To assess the efficacy of two school-based programmes to promote students’ willingness to engage in lifestyle changes related to eating habits and physical activity behaviours.

Elementary school-based health promotion intervention, designed as a multicomponent experimental study, based on a behavioural epidemiological model.

Nine intervention and eight comparative public and private elementary schools.

The goal was to determine the impact on the longitudinally assessed outcomes of two programmes that addressed healthy nutrition and active living in a cohort of 2038 children. The evaluations used pre-intervention and follow-up student surveys that were based on the Transtheoretical Model of the stages of behaviour change.

In the intervention group, there were significant (P < 0·001) differences between the pre- and post-intervention times in the stages of change, with a reduction in the percentage of children at the pre-contemplation and contemplation stages and increased percentages at the preparation, action and maintenance stages, leading to healthier behaviours in fatty food consumption, fruit and vegetable consumption, physical activity and time spent in sedentary activities. The determinants of the behaviour stage were the intervention programme, the type of school and the presence of motivated teachers. The comparison group did not show significant differences between the pre- and post-intervention times for any of the stages of behaviour.

The intervention programme encouraged the students to make healthy lifestyle choices related to eating habits and physical activity behaviours.

The emphasis in school nutrition policy has been on vending and competitive items. Our study was designed to characterize and quantify the amount and source of other foods and beverages on school campuses.

A cross-sectional observational study was conducted using a specially designed objective nutrition observation system.

One low-income school district in southern California with six elementary and two middle schools.

Data were not collected from individual children. A total of 4033 students, 42 % of whom were Hispanic/Latino, 26 % African American and 21 % non-Hispanic white, were observed across school settings.

Data were collected continuously from 9 January 2008 to 16 June 2010. Healthy foods had, per serving, total energy ≤732 kJ (≤175 kcal), total fat content ≤35 %, total saturated fat ≤10 %, sugar less ≤15 g, sodium <200 mg and trans-fat ≤0·5 g. Healthy beverages were only 100 % juice or water, and unflavoured non-fat, 1 %, 2 % milk and soya or rice milk. The system had high inter-rater reliability (r = 0·78 to 0·99), percentage agreement (83 % to 100 %) and test–retest reliability (r = 0·81 to 0·98). Significantly more unhealthy foods and beverages than healthy items were observed on all campuses (P < 0·001). An average of 1·26 (sd 0·46) items per student per week was found with an average of 0·86 (sd 0·34) unhealthy items per child per week.

There were substantial amounts of unhealthy foods and beverages brought onto campuses for classroom rewards, celebrations and fundraising that should be targeted for intervention.

To assess the school food environment in terms of breakfast consumption, school meals, learners’ lunch box, school vending and classroom activities related to nutrition.

Cross-sectional survey.

Ninety purposively selected poorly resourced schools in South Africa.

Questionnaires were completed by school principals (n 85), school feeding coordinators (n 77), food handlers (n 84), educators (n 687), randomly selected grade 5 to 7 learners (n 2547) and a convenience sample of parents (n 731). The school menu (n 75), meal served on the survey day, and foods at tuck shops and food vendors (n 74) were recorded.

Twenty-two per cent of learners had not eaten breakfast; 24 % brought a lunch box, mostly with bread. Vegetables (61 %) were more often on the school menu than fruit (28 %) and were served in 41 % of schools on the survey day compared with 4 % serving fruit. Fifty-seven per cent of learners brought money to school. Parents advised learners to buy fruit (37 %) and healthy foods (23 %). Tuck shops and vendors sold mostly unhealthy foods. Lack of money/poverty (74 %) and high food prices (68 %) were major challenges for healthy eating. Most (83 %) educators showed interest in nutrition, but only 15 % had received training in nutrition. Eighty-one per cent of educators taught nutrition as part of school subjects.

The school food environment has large scope for improvement towards promoting healthy eating. This includes increasing access to vegetables and fruit, encouraging learners to carry a healthy lunch box, and regulating foods sold through tuck shops and food vendors.

