Accurate estimation of food portion size is of paramount importance in dietary studies. We have developed a small, chest-worn electronic device called eButton which automatically takes pictures of consumed foods for objective dietary assessment. From the acquired pictures, the food portion size can be calculated semi-automatically with the help of computer software. The aim of the present study is to evaluate the accuracy of the calculated food portion size (volumes) from eButton pictures.

Participants wore an eButton during their lunch. The volume of food in each eButton picture was calculated using software. For comparison, three raters estimated the food volume by viewing the same picture. The actual volume was determined by physical measurement using seed displacement.

Dining room and offices in a research laboratory.

Seven lab member volunteers.

Images of 100 food samples (fifty Western and fifty Asian foods) were collected and each food volume was estimated from these images using software. The mean relative error between the estimated volume and the actual volume over all the samples was −2·8 % (95 % CI −6·8 %, 1·2 %) with sd of 20·4 %. For eighty-five samples, the food volumes determined by computer differed by no more than 30 % from the results of actual physical measurements. When the volume estimates by the computer and raters were compared, the computer estimates showed much less bias and variability.

From the same eButton pictures, the computer-based method provides more objective and accurate estimates of food volume than the visual estimation method.

To examine changes in the Na content of lunch/dinner menu offerings at eight of the leading fast-food restaurants in the USA between 1997/1998 and 2009/2010.

Menu offerings and nutrient composition information for the menu items were obtained from archival versions of the University of Minnesota Nutrition Coordinating Center (NCC) Food and Nutrient Database. Nutrient composition information for lunch/dinner menu items sold by the fast-food restaurants included in the present study was updated in the database biannually. Menus were analysed for changes in mean Na content of all menu offerings (except beverages) and specific categories of menu items among all restaurants and for each individual restaurant.

USA.

Lunch/dinner food menu of eight leading US fast-food restaurants.

Between 1997/1998 and 2009/2010 the mean Na content of menu offerings across the eight restaurants increased by 23·4 %. Examining specific food categories, mean Na content of entrées by increased 17·2 % and that of condiments increased by 26·1 %. Only side dishes showed a decrease of 6·6 %. None of the restaurants examined had a decrease in Na across the lunch/dinner menu offerings over the 14 years examined.

Results suggest that over the time period studied there has been no meaningful reduction in the Na content of lunch/dinner menu offerings at the leading fast-food restaurants examined in the present study.

To design and develop a literature-derived, population-based dietary inflammatory index (DII) to compare diverse populations on the inflammatory potential of their diets.

Peer-reviewed primary research articles published through December 2010 on the effect of diet on inflammation were screened for possible inclusion in the DII scoring algorithm. Qualifying articles were scored according to whether each dietary parameter increased (+1), decreased (−1) or had no (0) effect on six inflammatory biomarkers: IL-1β, IL-4, IL-6, IL-10, TNF-α and C-reactive protein.

The Dietary Inflammatory Index Development Study was conducted in the Cancer Prevention and Control Program of the University of South Carolina in Columbia, SC, USA from 2011 to 2012.

A total of ≈6500 articles published through December 2010 on the effect of dietary parameters on the six inflammatory markers were screened for inclusion in the DII scoring algorithm. Eleven food consumption data sets from countries around the world were identified that allowed individuals’ intakes to be expressed relative to the range of intakes of the forty-five food parameters observed across these diverse populations. Qualifying articles (n 1943) were read and scored based on the forty-five pro- and anti-inflammatory food parameters identified in the search. When fit to this composite global database, the DII score of the maximally pro-inflammatory diet was +7·98, the maximally anti-inflammatory DII score was −8·87 and the median was +0·23.

The DII reflects both a robust literature base and standardization of individual intakes to global referent values. The success of this first-of-a-kind attempt at relating intakes of inflammation-modulating foods relative to global norms sets the stage for use of the DII in a wide variety of epidemiological and clinical studies.

