To assess whether the amount of fruits and vegetables consumed depends on the serving size or on how often fruits and vegetables are eaten.

Estimation of the weight of serving sizes and the number of fruits and vegetables eaten daily, using a validated food diary method.

Free-living men and women participating in the Norfolk arm of the European Prospective Investigation into Cancer and Nutrition (EPIC).

Two hundred and sixty-nine men and women sampled from EPIC–Norfolk to participate in a study of simple methods of assessing fruit and vegetable intakes.

The average portion of all fruits and vegetables measured was 87 g, close to the standard portion size of 80 g used as the basis of ‘5-a-day’ recommendations. There was a wide variation; the average portion size for baked beans was 147 g while for lettuce it was 26 g. The 20th and 80th percentiles also showed a large range, e.g. 39–72 g for carrots and 60–150 g for strawberries. Women ate more fruit than did men but fewer vegetables, so the total amount of fruit and vegetables eaten by men and women was the same. High consumers of fruits and vegetables (≥400 g day-1) ate them ~5 times a day whilst low consumers (<400 g day-1) ate them less often (~3 servings per day, P<0.01). Portion size differed little between high and low consumers.

Frequency of intake is more important than portion size when distinguishing between high and low consumption of fruits and vegetables. Therefore, to increase intakes, low consumers should eat fruits and vegetables more often. This endorses the ‘5-a-day’ healthy eating message.

To investigate changes in the consumption of fruits and vegetables in work-site canteens using the tools of continuous quality improvement, and to gain knowledge of practical strategies being effective in increasing the consumption.

Study design included baseline data collection, an 8 h training session for all canteen staff, goal setting, strategy development and implementation for each canteen, end-point data collection and a follow-up data collection 4 months from the end-point (1 year from baseline). The main outcome measurement was average grams of fruits and vegetables per lunch meal served per customer (net weight; potatoes not included).

Five workplaces in Denmark: a military base, an electronic component distributor, a bank, a town hall and a waste-handling facility.

Work-site canteen managers, staff and customers.

There were significant increases in the total consumption of fruits and vegetables for all five work-site canteens from baseline to end-point, 70 g per customer on average (67, 54, 39, 88 and 103 g, respectively). The follow-up data collection showed that the canteens either maintained or significantly increased consumption, the average increase being 95 g per customer compared with baseline (77, 60, 86, 70 and 183 g, respectively).

This study demonstrates a large potential for work-site canteens to increase customers' intake of fruits and vegetables at lunch and suggests a broad spectrum of strategies to compose meals that are both rich in fruits and vegetables and attractive to customers.

To evaluate the efficacy and feasibility of using a computer-based teaching tool (http://www.coolfoodplanet.org) for nutrition and lifestyle education developed for primary school children.

This was a 2-week school-based intervention in third and fourth grades. The study design was multi-factorial with repeated measures of nutrition knowledge, at three points in time, of dependent samples from control and intervention groups. Control schools (n=7) used ‘traditional’ nutrition education materials and intervention schools (n=8) additionally used the computer-based educational tool. Qualitative information was collected in focus group discussions with student teachers and pupils, and by observing the nutrition lessons.

Pupils aged 8–11 years (n=271) from participating schools in Vienna, Austria.

Nutrition knowledge increased significantly in both intervention and control schools, irrespective of the teaching tool used (P<0.001). The significant effect was maintained at 3 months' follow-up. There was no detectable difference in nutrition knowledge post intervention or at follow-up between the two study groups. In intervention schools, younger pupils (8–9 years) had better nutrition knowledge than older pupils (10–11 years) (P=0.011).

This computer-based tool increases the possibilities of school-based nutrition education. If the tool's weaknesses identified during the formative evaluation are eliminated, it has the potential to make learning about nutrition more enjoyable, exciting and effective. This is of great importance considering that ‘healthy’ nutrition is not necessarily a topic that easily attracts pupils' attention and in view of the potential long-term health benefits of early and effective nutrition education.

It is debated whether the intake of added sugar displaces micronutrient-rich foods and dilutes the nutrient density of the diet, and whether there is a link between sugar and the increased rate of obesity. The objectives of this study were to examine the effect of added sugar on the intakes of energy, micronutrients, fruit and vegetables, and to examine the association between intake of added sugar and age, sex, body mass index, physical activity, inactivity and parents' education.

Participants recorded their food intake in pre-coded food diaries for 4 days and filled in a questionnaire about physical activity, watching television (TV)/using a personal computer (PC) and parents' education.

Three hundred and ninety-one 4-year-olds, 810 students in the 4th grade (9 years old) and 1005 in the 8th grade (13 years old) were included in the study.

The intakes of all nutrients, except α-tocopherol among 4-year-olds and vitamin C among 4-year-olds and 4th graders, decreased with increasing content of added sugar in the diet. Moreover, high consumers of added sugar had a 30–40% lower intake of fruit and vegetables than did low consumers. A negative association was observed between consumption of added sugar and body mass index among girls in the 8th grade (P = 0.013), whereas a positive association was observed among 4-year-old boys (P = 0.055). Associations between physical activity, hours spent watching TV/using a PC, parents' education and the energy intake from added sugar varied in the different age groups.

