The study aimed to highlight the determinants of overnutrition (overweight plus obesity) in fishing communities and establish if these were the same as reported elsewhere in Ghana.

Cross-sectional study.

The study was conducted in Idun, Ola and Duakor fishing communities in Cape Coast, Ghana.

Adults (n 252) aged 20 to 50 years.

Results showed that 32 % of participants were overweight/obese (BMI ≥ 25·0 kg/m2). Participants’ mean age was 31·7 (sd 1·0) years, they had 13·7 (sd 8·1) mean years of formal education, their median monthly income was $US 7·4 (interquartile range $US 3·3, 20·0) and their median daily energy intake was 7·3 (interquartile range 5·3, 9·8) MJ. Significant associations (P < 0·05) were found between BMI and gender, age, years of education, fat intake and marital status. Females were almost eight times more likely to be overweight/obese than males (adjusted OR = 7·7; 95 % CI 3·6, 16·4). Persons aged ≥40 years were about six times more likely to be overweight/obese than those aged 20–29 years (adjusted OR = 6·1; 95 % CI 2·6, 14·1). Married people were nearly three times more likely to be overweight/obese than singles (adjusted OR = 2·8; 95 % Cl 1·4, 5·7). People with more than 13 years of formal education (adjusted OR = 0·3; 95 % CI 0·1, 0·9) and people with >30 % fat contribution to daily energy intake (adjusted OR = 0·3; 95 % CI 0·1, 0·6) had reduced odds of being overweight/obese.

Overnutrition was prevalent in the fishing communities and associated with factors such as age, gender, marital status, educational status and fat intake.

The current discussion regarding ‘place effects on health’ is increasingly focusing on the characteristics of a specific physical environment. Our study investigated whether socially deprived residential areas are more likely than affluent neighbourhoods to provide access to addictive substances and fast food.

In this ecological study the total number of tobacco, alcohol and fast-food outlets was recorded and visualized using a geographic information system. Area affluence was measured through the percentage of parents with children of kindergarten or school age with joint annual taxable income <€12 272.

Eighteen social areas in Cologne, Germany.

All social areas in four districts in Cologne, Germany, with a total of 92 000 inhabitants, were analysed.

In the investigation area, 339 tobacco, 353 alcohol and sixty-seven fast-food outlets were identified. As area affluence declined the availability of the following potentially health damaging sources increased: cigarettes (Kendall's tau = 0·433; P = 0·012), alcohol (Kendall's tau = 0·341, P = 0·049) and fast food (Kendall's tau = 0·473; P = 0·009).

The availability of addictive substances and fast food can be seen to have a contextual influence on an individual's lifestyle and can, in the form of physical exposure to obesogenic and addictive environments, contribute to a culmination of health risks.

Adequate iodine and Fe intakes are imperative during pregnancy to prevent fetal defects, but such data are not available in the Democratic Republic of Congo. We aimed to assess iodine and Fe status in pregnant women from Lubumbashi.

Cross-sectional study. We measured urinary iodine concentration (UIC) in random urine samples using a modified Sandell–Kolthoff digestion method; the WHO reference medians were used to classify iodine intake as deficient, adequate, more than adequate or excessive. Serum ferritin concentrations were measured by immunoenzymatic assay and considered insufficient when <12 ng/ml.

Maternity units from rural, semi-urban and urban areas of Lubumbashi, Democratic Republic of Congo.

Two hundred and twenty-five randomly selected pregnant women attending prenatal consultation, seventy-five postpartum women and seventy-five non-pregnant women as controls.

Overall median UIC in pregnant women was 138 (interquartile range: 105–172) μg/l, indicating iodine deficiency, whereas postpartum and non-pregnant women had adequate iodine intake: median UIC = 144 μg/l and 204 μg/l, respectively. Median UIC values were lower in late pregnancy than in early pregnancy: in the first, second and third trimester respectively 255 μg/l, 70 μg/l and 88 μg/l in the rural area; 306 μg/l, 166 μg/l and 68 μg/l in the semi-urban area; and 203 μg/l, 174 μg/l and 99 μg/l in the urban area. Fe was insufficient in 39 % of pregnant women compared with 21 % of non-pregnant and postpartum women. In the third trimester, deficiencies in both iodine and Fe were high: 40 %, 12 % and 18 % in the rural, semi-urban and urban areas, respectively.

Our data suggest that pregnant women are at risk of iodine and Fe deficiencies in Lubumbashi. Country policies fighting against iodine and Fe deficiencies during pregnancy should be reinforced.