To assess impacts of the nationwide Norwegian School Fruit Scheme (NSFS) using nationally representative data.

The NSFS is organized such that primary-school children (grades 1–7) are randomly assigned to one of three school fruit arrangements: (i) the child receives one free fruit or vegetable per day; (ii) the child is given the option to subscribe to one fruit or vegetable per day at a subsidized price; and (iii) the child attends a school that has no school fruit arrangement.

Data from an Internet survey are used to compare child and parental fruit and vegetable intakes across the three NSFS groups focusing mainly on groups (i) and (iii). The analysis was conducted using multivariate regression techniques.

Parents of primary-school children (n 1423) who report on behalf of themselves and their children.

Children who receive free school fruit eat on average 0·36 more fruit portions daily – or 25·0 % more fruits – than children who attend schools with no fruit arrangement (P < 0·001). Moreover, parents of children who receive free school fruit eat on average 0·19 more fruit portions daily – or 12·5 % more fruits – than parents of children who attend schools with no fruit arrangement (P = 0·040). No significant associations were found between the NSFS and the vegetable intakes of children and their parents.

The study shows, using nationally representative data, that free school fruit is associated with increased child fruit intake and that it may also affect parental fruit intake.

Most children do not meet the recommended intake of vegetables. Variety was identified as a potential factor to increase children's intake of these foods, as it was shown that variety was effective in improving meal composition in adults. Because younger children are suggested to be more responsive to internal satiation signals than to external food-related cues compared with adults, it is not clear whether variety is effective to improve meal composition in 7- to 10-year-old children.

Experiment.

Children were assigned one of three different fake food buffets containing pasta, chicken, and either one vegetable (carrots or beans) or two vegetables (carrots and beans). The children were asked to serve themselves a meal that they would like to eat for lunch from the given selection.

One hundred children (fifty-two boys; mean age 8·8 (sd 1·1) years).

Children given the two-vegetable choice served themselves significantly more energy from vegetables (mean 64 (sd 51) kJ, 10·9 (sd 9·4) %) compared with children who were offered only either carrots (mean 37 (sd 25) kJ, 5·9 (sd 6·5) %) or beans (mean 38 (sd 34) kJ, 5·6 (sd 6·3) %). The total energy of the meal was not increased, indicating that children chose a more balanced lunch when offered more vegetables.

School-aged children are responsive to food-related cues and variety is effective in increasing their vegetable choice. Serving an assortment of vegetables in school cafeterias might be a simple and effective strategy to improve children's nutrition.

To compare the dietary intakes of Dutch nutrition and dietetics students with the Dutch RDA and the Dutch National Food Consumption Survey (DNFCS), and to assess whether dietary intake changes during education.

Cross-sectional and longitudinal research (2004–2010).

Data collection by 7 d dietary record and questionnaire.

Dutch nutrition and dietetics students.

Three hundred and fifty-two first-year and 216 fourth-year students were included. One hundred and thirty-three students in three cohorts were assessed twice. Of first-year students, >80 % met the RDA for all macronutrients. Of these students only 37 % met the RDA for fibre and in 43 % intake of saturated fat was too high. Fourth-year students more often met the RDA for fruits (55 %) and vegetables (74 %) compared with first-year students (32 % and 40 %, respectively). Intake of fruits and vegetables of both first- and fourth-year students was much higher than that of DNFCS participants (where 2 % and 7 %, respectively, met the corresponding RDA). Only <25 % of fourth-year students met the RDA for Fe, Se and vitamin D. In the cohorts, dietary intake for all macronutrients stabilised from the first to the fourth year (>80 %). Intakes of dietary fibre, Ca, Mg, Se, riboflavin, niacin, fruits, vegetables and fish improved significantly during education.

Dietary intake of nutrition and dietetics students is much better than that of DNFCS participants and improved during education. However, there is still a gap between actual dietary intake and the RDA, especially for Fe, Se and vitamin D.

