Canadians consume approximately twice the daily Adequate Intake of sodium. The present study examined the efficacy of four types of front-of-package (FOP) sodium labels at influencing consumers’ selection of products low v. high in sodium.

Participants were randomly assigned to one of five experimental conditions: (i) control condition with no FOP label; (ii) basic numeric FOP label; (iii) numeric FOP label with ‘high’ and ‘low’ sodium content descriptors; (iv) detailed Traffic Light (TL) label with colour coding, content descriptors and numeric information; and (v) simple TL label with no numeric information. Participants were shown pairs of grocery products that varied in sodium content and told they could choose a free sample. Selection of the low-sodium v. the high-sodium product was the primary behavioural outcome, in addition to ratings of effectiveness, understanding, liking and believability.

Waterloo, Ontario, Canada.

Adults (n 430) aged ≥18 years, recruited from community settings.

Participants in the three FOP conditions with ‘high/low’ sodium content descriptors were significantly more likely to choose the lower-sodium product compared with the control group. The detailed TL label was ranked most effective at helping participants select low-sodium products, and was rated significantly higher than other formats in liking, understanding and believability. Product selection did not differ significantly across sociodemographic groups.

FOP labels that include content descriptors may be more effective in helping consumers to select lower-sodium products. TL labels, which incorporate content descriptors and colour coding, should be considered for future FOP labelling initiatives.

To identify patterns of perception of front-of-pack (FOP) nutrition labels and to determine social factors, nutritional knowledge and attention to packaging features related to such patterns.

Cross-sectional. Perception was measured using indicators of understanding and acceptability of three simple FOP labels (the ‘Green Tick’, the logo of the French Nutrition and Health Programme (PNNS logo) and ‘simple traffic lights’ (STL)) and two detailed formats (‘multiple traffic lights’ (MTL) and the ‘colour range’ logo (CR)). Associations of perception patterns with individual characteristics were examined using χ2 tests.

Data from the French NutriNet-Santé cohort study.

A total of 38 763 adults.

Four perception patterns emerged. Poorly educated individuals were most often found in groups favouring simple formats. The ‘favourable to CR’ group had a high rate of men and older persons. Poor nutritional knowledge was more frequent in the ‘favourable to STL’ group, while individuals with substantial knowledge were proportionally more numerous in the ‘favourable to MTL’ group. The ‘favourable to STL’ group more frequently self-reported noting price and marketing characteristics during purchasing, while the ‘favourable to MTL’ and ‘favourable to CR’ groups declared more interest in nutritional information. The ‘favourable to Green Tick and PNNS logo’ group self-reported paying closer attention to claims and quality guarantee labels.

The ‘favourable to MTL’ cluster was most frequently represented in our survey. However, simple FOP formats may be most appropriate for increasing awareness of healthy eating among targeted groups with poor nutritional knowledge and little interest in the nutritional quality of packaged foods.

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.

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.

Information about healthy and unhealthy nutrients is increasingly conveyed at the point of purchase. Many studies have investigated the effects of product health information on attitudes and intentions, but the empirical evidence becomes sketchier when the focus of research is actual purchase behaviour. The present paper provides an overview of empirical evidence on the effectiveness of product health information for food products at the point of purchase.

A systematic literature review was conducted.

Only studies were included that assessed the effect of product health information at the point of purchase on actual purchase behaviour, using data provided by stores’ sales records or obtained by investigating customer receipts as the primary outcome measure.

The included studies’ target group comprised supermarket clientele.

Several studies found no significant effects of product health information on actual purchase behaviour. Interventions were more likely to be effective when they lasted for a longer time, when they included additional intervention components, and when they targeted the absence of unhealthy nutrients instead of or in addition to the presence of healthy nutrients.

No strong evidence for the effectiveness of product health information was found. The effect of intervention duration, additional promotional activities and targeting of healthy v. unhealthy nutrients should be closely examined in future studies.

The US Food and Drug Administration and Institute of Medicine are currently investigating front-of-package (FOP) food labelling systems to provide science-based guidance to the food industry. The present paper reviews the literature on FOP labelling and supermarket shelf-labelling systems published or under review by February 2011 to inform current investigations and identify areas of future research.

A structured search was undertaken of research studies on consumer use, understanding of, preference for, perception of and behaviours relating to FOP/shelf labelling published between January 2004 and February 2011.

Twenty-eight studies from a structured search met inclusion criteria. Reviewed studies examined consumer preferences, understanding and use of different labelling systems as well as label impact on purchasing patterns and industry product reformulation.

