The prevalence of child overweight in the Czech Republic is substantially lower than that in the USA. The objective of the present pilot study was to explore dietary intakes, frequency of dining in fast-food establishments, and the amount and intensity of physical activity between a sample of American and Czech children.

A cross-sectional correlational pilot study.

Four public schools in the USA and four public schools in the Czech Republic.

Ninety-five Czech and forty-four American 4–6th graders from urban public schools participated in the study. Dietary intake and number of fast-food visits were evaluated using two multiple-pass 24 h recalls. Physical activity was measured using the modified Self-Administered Physical Activity Checklist.

American children (mean age 10·8 (se 0·2) years) consumed more energy and fat, less fruits and vegetables, more soft drinks, and visited fast-food establishments more often than Czech children (mean age 11·0 (se 0·1) years). Although no differences were found in vigorous activity by nationality, Czech children spent significantly more time in moderate physical activities than American children.

Despite the influx of some negative Western dietary trends into the country, Czech children had a healthier diet and were more physically active than American children. Further research is warranted to determine whether the same differences in dietary intakes, physical activity and fast-food visits exist between nationally representative samples of American and Czech children.

Breakfast consumption has been associated with better mental health in adulthood, but the relationship between breakfast and mental health in adolescence is less well known. The aims of the present study were to evaluate breakfast quality in a cohort of adolescents and to investigate associations with mental health.

Cross-sectional population-based study. Breakfast quality was assessed by intake of core food groups at breakfast, as determined from 3 d food diaries. Mental health was assessed using the Child Behaviour Checklist (CBCL), with higher scores representing poorer behaviour.

The Western Australian Pregnancy Cohort (Raine) Study, Perth, Western Australia.

Eight hundred and thirty-six males and females aged between 13 and 15 years.

Mean mental health score as assessed by the CBCL was 45·24 (sd 11·29). A high-quality breakfast consisting of at least three food groups was consumed by 11 % of adolescents, while 7 % of adolescents did not consume any items from core food groups on average over the 3 d period. The two most common core food groups consumed at breakfast in this population were dairy products followed by breads and cereals. For every additional food group eaten at breakfast, the associated total mental health score decreased by 1·66 (95 % CI −2·74, −0·59) after adjustment for potential confounding factors, representing an improvement in mental health score.

These findings support the concept that breakfast quality is an important component in the complex interaction between lifestyle factors and mental health in early adolescence.

The objective of the present study was to assess the prevalence and determinants of preconceptional folic acid supplement use among pregnant women in Lebanon.

The study was a descriptive epidemiological study. Analysis was performed on 5280 deliveries admitted to twelve member hospitals of the National Collaborative Perinatal Neonatal Network during the period September 2003–January 2005. Information on folic acid intake and maternal and neonatal characteristics were obtained from obstetric charts along with direct interviews performed by trained personnel. Logistic regression was performed to determine the predictors of preconceptional folic acid use.

The overall use of preconceptional folic acid supplementation was 14·0 % (18·6 % in urban hospitals v. 2·7 % in rural hospitals). Higher socio-economic status, lower parity and having a history of previous spontaneous abortions were significantly associated with preconceptional folic acid use.

Our study shows that Lebanon currently has a low rate of preconceptional folic acid supplement use. Intervention through the means of awareness campaigns needs to be implemented on a national level.

To study the role of energy derived from sugar (both table sugar and sugar added to processed foods) in the total energy content of food purchases in Brazil.

Food purchase data were collected during a national household budget survey carried out between June 2002 and July 2003 on a probabilistic sample representative of all households in the country. The amount of food purchased in this 12-month period was transformed into energy and energy from sugar using food composition tables. Multiple linear regression models were used to study the association between amount of energy from sugar and total energy content of food purchases, controlling for sociodemographic variables and potential interactions between these variables and sugar purchases.

There was a positive and significant association between energy from sugar and total household energy purchases. A 1 kJ increase in sugar purchase corresponded to a 3·637 kJ increase in total energy. In the absence of expenditure on meals outside the home, i.e. when household food purchases tend to approximate actual food consumption by household members, sugar purchase of 1926·35 kJ/d (the 90th percentile of the distribution of sugar purchases in Brazil) was associated, depending on income strata, with total energy purchase over 40–60 % of the recommended daily value for energy intake in Brazil.

The present results corroborate the recommendations of the WHO and the Brazilian Ministry of Health regarding limiting the consumption of sugar.

To detect the association of diet and lifestyle with blood pressure in the Guangxi Hei Yi Zhuang and Han populations.

A cross-sectional study of hypertension.

