To investigate characteristics of exposure to violence in relation to food security status among female-headed households.

Ongoing mixed-method participatory action study. Questions addressed food insecurity, public assistance, and maternal and child health. Grounded theory analysis of qualitative themes related to violence was performed. These themes were then categorized by food security status.

Homes of low-income families in Philadelphia, PA, USA.

Forty-four mothers of children under 3 years of age participating in public assistance programmes.

Forty women described exposure to violence ranging from fear of violence to personal experiences with rape. Exposure to violence affected mental health, ability to continue school and obtain work with living wages, and subsequently the ability to afford food. Exposure to violence during childhood and being a perpetrator of violence were both linked to very low food security status and depressive symptoms. Ten of seventeen (59 %) participants reporting very low food security described life-changing violence, compared with three of fifteen (20 %) participants reporting low food security and four of twelve (33 %) reporting food security. Examples of violent experiences among the very low food secure group included exposure to child abuse, neglect and rape that suggest exposure to violence is an important factor in the experience of very low food security.

Descriptions of childhood trauma and life-changing violence are linked with severe food security. Policy makers and clinicians should incorporate violence prevention efforts when addressing hunger.

The present study sought to explore the factors that influence registration for free school meals and the subsequent take-up following registration in England.

The research design consisted of two phases, a qualitative research phase followed by an intervention phase. Findings are presented from the qualitative research phase, which comprised interviews with head teachers, school administrators, parents and focus groups with pupils.

The study took place in four primary schools and four secondary schools in Leeds, UK.

Participants included head teachers, school administrators, parents and pupils.

Findings suggested that parents felt the registration process to be relatively straightforward although many secondary schools were not proactive in promoting free school meals. Quality and choice of food were regarded by both pupils and parents as significant in determining school meal choices, with stigma being less of an issue than originally anticipated.

Schools should develop proactive approaches to promoting free school meals and attention should be given not only to the quality and availability of food, but also to the social, cultural and environmental aspects of dining. Processes to maintain pupils’ anonymity should be considered to allay parents’ fear of stigma.

We investigated the association between full breast-feeding up to 6 months as well as partial breast-feeding after 6 months and maternal weight retention at 6, 18 and 36 months after delivery in the Norwegian Mother and Child Cohort Study (MoBa), conducted by the Norwegian Institute of Public Health.

Cohort study. Information on exposure and outcome was collected by questionnaire.

Norway.

Women at 6 months (n 49 676), 18 months (n 27 187) and 36 months (n 17 343) postpartum.

Longer duration of full breast-feeding as well as partial breast-feeding was significantly related to lower weight retention at 6 months. At 18 months full breast-feeding (0–6 months) and partial breast-feeding for 12–18 months were significantly related to lower weight retention. At 36 months only full breast-feeding (0–6 months) was significantly related to lower weight retention. For each additional month of full breast-feeding, maternal weight was lowered by 0·50 kg/month at 6 months, 0·10 kg/month at 18 months and 0·14 kg/month at 36 months (adjusted for pre-pregnant BMI, pregnancy weight gain, age and parity). Partial breast-feeding resulted in 0·25 kg/month lower maternal weight at 6 months. Interactions were found between household income and full breast-feeding in relation to weight retention at 6, 18 and 36 months, indicating most benefit among women with low income.

The present study supports the hypothesis that full breast-feeding contributes to lower postpartum weight retention and shows that the effect is maintained for as long as 3 years postpartum.

The aim of the present study was to identify correlates of body image perception and dissatisfaction among school-aged children from Colombia, a country undergoing the nutrition transition.

Cross-sectional study. Using child-adapted Stunkard scales, children were asked to indicate the silhouette that most closely represented their current and desired body shapes. Body image dissatisfaction (BID) score was estimated as current minus desired silhouette. Height and weight were measured in all children. Sociodemographic data were collected through questionnaires completed by the children's mothers.

Public primary schools in Bogotá, Colombia.

Children aged 5–12 years (n 629) and their mothers.