The health-related effects of the Nordic diet remain mostly unidentified. We created a Baltic Sea Diet Score (BSDS) for epidemiological research to indicate adherence to a healthy Nordic diet. We examined associations between the score and nutrient intakes that are considered important in promoting public health. We also examined the performance of the BSDS under two different cut-off strategies.

The cross-sectional study included two phases of the National FINRISK 2007 Study. Diet was assessed using a validated FFQ. Food and nutrient intakes were calculated using in-house software. Nine components were selected for the score. Each component was scored according to both sex-specific consumption quartiles (BSDS-Q) and medians (BSDS-M), and summed to give the final score values.

A large representative sample of the Finnish population.

Men (n 2217) and women (n 2493) aged 25 to 74 years.

In the age- and energy-adjusted model, adherence to the diet was associated with a higher intake of carbohydrates (E%), and lower intakes of SFA (E%) and alcohol (E%, where E% is percentage of total energy intake; P < 0·01). Furthermore, the intakes of fibre, Fe, vitamins A, C and D, and folate were higher among participants who adhered to the diet (P < 0·05). After further adjustments, the results remained significant (P < 0·05) and did not differ remarkably between BSDS-Q and BSDS-M.

The BSDS can be used as a measure of a healthy Nordic diet to assess diet–health relationships in public health surveys in Nordic countries.

Urbanization is generally associated with increased CVD risk and accompanying dietary changes. Little is known regarding the association between increased CVD risk and dietary changes using approaches such as diet quality. The relevance of predefined diet quality scores (DQS) in non-Western developing countries has not yet been established.

The association between dietary intakes and CVD risk factors was investigated using two DQS, adapted to the black South African diet. Dietary intake data were collected using a quantitative FFQ. CVD risk was determined by analysing known CVD risk factors.

Urban and rural areas in North West Province, South Africa.

Apparently healthy volunteers from the South African Prospective Urban and Rural Epidemiological (PURE) study population (n 1710).

CVD risk factors were significantly increased in the urban participants, especially women. Urban men and women had significantly higher intakes of both macro- and micronutrients with macronutrient intakes well within the recommended CVD guidelines. While micronutrient intakes were generally higher in the urban groups than in the rural groups, intakes of selected micronutrients were low in both groups. Both DQS indicated improved diet quality in the urban groups and good agreement was shown between the scores, although they seemed to measure different aspects of diet quality.

The apparent paradox between improved diet quality and increased CVD risk in the urban groups can be explained when interpreting the cut-offs used in the scores against the absolute intakes of individual nutrients. Predefined DQS as well as current guidelines for CVD prevention should be interpreted with caution in non-Western developing countries.

To evaluate the dietary quality of Mexican adults’ diet, we constructed three dietary quality indices: a cardioprotective index (CPI), a micronutrient adequacy index (MAI) and a dietary diversity index (DDI).

Data were derived from the 2006 National Health and Nutrition Survey, which is a national survey representative of the Mexican population with a stratified, multistage, probabilistic sample design. Dietary intake was assessed from an FFQ with 101 different foods and daily nutrient intakes were computed. The CPI evaluated compliance with seven WHO recommendations for the prevention of CVD, the MAI evaluated the intake of six micronutrients based on the estimated average requirements from the US Institute of Medicine and the DDI was constructed based on the consumption of thirty different food groups.

Mexico.

Mexican adults aged 19–59 years old.

We evaluated the diet of 15 675 males and females. Adjusted means and adjusted proportions by age and sex were computed to predict adherence to dietary recommendations. Rural inhabitants, those living in the South and those from the lowest socio-economic status reported a significantly higher CPI (4·5 (se 0·08), 4·3 (se 0·08) and 4·2 (se 0·09), respectively; P < 0·05), but a significantly lower MAI and DDI, compared with urban inhabitants, those from the North and those of upper socio-economic status (P < 0·05).