Both populations were from seven to nine villages in Napo County, Guangxi Zhuang Autonomous Region, China.

A total of 1068 subjects of Hei Yi Zhuang and 933 participants of Han Chinese aged 20–89 years were surveyed by a stratified randomised cluster sampling.

The levels of systolic blood pressure and pulse pressure were higher in Hei Yi Zhuang than in Han (125·20 (sd 18·62) v. 121·88 (sd 15·99) mmHg and 48·64 (sd 14·75) v. 44·98 (sd 11·12 ) mmHg, P < 0·001 for each, respectively). The prevalence of hypertension and isolated systolic hypertension was also higher in Hei Yi Zhuang than in Han (25·19 % v. 17·26 % and 12·45 % v. 3·86 %, P < 0·001 for each, respectively). Mean arterial pressure was positively correlated with gender, age, physical activity, TAG, alcohol consumption, cigarette smoking, total energy, total fat and salt intakes, and negatively associated with education level and total dietary fibre intake in Hei Yi Zhuang (P < 0·05–0·001), whereas it was positively associated with gender, age, physical activity, BMI, waist circumference, total cholesterol, alcohol consumption, cigarette smoking, total energy, total fat and salt intakes, and negatively associated with education level and total dietary fibre intake in Han (P < 0·05–0·001).

The differences in blood pressure levels and the prevalence of hypertension between the Hei Yi Zhuang and Han populations were associated with different dietary habits, lifestyle choices, education level, as well as geographical surroundings.

The purpose of the present study was to examine the relationship between household food insecurity and maternal depression in a rural sample to determine whether food insecurity predicted mothers’ depression over time or vice versa.

The study employed a prospective design using three waves of data from ‘Rural Families Speak’, a multi-state study of low-income rural families in the USA. Food insecurity was measured using the Core Food Security Module and depression was measured using the Center for Epidemiologic Studies–Depression Scale. A structural equation model was fit to the data using the AMOS software package.

Sixteen states in the USA (California, Indiana, Kentucky, Louisiana, Massachusetts, Maryland, Michigan, Minnesota, Nebraska, New Hampshire, New York, Ohio, Oregon, South Dakota, West Virginia, Wyoming) between 2000 and 2002.

Subjects included 413 women with at least one child under the age of 13 years living in the home.

Findings based on the 184 subjects with complete data indicated that the causal relationship between household food insecurity and depression is bidirectional (P = 0·034 for causation from depression to food insecurity, P = 0·003 for causation from food insecurity to depression, χ2/df = 1·835, root-mean-square error of approximation = 0·068, comparative fit index = 0·989). Findings based on all 413 subjects after imputation of missing values also indicated bidirectionality.

The recursive relationship between food insecurity and depression has implications for US nutrition, mental health and poverty policies. The study highlights the need to integrate programmes addressing food insecurity and poor mental health for the population of rural, low-income women.

To evaluate the gap between food-based dietary guidelines (FBDG) and the usual food consumption in Belgium.

Information on food intake was collected with two non-consecutive 24 h recalls, using the validated software package EPIC-SOFT in combination with a self-administered FFQ. Habitual food intake was estimated by the Nusser method. Physical activity was evaluated according to the International Physical Activity Questionnaire.

A representative sample of the Belgian population aged 15 years and older was randomly selected from the National Register using a multistage stratified procedure. Dietary information was obtained from 3245 individuals.

Food intakes deviated significantly from the recommendations. In particular, fruit (118 g/d) and vegetable (138 g/d) consumption and intake of dairy and Ca-enriched soya products (159 g/d) were inadequate. Consumption of energy-dense, nutrient-poor foods (soft drinks, alcohol and snacks) was excessive (481 g/d). There were important age and gender differences. Fruit, vegetable and spreadable fat consumption was lowest, while consumption of dairy, starchy and energy-dense, nutrient-poor foods was highest among the youngest age group. Men consumed more animal and starchy foods than women, who consumed more fruits. There were only slight differences by education level.

Food intakes differed substantially from the FBDG. Improvement of the Belgian food pattern, in particular among the youngest age group, is necessary for a better prevention of diet-related diseases. In addition, continuous or regular monitoring is crucial to permit trend analyses and to plan effective education or intervention strategies.

To compare physical activity (PA) reported through pedometer registrations (step counts) with PA reported in four different questionnaires; to compare step count thresholds (7500, 10 000 and 12 500 steps/d) with the PA guideline of 30 min of moderate to vigorous PA (MVPA) per day.

A sample of 310 healthy adults, mean age 38·7 (sd 11·9) years, volunteered to participate. Forty-seven per cent was male and 93 % of the sample was employed.

