To measure dietary salt intake in a Swedish population.

A cross-sectional study with measured 24 h urinary excretion of Na and K. Completeness of urine collection was assessed using p-aminobenzoic acid. The subjects were interviewed on their habitual food intake.

Sahlgrenska University Hospital, Gothenburg, Sweden.

Eighty-six young men (age 18–20 years), randomly selected from the population of Gothenburg. Seven men were excluded due to incomplete urine collection.

The mean excretion of Na and K over 24 h was 198 and 84 mmol, respectively (corresponding to 11·5 g NaCl and 3·3 g K). The mean 24 h excretion in the highest quartile of Na excretion was 297 mmol Na and 105 mmol K, and in the lowest quartile, 100 mmol Na and 68 mmol K. The mean Na:K ratio was 2·3, and respectively 3·2 and 1·8 in the highest and lowest Na excretion quartiles. Calculated energy intake did not differ between the highest and lowest quartiles of Na excretion, but body weight, BMI and the intake of certain foods known to be Na-rich did.

Salt intake in young men was alarming high and even subjects in the lowest quartile of Na excretion did not meet present recommendations to limit salt intake to 5–6 g/d. At this point we can only speculate what the consequences of the high salt intake may be for CVD and stroke later in life. Regulation of the salt content in processed and fast food and in snacks is advocated, to curtail the salt burden on society imposed by the food industry.

To assess the effects of a school-based intervention on the diets of 7–9-year-olds.

Dietary intake of children in second and fourth grades was assessed with 3d weighed dietary records in autumn 2006 and autumn 2008, before and after a school-based intervention that started in the middle of second grade, and compared with control schools with no intervention. The diet was evaluated by comparison with food-based dietary guidelines (FBDG) and reference values for nutrient intake. The intervention aimed at several determinants of intake: knowledge, awareness, preferences/taste, self-efficacy and parental influence. Nutrition education material was developed for the intervention and implemented in collaboration with teachers. The main focus of the intervention was on fruit and vegetable intake as the children’s intake was far from meeting the FBDG on fruit and vegetables at baseline.

Elementary schools in Reykjavik, Iceland.

Complete dietary records were available for 106 children both at baseline and follow-up.

Total fruit and vegetable intake increased by 47 % in the intervention schools (mean: 61·3 (sd 126·4) g/d) and decreased by 27 % in the control schools (mean: 46·5 (sd 105·3) g/d; P < 0·001). The majority of the children in the intervention schools did still not meet the FBDG on fruits and vegetables at follow-up. Fibre intake increased significantly in the intervention schools, as well as that of potassium, magnesium, β-carotene and vitamin C (borderline).

The school-based intervention in 7–9-year-olds was effective in increasing fruit and vegetable intake, by 47 % increase from baseline, which was mirrored in nutrient intake.

To compare infant and young child feeding practices in children aged 0–23 months across nine East and Southeast Asian countries.

Secondary analyses of cross-sectional data from available Demographic and Health Surveys (DHS; Indonesia, Philippines, Timor-Leste, Cambodia and Vietnam), Multiple Indicator Country Surveys (Lao People's Democratic Republic (Lao PDR) and Myanmar) and national nutrition surveys (Democratic People’s Republic of Korea (DPR Korea) and Mongolia) conducted between 2000 and 2005.

Seven countries from Southeast Asia and two from East Asia.

Children aged 0–23 months with samples ranging from 826 to 5610 for DHS, and from 477 to 5860 for non-DHS data.

More than 93 % of infants were ever breast-fed, and over 75 % were currently breast-fed except in the Philippines. Timely initiation of breast-feeding varied from 32 % in Indonesia to 46 % in Timor-Leste. Exclusive breast-feeding (EBF) rate in infants under 6 months of age ranged from 11 % in Myanmar to 60 % in Cambodia. EBF rates were also low in Vietnam (15·5 %) and Lao PDR (23 %), and varied between 30 % and 40 % in Indonesia, Philippines and Timor-Leste. The proportion of infants under 6 months of age who were given breast milk with non-milk liquids was high except in Indonesia and Timor-Leste. Bottle-feeding rates were lower in DPR Korea (3 %), Lao PDR (6 %) and Myanmar (6 %) and higher in the Philippines (49 %) and Mongolia (31 %). Timely complementary-feeding rate varied widely across countries (6–99 %).

