To present and discuss the dietary guidelines issued by the Brazilian government in 2014.

The present paper describes the aims of the guidelines, their shaping principles and the approach used in the development of recommendations. The main recommendations are outlined, their significance for the cultural, socio-economic and environmental aspects of sustainability is discussed, and their application to other countries is considered.

Brazil in the twenty-first century.

All people in Brazil, now and in future.

The food- and meal-based Brazilian Dietary Guidelines address dietary patterns as a whole and so are different from nutrient-based guidelines, even those with some recommendations on specific foods or food groups. The guidelines are based on explicit principles. They take mental and emotional well-being into account, as well as physical health and disease prevention. They identify diet as having cultural, socio-economic and environmental as well as biological and behavioural dimensions. They emphasize the benefits of dietary patterns based on a variety of natural or minimally processed foods, mostly plants, and freshly prepared meals eaten in company, for health, well-being and all relevant aspects of sustainability, as well as the multiple negative effects of ready-to-consume ultra-processed food and drink products.

The guidelines’ recommendations are designed to be sustainable personally, culturally, socially, economically and environmentally, and thus fit to face this century. They are for foods, meals and dietary patterns of types that are already established in Brazil, which can be adapted to suit the climate, terrain and customs of all countries.

Energy (calorie) ranges currently appear on menu boards for customized menu items and will likely appear throughout the USA when menu-labelling legislation is implemented. Consumer welfare advocates have questioned whether energy ranges enable accurate energy estimates. In four studies, we examined: (i) whether energy range information improves energy estimation accuracy; (ii) whether misestimates persist because consumers misinterpret the meaning of the energy range end points; and (iii) whether energy estimates can be made more accurate by providing explicit information about the contents of items at the end points.

Four studies were conducted, all randomized experiments.

Study 1 took place outside a Chipotle restaurant. Studies 2 to 4 took place online.

Participants in study 1 were customers exiting a Chipotle restaurant (n 306). Participants in studies 2 (n 205), 3 (n 290) and 4 (n 874) were from an online panel.

Energy ranges reduced energy misestimation across different menu items (studies 1–4). One cause of remaining misestimation was misinterpretation of the low end point’s meaning (study 2). Providing explicit information about the contents of menu items associated with energy range end points further reduced energy misestimation (study 3) across different menu items (study 4).

Energy range information improved energy estimation accuracy and defining the meaning of the end points further improved accuracy. We suggest that when restaurants present energy range information to consumers, they should explicitly define the meaning of the end points.

Women (especially mothers) are theorized as critical to reducing household food insecurity through their work and caregiver roles. The present study tests these assumptions, assessing how maternal economic and social resources are associated with food insecurity in households with young children.

Data from a population-based sample of households was collected in León, Nicaragua (n 443). Data include a newly validated measure of household food insecurity (ELCSA), maternal resource measures, and household economic status and demographics. Regression analysis tests the statistical associations (P<0·05) of maternal resources with household, adult-specific and child-specific food insecurity.

Municipality of León, Nicaragua.

Households with children aged 3–11 years in rural and urban León.

Only 25 % of households with young children were food secure, with 50 % mildly food insecure and 25 % moderately/severely food insecure. When mothers contributed substantially to household income, the odds of moderate/severe household food insecurity were 34 % lower than when their spouse/partner was the main provider. The odds of food insecurity were 60 % lower when mothers managed household money, 48 % lower when mothers had a secondary (v. primary) education, 65 % higher among single mothers and 16 % lower with each indicator of social support. Results were similar for adult- and child-specific food insecurity.

This research provides new evidence that maternal economic and social resources are important for reducing household food insecurity and adult- and child-specific food insecurity. Women’s social status, social support and access to economic resources need to be enhanced as a part of policies aimed to reduce food insecurity in high-poverty settings.

To compare women's diets with recommended intakes from the new Australian Dietary Guidelines (ADG 2013).

Cross-sectional study using data from the Australian Longitudinal Study on Women's Health. Diet was assessed using a validated FFQ.

