To assess time trends in the contribution of processed foods to food purchases made by Brazilian households and to explore the potential impact on the overall quality of the diet.

Application of a new classification of foodstuffs based on extent and purpose of food processing to data collected by comparable probabilistic household budget surveys. The classification assigns foodstuffs to the following groups: unprocessed/minimally processed foods (Group 1); processed culinary ingredients (Group 2); or ultra-processed ready-to-eat or ready-to-heat food products (Group 3).

Eleven metropolitan areas of Brazil.

Households; n 13 611 in 1987–8, n 16 014 in 1995–5 and n 13 848 in 2002–3.

Over the last three decades, the household consumption of Group 1 and Group 2 foods has been steadily replaced by consumption of Group 3 ultra-processed food products, both overall and in lower- and upper-income groups. In the 2002–3 survey, Group 3 items represented more than one-quarter of total energy (more than one-third for higher-income households). The overall nutrient profile of Group 3 items, compared with that of Group 1 and Group 2 items, revealed more added sugar, more saturated fat, more sodium, less fibre and much higher energy density.

The high energy density and the unfavourable nutrition profiling of Group 3 food products, and also their potential harmful effects on eating and drinking behaviours, indicate that governments and health authorities should use all possible methods, including legislation and statutory regulation, to halt and reverse the replacement of minimally processed foods and processed culinary ingredients by ultra-processed food products.

To estimate the prevalence of overweight and obesity in schoolchildren from Aveiro, Portugal, according to two criteria: the International Obesity Task Force (IOTF) and the US Centers for Disease Control and Prevention (CDC) cut-offs.

Weight, height and waist circumference were measured. Using the BMI, gender- and age-specific prevalences of overweight and obesity were determined according to the IOTF cut-offs extrapolated from an adult BMI of 25 and 30 kg/m2 and the CDC cut-off values of 85th and 95th BMI percentile.

Aveiro, Portugal.

A random representative sample of 905 children (457 boys; 448 girls) aged 7–9 years.

The prevalence of excess weight (overweight and obesity) was lowest according to IOTF cut-offs compared to CDC (28·1 % v. 31·2 %), especially obesity (8·1 % v. 14·0 %). However, the CDC and IOTF criteria have a strong agreement (Cohen’s k = 0·755; P < 0·001). There were significant differences in excess weight between boys and girls according to the CDC (26·9 % v. 35·7 %; P = 0·003). Obese children are younger and the majority present abdominal obesity.

The present study shows a high prevalence of excess weight in Aveiro children, similar to other Portuguese regions and among the highest in Europe, especially in the female gender. The IOTF cut-off values give a lower prevalence of excess weight, namely obesity.

To derive age- and sex-specific reference values for waist circumference (WC) and waist-to-height ratio (WHtR) for Han Chinese children and adolescents and to establish the prevalence of excess central adiposity in our study population.

Cross-sectional study of schoolchildren attending randomly selected primary and secondary schools in south-west China in October 2003 and April 2004. Anthropometry was measured using standard procedures. The LMS method was used to construct smoothed WC and WHtR percentile curves. Overweight and obesity were defined by the International Obesity Task Force (IOTF) criteria and the Working Group on Obesity in Children. Excess central adiposity fat was defined by previously published WC cut-points and a WHtR ≥ 0·5.

Primary and secondary schools in Chongqing, south-west China.

A total of 7326 (49·2 % boys) Han Chinese students at 5–17 years old.

On the basis of the IOTF criteria, 26·4 % of boys were overweight or obese compared with 16·4 % of girls (P < 0·001). WC cut-points identified 31 % of boys and 28 % of girls as having excess central adiposity, whereas using the WHtR criterion, 14·8 % of boys and 5·6 % of girls were identified. Young boys (5–12 years) had a significantly (P < 0·001) higher WHtR than girls.

We have constructed WC and WHtR percentile curves for Han Chinese children and adolescents living in Chongqing. Our measurements were based on a student population with a relatively high rate of overweight and obesity. These data will provide a point of reference for future studies measuring the prevalence of overweight and obesity in China.