All the countries studied should make greater efforts to improve timely initiation of breast-feeding and EBF for 6 months. Measures should be taken to reduce high bottle-feeding rate in the Philippines, Mongolia, Indonesia and Vietnam, and improve complementary-feeding rate in Lao PDR, Myanmar, DPR Korea and Philippines.

Regular dietary intake of fish is associated with reduced risk of developing cardiovascular and other chronic diseases, and may improve general well-being. If fish eaters are healthier, they may use fewer health-care resources. The present study aimed to describe the reported intake of fish and fish products in a Danish general population, and to investigate whether fish consumption is associated with generic measures of self-reported health and consumption of health-care resources.

Data on eating patterns and health status for 3422 Danish adults were obtained by telephone interview in the Funen County Health Survey. These data were merged with individual-level register data on health-care utilisation. Survey respondents were categorised into those consuming fish at least once weekly (fish eaters) and those consuming fish less frequently (non-fish eaters).

People who reported eating fish twice monthly or once weekly had significantly better overall self-reported health than those who rarely eat fish, even after adjustment for age, gender, social characteristics and lifestyle factors. Fish eaters did not have significantly lower aggregated health-care costs, although their hospital utilisation was significantly lower than that for non-fish eaters.

Moderate fish consumption was associated with better self-reported general health even after controlling for possible confounding variables. Overall, fish eaters appeared to use the same amount of health-care resources as non-eaters, although fish eaters used more medicine but were less likely to be admitted to a hospital.

The Health-promotion through Obesity Prevention across Europe (HOPE) project aims to bring the European scientific knowledge on overweight, obesity and their determinants together and use the expertise of researchers across Europe to contribute to tackling the obesity epidemic.

This special issue of Public Health Nutrition presents important results from one of the work packages of the HOPE project that aims at gaining and integrating knowledge on the determinants of nutrition, physical activity and obesity among schoolchildren and adolescents (aged 10–18 years) in different European regions. It includes contributions from Northern Europe (Norway), Central and Eastern Europe (Germany, Poland and the Czech Republic), Southern Europe (Greece) and Western Europe (Belgium and The Netherlands), as well as an overview of the availability of good-quality data on prevalence rates and trends in overweight (including obesity) among adolescents in European Union (EU) countries. The studies that are included report prevalence differences, data on relevant nutrition and physical activity behaviours, as well as potential physical and environmental behavioural determinants.

These papers provide further evidence on differences in obesity and overweight prevalence among different EU regions and countries, and contribute to the further exploration of risk factors that may or should be addressed in obesity prevention efforts for school-aged children and adolescents in EU countries.

To adapt a scale to measure perceptions on food insecurity and hunger among households in urban and rural communities in Peru.

Qualitative and quantitative methodology including consultation with regional experts, key informant interviews and focus groups. A field survey trial was conducted in urban and rural communities using an adapted version of the US Department of Agriculture (USDA) Food Insecurity and Hunger Module (FIHM).

Five communities in three regions in Peru – Lima (coast), Ayacucho (Andean highlands) and San Martín (Amazon basin).

The qualitative component included forty intentionally selected people (fourteen key informants and twenty-six focus group participants). For the quantitative component 300 households that complied with selection criteria (poor or non-poor with at least one child below 12 years of age) were surveyed.

Qualitative research showed that concern about food availability and access was common among the three regions but its main cause varied across them. Participation in food aid programmes was a strategy to face constraints in food access. Mothers’ perceptions on the importance of balanced meals varied across households from different regions. Quantitative results showed robust findings for the reliability of the adapted FIHM’s fifteen-item scale (r > 0·863). In addition, descriptive results confirmed parallelism of item responses in the scale for variables such as farm ownership, family size and use of Communal Kitchens.

This mixed-method study allowed us to adapt the USDA module to assess food insecurity in Peru.

To examine the joint effect of family history and BMI on diabetes.

Cross-sectional study.

A rural community in Saskatchewan, Canada.

The analysis was based on data from 2081 adults, 18–79 years of age, who participated in the Humboldt Study conducted in 2003. Doctor-diagnosed diabetes and family history of diabetes of biological parents and siblings were self-reported. Body weight and height were objectively measured. The interaction of family history and BMI on diabetes was assessed on an additive scale.

The prevalence of diabetes was 7·9 %, and BMI and history of diabetes were two important predictors. The adjusted prevalence ratios were 1·76 (95 % CI 1·37, 2·27) and 2·59 (95 % CI 2·05, 3·31) for those with a BMI of 25·0–29·9 kg/m2 and of at least 30 kg/m2, respectively, compared with a BMI of less than 25 kg/m2, and was 2·41 (95 % CI 2·08, 2·80) for those with a family history of diabetes v. those without. The data indicated an additive interaction of family history and BMI on diabetes.

