We aimed at analysing changes in consumption of selected food groups in the Portuguese population before and after the Great Recession, which hit the country between 2008 and 2013.

We used pooled cross-sectional data from the Portuguese National Health Interview Surveys of 2005/2006 and 2014. We modelled the probability of consumption of soup, fish, meat, potatoes/rice/pasta, bread, legumes, fruit, vegetables and sweets/desserts, as a function of the year, controlling for age, sex and education, using logistic regressions. Then, we stratified the analysis by age group and education level. Analyses were adjusted for survey weights.

Portugal (2005/2006 to 2014).

Adults (n 43273) aged 25–79 years.

From 2005/2006 to 2014, there was a significantly lower consumption of fish, soup, fruit and vegetables. Conversely, the consumption of legumes and sweets/desserts was significantly higher in 2014. The changes in the selected food groups were consistent across most education levels. Among people aged 65 years or above, there were no significant changes in most foods, except an increase in the consumption of legumes and sweets/desserts. In contrast, people aged 25–39 and 40–64 years significantly decreased their intakes of fish and soup and increased their consumption of sweets/desserts.

The consistent results across education levels suggest that changes in dietary habits are not linked to the economic downturn. By contrast, our findings suggest a shift away from foods commonly linked to the Mediterranean diet, particularly among younger people.

We collected dietary records over the course of nine months to comprehensively characterize the consumption patterns of Malagasy people living in remote rainforest areas of north-eastern Madagascar.

The present study was a prospective longitudinal cohort study to estimate dietary diversity and nutrient intake for a suite of macronutrients, micronutrients and vitamins for 152 randomly selected households in two communities.

Madagascar, with over 25 million people living in an area the size of France, faces a multitude of nutritional challenges. Micronutrient-poor staples, especially rice, roots and tubers, comprise nearly 80 % of the Malagasy diet by weight. The remaining dietary components (including wild foods and animal-source foods) are critical for nutrition. We focus our study in north-eastern Madagascar, characterized by access to rainforest, rice paddies and local agriculture.

We enrolled men, women and children of both sexes and all ages in a randomized sample of households in two communities.

Although the Household Dietary Diversity Score and Food Consumption Score reflect high dietary diversity, the Minimum Dietary Diversity–Women indicator suggests poor micronutrient adequacy. The food intake data confirm a mixed nutritional picture. We found that the median individual consumed less than 50 % of his/her age/sex-specific Estimated Average Requirement (EAR) for vitamins A, B12, D and E, and Ca, and less than 100 % of his/her EAR for energy, riboflavin, folate and Na.

Malnutrition in remote communities of north-eastern Madagascar is pervasive and multidimensional, indicating an urgent need for comprehensive public health and development interventions focused on providing nutritional security.

To assess the extent of error present in self-reported weight data in the Women’s Health Initiative, variables that may be associated with error, and to develop methods to reduce any identified error.

Prospective cohort study.

Forty clinical centres in the USA.

Women (n 75 336) participating in the Women’s Health Initiative Observational Study (WHI-OS) and women (n 6236) participating in the WHI Long Life Study (LLS) with self-reported and measured weight collected about 20 years later (2013–2014).

The correlation between self-reported and measured weights was 0·97. On average, women under-reported their weight by about 2 lb (0·91 kg). The discrepancies varied by age, race/ethnicity, education and BMI. Compared with normal-weight women, underweight women over-reported their weight by 3·86 lb (1·75 kg) and obese women under-reported their weight by 4·18 lb (1·90 kg) on average. The higher the degree of excess weight, the greater the under-reporting of weight. Adjusting self-reported weight for an individual’s age, race/ethnicity and education yielded an identical average weight to that measured.

Correlations between self-reported and measured weights in the WHI are high. Discrepancies varied by different sociodemographic characteristics, especially an individual’s BMI. Correction of self-reported weight for individual characteristics could improve the accuracy of assessment of obesity status in postmenopausal women.

The present study aimed to identify dietary patterns, compare dietary patterns regarding nutrient profile and investigate the association between dietary patterns and body composition in a population in western Austria.