To describe the dietary composition of the New Nordic Diet (NND) and to compare it with the Nordic Nutrition Recommendations (NNR)/Danish Food-based Dietary Guidelines (DFDG) and with the average Danish diet.

Dietary components with clear health-promoting properties included in the DFDG were included in the NND in amounts at least equivalent to those prescribed by the DFDG. The quantities of the other dietary components in the NND were based on scientific arguments for their potential health-promoting properties together with considerations of acceptability, toxicological concerns, availability and the environment. Calculations were conducted for quantifying the dietary and nutrient composition of the NND.

Denmark.

None.

The NND is characterized by a high content of fruits and vegetables (especially berries, cabbages, root vegetables and legumes), fresh herbs, potatoes, plants and mushrooms from the wild countryside, whole grains, nuts, fish and shellfish, seaweed, free-range livestock (including pigs and poultry) and game. Overall, the average daily intakes of macro- and micronutrients in the NND meet the NNR with small adjustments based on evidence of their health-promoting properties.

The NND is a prototype regional diet that takes palatability, health, food culture and the environment into consideration. Regionally appropriate healthy diets could be created on similar principles anywhere in the world.

To outline the evolution of school food standards and their implementation and evaluation in each of the four countries of the UK since 2000.

Review of relevant policies, surveys and evaluations, including country-specific surveys and regional evaluations.

UK: England, Wales, Scotland and Northern Ireland.

Primary and secondary schools and schoolchildren.

By September 2013 standards will have been introduced in all primary and secondary schools in the UK. Evaluations have varied in their scope and timing, relating to government forward planning, appropriate baselines and funding. Where standards have been implemented, the quality and nutritional value of food provided have improved. Emerging evidence shows improved overall diet and nutrient intake by school-aged children as a result.

The re-introduction of school food standards in the UK has not been centrally coordinated, but by September 2013 will be compulsory across all four countries in the UK, except in England where academies are now exempt. Provision of improved school food has had a demonstrable impact on diet and nutrition beyond the school dining room and the school gate, benefiting children from all socio-economic groups. Improved school food and dining environments are associated with higher levels of school lunch take up. Implementation of school food standards requires investment. It is critical to policy development that the value of this investment is measured and protected using planned, appropriate, robust and timely evaluations. Where appropriate, evaluations should be carried out across government departments and between countries.

To characterize current feeding practices and to evaluate the adequacy of energy and nutrient intakes of young children in subsistence farming rural households in North Wollo, Ethiopia.

A cross-sectional study examining sociodemographic status, anthropometry, breast-feeding and complementary feeding practices using two in-home non-consecutive 24 h recalls.

Two rural villages in the highlands and lowlands of Gobalafto district, North Wollo.

Seventy-six young children aged 12–23 months, thirty-nine from the lowlands and thirty-seven from the highlands.

About 33 % of the children, ∼46 % in the highlands and 24 % in the lowlands (P = 0·05), were stunted. Complementary diets were low in animal products, fruits and vegetables. Cereals and legumes were the major sources of energy, protein, Ca, Fe, Zn and vitamin A. Legumes with potentially toxic components (grass pea, broad beans) and low nutrient-dense beverages such as tea were frequently consumed. Intakes of energy, Ca, Zn, vitamin A and vitamin C from complementary foods were below WHO recommendations assuming average breast-milk intakes. In contrast, Fe and protein intakes and densities met WHO recommendations. Although vitamin C intakes and densities were higher (P < 0·05) for the lowlands, they remained far below WHO recommendations.

Interventions promoting the WHO guiding principles for complementary feeding practices and behaviours that take the agro-ecological contexts into account are needed here. Furthermore, specific recommendations should be formulated to discourage the consumption of grass pea, broad beans and low nutrient-dense beverages such as tea.

To examine the relationship between intake of whole grains and BMI Z-score in rural children.

General linear models and logistic regression were used to examine the cross-sectional associations between whole grain intake and BMI Z-score, prevalence and odds ratios of overweight and obesity. Dietary intake was assessed using the Block Food Screener for ages 2–17 years. Children were classified into three categories according to servings of whole grain intake: <1·0 serving/d, 1·0–1·5 servings/d and >1·5 servings/d.

The CHANGE (Creating Healthy, Active and Nurturing Growing-up Environments) study, an obesity prevention intervention in elementary schools in eight rural US communities in California, Mississippi, Kentucky and South Carolina.

