The present study examines the impact of Health Bucks, a farmers’ market incentive programme, on awareness of and access to farmers’ markets, and fruit and vegetable purchase and consumption in low-income New York City neighbourhoods.

The evaluation used two primary data collection methods: (i) an on-site point-of-purchase survey of farmers’ market shoppers; and (ii) a random-digit-dial telephone survey of residents in neighbourhoods where the programme operates. Additionally, we conducted a quasi-experimental analysis examining differential time trends in consumption before and after programme introduction using secondary Community Health Survey (CHS) data.

New York City farmers’ markets and communities.

Farmers’ market shoppers (n 2287) completing point-of-purchase surveys in a representative sample of New York City farmers’ markets in 2010; residents (n 1025) completing random-digit-dial telephone survey interviews in 2010; and respondents (n 35 606) completing CHS interviews in 2002, 2004, 2008 and 2009.

Greater Health Bucks exposure was associated with: (i) greater awareness of farmers’ markets; (ii) increased frequency and amount of farmers’ market purchases; and (iii) greater likelihood of a self-reported year-over-year increase in fruit and vegetable consumption. However, our CHS analysis did not detect impacts on consumption.

While our study provides promising evidence that use of farmers’ market incentives is associated with increased awareness and use of farmers’ markets, additional research is needed to better understand impacts on fruit and vegetable consumption.

The study objective was to determine the relative validity and reproducibility of a modified FFQ for ranking the nutrient intakes of New Zealand toddlers aged 12–24 months.

Cross-sectional study.

Dunedin, New Zealand.

One hundred and fifty-two participants completed a ninety-five-item FFQ twice, and five days of weighed diet recording (WDR), over one month. Validity and reproducibility were assessed for crude data and for data that were weighted for total fruit and vegetable intake (FV-adjusted).

De-attenuated correlations between FV-adjusted FFQ data and WDR data ranged from 0·45 (Zn) to 0·77 (Ca). The percentage classified to the correct WDR quartile by the FV-adjusted FFQ data ranged from 34·6 % (total fat, Zn) to 50·3 % (Fe). Average gross misclassification was 3 %. Bland–Altman statistics showed crude data had a range of 128–178 % agreement with the WDR and mean FV-adjusted intakes had 112–160 % agreement. FV-adjusted intra-class correlations, assessing reproducibility, ranged from 0·65 (vitamin C) to 0·75 (Ca).

The Eating Assessment in Toddlers (EAT) FFQ showed acceptable to good relative validity, and good reproducibility, for ranking participants’ nutrient intake and is able to identify toddlers at extremes of the nutrient intake distribution. It will be a useful tool for investigating toddlers’ nutrient intakes in studies that require a method of dietary assessment with low respondent burden.

To study (i) the current prevalence of iodine-deficiency disorders among schoolchildren in south-western Saudi Arabia after universal salt iodization and (ii) the iodine content of table salts and water.

Cross-sectional study on a stratified proportional allocation sample of children. Thyroid gland enlargement was assessed clinically and by ultrasound scanning. Urine, table salt and water samples were taken to measure iodine content.

The Aseer region, south-western Saudi Arabia.

Schoolchildren aged 8–10 years.

The study included 3046 schoolchildren. The total goitre rate amounted to 24·0 %. Prevalence of enlarged thyroid by ultrasound was 22·7 %. The median urinary iodine concentration of the study sample amounted to 17·0 µg/l. The iodine content of table salt ranged from 0 to 112 mg/kg; 22·5 % of the table salt samples were below the recommended iodine content (15 mg/kg) set by WHO. The total goitre rate increased significantly from 19·8 % among children using table salt with iodine content ≥15 mg/kg to reach 48·5 % among children using table salt with 0 mg iodine/kg. Analysis of water samples taken from schools showed that the majority of water samples (78·8 %) had an iodine content of 0 µg/l.

The study documented that 18 years after the national study, and after more than a decade of universal salt iodization in Saudi Arabia, the problem of iodine-deficiency disorders is still endemic in the Aseer region. Efforts should focus on fostering advocacy and communication and ensuring the availability of adequately iodized salt.

The purpose of the present study was to investigate the associations of family sociodemographic characteristics with children’s weight status and whether these potential associations are mediated by children’s breakfast habits.