The findings indicate that the Multiple Traffic Light system has most consistently helped consumers identify healthier products; however, additional research on different labelling systems’ abilities to influence consumer behaviour is needed.

The purpose of the present study was to use a meta-analytic approach to examine the convergent validity of the International Physical Activity Questionnaire (IPAQ).

Systematic review by meta-analysis.

The relevant studies were surveyed from five electronic databases. Primary outcomes of interest were the product-moment correlation coefficients between IPAQ and other instruments. Five separate meta-analyses were performed for each physical activity (PA) category of IPAQ: walking, moderate PA (MPA), total moderate PA (TMPA), vigorous PA (VPA) and total PA (TPA). The corrected mean effect size (ESρ) unaffected by statistical artefacts (i.e. sampling error and reliability) was calculated for each PA category. Selected moderator variables were length of IPAQ (i.e. short and long form), reference period (i.e. last 7 d and usual week), mode of administration (i.e. interviewer and self-reported), language (i.e. English and translated) and instruments (i.e. accelerometer, pedometer and subjective measure).

A total of 152 ESρ across five PA categories were retrieved from twenty-one studies.

The results showed small- to medium-sized ESρ (0·27–0·49). The highest value was observed in VPA while the lowest value was found in MPA. The ESρ were differentiated by some of the moderator variables across PA categories.

The study shows the overall convergent validity of IPAQ within each PA category. Some differences in degree of convergent validity across PA categories and moderator variables imply that different research conditions should be taken into account prior to deciding on use of the appropriate type of IPAQ.

To determine the optimal cut-offs of BMI for Malaysian adults.

Population-based, cross-sectional study. Receiver operating characteristic curves were used to determine the cut-off values of BMI with optimum sensitivity and specificity for the detection of three cardiovascular risk factors: diabetes mellitus, hypertension and hypercholesterolaemia. Gender-specific logistic regression analyses were used to examine the association between BMI and these cardiovascular risk factors.

All fourteen states in Malaysia.

Malaysian adults aged ≥18 years (n 32 703) who participated in the Third National Health and Morbidity Survey in 2006.

The optimal BMI cut-off value for predicting the presence of diabetes mellitus, hypertension, hypercholesterolaemia or at least one of these cardiovascular risk factors varied from 23·3 to 24·1 kg/m2 for men and from 24·0 to 25·4 kg/m2 for women. In men and women, the odds ratio for having diabetes mellitus, hypertension, hypercholesterolaemia or at least one cardiovascular risk factor increased significantly as BMI cut-off point increased.

Our findings indicate that BMI cut-offs of 23·0 kg/m2 in men and 24·0 kg/m2 in women are appropriate for classification of overweight. We suggest that these cut-offs can be used by health professionals to identify individuals for cardiovascular risk screening and weight management programmes.

To evaluate plant sterol intake estimated with the eighty-four-item Northern Sweden FFQ against repeated 24 h dietary recalls (24-HDR) as the reference method.

Randomly recruited participants from the Västerbotten Intervention Programme (VIP) responded to an FFQ (FFQ1). Over the subsequent 12 months, ten repeated 24-HDR were carried out. After this, a second FFQ (FFQ2) was completed.

Västerbotten county, northern Sweden.

Ninety-six men and ninety-nine women.

The Pearson correlation coefficient for absolute total plant sterol intake estimated with FFQ1 and 24-HDR was 0·58 and 0·55 for the men and women, respectively. Cross-classification of participants into quartiles of absolute plant sterol intake estimated with FFQ1 and 24-HDR showed that 90 % of the men and 83 % of the women were classified into the same or an adjacent quartile. For energy-adjusted plant sterol intake, 71 % of the men and 74 % of the women were classified into the same or an adjacent quartile. The agreement for cross-classification of participants into quartiles between FFQ1 and FFQ2 was good for both absolute and energy-adjusted plant sterol intake.

The FFQ is able to capture absolute plant sterol intake to the same extent as other nutrients, and to rank individuals according to both their absolute and energy-adjusted plant sterol intake. The reproducibility of the FFQ was good, suggesting that the method is reliable. This makes it possible to use plant sterol data from the FFQ in large-scale studies of the association between plant sterol intake and disease.

To examine how different scoring models for a diet quality index influence associations with mortality outcomes.