Mean BID score was 0·1 (sd 1·7). The strongest predictor of BID was actual BMI-for-age Z-score (BAZ). Compared with children with BAZ ≥ −1 and <1, those with BAZ ≥ 2 had a 1·9 units higher BID score (P for trend <0·0001). BID tended to be higher in girls than boys at any level of BAZ. Other correlates of BID included child's height-for-age Z-score, maternal BMI and dissatisfaction with the child's body, and home ownership.

Among school-aged children from a country experiencing the nutrition transition, body image perception was associated with the child's weight and height, and with maternal BMI, dissatisfaction with the child's body and socio-economic level.

To review the available literature on accountability frameworks to construct a framework that is relevant to voluntary partnerships between government and food industry stakeholders.

Between November 2012 and May 2013, a desk review of ten databases was conducted to identify principles, conceptual frameworks, underlying theories, and strengths and limitations of existing accountability frameworks for institutional performance to construct a new framework relevant to promoting healthy food environments.

Food policy contexts within high-income countries to address obesity and diet-related non-communicable diseases.

Eligible resources (n 26) were reviewed and the guiding principles of fifteen interdisciplinary frameworks were used to construct a new accountability framework.

Strengths included shared principles across existing frameworks, such as trust, inclusivity, transparency and verification; government leadership and good governance; public deliberations; independent bodies recognizing compliance and performance achievements; remedial actions to improve accountability systems; and capacity to manage conflicts of interest and settle disputes. Limitations of the three-step frameworks and ‘mutual accountability’ approach were an explicit absence of an empowered authority to hold all stakeholders to account for their performance.

We propose a four-step accountability framework to guide government and food industry engagement to address unhealthy food environments as part of a broader government-led strategy to address obesity and diet-related non-communicable diseases. An independent body develops clear objectives, a governance process and performance standards for all stakeholders to address unhealthy food environments. The empowered body takes account (assessment), shares the account (communication), holds to account (enforcement) and responds to the account (improvements).

The increasing prevalence of childhood overweight is an important health issue. There is a need for longitudinal research among children in order to identify risk factors for childhood overweight. The objective of the present research was to identify potential sociodemographic and behavioural risk factors for development of childhood overweight among 3- to 6-year-old children.

Longitudinal study.

Sixteen pre-primary and primary schools.

BMI Z-scores at baseline and two follow-up measurements were calculated for 568 children. Sociodemographic, parental adiposity, familial composition, child's diet, physical activity and sedentary behavioural data were collected through questionnaires.

Several risk factors for the development of childhood overweight were found. Being an only child, lower maternal educational level, maternal and paternal overweight, more than 1 h screen time on weekdays and high soft drinks consumption were shown to be positively associated with the development of childhood overweight.

Although behavioural factors are important, our findings support the thesis that interventions on the prevention of childhood overweight should focus on high-risk groups, i.e. children from low socio-economic background or with high parental BMI. Interventions should address the whole family and take into account their lifestyle and structure.

The aim of the present work was to determine what dietary assessment method can provide a valid and accurate estimate of nutrient intake by comparison with the gold standard.

A MEDLINE, EMBASE, ISI Web of Science, Cochrane and related references literature review was conducted on dietary assessment methods for adolescents reporting the validity and/or reproducibility values. A study quality assessment on the retrieved FFQ was carried out according to two different scoring systems, judging respectively the quality of FFQ nutrition information and of FFQ validation and calibration.

The present review considered adolescents attending high schools and recruited in hospitals or at home.

The target of the review was the healthy adolescent population in the age range 13–17 years.

Thirty-two eligible papers were included and analysed separately as ‘original articles’ (n 20) and ‘reviews’ (n 12). The majority (n 17) assessed the validation and reproducibility of FFQ. Almost all studies found the questionnaires to be valid and reproducible (r > 0·4), except for some food groups and nutrients. Different design and validation issues were highlighted, such as portion-size estimation, number of food items and statistics used.

The present review offers new insights in relation to the characteristics of assessment methods for dietary intake in adolescents. Further meta-analysis is required although the current review provides important indications on the development of a new FFQ, addressing the need for a valid, reproducible, user-friendly, cost-effective method of accurately assessing nutrient intakes in adolescents.

