To examine changes in the age-specific prevalence of overweight and obesity in Japanese children between 2000 and 2005 and compare Japanese centile curves with international ones.

A large, Japanese, representative cross-sectional growth study.

Japan.

Japanese children aged 5–17 years, including 669 986 subjects in 2000, 670 143 in 2001, 668 760 in 2002, 670 785 in 2003, 669 120 in 2004 and 668 234 in 2005.

BMI (weight/height2).

The prevalence of overweight and obesity in children aged 5–17 years decreased from 2000 to 2005 in both males and females, according to the definitions of the Centers for Disease Control and Prevention and the International Obesity Taskforce. For each year, the centile curves were drawn so that at age 17 years they passed through respectively 24·46 kg/m2 and 24·70 kg/m2 for males, and 29·41 kg/m2 and 29·69 kg/m2 for females, which are the BMI values at age 17 years from the international reference curves.

The study results indicate that centile curves can change according to the time of observation, thus suggesting that international reference curves therefore need to be regularly revised while including more data from a larger range of countries.

To assess the relationship of dairy product consumption on diet quality and weight of low-income women.

Head Start centres in Texas and Alabama, USA.

Cross-sectional study. Women were divided into dairy consumption groups: ≤1, >1 to ≤2 and >2 servings/d. Nutrient intake/diet quality was determined by calculating the percentage meeting the Estimated Average Requirement, guidelines for fat and added sugar, and Mean Adequacy Ratio (MAR). Mean BMI was compared for the dairy consumption groups.

Mothers with children in Head Start; 609 African-Americans (43 %), Hispanic-Americans (32 %) and European-Americans (24 %).

Fifteen per cent of participants consumed >2 servings of dairy products and 57 % consumed ≤1 serving of dairy daily. Intakes of protein, vitamin D, riboflavin, P, Ca, K, Mg and Zn were significantly higher in those consuming >2 servings/d. Total SFA were higher and added sugars were lower in those consuming >2 servings of dairy products daily compared with those consuming ≤2 servings/d. Forty-one per cent of women consuming >2 servings of dairy daily had MAR scores under 85 compared with 94 % consuming ≤1 serving/d. Mean BMI was 30·36 kg/m2; there was no association between BMI and dairy product consumption.

Consumption of dairy products was low and was not associated with BMI in this low-income population. Higher levels of dairy product consumption were associated with higher MAR scores and improved intakes of Ca, K and Mg, which have been identified as shortfall nutrients in the diets of adults.

To analyse the relationship between maternal intakes of fish and other seafood during pregnancy and child neurodevelopment at age 4 years. Although pregnant women are advised to limit seafood intakes because of possible neurotoxin contamination, several studies suggest that overall maternal seafood intakes are associated with improved child neurodevelopment, perhaps because of higher DHA intakes.

The study uses data from a prospective birth cohort study. Maternal seafood intakes were assessed using a semi-quantitative FFQ administered shortly after delivery. Multivariate linear regression was used to estimate associations between seafood consumption and scores on the McCarthy Scales of Children’s Abilities (MCSA). Analyses were stratified by breast-feeding duration as breast milk is a source of DHA during the postnatal phase of the brain growth spurt.

Menorca, Spain, 1997–2001.

Full-term children (n 392) with data on maternal diet in pregnancy, breast-feeding duration and neurodevelopment at age 4 years.

Among children breast-fed for <6 months, maternal fish intakes of >2–3 times/week were associated with significantly higher scores on several MCSA subscales compared with intakes ≤1 time/week. There was no association among children breast-fed for longer periods. Maternal intakes of other seafood (shellfish/squid) were, however, inversely associated with scores on several subscales, regardless of breast-feeding duration.

The study suggests that moderately high intakes of fish, but not other seafood, during pregnancy may be beneficial for neurodevelopment among children breast-fed for <6 months. Further research in other populations with high seafood intakes and data on additional potential confounders are needed to confirm this finding.

To understand how access to natural resources may contribute to nutrition.