In a cross-sectional study, eating habits, anthropometric measurements and body composition were assessed. Food intake was collected by two non-consecutive 24 h recalls. Factor analysis (principal component analysis) with complementary cluster analysis was applied to identify dietary patterns. Associations of dietary patterns with body composition and nutrient profile were examined by the t test, one-way ANOVA and ANCOVA with Bonferroni’s correction. The χ2 test was used for categorical variables.

Tyrol, western Austria, 2014–2015.

Adults (n 463) aged 18–64 years.

Three dietary patterns were derived, labelled as the ‘health-conscious’, the ‘western’ and the ‘traditional’ dietary pattern. After adjustment for confounding variables, individuals following the traditional and western patterns were more likely to be overweight/obese (P <0·001) and to have a higher body fat percentage (P <0·05). Individuals following the traditional dietary pattern consumed significantly more SFA and less PUFA and dietary fibre (P <0·001) than those in the other groups.

Individuals who mostly eat in a traditional way should be encouraged to increase their consumption of vegetables, fruits, whole grains and healthy fats. It is important to know local eating habits not only for planning individual nutritional therapy, but also for well-directed public health actions.

Height-for-age shorter than 3th percentile or 2 sd below the median of the National Center for Health Statistics/WHO growth reference is known as stunting. The present study aimed to measure the association of several factors with stunting in a cohort born from 2009 to 2010 in Shiraz, Iran.

Nested case–control study conducted on pre-school children in 2016. Participants were 200 children suffering from stunting (case group) and 200 children with normal height (control group).

Results of multivariable logistic regression analysis suggested a significant relationship (adjusted OR; 95 % CI) between stunting and mother’s occupation (employed v. housewife: 3·58; 1·73, 7·39) and chronic diseases (yes v. no: 2·93; 1·25, 6·88). In addition, significant associations were found between family income (<10 million v. >30 million Rials: 5·63; 2·46, 12·87), diary consumption (very little v. high: 5·93; 1·74, 20·18) and animal protein in diet (low v. very high: 2·42; 1·13, 5·19) and stunting among children. Also, chance of stunting was inversely associated with birth interval (<2 years v. first child: 3·13; 1·45, 6·76) and duration of exclusive breast-feeding (18–24 months v. formula only or breast-feeding for <18 months: 0·53; 0·30, 0·92).

Mothers being housewife, possibly due to having more time to take care of their children, childhood diseases and consumption of dairy foods are strong and modifiable factors which can positively affect Iranian children’s stature. Higher family income is another important factor in stunting but under less parental control.

To identify the dietary patterns of children aged 4–7 years and verify their association with sociodemographic characteristics, lifestyle habits and exclusive breast-feeding (EBF).

A cross-sectional study nested within a cohort, performed with Brazilian children aged 4–7 years. The children were re-evaluated at age 4 to 7 years and food patterns were identified a posteriori through principal component analysis. The predictive variables were related to socio-economic characteristics, lifestyle habits and duration of EBF.

Viçosa, Minas Gerais, Brazil.

Representative sample of 403 children followed up by the Lactation Support Program from the Extension Program of the Universidade Federal de Viçosa during the first 6 months of life.

Five dietary patterns were identified: ‘Traditional’, ‘Unhealthy’, ‘Milk and chocolate’, ‘Snack’ and ‘Healthy’. Children who did not receive EBF until they were at least 4 months old had a higher adherence to the ‘Unhealthy’ and ‘Snack’ patterns, and older children also consumed more ‘Unhealthy’ foods. The highest income was associated with the highest consumption of foods of the patterns ‘Unhealthy’, ‘Milk and chocolate’ and ‘Healthy’.

In view of the results, we emphasize the importance of providing support and encouragement towards EBF in the first months of life, as it can positively influence lifelong eating habits.

The goal of the present study was to estimate prevalence and maternal risk factors for infant beverage consumption.

Observational birth cohort.

Central North Carolina, USA.

Mothers 20–36 weeks pregnant were surveyed every 3 months through their infant’s first year (n 666) on their sociodemographics and infant’s consumption frequency of 100 % fruit and vegetable juices and sugar-sweetened-beverages (SSB). Repeated-measure models, using a compound symmetry covariance structure, were used to assess the association of sociodemographic and maternal predictors with introducing juice and SSB separately and explored interaction terms with time to determine how the effects of the predictors change over time.

