To describe and compare caffeinated energy drink adverse event (AE) report/exposure call data from the US Food and Drug Administration Center for Food Safety and Applied Nutrition’s Adverse Event Reporting System (CAERS) and the American Association of Poison Control Centers’ National Poison Data System (NPDS).

Cross-sectional.

Data were evaluated from US-based CAERS reports and NPDS exposure calls, including report/exposure call year, age, sex, location, single v. multiple product consumption, outcome, symptom, intentionality (NPDS only), report type, product name (CAERS only).

The analysis defined participants (cases) by the number of caffeinated energy drink products indicated in each AE report or exposure call. Single product cases included 357 from CAERS and 12 822 from NPDS; multiple product cases included 153 from CAERS and 931 from NPDS.

CAERS v. NPDS single product cases were older and more frequently indicated serious symptoms. Multiple v. single product consumers were older in both. In CAERS, unlike NPDS, most multiple product consumers were female. CAERS single v. multiple product reports cited higher proportions of life-threatening events, but less often indicated hospitalization and serious events. NPDS multiple v. single product cases involved fewer ≤5-year-olds and were more often intentional.

Despite limitations, both data sources contribute to post-market surveillance and improve understanding of public health concerns.

To evaluate associations of demographic and socio-economic factors with diet quality among population subgroups in Bosnia and Herzegovina (B&H).

A cross-sectional analysis of 2017 B&H dietary survey data. Diet quality was assessed by the Prime Diet Quality Score (PDQS) utilizing data from two non-consecutive 24 h diet recalls. Socio-economic variables were extracted from the 2015 B&H Household Budget Survey. Homogeneity of means across population subgroups was evaluated using multivariable regression.

B&H population survey.

A population-based sample of 853 adults.

The mean PDQS was 15·8 (range 7–28 out of a possible 42 points). In general, Bosnian adults had low PDQS due to high intakes of refined grains, high-fat dairy and processed meats, and low intakes of whole grains, nuts and fish. The PDQS was significantly higher (P < 0·0001) among older individuals (17·0) compared with those in the youngest group (14·5), among individuals living in the central and northern regions (16·5) compared with those living in the south (15·1; P < 0·0001), and among people who are married/cohabitating (16·1) v. single (14·8; P = 0·02). In energy-adjusted models, socio-economic status (P = 0·04) and tertiles of household spending (P = 0·002) were inversely associated with the PDQS.

Diet quality in this population was low. Young and middle-aged individuals, singles and those living in the south had significantly lower quality diets compared with other subgroups. Public health action is needed to promote higher consumption of whole grains, nuts and fish, and a higher variety of fruits and vegetables.

The current study aimed to examine the correspondence between sales data and dietary recall data for sugary drinks in Canada.

Repeat cross-sectional analysis of sales data for sugary drinks sold in Canada from 2004 to 2015 from two sources: GlobalData (GD) and Euromonitor (EM). Sugary drinks included ten beverage categories containing free sugars. Analyses examined sales volumes over time, with adjustment for population growth. National intake estimates were drawn from the 2004 and 2015 Canadian Community Health Survey (CCHS) Nutrition.

Canada.

Not applicable.

In 2015, daily per capita sugary drinks consumption was estimated as 356 ml (GD) and 443 ml (EM) from sales data sources, and as 277 ml from dietary recall data. Both sales data sources and dietary recall data indicated that per capita sugary drinks consumption decreased from 2004 to 2015, although the magnitude of this change differed: −23 % (GD), −17 % (EM) and −32 % (CCHS Nutrition). Market sales data showed similar trends among categories of sugary drinks, with decreases in sales of traditional beverage categories (e.g. carbonated soft drinks) and increases in novel categories (e.g. sugar-sweetened coffee).

All data sources indicate a declining trend in sugary drinks consumption between 2004 and 2015, but with considerable differences in magnitude. Consumption estimates from sales data were substantially higher than estimates from dietary recall data, likely due to under-reporting of beverage intake through dietary recall and the inability of sales data to account for beverages sold but not consumed. Despite the observed decline, sugary drinks sales volumes remain high in Canada.