To describe trends in the prevalence of obesity and overweight in English adults.

Analysis of nationally representative cross-sectional population surveys. Sociodemographic information was gathered by an interviewer-administered questionnaire and measurements of height and weight were used to calculate the prevalence of obesity and overweight.

A total of 61 515 men and 69 733 women aged 16–65 years participating in the annual Health Survey for England between 1991 and 2006.

When the 4-year periods 1991/94 and 2003/06 were compared, male and female obesity had risen by 8·2 % and 6·0 %, and male and female overweight had risen by 8·8 % and 7·4 %. However, the rate of increase appears to be slowing down: the increases between 1995/98 and 1999/02 were greater than those between 1999/02 and 2003/06. There was relatively little variation across the age range in the average changes in obesity or overweight prevalence between time periods, except that the increase in male obesity between periods was significantly greater for older than younger males. When the subjects were divided into 10-year pseudo birth cohorts, it was seen that the prevalence of obesity and overweight was consistently higher at a given average age for pseudo cohorts born more recently. This agreed with data from two British cohort studies.

Obesity and overweight continued to rise over the study period, but there are signs that the rate of increase is slowing down, even though the prevalence is consistently higher for a given age in cohorts born more recently.

To assess the relationship between obesity and sedentary behaviours, such as watching television or using a computer (‘screen-time’), and describe how this relationship varies between population subgroups.

Cross-sectional analysis of the relationship between obesity (BMI ≥ 30 kg/m2) and screen-time, adjusted for age, sex, income and education and compared according to a range of personal characteristics.

New South Wales, Australia.

A total of 91 266 men and women aged 45 years and above from the general population of New South Wales in 2006–2007 and providing self-reported information on height and weight and other factors.

Obesity prevalence was 21·4 %. Compared to individuals with <2 h of daily screen-time, the adjusted relative risks (RR) of obesity were 1·35 (95 % CI 1·26, 1·44), 1·70 (95 % CI 1·59, 1·82), 1·94 (95 % CI 1·81, 2·08) and 1·92 (95 % CI 1·80, 2·06) for 2–3, 4–5, 6–7 and ≥8 h, respectively. The increase in obesity with increasing screen-time was similar within categories of overall physical activity, but was attenuated in those in full-time paid work, compared to non-workers (P for interaction < 0·0001). Among non-workers, the overall obesity RR per 2 h increase in daily screen-time was 1·23 (95 % CI 1·21, 1·25) and was significantly elevated in all groups examined, ranging from 1·16 to 1·31 according to sex, level of age, education, income, smoking and fruit consumption. The RR did not differ significantly according to overall physical activity, region of residence and alcohol and vegetable consumption, but was substantially lower in disabled v. not-disabled individuals (P for interaction < 0·0001).

Obesity increases with increasing screen-time, independent of purposeful physical activity. This was observed in all population groups examined, although it is attenuated in full-time workers and disabled individuals.

The prevalence of overweight and obesity is increasing in most countries, including Germany. The idea of estimating the population-wide energy gap that is likely responsible for the epidemic has recently been introduced and discussed.

Using published estimates of body weight from population-based data of national health surveys (1985–2002), the energy gap was calculated by estimating the distribution of the rate of weight gain within the German population (25–69 years of age) and the amount of excess energy storage that is responsible for this population-wide pattern of weight gain.

Germany.

A representative sample of 26 614 participants (12 984 men, 13 630 women).

The average annual weight gain was 0·22 kg for men and 0·32 kg for women over the 17-year period. An estimated 90 % of the population gained < 0·54 kg/year. Assuming that each kilogram of weight gained represents 32238 kJ (7700 kcal), the estimated energy accumulation was 19 kJ (4·64 kcal)/d in men and 28 kJ (6·75 kcal)/d in women aged 25–69 years. The distribution of estimated energy accumulation for 90 % of the German population was < 50 kJ (12 kcal)/d.

