To examine cross-sectional and longitudinal (one-year follow-up) associations of parental feeding styles with child snacking behaviour and weight in the context of general parenting, taking into account the multidimensionality of the controlling feeding style.

Linear regression analyses were performed. Parents completed a questionnaire to measure five feeding style dimensions (Instrumental Feeding, Emotional Feeding, Encouragement, Overt Control and Covert Control) and children's fruit, energy-dense snack and sugar-sweetened beverage (SSB) intakes. Children's height and weight were measured to calculate their BMI Z-scores. Moderation by parenting style was tested by adding interaction terms to the regression analyses.

Observational study in the Netherlands.

Parent–child dyads (n 1275) participating in the INPACT (IVO Nutrition and Physical Activity Child cohorT) study; children were (on average) 9 years of age.

Instrumental Feeding and Emotional Feeding were negatively related to child fruit intake one year later and positively to (changes in) child energy-dense snack intake. Encouragement was negatively related to child energy-dense snacking and SSB intake one year later. Overt Control was cross-sectionally and prospectively related to (changes in) child energy-dense snacking and SSB intake in a negative direction. Covert Control showed similar associations with child energy-dense snacking and SSB intake as Overt Control. Although Covert Control was also positively related to child fruit intake and (changes in) child BMI Z-score, bootstrapping analyses revealed only a differential effect of Overt Control and Covert Control on child BMI Z-score one year later, with Covert Control displaying a stronger, positive association. Moderation analyses showed that some significant associations between parental feeding styles and outcome measures were dependent on the degree of psychological control and behavioural control.

Instrumental Feeding and Emotional Feeding may have a detrimental impact on children's snacking behaviour, while Encouragement, Overt Control and Covert Control may lead to less energy-dense snacking and less SSB intake. Overt Control and Covert Control have differential effects on child BMI Z-score one year later, which supports the idea that they should be treated as separate constructs. Prospective studies with a longer follow-up may elucidate the causal pathways between the various feeding styles and children's snacking behaviour and weight, as well as the moderating influences of psychological and behavioural control.

The prevalence of overweight and obesity among children is on the rise worldwide. Prior studies find that parents’ child-feeding practices are associated with child weight status and the efficacy of specific parental child-feeding practices can be moderated by parenting styles. In the current longitudinal study, we examined the associations between child-feeding practices and weight status changes over 1 year among a sample of school-aged children in Taiwan.

In autumn 2008, a child-feeding questionnaire and parenting-style questionnaire were administered to parents of the second and fourth graders in an elementary school in Taiwan. The weight and height of the students were measured by a trained school nurse in 2008 and again in 2009.

An elementary school in central Taiwan.

A total of 465 parent–child pairs were included in the analysis.

Using a gender- and age-adjusted BMI classification scheme issued by the Taiwan Department of Health, 29·2 % of the students were considered overweight at the 2009 measurement. Controlling for 2008 weight status revealed moderating effects of parenting style on the relationship between child-feeding practices and child weight status. Both authoritative and authoritarian mothers might monitor their children's dietary intake; however, the effectiveness of this practice was better, in terms of weight status control, among the authoritative mothers.

Findings suggest that parenting styles have a moderating effect on specific parental child-feeding practices. Parenting styles and parent's feeding practices could be an important focus for future public health interventions addressing the rising childhood obesity epidemic.

The present study investigated parents’ understanding and approaches to providing energy-dense and nutrient-poor ‘extra foods’ to pre-school children and explored variation between parents of low and high socio-economic status in relation to these issues.

We conducted thirteen focus groups. Data were subject to framework analysis.

Child-care centres in distinctly socially disadvantaged and socially advantaged areas.

Eighty-eight parents of children aged 3–5 years.

The three most common terms parents identified to describe foods that are not ‘everyday foods’ were ‘treats’, ‘sometimes foods’ and ‘junk’. Parents’ perceptions regarding what influences them in providing food to their children included seven sub-themes: (i) the influence of the child; (ii) food-related parenting practices; (iii) health considerations; (iv) food costs and convenience; (v) external factors perceived as influencing their child; (vi) factors related to child care; and (vii) social influences and occasions. Parents’ decision-making processes regarding provision of ‘extra foods’ related to moderation and balance. Parents generally expressed the position that as long as a child is eating healthy foods, then treats are appropriate; and for many parents, this might apply frequently. All groups described the health of their child as an influence, but parents in low socio-economic groups were more likely to describe immediate concerns (dental health, behaviour) in relation to avoiding sugar-dense food or drink.

