To assess the agreement between self-reported and parent-reported dietary and physical activity habits in children; and to evaluate the socio-economic determinants of healthier habits (Mediterranean diet and physical activity) among children.

Cross-sectional analysis of children recruited to a cluster-randomized controlled trial (Program SI!). Information about children’s and parents’ dietary and physical activity habits was obtained through validated questionnaires (Program SI! questionnaires, Kidmed, Krece Plus and Predimed scores).

Twenty-four schools in Madrid, Spain.

Children (n 2062) aged 3–5 years and their parents (n 1949).

There was positive agreement between parental- and self-reporting for three of the six children’s habits examined. Parents’ dietary and physical activity patterns were associated with those of their children. The main determinants of higher scores in children were higher parental age, the mother’s scores, Spanish origin and higher awareness of human health (P<0·005). Children from parents with a low educational level had lower odds for scoring positively on items such as using olive oil (OR=0·23; 95 % CI 0·13, 0·41) and not skipping breakfast (OR=0·36; 95 % CI 0·23, 0·55), but higher odds for meeting the recommendations for consuming pulses (OR=1·71; 95 % CI 1·14, 2·55). Other habits being influenced by parental socio-economic status included the consumption of vegetables, fish, nuts, avoidance of fast food, and consumption of bakery products for breakfast.

Children’s habits may be influenced by their parents’ health awareness and other socio-economic characteristics. These findings suggest that intervention strategies, even in very young children, should also target parents in order to achieve maximum success.

The Common Risk Factor Approach proposes that public health efforts can be improved by multiple agencies working together on a shared risk factor. The present study aimed to assess the acceptability to parents, dental practice staff and commissioners of the delivery of dietary advice in the dentistry setting in order to address obesity.

Semi-structured focus groups with dental practice staff and one-to-one interviews with parents of pre-school children and public health commissioners involved in an oral health promotion initiative delivering dietary advice in dental surgeries. Data were analysed using the Framework Approach.

General dental practice surgeries and pre-schools in areas of high deprivation in north-east England.

Parents (n 4), dental practice staff (n 23) and one commissioner.

All participants found acceptable the concept of delivering public health messages in non-conventional settings. Dental practice staff were concerned about the potential for conflicting messages and deprioritisation of oral health advice, and they identified practical barriers to delivery, such as lack of training. Parents were very apprehensive about the potential of such approaches to stigmatise overweight children, including bullying. Uncertainty over the causes of obesity led to confusion about its solutions and the roles of public health and health care.

Major concerns about the implementation of the Common Risk Factor Approach were raised by parents and dental practice staff. Specific dietary guidance for both oral health and healthy weight, as well as further research into issues of suitability, feasibility and stigmatisation, are needed.

To identify and critique tools for the assessment of Ca and/or dairy intake in adults, in order to ascertain the most accurate and reliable tools available.

A systematic review of the literature was conducted using defined inclusion and exclusion criteria. Articles reporting on originally developed tools or testing the reliability or validity of existing tools that measure Ca and/or dairy intake in adults were included. Author-defined criteria for reporting reliability and validity properties were applied.

Studies conducted in Western countries.

Adults.

Thirty papers, utilising thirty-six tools assessing intake of dairy, Ca or both, were identified. Reliability testing was conducted on only two dairy and five Ca tools, with results indicating that only one dairy and two Ca tools were reliable. Validity testing was conducted for all but four Ca-only tools. There was high reliance in validity testing on lower-order tests such as correlation and failure to differentiate between statistical and clinically meaningful differences. Results of the validity testing suggest one dairy and five Ca tools are valid. Thus one tool was considered both reliable and valid for the assessment of dairy intake and only two tools proved reliable and valid for the assessment of Ca intake.

While several tools are reliable and valid, their application across adult populations is limited by the populations in which they were tested. These results indicate a need for tools that assess Ca and/or dairy intake in adults to be rigorously tested for reliability and validity.

To examine the cross-sectional and inter-temporal validity of the Household Food Insecurity Access Scale (HFIAS) for rural households in Burundi.

Longitudinal survey about food security and agricultural production, individually administered by trained interviewers in June 2007 and 2012.

Ngozi, north of Burundi.

Three hundred and fourteen household heads were interviewed.