With an assumed energy efficiency of 50 %, the findings suggest that weight gain could be prevented in 90 % of the German population with < 100 kJ (24 kcal) reduction in energy intake or increase in energy expenditure per day. Theoretically, further weight gain might be prevented using a small-changes approach that emphasizes the importance of making small changes in physical activity and food intake.

The objective was to examine the tracking of obesity from childhood to young adulthood in Slovenia.

A subsample included 4833 children from the Slovenian national sample (n 21 777) who were included in the SLOFIT monitoring system from 1997 to 2008, with complete data at 7 years and 18 years.

A 12-year prospective cohort study. Height, weight and triceps skinfold thickness (TSF) were measured at 7, 11, 14 and 18 years. The BMI cut-off points of the International Obesity Taskforce were used to identify excess weight and obesity.

The survey was conducted in Slovenian primary and secondary schools from 1988 to 2008 but only the data from the measurements in 1997, 2001, 2004 and 2008 are presented.

Height, weight and BMI at 18 years were well predicted from childhood and became more predictable with age, while TSF was not. Obese and overweight children had the greatest risk of becoming obese or overweight young adults. The history of their weight shows that 40·0 % of males and 48·6 % of females who were obese at 18 years had already been obese at 7 years.

Overweight or obese Slovenian children are more likely to become overweight or obese adolescents and young adults than reported in other similar European and American studies, which indicates the need for early prevention and treatment of excess weight and obesity.

To monitor growth trends in young children in order to ascertain success (or otherwise) in halting the rapid rise in childhood obesity prevalence, and to assess the suitability of using routinely measured data for this purpose.

Retrospective serial cross-sectional analyses of the proportion of obese children (logistic regression) and BMI standard deviation score (linear regression/maps) were undertaken. BMI coverage was calculated as percentage of sample with data (‘usual’), percentage of total births and percentage of census values. BMI was standardised for age and sex (British reference data set).

Metropolitan Leeds, UK.

Children aged 3 to 6 years. Weight, height, sex, age and postcode data were collected from Primary Care Trust records.

Data were collected on 42 396 children, of whom 13 020 (31 %) were excluded due to missing data/data problems. Seventy-two per cent of 3-year-olds and 92 % of 5-year-olds had data recorded (‘usual’ coverage). From 1998 to 2003 there was a significant increase in the proportion of obese children (4·5 % to 6·6 %; P < 0·001); children were 1·5 times more likely to be obese in 2003 than in 1998.

Childhood obesity rose significantly between 1998 and 2003. Routinely measured data are an important means of monitoring population-level obesity trends, although more effort is required to reduce the quantity of data-entry errors, for relatively low marginal cost.

To assess the relationship between diet and disease, consideration of whole-diet indices may be more informative than single-nutrient intake. The present study was conducted to report the relationship among dietary diversity score (DDS), obesity and abdominal adiposity among female university students.

Cross-sectional study.

Isfahan, Iran.

A representative sample of 289 healthy female students aged 18–28 years was selected randomly from Isfahan University of Medical Sciences, Iran. Usual dietary intake was assessed using a validated semi-quantitative FFQ. DDS was calculated according to the scoring of the five food groups based on the US Department of Agriculture Food Guide Pyramid. This is a score of diet variety, and shows the diversity of the consumed diet. Participants were categorised on the basis of quartile cut-off points of DDS. Potential confounders such as age, total energy intake and physical activity were considered in all the analyses.

The means (sd) of BMI and waist circumference were 25·9 (sd 5·1) kg/m2 and 85·5 (sd 14) cm, respectively. The probability of obesity decreased with quartiles of DDS (OR among quartiles: 1·00, 0·41, 0·31 and 0·21, P = 0·03; this was the same for abdominal adiposity: 1·00, 0·55, 0·36 and 0·21, P = 0·02). Those in the lowest quartile of the DDS had the highest risk for being overweight.

There were inverse associations among DDS, obesity and abdominal adiposity among the female students of Isfahan University. Further prospective investigations are needed to confirm this finding.