The belief that provision of ‘extra foods’ can be frequent as long as children are eating a healthy balance of foods is factored into parents’ decision making. Challenging this belief may be important for reducing the consumption of ‘extra foods’ by young children.

Increasing parental awareness of childhood obesity is an important part of tackling the issue. However, parents’ negative reactions to being informed that their children are overweight or obese can hinder their engagement with relevant services. The present study aimed to develop a deeper understanding of why parents react negatively, to help commissioners and service providers design services that are more acceptable to them.

Open, qualitative responses to a survey were collected using a postal questionnaire. Responses were analysed using content analysis.

One local authority in south-west England.

The sample frame included all parents receiving letters informing them that their child was overweight (91st–98th centile) or very overweight (98th–100th centile) through the UK National Child Measurement Programme in 2012.

Forty-five of 313 eligible parents (14 %) responded to the survey, of whom forty-three rejected either to the judgement that their child was overweight and/or being provided with this feedback. Primary reasons for objection included: lack of trust in the measures used, lack of belief that being overweight is important for children's health (relative to a healthy lifestyle), and fear that discussing weight with children will trigger eating disorders. In addition, parents’ responses suggested that they considered receiving this feedback to be a criticism of their parenting skills.

Overall, three areas for improving communication with parents were suggested: tailoring letters; providing information about the importance of weight independently of lifestyle; and addressing parents’ concerns about the risks of talking to children about their weight.

The purpose of the present study was to explore the relationship between family meals and parental encouragement of healthy eating overall and by ethnicity.

Family meal frequency was measured with one item asking how many times in the past 7 d all or most of the family ate a meal together, which was then categorized to represent three levels of family meals (≤2 times, 3–6 times and ≥7 times). Parental encouragement of healthy eating assessed how often parents encouraged the student to eat fruits and vegetables, drink water, eat wholegrain bread, eat breakfast and drink low-fat milk (never to always). An overall scale of parental encouragement of healthy eating was created. Mixed-effect regression analyses were run controlling for gender, ethnicity, age and socio-economic status. Moderation by ethnicity was explored.

Middle schools.

Participants included 2895 US eighth grade students participating in the Central Texas CATCH (Coordinated Approach To Child Health) Middle School Project (mean age 13·9 years; 24·5 % White, 52·7 % Hispanic, 13·0 % African-American, 9·8 % Other; 51·6 % female).

Eating more family meals was significantly associated with having parents who encouraged healthy eating behaviours (P for trend <0·001). The number of family meals was positively associated with encouragement of each of the healthy eating behaviours (P for trend <0·0001). There were no differences in the relationships by ethnicity of the students.

Families who eat together are more likely to encourage healthy eating in general. Interventions which promote family meals may include tips for parents to increase discussions about healthy eating.

To assess parents’ perspectives of their home environments to establish the validity of scores from the Behavior and Attitudes Questionnaire for Healthy Habits (BAQ-HH).

In the present descriptive study, we surveyed a cross-sectional sample of parents of pre-school children. Questionnaire items developed in an iterative process with community-based programming addressed parents’ knowledge/awareness, attitudes/concerns and behaviours about healthy foods and physical activity habits with 6-point rating scales. Exploratory and confirmatory factor analyses were used to psychometrically evaluate scores from the scales.

English and Spanish versions of the BAQ-HH were administered at parent–teacher conferences for pre-school children at ten Head Start centres across a five-county agency in autumn 2010.

From 672 families with pre-school children, 532 parents provided responses to the BAQ-HH (79 % response rate). The majority was female (83 %), Hispanic (66 %) or white (16 %), and ages ranged from 20 to 39 years (85 %).

Exploratory and confirmatory analyses revealed a knowledge scale (seven items), an attitude scale (four items) and three behaviour subscales (three items each). Correlations were identified between parents’ perceptions of home activities and reports of children's habits. Differences were identified by gender and ethnicity groupings.

As a first step in psychometric testing, the dimensionality of each of the three scales (Knowledge, Attitudes and Behaviours) was identified and scale scores were related to other indicators of child behaviours and parents’ demographic characteristics. This questionnaire offers a method to measure parents’ views to inform planning and monitoring of obesity-prevention education programmes.

To evaluate longitudinally the effectiveness of a cooking programme on self-reported confidence about cooking skills and food consumption patterns in parents of young children.

