Potential error sources in nutrient estimation with the FFQ include inaccurate or biased recall and overestimation or underestimation of intake due to too many or too few items on the FFQ, respectively. Here we report the refinement of an FFQ that overestimated nutrient intake and its validation against multiple 24 h recalls.

Data on 2527 participants in south India (Trivandrum) were available for the original FFQ (OFFQ) that overestimated nutrient intake (132 food items). After excluding participants with implausible energy intake estimates (<2·72 MJ/d (<650 kcal/d), >15·69 MJ/d (>3750 kcal/d)) we ran stepwise regression analyses with selected nutrients as the outcomes and food intake (servings/d) as predictor variables (n 1867). From these results and expert consultation we refined the FFQ (RFFQ), and validated it by comparing intakes obtained with it and the mean of two 24 h recalls among 100 participants.

The OFFQ overestimated usual daily nutrient intake before and after exclusions [for energy: 13·39 (sd 5·46) MJ (3201 (sd 1305) kcal) and 10·96 (sd 2·65) MJ (2619 (sd 634) kcal), respectively]. In stepwise analyses, fifty-seven food items explained 90 % of the variance in nutrients; we retained thirteen food items because participants consumed them at least twice monthly and twelve food items that local nutritionists recommended. Mean energy intake estimated from the RFFQ (eighty-two food items) was 7·94 (sd 2·05) MJ (1897 (sd 489) kcal). The de-attenuated correlations between mean 24 h recall and RFFQ intakes ranged from 0·25 (vitamin A) to 0·82 (fat).

We refined an FFQ that overestimated nutrient intake by shortening and redesigning, and validated it by comparisons with 24 h dietary recall data.

To evaluate the prevalence of undernutrition among community-dwelling elderly people in Spain using the Mini Nutritional Assessment (MNA) and to analyse its distribution according to age, gender and residence region.

Cross-sectional study assessing the nutritional status of elderly persons through both the short form and the full version of the MNA test.

Pharmacy offices across the whole country (Spain) were enrolled to recruit participants.

A total of 22 007 participants (8014 men and 13 993 women), aged ≥65 years, assessed during the last two months of 2005.

According to MNA screening, 4·3 % subjects were classified as undernourished (MNA score <17) and 25·4 % were at risk of undernutrition (MNA score ≥17 to ≤23·5). The MNA short form correlated strongly with the full MNA version (r = 0·85). MNA total score was significantly higher in men than in women (25·4 (sd 3·7) v. 24·6 (sd 3·9); P < 0·001) and lower in the oldest than in the youngest subjects (P < 0·001) in both genders. According to regional distribution, the best nutritional status was found in elderly from the north of Spain excluding the north-west area.

Female gender, older age and living in the south half or north-west of the country were associated with higher rates of undernutrition among community-dwelling elderly persons in Spain.

Because most of the top determinants of the worldwide burden of disease are diet-related, the promotion of healthful diets is important for population health across the world. Furthermore, changes in eating habits may contribute to preservation of the environment.

In the present paper it is argued that the translation of health-promoting dietary recommendations into practical recommendations for healthful eating should be more tailored to regional circumstances. This will promote population health as well as help preserve cultural diversity in eating habits and contribute to more environmentally friendly eating. A regional Nordic diet, mimicking the Mediterranean diet to some extent, is presented as an example.

A theoretically health-enhancing Nordic diet is possible including six evidence-based ingredients: (i) native berries; (ii) cabbage; (iii) native fish and other seafood; (iv) wild (and pasture-fed) land-based animals; (v) rapeseed oil; and (vi) oat/barley/rye.

Low-carbohydrate diets could lead to reduced fruit and vegetable intake, which may be protective against CVD. The role of carbohydrate intake in modifying the association between fruits and vegetables and CVD has not been evaluated.

To evaluate whether carbohydrate intake affects the association between fruits and vegetables and CVD.

We included participants from two large prospective studies, the Nurses’ Health Study (NHS) and the Health Professionals’ Follow-Up Study (HPFS). We followed 70 870 eligible NHS females for 16 years and 38 918 eligible HPFS males for 14 years. Diet was assessed from an FFQ updated every 4 years. Our primary outcome was ischaemic CVD (fatal and non-fatal myocardial infarction and ischaemic stroke). We used Cox proportional hazards models to evaluate the relationship between fruits and vegetables and ischaemic CVD within groups with low, moderate or high carbohydrate intake.