A study within the Malmö Diet and Cancer cohort. Food and nutrient intakes were estimated using a diet history method. The index included six components: SFA, PUFA, fish and shellfish, fibre, fruit and vegetables, and sucrose. Component scores were assigned using predefined (based on dietary recommendations) and population-based cut-offs (based on median or quintile intakes). Multivariate Cox regression was used to model associations between index scores (low, medium, high) and all-cause and cause-specific mortality by sex.

Malmö, the third largest city in Sweden.

Men (n 6940) and women (n 10 186) aged 44–73 years. During a mean follow-up of 14·2 years, 2450 deaths occurred, 1221 from cancer and 709 from CVD.

The predictive capability of the index for mortality outcomes varied with type of scoring model and by sex. Stronger associations were seen among men using predefined cut-offs. In contrast, the quintile-based scoring model showed greater predictability for mortality outcomes among women. The scoring model using median-based cut-offs showed low predictability for mortality among both men and women.

The scoring model used for dietary indices may have a significant impact on observed associations with disease outcomes. The rationale for selection of scoring model should be included in studies investigating the association between dietary indices and disease. Adherence to the current dietary recommendations was in the present study associated with decreased risk of all-cause and cause-specific mortality, particularly among men.

The present study aimed to evaluate the relationship between the consumption of selected food groups and insulin resistance, with an emphasis on sugar-sweetened beverages (SSB).

The present research is a large multicentre European study in adolescents, the HELENA-CSS (Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study).

Homeostasis model assessment–insulin resistance index (HOMA-IR) was calculated. Several anthropometric and lifestyle characteristics were recorded. Dietary assessment was conducted by using a short FFQ.

The participants were a subset of the original sample (n 546) with complete data on glucose, insulin and FFQ. All participants were recruited at schools.

Median (25th, 75th percentile) HOMA-IR was 0·62 (0·44, 0·87). Mean HOMA-IR was significantly higher among adolescents consuming brown bread ≤1 time/week than among those consuming 2–6 times/week (P = 0·011). Mean values of HOMA-IR were also higher in adolescents consuming SSB >5 times/week compared with those consuming less frequently, although a statistically significant difference was detected between those consuming SSB 5–6 times/week and 2–4 times/week (P = 0·049). Multiple linear regression analysis showed that only the frequency of SSB consumption was significantly associated with HOMA-IR after controlling for potential confounders. In particular, it was found that HOMA-IR levels were higher among adolescents consuming SSB 5–6 times/week and ≥1 time/d compared with those consuming ≤1 time/week by 0·281 and 0·191 units, respectively (P = 0·009 and 0·046, respectively).

The present study revealed that daily consumption of SSB was related with increased HOMA-IR in adolescents.

To assess the relationship between parental education level and the consumption frequency of obesity-related foods in European children.

The analysis was based on data from the cross-sectional baseline survey of a prospective cohort study. The effects of parental education on food consumption were explored using analysis of covariance and logistic regression.

Primary schools and pre-schools of selected regions in Italy, Estonia, Cyprus, Belgium, Sweden, Hungary, Germany and Spain.

Participants (n 14 426) of the IDEFICS baseline cohort study aged 2 to 9 years.

Parental education level affected the intake of obesity-related foods in children. Children in the low and medium parental education level groups had lower odds of more frequently eating low-sugar and low-fat foods (vegetables, fruits, pasta/noodles/rice and wholemeal bread) and higher odds of more frequently eating high-sugar and high-fat foods (fried potatoes, fruits with sugar and nuts, snacks/desserts and sugared beverages; P < 0·001). The largest odds ratio differences were found in the low category (reference category: high) for vegetables (OR = 0·56; 95 % CI 0·47, 0·65), fruits (OR = 0·56; 95 % CI 0·48, 0·65), fruits with sugar and nuts (OR = 2·23; 95 % CI 1·92, 2·59) and sugared beverages (OR = 2·01; 95 % CI 1·77, 2·37).

Low parental education level was associated with intakes of sugar-rich and fatty foods among children, while high parental education level was associated with intakes of low-sugar and low-fat foods. These findings should be taken into account in public health interventions, with more targeted policies aiming at an improvement of children's diet.

The current research aims to describe the weight-control strategies and family support for young people reporting sustained weight loss in a large, population-based sample.

Data were collected as part of Youth'07, a nationally representative survey of the health and well-being of New Zealand youth.

New Zealand secondary schools, 2007.

Secondary-school students (n 9107).