As part of a larger evaluation of school nutrition programmes (SNP), the present study examined programme coordinators’ perceptions of strengths, weaknesses, opportunities and threats (SWOT) regarding their SNP and public health professionals’ support.

Qualitative interviews were conducted with twenty-two of eighty-one programme coordinators who had completed a programme evaluation survey. Interviews followed a SWOT framework to evaluate programmes and assessed coordinators’ perceptions regarding current and future partnerships with public health professionals.

The study was conducted in a large, urban region within Ontario.

The twenty-two coordinators who participated represented a cross-section of elementary, secondary, Public and Catholic schools.

SNP varied enormously in foods/services offered, how they offered them and perceived needs. Major strengths included universality, the ability to reach needy students and the provision of social opportunities. Major weaknesses included challenges in forming funding partnerships, lack of volunteers, scheduling and timing issues, and coordinator workload. Common threats to effective SNP delivery included lack of sustainable funding, complexity in tracking programme use and food distribution, unreliable help from school staff, and conflicts with school administration. Opportunities for increased public health professionals’ assistance included menu planning, nutrition education, expansion of programme food offerings, and help identifying community partners and sustainable funding.

The present research identified opportunities for improving SNP and strategies for building on strengths. Since programmes were so diverse, tailored strategies are needed. Public health professionals can play a major role through supporting menu planning, food safety training, access to healthy foods, curriculum planning and by building community partnerships.

To (i) evaluate food choices and consumption patterns of elementary- and middle-school students who participate in the National School Lunch Program (NSLP) and (ii) compare students’ average nutrient intake from lunch with NSLP standards.

Plate waste from elementary- and middle-school students’ lunch trays was measured in autumn 2010 using a previously validated digital photography method. Percentage waste was estimated to the nearest 10 % for the entrée, canned fruit, fresh fruit, vegetable, grain and milk. Univariate ANOVA determined differences in percentage waste between schools, grades and genders. Daily nutrient intake was calculated using the district's menu analysis and percentage waste.

Elementary and middle schools in northern Colorado (USA).

Students, grades 1–8.

Plate waste was estimated from 899 lunch trays; 535 elementary- and 364 middle-school students. Only 45 % of elementary- and 34 % middle-school students selected a vegetable. Elementary-school students wasted more than a third of grain, fruit and vegetable menu items. Middle-school students left nearly 50 % of fresh fruit, 37 % of canned fruit and nearly a third of vegetables unconsumed. Less than half of the students met the national meal standards for vitamins A and C, or Fe.

Few students’ lunch consumption met previous or new, strengthened NSLP lunch standards. Due to the relatively low intake of vegetables, intakes of vitamins A and C were of particular concern. Effective behavioural interventions, combined with marketing, communications and behavioural economics, will likely be necessary to encourage increased vegetable intake to meet the new meal standards.

To develop a software to plan and evaluate school meals according to the main national and international standards for foods and nutrition.

Development of software.

Public schools, Portugal.

School meals for students.

The System of Planning and Evaluation of School Meals (SPARE) is a software that allows the planning of school meals in an effective and organized way, according to the main national and international standards for food and nutrition. The regular use of this tool enables the evaluation, monitoring and verification towards continuous improvement of the quality of school meals.

The SPARE software aims to promote healthy eating by focusing on the planning and production of safe and adequate meals in the school environment. This software can be adapted to different age groups and to different contexts, attending to specific nutritional and food standards.

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.

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.

Increasing numbers of overweight and obese youth draw attention to the school as an important setting for targeted nutrition interventions, given that it is where they spend a majority of their waking time. The objective of the present study was to explore local-level factors shaping the implementation of a school nutrition policy.

In-depth, semi-structured interviews were conducted in person or via the telephone (a maximum of 60 min). An interview guide was informed by the Analysis Grid for Environments Linked to Obesity (ANGELO) framework, research objectives and literature. Key themes centred on policy implementation, including facilitators and barriers (i.e. resources, capacity), user satisfaction (i.e. students) and communication strategies.

