To evaluate the extent of implementation of public policies aimed at creating healthy eating environments in Senegal compared to international best practice and identity priority actions to address the double burden of malnutrition.

The Healthy Food Environment Policy Index (Food-EPI) was used by a local expert panel to assess the level of implementation of forty-three good practice policy and infrastructure support indicators against international best practices using a Likert scale and identify priority actions to address the double burden of malnutrition in Senegal.

Senegal, West Africa.

A national group of independent experts from academia, civil society, non-governmental organisations and United Nations bodies (n =15) and a group of government experts from various ministries (n =16) participated in the study.

Implementation of most indicators aimed at creating healthy eating environments were rated as ‘low’ compared to best practice (31 on 43, or 72 %). The Gwet AC2 inter-rater reliability was good at 0·75 (95 % CI 0·70, 0·80). In a prioritisation workshop, experts identified forty-five actions, prioritising ten as relatively most feasible and important and relatively most effective to reduce the double burden of malnutrition in Senegal (e.g. develop and implement regional school menus based on local products (expand to fourteen regions) and measure the extent of the promotion of unhealthy foods to children).

Significant efforts remain to be made by Senegal to improve food environments. This project allowed to establish an agenda of priority actions for the government to transform food environments in Senegal to tackle the double burden of malnutrition.

To evaluate the fatty acid profiles and relevant vitamin and mineral compositions of margarine/margarine-like products and butter blend products available in the US marketplace and to compare with butter.

Analysis of the food and nutrient composition information available for margarine/margarine-like products, butter blend products and butter in the 2021 version of the University of Minnesota Nutrition Coordinating Center (NCC) Food and Nutrient Database.

The US retail food marketplace in 2020.

A selection of eighty-three margarine/margarine-like or butter blend products available in the USA in 2020 and regular and whipped butter (both salted and unsalted).

All products contained no or negligible amounts of trans fat. Mean daily values (DV) for SFA per 1 tablespoon ranged from 11 % for margarine/margarine-like tub and squeeze products to 18 % for margarine/margarine-like stick products and butter blend products. In contrast, one tablespoon butter provides 36 % of the DV for SFA. Results from ANOVA comparing the percent of total fat from SFA, PUFA and MUFA by product type indicated significant differences for SFA (P < 0·01) and PUFA (P < 0·01), but not MUFA (P = 0·07).

Leading brands of margarine/margarine-like and butter blend products examined in this study were found to be in greater alignment with current dietary recommendations for fatty acids and cholesterol than butter. Margarine/margarine-like tub and squeeze products were found to be optimal over margarine/margarine-like stick products and butter blend products. Future research should include an examination of private label products.

To assess facility readiness and identify barriers to the facility-based management of childhood severe acute malnutrition (SAM) in public healthcare settings.

Qualitative methods were applied to assess readiness and identify different perspectives on barriers to the facility-based management of children with SAM. Data collection was done using in-depth interviews, key informant interviews, exit interviews and pre-tested observation tools.

Two tertiary care and four district hospitals in Rangpur and Sylhet Divisions of Bangladesh.

Healthcare professionals and caregivers of children with SAM.

Anthropometric tools, glucometer, medicines, F-75, F-100 and national guidelines for facility-based management of childhood SAM were found unavailable in some of the hospitals. Sitting and sleeping arrangements for the caregivers were absent in all of the chosen facilities. We identified a combination of health system and contextual barriers that inhibited the facility-based management of SAM. The health system barriers include inadequate manpower, rapid turnover of staff, increased workload, lack of training and lack of adherence to management protocol. The major facility barriers were insufficient space and unavailability of required equipment, medicines and foods for hospitalised children with SAM. The reluctance of caregivers to complete the treatment regimen, their insufficient knowledge regarding proper feeding, increased number of attendants and poverty of parents were the principal contextual barriers.

The study findings provide insights on barriers that are curbing the facility-based management of SAM and emphasise policy efforts to develop feasible interventions to reduce the barriers and ensure the preparedness of the facilities for effective service delivery.

The Keyhole is an internationally recognised front-of-pack nutrition label, guiding consumers to healthier food options. It indicates products in accordance with specific criteria for dietary fats, sugars, fibres, salt and wholegrains. The objective of this study was to simulate the potential impact of the Keyhole on adolescents’ energy and nutrient intakes by modelling a shift from reported food intakes to foods meeting the Keyhole criteria.