Abdominal obesity is a major risk factor for chronic diseases. Yet there are no waist circumference (WC) cut-offs for children in the Arabian Gulf. We developed smoothed WC percentiles for 5–19-year-old Kuwaiti children and adolescents, which could be used in clinical and public health practice. We also examined the percentages of children who had WC ≥ 90th percentile, a value commonly associated with an elevated risk of CVD.

This is a cross-sectional study that was conducted by the Kuwait National Nutrition Surveillance System.

Data were collected from representative primary-, intermediate- and secondary-school children as part of the yearly nutrition and health monitoring. Least mean square regression was used to develop smoothed WC curves.

A total of 9593 healthy 5·0–18·9-year-old children of both sexes were studied from all areas of Kuwait. Age, gender, residency, education level, weight, height and WC were collected for all participants.

We developed the first smoothed WC curves for Kuwaiti children. Male children had higher WC than female children. WC increased with age in both genders, but larger percentages of male children had WC ≥ 90th percentile. Male children aged >10 years have higher WC percentiles than do female children at the 50th, 75th, 90th and 97th percentiles.

Male children (especially those aged >10 years) are at higher risk than female children. Few health-care professionals routinely measure WC. WC measurement should be promoted as an important tool in paediatric primary care practice. The use of these age- and gender-specific percentiles can impact public health recommendations for Kuwaiti and other Arab children from the Gulf.

To assess the predictive values of various adiposity indices for metabolic syndrome (MetS) among adults using baseline data from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) cohort.

In a cross-sectional study, BMI, waist circumference (WC), body composition by dual-energy X-ray absorptiometry (DEXA) and metabolic risk factors such as TAG, HDL cholesterol, blood pressure, fasting glucose and insulin, uric acid and C-reactive protein were measured. Receiver-operating characteristic (ROC) curves and logistic regression analyses were conducted.

Baltimore, Maryland.

White and African-American US adults (n 1981), aged 30–64 years.

In predicting risk of MetS using obesity-independent National Cholesterol Education Program Adult Treatment Panel III criteria, percentage total body fat mass (TtFM) assessed using DEXA measuring overall adiposity had no added value over WC. This was true among both men (area under the ROC curve (AUC) = 0·680 v. 0·733 for TtFM and WC, respectively; P < 0·05) and women (AUC = 0·581 v. 0·686). Percentage rib fat mass (RbFM) was superior to TtFM only in women for MetS (AUC = 0·701 and 0·581 for RbFM and TtFM, respectively; P < 0·05), particularly among African-American women. Elevated percentage leg fat mass (LgFM) was protective against MetS among African-American men. Among white men, BMI was inferior to WC in predicting MetS. Optimal WC cut-off points varied across ethnic–sex groups and differed from those recommended by the National Institutes of Health/North American Association for the Study of Obesity.

The study provides evidence that WC is among the most powerful tools to predict MetS, and that optimal cut-off points for various indices including WC may differ by sex and race.

The purpose of the present study was to examine the interactions between weight perceptions, weight control behaviours and body fatness in a multiethnic sample of adolescent girls.

A cross-sectional study.

Girls from European (37·7 %), Pacific Island (21·6 %), East Asian (15·8 %), Maori (10·2 %) and South Asian (9·6 %) populations and from other ethnicities (5·0 %).

A sample of 954 girls aged 11–15 years participated in the study. BMI was derived from height and weight, whereas body fat (BF) was determined from hand-to-foot bioimpedance measurements. Weight perceptions, weight control behaviours and pubertal stage were assessed by questionnaire.

Body size and fatness varied significantly across ethnic groups. Although few differences in weight perceptions were observed between BMI and %BF percentile groups, a relatively high degree of weight misclassification was evident across all BF categories. The number of girls trying to lose weight exceeded those who perceived themselves as being overweight, with the magnitude of the difference dependent on ethnicity. Of the girls trying to lose weight, the combination of dieting and exercise was the most common weight loss practice; however, a substantial proportion reported neither exercise nor dieting. Weight status perception was a stronger predictor of weight loss intent than actual BF when controlling for all other factors.