The constructed diet quality indices identify nutrients and foods whose recommended intakes are not adequately consumed by the population. Given the epidemiological and nutritional transition that Mexico is experiencing, the CPI is the most relevant index and its components should be considered in Mexican dietary guidelines as well as in any food and nutrition programmes developed.

To develop and validate an electronic FFQ that estimates the food and nutrient intakes, especially fat intake, in a healthy, adult population from the coastal (Mediterranean) part of Slovenia.

A new electronic FFQ was developed for a survey entitled ‘A multidisciplinary approach in the treatment of obesity’, conducted at the University of Primorska, and validated against a 3 d weighed food record (FR).

Coastal region of Slovenia.

Our study population included eighty-five healthy adults aged 25–49 years, recruited from the local coastal region of Slovenia. Intakes of food groups, macronutrients and energy, estimated by the FR and the FFQ, were compared using correlation coefficients, cross-classification and Bland–Altman plots.

The mean value of most nutrient intakes tended to be higher in the FFQ compared with the FR, except for carbohydrate, fibre and energy. Regression analysis demonstrated an acceptable agreement between the FFQ and FR. The FFQ was moderately correlated with the FR (0·30–0·54), and most of the correlations increased after energy adjustment and after de-attenuation. Relatively high (more than 70 %) proportions of participants were correctly classified into the same or an adjacent quartile. Bland–Altman analysis confirmed an acceptable level of agreement between the two methods.

The electronic FFQ, developed for a healthy adult Slovene population from the coastal region, was shown to be a valid tool to assess food group and nutrient intakes, especially fat intakes, and to rank individuals by their intakes within gene–nutrient studies.

The aim of the study was to assess the relative validity of a semi-quantitative FFQ (SFFQ) which measures the usual dietary intake of 3-year-old children.

The children's daily dietary intake was measured using the SFFQ. The average intake of three 24 h dietary recalls (24hDR) was calculated as a reference method. Wilcoxon's rank test and Spearman's rank-correlation coefficient were used to compare nutrient intakes assessed by both methods. The level of agreement between the SFFQ and the repeated 24hDR was determined by the Bland–Altman method. To assess the agreement in quartile distribution, the weighted kappa coefficient (κw) was used.

Krakow, Poland.

One hundred and forty-three 3-year-old children and their mothers, participants of a prospective cohort study.

Overall, the SFFQ overestimated energy and nutrient intakes compared with the repeated 24hDR. The median correlation coefficient for energy and nutrient intakes was 0·456, with higher results for Ca, P and riboflavin. Although the κw value showed only slight to fair agreement between the two methods, about 75 % of the children were classified into the same or adjacent quartile and the level of agreement assessed by the Bland–Altman method for most of the nutrients investigated was good.

The study indicated that the SFFQ might be a useful tool to assess dietary intakes of nutrients by small children, especially for ranking them according their nutrient intake.

To identify and critique tools that assess Ca and/or dairy intake in children to ascertain the most accurate and reliable tools available.

A systematic review of the literature was conducted using defined inclusion and exclusion criteria. Articles were included on the basis that they reported on a tool measuring Ca and/or dairy intake in children in Western countries and reported on originally developed tools or tested the validity or reliability of existing tools. Defined criteria for reporting reliability and validity properties were applied.

Studies in Western countries.

Children.

Eighteen papers reporting on two tools that assessed dairy intake, ten that assessed Ca intake and five that assessed both dairy and Ca were identified. An examination of tool testing revealed high reliance on lower-order tests such as correlation and failure to differentiate between statistical and clinically meaningful significance. Only half of the tools were tested for reliability and results indicated that only one Ca tool and one dairy tool were reliable. Validation studies showed acceptable levels of agreement (<100 mg difference) and/or sensitivity (62–83 %) and specificity (55–77 %) in three Ca tools. With reference to the testing methodology and results, no tools were considered both valid and reliable for the assessment of dairy intake and only one tool proved valid and reliable for the assessment of Ca intake.

