(i) To identify determinants of participation in the ‘Healthy School Canteen Program’, a programme that encourages schools to set up their canteen in a way that promotes healthy dietary behaviour. (ii) To compare food supply and actions between participating and non-participating schools. (iii) To investigate what reasons schools have to increase attention for nutrition in the curriculum.

A cross-sectional study based on information from questionnaires performed in 2010/2011.

All secondary schools (age group 12–18 years) in the Netherlands (n 1145).

Response was 33 % (n 375). Analyses included all schools with a canteen in which food is offered (28 %, n 325).

None of the investigated determinants was associated with participation. Participating schools offered significantly (P < 0·001) more of eleven inventoried healthy foods (e.g. sandwiches, (butter)milk, fruit, light soft drinks, yoghurt and salad) than non-participating schools. However, there was no difference in the number of less healthy products offered (e.g. candy bars, cakes and regular soft drinks). Participating schools reported more often that they took actions to improve dietary behaviour and more often had a policy on nutrition. Participating schools more often increased attention for nutrition in the curriculum in recent years than non-participating schools (57 % v. 43 %, P = 0·01). Reported reasons were similar and included media attention, eating behaviour of students and ‘overweight’.

Schools that participate in the programme seemed to offer more healthy products in their canteens and took more actions to improve dietary behaviour than non-participating schools. However, at all schools less healthy foods were also available.

A high intake of sugar-sweetened beverages (SSB) has been linked to weight gain, obesity and type 2 diabetes; however, the influence on CVD risk remains unclear. Therefore, our objective was to summarize current evidence for an association between SSB consumption and cardiovascular risk factors and events.

The article search was performed in August 2013. Two independent researchers performed the article search and selection, data extraction and quality assessment. Eligible studies reported the intake of SSB and one of the following outcomes: change in blood pressure, blood lipid or blood sugar, or CVD events such as stroke or myocardial infarction. Only intervention and longitudinal studies were included.

Only studies in adults (aged 18+ years old) were considered.

Two of four prospective studies found clear direct associations between SSB consumption and CHD, while two of three studies, including both men and women, found direct associations between SSB consumption and stroke; however, the association was significant among women only. All included studies examining vascular risk factors found direct associations between SSB consumption and change in blood pressure, blood lipid or blood sugar.

The reviewed studies generally showed that SSB intake was related to vascular risk factors, whereas associations with vascular events were less consistent. Due to a limited number of published papers, especially regarding vascular events, the strength of the evidence is still limited and hence more studies are needed before firm conclusions can be made.

To position the concept of sustainability within the context of food security.

An overview of the interrelationships between food security and sustainability based on a non-systematic literature review and informed discussions based principally on a quasi-historical approach from meetings and reports.

International and global food security and nutrition.

The Rome Declaration on World Food Security in 1996 defined its three basic dimensions as: availability, accessibility and utilization, with a focus on nutritional well-being. It also stressed the importance of sustainable management of natural resources and the elimination of unsustainable patterns of food consumption and production. In 2009, at the World Summit on Food Security, the concept of stability/vulnerability was added as the short-term time indicator of the ability of food systems to withstand shocks, whether natural or man-made, as part of the Five Rome Principles for Sustainable Global Food Security. More recently, intergovernmental processes have emphasized the importance of sustainability to preserve the environment, natural resources and agro-ecosystems (and thus the overlying social system), as well as the importance of food security as part of sustainability and vice versa.

Sustainability should be considered as part of the long-term time dimension in the assessment of food security. From such a perspective the concept of sustainable diets can play a key role as a goal and a way of maintaining nutritional well-being and health, while ensuring the sustainability for future food security. Without integrating sustainability as an explicit (fifth?) dimension of food security, today’s policies and programmes could become the very cause of increased food insecurity in the future.

Standard portions or substitution of missing portion sizes with medians may generate bias when quantifying the dietary intake from FFQ. The present study compared four different methods to include portion sizes in FFQ.

We evaluated three stochastic methods for imputation of portion sizes based on information about anthropometry, sex, physical activity and age. Energy intakes computed with standard portion sizes, defined as sex-specific medians (median), or with portion sizes estimated with multinomial logistic regression (MLR), ‘comparable categories’ (Coca) or k-nearest neighbours (KNN) were compared with a reference based on self-reported portion sizes (quantified by a photographic food atlas embedded in the FFQ).

The Danish Health Examination Survey 2007–2008.

The study included 3728 adults with complete portion size data.