An evaluation of cooking programmes delivered by National Health Service (NHS) community food workers using a single group pre-test/post-test repeated measures design. A shortened version of a validated questionnaire at baseline, post intervention and 1-year follow-up determined confidence in cooking using basic ingredients, following a simple recipe, tasting new foods, preparing and cooking new foods on consumption of ready meals, vegetables and fruit.

Deprived communities in Ayrshire and Arran, Scotland.

Parents of nursery age children, 97 % were female and <45 years old.

One hundred and two participants had completed baseline and post-intervention questionnaires. Forty-four participants contacted by telephone completed a follow-up questionnaire. In participants who completed all questionnaires (n 44), median confidence in four aspects of cooking increased significantly from baseline to post intervention (P < 0·001) but was retained at 1-year follow-up only for following a simple recipe and preparing and cooking new foods. Improved food consumption patterns were reported from baseline to post intervention (ready-meal consumption reduced from 2-4 times/week to 1 time/week, P < 0·001; vegetable consumption increased from 5–6 times/week to 1 time/d, P < 0·001; fruit consumption increased from 5–6 times/week to 1 time/d, P < 0·001) and remained at 1-year follow-up.

The cooking programmes appeared to improve cooking confidence and food consumption patterns in the target group and some of these changes were retained after 1 year.

To measure the prevalence of cooking dinner at home in the USA and test whether home dinner preparation habits are associated with socio-economic status, race/ethnicity, country of birth and family structure.

Cross-sectional analysis. The primary outcome, self-reported frequency of cooking dinner at home, was divided into three categories: 0–1 dinners cooked per week (‘never’), 2–5 (‘sometimes’) and 6–7 (‘always’). We used bivariable and multivariable regression analyses to test for associations between frequency of cooking dinner at home and factors of interest.

The 2007–2008 National Health and Nutrition Examination Survey (NHANES).

The sample consisted of 10 149 participants.

Americans reported cooking an average of five dinners per week; 8 % never, 43 % sometimes and 49 % always cooked dinner at home. Lower household wealth and educational attainment were associated with a higher likelihood of either always or never cooking dinner at home, whereas wealthier, more educated households were more likely to sometimes cook dinner at home (P < 0·05). Black households cooked the fewest dinners at home (mean = 4·4, 95 % CI 4·2, 4·6). Households with foreign-born reference persons cooked more dinners at home (mean = 5·8, 95 % CI 5·7, 6·0) than households with US-born reference persons (mean = 4·9, 95 % CI 4·7, 5·1). Households with dependants cooked more dinners at home (mean = 5·2, 95 % CI 5·1, 5·4) than households without dependants (mean = 4·6, 95 % CI 4·3, 5·0).

Home dinner preparation habits varied substantially with socio-economic status and race/ethnicity, associations that likely will have implications for designing and appropriately tailoring interventions to improve home food preparation practices and promote healthy eating.

To provide the evidence base for targeted nutrition policies to reduce the risk of micronutrient/diet-related diseases among disadvantaged populations in Europe, by focusing on: folate, vitamin B12, Fe, Zn and iodine for intake and status; and vitamin C, vitamin D, Ca, Se and Cu for intake.

MEDLINE and Embase databases were searched to collect original studies that: (i) were published from 1990 to 2011; (ii) involved >100 subjects; (iii) had assessed dietary intake at the individual level; and/or (iv) included best practice biomarkers reflecting micronutrient status. We estimated relative differences in mean micronutrient intake and/or status between the lowest and highest socio-economic groups to: (i) evaluate variation in intake and status between socio-economic groups; and (ii) report on data availability.

Europe.

Children, adults and elderly.

Data from eighteen publications originating primarily from Western Europe showed that there is a positive association between indicators of socio-economic status and micronutrient intake and/or status. The largest differences were observed for intake of vitamin C in eleven out of twelve studies (5–47 %) and for vitamin D in total of four studies (4–31 %).

The positive association observed between micronutrient intake and socio-economic status should complement existing evidence on socio-economic inequalities in diet-related diseases among disadvantaged populations in Europe. These findings could provide clues for further research and have implications for public health policy aimed at improving the intake of micronutrients and diet-related diseases.

Child undernutrition is a serious public health problem in many low- and middle-income countries. Data on child undernutrition prevalence and its risk factors in Armenia are limited. The present study aimed to estimate the prevalence and explore the predictors of undernutrition among children aged 5–17 months in Yerevan.

