Physical activity is an important determinant of energy balance. However, its impact on overweight/obesity has proved difficult to measure in pre-school children and few studies have found significant associations. A set of simple questions was used to distinguish pre-school children with high and low physical activity, and the association of this classification with childhood overweight/obesity and performance in an established motor test was investigated.

Survey, cross-sectional.

Weight and height were measured in 12 556 children taking part in the obligatory school entrance health examination 2004–5 and 2005–6 in three urban and three rural Bavarian regions. Their parents were asked to answer a questionnaire with a set of questions on physical activity.

The mean age of the children evaluated was 5·78 (sd 0·43) years, 6535 (52·1 %) were boys. Physically active children were less likely to be overweight (OR = 0·786, 95 % CI 0·687, 0·898) or obese (OR = 0·655, 95 % CI 0·506, 0·849) and achieved 6·7 (95 % CI 5·8, 7·7) % more jumps per 30 s than less active children in a motor test, adjusted for a number of potentially confounding variables.

Classification of pre-school children as physically active or not, based on a small set of questions, revealed significant associations with overweight/obesity and a motor test. Once further validated, this classification might provide a valuable tool to assess the impact of physical activity on the risk of childhood overweight and obesity.

To examine the sociodemographic determinants of fruit and vegetable (F&V) consumption in England and determine the differential effects of socio-economic variables at various parts of the intake distribution, with a special focus on severely inadequate intakes.

Quantile regression, expressing F&V intake as a function of sociodemographic variables, is employed. Here, quantile regression flexibly allows variables such as ethnicity to exert effects on F&V intake that vary depending on existing levels of intake.

The 2003 Health Survey of England.

Data were from 11 044 adult individuals.

The influence of particular sociodemographic variables is found to vary significantly across the intake distribution. We conclude that women consume more F&V than men; Asians and blacks more than whites; co-habiting individuals more than single-living ones. Increased incomes and education also boost intake. However, the key general finding of the present study is that the influence of most variables is relatively weak in the area of greatest concern, i.e. among those with the most inadequate intakes in any reference group.

Our findings emphasise the importance of allowing the effects of socio-economic drivers to vary across the intake distribution. The main finding, that variables which exert significant influence on F&V intake at other parts of the conditional distribution have a relatively weak influence at the lower tail, is cause for concern. It implies that in any defined group, those consuming the least F&V are hard to influence using campaigns or policy levers.

To describe the food and nutrient intakes of 9-month-old infants.

A survey undertaken as part of a longitudinal study of child growth and development. Infant diet was characterised through a structured interview in which consumption frequency and portion size of foods were obtained. This method was compared with a 4 d diary and had adequate relative validity.

Adelaide, Australia.

Three hundred and forty-one infants for whom dietary data were plausible according to pre-specified criteria.

At 9 months of age, the median body weights for 161 girls and 180 boys were 8·8 and 9·6 kg, respectively. Differences in intakes between boys and girls largely reflected differences in size. Median daily energy intake was 3541 kJ and median contributions of protein, fat and carbohydrate to total energy were 13 %, 36 % and 50 %. Using published Estimated Average Requirements, Zn intake was inadequate for <1 % of children not breast-fed at this age while Fe intake was inadequate for 9 %. Infants who were still breast-fed (35 %) had more diversity in the foods that provided additional energy, compared with those not receiving breast milk, and were less likely to consume nutrient-displacing drinks such as juice or cordial. Cow’s milk was the main drink for 5 % of infants.

In a group of Australian-born children, an important proportion had weaning diets that were low in Fe. Fat intake of many children was below current recommendations and cow’s milk was the main milk source for a small minority.

To evaluate the association between wholegrain products intake and other dietary, lifestyle, anthropometric and socio-economic factors.

Cross-sectional study, with data on diet, lifestyle and socio-economic factors obtained from questionnaires. Anthropometric measurements were collected by trained professionals. Multiple linear and principal components regression analyses were used in statistical analyses.

Part of the Diet, Cancer and Health study, a prospective cohort study to evaluate the aetiological role of diet on cancer risk, conducted in the greater Copenhagen and Aarhus area, Denmark.

Men and women (n 54 720) aged 50–64 years.

