher intakes of energy, dietary fat, cholesterol, vegetable oils, refined grains and high-fat dairy products, along with lower intakes of dietary carbohydrates, fruits, vegetables, and meat and fish. Adherence to an energy-dense diet was associated with elevated levels of serum TAG, total cholesterol and LDL cholesterol and lower levels of serum HDL cholesterol. Women in the top quartile of DED were more likely to have dyslipidaemia (61 % v. 31 %, P < 0·05), at least one (68 % v. 35 %, P < 0·05) and at least two (29 % v. 10 %, P < 0·05) cardiometabolic risk factors compared with those in the bottom quartile. Consumption of energy-dense diets was significantly associated with a greater chance of having dyslipidaemia (prevalence ratio in top quartile v. bottom quartile: 1·78; 95 % CI 1·33, 2·58), at least one (1·81; 1·44, 2·49) and at least two cardiometabolic risk factors (2·81; 1·51, 5·24). Additional control for BMI and total energy intake slightly attenuated the associations. No overall significant associations were found between consumption of energy-dense diets and risk of having diabetes or hypertension either before or after adjustment for confounders.

Consumption of energy-dense diets was significantly related to the high prevalence of dyslipidaemia, at least one and at least two cardiometabolic risk factors among Iranian adult women. Prospective studies are required to confirm our findings.

To assess the nutritional quality of lunchtime food consumption among elementary-school children on Prince Edward Island according to the source of food consumed (home v. school).

Students completed a lunchtime food record during an in-class survey. Dietary adequacy was assessed by comparing median micronutrient intakes with one-third of the Estimated Average Requirement; median macronutrient intakes were compared with the Acceptable Macronutrient Distribution Ranges. The Wilcoxon signed rank test was used to assess differences in nutrient intakes according to source of food consumed.

Elementary schools in Prince Edward Island, Canada.

Grade 5 and 6 students (n 1980).

Foods purchased at school were higher in nutrient density for ten micronutrients (Ca, Mg, K, Zn, vitamin A, vitamin D, riboflavin, niacin, vitamin B6 and vitamin B12) compared with packed lunch foods from home, which were higher in three micronutrients (Fe, vitamin C and folate). School lunches provided sufficient protein but were higher in sugar and fat than home lunches. Foods brought from home were higher in carbohydrates, fibre and Na than foods purchased at school.

The overall nutritional quality of lunches was poor, regardless of source. A significant proportion of foods consumed by the students came from home sources; these were lower nutritional quality and were higher in Na than foods offered at school. Findings suggest that improving the dietary habits of school-aged children will require a collaborative effort from multiple stakeholders, including parents.

To evaluate Zn utilization and status among a sample of Spanish boys consuming a diet based on Mediterranean patterns.

Dietary Zn balance was assessed by means of Zn intake in food and Zn output in faeces and urine as measured by flame atomic absorption spectrophotometry. In addition, biomarkers of Zn status were analysed.

Province of Granada, Spain.

Twenty healthy male adolescents aged 11–14 years, selected based on medical questionnaire, physical examination and nutritional survey of food habits and lifestyle.

Mean Zn intake was 11·36 (se 0·31) mg/d, 76% of the recommended value for Spanish adolescents. Zn absorption (2·53 (se 0·55) mg/d) was close to the value of 3·0 mg/d required for the growth spurt. Zn status biomarkers and growth parameters were within the normal values for this age group.

Although a diet based on Mediterranean patterns is associated with factors which can affect Zn absorption, such as high consumption of phytate, its consumption in adequate amounts allows Zn status to be maintained during adolescence. Due to the importance of Zn in preventing growth and behavioural disorders among adolescents, long-term intervention trials to investigate the suitability of the Mediterranean diet with respect to Zn requirements at this time of life are needed.

To determine the association between indicators of infant and young child feeding (IYCF) and anthropometric measures of nutritional status among children aged 0–23 months in a nationally representative data set.

Data from the 2007 Bangladesh Demographic and Health Survey were used. Analyses were conducted using multiple linear regression and logistic regression analyses adjusted for the complex survey design of the survey, controlling for child, maternal and household characteristics, and including regional dummy variables.

Bangladesh.

Pairs (n 2096) of last born infants and their mothers.

Exclusive breast-feeding under 6 months of age was associated with higher weight-for-height Z-score (effect size (ES) = 0·29; P < 0·05). Appropriate complementary feeding in children aged 6–8 months was associated with higher height-for-age Z-score (HAZ; ES = 0·63; P < 0·01) and higher weight-for-age Z-score (WAZ; ES = 0·30; P < 0·05). Higher dietary diversity index (DDI) was associated with higher HAZ (ES = 0·08; P < 0·01 for every 1 point higher DDI) and higher WAZ (ES = 0·04; P < 0·05). Children who achieved minimum diet diversity had higher HAZ (ES = 0·20; P < 0·05). Logistic regression models confirmed that exclusive breast-feeding was protective against wasting and DDI was protective against stunting and underweight.