A school-based survey among 10–12-year-old children was conducted in eight European countries. Children’s weight and height were measured and breakfast habits and family sociodemographic characteristics were self-reported by 5444 children and their parents. International Obesity Task Force cut-off points were used to categorize children as overweight/obese or normal weight. Mediation analyses were used to test the potential mediating effect of children’s breakfast consumption on the associations between family sociodemographic characteristics and children’s overweight/obesity.

Schools in eight European countries participating in the ENERGY (EuropeaN Energy balance Research to prevent excessive weight Gain among Youth) project.

Children aged 10–12 years and their parents (n 5444).

Children’s reported daily breakfast consumption varied from 56 % in Slovenia to 92 % in Spain on weekdays and from 79 % in Greece to 93 % in Norway on weekends. Children of native parents, with both parents employed and with at least one parent having more than 14 years of education were more likely to consume breakfast daily and less likely to be overweight/obese. Finally, mediation analyses revealed that the association of parental nationality and parental educational status with children’s overweight/obesity was partially mediated by children’s daily breakfast consumption.

The study shows that the lower likelihood of being overweight/obese among 10–12-year-old children of native background and higher parental educational status was partially mediated by children’s daily breakfast consumption.

The aim of the present study was to examine the prevalence and time trends in childhood overweight including obesity and obesity among Tuscan children from 2002 to 2012.

Cross-sectional study at five time points (Tuscan Nutritional Surveillance Surveys conducted in the years of 2002, 2006, 2008, 2010 and 2012). Trained personnel directly measured the height and weight of the subjects. BMI was assessed by means of the International Obesity Task Force (IOTF) and WHO cut-offs.

Representative sample of children in the Tuscany region (Italy).

Children (n 7183) aged between 7·5 and 9·5 years (3711 boys and 3472 girls).

With respect to the estimation of the absolute prevalence level of childhood overweight, a discrepancy was observed between the two criteria. In all surveys, more boys than girls were overweight (including obesity). Trend analysis showed a significant decrease in the prevalence of overweight including obesity and obesity in Tuscan children from 2002 to 2012 (32·0 % v. 25·8 %, P<0·001 on using IOTF criteria and 37·7 % v. 34·3 %, P<0·001 on using WHO criteria for overweight including obesity; and 10·0 % v. 6·7 %, P<0·001 on using IOTF criteria and 12·5 % v. 11·3 %, P=0·035 on using WHO criteria for obesity).

The present study is the first report from an Italian region showing a significant decrease in childhood obesity and overweight in the last 10 years. This reduction is probably a result of regional and local actions that have taken place in many sectors of society. However, efforts should be made to lower the prevalence of childhood obesity and overweight further.

The aim was to investigate autumn vitamin D intake and status in 7-year-old Icelanders, fitting BMI and cardiorespiratory fitness as predictors.

Three-day food records and fasting blood samples were collected evenly from September to November, and cardiorespiratory fitness was measured with an ergometer bike. Food and nutrient intakes were calculated, and serum 25-hydroxyvitamin D (s-25(OH)D) and serum parathyroid hormone were analysed. Suboptimal vitamin D status was defined s-25(OH)D <50 nmol/l, and deficient status as s-25(OH)D <25 nmol/l.

School-based study in Reykjavik, Iceland in 2006.

Of the 7-year-olds studied (n 265), 165 returned valid intake information (62 %), 158 gave blood samples (60 %) and 120 gave both (45 %).

Recommended vitamin D intake (10 μg/d) was reached by 22·4 % of the children and 65·2 % had s-25(OH)D <50 nmol/l. Median s-25(OH)D was higher for children taking vitamin D supplements (49·2 nmol/l v. 43·2 nmol/l, respectively; P < 0·0 0 1). Median s-25(OH)D was lower in November (36·7 nmol/l) than in September (59·9 nmol/l; P < 0·001). The regression model showed that week of autumn accounted for 18·9 % of the variance in s-25(OH)D (P < 0·001), vitamin D intake 5·2 % (P < 0·004) and cardiorespiratory fitness 4·6 % (P < 0·005).

A minority of children followed the vitamin D recommendations and 65 % had suboptimal vitamin D status during the autumn. Week of autumn was more strongly associated with vitamin D status than diet or cardiorespiratory fitness, which associated with vitamin D status to a similar extent. These results demonstrate the importance of sunlight exposure during summer to prevent suboptimal vitamin D status in young schoolchildren during autumn in northern countries. An increased effort is needed for enabling adherence to the vitamin D recommendations and increasing outdoor activities for sunlight exposure.

To determine the prospective relationship between changes in sugar-sweetened beverage (SSB) intake and central adiposity in older children.