On average, mothers were 28 years old, 72 % were non-Hispanic Black and 59 % were low-income. We found time by race, income, education, maternal age and breast-feeding duration interactions for both juice and SSB consumption. At approximately 6–7 months of age through 12 months of age, being Black, having a lower income (≤$US 20 000 v. >$US 20 000 per year) and education (less than high-school degree v. high-school degree or higher), being younger (<26 years v. ≥26 years) and breast-feeding for fewer than 26 weeks were each associated with introduction of both juice and SSB consumption.

Future efforts are needed to raise awareness on the importance of national recommendations of limiting juice and SSB for infants, together with decreasing disparities in unhealthy beverage intake early in life.

The present study aimed to compare Household Budget Survey (HBS) data on food purchasing and individual food consumption, collected in the same nationwide survey.

Food purchase information for each household was collected by a seven-day collective acquisition diary, applied to 55 970 households. Food consumption information was obtained from household members over 10 years old by the application of two non-consecutive food records in a sub-sample of the HBS. Cooking and correction factors were applied when necessary, and all food items reported were grouped into twelve main food groups. Food purchase and consumption data were presented as absolute weight (g/person per d) and as relative contribution to energy intake (%) for the overall study population, which was stratified according to household income.

Brazil.

National estimates of food consumption and purchase for Brazil.

The greatest differences between purchase and consumption data (purchase minus consumption) were observed for meat (−168 g), beans/legumes (−48 g), roots/tubers (−36 g) and fruits (−31 g). When expressed in terms of energy contribution, the highest differences were found for cereals (13 %) and oils and fats (11 %). Differences between purchase and consumption data were generally lower in the highest compared with the lowest household income quintile; and were lower for most main food groups when considering only foods reported as being eaten at home.

With few exceptions, food purchase expressed as relative energy contribution, as opposed to absolute weight, can provide a good picture of actual consumption in the Brazilian population.

Consumption of cow’s milk, which is associated with diet and health benefits, has decreased in the USA. The simultaneous increase in demand for more costly organic milk suggests consumer concern about exposure to production-related contaminants may be contributing to this decline. We sought to determine if contaminant levels differ by the production method used.

Half-gallon containers of organic and conventional milk (four each) were collected by volunteers in each of nine US regions and shipped on ice for analysis. Pesticide, antibiotic and hormone (bovine growth hormone (bGH), bGH-associated insulin-like growth factor 1 (IGF-1)) residues were measured using liquid or gas chromatography coupled to mass or tandem mass spectrometry. Levels were compared against established federal limits and by production method.

Laboratory analysis of retail milk samples.

Current-use pesticides (5/15 tested) and antibiotics (5/13 tested) were detected in several conventional (26–60 %; n 35) but not in organic (n 34) samples. Among the conventional samples, residue levels exceeded federal limits for amoxicillin in one sample (3 %) and in multiple samples for sulfamethazine (37 %) and sulfathiazole (26 %). Median bGH and IGF-1 concentrations in conventional milk were 9·8 and 3·5 ng/ml, respectively, twenty and three times that in organic samples (P < 0·0001).

Current-use antibiotics and pesticides were undetectable in organic but prevalent in conventionally produced milk samples, with multiple samples exceeding federal limits. Higher bGH and IGF-1 levels in conventional milk suggest the presence of synthetic growth hormone. Further research is needed to understand the impact of these differences, if any, on consumers.

Breakfast skipping is regarded as a public health issue among adults worldwide. Nutrition knowledge has been reported to be one of predictors of dietary behaviour. Therefore, the aim of the present study was to examine the association between nutrition knowledge and breakfast skipping.