To investigate whether low vitamin D status was related to insulin resistance (IR) or impaired fasting glucose (IFG) in Korean adolescents, after adjusting for total body fat mass (FM).

A cross-sectional study.

Korea National Health and Nutrition Examination Survey (KNAHNES) 2009–2010.

In total, 1466 participants (769 males) aged 10–19 years were assessed for serum 25-hydroxyvitamin D (25(OH)D) levels, for FM by whole-body dual-energy X-ray absorptiometry and for IR by homeostasis model assessment (HOMA-IR) after an 8 h fast.

Age-, sex-, season- and physical-activity-adjusted regression models showed that serum 25(OH)D levels were significantly related to markers of adiposity (P = 0·016 for FM (g), P = 0·023 for FM (%) and P = 0·035 for fat mass index). When the participants were stratified into three 25(OH)D categories (<37·5 nmol/l (n 553), 37·5 to < 50 nmol/l (n 543) and ≥ 50 nmol/l (n 370)), significantly decreasing trends were observed for fasting insulin (all P < 0·001), HOMA-IR (all P < 0·001) and the odds ratios for IFG (all P for trend < 0·05) from the lowest to the highest 25(OH)D category, after adjustments for age, sex, physical activity and all markers of adiposity. In the multivariate logistic regression analysis, the likelihood of participants in the lowest serum 25(OH)D category having IFG was 2·96–3·15 compared with those in the highest 25(OH)D category (all P < 0·05).

There was a significant inverse relationship between vitamin D status and IR and the risk of IFG, independent of adiposity, in Korean adolescents.

To determine the association of beverage consumption with obesity in Mexican American school-aged children.

Cross-sectional study using the baseline data from a cohort study. Mothers and children answered questions about the frequency and quantity of the child's consumption of soda, diet soda, other sugar-sweetened beverages, 100 % fruit juice, milk and water. The questions were adapted from the Youth/Adolescent FFQ. Children were weighed and measured. Data were collected on the following potential confounders: maternal BMI, household income, maternal education, maternal occupational status, maternal acculturation, child physical activity, child screen time and child fast-food consumption. Logistic regression was used to examine the association between servings (240 ml) of each beverage per week and obesity (BMI ≥ 95th percentile).

Participants were recruited from among enrolees of the Kaiser Permanente Health Plan of Northern California. Data were collected via an in-home assessment.

Mexican American children (n 319) aged 8–10 years.

Among participants, 20 % were overweight and 31 % were obese. After controlling for potential confounders, consuming more servings of soda was associated with increased odds of obesity (OR = 1·29; P < 0·001). Consuming more servings of flavoured milk per week was associated with lower odds of obesity (OR = 0·88; P = 0·004). Consumption of other beverages was not associated with obesity in the multivariate model.

Discouraging soda consumption among Mexican American children may help reduce the high obesity rates in this population.

To combine evidence from randomized controlled trials to assess the effect of Fe-fortified foods on mean Hb concentration in children (<10 years).

We conducted a meta-analysis of randomized, controlled, Fe-fortified feeding trials that evaluated Hb concentration. The weighted mean difference was calculated for net changes in Hb by using random-effects models. Meta-regression and covariate analyses were performed to explore the influence of confounders on the net pooled effect.

Trials were identified through a systematic search of PubMed, the Cochrane Library and secondary references.

Eighteen studies covering 5142 participants were identified. The duration of feeding of fortified foods ranged from 6 to 12 months in these studies.

Eighteen studies were included and evaluated in the meta-analysis. The overall pooled estimate of Hb concentration showed a significant increase in the fortification group compared with the control group (weighted mean difference = 5·09 g/l; 95 % CI 3·23, 6·95 g/l; I2 = 90 %, τ2 = 18·37, P < 0·0001). Meta-regression analysis indicated that duration of feeding was positively related to the effect size (regression coefficient = 0·368; 95 % CI 0·005, 0·731; P < 0·05). The net pooled effect size after removing the confounders was 4·74 (95 % CI 3·08, 6·40) g/l.

We observed an association between intake of Fe-fortified foods and Hb concentration in children aged <10 years. Fe-fortified foods could be an effective strategy for reducing Fe-deficiency anaemia in children.