Dietary intakes of children were obtained by 3 d food records at ages 10 and 13 years. Waist circumference (WC) and weight and height to determine BMI were measured at 10 and 13 years and total body fat mass (TBFM) at 13 years by dual-energy X-ray absorptiometry. Analyses were conducted using multivariable linear regression. Reporting errors were measured and participants were categorized as under-, plausible and over-reporters of dietary intakes.

Community-based British cohort of children participating in the Avon Longitudinal Study of Parents and Children.

Among 2455 older children, increased SSB consumption from ages 10 to 13 years was associated with higher WC (standardized β=0·020, P=0·19), BMI (β=0·028, P=0·03) and TBFM (β=0·017, P=0·20) at 13 years. Effects were strengthened among plausible dietary reporters (n 1059): WC (β=0·097, P<0·001), BMI (β=0·074, P<0·001) and TBFM (β=0·065, P=0·003). The association between change in SSB and WC was weakened, but remained statistically significant after accounting for BMI (β=0·042, P=0·02) and TBFM (β=0·048, P=0·01).

Higher consumption of SSB from ages 10 to 13 years was associated with a larger WC at age 13 years independent of differences in total adiposity. Accounting for dietary reporting errors strengthened associations. Our findings further support recommendations to limit intakes of SSB to reduce excess weight gain in children and suggest that SSB have an additional deleterious effect on central adiposity.

Analysing dietary data to capture how individuals typically consume foods is dependent on the coding variables used. Individual foods consumed simultaneously, like coffee with milk, are given codes to identify these combinations. Our literature review revealed a lack of discussion about using combination codes in analysis. The present study identified foods consumed at mealtimes and by race when combination codes were or were not utilized.

Duplicate analysis methods were performed on separate data sets. The original data set consisted of all foods reported; each food was coded as if it was consumed individually. The revised data set was derived from the original data set by first isolating coded foods consumed as individual items from those foods consumed simultaneously and assigning a code to designate a combination. Foods assigned a combination code, like pancakes with syrup, were aggregated and associated with a food group, defined by the major food component (i.e. pancakes), and then appended to the isolated coded foods.

Healthy Aging in Neighborhoods of Diversity across the Life Span study.

African-American and White adults with two dietary recalls (n 2177).

Differences existed in lists of foods most frequently consumed by mealtime and race when comparing results based on original and revised data sets. African Americans reported consumption of sausage/luncheon meat and poultry, while ready-to-eat cereals and cakes/doughnuts/pastries were reported by Whites on recalls.

Use of combination codes provided more accurate representation of how foods were consumed by populations. This information is beneficial when creating interventions and exploring diet–health relationships.

To present one of the first national dietary guidelines that incorporates food sustainability principles into its public health recommendations.

The paper outlines recommendations and utilizes an ecological framework of policy analysis to examine context, drivers, consequences and future suggestions in establishing and maintaining sustainability principles within the Qatar Dietary Guidelines.

Qatar.

Population of Qatar.

Qatar has produced one of the first national dietary guidelines to integrate principles of food sustainability. National interest in environmental sustainability and food security, population concern over food waste (reinforced by Islamic religious law), strong authority of the Supreme Council of Health (supported by an Emirate government), a small domestic food industry and a lack of food industry influence on the guidelines have contributed to the inclusion of sustainability principles within the document.

Whether these principles will be embraced or rejected by the population in the long term will likely be determined by the Dietary Guidelines Task Force and the Supreme Council of Health’s commitment to educating the population about the relevance and importance of these principles and establishing champions to advocate for them.

To examine the association between household food insecurity score and Z-scores of childhood nutritional status indicators.

Population-based, cross-sectional survey, Nepal Demographic and Health Survey 2011.

A nationally representative sample of 11 085 households selected by a two-stage, stratified cluster sampling design to interview eligible men and women.

Children (n 2591) aged 0–60 months in a sub-sample of households selected for men’s interview.