Our results highlight the importance of IYCF practices as determinants of child growth outcomes in this context, and reinforce the need for interventions that address the spectrum of IYCF practices, from exclusive breast-feeding to age-appropriate complementary feeding, especially diet diversity, in efforts to improve nutrition of infants and young children.

Due to a proliferation of measures for different components of the home environment related to childhood obesity, the purpose of the present systematic review was to examine these tools and the degree to which they can validly and reliably assess the home environment.

Relevant manuscripts published between 1998 and 2010 were obtained through electronic database searches and manual searches of reference lists. Manuscripts were included if the researchers reported on a measure of the home environment related to child eating and physical activity (PA) and childhood obesity and reported on at least one psychometric property.

Of the forty papers reviewed, 48 % discussed some aspect of parenting specific to food. Fifty-per cent of the manuscripts measured food availability/accessibility, 18 % measured PA availability/accessibility, 20 % measured media availability/accessibility, 30 % focused on feeding style, 23 % focused on parenting related to PA and 20 % focused on parenting related to screen time.

Many researchers chose to design new measures for their studies but often the items employed were brief and there was a lack of transparency in the psychometric properties. Many of the current measures of the home food and PA environment focus on one or two constructs; more comprehensive measures as well as short screeners guided by theoretical models are necessary to capture influences in the home on food and PA behaviours of children. Finally, the current measures of the home environment do not necessarily translate to specific sub-populations. Recommendations were made for future validation of measures in terms of appropriate psychometric testing.

The role of following the recommendations of Canada's Food Guide (CFG) and the Dietary Approaches to Stop Hypertension (DASH) diet on body composition in children is unknown. The present study assessed how conformity to the recommendations of these diets was associated with BMI, waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), waist girth (WG), hip girth (HG) and risk of overweight in peri-adolescents.

CFG and DASH indices were derived from responses to a food questionnaire, with a higher index representing greater conformity to CFG and DASH diet recommendations. Body composition was assessed by trained research assistants.

Schools within the Niagara region (Ontario, Canada).

Children (n 1570) aged 12·4 (sd 0·3) years.

After adjustment for age to peak height velocity and total physical activity, a higher CFG index was associated with lower WHtR (b = −0·001, 95 % CI −0·002, −0·0004), WHR (b = −0·001, 95 % CI −0·002, −0·001) and WG (b = −0·18, 95 % CI −0·30, −0·07) in girls. No associations were observed in boys. In contrast, a higher DASH index was associated with decreased body composition measures in both genders. Specifically, the DASH index was negatively associated with BMI (girls: b = −0·07, 95 % CI −0·10, −0·04; boys: b = −0·05, 95 % CI −0·08, −0·02), WHtR (girls: b = −0·001, 95 % CI −0·002, −0·001; boys: b = −0·001, 95 % CI −0·002, −0·0004), WHR (girls: b = −0·001, 95 % CI −0·002, −0·001; boys: b = −0·001, 95 % CI −0·001, −0·00004), WG (girls: b = −0·24, 95 % CI −0·31, −0·16; boys: b = −0·15, 95 % CI −0·24, −0·07) and HG (girls: b = −0·15, 95 % CI −0·23, −0·07; boys: b = −0·12, 95 % CI −0·19, −0·04). A higher DASH index was also associated with lower odds of overweight in girls (OR = 0·70, 95 % CI 0·56, 0·87) and boys (OR = 0·76, 95 % CI 0·62, 0·93).

The DASH diet may prevent overweight in peri-adolescents.

The purpose was to examine the role of dietary patterns derived from factor analysis and their association with health and disease.

Longitudinal population study, with measurement of diet (dietary history method), cardiovascular risk factors and a follow-up of 20 years for CHD incidence and 40 years for mortality.

Two population samples in rural villages in northern and central Italy.

Men (n 1221) aged 45–64 years were examined and followed up.

One of the factors identified with factor analysis, run on seventeen food groups, was converted into a factor score (Factor 2 score) and used as a possible predictor of morbid and fatal events. High values of Factor 2 score were characterized by higher consumption of bread, cereals (pasta), potatoes, vegetables, fish and oil and by lower consumption of milk, sugar, fruit and alcoholic beverages. In multivariate analysis, Factor 2 score (mean 0·0061; sd 1·3750) was inversely and significantly associated (hazard ratio for a 1 sd increase; 95% CI) with 20-year CHD incidence (0·88; 0·73, 0·96) and 40-year mortality from CHD (0·79; 0·66, 0·95), CVD (0·87; 0·78, 0·96), cancer (0·84; 0·74, 0·96) and all causes (0·89; 0·83, 0·96), after adjustment for five other risk factors. Men in quintile 5 of Factor 2 score had a 4·1 years longer life expectancy compared with men in quintile 1.

A dietary pattern derived from factor analysis, and resembling the characteristics of the Mediterranean diet, was protective for the occurrence of various morbid and fatal events during 40 years of follow-up.