PA was assessed by interview (Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ)), three self-administered questionnaires (long version and short version of the International Physical Activity Questionnaire (long-form IPAQ, short-form IPAQ), Baecke questionnaire) and seven consecutive days of pedometer registration.

Step counts correlated positively with questionnaire-based PA. The strongest correlations were found between step counts and total PA reported in the long-form IPAQ (rs = 0·37), moderate PA reported in the short-form IPAQ (rs = 0·33), total and moderate PA reported in the MLTPAQ (rs = 0·32), and the total and leisure-time PA indices (excluding sport) reported in the Baecke questionnaire (rs = 0·44). According to step counts, 22·6 % of the participants were somewhat active, 18·7 % active and 39·4 % highly active. As assessed by the long-form IPAQ, short-form IPAQ and MLTPAQ, the guideline of 30 min MVPA/d was reached by respectively 85·4 %, 84·8 % and 68·0 % of participants.

Pedometer-based data offer adequate information to discriminate between levels of PA. Caution is needed when comparing active samples based on different PA recommendations.

The present study was conducted to determine the impact of a community-based intervention on the nutritional behaviour of a representative sample of Iranian adults.

The Isfahan Healthy Heart Programme (IHHP), a six-year, action-oriented, integrated community-based study aimed at health promotion through the reduction of CVD risk factors, targeted the whole population living in two intervention cities, and compared outcomes with the population of a non-intervention city considered as reference. Dietary interventions were performed as educational, environmental and/or legislative strategies. A global dietary index (GDI) was calculated representing the general dietary behaviour. In addition, two consumption indices were calculated for specific food groups, i.e. meat products and major sources of fat. Univariate AVOVA was conducted to evaluate the impact of the intervention on dietary behaviours.

Isfahan and Najaf-Abad (intervention cities) and Arak (reference city), central Iran.

The baseline survey was conducted among 12514 randomly selected adults aged ≥19 years in both intervention and reference areas. The survey was repeated annually among about 5000 persons (2002–2005) in the intervention and reference communities.

According to significant year × group interactions in mean fat consumption index (FCI) and meat consumption index (MCI) in the total population, a significant improvement in FCI and MCI was found in the intervention areas v. the reference area (P < 0·001). In addition, the GDI improved significantly in the intervention areas v. the reference area (P < 0·001).

The IHHP interventions were effective in improving dietary behaviours at the population level. The highest effectiveness was documented in the change in the type of fat consumed. Such simple and integrated interventions can be adopted in other developing countries with limited financial resources.

To study the development of body weight with ageing, in a general adult population, taking into account possible period and cohort effects.

A prospective cohort study with 11 years of follow-up. At baseline and after 6 and 11 years, body weight and height were measured.

The Doetinchem Cohort Study, consisting of inhabitants of Doetinchem, a town in a rural area of The Netherlands.

In total, 4070 healthy men and women aged 20–59 years at baseline.

Increase in BMI with ageing was less profound based on cross-sectional data than based on longitudinal data. More recent-born cohorts had a higher BMI at a given age than cohorts who were born earlier. Increase in mean BMI with ageing was observed in all age groups and was similar for groups with a different educational level. Highest increase in BMI over 11 years was observed in the youngest group, aged 20–29 years at baseline (2·2 [95 % CL 2·0, 2·3] kg/m2), and lowest increase in the oldest group, aged 50–59 years at baseline (1·1 [1·0, 1·3] kg/m2).

Findings of the present study using longitudinal data suggest that increase in BMI with ageing is underestimated in all age groups by studying cross-sectional data only. Further, weight gain is present in all educational levels and does not stop at middle age.

To determine the uptake of a free fruit provision to low-decile primary-school children by quantitatively assessing changes in fruit intake.

A randomised controlled trial using a paired, cluster randomisation.

Twenty low-decile primary schools (schools attended by the most deprived children) in Auckland, New Zealand.

In total 2032 children, aged 7–11 years, provided data on at least one occasion.

Ten pairs of low-decile primary schools matched by roll size and location were randomly allocated to control (no free fruit) or intervention (free fruit) for a school term. Dietary assessments using the 24 h recall methodology were made at baseline, on the last week of the intervention and 6 weeks post-intervention.

Fruit intakes in this cohort were lower than the national average with over 40 % reporting no fruit intake at baseline and did not differ between groups. After the free fruit period the intervention group increased school fruit intakes by 0·39 pieces/school d from baseline (P ≤ 0·001) and the proportion of children consuming no fruit reduced to 22 %. This increase, however, was not sustained and fruit intakes fell below baseline levels at 6 weeks post-intervention. Control subjects did not significantly alter their fruit intakes throughout the study.