The study was cross-sectional and employed a review of the ambulatory charts of children selected through a multistage cluster sampling. This phase was followed by a case–control study. The cases were undernourished children identified during the record review and randomly matched with normally growing controls of the same age and gender from the same pool of records. Mothers of cases and controls participated in a telephone interview. The study used conditional logistic regression analysis.

Yerevan, Armenia.

Children aged 5–17 months residing in Yerevan, Armenia.

Review of 570 ambulatory charts suggested the prevalence of stunting, underweight and wasting among 5–17-month-old children in Yerevan to be 17·9 %, 7·3 % and 3·1 %, respectively. The case–control study of eighty-nine matched pairs identified four significant predictors of child undernutrition: family's socio-economic status score (P = 0·030), child's length at birth (P = 0·027), duration of predominant breast-feeding (P = 0·046) and food diversity score (P = 0·039).

The factors determining growth patterns of children in Yerevan are mostly behavioral and environmental, hence modifiable. Reducing poverty and inequalities in food availability, promoting breast-feeding and adequate complementary feeding, and ensuring optimal care before, during and after pregnancy are likely to help reduce child undernutrition in Yerevan, Armenia and societies with similar public health concerns.

Adjustment for body weight and physical activity has been suggested as an alternative to adjusting for reported energy intake in nutritional epidemiology. We examined which of these approaches would yield stronger correlations between nutrients and their biomarkers.

A cross-sectional study in which dietary fatty acids, carotenoids and retinol were adjusted for reported energy intake and, separately, for weight and physical activity using the residual method. Correlations between adjusted nutrients and their biomarkers were examined.

USA.

Cases and controls from a nested case–control study of erythrocyte fatty acids and CHD (n 442) and of plasma carotenoids and retinol and breast cancer (n 1254).

Correlations between intakes and plasma levels of trans-fatty acids were 0·30 (energy-adjusted) and 0·16 (weight- and activity-adjusted); for erythrocyte levels, the corresponding correlations were 0·37 and 0·25. Energy-adjusted intakes of linoleic acid and α-linolenic acid were more strongly correlated with their respective biomarkers than weight- and activity-adjusted intakes, but the differences were not significant except for linoleic acid (erythrocyte). Weight- and activity-adjusted DHA intake was slightly more strongly correlated with its plasma biomarker than energy-adjusted intake (0·37 v. 0·34). Neither method made a difference for DHA (erythrocyte), carotenoids and retinol.

The effect of energy adjustment depends on the nutrient under investigation, and adjustment for energy calculated from the same questionnaire used to estimate nutrient intakes improves the correlation of some nutrients with their biomarkers appreciably. For the nutrients examined, adjustment using weight and physical activity had at most a small effect on these correlations.

Initiatives promoting the reduction of high-salt food consumption by consumers need to be partly based on current levels of salt knowledge in the population. However, to date there is no validated salt knowledge questionnaire that could be used to assess population knowledge about dietary salt (i.e. salt knowledge). Therefore, the aim of the present study was to develop and validate a salt knowledge questionnaire.

A cross-sectional study was conducted on an online web survey platform using convenience, snowball sampling. The survey questionnaire was evaluated for content and face validity before being administered to the respondents.

Online survey.

A total of forty-one nutrition experts, thirty-two nutrition students and thirty-six lay people participated in the study.

Item analyses were performed to evaluate the psychometric properties of the test items. Twenty-five items were retained to form the final set of questions. The total scores of the experts were higher than those of the students and lay people (P < 0·05). The total salt knowledge score showed significant correlations with use of salt at the table (ρ = −0·197, P < 0·05) and inspection of the salt content in food products when shopping (ρ = 0·400; P < 0·01).

The questionnaire demonstrated sufficient evidence of construct validity and internal consistencies between the items. It is likely to be a useful tool for the evaluation and measurement of levels of salt knowledge in the general population.

To evaluate the use of an administered eighty-item FFQ to assess nutrient intake and diet quality in 3-year-old children.

Frequency of consumption and portion size of the foods listed on the FFQ during the 3 months preceding the interview were reported by the child's main caregiver; after the interview a 2 d prospective food diary (FD) was completed on behalf of the child. Nutrient intakes from the FFQ and FD were estimated using UK food composition data. Diet quality was assessed from the FFQ and FD according to the child's scores for a principal component analysis-defined dietary pattern (‘prudent’ pattern), characterised by high consumption of fruit, vegetables, water and wholemeal cereals.

