To test whether reduced away-from-home food expenditure (AFHFE) and better nutrition knowledge and beliefs (NKB) are associated with dietary quality among US adults.

The dietary intake data (average of two 24 h recalls) used were collected from US adults (20–65 years) participating in two cross-sectional surveys, the 1994–96 Continuing Survey of Food Intake by Individuals (CSFII; n 7148) and the CSFII/Diet and Health Knowledge Survey (DHKS; n 4252).

Dietary quality was assessed using selected nutrients and food groups and the 2005 revised US Department of Agriculture Healthy Eating Index (HEI).

(i) Absolute AFHFE (weekly, per capita) and proportion of this exposure out of total food expenditure (relative expenditure); (ii) NKB score using a composite of an eleven-item scale elicited among the CSFII/DHKS subgroup.

We used t tests, χ2 tests, Wilcoxon rank-sum tests and multivariate linear regression models adjusting standard errors for sample design complexity. We utilized a change-in-estimate approach to assess mediation. For effect modification, we tested the significance of interaction terms (NKB × AFHFE).

Absolute AFHFE was positively associated with grams of fat (β = 0·14 (se 0·06)) and saturated fat (β = 0·02 (se 0·01)) and negatively associated with fibre (β = −0·02 (se 0·01)) and HEI (β = −0·08 (se 0·01)). Relative AFHFE mediated NKB effects on intakes such as fat, saturated fat, cholesterol, Na, and fruits and vegetables (change in estimate >10 %). Among subjects with a poor NKB score, higher AFHFE resulted in lower diet quality, particularly Na and cholesterol intakes.

Higher AFHFE was associated with a lower dietary quality and interacted antagonistically with NKB in some instances, while mediating the relationship between NKB and dietary quality in others.

To determine the prevalence of metabolic syndrome (MetS) in schoolchildren from 6 to 16 years old, while considering their socio-economic status and other potential risk factors.

A cross-sectional study was conducted between April and November of 2005 in a semi-rural city with a total population of 13 000 inhabitants.

The study was conducted in Maracai city, located in the Brazilian state of Sao Paulo.

Schoolchildren (n 2170) of both genders, corresponding to approximately 82 % of all Maracai schoolchildren, were evaluated for components of MetS, as defined by the National Cholesterol Education Program; reference values for children and adolescents were adjusted for age and sex.

Overall, MetS prevalence was 3·6 % (95 % CI 2·9, 4·5) and did not differ statistically between genders, skin colour, between children and adolescents. However, when we analysed groups of subjects by weight, MetS prevalence progressively increased from 0·3 % (95 % CI 0·1, 0·8) in normal-weight subjects to 10·7 % (95 % CI 7·4, 14·8) and 34·5 % (95 % CI 25·9, 43·9) in overweight and obese subjects, respectively (both P < 0·001 compared to normal-weight controls). When socio-economic classes were considered, 4·7 % high-income students (95 % CI 3·5, 6·2) had MetS, which was significantly greater than low-income students (2·7 %; 95 % CI 1·9, 3·9; P = 0·023).

MetS prevalence was high in overweight and obese schoolchildren and these risk factors were present during childhood and adolescence. Changes in lifestyle and alimentary safety should be encouraged to avoid future cardiovascular morbidity and type 2 diabetes mellitus.

The aim of the present study was to investigate the relationship between out-of-home (OH) eating and overweight and obesity among adults in Brazil.

Data were based on the 2002–2003 Household Budget Survey (48 470 households) conducted by The Brazilian Census Bureau. Foods and drinks purchased for OH eating during a one-week period were recorded by each participant. We considered OH eating as the purchase of at least one food or drink item for OH consumption during this period. We classified items as: soft drinks, deep-fried snacks, fast foods, sweets and sit-down meals.

Urban areas in Brazil.

56 178 participants (26 225 men and 29 953 women), aged 25–65 years.

The weighted prevalence of OH eating was 40·3 %. Overall, OH eating was positively associated with overweight (OR = 1·21; 95 % CI 1·10, 1·33) and obesity (OR = 1·35; 95 % CI 1·16, 1·57) among men, but not among women. Sit-down meals and soft drinks were the most frequently reported food groups. Both were positively associated with overweight (OR = 1·34 for meals; OR = 1·17 for soft drinks, P < 0·05) and obesity (OR = 1·51 for meals; OR = 1·39 for soft drinks, P < 0·05) among men, but negatively associated with overweight and obesity among women.