To review the peer-reviewed literature on relationships between intuitive eating and health indicators and suggest areas of inquiry for future research. We define the fundamental principles of intuitive eating as: (i) eating when hungry; (ii) stopping eating when no longer hungry/full; and (iii) no restrictions on types of food eaten unless for medical reasons.

We include articles cited by PubMed, PsycInfo and Science Direct published in peer-reviewed journals or theses that include ‘intuitive eating’ or related concepts in the title or abstract and that test relationships between intuitive eating and physical or mental health indicators.

We found twenty-six articles that met our criteria: seventeen cross-sectional survey studies and nine clinical studies, eight of which were randomised controlled trials. The cross-sectional surveys indicate that intuitive eating is negatively associated with BMI, positively associated with various psychological health indicators, and possibly positively associated with improved dietary intake and/or eating behaviours, but not associated with higher levels of physical activity. From the clinical studies, we conclude that the implementation of intuitive eating results in weight maintenance but perhaps not weight loss, improved psychological health, possibly improved physical health indicators other than BMI (e.g. blood pressure; cholesterol levels) and dietary intake and/or eating behaviours, but probably not higher levels of physical activity.

Research on intuitive eating has increased in recent years. Extant research demonstrates substantial and consistent associations between intuitive eating and both lower BMI and better psychological health. Additional research can add to the breadth and depth of these findings. The article concludes with several suggestions for future research.

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

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

Yerevan, Armenia.

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

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

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

To simplify body weight measurement and, particularly, to encourage children and their parents to participate in the Italian nutritional surveillance system OKkio alla SALUTE, children were measured with clothes and then the weight was corrected for the estimated weight of the clothes. In the present study we compared the children's weight measured in underwear, as recommended by the WHO (WWHO), with that obtained using the OKkio alla SALUTE protocol (WOK) and investigated how the latter affects the calculation of BMI and the assessment of overweight and obesity prevalence.

Weight (twice in close sequence, with and without clothing) and height were measured. A checklist was used to describe the type of clothing worn. The estimated weight of clothing was subtracted from the WOK. BMI was calculated considering both values of weight and height; ponderal status was defined using both the International Obesity Task Force and WHO BMI cut-offs.

Thirty-seven third grade classes of thirteen primary schools in Rome and in two towns in the Lazio Region were recruited.

The anthropometric measurements were taken on 524 children aged 8–9 years.

The error in the calculation of BMI from WOK was very low, 0·005 kg/m2 (95 % CI −0·185, 0·195 kg/m2); the agreement between the percentages of overweight (not including obesity) and obese children calculated with the two methods was very close to 1 (κ = 0·98).

The error in BMI and in nutritional classification can be considered minor in a surveillance system for monitoring overweight/obesity, but eases the procedure for measuring children.

The present study assessed the impact of the 2009 food packages mandated by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on dietary intake and home food availability in low-income African-American and Hispanic parent/child dyads.

A natural experiment was conducted to assess if the revised WIC food package altered dietary intake, home food availability, weight and various lifestyle measures immediately (6 months) following policy implementation.

Twelve WIC clinics in Chicago, IL, USA.

Two hundred and seventy-three Hispanic and African-American children aged 2–3 years, enrolled in WIC, and their mothers.

Six months after the WIC food package revisions were implemented, we observed modest changes in dietary intake. Fruit consumption increased among Hispanic mothers (mean = 0·33 servings/d, P = 0·04) and low-fat dairy intake increased among Hispanic mothers (0·21 servings/d, P = 0·02), Hispanic children (0·34 servings/d, P < 0·001) and African-American children (0·24 servings/d, P = 0·02). Home food availability of low-fat dairy and whole grains also increased. Dietary changes, however, varied by racial/ethnic group. Changes in home food availability were not significantly correlated with changes in diet.

The WIC food package revisions are one of the first efforts to modify the nutrition guidelines that govern foods provided in a federal food and nutrition assistance programme. It will be important to examine the longer-term impact of these changes on dietary intake and weight status.

