To use an innovative mixed-method approach to analyse and describe 8–10-year-olds’ home and school food environments.

A mixed-method approach to collect qualitative and quantitative data was used, in which pupils took photographs over four days to record their food intake and food environment. The photographs were discussed in focus groups. A combination of lunchtime observations and questionnaires completed by parents were used to build up a picture of the children's home and school food environments.

A primary school in a suburb of Newcastle upon Tyne, UK.

Twenty-seven children aged 8–10 years consented to take part in the study. Twenty-four returned cameras, and eighteen parents completed questionnaires.

Photographs illustrated a range of locations throughout the home where children consumed food. Children's photographs revealed they ate less often with family and more often in front of the television than reported in parental questionnaires. Emergent themes during focus group discussions revealed a strong preference for packed lunches and dissatisfaction with school dinners. In this small sample, children's eating habits and preferences showed few associations with either gender or the deprivation level of the area in which they lived.

The children's home food environments showed a great deal of variation, with parents being key moderators of food availability and consumption. While the school's food provisions met national nutritional standards, the social aspects of having a packed lunch appeared to be a positive aspect of eating at school.

To explore nutrition and food provision in pre-school nurseries in order to develop interventions to promote healthy eating in early years settings, especially across deprived communities.

An ethnographic approach was used combining participant observation with semi-structured interviews. Research participants were selected purposively using convenience sampling.

Community pre-school nurseries.

Nursery managers (n 9), cooks (n 6), staff (n 12), parents (n 12) and children at six nurseries (four private and two attached to children's centres) in Liverpool, UK.

Private nurseries had minimal access to information and guidelines. Most nurseries did not have a specific healthy eating policy but used menu planning to maintain a focus on healthy eating. No staff had training in healthy eating for children under the age of 5 years. However, enthusiasm and interest were widespread. The level and depth of communication between the nursery and parents was important. Meal times can be an important means of developing social skills and achieving Early Years Foundation Stage competencies.

Nurseries are genuinely interested in providing appropriate healthy food for under-5s but require support. This includes: improved mechanisms for effective communication between all government levels as well as with nurseries; and funded training for cooks and managers in menu planning, cost-effective food sourcing and food preparation. Interventions to support healthy eating habits in young children developed at the area level need to be counterbalanced by continued appropriate national-level public health initiatives to address socio-economic differences.

To investigate the association of antioxidant intakes from diet and supplements with elevated blood C-reactive protein (CRP) and homocysteine (Hcy) concentrations.

A cross-sectional study. The main exposures were vitamins C and E, carotene, flavonoid and Se intakes from diet and supplements. Elevated blood CRP and Hcy concentrations were the outcome measures.

The US population and its subgroups.

We included 8335 US adults aged ≥19 years from the National Health and Nutrition Examination Survey 1999–2002.

In this US population, the mean serum CRP concentration was 4·14 (95 % CI 3·91, 4·37) mg/l. Intakes of vitamins C and E and carotene were inversely associated with the probability of having serum CRP concentrations >3 mg/l in multivariate logistic regression models. Flavonoid and Se intakes were not associated with the odds of elevated serum CRP concentrations. The mean plasma Hcy concentration was 8·61 (95 % CI 8·48, 8·74) μmol/l. Intakes of vitamins C, E, carotenes and Se were inversely associated with the odds of plasma Hcy concentrations >13 μmol/l after adjusting for covariates. Flavonoid intake was not associated with the chance of elevated plasma Hcy concentrations.

These results suggest that high antioxidant intake is associated with lower blood concentrations of CRP and Hcy. These inverse associations may be among the potential mechanisms for the beneficial effect of antioxidant intake on CVD risk mediators in observational studies.

Public health renewal in Canada has highlighted the need for development and expansion of the public health nutrition workforce, particularly in northern and rural communities. The purpose of the present paper is to describe the planning of a more accessible graduate programme for experienced nutrition professionals. The planning effort was challenged by a short timeframe between programme approval and implementation and required intense collaboration with stakeholders and students.