Two nationally representative age cohorts of Australian women.

Women in the young cohort (born 1973–1978, aged 31–36 years) and mid-age cohort (born 1946–1951, aged 50–55 years). Women (n 18 226) were categorised into three groups: ‘young women’ (n 5760), young ‘pregnant women’ at the time or who had given birth in the 12 months prior to the survey (n 1999) and ‘mid-age women’ (n 10 467).

Less than 2 % of women in all three groups attained the ADG 2013 recommendation of five daily servings of vegetables, with the majority needing more than two additional servings. For young women, less than one-third met recommendations for fruit (32%) and meat and alternatives (28 %), while only a small minority did so for dairy (12 %) and cereals (7 %). Fifty per cent of pregnant women met guidelines for fruit, but low percentages reached guidelines for dairy (22 %), meat and alternatives (10 %) and cereals (2·5 %). For mid-age women, adherence was higher for meat and alternatives (41 %) and cereals (45 %), whereas only 1 % had the suggested dairy intake of four daily servings.

For most women to follow ADG 2013 recommendations would require substantially increased consumption of cereals, vegetables and dairy. Findings have implications for tailoring the dissemination of dietary guidelines for women in different age groups and for pregnant women.

To utilize complementary biochemical and dietary data collected before the initiation of national flour fortification to (i) identify micronutrient insufficiencies or deficiencies and dietary inadequacies in Palestinian women and children in vulnerable communities and (ii) assess the suitability of the current wheat flour fortification formula.

Quantitative dietary intake questionnaires were administered and fasting venous blood samples collected in randomly selected households in Gaza City and Hebron. The impact of fortification was simulated by estimating the additional micronutrient content of fortified wheat flour.

Households in Gaza City and Hebron that were not receiving food aid from social programmes.

Non-pregnant women (18–49 years) and children aged 36–83 months.

The micronutrients with highest prevalence of insufficiency were vitamin D in women (84–97 % with serum 25-hydroxyvitamin D <50 nmol/l) and vitamin B12 in women and children (43–82 % with serum B12 <221 pmol/l). Deficiencies of vitamin A, Fe and Zn were also of public health concern. Current levels of wheat flour fortificants were predicted to improve, but not eliminate, micronutrient intake inadequacies. Modification of fortificant concentrations of vitamin D, thiamin, vitamin B12, Zn and folic acid may be indicated.

Micronutrient insufficiencies or deficiencies and intake inadequacies were prevalent based on either biochemical or dietary intake criteria. Adjustments to the current fortification formula for wheat flour are necessary to better meet the nutrient needs of Palestinian women and children.

Vitamin A deficiency is a serious health problem in Bangladesh. The 2011–12 Bangladesh Micronutrient Survey found 76·8 % of children of pre-school age were vitamin A deficient. In the absence of nationally representative, individual dietary assessment data, we use an alternative – household income and expenditure survey data – to estimate the potential impact of the introduction of vitamin A-fortified vegetable oil in Bangladesh.

Items in the household income and expenditure survey were matched to food composition tables to estimate households’ usual vitamin A intakes. Then, assuming (i) the intra-household distribution of food is in direct proportion to household members’ share of the household’s total adult male consumption equivalents, (ii) all vegetable oil that is made from other-than mustard seed and that is purchased is fortifiable and (iii) oil fortification standards are implemented, we modelled the additional vitamin A intake due to the new fortification initiative.

Nationwide in Bangladesh.

A weighted sample of 12240 households comprised of 55580 individuals.

Ninety-nine per cent of the Bangladesh population consumes vegetable oil. The quantities consumed are sufficiently large and, varying little by socio-economic status, are able to provide an important, large-scale impact. At full implementation, vegetable oil fortification will reduce the number of persons with inadequate vitamin A intake from 115 million to 86 million and decrease the prevalence of inadequate vitamin A intake from 80 % to 60 %.

Vegetable oil is an ideal fortification vehicle in Bangladesh. Its fortification with vitamin A is an important public health intervention.