OH eating was associated with overweight and obesity only among men, whereas, among women, eating sit-down meals out of home was protective for obesity, suggesting that women make healthier food choices when they eat out of home.

To examine knowledge of and adherence to the Mediterranean dietary pattern (MDP) among Greek adolescents, assess associations between MDP knowledge and adherence with BMI, and determine socio-cultural factors predicting MDP compliance.

Cross-sectional.

Greek adolescents aged 15–17 years.

Two hundred adolescents (103 females, ninety-seven males) from six schools on the Greek island of Chios. The sampling procedure was similar for all schools; schools were randomly selected from different geographic areas and all municipalities. BMI was calculated from measured height and weight; participants completed four questionnaires assessing parents’ socio-economic status and education, adolescents’ perceived and actual MDP knowledge, past-week dietary habits, and MDP adherence.

Participants’ BMI indicated 64·5 % were normal weight and 35·5 % were overweight/obese (mean BMI 23·7 (sd 3·8) kg/m2). Over half had very poor MDP knowledge (58·5 %) and adherence (59·5 %); both perceived (F = 3·35, P = 0·037) and actual MDP knowledge (F = 3·45, P = 0·034) were significantly different across MDP adherence. Perceived MDP knowledge was positively correlated with vegetable consumption (r = 0·185, P = 0·009); actual knowledge was negatively correlated with meat consumption (r = −0·191, P = 0·007). BMI was negatively correlated with family income (r = −0·202, P = 0·004), indicating higher BMI in less affluent households. Actual MDP knowledge was the only significant predictor of MDP adherence (standardized β = 0·162, P = 0·030) in a model accounting for 7·3 % of overall variance.

Greek adolescents reported consuming a more Westernized diet detached from the traditional MDP. Actual MDP knowledge and family income were important factors affecting MDP adherence and BMI, respectively. Promoting the traditional MDP among Greek adolescents and their families appears warranted.

To validate a 53-item quantitative FFQ (QFFQ) for the assessment of dietary protein intake in type 2 diabetic outpatients in Bamako, Mali.

Consumption of protein-containing foods over the week preceding the interview was measured with a 7d QFFQ and compared with intakes measured with 48-h recalls.

Centre National de Lutte contre le Diabète.

Seventeen male and forty female adults with type 2 diabetes.

Correlation between protein intakes estimated using the QFFQ and 48h recalls was 0·63 (P < 0·0001). There was no significant difference between the two methods concerning the total protein daily intakes and intakes per kilogram of body weight. The QFFQ indicated that foods of animal origin were a lesser source of protein. Animal protein intake did not differ between men and women but sources did. In men, the main sources were beef (54 % of total animal protein), fish (15 %) and milk powder (8 %). In women, the principal sources were fish (28 %), beef (20 %) and birds (13 %). In contrast, plant protein intake was significantly higher in men than in women (P = 0·01), but the same plant foods contributed in similar proportions for both genders, rice being by far the greatest source (47 % of plant protein in men, 53 % in women).

The QFFQ developed in this study is a valid tool to evaluate dietary protein intakes in Malian diabetic subjects. While the total protein intakes were low in both men and women, differences in choices and amounts of protein food sources were shown.

The present pilot project aimed to assess the effectiveness of social mobilization and social marketing in improving knowledge, attitudes and practices (KAP) and Fe status in an Fe-deficient population.

In an uncontrolled, before–after, community-based study, social mobilization and social marketing strategies were applied. The main outcomes included KAP and Hb level and were measured at baseline, 1 year later and 2 years later.

One urban county and two rural counties in Shijiazhuang Municipality, Hebei Province, China.

Adult women older than 20 years of age and young children aged from 3 to 7 years were selected from three counties to attend the evaluation protocol.