In each of the two major seasons, data were collected during a 7 d period using observations, semi-structured interviews, anthropometric measures and a weighed food consumption survey.

Four rural communities selected to represent inland and coastal areas of the Gamba Complex in Gabon.

In each community, all individuals from groups vulnerable to malnutrition, i.e. children aged 0–23 months (n 41) and 24–59 months (n 63) and the elderly (n 101), as well as women caregivers (n 96).

In most groups, household access to natural resources was associated with household access to food but not with individual nutritional status. In children aged 0–23 months, access to care and to health services and a healthy environment were the best predictors of length-for-age (adjusted R2: 14 %). Health status was the only predictor of weight-for-height in children aged 24–59 months (adjusted R2: 14 %). In women caregivers, household food security was negatively associated with nutritional status, as was being younger than 20 years (adjusted R2: 16 %). Among the elderly, only nutrient adequacy predicted nutritional status (adjusted R2: 5 %).

Improving access to care and health for young children would help reverse the process of undernutrition. Reaching a better understanding of how the access of individuals to both food and other resources relate to household access could further our appreciation of the constraints to good nutrition. This is particularly relevant in women to ensure that their possibly important contribution to the household is not at their own expense.

Amidst a hunger–obesity paradox, the purpose of the present study was to examine the grocery shopping behaviour and food stamp usage of low-income women with children to identify factors influencing their food choices on a limited budget.

Focus groups, which included questions based on Social Cognitive Theory constructs, examined food choice in the context of personal, behavioural and environmental factors. A quantitative grocery shopping activity required participants to prioritize food purchases from a 177-item list on a budget of $US 50 for a one-week period, an amount chosen based on the average household food stamp allotment in 2005.

Ninety-two low-income women, with at least one child aged 9–13 years in their household, residing in the Twin Cities, Minnesota, USA.

Participants' mean age was 37 years, and 76% were overweight or obese (BMI≥25·0kg/m2). Key findings suggest that their food choices and grocery shopping behaviour were shaped by not only individual and family preferences, but also their economic and environmental situation. Transportation and store accessibility were major determinants of shopping frequency, and they used various strategies to make their food dollars stretch (e.g. shopping based on prices, in-store specials). Generally, meat was the most important food group for purchase and consumption, according to both the qualitative and quantitative data.

Efforts to improve food budgeting skills, increase nutrition knowledge, and develop meal preparation strategies involving less meat and more fruits and vegetables, could be valuable in helping low-income families nutritionally make the best use of their food dollars.

A school-based nutrition information programme was initiated in 1992 in two towns in northern France (Fleurbaix and Laventie, FL) and was followed by a number of community-based interventions. We took the opportunity to measure the outcomes in terms of childhood obesity and overweight over the next 12 years.

Repeated, cross-sectional, school-based survey. For the school years beginning in 1992, 2000, 2002, 2003 and 2004, the height and weight of all 5- to 12-year-old children attending school were measured in FL. In 2004, the same assessments were made in two comparison towns with similar socio-economic characteristics but no intervention.

Fleurbaix and Laventie (intervention towns), Bois-Grenier and Violaines (comparison towns), northern France.

In 2002, 2003 and 2004, respectively 515, 592 and 633 children were measured in FL (participation rate of 95–98 % of all eligible individuals); in the comparison towns, 349 children were measured in the 2004 school year (98 % of the towns’ school population).

After an initial increase, trends in mean BMI and prevalence of overweight started to reverse. Compared with 2002, the age-adjusted OR for overweight in FL was significantly lower in 2003 and 2004 (but for girls only). In the 2004 school year, the overweight prevalence was significantly lower in FL (8·8 %) than in the comparison towns (17·8 %, P < 0·0001).

These data suggest that, over a long period of time, interventions targeting a variety of population groups can have synergistic effects on overweight prevalence. This gives hope that it is possible to reverse trends towards increasing overweight by actions at the community level.

To examine the association between fruit and vegetable access in the community and change in fruit and vegetable consumption among participants in community-based health promotion programmes.