The programme planning model developed by The Health Communication Unit (THCU) at the Centre for Health Promotion was used to guide the process. This six-step model was familiar to key stakeholders and involved pre-planning, conducting a situational assessment, establishing goals and objectives, developing strategies and outcome indicators, and monitoring feedback.

Resource constraints, short timelines and debates around distance education options presented challenges that were overcome by conducting a thorough needs assessment, creating an advisory committee, engaging key stakeholders in the planning process, and building on existing resources. Extensive involvement of the first cohort of students in ongoing planning and evaluation was particularly helpful in informing the evolution of the programme.

The THCU planning model provided a useful framework for stakeholder collaboration and for planning and implementing the new graduate programme in public health nutrition. Preliminary data suggest that graduates are benefiting from their educational experiences through career enhancement opportunities. The evaluation strategies built into the programme design will be useful in informing ongoing programme development.

To understand the barriers to farmer participation in Farm-to-Table (F2T) programmes and to identify possible solutions to these obstacles.

Cross-sectional analysis of farmer perspectives on F2T programmes.

Three service units on the Navajo Nation (Chinle, Tuba City and Fort Defiance).

Forty-four Navajo farmers.

Most participants reported that farming on the Navajo Nation is getting harder (61 %) but that it is very important to maintain Navajo farming traditions (98 %). A modest number of farmers (43 %) expressed interest in participating in an F2T programme. All farmers reported that childhood obesity was a very serious or serious problem in the Navajo Nation. The farmers expressed support for an F2T programme if key barriers to farming, including water access and pest control, could be addressed. Key barriers to participation identified included lack of fruits and vegetables to sell, sale price of crops and lack of certification of produce by the US Food and Drug Administration.

Navajo farmers are aware of the burden of childhood obesity on the Navajo Nation and feel that an F2T programme could be beneficial. To successfully implement a Farm-to-Table programme, the barriers to participation identified will need to be addressed.

To examine the associations between near and distant visual acuity and biomarkers of Hg, Pb, n-3 fatty acids and Se from the local diet of fish-eating communities of the Tapajós River in the Brazilian Amazon.

Visuo-ocular health and biomarkers of Hg (hair, whole blood, plasma), Pb (whole blood), Se (whole blood and plasma) and n-3 fatty acids (plasma total phospholipids) were assessed in a cross-sectional study.

Lower Tapajós River Basin (State of Pará, Brazil), May to July 2006.

Two hundred and forty-three adults (≥15 years) without diagnosed age-related cataracts or ocular pathologies.

Near visual acuity was negatively associated with hair Hg and positively associated with %DHA, with a highly significant Log Hg × age interaction term. Stratifying for age showed that while young people presented good acuity, for those aged ≥40 years, clinical presbyopia was associated with hair Hg ≥ 15 μg/g (OR = 3·93, 95 % CI 1·25, 14·18) and %DHA (OR = 0·37, 95 % CI 0·11, 1·11). A similar age-related pattern was observed for distant visual acuity in relation to blood Pb, but the evidence was weaker.

These findings suggest that Hg and Pb may affect visual acuity in older persons, while DHA appears to be protective for near visual acuity loss. In this population, with little access to eye care, diet may have an important influence on visuo-ocular ageing.

To explore nutrition and food provision in pre-school nurseries in order to develop interventions to promote healthy eating in pre-school settings.

Quantitative data were gathered using questionnaires and professional menu analysis.

In the community, at pre-school nurseries.

All 130 nurseries across Liverpool were a sent questionnaire (38 % response rate); thirty-four menus were returned for analysis (26 % response rate).

Only 21 % of respondents stated they had adequate knowledge on nutrition for pre-school children. Sixty-one per cent of cooks reported having received only a ‘little’ advice on healthy eating and this was often not specific to under-5 s nutrition. Fifty-seven per cent of nurseries did not regularly assess their menus for nutritional quality. The menu analysis revealed that all menus were deficient in energy, carbohydrate, Fe and Zn. Eighty-five per cent of nurseries had Na/salt levels which exceed guidelines.

Nurseries require support on healthy eating at policy, knowledge and training levels. This support should address concerns relating to both menu planning and ingredients used in food provision and meet current guidelines on food provision for the under-5 s.