Fruit intake was strongly related with carbohydrate intake, but vegetables showed a very small correlation. Vegetable intake showed stronger associations with ischaemic CVD among the low carbohydrate group (multivariate risk ratio (RR) = 0·82 for an increment of 3 servings/d; 95 % CI 0·68, 0·99); green leafy vegetables and carotene-rich fruits and vegetables followed a similar pattern. Total fruit intake was associated with a lower risk of ischaemic CVD only among participants with moderate carbohydrate intake (RR = 0·81 comparing extreme quintiles; 95 % CI 0·70, 0·94).

Total vegetables, green leafy vegetables and carotene-rich fruits and vegetables showed stronger associations with ischaemic CVD among the low carbohydrate group. No consistent trends were observed for fruit intake.

To determine the criterion validity and user acceptability of the Healthy Eating Self-Monitoring Tool (HEST), a CD-ROM-mediated food record for measuring fruit and vegetable consumption among economically disadvantaged black adolescents.

Item intakes, daily intake measures of fruit, vegetables and juices, and daily and total fruit and vegetable intake assessed with the HEST over a 3 d interval were compared with observed intake using Spearman correlations and Wilcoxon signed ranks tests. Mean ratings of participants’ interest in, enjoyment of and likelihood of recommending the HEST to peers were compared with an a priori criterion rating for establishing user acceptability of the HEST.

Youth services agencies in New York City.

Eighty-nine black adolescents aged 11 to 14 years.

Spearman correlations were significant for 67 % of items, for daily intake measures of fruit (days 1 and 3), vegetables and juices (days 1 and 2), and for fruit and vegetable intake (all three days). Wilcoxon signed ranks tests found non-significant intake differences for 78 % of these items, for daily intake measures of fruit and vegetables, and for fruit and vegetable intake (days 2 and 3). HEST-recorded 3 d intake of 14·65 servings was significantly correlated with and did not differ significantly from observed 3 d intake of 15·21 servings. Youths’ HEST-recorded intake was accurate to within 0·56 of a serving of their observed intake. Mean ratings of the HEST were above the criterion rating across user acceptability dimensions assessed.

The HEST is a promising food record approach that is acceptable to youths.

The present study was undertaken to compare plasma Se values and glutathione peroxidase (GPX) activity in normal and breast cancer patients.

In a case–control study, forty-five breast cancer patients and the same number of healthy women were randomly selected from their population. Se was measured in plasma by atomic absorption spectrophotometry and GPX activity in erythrocytes was measured using a standard spectrophotometric method.

Plasma Se concentration in healthy women and breast cancer patients was in the normal range, with no statistically significant difference observed between the two groups (138·40 (sd 40·36) μg/l v. 132·15 (sd 35·37) μg/l, respectively). Erythrocyte GPX activity was significantly (P<0·01) higher in breast cancer patients (24·81 (sd 11·66) U/g Hb) compared with healthy women (20·29 (sd 4·24) U/g Hb).

The present study indicated that Se deficiency was not a problem in the participants, and sufficient quantity of this element could increase GPX activity to have a protective effect against oxidative damage.

Chewing betel-nuts (Areca catechu) is carcinogenic but the risk for hepatocellular carcinoma (HCC) and liver cirrhosis (LC) is little considered. Worldwide 600 million people chew betel, including emigrants from palm-growing countries.

We aimed to assess the relationships and dose–response effects of betel chewing on LC and HCC risks, since habit cessation could reduce the increased risks of HCC and LC found in such communities.

Screening 60 326 subjects aged 30–79 years in a population-based study in Taiwan identified LC in 588 and HCC in 131 subjects. Demographic features, hepatitis B/C infections, other risk factors and betel chewing were noted. Multiple Cox regression models were used to assess independent relationships, interactions and synergisms between age, betel chewing and hepatitis B/C.

Betel chewing increased LC and HCC risk 4·25-fold (95 % CI 2·9, 6·2) in current chewers and 1·89-fold (95 % CI 1·13, 3·16) in ex-chewers v. never-chewers, with dose effects for quantity, duration and cumulative exposure in chewers. Subjects without hepatitis B/C infections had 5·0-fold (95 % CI 2·87, 9·03) increased risk of LC/HCC v. never-chewers, and betel chewing had an additive synergistic effect on hepatitis B/C-related risks. Risk reduction with betel habit cessation could exceed that expected from immunization programmes for hepatitis B and C.