To examine the acceptability and feasibility of using smartphone technology to assess beverage intake and evaluate whether the feasibility of smartphone use is greater among key sub-populations.

An acceptability and feasibility study of recording the video dietary record, the acceptability of the ecological momentary assessment (EMA), wearing smartphones and whether the videos helped participants recall intake after a cross-over validation study.

Rural and urban area in Shanghai, China.

Healthy adults (n 110) aged 20–40 years old.

Most participants reported that the phone was acceptable in most aspects, including that videos were easy to use (70 %), helped with recalls (77 %), EMA reminders helped them record intake (75 %) and apps were easy to understand (85 %). However, 49 % of the participants reported that they had trouble remembering to take videos of the beverages before consumption or 46 % felt embarrassed taking videos in front of others. Moreover, 72 % reported that the EMA reminders affected their consumption. When assessing overall acceptability of using smartphones, 72 % of the participants were favourable responders. There were no statistically significant differences in overall acceptability for overweight v. normal-weight participants or for rural v. urban residents. However, we did find that the overall acceptability was higher for males (81 %) than females (61 %, P=0·017).

Our study did not find smartphone technology helped with dietary assessments in a Chinese population. However, simpler approaches, such as using photographs instead of videos, may be more feasible for enhancing 24 h dietary recalls.

Obtaining valid, reliable measures of food environments that serve Latino communities is important for understanding barriers to healthy eating in this at-risk population.

The primary aim of the study was to examine agreement between retail food outlet data from two commercial databases, Nielsen TDLinx (TDLinx) for food stores and Dun & Bradstreet (D&B) for food stores and restaurants, relative to field observations of food stores and restaurants in thirty-one census tracts in Durham County, NC, USA. We also examined differences by proportion of Hispanic population (</≥23·4 % Hispanic population) in the census tract and for outlets classified in the field as ‘Latino’ on the basis of signage and use of Spanish language.

One hundred and seventy-four food stores and 337 restaurants in Durham County, NC, USA.

We found that overall sensitivity of food store listings in TDLinx was higher (64 %) than listings in D&B (55 %). Twenty-five food stores were characterized by auditors as Latino food stores, with 20 % identified in TDLinx, 52 % in D&B and 56 % in both sources. Overall sensitivity of restaurants (68 %) was higher than sensitivity of Latino restaurants (38 %) listed in D&B. Sensitivity did not differ substantially by Hispanic composition of neighbourhoods.

Our findings suggest that while TDLinx and D&B commercial data sources perform well for total food stores, they perform less well in identifying small and independent food outlets, including many Latino food stores and restaurants.

The present research was an experimental test that aimed to quantify the impact of two dominant front-of-pack (FOP) nutritional label formats on consumer evaluations of food products that carried them. The two FOP label types tested were the traffic light label and the Percentage Daily Intake.

A 4×5 partially replicated Latin square design was used that allowed the impact of the FOP labels to be isolated from the effects of the product and the consumers who were performing the evaluations.

The experiment was conducted on campus at the University of Otago, New Zealand.

The participants were 250 university students selected at random who met qualifying criteria of independent living and regular purchase of the products used in the research. They were not aware of the purpose of the research.

The presence of FOP labels led to significant and positive changes in consumer purchase intentions towards the products that carried them. These changes were not affected by the nature of FOP labels used, their size or the product nutritional status (good/bad) that they were reporting.

The result is consistent with the participants paying attention to the FOP label and then using it as an adimensional cue indicating product desirability. As such, it represents a complete functional failure of both of these FOP label types in this specific instance. This result supports calls for further research on the performance of these FOP labels before any move to compulsory deployment is made.

To determine whether food label information and advertisements for foods containing no fruit cause children to have a false impression of the foods’ fruit content.