Data regarding nutrition knowledge were obtained by using a validated, self-administered general nutrition knowledge questionnaire for Japanese adults (JGNKQ). Participants were classified into three nutrition knowledge level groups according to total JGNKQ score: Low, Middle and High. In addition, participants reported the frequency of meal consumption per week and rated the difficulty in finding time to eat breakfast, lunch and dinner in the lifestyle questionnaire. The differences in frequency of breakfast, lunch and dinner consumption among Low, Middle and High nutrition knowledge groups were determined by using ANCOVA adjusted for potential confounding factors.

Kanto region, Japan.

Japanese adults aged 18–64 years (n 1165, 57·3% women).

Mean age of the participants was 43·8 (sd 8·9) years. There were no significant differences found in the proportion of respondents reporting difficulty in finding time to eat each meal among the three groups. However, the frequency of breakfast consumption was significantly different among Low, Middle and High groups, while lunch and dinner frequency did not differ among the three groups.

The present study suggests that nutrition knowledge level is related to breakfast skipping among Japanese adults.

To examine associations between hours worked and diet quality, frequency of eating out and consuming takeaways.

Data were taken from the National Diet and Nutrition Survey (2008–2014). Associations between hours worked in paid employment and diet quality, assessed using the Diet Quality Index (DQI) and selected foods and nutrients, were tested using linear regression models. Associations between hours worked and frequency of eating out and consuming takeaways were tested using ordinal logistic regression models. All models were adjusted for sex, age, equivalised household income, household composition and household food role.

UK.

Adults (n 2154) aged 19–64 years in employment.

Mean (95 % CI) hours worked per week was 36·1 (35·6, 36·6) and mean DQI score was 41·9 (41·2, 42·5) %. Hours worked was not associated with DQI score, frequency of eating out or consuming takeaways. Hours worked was positively associated with consuming red meat, processed meat and alcohol intake. Adults working more hours had lower intake of fibre but higher total fat and saturated fat intakes if they lived in households with children.

Working hours may not be the main factor driving poor-quality diets among this sample of UK adults in employment. Focusing on consumption of foods prepared outside the household may not be the most efficient way to improve diet quality as effort is needed at all levels. Although it is unclear what is driving the differences in nutrient intakes according to household composition, they are important to consider when developing interventions to improve healthy eating.

To derive healthy and sustainable food-based dietary guidelines (FBDG) for different target groups in the Netherlands and describe the process.

Optimised dietary patterns for children, adolescents, adults and the elderly were calculated using an optimisation model. Foods high in saturated and trans-fatty acids, salt and sugar, and low in dietary fibre, were excluded. The dietary patterns resembled the current food consumption as closely as possible, while simultaneously meeting recommendations for food groups, nutrients, maximum limits for foods with a high environmental impact, and within 85 % of the energy requirement. Recommended daily amounts of food groups were based on the optimised dietary patterns and expert judgement.

The Netherlands.

FBDG were derived for Dutch people with different ages, genders, activity levels and food preferences.

For most target groups the optimisation model provided dietary patterns that complied with all requirements. For some food groups, the optimised amounts varied largely between target groups. For consistent messages to consumers, the optimised dietary patterns were adjusted to uniform recommendations per target group. Recommendations were visualised in the Wheel of Five. The advice is to eat the recommended amounts of foods according to the Wheel of Five and limit consumption of other foods.

Based on an optimisation model, scientific evidence, information on dietary patterns and expert knowledge, we derived FBDG for different target groups. The Wheel of Five is a key food-counselling model that can help Dutch consumers to make their diets healthier and more environmentally sustainable.

To evaluate the association between ultra-processed food intake and all-cause mortality and CVD mortality in a nationally representative sample of US adults.

Prospective analyses of reported frequency of ultra-processed food intake in 1988–1994 and all-cause mortality and CVD mortality through 2011.

The Third National Health and Nutrition Examination Survey (NHANES III, 1988–1994).

Adults aged ≥20 years (n 11898).

Over a median follow-up of 19 years, individuals in the highest quartile of frequency of ultra-processed food intake (e.g. sugar-sweetened or artificially sweetened beverages, sweetened milk, sausage or other reconstructed meats, sweetened cereals, confectionery, desserts) had a 31% higher risk of all-cause mortality, after adjusting for demographic and socio-economic confounders and health behaviours (adjusted hazard ratio=1·31; 95% CI 1·09, 1·58; P-trend = 0·001). No association with CVD mortality was observed (P-trend=0·86).