We analysed optimal nutrient levels using linear programming (LP) to reveal nutritional shortcomings of Korean dine-out meals and to stress the importance of fruits and dairy products for maintaining a healthy diet.

LP models that minimize deviation from recommended nutrient values were formulated to analyse deficiency or excess of nutrients under the best situation.

Korean dine-out menus and nutritional information were taken from the nutrient composition tables for dine-out menus developed by the Ministry of Food and Drug Safety and the nutrient database from Computerized Analysis Program. Acceptable macronutrient distribution ranges of macronutrients such as carbohydrate, protein and fat, and recommended intake levels for energy, vitamins, minerals and cholesterol, by sex, were based on the Dietary Reference Intake for Koreans aged 30–49 years.

Optimization was performed on selecting the optimal Korean meal combination.

LP optimization models showed that it is unlikely to satisfy all nutrient recommendations with any combination of dine-out menus. Specifically, meal combinations of Korean dine-out menus had high levels of Na and cholesterol and low levels of vitamins and minerals. Four formulations were considered to compare the effects of controlling Na and including fruit and dairy products. The unbalanced diet was resolved with extra consumption of fruits and dairy products.

The best meal combination in dine-out menus, even though the proportion and pairing of menus may be unrealistic, is not healthy, and thus one should consume fruits and dairy products to maintain a balanced diet.

To determine associations between household food security status and risk of Cu toxicity.

A population-level cross-sectional study to determine adult household food security status and its relationship with serum total Cu concentration (serum Cu) using multivariable regression models.

Adult participants in the US National Health and Nutrition Examination Survey (NHANES) 2011–2014.

The NHANES phlebotomy data, a nationally representative sample (n 2780; 1360 men and 1420 women), were analysed.

A significantly greater proportion of food-insecure persons had serum Cu that was above the upper value of the normal range (clinical cut-off) compared with their food-secure counterparts. In men, food insecurity (OR = 2·24, P < 0·001) and marginal food security (OR = 1·79, P < 0·001), and in women, marginal food security (OR = 1·82, P = 0·016), associated with greater likelihood to have serum Cu that was above the upper value of the normal range. Food insecurity was significantly associated with greater likelihood (OR = 1·65, P = 0·020) to have serum Cu that was within the upper quartile (≥75th centile).

Food-insecure persons associate with higher serum Cu concentration and are at greater risk of Cu toxicity. There is need to study the sources of Cu in general, and specifically in food-insecure persons, to facilitate reduction of Cu exposure. Examining Cu contents of the food and water supplies could explicate any relationships to food insecurity and Cu intake.

To investigate trends in total fat and fatty acid intakes and chronic health conditions among Korean adults over nine years between 2007 and 2015.

Cross-sectional, observational study using a stratified, multistage probability sampling design at a national level. Intakes of total fat and fatty acids were estimated from 24 h dietary recalls by sex and age groups. Trends of total fat and fatty acid intakes were determined by multiple linear regression after adjusting for covariates. Trends in age-standardized prevalence of obesity, hypercholesterolaemia and hypertriacylglycerolaemia were examined by sex.

Korea.

Population data of 47749 healthy adults (aged ≥19 years) derived from the Korea National Health and Nutrition Examination Survey between 2007 and 2015.

Over the survey period, daily intakes of energy and total, saturated, monounsaturated, polyunsaturated, n-3 and n-6 fats (grams and percentage of energy (%E)) increased steadily. In all sex and age groups, significant increases were seen in SFA intake from 9·9 g (4·7 %E) to 12·0 g (5·3 %E) and in MUFA intake from 9·9 g (4·6 %E) to 13·3 g (5·8 %E). The prevalence of hypercholesterolaemia increased from 10·7 to 17·9 % over the same period.

In Korean adults, total fat, SFA and other fatty acids have been increasing along with the prevalence of hypercholesterolaemia. This information can help set adequate macronutrient and fatty acid distribution ranges in developing population-specific preventive strategies against diet-related illness.

To identify cut-off points for waist circumference (WC), waist-to-height ratio (WHtR) and BMI associated with hypertension in the Brazilian adult and elderly population.