In the food label condition, a trained researcher showed each child sixteen different food label photographs depicting front-of-food label packages that varied with regard to fruit content (i.e. real fruit v. sham fruit) and label elements. In the food advertisement condition, children viewed sixteen, 30 s television food advertisements with similar fruit content and label elements as in the food label condition. After viewing each food label and advertisement, children responded to the question ‘Did they use fruit to make this?’ with responses of yes, no or don’t know.

Schools, day-care centres, after-school programmes and other community groups.

Children aged 4–7 years.

In the food label condition, χ2 analysis of within fruit content variation differences indicated children (n 58; mean age 4·2 years) were significantly more accurate in identifying real fruit foods as the label’s informational load increased and were least accurate when neither a fruit name nor an image was on the label. Children (n 49; mean age 5·4 years) in the food advertisement condition were more likely to identify real fruit foods when advertisements had fruit images compared with when no image was included, while fruit images in advertisements for sham fruit foods significantly reduced accuracy of responses.

Findings suggest that labels and advertisements for sham fruit foods mislead children with regard to the food’s real fruit content.

To develop and validate a novel FFQ to assess the daily intake of four methyl-group donors (methionine, choline, betaine and folate).

The relative validity of the FFQ was assessed by comparison with 7 d estimated diet records (n 80) and its reproducibility was evaluated by repeated administrations 6 weeks apart (n 92). Paired Student t tests were used to compare group means and de-attenuated intra-class correlations to investigate the ability of the FFQ to rank individuals according to their methyl-group donor intake. De-attenuated intra-class correlation coefficients were calculated between the test and reference method for methionine, choline, betaine, folate and the sum of methyl-group donors. The weighted kappa (κw) was calculated as a measure of tertile agreement.

Flanders, Belgium.

The FFQ was validated among Flemish women of reproductive age (18–35 years).

The questionnaire had an acceptable ranking ability (r=0·32–0·68; κw=0·10–0·35), but overestimated the daily intake of folate (280·6 μg v. 212·0 μg) and betaine (179·1 mg v. 147·0 mg) compared with the 7 d estimated diet record. Cross-classification analysis indicated that 20 % (choline) of the participants were grossly misclassified in the validation study. The correlation between repeated administrations was good (r=0·62–0·83) with a maximal misclassification of 7 % for betaine (κw=0·44–0·66).

These results indicate that this newly developed FFQ is a reliable instrument with acceptable validity for ranking individuals according to methyl-group donor intake (except for a poor agreement for choline (κw=0·10) and a fair ranking ability for betaine (r=0·32)) in Flemish women of reproductive age.

To verify the association between perceived social support and household food insecurity (HFI).

A cross-sectional survey.

A population-based study with a representative sample of households from a metropolitan area of Rio de Janeiro, Brazil, conducted in 2010. HFI was estimated with the Brazilian Food Insecurity Scale (EBIA). Social support was assessed using the adapted and validated Brazilian version of the Medical Outcomes Study Social Support Survey. Multinomial logistic regression was used to evaluate the association between social support and HFI, adjusting for potential confounders.

Adults (n 1022) aged 19–60 years old (27 % men, 73 % women) who were responsible for feeding the household.

Individuals with high scores of social support were less likely to experience moderate HFI (OR=0·96; 95 % CI 0·94, 0·99) and severe HFI (OR=0·96; 95 % CI 0·94, 0·98).

These findings indicate that social support may contribute to reducing HFI in populations vulnerable to poverty. Strategies to increase social relationships should be encouraged in this group to enhance their perceived social support.

To construct and evaluate an independent Children’s Index of Diet Quality (CIDQ).

A food consumption questionnaire, which contained twenty-five multiple-item questions on eating and food intake, was formulated and evaluated against 7 d food records. Key questions that best reflected a healthy diet, defined in criteria set by the nutrient recommendations, were searched and validated by correlation and analyses of receiver-operating characteristic curves.

A cohort of a young population of South-West Finland.

Participants (n 400) were 2–6-year-old children.