Prevalence of moderate and severe household food insecurity was 23·2 % and 19·0 %, respectively, for children aged 0–60 months. Weighted prevalence rates for stunting (height-for-age Z-score (HAZ) <−2), wasting (weight-for-height Z-score (WHZ) <−2) and underweight (weight-for-age Z-score (WAZ) <−2) were 41·6 % (95 % CI 38·9, 44·3 %), 11·5 % (95 % CI 9·8, 13·2 %) and 30·1 % (95 % CI 27·5, 32·8 %), respectively. Prevalences of stunting, severe stunting (HAZ<−3) and underweight by level of household food insecurity were statistically significant (P<0·001). By multiple linear regression analyses and after adjustment for sociodemographic, child and environmental factors, household food access insecurity score was associated with HAZ (β=−0·02, P=0·01) and WAZ (β=−0·01, P=0·01) but was not associated with WHZ and BMI-for-age Z-score. A 10-point increase in household food access insecurity score was associated with a decrease in HAZ of 0·2 (95 % CI 0·05, 0·39) and decrease in WAZ of 0·1 (95 % CI 0·03, 0·27).

Our results from a nationally representative sample confirm the previously reported association of household food insecurity with stunting and underweight. Community nutrition interventions may use household food insecurity scales for identifying those households where children may be at risk of growth faltering.

To estimate the average annual rates of reduction of stunting, underweight and wasting for the period 1996 to 2011, and to evaluate whether Bangladesh will be expected to achieve the target of Millennium Development Goal 1C of reducing the prevalence of underweight by half by 2015.

We used five nationwide, cross-sectional, Demographic and Health Survey data sets to estimate prevalence of undernutrition defined by stunting, underweight and wasting among children under 5 years of age using the WHO child growth standards. We then computed the average annual rates of reduction of prevalence of undernutrition using the formula derived by UNICEF. Finally, we projected the prevalence of undernutrition for the year 2015 using the estimated average annual rates of reduction.

Nationwide covering Bangladesh.

Children under 5 years of age (n 28 941).

The prevalence of stunting decreased by 18·8 % (from 60·0 % to 41·2 %), underweight by 16·0 % (from 52·2 % to 36·2 %) and wasting by 5·1 % (from 20·6 % to 15·5 %) during 1996 to 2011. The overall average annual rates of reduction were 2·84 %, 2·69 % and 2·47 %, respectively, for stunting, underweight and wasting. We forecast that in 2015, the prevalence of stunting, underweight and wasting will be 36·7 %, 32·5 % and 14·0 %, respectively, at the national level. The prevalence of undernutrition is likely to remain high in rural areas, in the Sylhet division and in the poorest wealth quintile.

Bangladesh is likely to achieve the Millennium Development Goal 1C target of reducing the prevalence of underweight by half by 2015. However, it is falling behind in reducing stunting and further investment is needed to reduce individual, household and environmental determinants of stunting in Bangladesh.

To compare the iodine status of pregnant women and their children who were sharing all meals in Bangalore, India.

A cross-sectional study evaluating demographic characteristics, household salt iodine concentration and salt usage patterns, urinary iodine concentrations (UIC) in women and children, and maternal thyroid volume (ultrasound).

Antenatal clinic of an urban tertiary-care hospital, which serves a low-income population.

Healthy pregnant women in all trimesters, aged 18–35 years, who had healthy children aged 3–15 years.

Median (range) iodine concentrations of household powdered and crystal salt were 55·9 (17·2–65·9) ppm and 18·9 (2·2–68·2) ppm, respectively. The contribution of iodine-containing supplements and multi-micronutrient powders to iodine intake in the families was negligible. Adequately iodized salt, together with small amounts of iodine in local foods, were providing adequate iodine during pregnancy: (i) the overall median (range) UIC in women was 172 (5–1024) µg/l; (ii) the median UIC was >150 µg/l in all trimesters; and (iii) thyroid size was not significantly different across trimesters. At the same time, the median (range) UIC in children was 220 (10–782) µg/l, indicating more-than-adequate iodine intake at this age. Median UIC was significantly higher in children than in their mothers (P=0·008).

In this selected urban population of southern India, the iodized salt programme provides adequate iodine to women throughout pregnancy, at the expense of higher iodine intake in their children. Thus we suggest that the current cut-off for median UIC in children indicating more-than-adequate intake, recommended by the WHO/UNICEF/International Council for the Control of Iodine Deficiency Disorders may, need to be reconsidered.

The current study examines the impact of a nutrition rating system on consumers’ food purchases in supermarkets.

Aggregate sales data for 102 categories of food (over 60 000 brands) on a weekly basis for 2005–2007 from a supermarket chain of over 150 stores are analysed. Change in weekly sales of nutritious and less nutritious foods, after the introduction of a nutrition rating system on store shelves, is calculated, controlling for seasonality and time trends in sales.

One hundred and sixty-eight supermarket stores in the north-east USA, from January 2005 to December 2007.