In multiple linear regression analyses focusing on individual dietary factors, intake of wholegrain products was associated with intake of all dietary factors studied (fish, red meat, poultry, processed meat, dairy products, fruits, vegetables, cakes and refined-grain products). The strongest positive associations were seen for intake of vegetables and processed meat, whereas the strongest negative associations were seen for intake of red meat and refined-grain products. Regression analyses on dietary patterns identified by principal components analysis yielded similar results. Also, wholegrain products intake was positively associated with cycling, taking dietary supplements and high school education, and negatively associated with intake of alcohol, BMI and smoking.

Intake of wholegrain products is associated with other dietary factors, healthier lifestyle habits and higher socio-economic status. Therefore future studies need to account for the possible confounding by other dietary and lifestyle-related parameters when investigating relationships between wholegrain products intake and disease risk.

Nutrient Reference Values (NRV) are evidence-based benchmarks for assessing the dietary adequacy of individuals and population groups as well as informing public health nutrition policies and programmes. The present paper presents the findings of an analysis of the views of submitters to a draft document associated with the development of the 2006 NRV for Australia and New Zealand. The aim of the study was to explore how these views were reflected in the policy-making process and final policy document.

The information necessary to fulfil this aim required access to stakeholder submissions to the NRV development process and this necessitated exploiting the provisions of the Commonwealth of Australia’s Freedom of Information (FOI) Act 1982. We understand that the present research represents the first time that an FOI request seeking information about a National Health and Medical Research Council food and nutrition policy process has been made and therefore is novel in its approach to public health nutrition policy analysis.

The analysis of stakeholder submissions identified that stakeholders had particular concerns about the conduct of the review process and the future application of the nutrient values to policy and programmes. There is a lack of evidence that the majority of stakeholder comments were addressed in the final NRV document.

Although these findings cannot be interpreted to assess the validity or otherwise of the set nutrient values, they do raise questions about the process for their development and the adequacy of the final document to reflect the views of key stakeholders.

To test whether change in the frequency of fish intake at population level would affect the trends of death from CHD and how many CHD events could be prevented in Hong Kong, a population among those with the highest fish consumption and the lowest CHD mortality in the world.

Time trends analysis with data from repeated dietary surveys and death registration.

Hong Kong SAR, People’s Republic of China.

A total of 3096 men and women aged 40–69 years who participated in territory-wide surveys in 1995 or 2003 were included in the analysis of changes in dietary fish intake; all adults aged 40–69 years in Hong Kong were included in the analysis of time trends of CHD mortality.

Over the period, the frequency of fish intake increased and CHD mortality decreased significantly in the population age group of 50–69 years, while in the age group of 40–49 years little change in both fish intake and CHD mortality was observed. It was estimated that 240 CHD deaths (or 29 % of the total) were avoided among the population aged 40–69 years in 2003, as more than half of the population consumed fish every day in Hong Kong.

The time trend of CHD mortality was inversely related to the trend of fish intake. The frequency of fish intake may have a substantial impact on the population for the prevention of CHD deaths in Hong Kong.

To examine the fruit and vegetable consumption in Thailand, the percentage of Thais meeting recommended intakes and the association with sociodemographic factors.

Cross-sectional survey with a stratified, three-stage, cluster probability sampling design.

Community-dwelling men and women participating in the Thailand National Health Examination Survey III.

A total of 39 290 individuals aged ≥15 years were interviewed using a questionnaire to obtain information on sociodemographic characteristics and fruit and vegetable consumption. Daily fruit and vegetable consumption was estimated through the use of a short semi-qualitative FFQ.

Overall, participants had average frequencies of fruit and vegetable consumption equal to 4·56 and 5·97 d/week, respectively. Average daily number of servings of fruit, vegetables and fruit plus vegetables were 1·46, 1·78 and 3·24, respectively. Intake amounts of fruit, vegetables and fruit plus vegetables varied by marital status and region, and were lower among males (except for vegetable intake), those of older age, those with low educational attainment, those with low monthly household income and those living in a rural area. Only 1/3, 1/4 and 1/4 of the population consumed the recommended ≥2, ≥3 and ≥5 servings/d for fruit, vegetables and fruit plus vegetables. Sociodemographic factors related to meeting the recommended intake of ≥5 servings/d for fruit plus vegetables included being female (OR = 1·13) and household income ≥50 000 Baht/month (OR = 1·66).