After 1 year, most knowledge and attitudes had changed positively towards the prevention and control of anaemia. The percentage of women who had adopted NaFeEDTA-fortified soya sauce increased from 8·9 % to 36·6 % (P ≤ 0·001). After 2 years, Hb levels had increased substantially, by 9·0 g/l (P ≤ 0·001) in adult women and 7·7 g/l (P ≤ 0·001) in young children.

Social mobilization and social marketing activities had a positive impact on the KAP of adult women, and resulted in marked improvements in Hb levels in both adult women and young children. This should be recommended as a national preventive strategy to prevent and control Fe deficiency and Fe-deficiency anaemia.

To examine the potential of anthropometry as a tool to measure gender discrimination, with particular attention to the WHO growth standards.

Surveillance data collected from 1990 to 1999 were analysed. Height-for-age Z-scores were calculated using three norms: the WHO standards, the 1978 National Center for Health Statistics (NCHS) reference and the 1990 British growth reference (UK90).

Bangladesh.

Boys and girls aged 6–59 months (n 504 358).

The three sets of growth curves provided conflicting pictures of the relative growth of girls and boys by age and over time. Conclusions on sex differences in growth depended also on the method used to analyse the curves, be it according to the shape or the relative position of the sex-specific curves. The shapes of the WHO-generated curves uniquely implied that Bangladeshi girls faltered faster or caught up slower than boys throughout their pre-school years, a finding consistent with the literature. In contrast, analysis of the relative position of the curves suggested that girls had higher WHO Z-scores than boys below 24 months of age.

Further research is needed to help establish whether and how the WHO international standards can measure gender discrimination in practice, which continues to be a serious problem in many parts of the world.

Consumers are increasingly relying on low-cost foods, although it is not clear if the nutritional quality of these foods is fully maintained. The aim of the present work was to analyse the relationship between cost and quality within a given food category.

The relationship was analysed between nutritional quality and cost for 220 food products belonging to seventeen different categories, controlling for package type and package size. Given that a summary of nutrient information was not available on the product label, a novel ingredient quality score was developed based on listed product ingredients.

Within a given category, the lowest-priced foods were not different from the equivalent branded products in terms of overall energy or total fat content. Nevertheless, a positive relationship, small but significant, was observed between the price and the ingredient quality score. On average, the branded products cost 2·5 times more than the low-cost products, for an equivalent energy and lipid content, and had a slightly higher (1·3 times) ingredient quality score.

More studies are necessary to evaluate the nutritional quality of low-cost foods. This evaluation would be facilitated if nutrition labelling was mandatory. Yet in view of the present results, it does not seem to be justified to divert consumers, especially the poorest, from low-cost foods because this may have an adverse effect on the nutritional quality of their diet, by reducing further the fraction of their food budget spent on fresh fruit and vegetables.

To test equations for calculating infants’ energy requirements as a simple and reliable instrument for estimating the amount of breast milk consumed in epidemiological studies where test-weighing is not possible.

Infants’ energy requirements were calculated using three different equations based on reference data and compared with actual energy intakes assessed using the 3 d weighed dietary records of breast-fed infants from the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study.

A sub-sample of 323 infants from the German DONALD Study who were predominantly breast-fed for at least the first four months of life, and who had 3 d weighed dietary records and repeated body weight measurements within the first year of life.

Healthy, term infants breast-fed for at least 4 months, 0–12 months of age.

The overall differences between measured energy intake and calculated energy requirements were quite small, never more than 10 % of total energy intake, and smaller than the mean variance of energy intake between the three days of recording. The equation of best fit incorporated body weight and recent growth, while the worst fit was found for the equation not considering body weight.

Breast milk consumption in fully and partially breast-fed infants can be reasonably quantified by calculating the infants’ individual energy requirements via simple equations. This provides a feasible approach for estimating infant energy intake in epidemiological studies where test-weighing of breast milk is not possible.

While epidemiological research on the protective role of the Mediterranean diet (MD) is highly publicised, little is known about MD education interventions. This exploratory study aimed to provide insight into methodology and effectiveness of the MD as a nutrition education and health promotion tool.

Two searches were conducted within PubMed using the terms ‘Mediterranean diet’ and ‘Education’ or ‘Intervention’. Abstracts yielded were screened for distinct studies in which participants were instructed on the application of MD principles in their diet. Four studies met this criterion. These were further analysed for sample/target population, and intervention design, duration, tools, evaluative measures/tests and outcomes.