Self-reported dietary intake data were derived from a cross-sectional survey. Multiple replacement scenarios were calculated, where foods meeting the Keyhole criteria replaced reported non-compliant foods with varying proportions of replacement.

Dietary survey ‘Riksmaten Adolescents 2016–2017’ in schools across Sweden.

A nationally representative sample of 3099 adolescents in school years 5, 8 and 11 (55 % girls).

Overall, replacement with foods meeting the Keyhole criteria led to more adolescents meeting nutrition recommendations. Largest median intake improvements were seen for wholegrains (+196 %), SFA (-13 %), PUFA (+17 %) and fibres (+15 %). Smallest improvements were seen for free sugars (-3 %) and salt (-2 %), partly explained by the ineligibility of main food sources of free sugars for the Keyhole, and non-inclusion of ready meals that are often high in salt. Most micronutrient intakes were stable or improved. Unintentional effects included decreases in vitamin A, MUFA and energy intakes. Largest potential improvements in fat and fibre sources were observed in the youngest age group.

A shift to Keyhole alternatives for everyday foods would improve adolescents’ nutrient intakes, even with smaller exchanges.

To compare and evaluate the prevalence of food and beverage marketing on the livestreaming platforms Twitch, Facebook Gaming and YouTube Gaming, as well as examine growth of food and beverage marketing on these platforms over a 17-month period of data collection.

Cross-sectional data were analysed across three livestreaming platforms and six food and beverage categories: alcohol, candy, energy drinks, snacks, sodas and restaurants.

Stream titles of livestreamed events as well as corresponding hours watched on Twitch, Facebook Gaming and YouTube Gaming.

None.

There were significant differences between the use of food and beverage brand mentions in stream titles across all three studied platforms (P < 0·05), as well as hours watched across platforms (P < 0·05). Energy drinks dominated food and beverage brand mentions across platforms, followed by restaurants, soda and snacks. All platforms demonstrated growth over the 17-month data collection period. Post-hoc analyses revealed that the COVID-19 pandemic impacted both immediate and sustained growth across all platforms, with the greatest impact observed on the Twitch platform.

Food and beverage marketing as measured through stream titles is widely prevalent across the three most popular livestreaming platforms, particularly for energy drinks. Food marketing on these platforms experienced growth over the past 17 months which was accelerated substantially by the COVID-19 pandemic. Future work should assess the sustained impact this growth may have on marketing practices and eating behaviour.

As tap water distrust has grown in the USA with greater levels among Black and Hispanic households, we aimed to examine recent trends in not drinking tap water including the period covering the US Flint Water Crisis and racial/ethnic disparities in these trends.

Cross-sectional analysis. We used log-binomial regressions and marginal predicted probabilities to examine US nationally representative trends in tap and bottled water consumption overall and by race/ethnicity.

The National Health and Nutrition Examination Survey data, 2011–2018.

Nationally representative sample of 9439 children aged 2–19 years and 17 268 adults.

Among US children and adults, respectively, in 2017–2018 there was a 63 % (adjusted prevalence ratio (PR): 1·63, 95 % CI (1·25, 2·12), P < 0·001)) and 40 % (PR: 1·40, 95 % CI (1·16, 1·69), P = 0·001)) higher prevalence of not drinking tap water compared to 2013–2014 (pre-Flint Water Crisis). For Black children and adults, the probability of not drinking tap water increased significantly from 18·1 % (95 % CI (13·4, 22·8)) and 24·6 % (95 % CI (20·7, 28·4)) in 2013–2014 to 29·3 % (95 % CI (23·5, 35·1)) and 34·5 % (95 % CI (29·4, 39·6)) in 2017–2018. Among Hispanic children and adults, not drinking tap water increased significantly from 24·5 % (95 % CI (19·4, 29·6)) and 27·1 % (95 % CI (23·0, 31·2)) in 2013–2014 to 39·7 % (95 % CI (32·7, 46·8)) and 38·1 % (95 % CI (33·0, 43·1)) in 2017–2018. No significant increases were observed among Asian or White persons between 2013–2014 and 2017–2018. Similar trends were found in bottled water consumption.

This study found persistent disparities in the tap water consumption gap from 2011 to 2018. Black and Hispanics’ probability of not drinking tap water increased following the Flint Water Crisis.