Compared with the reference, the root-mean-square errors of the mean daily total energy intake (in kJ) computed with portion sizes estimated by the four methods were (men; women): median (1118; 1061), MLR (1060; 1051), Coca (1230; 1146), KNN (1281; 1181). The equivalent biases (mean error) were (in kJ): median (579; 469), MLR (248; 178), Coca (234; 188), KNN (−340; 218).

The methods MLR and Coca provided the best agreement with the reference. The stochastic methods allowed for estimation of meaningful portion sizes by conditioning on information about physiology and they were suitable for multiple imputation. We propose to use MLR or Coca to substitute missing portion size values or when portion sizes needs to be included in FFQ without portion size data.

To design and develop a questionnaire that can account for an individual’s adherence to a Mediterranean lifestyle including the assessment of diet and physical activity patterns, as well as social interaction.

The Mediterranean Lifestyle (MEDLIFE) index was created based on the current Spanish Mediterranean food guide pyramid. MEDLIFE is a twenty-eight-item derived index consisting of questions about food consumption (fifteen items), traditional Mediterranean dietary habits (seven items) and physical activity, rest and social interaction habits (six items). Linear regression models and Spearman rank correlation were fitted to assess content validity and internal consistency.

A subset of participants in the Aragon Workers’ Health Study cohort (Zaragoza, Spain) provided the data for development of MEDLIFE.

Participants (n 988) of the Aragon Workers’ Health Study cohort in Spain.

Mean MEDLIFE score was 11·3 (sd 2·6; range: 0–28), and the quintile distribution of MEDLIFE score showed a significant association with each of the individual items as well as with specific nutrients and lifestyle indicators (intra-validity). We also quantified MEDLIFE correspondence with previously reported diet quality indices and found significant correlations (ρ range: 0·44–0·53; P<0·001) for the Alternate Healthy Eating Index, the Alternate Mediterranean Diet Index and Mediterranean Diet Adherence Screener.

MEDLIFE is the first index to include an overall assessment of lifestyle habits. It is expected to be a more holistic tool to measure adherence to the Mediterranean lifestyle in epidemiological studies.

To identify determinants of fruit and vegetable (F&V) consumption among school-aged children.

A survey study was conducted in October 2010. The questionnaire contained questions concerning social and demographic data, lifestyle and dietary habits, particularly the frequency of F&V consumption, availability of F&V and knowledge about recommended amounts of F&V intake.

Polish primary schools.

Children (n 1255) aged 9 years from randomly selected primary schools and their parents.

The children’s consumption of fruit and of vegetables was influenced by the fruit consumption and vegetable consumption of their parents (r=0·333 and r=0·273, respectively; P=0·001), parents encouraging their children to eat F&V (r=0·259 and r=0·271, respectively; P=0·001), giving children F&V to take to school (r=0·338 and r=0·321, respectively; P=0·001) and the availability of F&V at home (r=0·200 and r=0·296, respectively; P=0·001). Parental education influenced only the frequency of fruit consumption (r=0·074; P=0·01). A correlation between parents’ knowledge of the recommended intakes and the frequency of vegetable and fruit consumption by children was noticed (r=0·258 and r=0·192, respectively, P=0·001).

Factors within the family environment such as parents’ dietary habits and F&V availability had the greatest influence on the F&V consumption by children. Educational activities aimed at parents are crucial to increase the consumption of F&V among children.

Long-chain n-3 fatty acid intake in Colombia is low because fish consumption is limited. Vegetable oils with high n-3 fatty acid content are recommended, but their concentrations of trans fats were high in previous studies. Thus, regular monitoring of the fatty acid composition of vegetable oils is required. Our objective was to quantify the fatty acid composition in commercially available oils in Bogota, Colombia and determine if composition changed from 2008 to 2013.

Cross-sectional study. We obtained samples of all commercially available oils reported in a survey of low- and middle-income families with a child participating in the Bogota School Children Cohort.

Bogota, Colombia.

Not applicable.

Sunflower oil had the highest trans-fatty acid content (2·18 %). Canola oil had the lowest proportion of trans-fatty acids (0·40 %) and the highest n-3 fatty acid content (9·37 %). In terms of percentage reduction from 2008 to 2013 in 18:1 and 18:2 trans-fatty acids, canola oil had 89 % and 65 % reduction, mixed oils had 44 % and 48 % reduction, and sunflower oil had 25 % and 51 % reduction, respectively. Soyabean oil became widely available in 2013.

The content of trans-fatty acids decreased in all oils from 2008 to 2013, suggesting a voluntary reduction by industry. We believe that regular monitoring of the fatty acid composition of oils is warranted.

To describe changes in total and central adiposity and body fat distribution in children over a 5-year period by investigating variations in BMI, waist circumference (WC), waist-to-height ratio (WHtR) and skinfold thicknesses (SFT).