Interventions targeted both healthy and at-risk populations and lasted between 12 weeks to 1 year, including follow-up. They used individual counselling, tailored computer-based counselling, group education, internet-based education, cookery classes and printed materials. Outcomes were measured using food diaries, FFQ, questionnaires on psychosocial factors and on usage of the educational tools, as well as anthropometrics and biomarkers. Interventions showed statistically significant increases in participants’ intake of vegetables, legumes, nuts, fruit, whole grains, seeds, olive oil and dietary PUFA and MUFA, and statistically significant decreases in total cholesterol, ox-LDL-cholesterol, total:HDL-cholesterol ratio, insulin resistance, BMI, body weight and waist circumference.

MD education interventions may be cost-effective strategies for helping to protect against and treat a variety of health problems in different populations. Details of such interventions need to be publicised internationally. This introductory review could help inform the design of future targeted MD nutrition education.

Little is known about the relationship of dietary cost to health status. The present cross-sectional study examined the association between the monetary cost of dietary energy (Japanese yen/4184 kJ) and several metabolic risk factors.

Monetary cost of dietary energy was estimated based on dietary intake assessed by a self-administered diet history questionnaire and retail food prices. Body height and weight, from which BMI was derived, waist circumference and blood pressure were measured and fasting blood samples were collected for biochemical measurements.

A total of fifteen universities and colleges in Japan.

A total of 1136 female Japanese dietetic students aged 18–22 years.

After adjustment for potential confounding factors, monetary cost of dietary energy was significantly and negatively associated with BMI (P for trend = 0·0024). Monetary cost of dietary energy also showed a significant and negative association with waist circumference independently of potential confounding factors, including BMI (P for trend = 0·0003). No significant associations were observed for other metabolic risk factors examined (P for trend = 0·10–0·88).

The monetary cost of dietary energy was independently and negatively associated with both BMI and waist circumference, but not other metabolic risk factors, in a group of young Japanese women.

To review and update the current knowledge on the potential impact of strawberry on human health, with particular attention on compounds and indirect mechanisms of action not exhaustively considered.

Personal perspectives and recent data.

International.

Our research group was among the few groups that have recently investigated the folate content in fresh, stored and processed strawberries, and the data look very promising. As well, some in vivo evidence of the impact of strawberry intake on the folate status in humans have already been reported, but a new increasing interest on this field is strongly hoped. Furthermore, the hypouricaemic effects previously ascribed to cherry consumption need to be evaluated in respect to strawberry intake. At the moment, inconsistent results come from the few investigations designed at this proposal. In our studies, a great interindividual variability was observed on plasma urate levels in response to strawberry intake, suggesting a putative effect.

The mechanisms responsible for the potential health-promoting effects of strawberry may not be necessarily searched in the activity of phytochemicals. Particularly, a greater interest should be addressed to show whether a prolonged strawberry consumption may effectively improve the folate status and reduce the incidence of folate-related pathological conditions. Furthermore, the hypouricaemic effects of cherries need to be evaluated also in respect to strawberry intake, and the mechanisms of actions and anti-gout potentialities need to be studied in detail.

Future investigations involving human trials should be aimed at following these underestimated scientific tracks.

To compare the differences in hyperlipidaemia prevalence and its risk factors between the Guangxi Bai Ku Yao and Han populations.

Cross-sectional study of hyperlipidaemia.

Both populations were from Lihu and Baxu villages in Nandan County, Guangxi Zhuang Autonomous Region, People’s Republic of China.

A total of 1170 healthy subjects of Bai Ku Yao and 1173 participants of Han Chinese aged 15–89 years were surveyed by a stratified randomized cluster sampling. Information on demographic, dietary and lifestyle characteristics was collected by standard questionnaires. Blood pressure, height, weight, waist circumference, serum lipids and apolipoproteins were measured, and BMI (kg/m2) was calculated as weight divided by the square of height.