To explore government support service access, perceived barriers/enablers to menu planning and menu compliance in long day care (LDC) centres in Victoria, Australia, where the Victorian Government-funded Healthy Eating Advisory Service (HEAS) is available to provide free LDC menu planning support.

This is a cross-sectional study design. Data were collected from online surveys with the option of uploading 2 weeks of menus and recipes. Menu compliance was scored for quantity, quality and variety. Barriers/enablers to menu planning guideline implementation were determined using the Theoretical Domains Framework (TDF). Independent t tests, one-way ANOVA and chi-square tests assessed relationships between characteristics, barriers/enablers and menu scores.

Eighty-nine LDC centres that prepare food onsite.

LDC staff responsible for menu planning (n 89) and menus from eighteen centres.

Fifty-five per cent of centres had accessed HEAS. Of eighteen provided menus, only one menu was compliant with menu planning guidelines. HEAS access was associated with higher average scores in four of seven TDF domains, namely knowledge/awareness, skills/role, reinforcement/influence and optimism/intent. There were no correlations between menu score and barriers/enablers; however, menu quality scores were higher for those accessing HEAS.

Childcare-specific government support services may be an important public health nutrition strategy and may improve menu planning guideline implementation as well as menu quality; however, this does not necessarily translate into menu compliance. Research should confirm these findings in larger studies to ascertain uptake of these services. Public health efforts should focus on exploring barriers and enablers to uptake of government support services to increase reach and acceptability.

Sweden updated its legislation on universal free school meals in 2011 and nutrition was explicitly mentioned. The current study (i) describes cross-sectional changes in school lunch nutritional quality during the following eight years and (ii) examines if repeated self-auditing, using a fully automated, online tool (School Food Sweden), based on the implementation strategy of audit and feedback, was associated with improvements.

Both repeated cross-sectional and longitudinal design. Factors associated with meeting nutritional criteria were examined using variance weighted least squares regression and logistic regression.

Sweden.

Primary schools who self-selected to audit meal quality between March 2012 and July 2019.

Almost half of all (ca 4800) primary schools signed up to use the tool and 1500 audited nutritional quality at least once. Repeated cross-sectional analyses showed the proportion meeting the nutritional criteria increased significantly between 2012/13 (11 %) and 2018/19 (34 %). Longitudinally, each additional audit completed increased the odds of meeting the nutritional criteria by 1·30 (CI 1·20, 1·41), controlling for region and time elapsed since the legislative change. In 774 schools with repeat audits, both number of audits and frequency of accessing feedback predicted meeting the nutritional criteria (OR 2·02, CI 1·23, 3·31), even after adjusting for time since the legislative change and days elapsed since previous audit.

Both legislation and self-audit with automatic feedback appear effective in helping schools to improve school meal quality. Self-audit with feedback may be an effective complement to legislation, or a promising alternative in settings where regulation is not an option.

To report on vitamin D status, measured as plasma 25-hydroxyvitamin D concentration (25(OH)D), the prevalence of vitamin D insufficiency and deficiency, and to explore associations between vitamin D status and background characteristics.

Data were collected in a National Dietary Survey, Riksmaten adolescents 2016–2017. The participants completed dietary assessments and questionnaires on the web and wore accelerometers. (25(OH)D) was measured with a MS method.

Representative survey conducted in schools throughout Sweden.

Participants attended school years 5 (Y5, mean age 12. 5 years), 8 (Y8, mean age 14. 5 years) and 11 (Y11, mean age 18 years), and included 1100 participants.

Overall, there was no difference in plasma 25(OH)D between girls and boys. Vitamin D insufficiency differed between the three school years. The prevalence of insufficiency in Y5 was 32 (boys) and 48 (girls) percent, while in Y11 62 (boys) and 43 (girls) percent. The prevalence of deficiency in Y11 was 16 and 15 % in boys and girls, respectively. Being born outside of Sweden was associated with a 10-fold increased risk of being vitamin D deficient. Deficiency was also associated with longer time spent in sedentary intensity, a lower consumption of fortified dairy products and fats and oils.

Vitamin D deficiency was most common in the oldest age group and being born outside of Sweden increased the risk of being deficient. The present study will form a baseline for future follow-up studies of the implementation of a new mandatory vitamin D fortification policy in 2018.

To assess the price promotions offered by major quick service restaurant (QSR) chains in Australia from an obesity prevention perspective.