These results clearly indicate the need for development and rigorous testing of tools to assess Ca and/or dairy intake in children and adolescents.

To review the peer-reviewed literature on relationships between intuitive eating and health indicators and suggest areas of inquiry for future research. We define the fundamental principles of intuitive eating as: (i) eating when hungry; (ii) stopping eating when no longer hungry/full; and (iii) no restrictions on types of food eaten unless for medical reasons.

We include articles cited by PubMed, PsycInfo and Science Direct published in peer-reviewed journals or theses that include ‘intuitive eating’ or related concepts in the title or abstract and that test relationships between intuitive eating and physical or mental health indicators.

We found twenty-six articles that met our criteria: seventeen cross-sectional survey studies and nine clinical studies, eight of which were randomised controlled trials. The cross-sectional surveys indicate that intuitive eating is negatively associated with BMI, positively associated with various psychological health indicators, and possibly positively associated with improved dietary intake and/or eating behaviours, but not associated with higher levels of physical activity. From the clinical studies, we conclude that the implementation of intuitive eating results in weight maintenance but perhaps not weight loss, improved psychological health, possibly improved physical health indicators other than BMI (e.g. blood pressure; cholesterol levels) and dietary intake and/or eating behaviours, but probably not higher levels of physical activity.

Research on intuitive eating has increased in recent years. Extant research demonstrates substantial and consistent associations between intuitive eating and both lower BMI and better psychological health. Additional research can add to the breadth and depth of these findings. The article concludes with several suggestions for future research.

To determine the diet quality of a group of young adults and explore its associations with two food-related behaviours (involvement in meal preparation and consumption of commercially prepared meals).

Cross-sectional study of young adults. Sample characteristics, food-related behaviours and dietary intake were assessed using a self-administered questionnaire including an FFQ. Diet quality was measured using the fifteen-item Dietary Guideline Index (DGI) designed to assess adherence to Australian dietary guidelines. One-way ANOVA, t tests and multiple linear regression analyses were used to explore the relationships between DGI scores, sample characteristics and food-related behaviours.

University students enrolled in an undergraduate nutrition class, Melbourne, Australia.

Students (n 309) aged 18–36 years.

The DGI score was normally distributed, with a mean score of 93·4 (sd 17·1) points (range 51·9–127·4 points), out of a possible score of 150 points. In multivariate analyses adjusted for age, sex, nationality, BMI and maternal education, cooking meals for oneself was positively associated with DGI score (β = 0·15; 95 % CI 1·15, 10·03; P = 0·01); frequency of takeaway and frequency of convenience meal consumption were inversely associated with DGI score (β = −0·21; 95 % CI −9·96, −2·32; P = 0·002 and β = −0·16; 95 % CI −7·40, −0·97; P < 0·01, respectively).

Cooking meals for oneself was linked to higher diet quality among young adults, while consumption of commercially prepared meals was associated with poorer diet quality. Maintaining education programmes that promote cooking skills within young adults has the potential to improve DGI scores.

Improving the diet of the Scottish population has been a government focus in recent years. Population health is known to vary between geographies; therefore alongside trends and socio-economic inequalities in eating behaviour, geographic differences should also be monitored.

Eating behaviour data from the 2010 Scotland Health Behaviour in School-aged Children survey were modelled using multilevel linear and logistic modelling.

Data were collected in schools across urban and rural Scotland.

Schoolchildren aged 15 years.

Adolescents living in remote rural Scotland had the highest consumption frequency of vegetables (on average consumed on 6·68 d/week) and the lowest consumption frequency of sweets and crisps (on 4·27 and 3·02 d/week, respectively). However, it was not in the major four cities of Scotland (Glasgow, Edinburgh, Dundee and Aberdeen) but in the geography described by the classification ‘other urban’ areas (large towns of between 10 000 and 125 000 residents) that adolescents had the poorest diet. Deprivation and rurality were independently associated with food consumption for all but fruit consumption. Sharing a family meal, dieting behaviour, food poverty and breakfast consumption did not differ by rurality. Variance at the school level was significant for fruit and vegetable consumption frequencies and for irregular breakfast consumption, regardless of rurality.