When exposed to both family history and overweight/obesity, individuals would have an increased risk that was greater than the sum of their single effects. Reduction of BMI would also reduce the risk of diabetes associated family history.

To review recent data on objectively measured overweight/obesity in national representative samples of European adolescents (aged 10–18 years), as well as availability of studies assessing trends in overweight/obesity in this target group. Attention was paid to the ability of the data to describe the obesity epidemic, especially in sociodemographic subgroups.

Data on prevalence and trends in overweight/obesity among adolescents in the twenty-seven European Community member states, Iceland, Norway and Switzerland, available as scientific publications as well as reports or unpublished data by the end of 2009, were retrieved. Reports on the most recent objectively measured data from national representative samples were selected and described with regard to the years of data collection, sample sizes, response rates, age ranges included, trends by age, type of measures of overweight/obesity, sociodemographic variables and the sources of information.

Objectively measured data on national representative samples were identified for only half of the countries, and the trend studies were mainly conducted applying subnational samples. Most studies used the criteria from the International Obesity Task Force (IOTF) to define overweight/obesity, but the age ranges studied and the years of data collection varied, and information on sample sizes and response rates were often not presented. Data on trends of overweight/obesity over time are increasing, and the most recent studies indicate that the prevalence rate of overweight/obesity has stabilized. Few studies reported data by sociodemographic subgroups other than gender and age.

Objectively measured data on national representative samples of adolescents appear scattered, and there is a large heterogeneity with respect to the quality and comparability of available data. Increasing use of the IOTF criteria for overweight/obesity contributes to improved comparability across studies. Data by sociodemographic subgroups, and in particular by socio-economic status, are scarce.

To assess whether persistent micronutrient deficiencies in Mongolian children identified in our earlier biochemical study are associated with inadequacies in quantity and/or quality in their complementary diets.

A cross-sectional study of breast-fed children aged 6–23 months, randomly selected from four districts in Ulaanbaatar and four provincial capitals.

Weight and length were measured, and sociodemographic status, feeding practices and nutrient adequacy of complementary foods for children aged 6–8 months (n 26), 9–11 months (n 29) and 12–23 months (n 73) were assessed via questionnaire and in-home interactive 24 h recalls.

No geographic differences existed so data were combined. Adherence to WHO infant and young child feeding practices was poor: few children were exclusively breast-fed up to 6 months of age or received the recommended number of feedings containing the recommended number of food groups. Nevertheless, energy intakes from complementary diets, primarily from cereals and non-nutritious snacks, were above WHO-estimated needs; <1 % of energy was from meat and eggs or fruits and vegetables. Median intakes and densities of most nutrients (except protein, thiamin and riboflavin) failed to meet WHO recommendations for at least two age groups, assuming average breast milk intake; greatest density deficits were for Fe > vitamin C > vitamin A > Zn > Ca.

Complementary feeding in Mongolia is compromised by deficits in several micronutrients but not energy, in part because of frequent consumption of non-nutritious snacks. The latter may interfere with breast-feeding and should be avoided. Instead, wheat-based complementary foods should be enriched with affordable cellular animal foods and fruits rich in vitamin C to combat existing micronutrient deficits.

To assess breast-feeding initiation and prevalence from birth to 6 months in a sample of mothers in Dublin, and to determine the factors associated with breast-feeding initiation and ‘any’ breast-feeding at 6 weeks in a sample of Irish-national mothers.

This prospective cross-sectional study involved the recruitment of women during the antenatal period, with subsequent follow-up of mothers who delivered healthy, term singleton infants, at 6 weeks and 6 months postpartum.

Participants were recruited from antenatal clinics in the Coombe Women and Infants University Hospital, Dublin.

In all, 401 Irish-national and forty-nine non-Irish-national mothers met the criteria for inclusion in the present study.

Breast-feeding initiation rates of the Irish-national and non-Irish-nationals were 47 % and 79·6 %, respectively. Factors that were significantly (P = 0·000) associated with both breast-feeding initiation and ‘any’ breast-feeding at 6 weeks included mothers who were ≥35 years, educated to third level, reported positive postnatal encouragement to breast-feed from their partners and had a positive antenatal intention to breast-feed. The maternal negative perception that breast-feeding is an embarrassing way to feed an infant was demonstrated as a major barrier to initiation.