Tobit models showed that the HFIAS was significantly correlated with objective measures of food security, in this case total annual food production (P<0·01), livestock keeping (P<0·01) and coffee production (P<0·01) in both 2007 and 2012. This confirms that the HFIAS is cross-sectionally valid and corroborates the findings of previous studies. However, while total food production decreased by more than 25 % in terms of energy between 2007 and 2012, households reported an improvement in their perceived food security over the same period, with the HFIAS decreasing from 13·9 to 10·8 (P<0·001). This finding questions the inter-temporal validity of the HFIAS. It may be partly explained through response shifts, in which households assess their own food security status in comparison to that of their peers.

The evidence from our study suggests that the HFIAS is cross-sectionally valid, but may not be inter-temporally valid, and should not be used as a single indicator to study temporal trends in food security.

Acculturation to the UK diet may contribute to the increased burden of non-communicable diseases in Black British communities. The present study aimed to assess nutritional composition and the contribution that traditional foods make to dietary intake in a group of UK-residing Caribbean and West African adults and to explore differences according to ethnicity and duration of residence.

Observational study. Dietary intake was assessed using multiple, standardised triple-pass 24 h recalls and analysed using a nutritional composition database. Associations between sociodemographic variables and duration of residence with dietary intake were assessed using ANCOVA.

London, UK, October 2011–December 2012.

UK adults of Caribbean (n 50) or West African (n 83) ancestry, aged 18–75 years.

The Caribbean participants were older and more likely to be born in the UK. After adjusting for age, sex and ethnicity, those who had been resident in the UK for the longest duration had significantly higher intakes of energy (P<0·001), fat (P=0·002) and Na (P=0·03). The West African participants sourced significantly more energy (P=0·04), fat (P=0·02), saturated fat (P=0·02) and Na (P=0·001) from traditional cultural foods compared with the Caribbean diet, which was more reliant on ‘Westernised’ foods such as sugar-sweetened beverages.

These results are novel in demonstrating dietary acculturation in UK adults of Caribbean and West African ancestry. We have provided detailed data regarding the role of traditional foods, presenting dietary information that may guide in individualising care for patients from these communities and improve the cultural sensitivity of public health strategies.

Rice consumption patterns are considered an important risk factor for diabetes in many countries. The present study aimed to model the impact of a shift in consumption of white rice from current to appropriately reduced levels and a shift in rice variety from one with a high glycaemic index to one with a low glycaemic index, on the burden of type 2 diabetes in Cambodia.

Prevent Plus software was used to model the impact of selected changes to white rice consumption on the burden of type 2 diabetes. Data used for modelling included: demographic projections, relative risk estimates for white rice consumption and diabetes, diabetes incidence, rice type and quantities consumed. The 10-year projections were based on different scenarios of changes in risk factors.

With no intervention, 10-year projections showed that total new diabetes cases will increase from 11 315 (9·1 per 10 000 person-years) for the year 2011 to 14 852 new cases (12·4 per 10 000 person-years) in 2020. However, this increase will be reduced by 27 % (average across 10 years) with a change in rice variety from Phka Rumdual to IR66 and by 26 % (average across 10 years) with a 25 % reduction in quantity from current consumption levels.

Changing rice consumption patterns has potential for an important impact on diabetes risk, with a change of rice variety having a similar impact on the burden of diabetes in communities consuming rice with a high glycaemic index as a 25 % reduction in the quantity of rice consumed. Similar effects are likely for other countries with rice as a staple food, diversity in rice varieties and high incidence of diabetes.

To study the relationship between diet quality and 24 h urinary K excretion.

K was measured in 24 h urine samples, while diet was studied using a 24 h recall method over two consecutive days. Diet quality was determined using the Healthy Eating Index (HEI). The body weight, height and body composition of all participants were recorded, and the BMI of each calculated.

Representative members of the adult Spanish population from the FANPE Study (‘Fuentes Alimentarias de Nutrientes en Población Española’; Dietary Sources of Nutrients in the Spanish Population).

The final sample size was 329 participants aged 18–60 years.

Participants with a 24 h urinary K excretion ≥93 mmol/d (group AP = adequate potassium) had greater self-reported K intakes, consumed more fruit and vegetables, had a more varied diet and had better HEI scores than those with a 24 h urinary K excretion <93 mmol/d (group IP = inadequate potassium). A significant positive correlation was seen between 24 h urinary K and dietary variety and the number of servings of fruits, vegetables and dairy products consumed, and between each of these and the HEI after correcting for age, sex, BMI, coefficient of activity, energy intake and the under-reporting of energy intake. AP participants were less likely to have an inadequate diet (HEI score <50) than IP participants (OR =0·439; 95 % CI 0·201, 0·961; P=0·039).