Among young people who attempted weight loss in the previous year, 51 % reported long-term weight loss (lost weight and maintained weight loss for 6 months). Students reporting long-term weight loss were more likely to be male, but did not differ by age, ethnicity, socio-economic deprivation or measured weight status from students who reported temporary/recent weight loss or no weight loss. Students with long-term weight loss also reported healthier weight-control strategies (e.g. exercising, eating fewer fatty foods, eating fewer sweets), high parental support for healthy eating/activity and were less likely to report being teased about their weight by their family and having junk food available at home than students with temporary/recent weight loss or no weight loss.

Approximately 50 % of young people attempting weight loss reported sustained weight loss. Young people who reported sustained weight loss appeared to have more family support than those who did not achieve this, suggesting the importance for weight-control services and interventions in adolescents of actively engaging the family.

The present study examined associations of several home and neighbourhood environmental variables with fruit consumption and explored whether these associations were mediated by variables derived from the Theory of Planned Behaviour (TPB) and by habit strength.

Data of the Dutch GLOBE study on household and neighbourhood environment, fruit intake and related factors were used, obtained by self-administered questionnaires (cross-sectional), face-to-face interviews and audits.

The city of Eindhoven in the Netherlands

Adults (n 333; mean age 58 years, 54 % female).

Multiple mediation analyses were conducted using regression analyses to assess the association between environmental variables and fruit consumption, as well as mediation of these associations by TPB variables and by habit strength. Intention, perceived behaviour control, subjective norm and habit strength were associated with fruit intake. None of the neighbourhood environmental variables was directly or indirectly associated with fruit intake. The home environmental variable ‘modelling behaviour by family members’ was indirectly, but not directly, associated with fruit intake. Habit strength and perceived behaviour control explained most of the mediated effect (71·9 %).

Modelling behaviour by family members was indirectly associated with fruit intake through habit strength and perceived behaviour control. None of the neighbourhood variables was directly or indirectly, through any of the proposed mediators, associated with adult fruit intake. These findings suggest that future interventions promoting fruit intake should address a combination of the home environment (especially modelling behaviour by family members), TPB variables and habit strength for fruit intake.

To assess the adequacy of milk and alternatives, Ca and vitamin D intakes in First Nations (FN) youth in Ontario, Canada. Intakes were compared with the general population and dietary standards. Variation in intakes by community (proxy for remoteness) and BMI was examined.

Data were collected by 24 h recall between November 2003 and June 2010. Intakes were analysed descriptively. Variation in intakes, by community and BMI category, was assessed using ANOVA.

Five remote FN communities of the Mushkegowuk Territory (northern Ontario, Canada) and two less-remote southern Ontario FN communities.

Schoolchildren (n 457) in grades 6 to 12.

Compared with Canada's Food Guide recommendations, 72·6 to 84·7 % had an inadequate intake of milk and alternatives depending on age and sex group; 86·2 % of individuals fell below the RDA for Ca; 96·4 % fell below the RDA for vitamin D. Community variation in intakes was detected, although in all cases Fort Albany had higher intakes, even when it was the more northern (remote) community. A BMI × sex interaction was found for intake of milk and alternatives (P = 0·041): an inverse relationship between intake and BMI was seen in females; in males, those who were overweight had the highest intake, followed by normal-weight and obese youth.

The nutritional inadequacies parallel the results of other Canadian studies of Aboriginal populations. Population health interventions to improve intakes are warranted. Moreover, community variation in intakes exists among FN youth in the present study (Fort Albany pairs only), but results were not as expected.

To evaluate the nutritional adequacy of diets in early childhood as a function of milk intake, cows’ milk (CM) or growing-up milk (GUM).

From a cross-sectional food consumption survey, two groups of children aged 1–2 years were defined: Group CM fed exclusively on CM ≥ 250 ml/d and Group GUM fed on GUM ≥ 250 ml/d. Proportions of children at risk of nutrient excess or insufficiency were estimated relative to the French Recommended Daily Allowances, Estimated Average Requirements or Adequate Intakes.

Parents participating in the survey were recruited from all regions of France by a polling organization. Distribution was adjusted to that of the French population.

Sixty-three (Group CM) and fifty-five (Group GUM) children.