Young people from rural areas have a healthier diet than those living in urban areas. The eating behaviours examined did not explain these differences. Future research should investigate why urban–rural differences exist for consumption frequencies of ‘healthy’ and ‘unhealthy’ foods.

To assess micronutrient intakes and the prevalence of inadequacy in a sample of high-school pupils in Ouarzazate, Morocco.

Food records were compiled over three non-consecutive days by pre-trained pupils. Micronutrient intakes were estimated using the DIAL software, adapted to include foods commonly eaten in Morocco. The prevalence of inadequacy was estimated by the proportion of individuals with intakes below the Estimated Average Requirement (EAR) for vitamins B12, A and K, thiamin, riboflavin, niacin, pyridoxine, folate, ascorbic acid, iodine, Ca, Mg and P; below the Adequate Intake (AI) level for pantothenic acid, biotin, Na and K; and using the probability approach for Fe. Data were adjusted for intra-individual variation with exclusion of under-reporters.

Ouarzazate, a semi-urban region situated on the southern slopes of the High Atlas with little industrial development but an important tourism sector.

A self-selected sample of 312 pupils aged 15–19 years from the five public high schools. After exclusion of under-reporters, 293 remained for analysis.

The highest proportions of below-EAR/AI intakes were seen for pantothenic acid (girls 85·1 %, boys 78·0 %), biotin (boys 83·1 %, girls 79·4 %), thiamin (boys 66·9 %), folate (girls 93·1 %, boys 74·6 %), iodine (boys 94·9 %, girls 88·0 %) and Ca (girls 83·4 %, boys 74·6 %). Na intake was generally in excess whereas K intake was below the AI level. In general, girls had better-quality diets than boys, who appeared to consume more ‘empty calories’.

Our findings suggest that in this population of Moroccan adolescents, nutritional intervention and educational strategies are needed to promote healthy eating habits and correct micronutrient inadequacies. To provide reliable and precise estimates of nutrient intakes, an update of Moroccan food composition databases is urgently needed. We recommend that national authorities address these issues.

To evaluate ethnic and anthropometric correlates of adiposity among a nationally representative, multi-ethnic, Trinidadian pre-school population.

Cross-sectional study conducted between June 2008 and July 2009.

Government and privately owned Early Childhood Care and Education Centres in Trinidad.

A total of 596 pre-school children (aged 31–73 months) from thirty-four schools had their weight, height, mid-upper arm circumference, waist circumference, biceps and triceps skinfold thicknesses measured by a registered dietitian using standard procedures. Percentage body fat was estimated using a foot-to-foot bioelectric impedance analyser (Tanita 531, Tokyo, Japan). Date of birth, religion and ethnicity were extracted from school records and pre-schoolers’ ethnicity was categorized as East Indian, African, Mixed (a combination of two or more ethnicities), Chinese or Caucasian.

Anthropometric variables explained significantly more of the variance in adiposity among girls (67·4–88·1 %) than boys (24·4–39·2 %; P < 0·0 0 1). Pre-schoolers of African descent were significantly taller, heavier and had higher abdominal fat and mid-upper arm circumference than their East Indian and Mixed counterparts (all P < 0·001). The overall prevalence of excess adiposity (≥25 % body fat) as determined by bioelectrical impedance was 14·6 %, while 2·9 % of the children were undernourished according to WHO weight-for-age criteria. Differences in anthropometry were non-existent between children attending government and private pre-schools.

Gender, ethnicity and anthropometry all explained excess adiposity in these pre-schoolers. These findings highlight the need to elucidate the mechanisms that may be involved in explaining these differences, particularly those of ethnic origin.