Improving exposure and accessibility to fruits at school increases fruit intakes of low socio-economic group children, particularly those who do not normally eat fruit. The present pilot study demonstrates some possible negative effects of short-term free fruit interventions, but is informative for developing and evaluating sustained fruit intervention programmes.

Stunting is a chronic condition reflecting poor nutrition and health. Our aim was to ascertain major predictors of stunting in children <5 years old in Libya.

A nationally representative, cross-sectional, two-stage stratified cluster sample survey enrolled 4549 under-fives from 6707 households. Logistic regression was used to determine individual risk factors in bivariate and multivariate analyses.

Anthropometric measurements were available for 4498 children. Among the 929 stunted children (20·7 %), 495 were boys (53·3 %) and 434 were girls (46·5 %). In multivariate analysis, risk factors were young age (1–2 years: OR = 2·32, 95 % CI 1·67, 3·22; 2–3 years: OR = 1·64, 95 % CI 1·22, 2·21), resident of Al-Akhdar (OR = 1·67, 95 % CI 1·08, 2·58), being a boy (OR = 1·28, 95 % CI 1·05, 1·55), having a less educated father (illiterate: OR = 2·10, 95 % CI 1·17, 3·77; preparatory school: OR = 1·71, 95 % CI 1·11, 2·65), poor psychosocial stimulation (no family visits or trips: OR = 1·52, 95 % CI 1·07, 2·16; father rarely/never plays with child: OR = 2·24, 95 % CI 1·20, 4·16), filtered water (OR = 8·45, 95 % CI 2·31, 30·95), throwing garbage in the street (OR = 13·81, 95 % CI 2·33, 81·72), diarrhoea (OR = 1·58, 95 % CI 1·09, 2·29) and low birth weight (OR = 1·8, 95 % CI 1·17, 2·40). Protective factors were older age of father (OR = 0·53, 95 % CI 0·32, 0·90) and water storage (OR = 0·70, 95 % CI 0·54, 0·90). These variables only explained 20 % of cases of stunting.

Various multilevel actions are needed to improve nutritional status of under-fives in Libya. At risk-groups include those with young age (1–3 years), resident of Al-Akhdar region, boys, father’s low educational level, poor psychosocial stimulation, poor housing environment, diarrhoea and low birth weight.

The Mediterranean diet (MD) prototype is widely used as an educational tool in public health programmes; few studies, however, have been conducted on the adherence of children to this diet.

To evaluate the quality of Cypriot children’s diet by assessing the degree of adherence to the MD.

A national cross-sectional study among 1140 children (mean age = 10·7 (sd 0·98) years), using stratified multistage sampling design, was conducted in primary schools of Cyprus. Dietary assessment was based on a 154-item semi-quantitative FFQ and the two supplementary questionnaires (a Food Groups Frequency Questionnaire and a Short Eating Habits Questionnaire). Adherence to the MD was assessed by the KIDMED index. The association between the frequencies of consumption of various food groups and the level of adherence to the MD (poor v. average v. good KIDMED score) was also evaluated. Multiple logistic regression analyses were used to adjust for potential confounders.

Only 6·7 % of the sample was classified as high adherers of MD, whereas 37 % had a poor KIDMED score. Multiple logistic regression analysis has shown that children with at least an average KIDMED score were more likely to eat frequently seafood and fish, legumes, nuts, bread, fruits, leafy vegetables, olives, low glycaemic index foods and unrefined foods. Effect size of associations was from medium to high.

Higher adherence to MD is associated with better diet quality in children. The MD prototype may thus represent a useful educational tool for promotion of healthy eating habits in children.

Dietary intake during adolescence contributes to lifelong eating habits and the development of early risk factors for disease in adulthood. Few studies have examined the dietary patterns of adolescents and the social and environmental factors that may affect them during this life stage. The present study describes dietary patterns in a cohort of adolescents and examines their associations with socio-economic factors, as well as parental and adolescent risk factor behaviours.

A semi-quantitative FFQ was used to assess study adolescents’ usual dietary intake over the previous year. Information was collected on family functioning and various socio-economic and risk factor variables via questionnaire. Adolescents visited the study clinic for anthropometric measurements.

The Western Australian Pregnancy Cohort Study (Raine Study), Perth, Western Australia.

Adolescents (n 1631) aged 14 years from a pregnancy cohort study.