Secondary schools in Ontario, Canada.

Twenty-two participants from local agencies supporting school nutrition programming (n 8) and secondary-school principals, vice principals and teachers (n 14) from nine schools across three Ontario school boards.

Results are organized according to environments outlined in the ANGELO framework. The cost of healthy food for sale, revenue loss (economic), proximity of schools to off-site food outlets (physical), the restrictive nature of policy, the role of key stakeholders (political), the role of stigma and school culture (sociocultural) act as local-level barriers to policy implementation.

Gaps in policy implementation include the high cost of food for sale and subsequent revenue generation, the close proximity of internal and external food environments, the need for consultation and communication between stakeholders, and strategies to reduce stigma and improve the school nutrition culture.

The present study investigates whether public organic food procurement policies have the potential to induce changes in the school food service environment.

A comparative cross-national survey was conducted in public primary and/or secondary schools in Finland, Germany and Italy. The school food coordinators completed a web-based questionnaire on their attitudes, intentions and actions towards organic school food provision.

In Germany, 122 out of 2050 schools in the state of Hesse responded. In Finland, 250 out of 998 schools across the country responded. In Italy, 215 out of 940 schools from eight provinces responded.

School food coordinators in the sample of schools in the three countries.

The German and Finnish school food coordinators separately most agreed with the promotion of healthy eating habits (P < 0·001) and organic food (P < 0·001) by schools. The Finnish schools were most likely to adopt a food and nutrition policy (P < 0·001), a health-promoting school policy according to WHO principles (P < 0·001), to have a playground (P < 0·001), to involve physical activity themes in teaching (P = 0·012) and to have a canteen (P < 0·001). The Italian schools were most likely to involve the food and nutrition policy in pedagogical activities (P = 0·004), to serve nutritional school meals (P < 0·001) and to recommend children to eat healthily (P < 0·001). In the three countries, the non-organic schools were less likely to adopt a food and nutrition policy (P < 0·001), a WHO health-promoting policy (P < 0·001) and have a canteen (P = 0·017) than the organic schools.

The study suggests that there is a gap in the effects of public organic food procurement policy on building a healthier school food environment.

To assess racial/ethnic differences in the diet in young children and the explanatory role of maternal BMI, immigrant status and perception of child's weight.

Among white, black and Hispanic 3-year-olds, we used negative binomial and linear regression to examine associations of race/ethnicity with foods and nutrients assessed by a validated FFQ.

Project Viva, Boston (MA), USA.

Children aged 3 years (n 898).

Mean age was 38·3 (sd 2·8) months; 464 (52 %) were boys and 127 mothers (14 %) were immigrants. After adjustment for sociodemographic factors, black and Hispanic children (v. white) had a higher intake of sugar-sweetened beverages (rate ratio (RR) = 2·59 (95 % CI 1·95, 3·48) and RR = 1·59 (95 % CI 1·07, 2·47), respectively) and lower intakes of skimmed/1 % milk (RR = 0·42 (95 % CI 0·33, 0·53) and RR = 0·43 (95 % CI 0·31, 0·61), respectively) and trans-fat (−0·10 (95 % CI −0·18, −0·03) % of energy and −0·15 (95 % CI −0·26, −0·04) % of energy, respectively). Among Hispanics only, a lower intake of snack food (RR = 0·83 (95 % CI 0·72, 0·98)) was found and among blacks only, a higher intake of fast food (RR = 1·28 (95 % CI 1·05, 1·55)) and lower intakes of saturated fat (−0·86 (95 % CI −1·48, −0·23) % of energy), dietary fibre (0·85 (95 % CI 0·08, 1·62) g/d) and Ca (−120 (95 % CI −175, −65) mg/d) were found. Being born outside the USA was associated with more healthful nutrient intakes and less fast food.