To determine the demographic profile of fast-food consumers among adult Singapore residents and ascertain whether fast-food consumption frequency is associated with diet quality and weight status.

A nationally representative cross-sectional survey including an FFQ and anthropometric measures. Participants were grouped based on their fast-food consumption frequency as non-consumer, occasional consumer or regular consumer, with regular defined as at least once per week.

Individuals living in the community in Singapore.

Singapore residents (n 1627) aged 18–69 years of Chinese, Malay and Indian ethnicity.

Proportions of regular fast-food consumers were higher in younger age groups, higher income groups and middle education level groups. Mean daily energy intake was positively associated with fast-food consumption frequency (non-consumers 9636 kJ (2303 kcal); occasional consumers 11 159 kJ (2667 kcal); regular consumers 13 100 kJ (3131 kcal); P for trend < 0·001). Fast-food consumers were more likely to exceed the RDA for energy, fat and saturated fat, and less likely to meet wholegrain and fruit recommendations. Both regular consumers (OR = 1·24; 95 % CI 1·03, 1·51) and occasional consumers (OR = 1·52; 95 % CI 1·32, 1·77) were more likely to have a waist:hip ratio indicating abdominal obesity. Occasional consumers were more likely to have a BMI ≥ 23·0 kg/m2 (OR = 1·19; 95 % CI 1·04, 1·37), whereas regular consumers were less likely (OR = 0·76; 95 % CI 0·64, 0·91) to have an ‘at-risk’ BMI.

Fast-food consumption is most prevalent in young adults, high income and middle education level groups. Frequent fast-food consumption in Singapore is associated with unfavourable dietary and nutrient profiles and abdominal obesity.

To assess socio-economic differences in three components of nutrition knowledge, i.e. knowledge of (i) the relationship between diet and disease, (ii) the nutrient content of foods and (iii) dietary guideline recommendations; furthermore, to determine if socio-economic differences in nutrition knowledge contribute to inequalities in food purchasing choices.

The cross-sectional study considered household food purchasing, nutrition knowledge, socio-economic and demographic information. Household food purchasing choices were summarised by three indices, based on self-reported purchasing of sixteen groceries, nineteen fruits and twenty-one vegetables. Socio-economic position (SEP) was measured by household income and education. Associations between SEP, nutrition knowledge and food purchasing were examined using general linear models adjusted for age, gender, household type and household size.

Brisbane, Australia in 2000.

Main household food shoppers (n 1003, response rate 66·4 %), located in fifty small areas (Census Collectors Districts).

Shoppers in households of low SEP made food purchasing choices that were less consistent with dietary guideline recommendations: they were more likely to purchase grocery foods comparatively higher in salt, sugar and fat, and lower in fibre, and they purchased a narrower range of fruits and vegetables. Those of higher SEP had greater nutrition knowledge and this factor attenuated most associations between SEP and food purchasing choices. Among nutrition knowledge factors, knowledge of the relationship between diet and disease made the greatest and most consistent contribution to explaining socio-economic differences in food purchasing.

Addressing inequalities in nutrition knowledge is likely to reduce socio-economic differences in compliance with dietary guidelines. Improving knowledge of the relationship between diet and disease appears to be a particularly relevant focus for health promotion aimed to reduce socio-economic differences in diet and related health inequalities.

To perform construct validation of the population-based Dietary Inflammatory Index (DII) using dietary data from two different dietary assessments and serum high-sensitivity C-reactive protein (hs-CRP) as the construct validator.

Using data derived from (i) three 24 h dietary recalls (24HR) at baseline and at the end of each subsequent quarter (i.e. up to fifteen over a year) and (ii) a 7 d dietary recall (7DDR) measured at baseline and then quarterly, regression analyses were conducted to test the effect of the DII score on serum hs-CRP as dichotomous (≤3 mg/l, >3 mg/l), while controlling for important potential confounders.