Increased risks of cirrhosis and hepatocellular cancer were found in betel chewers free of hepatitis B/C infection, and these risks were synergistically additive to those of hepatitis B/C infections. Estimated risk reduction from effective anti-betel chewing programmes would be sizeable.

To examine the association between skipping breakfast, daily energy, macronutrients and food intakes, and BMI in pre-school children.

A cross-sectional study using information on children’s food consumption and measured height and weight. Energy and macronutrient intakes of the children were derived from parent/day-care attendant’s responses to 24 h recall interviews and eating behaviour questionnaires.

Data obtained from a representative sample (n 2103) of children born in Quebec (Canada) in 1998.

One thousand five hundred and forty-nine children, with a mean age of 49 (sd 3·12) months.

Ten per cent of children ate breakfast on fewer than 7 days per week. This behaviour was associated with a lower diet quality and concentrated energy intakes through higher protein intakes at lunch and the consumption of snacks higher in energy and carbohydrate in the afternoon and evening; yet total daily energy intakes were not significantly different from those of pre-school children who ate breakfast every day. Breakfast skippers’ mean BMI increased as intake of energy, carbohydrates or servings of grain products increased; however, this was not the case for breakfast eaters. When Cole’s cut-off for overweight/obesity was used, overweight/obesity in breakfast skippers was related to the dinner-time consumption of approximately 3000 kJ (700 kcal) or more for energy intake, approximately 100 g or more of carbohydrates, or approximately 3 servings or more of grain products.

Eating breakfast every day is associated with having a healthy body weight, likely due to a more even distribution of energy intake across meals throughout the day.

To evaluate the 5-year incidence of obesity in a sample of CVD-free adults and investigate the potential effect of several sociodemographic and lifestyle habits on weight change and obesity incidence in these individuals.

Men (n 1514) and women (n 1528) (>18 years) without any clinical evidence of CVD, living in the Attica area of Greece, were enrolled in the ATTICA study from May 2001 to December 2002. The sampling was random, multistage and included information about various sociodemographic, lifestyle (diet, exercise and smoking), biochemical and clinical characteristics. In 2006, the 5-year follow-up was performed through telephone calls or personal visits. Data from the 1364 participants are analysed in the present work.

The 5-year incidence of obesity was 21·8 % in men and 11·9 % in women. The ratio of men to women revealed that more men than women developed obesity, while more women than men became overweight during the follow-up period. It was found that men were 1·6 times more likely to develop obesity compared with women; abnormal waist circumference, smoking habits and the presence of hypercholesterolaemia increased the risk for developing obesity, irrespective of age and baseline lifestyle characteristics of the participants. In the multivariate analysis, no association was detected between adherence to a Mediterranean diet and incidence of obesity in initially normal-weight individuals.

Obesity remains a serious health problem for the Greek population; the alarming rates of excess body weight continue to increase. Preventive measures should be urgently addressed, targeting particularly those with metabolic risk factors.

Signal detection analysis, a form of recursive partitioning, was used to identify combinations of sociodemographic and acculturation factors that predict trying to lose weight in a community-based sample of 957 overweight and obese Mexican-American adults (ages 18–69 years).

Data were pooled from the 2004 and 2006 Behavioral Risk Factor Surveillance System conducted in a low-income, semi-rural community in California.

Overall, 59 % of the population reported trying to lose weight. The proportion of adults who were trying to lose weight was highly variable across the seven mutually exclusive groups identified by signal detection (range 30–79 %). Significant predictors of trying to lose weight included BMI, gender, age and income. Women who were very overweight (BMI > 28·5 kg/m2) were most likely to be trying to lose weight (79 %), followed by very overweight higher-income men and moderately overweight (BMI = 25·0–28·5 kg/m2) higher-income women (72 % and 70 %, respectively). Moderately overweight men, aged 28–69 years, were the least likely to be trying to lose weight (30 %), followed by moderately overweight lower-income women (47 %) and very overweight lower-income men (49 %). The latter group is of particular concern since they have characteristics associated with medical complications of obesity (low education and poor access to medical care).