Three-year-old black and Hispanic (v. white) children ate more sugar-sweetened beverages and less low-fat dairy. Total energy intake was substantially higher in Hispanic children. Snack food (Hispanic children) and fat intakes (black children) tended to be lower. Children of immigrants ate less fast food and bad fats and more fibre.

We assessed associations of maternal common mental disorders (CMD) with undernutrition and two common illnesses in children aged 0–5 years.

Cross-sectional survey. Maternal CMD was measured using the WHO Self-Reporting Questionnaire-20. Child undernutrition was defined as stunting, underweight or wasting. Child illnesses included diarrhoea and acute respiratory infections (ARI). Multivariate logistic regression was used to test these associations adjusting for confounders at child, maternal and household levels.

Bangladesh, Vietnam and Ethiopia.

Mothers with children aged 0–5 years from 4400 households in Bangladesh, 4029 households in Vietnam and 3000 households in Ethiopia.

The prevalence of maternal CMD was high, ranging from 31 % in Vietnam to 49 % in Bangladesh. Child undernutrition was more prevalent in Bangladesh and Ethiopia than in Vietnam. Symptoms of ARI and diarrhoea were also prevalent. In multivariate analysis, maternal CMD was associated with child stunting in Bangladesh (OR = 1·21; 95 % CI 1·03, 1·41) and with child underweight in Vietnam (OR = 1·27; 95 % CI 1·01, 1·61); no association was found with wasting. Maternal CMD was strongly associated with diarrhoea and ARI in all three countries.

Maternal CMD, which affected nearly half of women in Bangladesh and one-third in Vietnam, was an important determinant of child stunting and underweight, respectively. No such association was found in Ethiopia, although CMD affected 39 % of women. Maternal CMD was strongly associated with childhood illnesses in all three countries. Interventions to support maternal mental health are important for women's own well-being and could make important contributions to improving child health and nutrition.

We evaluated the influence of coffee consumption on diabetes incidence among the Hawaii component of the Multiethnic Cohort (MEC).

Prospective cohort.

Population-based sample residing in Hawaii.

After exclusions, 75 140 men and women of Caucasian, Japanese American and Native Hawaiian ancestry aged 45–75 years were part of the current analysis. All participants provided information on diet and lifestyle through an FFQ. After 14 years of follow-up 8582 incident diabetes cases were identified using self-reports, medication questionnaires and health plan linkages. Hazard ratios (HR) and 95 % confidence intervals were calculated using Cox regression while adjusting for known covariates.

The risk for diabetes associated with total coffee consumption differed by sex (Pinteraction < 0·0001). Women consuming ≥3 cups of any type of coffee daily had a significantly lower risk (HR = 0·66; 95 % CI 0·58, 0·77; Ptrend < 0·0001) than those reporting <1 cup/d, whereas the relationship in men was borderline (HR = 0·89; 95 % CI 0·80, 0·99; Ptrend = 0·09). The same difference by sex was seen for regular coffee consumption, with HR of 0·65 (95 % CI 0·54, 0·78; Ptrend < 0·0001) and 0·86 (95 % CI 0·75, 0·98; Ptrend = 0·09) in men and women, respectively. No significant association with diabetes was apparent for decaffeinated coffee in women (HR = 0·85; 95 % CI 0·72, 1·01; Ptrend = 0·73) or men (HR = 1·07; 95 % CI 0·93, 1·23; Ptrend = 0·71). Despite small differences by ethnicity, the interaction terms between coffee intake and ethnicity were not significant.

In this multiethnic population, regular, but not decaffeinated, coffee intake was much more protective against diabetes in women of all ethnic groups than in men.

The present study sought to investigate the associations of total n-3 fatty acid and SFA intakes with insulin resistance in a Canadian First Nation sample at risk for type 2 diabetes.