The number of extremely thin young women has increased and education at school on maintaining an optimal weight has become important. The aim of the present study was to assess the effectiveness of a group-based home-collaborative dietary education (HCDE) programme to maintain appropriate dietary intake compared to conventional school classroom education.

Two-arm cluster randomized controlled trial. Twelve classes were randomly assigned as clusters to either the HCDE group or the control group. Each participant in the HCDE group received twelve sessions of group counselling aimed at increasing energy intake at breakfast by modifying dietary intake and adopting appropriate habits. The hypothesis underlying the study was that after 6 months of HCDE the total energy intake would be increased by 627 kJ from baseline (primary endpoint). Secondary outcomes were differences in intake of various nutrients from baseline. Outcome measures after log transformation were examined by t tests and linear mixed models (crude and baseline-adjusted).

Young women among Japanese female adolescents in Tokyo.

Four hundred and seventy-four participants aged 13–15 years.

Students in twelve classes were used for analysis (n 459). Energy intake was decreased in many of the classes during the 6-month period, especially for those in the control group. After adjustment for the baseline value, significant increases in energy intake and protein, calcium, magnesium and iron intakes at breakfast were observed (P < 0·05)

Although energy intake was increased in the HCDE group compared to the control group, further study of the HCDE is warranted.

Vegetarians and vegans exclude certain food sources of vitamin D from their diet, but it is not clear to what extent this affects plasma concentrations of 25-hydroxyvitamin D (25(OH)D). The objective was to investigate differences in vitamin D intake and plasma concentrations of 25(OH)D among meat eaters, fish eaters, vegetarians and vegans.

A cross-sectional analysis.

United Kingdom.

Plasma 25(OH)D concentrations were measured in 2107 white men and women (1388 meat eaters, 210 fish eaters, 420 vegetarians and eighty-nine vegans) aged 20–76 years from the European Prospective Investigation into Cancer and Nutrition (EPIC)–Oxford cohort.

Plasma 25(OH)D concentrations reflected the degree of animal product exclusion and, hence, dietary intake of vitamin D; meat eaters had the highest mean intake of vitamin D (3·1 (95 % CI 3·0, 3·2) μg/d) and mean plasma 25(OH)D concentrations (77·0 (95 % CI 75·4, 78·8) nmol/l) and vegans the lowest (0·7 (95 % CI 0·6, 0·8) μg/d and 55·8 (95 % CI 51·0, 61·0) nmol/l, respectively). The magnitude of difference in 25(OH)D concentrations between meat eaters and vegans was smaller (20 %) among those participants who had a blood sample collected during the summer months (July–September) compared with the winter months (38 %; January–March). The prevalence of low plasma concentrations of 25(OH)D (<25 nmol/l) during the winter and spring ranged from <1 % to 8 % across the diet groups.

Plasma 25(OH)D concentrations were lower in vegetarians and vegans than in meat and fish eaters; diet is an important determinant of plasma 25(OH)D in this British population.

Nutrition plays a central role in health, with poor dietary habits and nutritional intake being associated with a range of chronic diseases. The aim was to examine grocery purchasing behaviour in relation to chewing ability, dietary knowledge and socio-economic status (SES) among older adults.

Data were collected by mailed survey in 2008. Grocery purchasing was measured using a sixteen-item index of compliance of food purchasing with dietary guidelines. Self-reported number of teeth was classified as an inadequate dentition if less than twenty-one teeth were present. Chewing ability was based on a five-item chewing index. Dietary knowledge was collected using twenty true/false items. SES was assessed using a subjective social status rating representing where people stand in society.

Population survey in Adelaide, South Australia.

Adults aged 60–71 years.

Responses were collected from 444 persons (response rate = 68·8 %). Among dentate persons, 24·4 % had an inadequate dentition with 10·3 % defined as ‘chewing deficient’. Multivariate regression coefficients adjusted for age, sex and income showed chewing deficiency (−5·8) and low SES (−3·6) was associated (P < 0·05) with lower grocery purchasing scores, but dietary knowledge was not statistically significant.

For older adults, chewing deficiency and lower social status were associated with lower compliance with dietary guidelines, independent of dietary knowledge.