The prevalence rates of hypercholesterolaemia, hypertriacylglycerolaemia and hyperlipidaemia in Bai Ku Yao and Han were 12·4 % v. 26·2 % (P < 0·001), 15·0 % v. 14·8 % (P > 0·05) and 24·4 % v. 33·9 % (P < 0·001), respectively. Hyperlipidaemia was positively correlated with BMI, waist circumference, total energy and total fat intakes, and negatively associated with physical activity and total dietary fibre intake in Bai Ku Yao (P < 0·05 to 0·001). Hyperlipidaemia was positively associated with age, alcohol consumption, BMI, waist circumference, total energy and total fat intakes, and inversely correlated with physical activity and total dietary fibre intake in Han (P < 0·05 to 0·001).

The prevalence of hypercholesterolaemia and hyperlipidaemia was significantly lower in the Bai Ku Yao than in the Han population, which might result from different dietary habits, lifestyle choices and physical activity level, as well as genetic factors between the two ethnic groups.

Every society follows its own traditional health-care beliefs and practices during and after pregnancy, which is intimately linked to its socio-cultural environment. The objective of the present study was to document pregnancy-related food practices and the social-cultural factors linked with them.

The present study was a cross-sectional one conducted among a group of women residing in five villages in east Sikkim, India. Mothers who had given birth to a child one year before the survey participated in the study. The mothers answered a pre-tested questionnaire on food habits and practices followed antepartum and for 6 weeks postpartum.

The study group consisted of 199 women of Nepali caste groups with variations in economic condition.

More than 86 % of mothers consumed special foods during the postpartum period. Taboos on different food categories during the postpartum were reported only by 65·3 % of mothers. Factors found to be significantly associated with special food consumption were literacy status during the antepartum and parity during the postpartum.

The change in consumption patterns reflects the success of a safe motherhood campaign propagated by the government. Detailed investigation in this area, involving per capita daily consumption during pregnancy and the postpartum period, is needed.

Neighbourhood differences in access to fresh fruit and vegetables may explain social inequalities in diet. Investigations have focused on variations in cost and availability as barriers to the purchase and consumption of fresh produce; investigations of quality have been neglected. Here we investigate whether produce quality systematically varies by food store type, rural–urban location and neighbourhood deprivation in a selection of communities across Scotland.

Cross-sectional survey of twelve fresh fruit and vegetable items in 288 food stores in ten communities across Scotland. Communities were selected to reflect a range of urban–rural settings and a food retail census was conducted in each location. The quality of twelve fruit and vegetable items within each food store was evaluated. Data from the Scottish Executive were used to characterise each small area by deprivation and urban–rural classification.

Scotland.

Quality of fruit and vegetables within the surveyed stores was high. Medium-sized stores, stores in small town and rural areas, and stores in more affluent areas tended to have the highest-quality fresh fruit and vegetables. Stores where food is secondary, stores in urban settings and stores in more deprived areas tended have the lowest-quality fresh produce. Although differences in quality were not always statistically significant, patterns were consistent for the majority of fruit and vegetable items.

The study provides evidence that variations in food quality may plausibly be a micro-environmental mediating variable in food purchase and consumption and help partially explain neighbourhood differences in food consumption patterns.

To estimate the prevalence of underweight between 1998 and 2006 in Liverpool schoolchildren aged 9–10 years using recently published underweight cut-off points.

Stature and body mass data collected at the Liverpool SportsLinx project’s fitness testing sessions were used to calculate BMI.

Data were available on 26 782 (n 13 637 boys, 13 145 girls) participants.

Overall underweight declined in boys from 10·3 % in 1998–1999 to 6·9 % in 2005–2006, and all sub-classifications of underweight declined, in particular grade 3 underweight, with the most recent prevalence being 0·1 %. In girls, the prevalence of underweight declined from 10·8 % in 1998–1999 to 7·5 % in 2005–2006. The prevalence of all grades of underweight was higher in girls than in boys. Underweight showed a fluctuating pattern across all grades over time for boys and girls, and overall prevalence in 2005–2006 represents over 200 children across the city.

Underweight may have reduced slightly from baseline, but remains a substantial problem in Liverpool, with the prevalence of overall underweight being relatively similar to the prevalence of obesity. The present study highlights the requirement for policy makers and funders to consider both ends of the body mass spectrum when fixing priorities in child health.