Consumers purchasing goods at the supermarket chain during the study period.

After the introduction of the nutrition ratings, overall weekly food sales declined by an average of 3637 units per category (95 % CI –5961, –1313; P<0·01). Sales of less nutritious foods fell by 8·31 % (95 % CI –13·50, –2·80 %; P=0·004), while sales of nutritious foods did not change significantly (P=0·21); as a result, the percentage of food purchases rated as nutritious rose by 1·39 % (95 % CI 0·58, 2·20 %; P<0·01). The decrease in sales of less nutritious foods was greatest in the categories of canned meat and fish, soda pop, bakery and canned vegetables.

The introduction of the nutrition ratings led shoppers to buy a more nutritious mix of products. Interestingly, it did so by reducing purchases of less nutritious foods rather than by increasing purchases of nutritious foods. In evaluating nutrition information systems, researchers should focus on the entire market basket, not just sales of nutritious foods.

To provide an overview of beverage consumption patterns using the first nationally representative survey of dietary intake in Brazil.

Beverage consumption data were obtained by 1 d food records in an individual dietary survey.

Nationwide cross-sectional survey, 2008–2009.

Nationally representative sample of individuals aged ≥10 years (n 34 003).

Beverages contributed 17·1 % of total energy consumption. Caloric coffee beverages provided the greatest level of energy overall (464 kJ (111 kcal)/d). Individuals aged 10–18 years (243 kJ (58 kcal)/d) and 19–39 years (230 kJ (55 kcal)/d) consumed a higher proportion of energy from sugar-sweetened soft drinks than individuals over this age (142 kJ (34 kcal)/d for those aged 40–59 years and 79 kJ (19 kcal)/d for those aged ≥60 years).

Overall, the contribution of beverages, particularly sugary beverages, to total energy consumption in Brazil represents an important public health challenge and is comparable with those from other countries.

To characterize energy and macronutrient intakes in Brazil and to describe the top food items contributing to energy and macronutrient intakes.

Two non-consecutive 24 h dietary records were collected and energy and macronutrient data were adjusted for usual intake distribution. Descriptive statistics and ANOVA with the Bonferroni post hoc test were analysed using SAS version 9·1. Means and standard deviations were estimated for sex, age and income strata.

Nationwide cross-sectional survey, 2008–2009.

Nationally representative sample of individuals ≥10 years old (n32 749), excluding pregnant and lactating women (n 1254).

The average energy intake was 7958 kJ/d (1902 kcal/d) and mean energy density was 6·82 kJ/g (1·63 kcal/g). Added sugar represented 13 % of total energy intake and animal protein represented 10 %. The mean contribution of total fat to energy intake was 27 %, while the mean saturated fat contribution was 9 %. Compared with the lowest quartile of income, individuals in the highest income quartile had greater mean intakes of energy, added sugar, alcohol, animal protein, total fat, saturated fat, monounsaturated fat and trans fat. Rice, beans, beef, bread and coffee were among the top five foods contributing most to the intakes of energy, carbohydrates, protein, fat and fibre.

In general, Brazilians’ dietary intake is compatible with a high risk of obesity and non-communicable chronic diseases, being characterized by high intakes of added sugar and saturated fat. Income may be a major determinant of diet nutritional characteristics.

Research about the prevalence of underweight and overweight/obesity in the Saudi Arabian female population is limited. The aim of the present study was to examine the dietary habits and the prevalence of underweight and overweight/obesity and associated factors among female university students.

A cross-sectional study.

A university centre for female students in south-western Saudi Arabia.

The study involved 663 randomly selected female university students who self-reported their physical activities, nutritional habits and socio-economic factors. Multiple linear and logistic regression analyses were used to identify factors associated with the students’ BMI, dietary variables, underweight and overweight/obesity.

The majority of the university females were normal weight (56·9 %), but a high prevalence of underweight (19·2 %) and overweight/obesity (23·8 %) occurred. Social factors significantly associated with BMI were the presence of obese parents and siblings as well as physical activity levels, marital status, number of sisters, father’s level of education and more frequent intake of French fries/potato chips (>3 times/week). Several variables were found to correlate with dietary habits, underweight and overweight/obesity. Of special interest is the association between the number of siblings and the participants’ BMI and dietary intake in both negative and positive ways.

The findings of this research have implications for health promotion and prevention of malnutrition among college-aged females. Health-care providers and policy makers need to involve the whole family when promoting females’ physical activity. The study serves as an evidence-based background for planning and implementation of interventions targeting improvement of highly educated populations’ nutritional habits.