Higher frequency of ultra-processed food intake was associated with higher risk of all-cause mortality in a representative sample of US adults. More longitudinal studies with dietary data reflecting the modern food supply are needed to confirm our results.

To estimate the changes in the prevalence of underweight among girls and boys living in Kraków that occurred between 1983 and 2010.

The study was based on two cross-sectional surveys conducted in 1983 and 2010. The prevalence of underweight was estimated based on the International Obesity Task Force (IOTF) and Centers for Disease Control and Prevention (CDC) cut-off points.

The study was conducted in Kraków, Poland.

Children aged 3–18 years (n 5245).

Between 1983 and 2010 the prevalence of underweight decreased in both sexes. Using the IOTF criteria, the prevalence of underweight decreased from 10·5 to 10·3 % in girls and from 8·9 to 7·5 % in boys, but it was still higher in girls than in boys. According to the CDC criteria, this prevalence decreased from 5·1 to 4·4 % and from 5·9 to 4·6 %, respectively, and was slightly lower in girls. According to the IOTF criteria, underweight prevalence increased slightly during childhood in both sexes while according to the CDC criteria it decreased in boys and did not change in girls. Among juveniles and adolescents, it decreased regardless of the method used.

The frequency of underweight in the population of children and adolescents from Kraków changed slightly in 1983 and 2010 despite economic and social changes. Depending on the cut-off points used, not only the magnitude but also the direction of changes between series could be different. In order to aid global monitoring, the prevalence of underweight as well as overweight should always be evaluated by several methods.

To assess differences in cognition functions and gross brain structure in children seven years after an episode of severe acute malnutrition (SAM), compared with other Malawian children.

Prospective longitudinal cohort assessing school grade achieved and results of five computer-based (CANTAB) tests, covering three cognitive domains. A subset underwent brain MRI scans which were reviewed using a standardized checklist of gross abnormalities and compared with a reference population of Malawian children.

Blantyre, Malawi.

Children discharged from SAM treatment in 2006 and 2007 (n 320; median age 9·3 years) were compared with controls: siblings closest in age to the SAM survivors and age/sex-matched community children.

SAM survivors were significantly more likely to be in a lower grade at school than controls (adjusted OR = 0·4; 95 % CI 0·3, 0·6; P < 0·0001) and had consistently poorer scores in all CANTAB cognitive tests. Adjusting for HIV and socio-economic status diminished statistically significant differences. There were no significant differences in odds of brain abnormalities and sinusitis between SAM survivors (n 49) and reference children (OR = 1·11; 95 % CI 0·61, 2·03; P = 0·73).

Despite apparent preservation in gross brain structure, persistent impaired school achievement is likely to be detrimental to individual attainment and economic well-being. Understanding the multifactorial causes of lower school achievement is therefore needed to design interventions for SAM survivors to thrive in adulthood. The cognitive and potential economic implications of SAM need further emphasis to better advocate for SAM prevention and early treatment.

The purpose of the present meta-analysis was to evaluate the association between the inflammatory potential of diet, determined by the dietary inflammatory index (DII®) score, and depression.

Systematic review and meta-analysis.

A comprehensive literature search was conducted in PubMed, Web of Science and EMBASE databases up to August 2018. All observational studies that examined the association of the DII score with depression/depressive symptoms were included.

Four prospective cohorts and two cross-sectional studies enrolling a total of 49 584 subjects.

Overall, individuals in the highest DII v. the lowest DII category had a 23 % higher risk of depression (risk ratio (RR)=1·23; 95 % CI 1·12, 1·35). When stratified by study design, the pooled RR was 1·25 (95 % CI 1·12, 1·40) for the prospective cohort studies and 1·16 (95 % CI 0·96, 1·41) for the cross-sectional studies. Gender-specific analysis showed that this association was observed in women (RR=1·25; 95 % CI 1·09, 1·42) but was not statistically significant in men (RR=1·15; 95 % CI 0·83, 1·59).