Fruit and vegetable consumption and perceived access to fresh fruit and vegetables were measured by self-administered questionnaires at programme start, end and 1-year follow-up. Community produce availability was determined by grocery store assessments measuring the display space devoted to fruit and vegetable offerings, as well as price, variety and freshness. A total of nine communities were studied; 130 participants completed the fruit and vegetable portions of the questionnaires and could be linked to grocery store assessments.

Participants made modest but significant increases in fruit and vegetable consumption from programme start to end: the average increase was 2·88 (95 % CI 1·52, 4·25) servings weekly; the average increase from start to follow-up was 2·52 (95 % CI 1·09, 3·95) servings weekly. Greater perceived access to fruits and vegetables was significantly associated with higher increases in fruit and vegetable consumption from programme start to programme end. Greater availability of produce was associated with greater increases in fruit and vegetable servings from programme start to programme end as measured by store assessments.

Environmental factors, such as access to fruits and vegetables, can modify the effects of community interventions. Interventions with the goal of increasing fruit and vegetable consumption should consider focusing on increasing access to fresh fruits and vegetables in target communities. Similarly, researchers may want to study access as an intervention, not just a contextual variable.

The present pilot project aimed to assess the effectiveness of social mobilization and social marketing in improving knowledge, attitudes and practices (KAP) and Fe status in an Fe-deficient population.

In an uncontrolled, before–after, community-based study, social mobilization and social marketing strategies were applied. The main outcomes included KAP and Hb level and were measured at baseline, 1 year later and 2 years later.

One urban county and two rural counties in Shijiazhuang Municipality, Hebei Province, China.

Adult women older than 20 years of age and young children aged from 3 to 7 years were selected from three counties to attend the evaluation protocol.

After 1 year, most knowledge and attitudes had changed positively towards the prevention and control of anaemia. The percentage of women who had adopted NaFeEDTA-fortified soya sauce increased from 8·9 % to 36·6 % (P ≤ 0·001). After 2 years, Hb levels had increased substantially, by 9·0 g/l (P ≤ 0·001) in adult women and 7·7 g/l (P ≤ 0·001) in young children.

Social mobilization and social marketing activities had a positive impact on the KAP of adult women, and resulted in marked improvements in Hb levels in both adult women and young children. This should be recommended as a national preventive strategy to prevent and control Fe deficiency and Fe-deficiency anaemia.

We aimed to describe the difference in B-vitamin intake and in plasma B-vitamin and homocysteine concentrations before and after folic acid fortification, in relation to dietary patterns.

The Normative Aging Study (NAS) is a longitudinal study on ageing. Between 1961 and 1970, 2280 male volunteers aged 21–80 years (mean 42 years) were recruited. Dietary intake data have been collected since 1987 and assessment of plasma B vitamins and homocysteine was added in 1993.

Boston, Massachusetts, USA.

In the present study, 354 men who had completed at least one FFQ and one measurement of homocysteine, both before and after the fortification period, were included.

Three dietary patterns were identified by cluster analysis: (i) a prudent pattern, with relatively high intakes of fruit, vegetables, low-fat milk and breakfast cereals; (ii) an unhealthy pattern, with high intakes of baked products, sweets and added fats; and (iii) a low fruit and vegetable but relatively high alcohol intake pattern. Dietary intake and plasma concentrations of folate increased significantly (P < 0·05) among all dietary patterns after the fortification period. Homocysteine tended to decrease in supplement non-users and in subjects in the high alcohol, low fruit and vegetable dietary pattern (both P = 0·08).

After fortification with folic acid, folate intake and plasma folate concentration increased significantly in all dietary patterns. There was a trend towards greatest homocysteine lowering in the high alcohol, low fruit and vegetable group.

To identify the socio-environmental, personal and behavioural factors that are longitudinally predictive of changes in adolescents’ fast-food intake.

Population-based longitudinal cohort study.

Participants from Minnesota schools completed in-class assessments in 1999 (Time 1) while in middle school and mailed surveys in 2004 (Time 2) while in high school.

A racially, ethnically and socio-economically diverse sample of adolescents (n 806).