Diet quality, measured by the HEI, is correlated with 24 h urinary K excretion in Spanish adults.

To test the hypothesis that maternal psychological profiles relate to children’s quality of diet.

Cross-sectional study. Mothers provided information on their health-related psychological factors and aspects of their child’s mealtime environment. Children’s diet quality was assessed using an FFQ from which weekly intakes of foods and a diet Z-score were calculated. A high score described children with a better quality diet. Cluster analysis was performed to assess grouping of mothers based on psychological factors. Mealtime characteristics, describing how often children ate while sitting at a table or in front of the television, their frequency of takeaway food consumption, maternal covert control and food security, and children’s quality of diet were examined, according to mothers’ cluster membership.

Mother–child pairs (n 324) in the Southampton Initiative for Health. Children were aged 2–5 years.

Hampshire, UK.

Two main clusters were identified. Mothers in cluster 1 had significantly higher scores for all psychological factors than mothers in cluster 2 (all P<0·001). Clusters were termed ‘more resilient’ and ‘less resilient’, respectively. Children of mothers in the less resilient cluster ate meals sitting at a table less often (P=0·03) and watched more television (P=0·01). These children had significantly poorer-quality diets (β=−0·61, 95 % CI −0·82, −0·40, P≤0·001). This association was attenuated, but remained significant after controlling for confounding factors that included maternal education and home/mealtime characteristics (P=0·006).

The study suggests that mothers should be offered psychological support as part of interventions to improve children’s quality of diet.

Nutritional information panels are required on all packaged food products in the USA, yet are perceived as difficult to use by consumers. Nutritional symbols have been developed by various groups to assist consumers in making healthier food purchases. Different nutritional criteria are used depending on the authorizing body of these symbols. The present study assesses the nutrient profile of baby and toddler foods in light of their accompanying nutritional symbols.

Kruskal–Wallis and χ2 tests were used to assess differences in the nutritional content of products based on the presence and issuing body of nutritional symbols.

Nine grocery, drug and department stores in Philadelphia, PA, USA.

Two hundred and forty packaged baby and toddler foods.

Products whose nutritional symbol was issued by government/health professionals contained significantly more Ca (P = 0·002), fibre (P = 0·001), protein (P = 0·005), vitamin A (P = 0·011), vitamin C (P < 0·001) and Zn (P < 0·001) and less sugar (P = 0·004) per serving than products without a nutritional symbol and products whose nutritional symbol was issued by the manufacturer.

Products with a nutritional symbol issued by government/health professionals were healthier than foods with nutritional symbols issued by the manufacturer directly and foods with no nutritional symbols.

The aim of the present systematic review was to investigate the evidence on the association between food literacy and adolescents’ dietary intake.

The review included searches of six databases with no restriction on the year of publication or language.

The studies eligible for review were from five countries/regions: USA (n 6), Europe (n 4), Australia (n 1), Middle East (n 1) and South Africa (n 1).

Adolescents aged 10 to 19 years.

Thirteen studies were eligible for inclusion. None of the studies investigated all aspects of food literacy. Eight studies reported a positive association between food literacy and adolescents’ dietary intake. For example, adolescents with greater food knowledge and frequent food preparation behaviours were shown to have healthier dietary practices. Three studies found a mixed association of food literacy and adolescents’ dietary intake. For example, adolescents who frequently helped to prepare dinner had healthier dietary intake, but food shopping tasks were associated with less healthy food choices. Two studies found no association between measures of food literacy and adolescents’ dietary intake.

Food literacy may play a role in shaping adolescents’ dietary intake. More rigorous research methods are required to effectively assess the causality between food literacy and adolescents’ dietary intake in order to confirm the extent of the relationship. Evidence recommends public health practitioners and policy makers consider new public health strategies that focus on increasing understanding of food literacy in adolescence.

To describe the development and application of the School Food Environment Assessment Tools and a novel scoring system to assess the integration of healthy and environmentally sustainable food initiatives in elementary and secondary schools.