A school-based sample of children from 2nd to 5th grades of elementary schools participated in two cross-sectional studies in 2002 (n 2936) and 2007 (n 1232).

Public and private schools of Florianopolis, Brazil.

Schoolchildren aged 7–10 years had their weight, height, WC and SFT measured according to standard procedures. Body fat distribution was assessed by triceps, subscapular, suprailiac and medial calf skinfold measurements. Changes in BMI, WC, WHtR and SFT were analysed, adjusting for type of school and monthly family income.

Adjusted mean differences between 2002 and 2007 for BMI and WC were always positive and of similar magnitude between boys and girls. However, a statistically significant increase was observed only for BMI (raw and Z-score values) in boys. WHtR remained stable in both sexes. Adjusted median values for SFT also increased in boys and girls, except for triceps skinfold. BMI, WC and SFT tended to increase across age classes in both sexes. The relative change observed for the median central skinfolds (subscapular and suprailiac) was greater than that of peripheral skinfolds (triceps and medial calf).

The subcutaneous adipose tissue (SFT) appeared to increase at a faster rate than total adiposity (BMI). The increase in central SFT indicates that the relative change is due primarily to a rise in central adiposity.

To examine overweight and obesity (OWOB), changes in prevalence and potential risk factors in Barbadian children.

A cross-section of students were weighed and measured. The WHO BMI-for-age growth references (BAZ), the International Obesity Task Force cut-offs and the US Centers for Disease Control and Prevention growth percentiles were used to determine OWOB prevalence. Harvard weight-for-height-for-age growth standards were used to estimate differences in OWOB prevalence from 1981 to 2010. Samples of parents and students were interviewed to describe correlates of OWOB.

Barbados.

Public-school students (n 580) in class 3.

Based on WHO BAZ, the overall prevalence of OWOB was 34·8 % (95 % CI 30·9, 38·7 %). A trend of higher OWOB prevalence was seen for girls across cut-offs, with significant sex differences noted using the International Obesity Task Force cut-offs. According to Harvard growth standards, OWOB has increased dramatically, from 8·52 % to 32·5 %. Children were more likely to be OWOB when annual household income was below BBD 9000 (OR=2·69; 95 % CI 1·21, 5·99). Eating dinner with the family every night was associated with a lower prevalence of OWOB (OR=0·56; 95 % CI 0·36, 0·87).

The sharp increase of OWOB rates in Barbados warrants attention. Sex disparities in OWOB prevalence may emerge at a young age. Promoting family meals may be a feasible option for OWOB prevention. Understanding familial and sociodemographic factors influencing OWOB will be useful in planning successful intervention or prevention programmes in Barbados.

To assess oil consumption, vitamin A intake and retinol status before and a year after the fortification of unbranded palm oil with retinyl palmitate.

Pre–post evaluation between two surveys.

Twenty-four villages in West Java.

Poor households were randomly sampled. Serum retinol (adjusted for subclinical infection) was analysed in cross-sectional samples of lactating mothers (baseline n 324/endline n 349), their infants aged 6–11 months (n 318/n 335) and children aged 12–59 months (n 469/477), and cohorts of children aged 5–9 years (n 186) and women aged 15–29 years (n 171), alongside food and oil consumption from dietary recall.

Fortified oil improved vitamin A intakes, contributing on average 26 %, 40 %, 38 %, 29 % and 35 % of the daily Recommended Nutrient Intake for children aged 12–23 months, 24–59 months, 5–9 years, lactating and non-lactating women, respectively. Serum retinol was 2–19 % higher at endline than baseline (P<0·001 in infants aged 6–11 months, children aged 5–9 years, lactating and non-lactating women; non-significant in children aged 12–23 months; P=0·057 in children aged 24–59 months). Retinol in breast milk averaged 20·5 μg/dl at baseline and 32·5 μg/dl at endline (P<0·01). Deficiency prevalence (serum retinol <20 μg/dl) was 6·5–18 % across groups at baseline, and 0·6–6 % at endline (P≤0·011). In multivariate regressions adjusting for socio-economic differences, vitamin A intake from fortified oil predicted improved retinol status for children aged 6–59 months (P=0·003) and 5–9 years (P=0·03).

Although this evaluation without a comparison group cannot prove causality, retinyl contents in oil, Recommended Nutrient Intake contributions and relationships between vitamin intake and serum retinol provide strong plausibility of oil fortification impacting vitamin A status in Indonesian women and children.

To identify dietary availability and its time trends in elderly Portuguese households.