Seven hundred and ninety-two children attending 3rd–6th grade.

After adjusting for age, sex, race/ethnicity, physical activity and state of residence, whole grain intake was inversely associated with BMI Z-score (0·90 v. 0·61 in the lowest v. the highest whole grain intake category; P trend = 0·01). Children who consumed >1·5 servings of whole grains/d had a 40 % lower risk of being obese (OR = 0·60; 95 % CI 0·38, 0·95, P = 0·02) compared with children who consumed <1·0 serving/d. Further adjustment for potential dietary predictors of body weight (fruit, vegetable and dairy intakes) did not change the observed associations.

Increasing the intake of whole grains as part of an overall healthy lifestyle may be beneficial for children to achieve and maintain a healthy weight.

To determine the ability of consumers to: locate and manipulate food label information; assess the accuracy of nutrient content claims and which health/nutrient claims are allowed; and identify symbols on food labels. Associations pertaining to use and knowledge regarding food label information were also determined for consumers from different demographic and related groups.

An exploratory descriptive study was undertaken, employing a face-to-face survey focusing on demographic information, shopping behaviour, nutrition is important beliefs, label use, label knowledge and label preference and information sources.

Selected public locations in Potchefstroom in the North West Province of South Africa.

Respondents (n 229) complying with set inclusion criteria were recruited through purposive sampling.

The results indicated respondents’ general health and label awareness, as most of them (>80 %) could locate label information and identify symbols and specific nutrient content claims although only 53 % were able to calculate the number of servings. Nevertheless, an inability was found to assess the accuracy of some nutrient content claims and permissible health/nutrient claims. More educated, younger, Afrikaans- and English-speaking respondents seemed to be more knowledgeable regarding food label information.

Respondents who were informed about nutrition were also informed about label information, while label reading practices resulted in label-influenced purchasing decisions. Educational programmes on food labels should start with nutritional background that could be implemented by consumers during label reading and purchasing decisions.

The present study aimed to estimate the health benefits of selective taxation of healthy and unhealthy food commodities in relation to CVD and nutrition-related cancers.

The potential health effects of a selective taxation scenario were estimated as changes in the burden of disease, measured by disability-adjusted life years, from health outcomes affected by the changes in food intake. The change in burden of a disease was calculated as the change in incidence of the disease due to a modified exposure level, using the potential impact fraction. Estimates of relative risk for the associations between various foods and relevant diseases were found through a literature search and used in the calculation of potential impact fractions.

The study was based in Denmark, estimating the health effects of a Danish selective taxation scenario.

The potential health effects of selective taxation were modelled for the adult Danish population.

Halving the rate of value-added tax on fruit and vegetables and increasing the tax on fats would result in moderate reductions in the burden of disease from IHD, ischaemic stroke, and colorectal, lung and breast cancer (0·4–2·4 % change). The largest effect could be obtained through increased intake of fruit and vegetables (0·9–2·4 %).

Applying selective taxation to healthy and unhealthy foods can moderately reduce the burden of disease in the Danish population.

The aim of the paper is to describe the formative evaluation of the feedback component of an online nutrition tailoring instrument, the Children's and Adolescents’ Nutrition Assessment and Advice on the Web (CANAA-W), among parents of schoolchildren.

Parents of pre-primary and primary-school children recorded their child's food intake over 3 d with CANAA-W and completed the evaluation questionnaire online. A subsample participated in focus group discussions.

Parents completed CANAA-W at home.

Forty-six parents completed the evaluation questionnaire. Seventeen parents participated in three focus group discussions.

Parents were enthusiastic: the majority (81 % or more) found the advice comprehensible, interesting, logical, useful, believable, well formulated, correct, personal, relevant, complete, attractive, containing enough and not too much information; they indicated that it is helpful to improve their children's eating habits and that they intend to use it. The qualitative analyses revealed that the respondents appreciated the confrontation with their child's diet and the visualization (i.e. traffic light colours, pictograms, food models, diagrams). The length of the feedback was rather a drawback, but it was useful nevertheless.

CANAA-W was well received by the parents; the scores on the feasibility questionnaire were high and the qualitative analyses showed that the confrontation with their child's diet, and attractive visualization of the most relevant feedback linked to more elaborated optional feedback, were well appreciated. The major challenge will be to convince parents who are less interested in food habits and less computer-literate to participate in this type of study.

To improve estimates of vitamin A deficiency in children of pre-school age in the 2006 Uganda Demographic and Health Survey (UDHS 2006).