Total energy and macronutrient intakes were similar in the two groups except protein intake of Group CM, which was much higher than the Recommended Daily Allowance and significantly higher than in Group GUM. A high percentage of children of Group CM had intake of linoleic acid (51 %) and α-linolenic acid (84 %) below the lower limit of the Adequate Intake, and intake of Fe (59 %) vitamin C (49 %) and alimentary vitamin D (100 %) less than the Estimated Average Requirement. Significant differences were observed in the proportions of children with a risk of dietary inadequacy between the two groups for all the mentioned nutrients (P < 0·001). In Group GUM, this imbalance was only observed for vitamin D. Intake of foods other than milk and dairy products could not account for these discrepancies.

Consumption of CM (≥250 ml/d) entails the risk of insufficiency in α-linolenic acid, Fe, vitamin C and vitamin D. Use of GUM (≥250 ml/d) significantly reduces the risk of insufficiencies in the mentioned nutrients.

Community kitchens have been implemented by communities as a public health strategy to prevent food insecurity through reducing social isolation, improving food and cooking skills and empowering participants. The aim of the present paper was to investigate whether community kitchens can improve the social and nutritional health of participants and their families.

A systematic review of the literature was conducted including searches of seven databases with no date limitations.

Community kitchens internationally.

Participants of community kitchens across the world.

Ten studies (eight qualitative studies, one mixed-method study and one cross-sectional study) were selected for inclusion. Evidence synthesis suggested that community kitchens may be an effective strategy to improve participants’ cooking skills, social interactions and nutritional intake. Community kitchens may also play a role in improving participants’ budgeting skills and address some concerns around food insecurity. Long-term solutions are required to address income-related food insecurity.

Community kitchens may improve social interactions and nutritional intake of participants and their families. More rigorous research methods, for both qualitative and quantitative studies, are required to effectively assess the impact of community kitchens on social and nutritional health in order to confidently recommend them as a strategy in evidence-based public health practice.

The aim of the present study was to investigate vitamin D status among female out-patients in Saudi Arabia during the summer and winter seasons.

Data were retrospectively collected using medical record abstraction.

A multidisciplinary hospital in Riyadh between January and December 2009.

Saudi females (age ≥19 years; n 1556) attending out-patient clinics for various complaints comprised the studied population. The population was subdivided into two groups depending on the date of their visit where blood samples were collected: summer (n 659) and winter groups (n 897). The summer group was further subdivided into premenopausal (age 19–49 years; n 425) and postmenopausal subgroups (age ≥50 years; n 234). Similarly, the winter group was subdivided into premenopausal (n 543) and postmenopausal subgroups (n 354). Serum levels of 25-hydroxyvitamin D (25(OH)D) were measured using HPLC.

The prevalence of vitamin D deficiency (25(OH)D <50 nmol/l) was high in both premenopausal and postmenopausal groups (80 % and 68 %, respectively) during the summer, as well as during the winter (85 % and 76 %, respectively).

A high prevalence of vitamin D deficiency among Saudi female out-patients was observed throughout the year despite the routine supplementation with 10–20 μg vitamin D3 for postmenopausal women. Clinicians should seriously consider determining the vitamin D status of Saudi females routinely and prescribing them proper supplementation.

Low BMI is a major risk factor for early mortality among HIV-infected persons starting antiretrovial therapy (ART) in sub-Saharan Africa and the common patient belief that antiretroviral medications produce distressing levels of hunger is a barrier to treatment adherence. We assessed relationships between appetite, dietary intake and treatment outcome 12 weeks after ART initiation among HIV-infected adults with advanced malnutrition and immunosuppression.

A prospective, observational cohort study. Dietary intake was assessed using a 24 h recall survey. The relationships of appetite, intake and treatment outcome were analysed using time-varying Cox models.

A public-sector HIV clinic in Lusaka, Zambia.

One hundred and forty-two HIV-infected adults starting ART with BMI <16 kg/m2 and/or CD4+ lymphocyte count <50 cells/μl.

Median age, BMI and CD4+ lymphocyte count were 32 years, 16 kg/m2 and 34 cells/μl, respectively. Twenty-five participants (18 %) died before 12 weeks and another thirty-three (23 %) were lost to care. A 500 kJ/d higher energy intake at any time after ART initiation was associated with an approximate 16 % reduction in the hazard of death (adjusted hazard ratio = 0·84; P = 0·01), but the relative contribution of carbohydrate, protein or fat to total energy was not a significant predictor of outcome. Appetite normalized gradually among survivors and hunger was rarely reported.

Poor early ART outcomes were strikingly high in a cohort of HIV-infected adults with advanced malnutrition and mortality was predicted by lower dietary intake. Intervention trials to promote post-ART intake in this population may benefit survival and are warranted.