Our findings highlight opportunities and challenges for public health professionals working with overweight Mexican-American adults – particularly lower-income adults who were born in Mexico – who are not trying to lose weight and are therefore at high risk for obesity-related co-morbidities.

To compare physical activity (PA) reported through pedometer registrations (step counts) with PA reported in four different questionnaires; to compare step count thresholds (7500, 10 000 and 12 500 steps/d) with the PA guideline of 30 min of moderate to vigorous PA (MVPA) per day.

A sample of 310 healthy adults, mean age 38·7 (sd 11·9) years, volunteered to participate. Forty-seven per cent was male and 93 % of the sample was employed.

PA was assessed by interview (Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ)), three self-administered questionnaires (long version and short version of the International Physical Activity Questionnaire (long-form IPAQ, short-form IPAQ), Baecke questionnaire) and seven consecutive days of pedometer registration.

Step counts correlated positively with questionnaire-based PA. The strongest correlations were found between step counts and total PA reported in the long-form IPAQ (rs = 0·37), moderate PA reported in the short-form IPAQ (rs = 0·33), total and moderate PA reported in the MLTPAQ (rs = 0·32), and the total and leisure-time PA indices (excluding sport) reported in the Baecke questionnaire (rs = 0·44). According to step counts, 22·6 % of the participants were somewhat active, 18·7 % active and 39·4 % highly active. As assessed by the long-form IPAQ, short-form IPAQ and MLTPAQ, the guideline of 30 min MVPA/d was reached by respectively 85·4 %, 84·8 % and 68·0 % of participants.

Pedometer-based data offer adequate information to discriminate between levels of PA. Caution is needed when comparing active samples based on different PA recommendations.

The WHO recommends a daily Ca intake for postmenopausal women of 1300 mg. The objective of the present study was to assess the dietary Ca intake in European postmenopausal osteoporotic women.

Assessment of dietary Ca intake (food and supplements) was performed with a validated self-questionnaire in 8524 osteoporotic women from nine European countries (Belgium, Denmark, France, Germany, Hungary, Italy, Poland, Spain and the UK).

Mean age of the patients was 74·2 (sd 7·1) years, mean BMI was 25·7 (sd 4·2) kg/m2. Of the study population, 37·2 % of the women took Ca supplements. The mean dietary intake of Ca was 930·7 (sd 422·9) mg/d. The lowest Ca intake was found in Hungary (586·7 (sd 319·1) mg/d) and the highest in Denmark (1145·6 (sd 463·0) mg/d). In the whole study population, only 19·1 % of the women had a dietary Ca intake >1300 mg/d. Only 17·1 % of women aged over 75 years achieved 1300 mg/d compared with 20·5 % of women aged less than 75 years (P = 0·0001 for the difference between the two groups).

Dietary intake of Ca is very low in European postmenopausal women. A greater awareness is needed to resolve this public health problem.

To examine the association between television advertising exposure and adults’ consumption of fast foods.

Cross-sectional telephone survey. Questions included measures of frequency of fast-food consumption at different meal times and average daily hours spent watching commercial television.

Subjects comprised 1495 adults (41 % response rate) aged ≥18 years from Victoria, Australia.

Twenty-three per cent of respondents usually ate fast food for dinner at least once weekly, while 17 % consumed fast food for lunch on a weekly basis. The majority of respondents reported never eating fast food for breakfast (73 %) or snacks (65 %). Forty-one per cent of respondents estimated watching commercial television for ≤1 h/d (low viewers); 29 % watched for 2 h/d (moderate viewers); 30 % watched for ≥3 h/d (high viewers). After adjusting for demographic variables, high viewers were more likely to eat fast food for dinner at least once weekly compared with low viewers (OR = 1·45; 95 % CI 1·04, 2·03). Both moderate viewers (OR = 1·53; 95 % CI 1·01, 2·31) and high viewers (OR = 1·81; 95 % CI 1·20, 2·72) were more likely to eat fast food for snacks at least once weekly compared with low viewers. Commercial television viewing was not significantly related (P > 0·05) to fast-food consumption at breakfast or lunch.

The results of the present study provide evidence to suggest that cumulative exposure to television food advertising is linked to adults’ fast-food consumption. Additional research that systematically assesses adults’ behavioural responses to fast-food advertisements is needed to gain a greater understanding of the mechanisms driving this association.