The current paper aims to describe the characteristics of mothers failing to initiate breast-feeding, provide information on the factors contributing to longer duration of breast-feeding and identify the association of maternal obesity with both initiation and duration of breast-feeding in the Greek population.

Data from the cross-sectional GENESIS (Growth, Exercise and Nutrition Epidemiological Study In preSchoolers) study were used. Mothers were categorized by their pre-pregnancy BMI and their gestational weight gain according to guidelines from the Institute of Medicine.

Preschool children aged 1–5 years in five counties in Greece.

Preschoolers (n 2374) with full maternal anthropometric data before and during pregnancy and breast-feeding data.

A higher percentage of mothers with increased pre-pregnancy BMI or high gestational weight gain failed to initiate breast-feeding compared with their normal-weight counterparts. Obese mothers were 2·86 times more likely to fail in initiating breast-feeding in a multiple logistic regression model. Multiple linear regression analysis showed that among women initiating breast-feeding, those who were either underweight before pregnancy or smoked at the third trimester of pregnancy breast-fed their children for about 1·5 weeks less than their normal-weight or non-smoking counterparts, respectively. Similarly, multiparous women breast-fed their children for about 7 weeks less than uniparous women. In women who initiated breast-feeding, no significant differences in breast-feeding duration were found between women of different gestational weight gains.

Mothers with high pre-pregnancy BMI are less likely to initiate breast-feeding while high gestational weight gain has no effect on either the initiation or duration of breast-feeding in Greece.

To determine changes in ability to identify specific vegetables and fruits, and attitudes towards vegetables and fruit, associated with the introduction of a school-based food garden.

A 12-month intervention trial using a historical control (control n 132, intervention n 120), class-based, self-administered questionnaires requiring one-word answers and 3-point Likert scale responses.

A state primary school (grades 4 to 7) in a low socio-economic area of Brisbane, Australia.

The introduction of a school-based food garden, including the funding of a teacher coordinator for 11 h/week to facilitate integration of garden activities into the curriculum.

Ability to identify a series of vegetables and fruits, attitudes towards vegetables and fruit.

Frequency distributions for each item were generated and χ2 analyses were used to determine statistical significance. Exploratory factor analysis was employed to detect major trends in data.

The intervention led to enhanced ability to identify individual vegetables and fruits, greater attention to origins of produce (garden-grown and fresh), changes to perceived consumption of vegetables and fruits, and enhanced confidence in preparing fruit and vegetable snacks, but decreased interest in trying new fruits.

The introduction of this school-based food garden was associated with skill and attitudinal changes conducive to enhancing vegetable and fruit consumption. The ways in which such changes might impact on dietary behaviours and intake require further analysis.

The present study examined whether ethanol exposure influences lactation parameters. Specifically, selected constituents in maternal blood and milk and the lactation performance of Chinese lactating mothers were evaluated after they had consumed chicken soup flavoured with sesame oil and rice wine (CSSR), a diet traditionally prescribed during the postpartum ‘doing-the-month’ ritual.

Twenty-three lactating mothers were examined. Informed consent was obtained from each subject. Each subject was tested on two occasions separated by a week. The target alcohol dosage was 0·3 g/kg body weight. Milk and blood samples were collected prior to consumption of soup and at 120 and 150 min, respectively, after consumption. Levels of various constituents were measured. The time for ejection of the first milk droplet and total milk volume yielded were also measured.

Consumption of CSSR influenced TAG, insulin and lactate levels in maternal blood. Likewise, consumption of the soup affected milk composition and its nutritional status, particularly total protein, TAG, fatty acid, β-hydroxybutyrate and lactate levels. CSSR intake significantly affected TAG and lactate levels in milk. The time for the first milk droplet to be ejected was significantly longer in the CSSR group, indicating that the milk-ejecting reflex is inhibited. However, blood prolactin level increased slightly after ethanol intake. Milk yields were reduced after ingestion of CSSR although the difference was not statistically significant.

Consumption of CSSR affects not only the composition of maternal blood and milk, but also lactation performance. These findings suggest that an alcoholic diet should be avoided during lactation.