Breast-feeding initiation and prevalence rates of the Irish-national population remain low and lag considerably behind national and international targets. Inclusion of the partner in breast-feeding promotional initiatives during the antenatal period may be crucial to increase breast-feeding rates in Ireland. Public health campaigns that focus on increasing the social acceptability of breast-feeding may prove effective in addressing this cultural barrier.

To evaluate the level of compliance with the PAOS Code (Publicidad, Actividad, Obesidad y Salud), which establishes standards for the self-regulation of food marketing aimed at minors, in television advertising by food and beverage companies that have agreed to abide by the Code.

The study sample consisted of food and beverage advertisements targeting children during 80 h of programming by four Spanish television networks. The level of compliance with each standard of the PAOS Code was classified into three categories: ‘compliance’, ‘non-compliance’ and ‘uncertain compliance’. Overall, an advertisement was considered compliant with the PAOS Code if it met all the standards; non-compliant if it contravened one or more standards; and uncertain in all other cases.

Of a total of 203 television advertisements from companies that agreed to the PAOS Code, the overall prevalence of non-compliance was 49·3 % (v. 50·8 % among those that did not agree to the code), with 20·7 % of advertisements considered of uncertain compliance. Non-compliance was more frequent on Saturdays, in longer advertisements, in advertisements containing promotions or dairy products, and for advertisements from companies of French or US origin.

Non-compliance with the PAOS Code was very high and was similar for companies that did and did not agree to the Code, casting doubt on the Code’s effectiveness and oversight system. It seems the time has come to commit to statutory regulations that reduce the negative impact of advertising on children’s diets, as demanded by public health experts and consumer associations.

The aim of the present study was to examine to what extent children and adolescents in Greenland comply with the national dietary guidelines, and to analyse the influence of habitation and family affluence on the compliance with dietary guidelines.

Data were from the Health Behaviour in School-aged Children (HBSC) survey in Greenland. The 2006 survey included 2462 students aged 11 to 17 years.

The proportion of students complying with the national dietary guidelines varied from 14 % to 87 % depending on the food item. Sweets and soft drinks had the lowest compliance. The oldest children had the following characteristics compared with the younger children: fewer ate traditional Greenlandic foods, fewer ate fruit, fewer ate breakfast daily on school days and more drank soft drinks frequently. More boys than girls ate traditional Greenlandic foods often, while more girls ate vegetables daily. The least favourable eating habits in general were found among children from low affluent families and children in villages.

Many Greenlandic schoolchildren did not comply with the national dietary guidelines. Despite a higher intake of traditional foods as a whole, children in villages and less affluent children were less likely to comply with guidelines. A strong relationship between diet, family affluence and availability was found. The study findings indicate that factors such as availability, cost and seasonal variation are important to the intake of both imported and traditional Greenlandic foods. The findings should be taken into consideration when promoting the national guidelines.

To develop a framework to guide action in the public health nutrition workforce to develop policies and practices addressing factors contributing to climate change.

Action/consultative research.

Interviews – South Australia, questionnaire – Australia.

Interviews – key informants (n 6) were from various government, academic and non-government positions, invited through email. Questionnaire – participants were members of the public health nutrition workforce (n 186), recruited to the study through emails from public health nutrition contacts for each State in Australia (with the exception of South Australia).

Support by participants for climate change as a valid role for dietitians and nutritionists was high (78 %). However, climate change was ranked low against other public health nutrition priorities. Support of participants to conduct programmes to address climate change from professional and work organisations was low. The final framework developed included elements of advocacy/lobbying, policy, professional recognition/support, organisational support, knowledge/skills, partnerships and programmes.

This research demonstrates a need for public health nutrition to address climate change, which requires support by organisations, policy, improved knowledge and increased professional development opportunities.

To compare macronutrient intakes of Swedish children and adolescents to population goals; to identify the major sources of energy, fat, saturated fat and sucrose; and to simulate the effect adherence to current food-based dietary guidelines (FBDG) would have on saturated fat and sucrose intakes.

Cross-sectional study. From 24 h recall data, food groups contributing most to energy, fat, saturated fat and sucrose were identified. Based on the prevailing consumption of foods mentioned in the FBDG, we simulated five scenarios: changes in milk and yoghurt; cheese; energy-dense, nutrient-dilute foods; soft drinks; and burger and sausage consumption.

Stockholm and Örebro (Sweden) in 1998–1999.