Southampton, UK.

Children (n 892) aged 3 years in the Southampton Women's Survey.

Intakes of all nutrients assessed by the FFQ were higher than FD estimates, but there was reasonable agreement in terms of ranking of children (range of Spearman rank correlations for energy-adjusted nutrient intakes, rs = 0·41 to 0·59). Prudent diet scores estimated from the FFQ and FD were highly correlated (r = 0·72). Some family and child characteristics appeared to influence the ability of the FFQ to rank children, most notably the number of child's meals eaten away from home.

The FFQ provides useful information to allow ranking of children at this age with respect to nutrient intake and quality of diet, but may overestimate absolute intakes. Dietary studies of young children need to consider family and child characteristics that may impact on reporting error associated with an FFQ.

The present study aimed to model obesity trends and future obesity-related disease for nine countries in the Middle East; in addition, to explore how hypothetical reductions in population obesity levels could ameliorate anticipated disease burdens.

A regression analysis of cross-sectional data v. BMI showed age- and sex-specific BMI trends, which fed into a micro simulation with a million Monte Carlo trials for each country. We also examined two alternative scenarios where population BMI was reduced by 1 % and 5 %.

Statistical modelling of obesity trends was carried out in nine Middle East countries (Bahrain, Egypt, Iran, Jordan, Kuwait, Lebanon, Oman, Saudi Arabia and Turkey).

BMI data along with disease incidence, mortality and survival data from national and sub-national data sets were used for the modelling process.

High rates of overweight and obesity increased in both men and women in most countries. The burden of incident type 2 diabetes, CHD and stroke would be moderated with even small reductions in obesity levels.

Obesity is a growing problem in the Middle East which requires government action on the primary prevention of obesity. The present results are important for policy makers to know the effectiveness of obesity interventions on future disease burden.

To identify predictors of increased adiposity for different measures of adiposity.

Prospective cohort study, the Melbourne Collaborative Cohort Study (MCCS), with data at baseline (1990–1994) and wave 2 (2003–2007).

Participants recruited from the community.

Australian-born participants (n 5879) aged 40 to 69 years who were not current smokers and who were free from common chronic diseases at recruitment. At baseline and at wave 2, weight and waist circumference were measured; while demographic and lifestyle variables were obtained at baseline via structured interviews.

Participants who reported any recreational physical activity at baseline had lower weight and smaller waist circumference at wave 2 than those who did not, particularly for younger participants and for vigorous physical activity. Walking for leisure was not associated, and greater physical activity at work was associated, with greater adiposity measures at wave 2. A diet low in carbohydrates and fibre, but high in fat and protein, predicted greater weight and waist circumference at wave 2. Participants were less likely to have elevated weight or waist circumference at wave 2 if they consumed low to moderate amounts of alcohol.

Our findings indicate that promoting vigorous physical activity, encouraging a diet high in carbohydrate and fibre but low in fat and protein, and limiting alcohol intake could be promising approaches for preventing obesity in middle-aged adults. Similar interventions should successfully address the management of both weight and waist circumference, as they were predicted by similar factors.

Breast cancer is the most common type of cancer in women worldwide. Several studies have examined the role of single nutrients and food groups in breast cancer pathogenesis but fewer investigations have addressed the role of dietary patterns. Our main objective was to identify the relationship between major dietary patterns and breast cancer risk among Iranian women.

Hospital-based case–control study.

Shohada Teaching Hospital, Tehran, Iran.

Overall, 100 female patients aged 30–65 years with breast cancer and 174 female hospital controls were included in the present study. Dietary intake was assessed using a valid and reliable semi-quantitative FFQ consisting of 168 food items.

Two dietary patterns were identified explaining 24·31 % of dietary variation in the study population. The ‘healthy’ food pattern was characterized by the consumption of vegetables, fruits, low-fat dairy products, legumes, olive and vegetable oils, fish, condiments, organ meat, poultry, pickles, soya and whole grains; while the ‘unhealthy’ food pattern was characterized by the consumption of soft drinks, sugars, tea and coffee, French fries and potato chips, salt, sweets and desserts, hydrogenated fats, nuts, industrial juice, refined grains, and red and processed meat. Compared with the lowest tertile, women in the highest tertile of the ‘healthy’ dietary pattern score had 75 % decreased risk of breast cancer (OR = 0·25, 95 % CI 0·08, 0·78), whereas women in the highest tertile of the ‘unhealthy’ dietary pattern had a significantly increased breast cancer risk (OR = 7·78, 95 % CI 2·31, 26·22).