A set of four cross-sectional studies based on the Household Budget Surveys was used. The dietary data were described using the daily per capita availability of food and beverages, energy and selected nutrients (macronutrients, different lipid fractions and simple sugars). Differences between elderly household types and time trends were studied.

Portuguese Household Budget Survey data from 1989/1990, 1994/1995, 2000/2001 and 2005/2006.

Households with members aged ≥65 years were selected and categorized as solitary elderly female, solitary elderly male or couple (composed of one elderly female and one elderly male).

While cereals, fats/oils, potatoes and sugar/sugar products decreased, an increase occurred in milk/milk products, fruits, bottled water, fruit/vegetable juices and soft drinks (P<0·05). The highest values for foods and beverages were mostly found in couples, while the lowest ones were from solitary males. Exceptions were observed for cereals, eggs, milk/milk products, vegetables, fruits and non-alcoholic beverages, higher in solitary females; and for sugar/sugar products and alcoholic beverages, higher in solitary males. Over time, total energy and carbohydrates decreased while proteins and saturated fatty acids increased (P<0·001). Lipids increased in solitary males and couples (P<0·05). Simple sugars increased in solitary males but decreased in solitary females and couples (P<0·05).

The increases in fruits and vegetables in solitary females accord with a healthier food pattern, but overall imbalances in the macronutrient profile for all elderly households may imply a decreasing diet quality.

To determine the reliability, validity and correlates of measures of food insecurity (FI) obtained using an individually focused food insecurity access scale (IFIAS) among pregnant women of mixed HIV status in northern Uganda.

A mixed-methods study involving cognitive interviews nested within a cross-sectional survey.

The antenatal care clinic of Gulu Regional Referral Hospital.

Survey respondents included 403 pregnant women, recruited in a ratio of one HIV-infected to two HIV-uninfected respondents, twenty-six (nine of them HIV-infected) of whom were asked to participate in the cognitive interviews.

Over 80 % of cognitive interview participants reported understanding the respective meanings of six of the nine items (i.e. items 4 to 9) on the IFIAS. Two main factors emerged from rotated exploratory factor analysis of the IFIAS: mild to moderate FI (IFIAS items 1–6) and severe FI (items 7–9). Together, they explained 90·4 % of the FI measure’s variance. The full IFIAS and the two subscales had moderate to high internal consistency (Cronbach’s α ranged from 0.75 to 0.87). Dose–response associations between IFIAS scores, and measures of socio-economic status and women’s diet quality, were observed. Multivariate linear regression revealed significant positive associations between IFIAS scores and HIV infection, maternal age, number of children and a history of internal displacement. IFIAS scores were negatively associated with women’s diet diversity score, asset index and being employed.

The IFIAS showed strong reliability, validity and contextual relevance among women attending antenatal care in northern Uganda.

To assess the change in daily energy intake associated with pairwise compositional change in carbohydrate, fat and protein intake among US adults stratified by sex, race/ethnicity and weight status.

Linear mixture model was performed to estimate the relationship between daily energy intake and macronutrient composition, adjusted for age and alcohol consumption, and accounting for survey design.

Study sample from the National Health and Nutrition Examination Survey, 1999–2010 waves.

A total of 27 589 US adults aged 20 years and older were included in the study. Dietary macronutrient intake was calculated from 24 h dietary recall and BMI from objectively measured weight/height.

Across all population subgroups, substituting protein or carbohydrate for fat and substituting protein for carbohydrate were associated with decreased daily energy intake, with the largest effect resulting from substituting protein for fat. A 1 % increase in the percentage of energy from protein substituted for a 1 % decrease in the percentage of energy from fat was associated with a decrease in daily energy intake of 268·2 (95 % CI 169·0, 367·4) kJ, 289·5 (95 % CI 215·9, 363·2) kJ and 293·7 (95 % CI 210·0, 377·4) kJ among normal-weight (18·5≤BMI, kg/m2<25·0), overweight (25·0≤BMI, kg/m2<30·0) and obese (BMI≥30·0 kg/m2) men, and 177·4 (95 % CI 130·5, 224·3) kJ, 188·7 (95 % CI 139·3, 238·1) kJ and 204·2 (95 % CI 158·2, 250·2) kJ among normal-weight, overweight and obese women, respectively. The relationship between macronutrient composition and daily energy intake varied substantially across sex, race/ethnicity and weight status.

Policies promoting higher daily protein intake at the expense of lower fat intake could be effective in reducing total energy intake among US adults.

To examine changes in periconceptional folic acid supplementation behaviour among Chinese women of reproductive age after the implementation of a folic acid supplementation programme.

Two cross-sectional surveys were conducted.