Cross-sectional study. The receiver-operating characteristic (ROC) curve was used to determine the cut-off points of WC, WHtR and BMI in the prediction of hypertension. Those who had systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and those who reported use of antihypertensive medication were considered hypertensive.

Brazil.

Participants from the National Health Survey, the Brazilian household-based survey conducted in 2013, of both sexes and age ≥20 years.

Cut-off points for WC and WHtR increased with age in both sexes. WC cut-off limits ranged between 88·0 and 95·9 cm in men and between 85·0 and 93·2 cm in women. For WHtR, cut-off scores ranged from 0·51 to 0·58 for men and from 0·53 to 0·61 for women. Additionally, the area under the ROC curve (AUC) for all age and sex groups was greater than 0·60 while the lower limit of the AUC 95 % CI for both WC and WHtR was not less than 0·50. The performance of BMI was similar to that of indicators of fat location.

All analysed anthropometric indicators had similar performance in identifying hypertension in the Brazilian population.

To develop an index to assess the nutritional quality of household food purchases based on food expenditures only.

A database of monthly food purchases of a convenience sample of low-income households was used to develop the Healthy Purchase Index (HPI). The HPI is the sum of two sub-scores based on expenditure shares of food categories in total household food expenditure: the purchase diversity sub-score and the purchase quality sub-score. The first was adapted from an existing diversity score. The second integrated those food categories identified as the best predictors of the nutritional quality of purchases based on associations between expenditure shares of food categories and two nutritional quality indicators: the mean adequacy ratio (MAR) and the mean excess ratio (MER). Correlation between the HPI and a score assessing adherence to French dietary guidelines (PNNS-GSmod) was performed as a first validation.

Food purchases of 112 households from deprived neighbourhoods of Marseille (France), participating in the Opticourses and Jassur projects (2012–2015).

The purchase diversity sub-score reflects the presence in food purchases of five food categories: fruits, vegetables, starches, dairy products, and meat, fish & eggs. The purchase quality sub-score is based on expenditure shares for fruit & vegetables, added fats & seasonings, sweet snacks, cheese, sugary drinks, refined grains and fish, as these were identified as predictors of the nutritional quality of purchases. The HPI was positively associated with the PNNS-GSmod (rs=0·378; P<0·001).

The HPI helps assess the healthiness of household food purchases.

The present study evaluates the use of multiple correspondence analysis (MCA), a type of exploratory factor analysis designed to reduce the dimensionality of large categorical data sets, in identifying behaviours associated with measures of overweight/obesity in Vanuatu, a rapidly modernizing Pacific Island country.

Starting with seventy-three true/false questions regarding a variety of behaviours, MCA identified twelve most significantly associated with modernization status and transformed the aggregate binary responses of participants to these twelve questions into a linear scale. Using this scale, individuals were separated into three modernization groups (tertiles) among which measures of body fat were compared and OR for overweight/obesity were computed.

Vanuatu.

Ni-Vanuatu adults (n 810) aged 20–85 years.

Among individuals in the tertile characterized by positive responses to most of or all the twelve modernization questions, weight and measures of body fat and the likelihood that measures of body fat were above the US 75th percentile were significantly greater compared with individuals in the tertiles characterized by mostly or partly negative responses.

The study indicates that MCA can be used to identify individuals or groups at risk for overweight/obesity, based on answers to simply-put questions. MCA therefore may be useful in areas where obtaining detailed information about modernization status is constrained by time, money or manpower.

To delineate trends in types of protein in US adults from 1999 to 2010, we examined the mean intake of beef, pork, lamb or goat, chicken, turkey, fish, dairy, eggs, legumes, and nuts and seeds (grams per kilogram of body weight) among adults and according to subgroups, including chronic disease status.

Six cycles of the repeated cross-sectional surveys.

National Health and Nutrition Examination Survey 1999 to 2010.

US adults aged ≥20 years (n 29 145, range: 4252–5762 per cycle).