The meta-analysis suggests that pro-inflammatory diet estimated by a higher DII score is independently associated with an increased risk of depression, particularly in women. However, more well-designed studies are needed to evaluate whether an anti-inflammatory diet can reduce the risk of depression.

We describe diet quality by demographic factors and weight status among Barbadian children and examine associations with excess energy intake (EI). A screening tool for the identification of children at risk of excess EI was developed.

In a cross-sectional survey, the Diet Quality Index–International (DQI-I) was used to assess dietary intakes from repeat 24h recalls among 362 children aged 9–10 years. Participants were selected by probability proportional to size. A model to identify excess energy intake from easily measured components of the DQI-I was developed.

Barbados.

Primary-school children in Barbados.

Over one-third of children were overweight/obese, and mean EI for boys (8644 (se 174·5) kJ/d (2066 (se 41·7) kcal/d)) and girls (8912 (se 169·9) kJ/d (2130 (se 40·6) kcal/d)) exceeded the RDA. Children consuming a variety of food groups, more vegetables and fruits, and lower percentage energy contribution from empty-calorie foods showed reduced likelihood of excess EI. Intake of more than 2400 mg Na/d and higher macronutrient and fatty acid ratios were positively related to the consumption of excess energy. A model using five DQI-I components (overall food group variety, variety for protein source, vegetables, fruits and empty calorie intake) had high sensitivity for identification of children at risk of excess EI.

Children’s diet quality, despite low intakes of fruit and vegetables, was within acceptable ranges as assessed by the DQI-I and RDA; however, portion size was large and EI high. A practical model for identification of children at risk of excess EI has been developed.

To evaluate the effectiveness of a social marketing intervention in enhancing knowledge, attitudes and practice (KAP) related to consumption of vitamin A-fortified oil.

The intervention employed community events, distribution of educational materials and radio broadcasts. The intervention was assessed in a quasi-experimental non-equivalent control group study design by collecting information on KAP regarding vitamin A-fortified oil consumption before and after 9 months of a 13-month intervention.

Six districts in Manyara and Shinyanga regions in Tanzania were non-randomly selected as the intervention districts and two districts served as the control districts.

At baseline, 568 lactating mothers with children aged <5 years were randomly selected from the intervention and control districts. Of these, 494 mothers were followed up at endline.

After 9 months of intervention, knowledge of fortification and actual consumption of adequately fortified oil were significantly higher in the intervention districts compared with the control districts (P <0·05). Knowledge of the health benefits of vitamin A improved significantly from about 33 to 45 % in both the intervention and control districts. The major sources of information for women were health clinics and community health workers (CHW).

The study showed that a social marketing intervention is effective in improving KAP regarding fortified oil consumption at the household level. Clinics and CHW are channels that should be prioritized when communicating health messages, particularly those targeting women.

To evaluate daily eating frequency (main meals and snacks) in relation to weight status in children aged 3–9 years, representative of the Portuguese population.

Cross-sectional study. Dietary intake was estimated as the mean of two non-consecutive days of food diaries, followed by face-to-face interviews. Weight and height were measured by trained observers. Eating occasions (EO) were defined by the children’s caregiver; an EO was considered separate if the time of consumption was different from other EO and it provided at least 209 kJ (50 kcal). Main meals defined as ‘breakfast’, ‘lunch’ and ‘dinner’ could be selected only once per day. The remaining EO were considered snacks. The association between eating frequency and overweight/obesity was evaluated through logistic regressions weighted for the population distribution.

National Food, Nutrition and Physical Activity Survey of the Portuguese population, 2015–2016.

Portuguese children aged 3–9 years with complete dietary data and anthropometric measurements (n 517).

Overall, the number of daily EO ranged from 3·5 to 11, and on average children had 5·7 daily EO. After adjustment for child’s sex, age and total energy intake, and considering only plausible energy intake reporters, having < 3 snacks/d was positively associated with being overweight/obese (OR = 1·98; 95 % CI 1·00, 3·90), compared with having ≥ 3 snacks/d.

Lower daily frequency of EO was associated with increased odds of being overweight or obese in children. A higher eating frequency, maintaining the same energy intake, seems to contribute to a healthy body weight in children.