Cross-sectional audit of ten of the largest QSR chains in Australia. We collected information regarding temporary price promotions and ‘combination deals’ offered by each chain over thirteen consecutive weeks in 2019–2020. We assessed the type of promotions, the magnitude of discount, and the energy content and healthiness of items promoted (based on Victorian Government criteria).

Melbourne, Australia.

Ten major QSR chains.

Temporary price promotions (n 196) and combination deals (n 537 on regular menus, n 36 on children’s menus) were observed across the ten selected QSR chains. In relation to temporary price promotions, the mean magnitude of discount for main menu items (n 75) was 41·7 %. The price reductions and energy content of combination deals varied substantially the by chain, the meal size and the sides/drinks selected as part of the ‘deal’. When the lowest-energy options (e.g. small chips, small sugar-free drink) were included as part of each combination deal, the mean energy content was 2935 kJ, compared to 5764 kJ when the highest-energy options (e.g. large fries, large sugar-sweetened drink) were included. Almost all available products were classified as unhealthy.

Price promotions are ubiquitous in major QSR chains in Australia and provide incentives to consume high levels of energy. The action to restrict price promotions on unhealthy foods and ensure lower-energy default items as part of combination deals should be included as part of efforts to improve population diets and address obesity in Australia.

Outdoor advertisements for food and drink products form a large part of the food environment and they disproportionately promote unhealthy products. However, less is known about the social patterning of such advertisements. The main aim of this study was to explore the socio-economic patterning of food and drink advertising at bus stops in Scotland’s capital city, Edinburgh.

Bus stop advertisements were audited to identify food/drink adverts and classify them by food/drink category (i.e. ‘advert category’). This data were then linked to area-based deprivation and proximity measures. Neighbourhood deprivation was measured using the bus stop x/y co-ordinates, which were converted to postcodes to identify the matching 2012 deprivation level via the Scottish Index of Multiple Deprivation. Distance to schools and leisure centres were also collected using location data. Generalised estimating equations and linear regression analyses were used to assess associations between the promotion of advert categories and deprivation and proximity to schools/leisure centres, respectively.

Edinburgh city, United Kingdom.

561 food/drink advertisements were identified across 349 bus stops, with 8 advertisement categories noted and included in the final analysis, including alcohol, fast food outlets and confectionary. The majority of adverts were for ‘unhealthy’ food and drink categories, however there was no evidence for any socio-economic patterning of these advertisements. There was no evidence of a relationship between advertisements and proximity to schools and leisure centres.

While there is no evidence for food and drink advertising being patterned by neighbourhood deprivation, the scale of unhealthy advertising is an area for policy evaluations and interventions on the control of such outdoor advertising.

We present prevalence estimates and secular trends of stunting, wasting, underweight, and anaemia among children under 5 years of age and low birth weight (LBW) over the period 1985–2019 in West Africa (WA).

Analysis of Demographic and Health Survey (DHS) and World Bank data. DerSimonian–Laird random effect model with the Knapp–Hartung adjustment to the standard error was used to derive overall prevalence estimates. We used fixed effect ordinary least square regression models with cluster robust standard error to conduct time trends analyses.

West Africa.

Children aged 0 to 59 months.

Three distinct periods (1986–1990, 1993–1996 and 1997–2000) of sharp increases in prevalence of all outcomes was observed. After the year 2000, prevalence of all outcomes except LBW started to decline with some fluctuations. LBW prevalence showed a steady increase after 2000. We observed a decline in prevalence of stunting (β = –0·20 %; 95 % CI –0·43 %, 0·03 %), log-wasting (β = –0·02 %; 95 % CI –0·02 %, –0·01 %), log-underweight (β = –0·02 %; 95 % CI –0·03 %, –0·01 %) anaemia (β = –0·44; 95 % CI –0·55 %, –0·34 %), and an increase in LBW (β = 0·06 %; 95 % CI –0·10 %, 0·22 %) in WA over the period. Pooled prevalence of stunting, wasting, underweight, anaemia and LBW in WA for the period 1985–2019 was 26·1 %, 16·4 %, 22·7 %, 76·2 % and 11·3 %, respectively.

Child undernutrition prevalence varied greatly between countries and the year cohorts. We observed marginal reductions in prevalence of all outcomes except anaemia where the reductions were quite striking and LBW where an increase was noted. There is the need for more rigorous and sustained targeted interventions in WA.