Existing data from the Seasonal Variation of Blood Cholesterol Study (SEASONS), a longitudinal observational study of healthy participants recruited in Worcester, MA, USA and participants were followed for 1 year.

Participants who had at least one hs-CRP measurement over her/his 1-year participation (n 495 for 24HR, n 559 for 7DDR).

Higher DII scores were associated with values of hs-CRP >3 mg/l (OR = 1·08; 95 % CI 1·01, 1·16, P = 0·035 for the 24HR; and OR = 1·10; 95 % CI 1·02, 1·19, P = 0·015 for the 7DDR).

The population-based DII was associated with interval changes in hs-CRP using both the 24HR and 7DDR. The success of this first-of-a-kind attempt at relating individuals’ intakes of inflammation-modulating foods using this refined DII, and the finding that there is virtually no drop-off in predictive capability using a structured questionnaire in comparison to the 24HR standard, sets the stage for use of the DII in a wide variety of other epidemiological and clinical studies.

To examine the association between obesity and food group intakes, physical activity and socio-economic status in adolescents.

A cross-sectional study was carried out in 2008. Cole's cut-off points were used to categorize BMI. Abdominal obesity was defined by a waist circumference at or above the 90th percentile, as well as a waist-to-height ratio at or above 0·500. Diet was evaluated using an FFQ, and the food group consumption was categorized using sex-specific tertiles of each food group amount. Physical activity was assessed via a self-report questionnaire. Socio-economic status was assessed referring to parental education and employment status. Data were analysed separately for girls and boys and the associations among food consumption, physical activity, socio-economic status and BMI, waist circumference and waist-to-height ratio were evaluated using logistic regression analysis, adjusting the results for potential confounders.

Public schools in the Azorean Archipelago, Portugal.

Adolescents (n 1209) aged 15–18 years.

After adjustment, in boys, higher intake of ready-to-eat cereals was a negative predictor while vegetables were a positive predictor of overweight/obesity and abdominal obesity. Active boys had lower odds of abdominal obesity compared with inactive boys. Boys whose mother showed a low education level had higher odds of abdominal obesity compared with boys whose mother presented a high education level. Concerning girls, higher intake of sweets and pastries was a negative predictor of overweight/obesity and abdominal obesity. Girls in tertile 2 of milk intake had lower odds of abdominal obesity than those in tertile 1. Girls whose father had no relationship with employment displayed higher odds of abdominal obesity compared with girls whose father had high employment status.

We have found that different measures of obesity have distinct associations with food group intakes, physical activity and socio-economic status.

To evaluate the relationship between dietary habits, physical activity and cognitive views and the risk of gestational diabetes mellitus (GDM) in Chinese women.

A cross-sectional study to explore the potential risk factors of GMD through the International Physical Activity Questionnaire, an FFQ and a self-designed structured questionnaire, respectively.

Guangzhou, Guangdong Province, China.

Chinese pregnant women (n 571) who underwent a 75-g oral glucose tolerance test at their 24th to 28th gestational week.

Thirteen per cent of the investigated women were identified as having GDM, and an increased intake of local featured foods and lower physical activity were observed in the GDM-positive group v. the GDM-negative group. Women who regarded early-pregnancy morning sickness as relevant to fetal abnormalities and those with unlimited dietary intake after the ending of morning sickness both had an increased risk for GDM (P = 0·018 and P = 0·038, respectively). After multiple logistic regression analysis, cognitive views for unlimited food intake subsequent to morning sickness, increased consumption of energy-dense snack foods and high-glycaemic-index fruits were strongly associated with the risk of GDM (OR = 1·911, P = 0·032; OR = 1·050, P = 0·001; and OR = 1·002, P = 0·017, respectively).

Local featured foods and incorrect cognitive views on pregnancy-related health were closely related to the risk of GDM in Chinese women. Intensive health education about pregnancy physiology and reasonable dietary and physical exercise behaviours should be strengthened for the control of GDM.