Children (n 551, 9·6 years) and adolescents (n 569, 15·5 years) participating in the European Youth Heart Study.

Intakes of saturated fat and sucrose exceeded population goals in all age and gender subgroups. Compliance to the goal for saturated fat was lower in children, particularly boys. Compliance to the sucrose goal was lower among adolescents. The major sources of energy, fat, saturated fat and sucrose in the diet reflect not only the traditional Swedish diet but also the influence of energy-dense, nutrient-dilute foods. The simulations suggest that a combination of FBDG is required to bring both saturated fat and sucrose intakes in line with recommendations.

Widespread adherence to a combination of FBDG could theoretically bring mean intakes in line with population goals. The effect on overall nutrient intakes as well as consumer acceptance of such changes needs to be considered.

To determine the prevalence of anaemia and maternal and infant factors associated with Hb values in infants at 6 months of age in rural Bangladesh.

Infants (born to mothers supplemented with Fe–folic acid from mid-pregnancy) were visited at birth and 6 months of age. Mothers’ anthropometric status, and infants’ birth weight, gestational age at birth, weight and Hb concentration at 6 months were measured. Household socio-economic and demographic data, infant feeding practices and health status were collected using a pre-tested structured questionnaire.

Rural Bangladesh.

Four hundred and two infants.

For the total cohort (n 402), the range of anaemia prevalence values was from 30·6 % using a cut-off value of Hb < 95 g/l to 71·9 % using a value of Hb < 110 g/l. Birth weight and month of birth were the only factors positively associated with infant Hb in a linear regression model (P = 0·008 and 0·011, respectively).

There was an unexpectedly high prevalence of anaemia in infants at 6 months of age, before the assumed period of vulnerability. Hb at this age tended to be higher in those with higher birth weight. We also found a season effect on Hb, as it tended to be higher as the study progressed. The high prevalence of anaemia at such an early age needs to be addressed to minimize the disease’s long-term consequences.

Current nutrition environment instruments are typically designed to measure a small number of healthy foods based on national trends. They lack the depth to accurately measure the unique dietary choices of subpopulations, such as Texas consumers whose food preferences are influenced by Hispanic/Latino culture. Thus the purposes of the present study were to: (i) develop a comprehensive observational tool to measure the availability of healthy foods from retail stores in Texas; and (ii) conduct a pilot test to examine the tool’s reliability, as well as differences in the availability of healthy foods in stores between high- and low-income neighbourhoods.

Grocery and convenience stores were assessed for availability of healthy foods. Reliability was calculated using percentage agreement, and differences in availability were examined using 2 (store type) × 2 (neighbourhood income) ANOVA.

One high-income and one low-income neighbourhood in Austin, Texas.

A sample of thirty-eight stores comprising twenty-five convenience stores and thirteen grocery stores.

The low-income neighbourhood had 324 % more convenience stores and 56 % fewer grocery stores than the high-income neighbourhood. High inter-rater (mean = 0·95) and test–retest reliability (mean = 0·92) and a significant interaction (P = 0·028) between store type and neighbourhood income were found.

The TxNEA-S tool includes 106 healthy food items, such as fruits, vegetables, dairy, proteins and grains. The tool is reliable and face validity is affirmed by the Texas Department of Health. Grocery stores have more healthy foods than convenience stores, and high-income grocery stores offer more healthy foods than low-income grocery stores.

To estimate dietary cholesterol contribution to CHD risk among US females, relative to other dietary risk factors.

A risk apportionment model was applied to apportion CHD risk shares among the lifestyle and dietary risk factors.

The model was implemented using relative risks from the Nurses’ Health Study and data on CHD risk factors and consumption from the National Health and Nutrition Examination Survey 1999–2002.

US females aged 25 years or older.

On average, poor diet contributes 20 % of the CHD risk relative to obesity, inactivity and smoking, of which trans fat intake contributes 2·9 %, dietary cholesterol 1·5 % and 16 % is due to low consumption of nutrients, i.e. MUFA (1·5 %), PUFA (1·7 %), marine n-3 fatty acids (2·7 %), α-linolenic acid (1·1 %), dietary fibre (2·4 %), vitamin B6 (4·1 %), vitamin C (0·5 %) and folate (1·8 %).

Reducing trans fat and dietary cholesterol intakes could lead to CHD reduction, but greater risk reduction may be achieved by improving intakes of heart-healthy nutrients currently deficient in US females’ diets. Total diet consideration is essential in any CHD risk reduction strategy.