The cross-sectional study included direct observations of physical food environments and interviews with key school personnel regarding food-related programmes and policies. A five-point scoring system was then developed to assess actions across six domains: (i) food gardens; (ii) composting systems; (iii) food preparation activities; (iv) food-related teaching and learning activities; and availability of (v) healthy food; and (vi) environmentally sustainable food.

Vancouver, Canada.

A purposive sample of public schools (n 33) from all six sectors of the Vancouver Board of Education.

Schools scored highest in the areas of food garden and compost system development and use. Regular integration of food-related teaching and learning activities and hands-on food preparation experiences were also commonly reported. Most schools demonstrated rudimentary efforts to make healthy and environmentally sustainable food choices available, but in general scored lowest on these two domains. Moreover, no schools reported widespread initiatives fully supporting availability or integration of healthy or environmentally sustainable foods across campus.

More work is needed in all areas to fully integrate programmes and policies that support healthy, environmentally sustainable food systems in Vancouver schools. The assessment tools and proposed indicators offer a practical approach for researchers, policy makers and school stakeholders to assess school food system environments, identify priority areas for intervention and track relevant changes over time.

To holistically evaluate the extent of implementation of dietary guidelines in schools and present various monitoring systems.

The study comprises three methods: (i) a cross-sectional survey (process evaluation); (ii) an indicator-based evaluation (menu quality); and (iii) a 5 d weighed food record of school lunches (output evaluation).

Slovenian primary schools.

A total 234 food-service managers from 488 schools completed a self-administrated questionnaire for process evaluation; 177 out of 194 randomly selected schools provided menus for menu quality evaluation; and 120 school lunches from twenty-four schools were measured and nutritionally analysed for output evaluation.

The survey among food-service managers revealed high levels of implementation at almost all process evaluation areas of the guidelines. An even more successful implementation of these guidelines was found in relation to organization cultural issues as compared with technical issues. Differences found in some process evaluation areas were related to location, size and socio-economic characteristics of schools. Evaluation of school menu quality demonstrated that score values followed a normal distribution. Higher (better) nutrition scores were found in larger-sized schools and corresponding municipalities with higher socio-economic status. School lunches did not meet minimum recommendations for energy, carbohydrates or dietary fibre intake, nor for six vitamins and three (macro, micro and trace) elements.

The implementation of the guidelines was achieved differently at distinct levels. The presented multilevel evaluation suggests that different success in implementation might be attributed to different characteristics of individual schools. System changes might also be needed to support and improve implementation of the guidelines.

Some recent studies have shown stablity or declining trends in obesity while others still report increasing trends. The present study aimed to investigate the trends of obesity and abdominal obesity in Tehranian adults during a median follow-up of 10 years.

Prospective cohort study.

Community-based data collection from the Tehran Lipid and Glucose Study (TLGS).

Participants from four phases of the TLGS from 1999 to 2011 (n 10 368), aged ≥20 years.

The crude prevalence of obesity and abdominal obesity increased from 23·1 % and 47·9 % at baseline to 34·1 % and 71·1 % at the end of follow-up, respectively. Generalized estimating equation (GEE) models were used to analyse the correlated data and calculate the relative risks (RR). Risks of obesity and abdominal obesity increased over the whole study period for men (RR=1·62; 95 % CI 1·49, 1·76 and RR=1·46; 95 % CI 1·41, 1·52, respectively) and women (RR=1·24; 95 % CI 1·19, 1·29 and RR=1·22; 95 % CI 1·18, 1·27, respectively). These rising trends were observed in all subgroups regardless of age, marital status and educational level.

Trends of obesity and abdominal obesity are increasing in Tehranian adults during a decade of follow-up in both genders and in all study subgroups. These results underscore the still growing obesity epidemic in the capital of Iran, calling for urgent action to educate people in lifestyle modifications and the need for effective preventive and educational strategies on obesity.

Parents report that children’s eating behaviours are a major barrier to providing them with a healthy diet. Links between problem eating behaviours and parental feeding practices are not well established and have not previously been examined in overweight children. The aim of the present study was to assess associations between problem food behaviours, dietary intake and parental feeding practices of overweight children aged 4–8 years.

Participants were recruited for a lifestyle intervention (n 203). At baseline, children’s BMI was measured and parents completed comprehensive questionnaires about the feeding practices they used, the problem food behaviours their children exhibited and the foods their child consumed. A fussy eating scale was developed and associations were determined using correlations and regression analysis, including interactions.