Availability of unhealthy food at home, being born in the USA and preferring the taste of unhealthy foods were predictive of higher fast-food intake after 5 years among both males and females. Among females, personal and behavioural factors, including concern about weight and use of healthy weight-control techniques, were protective against increased fast-food intake. Among males, socio-environmental factors, including maternal and friends’ concern for eating healthy food and maternal encouragement to eat healthy food, were predictive of lower fast-food intake. Sports team participation was a strong risk factor for increased fast-food intake among males.

Our findings suggest that addressing socio-environmental factors such as acculturation and home food availability may help reduce fast-food intake among adolescents. Additionally, gender-specific intervention strategies, including working with boys’ sports teams, family members and the peer group, and for girls, emphasizing the importance of healthy weight-maintenance strategies and the addition of flavourful and healthy food options to their diet, may help reduce fast-food intake.

To investigate associations between nutritional and non-nutritional variables and Fe status parameters, i.e. serum ferritin and soluble transferrin receptors (sTfR).

Cross-sectional design. Fe status parameters were determined on a fasting venous blood sample. Nutritional variables were assessed using a 2 d food record and non-nutritional variables by a general questionnaire. A general linear model was used to investigate associations between the variables and Fe status parameters.

Region of Ghent, Dutch-speaking part of Belgium.

Random sample of 788 women (aged 18–39 years).

Median (interquartile range) ferritin and sTfR were 26·3 (15·9, 48·9) ng/ml and 1·11 (0·95, 1·30) mg/l, respectively. BMI and alcohol intake were positively associated and tea intake was negatively associated with serum ferritin. Women who used a non-hormonal intra-uterine device, who gave blood within the past year or who had been pregnant within the past year had lower serum ferritin values than their counterparts. Significant determinants of sTfR were smoking habit and pregnancy, with higher values for non-smokers and women who had been pregnant within the past year.

The present study indicates that contraceptive use, time since last blood donation, time since last pregnancy, BMI, alcohol and tea intake are determinants of Fe stores, whereas smoking habit and time since last pregnancy are determinants of tissue Fe needs. When developing strategies to improve Fe status, special attention should be given to women who use a non-hormonal intra-uterine device, gave blood within the past year and had been pregnant within the past year.

To validate an FFQ for the assessment of dietary EPA and DHA against their relative concentrations in red blood cells (RBC).

Cross-sectional analysis of baseline data. Intakes of marine food products and EPA and DHA were estimated by FFQ on the basis of consumption of marine food products in the last month. Fatty acid composition of RBC membranes was quantified by GC.

Saint-François d’Assise Hospital, Québec, Canada.

A total of sixty-five middle-aged women who participated in a randomized clinical trial.

Spearman’s correlation coefficient between intake of EPA, DHA and EPA + DHA and their corresponding concentration in RBC was 0·46, 0·40 and 0·42, respectively (all P < 0·05). Multiple regression analysis of EPA+DHA intake and RBC EPA + DHA concentration indicated positive and significant correlations for oily fish (β = 0·44, 95 % CI 0·16, 0·72, P = 0·0027), total fish (β = 0·42, 95 % CI 0·19, 0·64, P = 0·0005) and marine food products (β = 0·42, 95 % CI 0·20, 0·64, P = 0·0003). No other marine food products significantly predicted RBC EPA + DHA concentration.

Although the present validation study was undertaken among middle-aged women with low consumption of marine food products (<3 servings/week), our FFQ provided estimates of EPA and DHA intakes that correlated fairly well with their RBC concentrations. However, the absence of correlations between EPA + DHA intakes from different marine species suggests that a minimum EPA + DHA intake is necessary to observe a relationship with RBC EPA + DHA concentrations.

To examine the opinions of physicians in Bahrain regarding their role in obesity control, and to evaluate their knowledge, attitudes and practices towards obesity prevention and management in primary health care.

A cross-sectional survey of physicians in Bahrain. A single-stage cluster sample was used, which included twelve health centres and 107 physicians. Ninety-seven physicians participated in the study with a 90 % response rate. A self-administered questionnaire was used to measure physicians’ knowledge and practices, their perceived role and potential limitations. Correction for design effect and finite population were considered in the analysis.