A family of nutrient-rich food (NRF) indices was validated against the mean adequacy ratio (MAR) and their associations with obesity were tested.

Cross-sectional study. NRF indices include nutrients to encourage ranging from 6–11 (protein; fibre; vitamin A, vitamin C, vitamin E and vitamin B12; Ca; Fe; K; Mg; Zn) and two nutrients to limit (saturated fat and Na), described as NRFn.2 (where n 6–11), based on reference amount of 100 g or 100 kcal using the NRF index family of algorithms. The percentage of variation in MAR (R 2) was the criteria of index performance. Logistic regression models were applied to predict the association between NRF index and obesity.

Three communities in Zhengzhou city, Henan province, China.

A total of 656 adults were recruited from Henan as the subjects.

The NRF9·2 index, based on nine beneficial nutrients and two nutrients to limit, using the algorithm based on sums and 100 kcal, had the higher R 2 values (R 2 = 0·232). The OR for overweight (defined by BMI) in the 4th quartile (Q4) v. the 1st quartile (Q1) of the NRF9·2 index was 0·61 (95 % CI = 0·37, 0·98) after multiple adjustments.

NRF9·2 index using the algorithm based on sums and 100 kcal gave the best predicted model for diet quality. NRF9·2 index score was associated with overweight defined by BMI, but it was not associated with central obesity. The NRF9·2 index is a valid tool to assess the overall diet quality among adults in Henan province of China.

Monitoring population salt intake is operationally and economically challenging. We explored whether a questionnaire assessment and a prediction of Na intake from spot-urine could replace or complement the recommended measurement of Na in 24-h urine (24-h U).

Compare the agreement of a Na-specific food record checklist (FRCL) and a late-afternoon spot-urine measurement (PM-spot) with 24-h U measurement in estimating Na intake at group level. Each participant’s use of these methods extended over 3 d. Agreement was assessed using mean (95 % CI) differences, linear regression models and Bland–Altman plots.

The validation study was part of a 1-year workplace intervention trial to lower salt intake in Switzerland.

Seventy women and 71 men, aged 21–61 years, completed three FRCL, and acceptable PM-spot and 24-h U samples at baseline (April–October 2015).

Mean Na intake estimates varied slightly across methods (3·5–3·9 g/d). Mean Na intake differences from 24-h U were 0·2 (95 % CI (0, 0·5)) g/d for FRCL and 0·4 (95 % CI (0·2, 0·6)) g/d for PM-spot. Linear regression models and Bland–Altmann plots more clearly depicted differences by sex and discretionary salt use.

Although 24-h U remains the best reference method for monitoring Na intake at the population level, PM-spot and FRCL might be more practical instruments for frequent, periodic Na intake assessments. Population-specific prediction models to estimate 24-h U could be developed and evaluated.

Increasing evidence supports sarcopenia as an important parameter for predicting cardiometabolic risks. The objective of this study was to investigate the relationship between muscle mass, muscle strength, and physical performance, and cardiovascular risk among older community-dwelling adults.

The associations between dynapenia, sarcopenia, and Framingham risk score (FRS) were estimated by multivariate regression models.

Muscle mass is estimated by skeletal muscle mass index using a bioelectrical impedance analysis. Muscle strength is measured by handgrip strength using an analogue isometric dynamometer. Physical performance is measured by gait speed using a 6-m walking distance. Dynapenia was defined as low muscle strength and/or slow gait speed presents with normal muscle mass. The diagnosis of presarcopenia and sarcopenia was based on criteria proposed by the Asian Working Group for Sarcopenia in 2014. The FRS was used for evaluating 10-year coronary heart disease (CHD) risk.

Adults aged 65 years and older who attended health examinations from 2015 to 2017 were recruited.

There were totally 709 subjects enrolled in this study. Dynapenic men (n 47) had 17·70 ± 5·08 % FRS and sarcopenic women (n 74) had 7·74 ± 6·06 % FRS. Participants with presarcopenia had the lowest FRS (men: 15·41 ± 5·35 %; women: 5·25 ± 3·70 %). Men with dynapenia had higher FRS than the presarcopenia group with odds ratio (OR) of 2·52 (95 % confidence interval (CI): 1·03, 6·14). Women with sarcopenia had significantly higher FRS than the presarcopenia group with OR of 2·81 (95 % CI: 1·09, 7·27).