To compare commonly used dietary screeners for fat intake and fruit and vegetable intake with 24 h dietary recalls among low-income, overweight and obese African-American women.

Three telephone interviews were completed; measures included two 24 h dietary recalls (a weekday and weekend day) using the Nutrition Data System for Research software, the Behavioral Risk Factor Surveillance System’s (BRFSS) Fruit and Vegetable Consumption Module and the National Cancer Institute’s (NCI) Percentage Energy from Fat Screener.

Participants were recruited from three federally qualified health centres in south-west Georgia, USA.

Participants (n 260) were African-American women ranging in age from 35 to 65 years. About half were unemployed (49·6 %) and 58·7 % had a high-school education or less. Most were obese (88·5 %), with 39·6 % reporting a BMI≥40·0 kg/m2.

Mean fruit and vegetable intake reported from the 24 h dietary recall was 2·66 servings/d compared with 2·79 servings/d with the BRFSS measure. The deattenuated Pearson correlation was 0·22, with notable variation by weight status, education level and age. Mean percentage of energy from fat was 35·5 % as reported from the 24 h dietary recall, compared with 33·0 % as measured by the NCI fat screener. The deattenuated Pearson correlation was 0·38, also with notable variation by weight status, education level and age.

Validity of brief dietary intake measures may vary by demographic characteristics of the sample. Additional measurement work may be needed to accurately measure dietary intake in obese African-American women.

The aims of the present study were to examine the Zn intake and characteristics of Zn supplement users and non-users and to survey Zn supplements that are commercially available.

Cross-sectional national nutrition survey (2007 Australian Children’s Nutrition and Physical Activity Survey) and a review of commercially available Zn supplements.

Australia.

Children (n 4834) aged 2–16 years.

Zn supplement use was associated with younger age, being female, having a lower BMI and consuming a vegetarian or modified diet. Supplement users had significantly higher intakes of Zn than non-users in all age and gender subgroups. Adolescent boys aged 14–16 years who did not use Zn supplements were at highest risk of inadequate Zn intake (15 % compared with 1 % of users). Conversely, children aged 2–3 years were at highest risk of exceeding the recommended upper limit of Zn intake (86–87 % of users and 64–71 % of non-users), followed by children aged 4–8 years (9–29 % of users and 3–12 % of non-users). The most common sources of Zn supplements consumed by children were multi-vitamin and mineral preparations (92 %), followed by Zn-only supplements (5 %) and Zn-containing cold and flu, or cold sore supplements (3 %). A survey of commercially available Zn supplements revealed that the median elemental Zn content was 2 and 25 mg for multi-vitamin and mineral preparations and Zn-only supplements, respectively.

Based on these data, widespread Zn supplement use among young children is unlikely to be warranted. The impact of exceeding the upper limit of Zn intake on biomarkers of Zn toxicity requires further investigation.

Measurements of length at birth, or in the neonatal period, are challenging to obtain and often discounted for lack of validity. Hence, classical ‘under-5’ stunting rates have been derived from surveys on children from 6 to 59 months of age. Guatemala has a high prevalence of stunting (49·8 %), but the age of onset of growth failure is not clearly defined. The objective of the study was to assess length-for-age within the first 1·5 months of life among Guatemalan infants.

As part of a cross-sectional observational study, supine length was measured in young infants. Mothers’ height was measured. Length-for-age Z-scores (HAZ) were generated and stunting was defined as HAZ <−2 using WHO growth standards.

Eight rural, indigenous Mam-Mayan villages (n 200, 100 % of Mayan indigenous origin) and an urban clinic of Quetzaltenango (n 106, 27 % of Mayan indigenous origin), Guatemala.

Three hundred and six newborns with a median age of 19 d.

The median rural HAZ was −1·56 and prevalence of stunting was 38 %; the respective urban values were −1·41 and 25 %. Linear regression revealed no relationship between infant age and HAZ (r=0·101, r2=0·010, P=0·077). Maternal height explained 3 % of the variability in HAZ (r=0·171, r2=0·029, P=0·003).

Stunting must be carried over from in utero growth retardation in short-stature Guatemalan mothers. As linear growth failure in this setting begins in utero, its prevention must be linked to maternal care strategies during gestation, or even before. A focus on maternal nutrition and health in an intergenerational dimension is needed to reduce its prevalence.