The majority of physicians in Bahrain (92 %) were aware of the obesity epidemic and 60 % of them felt capable of assuming a major role in obesity control, regardless of their negative views towards the success rates of weight management. Only 36 % agreed that they had effective weight-management practices. They were knowledgeable about weight-loss goals and showed a reasonable level of obesity identification, especially as part of chronic disease care (71 %). Physicians reported a high rate of utilization of various weight-loss strategies, except for pharmacotherapy and surgery. The major barriers identified in patient care included time constraints (91 %), lack of specialty clinics (81 %), absence of guidelines (78 %) and an inadequate number of dietitians (71 %). Sixty-four per cent reported that training in lifestyle counselling and behaviour modification are important requirements.

Physicians in Bahrain showed a reasonable level of interest in participating in obesity prevention and management. It seems that there would be a good opportunity for better practice if physicians were supported with appropriate training and the constraints of their working environment were adequately addressed.

To evaluate the modification effect of sex in the association between lifestyles and acute myocardial infarction (AMI).

Population-based case–control study. Trained interviewers collected information using a standard structured questionnaire. Associations were estimated using unconditional logistic regression. The effect modification by sex was evaluated in the regression models, testing interaction terms between lifestyles and sex.

Porto, Portugal.

Portuguese Caucasian adults, aged ≥18 years. Cases were patients consecutively admitted with an incident AMI during 1999–2003 (n 918) and controls were a representative sample of non-institutionalized inhabitants of Porto with no evidence of previous clinical or silent infarction (n 2316).

Cigarette smoking was positively associated with AMI in both men and women (smokers >15 cigarettes/d v. never smokers: OR = 9·11, 95 % CI 4·83, 17·20 for women; OR = 3·92, 95 % CI 2·75, 5·58 for men; interaction term P value = 0·001). A significant protective effect of moderate alcohol intake on AMI occurrence was found in women (0·1–15·0 g/d v. non-drinkers: OR = 0·48, 95 % CI 0·31, 0·74), but not in men. Fruit and vegetable intake, vitamin and mineral supplement use and leisure-time physical activity practice were found to decrease AMI risk, with similar effects between sexes.

A strong positive association between smoking and AMI was found in women. Also, a protective effect of moderate alcohol intake was only found among females. Fruit and vegetable intake, vitamin and mineral supplement use and leisure-time physical activity practice were found to decrease AMI risk in both sexes.

Dietary intake during adolescence contributes to lifelong eating habits and the development of early risk factors for disease in adulthood. Few studies have examined the dietary patterns of adolescents and the social and environmental factors that may affect them during this life stage. The present study describes dietary patterns in a cohort of adolescents and examines their associations with socio-economic factors, as well as parental and adolescent risk factor behaviours.

A semi-quantitative FFQ was used to assess study adolescents’ usual dietary intake over the previous year. Information was collected on family functioning and various socio-economic and risk factor variables via questionnaire. Adolescents visited the study clinic for anthropometric measurements.

The Western Australian Pregnancy Cohort Study (Raine Study), Perth, Western Australia.

Adolescents (n 1631) aged 14 years from a pregnancy cohort study.

Factor analysis identified two distinct dietary patterns that differed predominantly in fat and sugar intakes. The ‘Western’ pattern consisted of high intakes of take-away foods, soft drinks, confectionery, French fries, refined grains, full-fat dairy products and processed meats. The ‘healthy’ pattern included high intakes of whole grains, fruit, vegetables, legumes and fish. ANOVA showed that the ‘Western’ dietary pattern was positively associated with greater television viewing and having a parent who smoked, and was inversely associated with family income. The ‘healthy’ pattern was positively associated with female gender, greater maternal education, better family functioning and being in a two-parent family, and was inversely associated with television viewing.

The study suggests that both lifestyle factors and family psycho-social environment are related to dietary patterns in Australian adolescents.