A healthy dietary pattern may be negatively associated with breast cancer risk, while an unhealthy dietary pattern is likely to increase the risk among Iranian women.

There are few data on the dietary intake of children in Libya, and none on free sugars intake. The present study aimed to report the intake of macronutrients and eating habits of relevance to dental health in a group of Libyan schoolchildren and to investigate any gender differences for these variables.

Dietary information was obtained from a randomly selected sample using an estimated 3 d food diary. Dietary data were coded using food composition tables and entered into a Microsoft® Access database. Intakes of energy, macronutrients, sugars and the amount of acidic items consumed were determined using purpose-written programs.

Benghazi, Libya.

Schoolchildren aged 12 years.

One hundred and eighty children (ninety-two boys and eighty-eight girls) completed the study. Their mean age was 12·3 (sd 0·29) years. The average daily energy intake was 7·01 (sd 1·54) MJ/d. The percentage contributions to energy intake from protein, fat and carbohydrate were 16 %, 30 % and 54 %, respectively. Total sugars contributed 20·4 % of the daily energy intake, and free sugars 12·6 %. The median daily intake of acidic items was 203 g/d, and of acidic drinks was 146 g/d. There were no statistically significant differences in nutrient intakes between genders. Intake of acidic items was higher in girls (P < 0·001).

The contribution to energy intake from macronutrients was in accordance with global nutrition guidelines. The acidic drinks intake was low compared with other populations, while free sugars intake was above the recommended threshold of 10 % of energy intake.

The purpose was to examine the associations among body weight status, blood pressure and daily Na intake among grade 7 students from south-western Ontario, Canada.

Cross-sectional. Data were collected using the Food Behaviour Questionnaire, including a 24 h diet recall. Measured height and weight were used to determine BMI. Blood pressure was taken manually using mercury sphygmomanometers.

Twenty-six schools in south-western Ontario, Canada.

Grade 7 students (n 1068).

Body weight status indicated 1 % were underweight, 56 % normal weight, 23 % overweight and 20 % were obese. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 108·3 (sd 10·3) mmHg and 66·0 (sd 7·5) mmHg, respectively, and mean Na intake was 2799 (sd 1539) mg/d. Bivariate analyses suggested that SBP (P < 0·001) and DBP (P < 0·001) were significantly different by body weight status, yet no associations were observed for Na. Adjusted for gender, ethnicity and under-reporting, participants were more likely to be overweight/obese if they had higher SBP (v. lower: OR = 1·06, 95 % CI 1·05, 1·08, P < 0·001), higher DBP (v. lower: OR = 1·02, 95 % CI 1·00, 1·04, P = 0·043) and higher intakes of Na (3rd v. 1st quartile: OR = 1·72, 95 % CI 1·14, 2·59, P = 0·009; 4th v. 1st quartile: OR = 2·88, 95 % CI, 1·76, 4·73, P < 0·001).

High intakes of Na, coupled with high SBP and DBP, were associated with overweight and obesity status among the grade 7 sample from south-western Ontario, Canada.

The present study aimed to assess the effect of iodine deficiency on academic achievement of schoolchildren in Wolaita Sodo town, Southern Ethiopia.

School-based comparative cross-sectional study.

Primary school in Sodo town, Southern Ethiopia.

A sample population of 270 children with goitre and 264 without goitre. All students in each class were examined for the presence of goitre and classified based on WHO recommendations.

Among children with goitre, a higher proportion (54·8 %) was female and the proportion increased with age. The odds of scoring low on school performance was higher among children whose fathers were illiterate (adjusted OR = 1·9; 95 % CI 1·1, 3·5) and those who were absent for more than 5 d in the last academic year (adjusted OR = 1·5; 95 % CI 1·1, 2·3). Goitre was significantly associated with low academic achievement (adjusted OR = 1·8; 95 % CI 1·2, 2·5).

The study showed that the presence of goitre has a negative effect on academic achievement even after accounting for parental education and absenteeism from school. Awareness of endemic goitre and its impact on school performance, and an emphasis on prevention and control by concerned bodies, are recommended to alleviate the problem.