A cross-sectional study in which dried blood spot samples were analysed for C-reactive protein (CRP). Retinol-binding protein (RBP) had previously been analysed using a commercial enzyme immunoassay.

A population-based study in Uganda.

A systematically selected subset of the dried blood spot samples collected from children aged 6–59 months for UDHS 2006. Children were categorized into ‘normal CRP’ (Group A) and ‘raised CRP’ (Group B) using a CRP cut-off of 5 mg/l. A correction factor was calculated to adjust the Group B RBP values for the influence of the acute-phase response.

Geometric mean CRP was 6·2 (95 % CI 5·5, 7·0) mg/l, 1·6 (95 % CI 1·5, 1·8) mg/l and 17·9 (95 % CI 16·4, 19·6) mg/l in all children, in Group A and in Group B, respectively. Geometric mean RBP in all children, in Group A and in Group B was 1·18 (95 % CI 1·14, 1·22) μmol/l, 1·26 (95 % CI 1·20, 1·33) μmol/l and 1·12 (95 % CI 1·07, 1·17) μmol/l, respectively, before correction. Correction increased mean RBP in Group B to 1·26 (95 % CI 1·21, 1·31) μmol/l. The prevalence of vitamin A deficiency (RBP < 0·825 μmol/l) reduced from 18·4 % (95 % CI 17·2, 23·0 %) to 13·9 % (95 % CI 11·3, 16·5 %).

Correcting for the acute-phase response significantly reduced the prevalence of vitamin A deficiency; thus, the acute-phase response should be considered when vitamin A status is assessed using RBP in order to improve population-level estimates of vitamin A deficiency.

Intake of white potatoes in and out of school was estimated to provide context for a recent proposal by the US Department of Agriculture to limit provision of white potatoes in US school meals.

Mean daily servings of white potatoes and other vegetables consumed in and out of school for school-aged children were estimated from two days of 24 h dietary recall data from the National Health and Nutrition Examination Surveys (NHANES). Total energy intake and percentage energy contribution from discretionary oils and solid fats were also estimated for all white potato dishes consumed.

The NHANES is nationally representative of the US civilian non-institutionalized population.

Children and adolescents aged 6–19 years (n 8466) from three combined NHANES cycles (2003–2004, 2005–2006 and 2007–2008).

White potatoes represented 32 % of all vegetable servings consumed by US children and adolescents. Preparations high in fats and oils, including French fries, were most popular both in and out of school. Mean consumption of white potatoes obtained from school cafeterias was approximately 0·05 servings/d among all children and adolescents, and about 0·15 servings/d among children and adolescents acquiring at least one item from the school cafeteria, implying current weekly intake levels well below the limit of 2 servings/week proposed by the US Department of Agriculture.

Although white potatoes represent a substantial proportion of vegetable consumption among school-aged children, it is unclear that proposed limits would influence white potato intake from school cafeterias. Policy makers should consider targeting preparation methods to improve the healthfulness of white potato dishes.

To assess the associations between maternal HIV infection and growth outcomes of HIV-exposed but uninfected infants and to identify other predictors for poor growth among this population.

Within a trial of de-worming during pregnancy, the cohort of offspring was followed from birth. HIV status of the mothers and their children was investigated and growth data for children were obtained at age 1 year. Length-for-age, weight-for-age and weight-for-length Z-scores were calculated for each child; Z-scores <−2 were defined as stunting, underweight and wasting, respectively.

The study was conducted in Entebbe municipality and Katabi sub-county, Uganda.

The sample consisted of 1502 children aged 1 year: HIV-unexposed (n 1380) and HIV-exposed not infected (n 122).

Prevalence of stunting, underweight and wasting was 14·2 %, 8·0 % and 3·9 %, respectively. There was evidence for an association between maternal HIV infection and odds of being underweight (adjusted OR = 2·32; 95 % CI 1·32, 4·09; P = 0·006) but no evidence for an association with stunting or with wasting. Young maternal age, low maternal education, low birth weight, early weaning and experiencing a higher number of episodes of malaria during infancy were independent predictors for stunting and underweight. A higher number of living children in the family was associated with wasting.

Maternal HIV infection was associated with being underweight in HIV-exposed uninfected infants. The success of programmes for prevention of mother-to-child HIV transmission means that an increasing number of infants will be born to HIV-infected women without acquiring HIV. Therefore, viable nutritional interventions need to be identified for this population.