Universal interventions may widen or narrow inequalities if disproportionately effective among higher or lower socio-economic groups. The present paper examines impacts of the Primary School Free Breakfast Initiative in Wales on inequalities in children's dietary behaviours and cognitive functioning.

Cluster-randomised controlled trial. Responses were linked to free school meal (FSM) entitlement via the Secure Anonymised Information Linkage databank. Impacts on inequalities were evaluated using weighted school-level regression models with interaction terms for intervention × whole-school percentage FSM entitlement and intervention × aggregated individual FSM entitlement. Individual-level regression models included interaction terms for intervention × individual FSM entitlement.

Fifty-five intervention and fifty-six wait-list control primary schools.

Approximately 4500 children completed measures of dietary behaviours and cognitive tests at baseline and 12-month follow-up.

School-level models indicated that children in intervention schools ate a greater number of healthy items for breakfast than children in control schools (b = 0·25; 95 % CI 0·07, 0·44), with larger increases observed in more deprived schools (interaction term b = 1·76; 95 % CI 0·36, 3·16). An interaction between intervention and household-level deprivation was not significant. Despite no main effects on breakfast skipping, a significant interaction was observed, indicating declines in breakfast skipping in more deprived schools (interaction term b = −0·07; 95 % CI −0·15, −0·00) and households (OR = 0·67; 95 % CI 0·46, 0·98). No significant influence on inequality was observed for the remaining outcomes.

Universal breakfast provision may reduce socio-economic inequalities in consumption of healthy breakfast items and breakfast skipping. There was no evidence of intervention-generated inequalities in any outcomes.

To determine the diet quality of a group of young adults and explore its associations with two food-related behaviours (involvement in meal preparation and consumption of commercially prepared meals).

Cross-sectional study of young adults. Sample characteristics, food-related behaviours and dietary intake were assessed using a self-administered questionnaire including an FFQ. Diet quality was measured using the fifteen-item Dietary Guideline Index (DGI) designed to assess adherence to Australian dietary guidelines. One-way ANOVA, t tests and multiple linear regression analyses were used to explore the relationships between DGI scores, sample characteristics and food-related behaviours.

University students enrolled in an undergraduate nutrition class, Melbourne, Australia.

Students (n 309) aged 18–36 years.

The DGI score was normally distributed, with a mean score of 93·4 (sd 17·1) points (range 51·9–127·4 points), out of a possible score of 150 points. In multivariate analyses adjusted for age, sex, nationality, BMI and maternal education, cooking meals for oneself was positively associated with DGI score (β = 0·15; 95 % CI 1·15, 10·03; P = 0·01); frequency of takeaway and frequency of convenience meal consumption were inversely associated with DGI score (β = −0·21; 95 % CI −9·96, −2·32; P = 0·002 and β = −0·16; 95 % CI −7·40, −0·97; P < 0·01, respectively).

Cooking meals for oneself was linked to higher diet quality among young adults, while consumption of commercially prepared meals was associated with poorer diet quality. Maintaining education programmes that promote cooking skills within young adults has the potential to improve DGI scores.

To examine the association of breakfast consumption with objectively measured and self-reported physical activity, sedentary time and physical fitness.

The HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Cross-Sectional Study. Breakfast consumption was assessed by two non-consecutive 24 h recalls and by a ‘Food Choices and Preferences’ questionnaire. Physical activity, sedentary time and physical fitness components (cardiorespiratory fitness, muscular fitness and speed/agility) were measured and self-reported. Socio-economic status was assessed by questionnaire.

Ten European cities.

Adolescents (n 2148; aged 12·5–17·5 years).

Breakfast consumption was not associated with measured or self-reported physical activity. However, 24 h recall breakfast consumption was related to measured sedentary time in males and females; although results were not confirmed when using other methods to assess breakfast patterns or sedentary time. Breakfast consumption was not related to muscular fitness and speed/agility in males and females. However, male breakfast consumers had higher cardiorespiratory fitness compared with occasional breakfast consumers and breakfast skippers, while no differences were observed in females. Overall, results were consistent using different methods to assess breakfast consumption or cardiorespiratory fitness (all P ≤ 0·005). In addition, both male and female breakfast skippers (assessed by 24 h recall) were less likely to have high measured cardiorespiratory fitness compared with breakfast consumers (OR = 0·33; 95 % CI 0·18, 0·59 and OR = 0·56; 95 %CI 0·32, 0·98, respectively). Results persisted across methods.