Fasting values for glucose and insulin were used to estimate insulin resistance by homeostasis model assessment (HOMA-IR). Intakes of n-3 fatty acids and SFA were computed from dietary food and drink data obtained using 3 d food records. Associations between HOMA-IR and dietary n-3 and SFA consumption were tested using linear regression models accounting for age, sex, community, education, physical activity, waist circumference, fibre, protein and carbohydrate intakes, and HDL-cholesterol and TAG concentrations.

Rural Okanagan region of British Columbia, Canada.

On-reserve First Nation individuals (Interior Salishan) aged 18 years and over, recruited for community-based diabetes screening and determined to be normoglycaemic (n 126).

HOMA-IR was negatively associated with dietary n-3 fatty acid intake (β = −0·22; 95 % CI −0·39, −0·04; P = 0·016) and positively associated with dietary SFA intake (β = 0·34; 95 % CI 0·15, 0·53; P = 0·0 0 1).

Intake of dietary n-3 fatty acids may be protective against whereas SFA intake may promote insulin resistance in this high-risk Canadian First Nation sample. Reduced dietary SFA intake and greater n-3 fatty acid intake may assist the prevention of glycaemic disease among First Nations peoples. More rigorous, controlled trials are required to test whether dietary supplementation with n-3 fatty acids in natural or supplement-based form might reduce diabetes risk in high-risk aboriginal groups.

Se is an antioxidant micronutrient and has been studied for its potential role in CVD prevention. The purpose of the present study was to conduct a systematic review of the literature on the relationship between Se and hypertension.

We conducted a systematic literature search in PubMed and OVID of studies on Se levels and hypertension or blood pressure published in English up to June 2011. Articles meeting inclusion criteria were reviewed and the following information was gathered from each publication: study setting, participant demographics, exclusion criteria, intervention if applicable, medium of Se measure, mean level of Se, outcome definition, relationship between Se and the outcome variable, significance of this relationship, and covariates. In studies that also reported glutathione peroxidase levels, we extracted results on the relationship between glutathione peroxidase and hypertension.

Twenty-five articles were included. Approximately half of the studies reported no significant relationship between Se and hypertension. Of the remaining studies, about half found that higher Se levels were associated with lower blood pressure and the other half found the opposite relationship. The studies varied greatly in terms of study population, study design and Se levels measured in participants.

Based on the present systematic review, there is no conclusive evidence supporting an association between Se and hypertension. Randomized controlled trials and prospective studies with sufficient sample size in populations with different Se levels are needed to fully investigate the relationship between Se and hypertension.

To document iodine status in Indian pregnancies, associations with maternal diet and demographics, and offspring developmental measures.

Longitudinal study following mothers through pregnancy and offspring up to 24 months.

Rural health-care centre (Vadu) and urban antenatal clinic (Pune) in the Maharashtra region of India.

Pregnant mothers at 17 (n 132) and 34 weeks’ (n 151) gestation and their infants from birth to the age of 24 months.

Median urinary iodine concentration (UIC) was 203 and 211 μg/l at 17 and 34 weeks of pregnancy, respectively (range 26–800 μg/l). Using the UIC distribution adjusted for within-person variation, extreme UIC quartiles were compared for predictors and outcomes. There was no correlation between UIC at 17 and 34 weeks, but 24 % of those with UIC in the lowest quartile at 17 weeks had UIC in the same lowest quartile at 34 weeks. Maternal educational, socio-economic status and milk products consumption (frequency) were different between the lowest and highest quartile of UIC at 34 weeks. Selected offspring developmental outcomes differed between the lowest and highest UIC quartiles (abdominal circumference at 24 months, subscapular and triceps skinfolds at 12 and 24 months). However, UIC was only a weak predictor of subscapular skinfold at 12 months and of triceps skinfold at 24 months.

Median UIC in this pregnant population suggested adequate dietary provision at both gestational stages studied. Occasional high results found in spot samples may indicate intermittent consumption of iodine-rich foods. Maternal UIC had limited influence on offspring developmental outcomes.