Dunedin, New Zealand.

Overweight children aged 4–8 years.

Healthy eating guidance and monitoring by parents were related to the consumption of fewer unhealthy foods (B=−0·4, P=0·001 and B=−0·4, P<0·001). Conversely, a lack of parental control (child control) was related to a higher intake of unhealthy foods (B = 0·5, P<0·001). Parents of children who were fussy eaters monitored their child’s food intake less (P<0·001) and allowed the child more freedom over what he/she ate (P<0·001). These children consumed fewer fruit and vegetables than those who were not fussy eaters (P<0·001). However, fussy eaters with food-restrictive parents ate more fruit and vegetables (B=2·9, P<0·001).

These results suggest that a more structured food environment might be beneficial for the diet and food behaviours of young overweight children.

We investigated the association between adherence to the recommendations of the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) and breast cancer (BC) risk in the Cancer de Màma (CAMA) study in a Mexican population.

Population-based case–control study.

Incident BC cases (n 1000) and controls (n 1074) matched on age, region and health-care system were recruited.

In-person interviews were conducted to assess BC risk factors and habitual diet was assessed with an FFQ. Conformity to the WCRF/AICR recommendations was evaluated through a score incorporating seven WCRF/AICR components (body fatness, physical activity, foods and drinks that promote weight gain, plant foods, animal foods, alcoholic drinks and breast-feeding), with high scores indicating adherence to the WCRF/AICR recommendations.

No statistically significant associations between WCRF/AICR score and risk of BC were observed. After excluding BMI from the WCRF/AICR score, the top quartile was associated with a decreased BC risk overall, with ORQ4–Q1=0·68 (95 % CI 0·49, 0·92, Ptrend=0·03), and among postmenopausal women, with ORQ4–Q1=0·60 (95 % CI 0·39, 0·94, Ptrend=0·03). Inverse associations were observed between BMI and risk of BC overall and among premenopausal women, with OR=0·57 (95 % CI 0·42, 0·76, Ptrend<0·01) and 0·48 (95 % CI 0·31, 0·73, Ptrend<0·01), respectively. Physical activity level was inversely associated with BC risk.

The WCRF/AICR index was not related with BC risk in the CAMA study. A combination of six components excluding BMI showed strong protective associations, particularly in postmenopausal women. Further prospective studies are required to clarify the role of adherence to WCRF/AICR recommendations, particularly with respect to BMI, in the Mexican population.

To explore shoppers’ responses to the taste of different types of cow’s milk in a blind taste test and to examine their willingness to purchase lower-fat milk as part of an in-store marketing intervention.

Participants were recruited on-site in the supermarket to participate in a blind taste test of three varieties of cow’s milk and asked to guess what type they sampled.

The taste testing was conducted as part of the Healthy Retail Solution (HRS) intervention that took place in four large supermarkets in Philadelphia, PA, USA over the course of six months.

Adults (n 444) at participating Philadelphia supermarkets.

The majority of participants at all stores reported typically purchasing higher-fat milk. Forty per cent of participants reported buying whole milk, 38 % purchased milk with 2 % fat. Very few participants correctly identified all three milk samples during the taste test (6·9 %) and a majority of participants were unable to identify the type of milk they self-reported typically purchased.

Most consumers could not accurately distinguish between various types of milk. Taste testing is a promising strategy to introduce lower-fat milks to consumers who have not tried them before. Campaigns to purchase skimmed, 1 % or 2 % milk may result in significant energy reduction over time and can serve as a simple way to combat overweight and obesity.

The present study aimed to investigate the correlation between mothers’ and children’s vegetable intake and whether children are conscious about their vegetable intake.

Cross-sectional study. Self-administered questionnaires for mothers and children, consisting of items regarding diet history, were distributed to children via homeroom teachers. We created dummy exposure variables for each quartile of mothers’ vegetable intake. Multiple regression analysis was performed with children’s vegetable intake as the outcome variable.

Two public elementary schools in a residential district of Tokyo, Japan.

Study participants were upper-grade children (aged 10–12 years) and their mothers (332 pairs of mothers and children).

The mean vegetable intake in mothers and children was 310 (sd 145) g/d and 276 (sd 105) g/d, respectively. A positive linear relationship was found between mothers’ and children’s vegetable intake even after adjustment for considerable covariates (P<0·001). When stratified by children’s consciousness, the positive linear relationship was more pronounced in children who were conscious of eating all their vegetables (P<0·001 for interaction with children’s consciousness).