This study showed a negative association between the intake of added sugar and intakes of micronutrients, fruit and vegetables. The negative association between sugar intake and intake of fruit and vegetables is important from a public health perspective, since one of the main health messages today is to increase current intake of fruit and vegetables.

To examine the contribution to fruit and vegetable eating in children of potential predictive variables within the domains of demographics, parental feeding practices and personality traits.

Cross-sectional survey.

Questionnaires were distributed to parents through 22 London nursery schools.

Questionnaires were completed and returned by 564 parents or principal caregivers of 2–6-year-old children.

Significant predictors of children's fruit and vegetable intake emerged from all three domains examined. Demographic variables associated with child's vegetable consumption were mother's education and child's age and gender. Only ethnicity was significantly associated with fruit consumption. Parental consumption, breast-feeding and early introduction to fruit and vegetables were related to intake of both. Family mealtimes were associated with higher intake of vegetables, but not of fruit. Two characteristics of children themselves (food neophobia and enjoyment of food) were strongly related to the consumption of fruit and vegetables. Subsequent multivariate analyses revealed that parental intake and child food neophobia independently predicted intake of both foods. In the presence of these, fruit consumption was affected by breast-feeding and early introduction to fruit, whereas vegetable consumption was related only to child's gender and enjoyment of food.

These findings may be used to inform future interventions aimed at increasing children's consumption of fruit and vegetables. Parents should be made aware of the possible impact of their own behaviour on the eating habits of their children.

To investigate the prevalence and incidence of overweight and obesity, the frequency of overweight resolution and the influence of parental adiposity during middle childhood.

As part of a prospective cohort study, height and weight were measured in 1997 and 2000/2001. Children were classified as non-overweight, overweight or obese based on standard international definitions. Body mass index (BMI) was transformed into age- and gender-specific Z-scores employing the LMS method and 2000 growth chart data of the Centers for Disease Control and Prevention. Parents self-reported height and weight, and were classified as underweight, healthy weight, overweight or obese based on World Health Organization definitions.

Primary schools in Victoria, Australia.

In total, 1438 children aged 5–10 years at baseline.

The prevalence of overweight and obesity increased between baseline (15.0 and 4.3%, respectively) and follow-up (19.7 and 4.8%, respectively; P < 0.001 for increase in overweight and obesity combined). There were 140 incident cases of overweight (9.7% of the cohort) and 24 of obesity (1.7% of the cohort); only 3.8% of the cohort (19.8% of overweight/obese children) resolved to a healthy weight. The stability of child adiposity as measured by BMI category (84.8% remained in the same category) and BMI Z-score (r = 0.84; mean change = −0.05) was extremely high. Mean change in BMI Z-score decreased with age (linear trend β = 0.03, 95% confidence interval 0.01–0.05). The influence of parental adiposity largely disappeared when children's baseline BMI was adjusted for.

During middle childhood, the incidence of overweight/obesity exceeds the proportion of children resolving to non-overweight. However, for most children adiposity remains stable, and stability appears to increase with age. Prevention strategies targeting children in early childhood are required.

To identify socio-economic demographic and environmental factors that predict better height-for-age for children under 5 years of age in a Dhaka slum population.

A panel survey, conducted between 1995 and 1997. A random sample of households was selected. Socio-economic, demographic and environmental variables were collected monthly by questionnaire and nutritional status was assessed.

Dhaka slums in Bangladesh.

Three hundred and ninety-two children, surveyed in September–November 1996.

Height-for-age Z-score (HAZ) above −2.

Thirty-one per cent of children had HAZ <−2. Logistic regression adjusted for cluster sampling showed that better nourished children were more likely to have taller mothers, to be from female-headed households and from families with higher income, electricity in the home, better latrines, more floor space and living in Central Mohammadpur. Better nourished children were less likely to have fathers who have taken days off from work due to illness.

Interest in ‘positive deviance’ is motivated by the recognition that a focus on the malnourished only – the bottom tail of the distribution – provides indications of how families fail, but not of how they succeed in maintaining child nutrition in the face of adversity. Our analysis provides an alternative perspective on nutrition and vulnerability in an urban slum setting.

To compare the dietary habits of Japanese women in Japan with those of Japanese and Caucasian women living in Hawaii.

Data from two previous cross-sectional studies conducted within two years in Hawaii and Gifu, Japan were pooled and analysed. Dietary intakes were assessed with validated food-frequency questionnaires and urine samples were collected for isoflavone measurement.

Participants were recruited through mammography clinics in both locations.

In Hawaii, 164 Caucasian and 146 Japanese women; in Japan, 206 women.