The amounts of fruit and vegetables consumed by Thai participants were far below the level of current recommendations. Public education and campaigns on adequate consumption of fruits and vegetables should be targeted more towards low socio-economic groups.

To examine whether eating while watching television poses a risk for poor nutrition and excess body weight over and above that of time spent watching television.

We analysed data of grade 5 students participating in a comprehensive population-based survey in the Canadian province of Nova Scotia. This survey included the Harvard’s Youth Food Frequency Questionnaire, students’ height and weight measurements, and a parent survey. We applied multivariable linear and logistic random effects models to quantify the associations of watching television and eating while watching television with diet quality and body weight.

The province of Nova Scotia, Canada.

Grade 5 students (n 4966).

Eating supper while watching television negatively affected the consumption of fruits and vegetables and overall diet quality. More frequent supper while watching television was associated with more soft drink consumption, a higher percentage energy intake from sugar out of total energy from carbohydrate, a higher percentage energy intake from fat, and a higher percentage energy intake from snack food. These associations appeared independent of time children spent watching television. Both watching television and eating while watching television were positively and independently associated with overweight.

Our observations suggest that both sedentary behaviours from time spent watching television as well as poor nutrition as a result of eating while watching television contribute to overweight in children. They justify current health promotion targeting time spent watching television and call for promotion of family meals as a means to avoid eating in front of the television.

To compare the food consumption and nutrient intakes of German children and adolescents in the 1980s with present dietary habits.

Two cross-sectional representative surveys, the German National Food Consumption Study (Nationale Verzehrsstudie, NVS) from 1985–8 and the nutrition module ‘EsKiMo’ of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) from 2006, were analysed for differences in food and nutrient intakes stratified by age and sex groups.

Secondary analyses of data from representative observational studies.

Children and adolescents aged 6–17 years living in Germany in the 1980s (n 2265) and in 2006 (n 2506).

Food consumption was characterised by higher amounts of vegetables/pulses, fruits/nuts and beverages and less meat products/sausages, butter, fats/oils, potatoes/potato products and bread/pastries in 2006 than in 1985–8. The overall changes in food intake were reflected in improvements of macronutrient composition, increased water intake and lower energy density of the diet. Intake of most vitamins and minerals increased in relation to energy intake, but the nutrient density of the diet for vitamins B12 and D decreased. The most critical nutrients observed in NVS and EsKiMo were folate, vitamin D, vitamin A, vitamin E, Ca and Fe. In addition, dietary fibre intake was relatively low and fatty acid and carbohydrate compositions were not favourable.

Further efforts will be necessary to improve dietary habits among children and adolescents.

To investigate the possible dietary risk factors for anaemia in rural elderly women.

Case–control study conducted in 2005. Cases and matched controls were interviewed in person to elicit information on lifestyle, diet and individual health. Main foods and nutrients were calculated by three 24 h recalls; intake data of tea, edible oils and spices were from an FFQ.

Fourteen villages in two counties of Guangxi Province, south-west China.

Four hundred and twenty anaemic cases and 433 matched controls, aged 50–75 years.

The mean consumption of animal foods for cases (82·4 g/d) was significantly lower than for controls (91·0 g/d), similarly for egg consumption (3·8 g/d for cases and 5·8 g/d for controls; P < 0·05). The absolute value of the Dietary Balance Index, low bound score (DBI_LBS) was significantly higher for cases than for controls (P < 0·05). Intakes of energy, protein, carbohydrate, vitamin A (retinol equivalents, RE), vitamin B1, riboflavin and Ca were significantly lower in cases than in controls (P < 0·05). There was no significant difference in Fe intake between the two groups. High intake of vitamin A (RE) was inversely associated with anaemia (quartile 4 v. quartile 1: OR = 0·6, P for linear trend = 0·02). The absolute value of DBI_LBS was positively related to anaemia (quartile 4 v. quartile 1: OR = 0·4, P for linear trend < 0·0001).