Fifteen questions were identified to best depict the children’s diet quality in reference to the recommendations. These questions were scored, summarized and further constructed into a three-class index (good, moderate and poor dietary quality) where higher scores depicted better diet quality. The CIDQ cut-off score of 14 points for good dietary quality had a sensitivity of 0·59 and a specificity of 0·82 and the cut-off score of 10 points, for at least moderate dietary quality, had a sensitivity of 0·77 and a specificity of 0·69. Higher index scores were related to higher dietary intakes of several vitamins, lower dietary intakes of SFA and cholesterol, and further with lower serum cholesterol and higher serum vitamin C concentrations.

The three-class food index was found to represent diet quality as defined in recommendations and evaluated against nutrient intakes from food diaries and biochemical markers. This self-standing index could provide an effective and low-burden method to obtain information about diet quality and guide future recommendations.

To illustrate the impact of intake-related bias in FFQ and 24 h recall (24hR), and correlated errors between these methods, on intake–health associations.

Dietary intake was assessed by a 180-item semi-quantitative FFQ and two 24hR. Urinary N and urinary K were estimated from two 24 h urine samples. We compared four scenarios to correct associations for errors in an FFQ estimating protein and K intakes.

Wageningen, The Netherlands.

Fifty-nine men and fifty-eight women aged 45–65 years.

For this FFQ, measurement error weakened a true relative risk of 2·0 to 1·4 for protein and 1·5 for K. As compared with calibration to duplicate recovery biomarkers (i.e. the preferred scenario 1), estimating a validity coefficient using this duplicate biomarker resulted in overcorrected associations, caused by intake-related bias in the FFQ (scenario 2). The correction factor based on a triad using biomarkers and 24hR was hampered by this intake-related bias and by correlated errors between FFQ and 24hR, and in this population resulted in a nearly perfect correction for protein but an overcorrection for K (scenario 3). When the 24hR was used for calibration, only a small correction was done, due to correlated errors between the methods and intake-related bias in the 24hR (scenario 4).

Calibration to a gold standard reference method is the preferred approach to correct intake–health associations for FFQ measurement error. If it is not possible to do so, using the 24hR as reference method only partly removes the errors, but may result in improved intake–health associations.

Changes to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) occurred in 2009 when supplemental foods offered through the programme were updated to align with current dietary recommendations. The present study reports on a new index developed to monitor the retail environment’s adoption of these new food supply requirements in New Orleans.

A 100-point WIC Availability Index (WIC-AI) was derived from new minimum state stocking requirements for WIC vendors. A sample of supermarkets, medium and small food stores was assessed in 2009 before changes were implemented and in 2010 after revisions had gone into effect. WIC-AI scores were utilized to compare differences in meeting requirements by store type, WIC vendor status and year of measurement.

Supermarkets, medium and small WIC and non-WIC food stores in New Orleans, Louisiana, USA.

At baseline supermarkets had the highest median WIC-AI score (93·3) followed by medium (69·8) and small food stores (48·0). Small WIC stores had a higher median WIC-AI score at baseline than small non-WIC stores (66·9 v. 38·0). Both medium and small WIC stores significantly increased their median WIC-AI scores between 2009 and 2010 (P<0·01). The increased median WIC-AI score in small food stores was largely attributed to increased availability of cereals and grains, juices and fruit, and infant fruit and vegetables.

The WIC-AI is a simple tool useful in summarizing complex food store environment data and may be adapted for use in other states or a national level to inform food policy decisions and direction.

We aimed to evaluate the reproducibility and validity of the newly developed FFQ for the Korean National Health and Nutrition Examination Survey (KNHANES) and to estimate the measure’s calibration factors.

The 109-item FFQ was administered twice, approximately 9 months apart. We also collected four seasonal 3 d dietary records (DR) as a reference method. Correlation coefficients and joint classification were computed to compare intakes of energy, thirteen nutrients and eleven food groups between the two FFQ to evaluate reproducibility. For validity, de-attenuated and energy-adjusted correlation, joint classification and Bland–Altman statistics were calculated for energy and nutrients between the first FFQ and the DR. To calibrate the FFQ, we performed a linear regression analysis in which the DR were the dependent variables and FFQ, age and sex were the independent variables.