Despite extensive research into the biological mechanisms behind obesity-related inflammation, knowledge of environmental and genetic factors triggering such mechanisms is limited. In the present narrative review we present potential determinants of adipose tissue inflammation and suggest ways ahead for future research in the field.

We searched the literature for potential determinants of obesity with inflammation through MEDLINE by applying the MeSH headings ‘obesity’ and ‘inflammation’ in combination with specific terms for a series of environmental and genetic factors.

Numerous articles reported on the association between environmental or genetic factors and respectively obesity and inflammation, whereas only a few studies assessed obesity and inflammation as a combined outcome. Among suggested determinants for obesity with inflammation were Adenovirus-36, the gut microbiota, trans-fatty acids, and the four genes FTO, MC4R, TNF-α and LEPR.

We present a limited number of factors potentially contributing to the development of obesity with inflammation, while concluding that overall the area is indeed sparsely investigated. We present ideas for future studies that can identify relevant aetiological factors. This identification is essential for targeted prevention of obesity with inflammation and the clinical consequences thereof.

To assess the association between exclusive breast-feeding and childhood overweight.

Cross-sectional data are from the baseline survey of the longitudinal cohort study IDEFICS. Exclusive rather than partial breast-feeding is the focus of the study due to the theoretical relationship between exclusive breast-feeding and development of dietary self-regulation. Children's measured heights and weights were used to calculate weight status, while waist-to-height ratio (WtHR) and skinfold measures were examined as alternative indicators of adiposity and fat patterning.

Examination centres in eight European countries (Italy, Estonia, Cyprus, Belgium, Sweden, Hungary, Germany and Spain).

The analysis included 14 726 children aged 2–9 years for whom early feeding practices were reported by parents in standardized questionnaires.

After controlling for education, income and other potential confounders, breast-feeding exclusively for 4–6 months was protective of overweight (including obesity) when compared with children never exclusively breast-fed (OR = 0·73; 95 % CI 0·63, 0·85) across all measures of overweight. Exclusively breast-feeding for 6 months offered slightly more protection than for 4 and 5 months combined (OR = 0·71; 95 % CI 0·58, 0·85). The associations could not be explained by socio-economic characteristics or maternal overweight.

This multi-country investigation indicated that exclusive breast-feeding for 4–6 months may confer protection against overweight in addition to other known benefits. There was no demonstrated benefit of exclusive breast-feeding for more than 6 months or combination feeding for any duration across all measures of overweight examined.

To investigate nutrition literacy among adult grocery buyers regarding energy-related labelling terms on food packaging.

Qualitative interviews and quantitative surveys to determine shoppers’ understanding of energy terms (‘energy’, ‘calories’ and ‘kilojoules’) and how energy terms affect perceptions of healthiness and intentions to purchase breakfast cereals, muesli bars and frozen meals.

Individual in-depth interviews and surveys in two metropolitan supermarkets, Sydney, Australia.

Australian adults (interview n 40, survey n 405) aged 18–79 years.

The relationship between energy and perceived healthiness of food varied by product type: higher energy breakfast cereals were perceived to be healthier, while lower energy frozen meals were seen as healthier choices. Likewise, intentions to purchase the higher energy product varied according to product type. The primary reason stated for purchasing higher energy products was for sustained energy. Participants from households of lower socio-economic status were significantly more likely to perceive higher energy products as healthier. From the qualitative interviews, participants expressed uncertainty about their understanding of kilojoules, while only 40 % of participants in intercept surveys correctly answered that kilojoules and calories measured the same thing.

Australian consumers have a poor understanding of energy and kilojoules and tend to perceive higher energy products as healthier and providing sustained energy. This has implications regarding the usefulness of industry front-of-pack labelling initiatives and quick service restaurant menu labelling that provides information on energy content only. Comprehensive and widely communicated education campaigns will be essential to guide consumers towards healthier choices.

To describe nutrient intakes and prevalence of overweight and obesity in a nationally representative sample of Kuwaitis and to compare intakes with reference values.

Cross-sectional, multistage stratified, cluster sample.

National nutrition survey covering all geographical areas of the country.

Kuwaitis (n 1704) between 3 and 86 years of age.