For rural elderly women in south-west China, anaemia had a strong positive association with undernutrition and a negative association with vitamin A intake. Dietary Fe intake was not found to be an independent risk factor for anaemia.

The purposes of the present study were to estimate individual intake from common-plate meals among Bedouin Arabs using a modified 24 h recall questionnaire, and to evaluate reported energy intake (EI) by comparison with estimated energy requirement (EER).

Weighed records were used to develop a method of quantifying intake from common plates. Reported EI and nutrient intakes were obtained from administration of the modified 24 h recall. The relative standard error (RSE) was used to evaluate the reliability of reported nutrient intakes. The FAO/WHO/United Nations University and Oxford equations and reported physical activity levels were used to compute ratios of reported EI to BMR and EER.

Population centres of traditionally semi-nomadic Bedouin Arabs undergoing sedentarization/urbanization in southern Israel.

A convenience sample of 451 adults (aged 19–82 years).

Mean (se) energy intake was 9648 (276) kJ/d (2306 (66) kcal/d) for men and 8230 (172) kJ/d (1967 (41) kcal/d) for women, of which carbohydrates accounted for 63–64 %. The nutrient intakes evaluated had RSE ratios of less than 25 %. EI:EER ratios ranged from 0·86 to 0·89, and from 0·87 to 0·93 among non-dieters who ate the usual amount on the recall day.

The modified 24 h recall produced plausible estimates of energy and nutrient intakes, comparable to those obtained with the 24 h recall in other populations. The modified questionnaire makes an important contribution to facilitating large-scale nutritional surveillance in the Bedouin population, and may serve as a model for modifying dietary instruments to quantify individual intake in other populations that practise common-plate eating.

The purpose of this impact evaluation was to measure the influence of a government of Ontario, Canada health promotion initiative, the Northern Fruit and Vegetable Pilot Programme (NFVPP), on elementary school-aged children’s psychosocial variables regarding fruit and vegetables, and fruit and vegetable consumption patterns.

A cluster-randomised controlled trial design was used. The NFVPP consisted of three intervention arms: (i) Intervention I: Free Fruit and Vegetable Snack (FFVS) + Enhanced Nutrition Education; (ii) Intervention II: FFVS-alone; and (iii) Control group. Using the Pro-Children Questionnaire, the primary outcome measure was children’s fruit and vegetable consumption, and the secondary outcome measures included differences in children’s awareness, knowledge, self-efficacy, preference, intention and willingness to increase fruit and vegetable consumption.

Twenty-six elementary schools in a defined area of Northern Ontario were eligible to participate in the impact evaluation. A final sample size of 1277 students in grades five to eight was achieved.

Intervention I students consumed more fruit and vegetables at school than their Control counterparts by 0·49 serving/d (P < 0·05). Similarly, Intervention II students consumed more fruit and vegetables at school than Control students by 0·42 serving/d, although this difference was not statistically significant. Among students in both intervention groups, preferences for certain fruit and vegetables shifted from ‘never tried it’ towards ‘like it’.

The NFVPP resulted in positive changes in elementary school-aged children’s fruit and vegetable consumption at school, and favourable preference changes for certain fruit and vegetables.

The dietary diversity score (DDS) is a good indicator of diet quality as well as of diet–disease relationships; therefore, the present study was undertaken to reveal the effect of a lifestyle intervention on this index.

A baseline and three evaluation studies were conducted in two intervention districts (Isfahan and Najaf-Abad) and a reference area (Arak), all located in central Iran. The Isfahan Healthy Hearth Programme (IHHP) targeted the entire population of nearly 2 million in urban and rural areas of the intervention communities. One of the main strategies of the lifestyle intervention phase in the IHHP was healthy nutrition. Usual dietary intake was assessed using a forty-nine-item FFQ. A diversity score for each food group was calculated and the DDS was considered the sum of the diversity scores of the food groups.

There were significant increases in DDS in both intervention areas (P = 0·0001) after controlling for confounding factors. There was a significant interaction between area and evaluation stage with regard to DDS (P = 0·0001). The effect of the intervention on the diversity scores of all food groups was also significant (P = 0·0001 for all) after adjusting for socio-economic status.