One survey was before (2002–2004) and the other was after (2011–2012) implementation of the programme, both were conducted in two areas of China with different prevalence of neural tube defects. Information on supplementation behaviours was collected in face-to-face interviews with women early in their pregnancy.

A total of 1257 and 1736 pregnant women participated before and after the programme, respectively.

The rate of periconceptional folic acid supplementation increased from 15 % to 85 % in the high-prevalence population and from 66 % to 92 % in the low-prevalence population. However, more than half of the women began taking the supplement after learning they were pregnant. The proportion of women who began taking folic acid before their last menstrual period decreased after the programme in rural areas with both a high and low prevalence of neural tube defects.

Although periconceptional folic acid supplementation among Chinese women increased substantially after the programme, supplementation was often initiated too late to be effective in preventing neural tube defects. Educational and promotional campaigns should focus on how to increase the rate of folic acid supplementation before pregnancy.

To develop a composition database of a number of foods representative of different categories of gluten-free products in the Italian diet.

The database was built using the nutritional composition of the products, taking into consideration both the composition of the ingredients and the nutritional information reported on the product label.

The nutrient composition of each ingredient was obtained from two Italian databases (European Institute of Oncology and the National Institute for Food and Nutrition).

The study developed a food composition database including a total of sixty foods representative of different categories of gluten-free products sold on the Italian market. The composition of the products included in the database is given in terms of quantity of macro- and micronutrients per 100 g of product as sold, and includes the full range of nutrient data present in traditional databases of gluten-containing foods.

As expected, most of the products had a high content of carbohydrates and some of them can be labelled as a source of fibre (>3 g/100 g). Regarding micronutrients, among the products considered, breads, pizzas and snacks were especially very high in Na content (>400–500 mg/100 g).

This database provides an initial useful tool for future nutritional surveys on the dietary habits of coeliac people.

To assess the relative validity and repeatability of a sixty-four-item FFQ for estimating dietary intake of Zn and its absorption modifiers in Saudi adults. In addition, we used the FFQ to investigate the effect of age and gender on these intakes.

To assess validity, all participants completed the FFQ (FFQ1) and a 3 d food record. After 1 month, the FFQ was administered for a second time (FFQ2) to assess repeatability.

Jeddah, Saudi Arabia.

One hundred males and females aged 20–30 years and 60–70 years participated.

Mean intakes of Zn and protein from FFQ1 were significantly higher than those from the food record while there were no detectable differences between tools for measurement of phytic acid intake. Estimated intakes of Zn, protein and phytate by both approaches were strongly correlated (P<0·001). Bland–Altman analysis showed for protein that the difference in intake as measured by the two methods was similar across the range of intakes while for Zn and phytic acid, the difference increased with increasing mean intake. Zn and protein intakes from FFQ1 and FFQ2 were highly correlated (r>0·68, P<0·001) but were significantly lower at the second measurement (FFQ2). Older adults consumed less Zn and protein compared with young adults. Intakes of all dietary components were lower in females than in males.

The FFQ developed and tested in the current study demonstrated reasonable relative validity and high repeatability and was capable of detecting differences in intakes between age and gender groups.

Weight self-perceptions, or how a person perceives his/her weight status, may affect weight outcomes. We use nationally representative data from 1988–1994 and 1999–2008 to examine racial/ethnic disparities in weight self-perceptions and understand how disparities have changed over time.

Using data from two time periods, 1988–1994 and 1999–2008, we calculated descriptive statistics, multivariate logistic regression models and predicted probabilities to examine trends in weight self-perceptions among Whites, Blacks, US-born Mexican Americans and Mexican immigrants to the USA.

National Health and Nutrition Examination Survey (NHANES) III (1988–1994) and continuous NHANES (1999–2008).

Adult NHANES participants aged 18 years and older (n 37 050).

The likelihood of self-classifying as overweight declined between 1988–1994 and 1999–2008 among all US adults, despite significant increases in mean BMI and overweight prevalence. Trends in weight self-perceptions varied by gender and between racial/ethnic groups. Whites in both time periods were more likely than racial/ethnic minorities to perceive themselves as overweight. After adjustment for other factors, disparities in weight self-perceptions between Whites and Blacks of both genders grew between survey periods (P<0·05), but differences between overweight White women and Mexican immigrants decreased (P<0·05).

Weight self-perceptions have changed during the obesity epidemic in the USA, but changes have not been consistent across racial/ethnic groups. Secular declines in the likelihood of self-classifying as overweight, particularly among Blacks, are troubling because weight self-perceptions may affect weight-loss efforts and obesity outcomes.