Obesity was more prevalent among women than men (50 % and 70 % for females aged 19–50 years and ≥51 years, respectively, v. 29 % and 42 % for their male counterparts). Boys were more obese than girls, with the highest obesity rate among those aged 9–13 years (37 % and 24 % of males and females, respectively). Energy intake was higher than the estimated energy requirements for almost half of Kuwaiti children and one-third of adults. The Estimated Average Requirement was exceeded by 78–100 % of the recommendation for protein and carbohydrates. More than two-thirds of males aged ≥4 years exceeded the Tolerable Upper Intake Level for Na. Conversely, less than 20 % of Kuwaitis, regardless of age, consumed 100 % or more of the Estimated Average Requirement for vitamin D, vitamin E, Ca, n-3 and n-6 fatty acids. Less than 20 % of children met the recommended level for fibre.

Nutrition transition among Kuwaitis was demonstrated by the increased prevalence of obesity and overweight, increased intakes of energy and macronutrients and decreased intakes of fibre and micronutrients. Interventions to increase awareness about healthy foods combined with modifications in subsidy policies are clearly warranted to increase consumption of low-energy, nutrient-dense foods.

To describe the prevalence of iron depletion (ID), iron-deficiency anaemia (IDA) and risk of haemoconcentration during pregnancy and at delivery and to assess the influence of initial Fe stores and Fe supplementation on that prevalence.

Longitudinal study.

Hospital Universitari Sant Joan de Reus (Catalonia, Spain).

Two hundred and eighty-five pregnant women. Serum ferritin and Hb were measured in the first, second and third trimesters and at delivery. Women were classified according to initial Fe stores as ID or no ID (serum ferritin ≥12 μg/l) and according to Fe supplement use as supplemented or non-supplemented.

Initial ID was 16·2 %. At delivery, 45·7 % had ID, 13·5 % IDA and 13·3 % had risk of haemoconcentration. Initial ID and non-supplemented groups had significantly higher prevalences of ID and IDA and lower risk of haemoconcentration at delivery than the other groups. In the multiple logistic models, no initial ID and Fe supplementation exerted a protective effect against ID at delivery (adjusted OR = 0·28; 95 % CI 0·13, 0·58 and adjusted OR = 0·39; 95 % CI 0·22, 0·69, respectively). Moderate Fe supplementation did not seem to clearly prevent IDA (adjusted OR = 0·91; 95 % CI 0·42, 1·96) or to enhance the haemoconcentration (adjusted OR = 1·42; 95 % CI 0·58, 3·50).

The prevalence of ID and IDA was high in late pregnancy in healthy pregnant women, particularly in those with initial ID and/or those not taking supplements. Starting pregnancy with no ID and/or taking moderate Fe supplementation decreased the likelihood of ID at delivery. The risk of haemoconcentration was high at delivery, but did not seem to be promoted by Fe supplementation. Further research is necessary to determine the most appropriate nutritional advice for pregnant women.

The present study aimed to examine the availability of energy-dense, nutrient-poor snack foods (and fruits and vegetables) in supermarkets located in socio-economically advantaged and disadvantaged neighbourhoods.

Cross-sectional supermarket audit.

Melbourne, Australia. Measures included product shelf space and number of varieties for soft drinks, crisps, chocolate, confectionery and fruits and vegetables, as well as store size.

Thirty-five supermarkets (response 83 %) from neighbourhoods in the lowest and highest quintile of socio-economic disadvantage.

Shelf space allocated to soft drinks (23·6 m v. 17·7 m, P = 0·006), crisps (16·5 m v. 13·0 m, P = 0·016), chocolate (12·2 m v. 10·1 m, P = 0·022) and confectionery (6·7 m v. 5·1 m, P = 0·003) was greater in stores from socio-economically disadvantaged neighbourhoods. After adjustment for store size (stores in disadvantaged areas being larger), shelf space for confectionery (6·3 m v. 5·6 m, P = 0·024) and combined shelf space for all energy-dense foods and drinks (55·0 m v. 48·9 m, P = 0·017) remained greater in stores from socio-economically disadvantaged neighbourhoods. The ratio of shelf space allocated to fruits and vegetables to that for energy-dense snack foods also varied by socio-economic disadvantage after adjustment for store size (most disadvantaged v. least disadvantaged: 1·7 v. 2·1, P = 0·025). Varieties of fruits and vegetables and chocolate bars were more numerous in less disadvantaged areas (P < 0·05).

Exposure to energy-dense snack foods and soft drinks in supermarkets was greater in socio-economically disadvantaged neighbourhoods. This may impact purchasing, consumption and cultural norms related to eating behaviours and may therefore work against elimination of the known socio-economic gradient in obesity levels. Reform of supermarket stocking practices may represent an effective means of obesity prevention.