The community-based lifestyle intervention in the IHHP was successful in improving DDS which might be related to an increase of diet quality of the population that in turn might decrease the risks of chronic diseases.

To investigate the maternal factors associated with poor diet among disadvantaged children.

Survey of 300 mothers of 2-year-old children from areas of high deprivation in Scotland (response rate 81 %). A diet quality score was derived from reported consumption of carbohydrates, protein, fruit and vegetables, dairy products and restriction of sugary fatty foods.

Most children (85 %) were classified as having a poor quality diet (low diet quality score). Mothers’ general knowledge about healthy eating was high, but did not predict the quality of the children’s diet. Lower frequencies of food preparation and serving, such as cooking with raw ingredients, providing breakfast daily and the family eating together, were also associated with a poorer diet. Regression modelling identified five significant factors. An increased risk of a poor diet was associated with mothers being unlikely to restrict sweets (OR = 21·63, 95 % CI 2·70, 173·30) or finding it difficult to provide 2–3 portions of fruit daily (OR = 2·94, 95 % CI 1·09, 7·95). Concern that the child did not eat enough increased the risk of a poor diet (OR = 2·37, 95 % CI 1·09, 5·16). Believing a healthy diet would help the child eat more reduced the risk of having a poor diet (OR = 0·28, 95 % CI 0·11, 0·74), as did providing breakfast daily (OR = 0·22, 95 % CI 0·05, 0·99).

Interventions to improve children’s diet could promote more positive intentions about preparing and serving of foods, particularly of specific meals at which the family eats together. The benefits of these behaviours to the child (improved diet, weight control) should be emphasised.

Measures of diet quality have evolved with a number of scoring indices currently in use. They are increasingly being used to examine epidemiological associations between dietary intake and nutrition-related health outcomes. The present review aims to describe current diet quality tools and their applications, and to examine the relationship between diet quality and morbidity and mortality.

A search was conducted of MEDLINE, Cochrane, EMBASE, CINAHL and ProQuest electronic databases. Inclusion criteria were: English language; published from 2004 on; conducted in adult populations; longitudinal/cohort/case–control or cross-sectional study; included a theoretically defined measure of diet quality.

A total of twenty-five indices of overall diet quality and/or variety were found, with components ranging from nutrients only to adherence to recommended food group servings, to variety within healthful food groups. The majority of studies reviewed had methodological weaknesses but demonstrated that higher dietary quality was consistently inversely related to all-cause mortality, with a protective effect of moderate magnitude. The associations were stronger for men and for all-cause and CVD mortality.

The limitations of both the indices and the studies that use them need to be considered when interpreting and comparing results. However, diet quality indices do appear to be able to quantify risk of some health outcomes, including biomarkers of disease and risk of CVD, some cancers and mortality. Further research is needed to improve the validity of these tools and to adapt them for use in clinical dietetic practice.

Fish consumption has been shown to be inversely associated with CHD, which may be due to n-3 fatty acids. The n-3 fatty acids, EPA and DHA, are naturally found only in marine sources. Dietary intakes of methylmercury from certain fish have been hypothesized to increase the risk of CHD.

To investigate the relationship between 30 d fish frequency consumption (assessed by FFQ), total blood Hg concentrations and risk markers of CHD in women aged 16–49 years participating in the National Health and Nutrition Examination Survey 1999–2002.

Multiple linear regression analyses were used to test (i) the relationships between 30 d fish frequency consumption and five CHD risk markers, i.e. HDL cholesterol (HDL-C), LDL cholesterol, total cholesterol, TAG and C-reactive protein (CRP); and (ii) if total blood Hg attenuated any associations between fish consumption and CHD risk markers in non-pregnant, non-diabetic females aged 16–49 years.

Total 30 d fish frequency consumption was negatively associated with CRP (b = −0·10, 95 % CI −0·19, −0·02, P = 0·015) and positively associated with HDL-C (b = 1·40, 95 % CI 0·31, 2·50, P = 0·014). Adjustment for other risk factors did not significantly attenuate the associations. Despite the collinearity between fish and Hg, there is a protective association between fish intake and CHD risk factors.

The levels of DHA + EPA and other nutrients in fish may be adequate to offset the hypothesized risks of heart disease related to ingesting Hg from fish.