Dietary habits differed considerably by ethnicity and location. In comparison to the Caucasian diet, the diet in Japan was relatively low in fat and high in carbohydrates and protein, whereas the Japanese women in Hawaii reported intermediate intakes. Japanese women in Gifu consumed a diet that was relatively high in fish, soy, eggs and vegetables, and low in fruits, dairy products and meat. In contrast, the Caucasian women consumed the most dairy products and fruits and the Japanese women in Hawaii reported the highest grain and meat intakes.

The diet of Japanese women in Hawaii appeared to be a combination of foods eaten in Japan and the dietary habits of Caucasian women in Hawaii, but eating habits in Japan are also different from traditional nutritional patterns. This study illustrates several problems related to dietary comparisons across populations and provides information for future investigations on chronic disease risk.

To determine the vitamin D status of middle-aged women living in the Norwegian arctic and its relationship with vitamin D intake and exposure to ultraviolet (UV) radiation.

Cross-sectional study.

This study is based on measurements of 25-hydroxyvitamin D (25(OH)D) levels in a sub-sample of the Norwegian component of the EPIC biological bank, which consists of blood samples from a random selection of participants in the Norwegian Women and Cancer Study. From November 2001 until June 2002, 309 blood samples were collected from a total of 443 invited middle-aged women (44–59 years) in northern Norway (65–71°N) (crude response rate, 69.8%). Questionnaire data provided information on dietary sources of vitamin D and UV exposure.

Median plasma 25(OH)D concentration for the whole group was 55.0 nmol l−1 (range 8.1–142.8 nmol l−1). Vitamin D intake was a significant predictor of 25(OH)D status (P = 0.0003). The time of the year when the blood sample was collected significantly predicted plasma 25(OH)D level (P = 0.005). Levels of 25(OH)D were positively associated (P = 0.0002) with estimated hours per day of exposure to UV-B radiation. Residing in northern Norway during the summer prior to blood sampling was negatively associated with 25(OH)D concentration (P = 0.001). The prevalence of moderate hypovitaminosis D was highest in January–February, when a quarter of the participants had 25(OH)D concentrations ≤37.5 nmol l−1.

Increased ingestion of marine food items that provide vitamin D should be promoted and further studies should be carried out to investigate vitamin D status in arctic populations in relation to both UV exposure and traditional food sources.

To document knowledge, attitudes, beliefs and eating habits of health professionals with respect to obesity, nutrition and weight management.

A self-complete questionnaire postal survey.

Primary care and dietetic practice in Scotland.

A systematic stratified sample of 2290 subjects incorporated general practitioners (n = 1400), practice nurses (n = 613) and all practising dietitians (n = 360) who were members of the British Dietetic Association.

The overall response rate was 65%. All professionals showed a clear understanding of nutrition and health. Understanding of obesity as a disease and of the effectiveness of weight management using low-energy diets was limited. Below 10% had carried out audit to determine the incidence of obesity and overweight, and most were uncertain about their own effectiveness in delivering weight management advice.

This study confirms that health professionals have some knowledge of nutrition and weight management but are unclear how to deliver effective weight management advice. Further training is justified to ensure the effective provision of nutritional advice to patients.

To investigate the feasibility of using commercially available data on household food consumption to carry out food and nutritional surveillance.

Taylor Nelson Sofres (TNS) collects information on foods brought home for consumption among a representative quota sample of the British population. In total, 33 177 households and 105 667 individuals provided data between 1991 and 2000. These were used to investigate sociodemographic, geographical and temporal trends in purchase patterns of the main macronutrients and four groups of marker products.

Sociodemographic characteristics of the TNS sample were broadly consistent with those of the British population. Estimated energy intakes were slightly low (1667±715 kcal) in comparison with other national data. However, percentage energy contributions were consistent with national trends: e.g. consumption of alcohol in the home increased between 1991 and 2000 with higher intakes among more affluent households, while fat intakes decreased slightly over the same period. Significant temporal, geographic and socio-economic trends were found for all nutrients (P < 0.0001). Intakes of marker products were sparse (purchased by <4% of households), but significant variations were detected in the proportion of households purchasing some or all of the marker products across temporal, geographic and socio–economic strata.

A prospective nutrient surveillance system could be used to trace consumption patterns of foods or nutrients to inform nutritional surveillance. However, existing data sources would require a number of modifications to increase their suitability for such a project. Increasing surveillance to consider ingredients would require the development of a central coding system, with electronically linked barcode, ingredient and nutrient information.

To assess the reliability of newly developed questionnaires measuring theoretical constructs believed to predict fruit and vegetable consumption among 6th–grade pupils.

Participating pupils and parents completed questionnaires twice, 14 days apart.

One hundred and twenty–nine pupils from 6th–grade classes (average age: 11.9 years) at two schools in Norway and their parents were invited to participate.

The test–retest reliability was found to be good or very good for scales reported both by the pupils and their parents. All scales showed acceptable to strong correlations between time 1 and time 2, and only one scale had significant different mean values at the two times. The internal consistency reliability of the scales was acceptable to good.

Sixth graders and their parents are able to provide reliable reports on theoretical determinants of the pupilapos;s fruit and vegetable consumption.