Interventions and educational campaigns that assist girls in recognising a state of excess BF are a priority for all ethnic groups to increase the likelihood that behavioural changes necessary to combat widespread overweight and obesity are adopted.

The increasing prevalence of obesity worldwide is a major health concern. Our study, which is part of the First National Epidemiological Study of Obesity in Greece, aimed to assess (i) breakfast habits and their relationship to BMI in Greek adolescents, as well as (ii) breakfast skipping in relation to other health behaviours.

Epidemiological survey throughout Greece. Participants completed a questionnaire concerning breakfast habits and many lifestyle parameters.

The survey was conducted in schools throughout Greece.

Anthropometric measurements were performed on 6500 boys and 7778 girls, aged 13–19 years, from schools throughout Greece.

Among both boys and girls, breakfast consumers had a lower BMI than breakfast skippers. Moreover, breakfast skippers among both boys and girls were found to smoke more than breakfast consumers. The proportion of boys and girls who ate breakfast was found to be greater among those who had never been on a diet than among those who had already experienced dieting. Leisure-time activity was greater in breakfast consumers than breakfast skippers; among boys, 71·8 % of breakfast consumers walked compared with 66·4 % of breakfast skippers, whereas 38·4 % and 35·0 %, respectively, exercised. Among girls, these percentages were 73·1 % v. 68·7 % for walking and 36·7 % v. 31·5 % for exercising.

We found that breakfast skipping can be part of a constellation of several unhealthy lifestyle parameters and is related to higher BMI in Greek adolescents.

To test the hypothesis that diets with high glycaemic index (GI) and glycaemic load (GL) increase the risk of heart disease.

Overall GI and GL were assessed from 7 d diet records or diet history interviews.

Information on hospitalization and death due to CVD and CHD was obtained from the National Register of Cause of Death and the National Register of Patients.

In total 3959 adult Danes were – depending on time of entry – followed for 6–25 years until 31 December 1999.

Overall GI was inversely associated with heart disease in men. The hazard ratios (95 % CI) for the 10th and 90th GI percentiles compared with the median were 1·38 (1·13, 1·68) and 0·90 (0·76, 1·07) for CVD morbidity, 1·45 (1·05, 1·99) and 0·81 (0·62, 1·06) for CVD mortality, and 1·31 (0·97, 1·76) and 0·65 (0·51, 0·84) for CHD morbidity. In male subjects GL was not associated with either outcome. In women no clear association between overall GI and heart disease was found, whereas positive non-linear associations were found for GL: at very high levels of GL, increase in GL was associated with increasing CVD and CHD morbidity.

In men low-GI diets were associated increased risk of heart disease and GL was not associated with heart disease. In women there was no clear association between GI and heart disease, but to some extent a positive association between GL and heart disease was observed as hypothesized.

The evidence for the association between obesity and the risk of type 2 diabetes has been derived mainly from the analysis of the degree of obesity. The role of the duration of obesity as an independent risk has not been fully explored. The objective of the present study was to investigate the association between the duration of obesity and the risk of type 2 diabetes.

Prospective cohort study.

The Framingham Heart Study (FHS), follow-up from 1948 to 1998.

A total of 1256 FHS participants who were free from type 2 diabetes at baseline, but were obese on at least two consecutive of the study’s twenty-four biennial examinations, were included. Type 2 diabetes status was collected throughout the 48 years of follow-up of the study. The relationship between duration of obesity and type 2 diabetes was analysed using time-dependent Cox models, adjusting for a number of covariates.

The unadjusted hazard ratio (HR) for the risk of type 2 diabetes for men was 1·13 (95 % CI 1·09, 1·17) and for women was 1·12 (95 % CI 1·08, 1·16) per additional 2-year increase in the duration of obesity. Adjustment for sociodemographic variables, family history of diabetes, health behaviour and physical activity made little difference to these HR. For women the evidence of a dose–response relationship was less clear than for men, particularly for women with an older age at obesity onset.

The duration of obesity is a relevant risk factor for type 2 diabetes, independent of the degree of BMI.