Mothers’ vegetable intake was significantly correlated with children’s vegetable intake. However, this correlation was stronger in children who were conscious of eating all their vegetables. Our findings suggest that enhancing mother’s vegetable intake and health consciousness of children are indispensable prerequisites for increasing vegetable intake among children.

The relationship of meal and snacking patterns with overall dietary intake and relative weight in children is unclear. The current study was done to examine how eating, snack and meal frequencies relate to total energy intake and diet quality.

The cross-sectional associations of eating, meal and snack frequencies with total energy intake and diet quality, measured by the Healthy Eating Index 2005 (HEI-2005), were examined in separate multivariable mixed models. Differences were examined between elementary school-age participants (9–11 years) and adolescents (12–15 years).

Two non-consecutive 24 h diet recalls were collected from children attending four schools in the greater Boston area, MA, USA.

One hundred and seventy-six schoolchildren, aged 9–15 years.

Overall, 82 % of participants consumed three daily meals. Eating, meal and snack frequencies were statistically significantly and positively associated with total energy intake. Each additional reported meal and snack was associated with an 18·5 % and a 9·4 % increase in total energy intake, respectively (P<0·001). The relationships of eating, meal and snack frequencies with diet quality differed by age category. In elementary school-age participants, total eating occasions and snacks increased HEI-2005 score. In adolescents, each additional meal increased HEI-2005 score by 5·40 points (P=0·01), whereas each additional snack decreased HEI-2005 score by 2·73 points (P=0·006).

Findings suggest that snacking increases energy intake in schoolchildren. Snacking is associated with better diet quality in elementary school-age children and lower diet quality in adolescents. Further research is needed to elucidate the role of snacking in excess weight gain in children and adolescents.

The Dietary Guidelines for Americans (DGA) promote healthy dietary choices for all Americans aged 2 years and older; however, the majority of Americans do not meet recommendations. The goal of the present study was to identify both barriers and facilitators to adherence to DGA recommendations for consumption of five recommended food groups: grains (specifically whole grains), vegetables, fruits, meat/beans and milk (specifically reduced-fat/non-fat), among American-Indian children.

Nominal group technique sessions were conducted to identify and prioritize children’s perceived barriers and facilitators to following the DGA, as presented in the ‘MyPyramid’ consumer education icon. After response generation to a single question about each food group (e.g. ‘What sorts of things make it harder (or easier) for kids to follow the MyPyramid recommendation for vegetables?’), children individually ranked their top five most salient responses. Ranked responses are presented verbatim.

A rural Northern Plains American-Indian reservation, USA.

Sixty-one self-selected fifth-grade children.

Core barriers for all food groups studied included personal preference (i.e. ‘don’t like’) and environmental (i.e. ‘cost too much’; ‘store is too far to get them’; ‘grandma don’t have’). Core facilitators included suggestions, i.e. ‘make a garden and plant vegetables’; ‘tell your friends to eat healthy’.

Barriers and facilitators are dissimilar for individual food groups, suggesting that dietary interventions should target reduction of barriers and promotion of facilitators specific to individual food groups recommended by the DGA.

To study how different meals contribute to intakes of fruits, vegetables, fish and whole grains in a group of Norwegian adults and in subgroups of this population. Moreover, to investigate the consequences of skipping the meal contributing most to the intake of each food group (main contributing meal).

Cross-sectional dietary survey in Norwegian adults. Dietary data were collected using two non-consecutive telephone-administered 24 h recalls. The recorded meal types were breakfast, lunch, dinner, supper/evening meal and snacks.

Nationwide, Norway (2010–2011).

Adults aged 18–70 years (n 1787).

Dinner was the main contributing meal for fish and vegetables, while snacks were the main contributing meal for fruit intake. For whole grains, breakfast was the main contributing meal. The main contributing meal did not change for any of the food groups when studying subgroups of the participants according to intake of each food group, educational level or age. A substantially lower intake of the food groups in question was found on days when the main contributing meal was skipped.

Intakes of fruits, vegetables, fish and whole grains largely depend on one meal type. Inclusion of these foods in other meals in addition to the main contributing meal, preferably replacing energy-dense nutrient-poor foods, should be promoted.