To examine the prevalence of food insecurity and to identify factors that contribute to it in the Republic of Korea.

A cross-sectional study.

Data were selected from a secondary data set, the third Korean Welfare Panel Study. Household food insecurity was measured with a six-item Korean version of the US Household Food Security Survey Module. The differences in proportions or means of household characteristics, householder's characteristics, economic status and social benefits by food insecurity status were tested with the χ2 or t test. The independent associations of food insecurity with each characteristic were assessed with multivariate logistic regression analysis.

The sample size consisted of 6238 households.

The prevalence of food insecurity was 5·3 % among all households and 25·7 % among low-income households. Risk factors that were associated with a higher risk of food insecurity included living alone, unemployment, no job, low household income and living in a leased or rented home. For low-income households, living in a leased or rented home increased the risk of food insecurity. Among food-insecure households, 26·1 % of the full sample of households and 34·3 % of low-income households were participating in food assistance programmes.

Food insecurity among the Korean population was related to household type, income, job status and housing. Food assistance programmes were not enough to completely alleviate food insecurity.

To assess energy and nutrient intakes and physical activity of adolescents in urban Cameroon according to sex and socio-economic status (SES).

Cross-sectional study with adolescents randomly selected from schools in low-, middle- and high-SES areas. Weight and height were measured and information about food intake and physical activity was obtained through repeated individual 24 h recalls. Under- and over-reporting of energy intake and inadequacy of nutrient intake were assessed.

Yaoundé, Cameroon.

Boys and girls aged 12–16 years (n 227).

Boys had a lower BMI and reported higher energy expenditures and physical activity levels (PAL) than girls. Under-reporting of energy intake was large among boys and girls regardless of PAL; boys under-reported more than girls. Among those with low PAL, over-reporting of energy intake was common. Over 50 % of boys and girls had protein below the recommendations. The intake of fat varied; 26 % of the adolescents were below and 25 % were above the recommendations. Inadequate intakes of vitamin B1, vitamin B3 and Fe were more common among girls, while boys more often had inadequate intake of vitamin A. Adolescents with low SES were more likely to be below the recommendations for fat and vitamins B2, B3, B6 and B12 than those with high SES.

A high proportion of boys and girls reported inadequate intakes. However under- and over-reporting were also very common. Boys under-reported energy intake more than girls and inadequate nutrient intake was more frequently reported by adolescents with low SES than by those with high SES.

European governments have yet to introduce mandatory folic acid fortification of foods for neural tube defect prevention because of uncertainty about the long-term safety of high intake of folic acid. Novel folate-enriched eggs have been proposed as offering a practical way of increasing intake of natural folates, which do not have the same safety concerns as synthetic folic acid. Our objective was to estimate the potential increase in folate supply that could occur in European Union (EU) countries if normal eggs were replaced by folate-enriched eggs.

FAOSTAT data on daily per capita availability of eggs were linked to mean folate concentrations of un-enriched and folate-enriched eggs from three representative feeding trials from the recent literature.

Data were collated in Microsoft Excel.

The study used food balance sheets for Europe for 1961–2003 and for twenty-six individual EU countries for 2003.

There has been little variation in egg supply in Europe over the past 40 years, with eggs providing only about 1·3–1·6 % of total energy. In 2003, the average per capita egg supply across twenty-six EU countries was 32·8 g/d, equivalent to a little over half an egg. Even if the folate concentrations of all eggs across the EU were increased two- to threefold, per capita folate supply would increase only by about 25 μg/d.

At current enrichment levels, the availability of novel folate-enriched eggs will have little impact on folate supply in EU countries. In the absence of mandatory fortification, additional natural folate sources are needed urgently.

To assess the nutritional status, food intake and physical activity patterns in schoolchildren attending 5th and 6th grade in basic schools from different socio-economic levels in the metropolitan region of Santiago.

Cross-sectional study in children 5th and 6th grade of eighteen basic schools in the metropolitan region of Santiago.

Boys and girls aged 9–12 years from basic schools were evaluated in terms of physical capacity. An anthropometric evaluation was also performed which included weight, height and triceps and subscapular skinfold thicknesses. Food intake was evaluated by a 24 h recall, socio-economic level by the ESOMAR method and physical activity by a questionnaire.