Folic acid food fortification has successfully reduced neural tube defect-affected pregnancies across Canada. The effect of this uncontrolled public health intervention on folate intake among Canadian children is, however, unknown. Our objectives were to determine folic acid intake from food fortification and whether fortification promoted adequate folate intakes, and to describe folic acid-fortified food usage among Ontario preschoolers.

Cross-sectional data were used from the NutriSTEP™ validation project with preschoolers recruited using convenience sampling. Mean daily total folate and folic acid intakes were estimated from 3 d food records, which included multivitamin supplement use. Comparisons were made to Dietary Reference Intakes, accounting for and excluding fortificant folic acid, to determine the prevalence of inadequate and excessive intakes.

Canada.

Two hundred and fifty-four preschoolers (aged 3–5 years).

All participants (130 girls, 124 boys) ate folic acid-fortified foods and 30 % (n 76) used folic acid-containing supplements. Mean (se) fortificant folic acid intake was 83 (2) μg/d, which contributed 30 % and 50 % to total folate intake for supplement users and non-users, respectively. The prevalence of total folate intakes below the Estimated Average Requirement was <1 %; however, excluding fortificant folic acid, the prevalence was 32 %, 54 % and 47 % for 3-, 4- and 5-year-olds, respectively. The overall prevalence of folic acid (fortificant and supplemental) intakes above the Tolerable Upper Intake Level was 2 % (7 % among supplement users).

Folic acid food fortification promotes dietary folate adequacy and did not appear to result in excessive folic acid intake unless folic acid-containing supplements were consumed.

To investigate the correlation between the consumption of refined carbohydrates and fats and the prevalence of obesity in the state capitals of Brazil.

An ecological evaluation of obesity and dietary risk factors was carried out in twenty-six state capitals of Brazil.

Analysis was based on the age-standardized prevalence of obesity (BMI ≥ 30·0 kg/m2) among adults aged 20–59 years. Both intake and obesity prevalence were obtained from the last National Family Household Budget Survey (HBS). The survey was conducted from July 2002 to June 2003, based on a probabilistic national sample of 48 470 households. In each household, during seven consecutive days, all monetary and non-monetary expenses for food and beverages for family consumption were transformed into energy. The relative contribution of foods and food groups was expressed as the proportion (%) of total energy. Fruits and vegetables were also measured by the quantity bought in grams.

Prevalence of obesity varied from 5·1 % to 13·6 % among women and from 5·2 % to 17·6 % among men. For women, there were statistically significant correlations between obesity and intake of sugar and soft drinks (rS = 0·60; P = 0·001), ready-to-eat meals (rS = 0·39; P = 0·05) and potatoes (rS = 0·40; P = 0·04). For men there were no such associations.

Increasing intake of refined carbohydrates, mainly soft drinks, may play a role in the prevalence of obesity among women in Brazil. Effecting changes in family purchase patterns may be a strategy to reduce obesity.

To explore the relationship between industry sponsorship of Ca supplementation studies in healthy children and study outcomes.

An electronic search for published randomized controlled trials (RCT) was conducted. We collected data on study design features aimed at reducing bias, statistical significance of results, authors’ conclusions and financial sponsorship of study. We used Fischer’s exact test to examine associations between sponsorship and study results and conclusions.

Healthy children between the ages of 9 and 18 years.

Nineteen trials met our inclusion criteria. Seventeen out of nineteen studies reported a statistically significant improvement of supplementation on bone mineral density. Subjects in eight of the seventeen studies had a baseline daily Ca intake of 800–1300 mg. There was no significant association between study design features and the results or conclusions of the studies. Three studies received government funding, two of which (66·7 %) concluded in favour of additional supplementation. Sixteen studies were either industry-funded or had mixed industry funding, thirteen (81·3 %) of which had a conclusion supporting Ca supplementation in children. There was no significant association between study sponsorship and authors’ conclusions.

The majority of RCT assessing the effects of Ca supplementation in healthy children are industry-funded and support Ca supplementation. The clinical significance of the outcomes measured in Ca supplementation studies should be considered when examining associations between study design and results. Further non-industry funded research is needed to thoroughly assess the impact of funding on authors’ conclusions in nutrition research.