To explore knowledge, attitudes and behaviours regarding caloric soft drinks in a group of young adults attending university and to identify opportunities for a health promotion intervention aimed at reducing consumption.

In-depth, semi-structured focus groups segmented by gender.

Sydney, Australia.

Undergraduate University of Sydney students aged 18–30 years (n 35).

Social and environmental cues, intrinsic qualities of beverages and personal health beliefs were identified as important influences on consumption. Social cues included settings in which alcohol is usually consumed, socialising with friends, and family influences. Environmental cues included purchasing of fast foods, and ready availability, preferential pricing and promotion of caloric beverages. Reinforcing intrinsic qualities of caloric soft drinks included taste, sugar and caffeine content, and their association with treats and rewards. Major gender differences as well as variations in individual readiness for behaviour change were observed. Raising awareness of the sugar content of various beverages and the potential health impacts associated with their consumption was considered important.

The findings provide new insights with important implications for policy and practice, and suggest that there is considerable scope for promoting awareness in this group. Carefully designed social marketing campaigns highlighting the health issues and addressing social and environmental cues relating to caloric soft drink consumption are required. There is a need for gender-differentiated intervention programmes which are both informational and appealing to young adults. Further research is warranted, particularly to investigate beverage consumption relating to fast-food meal deals and young adults’ consumption patterns in more depth.

To quantify the role of dietary Fe in total body Fe (TBI) accumulation among homozygotes for the HFE gene associated with haemochromatosis.

A Monte Carlo model was built to simulate Fe accumulation based on findings from human feeding experiments and national dietary surveys. A hypothetical cohort of 1000 homozygotes with starting age 25 years was used in 39-year simulations. The impact of reducing dietary Fe intake on Fe accumulation was tested.

In the baseline model without any dietary intervention, by age 64, the percentage of males with TBI > 10 g, >15 g and >20 g was 93·2 %, 49·6 % and 14·7 %, respectively. When the Fe intake of individuals in the cohort was reduced to ≤200 % of the recommended dietary allowance (RDA), the corresponding percentages were 92·0 %, 40·5 % and 10·2 %, respectively. The corresponding figures were 91·0 %, 40·0 % and 9·3 % for Fe defortification and 70·3 %, 21·3 % and 4·1 % when Fe intake was capped at 100 % RDA. Similar trends were seen with sexes combined, although the impact of interventions was less. Sensitivity analysis revealed that the rate of Fe accumulation and the impact of dietary interventions are highly dependent on assumptions concerning Fe absorption rates.

Variation in Fe intake as currently observed in the USA contributes to variation in Fe accumulation among homozygotes, when continued over an extended period. Lifelong dietary habits and national fortification policy can affect the rate of Fe accumulation, although the magnitude of the effect varies by gender, the TBI level of interest and factors affecting the Fe absorption rate.

To describe the development of a short questionnaire including a wide range of personal, social and environmental constructs in relation to a healthy diet in an adolescent population.

The questionnaire was developed based on the literature, past experiences and feedback from a small pilot study (n 10). Test and retest (2 weeks later) of the questionnaire was done to investigate test–retest reliability. Data of four non-consecutive 24 h recalls were collected to investigate the predictive validity with food (fruit, vegetables, milk, snacks, soft drinks), nutrient (fibre, ascorbic acid, Ca, percentage energy from fat) and energy intakes.

At home, in the presence of a student.

Convenience sample of fifty-five Belgian-Flemish adolescents approached by university students for course credits.

Test–retest correlations of the constructs ranged between 0·51 and 0·78. Eleven of the eighteen final constructs were significantly associated with one or more of the five selected food items, all in the expected direction. Most significant associations with the food items were found for taste, perceived peers’ behaviour and availability of soft drinks at home. Fresh fruit and soft drinks were correlated with most constructs (seven) followed by snacks (five). Concerning energy and the selected nutrient variables, the findings were less clear.

The results are promising: the test–retest stability was moderate to good; most of the psychosocial constructs were significantly associated with one or more of the selected dietary variables. Future work in a larger sample of European adolescents is warranted.