Boys and girls aged 9–12 years (n 1732).

The average prevalence of overweight and obesity was 40 %, with the highest prevalence in males and those from lower socio-economic level. A majority (64 %) of the children had a low level of physical activity. A higher intake of fat and protein and a higher intake of carbohydrate were found in the higher and lower socio-economic levels, respectively. Both males and females showed adequacy greater than 75 % in macronutrient intake except for fibre, with both groups showing a deficit in the consumption of fruits, vegetables, legumes, fish and milk products according to Chilean recommendations.

A high prevalence of malnutrition by excess was observed in both sexes and a better eating and physical activity pattern was seen in children from higher socio-economic level.

To use the north Queensland banana industry as a case study to examine the extent to which cosmetic standards set by retailers influence the amount of edible waste generated on-farm and the effect of this on the sustainability of the Australian food and nutrition system.

Waste audits were performed on-farm at a banana packing shed to quantify the amount of fruit discarded due to cosmetic imperfections. These data, together with production records provided by the Department of Primary Industries and Fisheries and interviews with growers, were used to inform a nutritional analysis, a life cycle assessment and an economic analysis to quantify nutritional, environmental and economic impacts.

North Queensland, Australia

Banana farms and packing shed.

Between 10 and 30 % of the north Queensland banana crop is discarded on-farm. Of this, 78 % was found to be due to cosmetic imperfections, which equates to an industry total of 37 000 tonnes per annum. This waste represents a loss of 137 billion kilojoules with accompanying macro- and micronutrients. The life cycle assessment indicated that approximately 16 300 tonnes of carbon dioxide emissions, 11·2 gigalitres of virtual water as well as other natural resources are embodied in the waste. There is an industry-wide, economic loss of approximately $AU 26·9 million per annum.

The majority of on-farm banana waste is caused by arbitrary cosmetic standards set by retailers, resulting in significant nutritional, environmental and economic losses. Public health nutritionists have a role to play across the entire food chain to minimize the impacts of waste on the food system.

To compare the school lunch consumption of Texas middle-school students with the 2009 Institute of Medicine's (IOM) school meal report recommendations. These new lunch menu patterns increase fruit to one serving and vegetables to two servings, with 50 % wholegrain food.

Lunch food records were collected from middle-school students from four schools in south-east Texas in the spring of 2008, and entered into the Nutrition Data System for Research software. Average intake was calculated for those consuming meals according to the National School Lunch Program (NSLP; n 5414) and for those consuming lunch from other sources (n 239). The percentage of students selecting each food group was calculated.

Middle schools in south-east Texas.

Middle-school students in south-east Texas.

Students consuming NSLP meals reported consuming almost serving of fruit, serving of vegetables, 8 oz of milk and serving of whole grains at lunch. Non-NSLP consumers reported almost no intake of fruit, vegetables or milk, and consumed serving of whole grains at lunch. Among NSLP consumers, about 40 % selected and consumed a fruit serving. About two-thirds of students selected a vegetable, consuming about 67 %. Less than 4 % selected a dark green or orange vegetable.

Students’ lunch intake did not meet the new IOM recommendations. Few students selected dark green or orange vegetables, and only 40 % selected fruit. Whole grains consumption was low. Interventions with all stakeholders will be necessary to improve students’ food and beverage selections overall when school meal patterns are revised.

To examine the sociodemographic correlates of obesity among Ghanaian women.

The 2003 and 2008 Ghana Demographic and Health Survey data sets were used to examine the sociodemographic characteristics and the BMI of women aged 15–49 years using descriptive statistics, bivariate and multivariate analyses.

Ghana is a West African country which is divided into ten administrative regions. The country is further divided into the northern and southern sectors. The northern sector includes the three northern regions (Northern, Upper East and Upper Westen regions) and the seven remaining regions form the southern sector.

Women aged 15–49 years whose BMI values were available.

The overall prevalence of obesity and overweight increased from 25·5 % in 2003 to 30·5 % in 2008. Obesity varied directly with age from 20 to 44 years. Women with higher education had the highest rate of obesity. Obesity was more common among women from wealthy households compared to women from poor households.