Skipping breakfast does not seem to be related to physical activity, sedentary time or muscular fitness and speed/agility as physical fitness components in European adolescents; yet it is associated with both measured and self-reported cardiorespiratory fitness, which extends previous findings.

To assess adherence to the Mediterranean diet and nutrient intakes in a population of Sicily, southern Italy and to evaluate possible determinants, particularly socio-cultural and lifestyle factors.

Cross-sectional.

Urban and rural areas of eastern Sicily.

Between May 2009 and December 2010, 3090 adults were randomly recruited through the collaboration of fourteen general practitioners. Adherence to the Mediterranean diet was measured by the MedDietScore. Nutrient intakes were assessed through the 24 h recall of the previous day's dietary intake.

Rural participants were barely more adherent to the Mediterranean diet than their urban counterparts (mean scores were 27·8 and 27·2, respectively, P = 0·037). The MedDietScore was correlated with intakes of MUFA, fibre and vitamin C, as well as with consumption of non-refined cereals, vegetables, fruit, meat, dairy products, alcohol and nuts. Regression analysis revealed that older and more educated people were more likely to be in the highest tertile of MedDietScore (OR = 1.90; 95 % CI 1·39, 2·59 and OR = 1·29; 95 % CI 1·05, 1·58, respectively). A significant difference in quantity (moderate) and quality (red wine and beer) of alcohol was found according to adherence to the Mediterranean diet. Finally, more active participants were 1·5 times more likely to form part of the high-adherence group.

A slow but concrete moving away from traditional patterns has been observed in younger people and low educated people. Public health interventions should focus on these target populations in order to improve the quality of their diet.

The aim of the present study was to compare BMI and anthropometric indicators of abdominal obesity in Brazilian adolescents from public schools between 2003 and 2008.

A comparison of anthropometric indicators in adolescents was done based on two cross-sectional surveys conducted in 2003 (n 530) and in 2008 (n 498). BMI (= weight/height2), waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were evaluated. The age-adjusted means were compared between the two studies by linear regression and the percentile values were compared by quantile regression. A P value <0·05 was adopted for statistical significance.

Metropolitan area of Rio de Janeiro, Brazil.

Two probabilistic samples of students aged 15–19 years old, from public schools.

There was a decrease in boys’ mean WC (72·9 cm v. 70·9 cm, P = 0·01) and an increase in girls’ mean BMI (21·1 kg/m2v. 22·0 kg/m2, P = 0·03). Among boys, the WC, HC and WHtR percentiles were lower whereas the WHR percentiles were higher in 2008 than in 2003. Among girls, the percentiles of all measures were higher in 2008, except for WHR.

Anthropometric measures among boys tended to decrease, while among girls there was a tendency to increase from 2003 to 2008, indicating an important gender effect and a higher morbidity risk associated with excess body fat in girls. The school setting offers opportunities for interventions to address this situation.

To contrast mean values of Na:K with Na and K mean intakes by demographic factors, and to calculate the prevalence of New York City (NYC) adults meeting the WHO guideline for optimal Na:K (<1 mmol/mmol, i.e. <0·59 mg/mg) using 24 h urinary values.

Data were from the 2010 Community Health Survey Heart Follow-Up Study, a population-based, representative study including data from 24 h urine collections.

Participants were interviewed using a dual-frame sample design consisting of random-digit dial telephone exchanges that cover NYC. Data were weighted to be representative of NYC adults as a whole.

The final sample of 1656 adults provided 24 h urine collections and self-reported health data.

Mean Na:K in NYC adults was 1·7 mg/mg. Elevated Na:K was observed in young, minority, low-education and high-poverty adults. Only 5·2 % of NYC adults had Na:K in the optimal range.

Na intake is high and K intake is low in NYC adults, leading to high Na:K. Na:K is a useful marker and its inclusion for nutrition surveillance in populations, in addition to Na and K intakes, is indicated.