Older dynapenic men and older sarcopenic women had higher risks of 10-year CHD. Presarcopenic older adults had the lowest CHD risk in both genders.

Food insecurity is associated with numerous adverse health outcomes. The US Veterans Health Administration (VHA) began universal food insecurity screening in 2017. This study examined prevalence and correlates of food insecurity among Veterans screened.

Retrospective cross-sectional study using VHA administrative data. Multivariable logistic regression models were estimated to identify sociodemographic and medical characteristics associated with a positive food insecurity screen.

All US Veterans Administration (VA) medical centres (n 161).

All Veterans were screened for food insecurity since screening initiation (July 2017–December 2018).

Of 3 304 702 Veterans screened for food insecurity, 44 298 were positive on their initial screen (1·3 % of men; 2·0 % of women). Food insecurity was associated with identifying as non-Hispanic Black or Hispanic. Veterans who were non-married/partnered, low-income Veterans without VA disability-related compensation and those with housing instability had higher odds of food insecurity, as did Veterans with a BMI < 18·5, diabetes, depression and post-traumatic stress disorder. Prior military sexual trauma (MST) was associated with food insecurity among both men and women. Women screening positive, however, were eight times more likely than men to have experienced MST (48·9 % v. 5·9 %).

Food insecurity was associated with medical and trauma-related comorbidities as well as unmet social needs including housing instability. Additionally, Veterans of colour and women were at higher risk for food insecurity. Findings can inform development of tailored interventions to address food insecurity such as more frequent screening among high-risk populations, onsite support applying for federal food assistance programs and formal partnerships with community-based resources.

To quantify the sector-wide energy and nutritional differences of both adult and children’s restaurant menu items in the UK and the USA in 2018.

Cross-sectional study.

Energy and nutritional information provided on restaurant websites.

Menu items (n 40 902) served by forty-two large UK chains and ninety-six large USA chains.

Mean absolute energy, fat and saturated fat values were higher in USA menu items. For example, the mean adjusted per-item differences of adult menu items between the USA and the UK were 45·6 kcal for energy and 3·2 g for fat. Comparable figures for children’s menu items were 43·7 kcal and 4 g. Compared with UK menu items, USA adult menu items also had higher sugar content (3·2 g, 95 % CI (0·5, 6)), and children’s menu items had higher Na content (181·1 mg, 95 % CI (108·4, 253·7)). Overall, 96·8 % of UK and 95·8 % of USA menu items exceeded recommended levels for at least one of Na, fat, saturated fat or sugars.

Menu items served by large chain restaurants had higher mean absolute levels of energy, fat and saturated fat in the USA compared with the UK. UK adult menu items were also lower in sugars compared with the USA ones and children’s items lower in Na. As more than 95 % of all items were considered to have high levels of at least one nutrient of public health concern in the USA and the UK, improvements in restaurant menu items are needed in both countries.

The purpose of this study was to assess the validity of MEDFICTS (Meats, Eggs, Dairy, Fried foods, fat In baked goods, Convenience foods, fats added at the Table, Snacks) questionnaire in Turkish population.

MEDFICTS questionnaire is a brief dietary assessment tool developed as part of the National Cholesterol Education Program Adult Treatment Panel guidelines, and it measures the adherence to Step 1 and Step 2 diets that are recommended for the prevention and treatment of CVD. MEDFICTS questionnaire was administered with 3-d food record to compare overall dietary fat intake.

This study was conducted at the Hacettepe University (Ankara, Turkey) in 2017.

Subjects were university students, recruited from several departments of Hacettepe University by trained dietitians. A total of 442 adults (249 females and 194 males) between the ages of 18 and 31 years participated in the study. Students with CVD were excluded.

Total fat intake ratio was higher than the recommended level for both males and females (39·4 % and 39·9 %, respectively). Mean MEDCISTS score was 66·3 ± 27·24 points. Total energy, total fat, SFA and cholesterol intakes from 3-d food records within the different MEDFICTS diet groups significantly differed (P < 0·001 for all). Receiver operating characteristics curve analysis demonstrated that a cut-off point of 60 showed 80 % sensitivity and 65 % specificity.

Our data indicate that the MEDFICTS questionnaire is moderately accurate; however, sensitivity analysis did not demonstrate the recommended 40 points as an optimal cut-off point for Turkish population.