Factor analysis identified two distinct dietary patterns that differed predominantly in fat and sugar intakes. The ‘Western’ pattern consisted of high intakes of take-away foods, soft drinks, confectionery, French fries, refined grains, full-fat dairy products and processed meats. The ‘healthy’ pattern included high intakes of whole grains, fruit, vegetables, legumes and fish. ANOVA showed that the ‘Western’ dietary pattern was positively associated with greater television viewing and having a parent who smoked, and was inversely associated with family income. The ‘healthy’ pattern was positively associated with female gender, greater maternal education, better family functioning and being in a two-parent family, and was inversely associated with television viewing.

The study suggests that both lifestyle factors and family psycho-social environment are related to dietary patterns in Australian adolescents.

Previous studies have shown that highly nutritious diets are more costly, but to date there has been no evaluation of the costs associated with failing to meet micronutrient recommendations in a Spanish population.

We examined whether daily food consumption costs (classified in quintiles) were associated with failing to meet at least three daily nutritional recommendations out of twenty (including fibre and nineteen micronutrients) in a cross-sectional analysis of baseline data of a cohort of 17 197 Spanish university graduates. Micronutrients and fibre intake were assessed with a validated 136-item FFQ. Average cost of food was calculated from official Spanish government data.

As participants presented higher dietary energy cost from their diet, their intake of micronutrients increased significantly. Low dietary energy cost was associated with a higher likelihood of failing to meet three or more recommendations (P for trend <0·001 across quintiles of dietary cost), the association being stronger among female than male participants (P for interaction between sex and quintile of dietary energy cost <0·001).

To investigate whether fruit and vegetable (F&V) intake in 11-year-olds, and social–environmental correlates of F&V intake such as parental modelling and encouragement, family food rules and home availability, differ according to general parenting styles in Belgium, The Netherlands, Portugal and Spain.

Cross-sectional study.

Primary schools in four countries.

Pupils and one of their parents completed questionnaires to measure F&V intake, related social–environmental correlates and general parenting styles. The sample size was 4555 (49·3 % boys); 1180 for Belgium, 883 for The Netherlands, 1515 for Portugal and 977 for Spain. Parenting styles were divided into authoritative, authoritarian, indulgent and neglectful.

No differences were found in F&V intake across parenting styles and only very few significant differences in social–environmental correlates. The authoritarian (more parental encouragement and more demands to eat fruit) and the authoritative (more availability of fruit and vegetables) parenting styles resulted in more favourable correlates.

Despite earlier studies suggesting that general parenting styles are associated with health behaviours in children, the present study suggests that this association is weak to non-existent for F&V intakes in four different European countries.

To evaluate pregnant women’s knowledge regarding the importance of long-chain omega-3 polyunsaturated fatty acids (LC n-3 PUFA) consumption during pregnancy and assess their views on current information availability.

A 27-item demographic and food safety/behaviour questionnaire was administered to pregnant women during their antenatal clinic visits. χ2 tests were performed using SPSS.

Antenatal clinics at two regional hospitals in New South Wales, Australia.

One hundred and ninety (n 190) pregnant women.

Three quarters of the women had not received information regarding LC n-3 PUFA. Approximately half of the women were aware of issues relating to LC n-3 PUFA; however, their knowledge was limited, with most obtaining their knowledge from books and magazines. Women generally had low (30 %, 29 %) to moderate (28 %, 24 %) levels of concern about LC n-3 PUFA and mercury, respectively.

Pregnant women lack knowledge of LC n-3 PUFA and health-care services do not provide pregnant women with adequate information on the importance of eating foods high in LC n-3 PUFA during pregnancy.

To assess the reproducibility of a 135-item self-administered semi-quantitative FFQ.

Control subjects who had previously completed an FFQ relating to usual dietary intake in a nationwide case–control study of cancer between November 2003 and April 2004 were randomly selected, re-contacted, and invited to complete the same FFQ a second time approximately one year later (between January and April 2005). Agreement between the two FFQ was compared using weighted kappa statistics and intraclass correlation coefficients (ICC) for food groups and nutrients. Summary questions, included in the FFQ, were used to assess overall intakes of vegetables, fruits and meat.

General community in Australia.

One hundred men and women aged 22–79 years, randomly selected from the previous control population.

The weighted κ and ICC measures of agreement for food groups were moderate to substantial for seventeen of the eighteen food groups. For nutrients, weighted κ ranged from 0·44 for starch to 0·83 for alcohol while ICC ranged from 0·51 to 0·91 for the same nutrients. Estimates of meat, fruit and vegetable intake using summary questions were similar for both survey periods, but were significantly lower than estimates from summed individual food items.

The FFQ produced reproducible results and is reasonable in assessing the usual intake of various foods and nutrients among an Australian adult population.