Obesity and overweight were found to be more common among older women, urban women, married women, women with higher education and women from rich households. Adoption of healthy lifestyles and the implementation of policies that promote healthy living can help reduce the prevalence of overweight and obesity.

To identify and describe dietary patterns in a cohort of pregnant women, and investigate whether dietary patterns during pregnancy are related to postpartum depression (PPD).

The study uses data from the prospective mother–child cohort ‘Rhea’ study. Pregnant women completed an FFQ in mid-pregnancy and the Edinburg Postpartum Depression Scale (EPDS) at 8–10 weeks postpartum. Dietary patterns during pregnancy (‘health conscious’, ‘Western’) were identified using principal component analysis. Associations between dietary patterns categorized in tertiles and PPD symptoms were investigated by multivariable regression models after adjusting for confounders.

Heraklion, Crete, Greece, 2007–2010.

A total of 529 women, participating in the ‘Rhea’ cohort.

High adherence to a ‘health conscious’ diet, characterized by vegetables, fruit, pulses, nuts, dairy products, fish and olive oil, was associated with lower EPDS scores (highest v. lowest tertile: β-coefficient = −1·75, P = 0·02). Women in the second (relative risk (RR) = 0·52, 95 % CI 0·30, 0·92) or third tertile (RR = 0·51, 95 % CI 0·25, 1·05) of the ‘health conscious’ dietary pattern were about 50 % less likely to have high levels of PPD symptoms (EPDS ≥ 13) compared with those in the lowest tertile.

This is the first prospective study showing that a healthy diet during pregnancy is associated with reduced risk for PPD. Additional longitudinal studies and trials are needed to confirm these findings.

To identify dietary patterns among young adults and the relationships with socio-economic, demographic and lifestyle characteristics.

Population-based, cross-sectional analysis of a cohort study. Food intake was assessed by a frequency questionnaire, and dietary patterns were identified using principal components analysis.

Southern Brazil.

A total of 4202 men and women aged 23 years, who participated in the 1982 Pelotas Birth Cohort Study.

Five dietary patterns were identified: common Brazilian, processed food, vegetable/fruit, dairy/dessert and tubers/pasta. Subjects who had low own or maternal educational levels, low social position or who were always poor throughout life had high adherence to the common Brazilian dietary pattern. In contrast, the processed food pattern was more likely to be followed by those belonging to middle and high social position and who were never poor. Men and smokers showed high adherence to the processed food and common Brazilian dietary patterns. Vegetable/fruit pattern was more likely to be followed by women and subjects engaged in physical activity. Women also showed high adherence to the dairy/dessert pattern.

Our study among young Brazilian adults has identified distinct dietary patterns that are clearly influenced by socio-economic and lifestyle characteristics, which have important policy implications in a country with marked social and economic inequalities.

To identify the association of individual and school environment factors with overweight among adolescents.

Cross-sectional study. Sociodemographic and behavioural information was collected using an anonymous self-administered questionnaire. Indicators on human and physical resources of the schools were based on information collected in interviews with school principals. Overweight was defined based on the BMI Z-score for age and sex recommended by WHO. Logistic regression models were used for statistical analysis.

Rio de Janeiro, Brazil.

By means of a two-stage (classrooms and students) probabilistic sampling, subjects comprised 1632 students enrolled in the last year of primary education of the municipal public school network, stratified by city region.

The mean prevalence of overweight at schools was 17·2 %, ranging from 0 % to 50 %. Adolescents more likely to be overweight were those who attended schools without knives and forks or ceramic/glass plates for students in the school refectory (prevalence odds ratio (POR) = 1·40; P = 0·04), those whose head of household had completed between 8 and 10 years of schooling (POR = 1·46; P = 0·03), those who did not live with both parents (POR = 1·24; P = 0·06) and those who had not practised physical activity outside school on at least 1 d in the 7 d before the study (POR = 1·56; P = 0·04).

Sociodemographic and behavioural variables of adolescents and school characteristics were associated with overweight, confirming individual and context effects on this health disorder. Studies such as the present one, identifying variables in context, may support actions to prevent overweight among adolescents.