Overall, mean chicken (0·47 to 0·52 g/kg), turkey (0·09 to 0·13 g/kg), fish (0·21 to 0·27 g/kg) and legume (0·21 to 0·26 g/kg) intake increased, whereas dairy decreased (3·56 to 3·22 g/kg) in US adults (P <0·03). Beef, lamb or goat intake did not change in adults or among those with a chronic disease. Over time, beef intake declined less, and lamb or goat intake increased more, for those of lower socio-economic status compared with those of higher socio-economic status.

Despite recommendations to reduce red meat, beef, lamb or goat intake did not change in adults, among those with a chronic disease or with lower socio-economic status.

To assess rates of food insecurity (FI) among college students enrolled at a large public university system across one US state and identify factors associated with experiencing FI.

Cross-sectional online survey administered to eligible, enrolled students (n 38 614) across three campuses within the university system, with 5593 students responding (4824 final sample after applying exclusion criteria, 12·5 % response rate). FI was assessed using the US Department of Agriculture’s Adult Food Security Survey Module. Descriptive statistics were conducted to calculate FI status and identify sample characteristics. Associations between FI status and independent variables were assessed using bivariate analyses (χ2 and ANOVA tests) and multivariate logistic regression.

Large public university system, Southeast USA.

Enrolled college students (excluding freshman, <18 years of age).

Thirty-six per cent of students were classified as FI. After controlling for confounders, factors that were significantly associated with increased likelihood of FI included previous FI (P<0·001; OR=4·78), financial factors and self-reported grade point average ≤3·85. Seniors were significantly more likely experience FI than graduate students (P=0·004, OR=1·41). A significant relationship was not identified between FI and meal plan participation, and no differences in FI were found between graduate students and individuals with sophomore or junior standing.

This research identifies high rates of FI among college students enrolled in a large public university system in the Southeast USA, as well as selected factors related to FI. Programmes to assist college students experiencing FI need to be developed and tested.

To determine the acceptability, internal consistency and test–retest reliability of self-efficacy, motivation and knowledge scales relating to pre-school children’s nutrition, oral health and physical activity.

An online questionnaire was completed twice with an interval of 7–11d.

Online questionnaires were sent to participants via email from nursery managers. The parent questionnaire was also available on the parenting website www.netmums.com.

Eighty-two parents and sixty-nine nursery staff from Bristol, UK who had and worked with 2–4-year-olds, respectively.

Response rates were 86·3 and 86·0 % and missing data 15·9 and 14·5 % for the second administration of the parent and nursery staff questionnaires, respectively. Weighted κ coefficients for individual items mostly fell under the ‘moderate’ agreement category for the parental (75·0 %) and nursery staff (55·8 %) items. All self-efficacy and motivation scales had acceptable levels of internal consistency (Cronbach’s α coefficients>0·7). The intraclass correlation coefficients for the self-efficacy, motivation and knowledge scales ranged between 0·48 and 0·82. Paired t tests found an increase between test and retest knowledge scores for the Nutrition Motivation (t=−2·91, df=81, P=0·00) and Knowledge (t=−3·22, df=81, P=0·00) scales in the parent questionnaire.

Our findings demonstrate that the items and scales show good acceptability, internal consistency and test–retest reliability.

To investigate the relationship between social deprivation and the food environment. Furthermore, to evaluate if the food environment is associated with the prevalence of obesity among students in Brazilian public schools.

Cross-sectional. For the classification of obesity, weight and height were measured, and the cut-off point of BMI-for-age Z-score >+2 was adopted. Social deprivation level was determined from the Health Vulnerability Index (HVI). To assess the food environment, the density of food establishments in urban residential areas was calculated. Associations between the food environment and the presence of obesity were estimated by binary logistic regression through a generalized estimating equations model.

Juiz de Fora, Minas Gerais, Brazil.

Children and adolescents (n 661) aged 7–14 years.

The lowest social deprivation level showed a higher density of all types of establishments that sold predominantly unhealthy foods. An inverse association was found between the density of supermarkets and hypermarkets and the presence of obesity (OR=0·58; 95 % CI 0·36, 0·93). For the other categories of food retailers, no significant differences were found.

The findings reinforce the need for public policies that promote equality in the food environments of the city. Also, further investigations into the influence of the presence of supermarkets on the nutritional status of children and adolescents are required.