To assess the association between sugar-sweetened beverage (SSB) consumption and overweight in children from a Mediterranean country.

The children’s dietary intake was measured using a semi-quantitative FFQ completed by the parents. Overall, 2512 questionnaires were returned and 837 children were removed, leaving a final sample of 1675 children, aged between 5 and 10 years. Height and weight were measured according to international standards, and BMI was calculated. The definition of overweight and obesity was based on average centiles according to the International Obesity Task Force cut-offs. To determine the magnitude of the association between SSB consumption and overweight, OR estimates, including CI, were computed using unconditional logistic regression, adjusting for confounders.

Elementary schools throughout the city of Porto, Portugal.

We invited 5867 children, randomly selected, and their parents to participate in the study. Of those schools that agreed to take part, 3391 parents signed and returned the fully filled out consent form.

The prevalence of overweight (including obesity) was 36·6 % for girls and 38·8 % for boys. With regard to SSB consumption (serving/d), no differences between with overweight and non-overweight children were found even after adjustment for confounders (1–2 servings/d: OR = 1·67, 95 % CI 0·76, 3·66, in girls; OR = 1·63, 95 % CI 0·76, 3·47, in boys; and >2 servings/d: OR = 0·63, 95 % CI 0·33, 1·22, in girls; OR = 0·64, 95 % CI 0·33, 1·52, in boys).

The intake of SSB was not associated with increased risk of overweight in Portuguese schoolchildren.

To explore socio-economic differences in use of staff canteens and whether frequent use of staff canteens is associated with different food patterns and obesity.

Cross-sectional study using three self-administered questionnaires, two of them including food frequency questions. Factor analysis was used to explore food patterns.

Oslo, Norway, 2000–2001.

In total 8943 adult, working Oslo citizens.

Frequent (≥3 times/week) use of staff canteens was most likely among men, younger workers and those in the highest education and income groups. However, after adjustment for demographic, socio-economic and lifestyle factors, those with highest education were least likely to use staff canteens frequently. Frequent eating in staff canteens was positively associated with a Western food pattern (based on fat-rich food, fast food and red meat) and inversely associated with a traditional food pattern (based on boiled potatoes and gravy, and less rice, pasta and oil) in multivariate analyses. Unadjusted, frequent eating in staff canteens was also inversely associated with a prudent food pattern (based on fruit, vegetables, fish, legumes and oil). The likelihood of being obese (BMI ≥ 30 kg/m2) increased significantly with frequent eating in staff canteens, also when adjusted for demographic and socio-economic variables. Adjustment for the food patterns attenuated this relationship, but it was still significant.

Frequent eating in staff canteens was negatively related to socio-economic position and positively associated with unhealthy dietary habits. This partly explained higher odds for obesity among frequent users of staff canteens. Future research should assess the availability and food options of staff canteens.

To assess the nutritional status, food intake and physical activity patterns in schoolchildren attending 5th and 6th grade in basic schools from different socio-economic levels in the metropolitan region of Santiago.

Cross-sectional study in children 5th and 6th grade of eighteen basic schools in the metropolitan region of Santiago.

Boys and girls aged 9–12 years from basic schools were evaluated in terms of physical capacity. An anthropometric evaluation was also performed which included weight, height and triceps and subscapular skinfold thicknesses. Food intake was evaluated by a 24 h recall, socio-economic level by the ESOMAR method and physical activity by a questionnaire.

Boys and girls aged 9–12 years (n 1732).

The average prevalence of overweight and obesity was 40 %, with the highest prevalence in males and those from lower socio-economic level. A majority (64 %) of the children had a low level of physical activity. A higher intake of fat and protein and a higher intake of carbohydrate were found in the higher and lower socio-economic levels, respectively. Both males and females showed adequacy greater than 75 % in macronutrient intake except for fibre, with both groups showing a deficit in the consumption of fruits, vegetables, legumes, fish and milk products according to Chilean recommendations.

A high prevalence of malnutrition by excess was observed in both sexes and a better eating and physical activity pattern was seen in children from higher socio-economic level.