Seoul metropolitan area, Republic of Korea.

A total of 126 adults aged 20–65 years.

The average correlation coefficients measuring reproducibility were 0·54 for nutrients and 0·57 for food groups. The mean correlation coefficient measuring validity was 0·40 for all nutrients between the first FFQ and the DR. On average, 75 % of the participants were classified into the same or adjacent quartiles, while 5 % of the participants were grossly misclassified. The mean energy and nutrient intakes estimated by the calibrated FFQ were similar to the means estimated by the DR.

The newly developed FFQ for assessing dietary intake in the KNHANES has acceptable reproducibility and modest validity compared with a 12 d DR collected over a 9-month period.

To examine the relative validity of an FFQ based on parental report for pre-school children in the mother–child ‘Rhea’ birth cohort.

The children’s mothers completed an FFQ that referred to the children’s dietary intake for the previous year by telephone interview. Mothers completed also three food records, two on weekdays and one on a weekend day. Spearman correlation coefficients were calculated for the energy-adjusted values. Weighted kappa statistics (κw) and the Bland–Altman technique were used to test the degree of agreement between the two dietary methods.

Heraklion, Crete, Greece, 2011–2012.

A total of ninety-nine mothers (corresponding to fifty-one boys and forty-eight girls) participated in the validation study.

The mean and median values of all food group and nutrient intakes did not differ significantly between the two dietary methods. Overall, fair agreement was observed between the FFQ and the food records for ranking participants based on their intake, with κw ranging from 0·21 to 0·40 for most foods and nutrients. On average, 88 % of participants were classified into the same or adjacent tertiles for nutrient and food group intakes by both dietary methods. The degree of agreement was also confirmed by the visual examination of the Bland–Altman plots.

The study indicates that the Rhea 4 years FFQ is a relatively accurate tool for assessing habitual food group and nutrient intakes among pre-school children in Crete, Greece.

To investigate how consumption of ultra-processed foods has changed in Sweden in relation to obesity.

Nationwide ecological analysis of changes in processed foods along with corresponding changes in obesity. Trends in per capita food consumption during 1960–2010 were investigated using data from the Swedish Board of Agriculture. Food items were classified as group 1 (unprocessed/minimally processed), group 2 (processed culinary ingredients) or group 3 (3·1, processed food products; and 3·2, ultra-processed products). Obesity prevalence data were pooled from the peer-reviewed literature, Statistics Sweden and the WHO Global Health Observatory.

Nationwide analysis in Sweden, 1960–2010.

Swedish nationals aged 18 years and older.

During the study period consumption of group 1 foods (minimal processing) decreased by 2 %, while consumption of group 2 foods (processed ingredients) decreased by 34 %. Consumption of group 3·1 foods (processed food products) increased by 116 % and group 3·2 foods (ultra-processed products) increased by 142 %. Among ultra-processed products, there were particularly large increases in soda (315 %; 22 v. 92 litres/capita per annum) and snack foods such as crisps and candies (367 %; 7 v. 34 kg/capita per annum). In parallel to these changes in ultra-processed products, rates of adult obesity increased from 5 % in 1980 to over 11 % in 2010.

The consumption of ultra-processed products (i.e. foods with low nutritional value but high energy density) has increased dramatically in Sweden since 1960, which mirrors the increased prevalence of obesity. Future research should clarify the potential causal role of ultra-processed products in weight gain and obesity.

Many colleges are removing trays from their dining facilities in hope of reducing waste. How does not having a tray impact food choice?

A field study was conducted in a university cafeteria (n 417) on two evenings with identical menus, one with tray service and one without.

A dining hall of a large north-eastern university, USA.

Undergraduate students.

Trayless dining decreased the percentage of diners (average age 19·1 years) who took salad by 65·2 % but did not decrease the percentage who took dessert, leading to a markedly higher ratio of dessert to salad.

Cafeterias going trayless should consider complementary policies to encourage balanced diets.