Few studies have considered the combined effects of home-related determinants on children's diet. The present study investigated independent associations between sociodemographic and food practice (SFP) characteristics and fruit and vegetable consumption in UK children and the combined effects of SFP on consumption using pattern analysis.

Diet was assessed using 4 d food diaries, SFP were collected using computer-assisted personal interview. Linear regressions were used to test associations; principal component analysis was used to identify patterns of SFP characteristics. Regression of fruit (g/d) and vegetables (g/d) v. component scores of each pattern were performed.

UK National Diet and Nutrition Survey Rolling Programme (2008–2010).

Children aged 1·5–10 years (n 642).

Significant associations were found between fruit and vegetable consumption and household socio-economic status. Pattern 1, which was positively correlated with household structure characteristics, was associated with increased fruit consumption (P < 0·001). Pattern 2, characterised by positive correlations for socio-economic status, fruit availability and organic food purchase, and negatively correlated with household size and the number of children per household, was associated with higher fruit and vegetable consumption (both P < 0·001). Pattern 3, characterised by high frequency of eating out and eating takeaway, was associated with a lower consumption of both fruit (P < 0·012) and vegetables (P < 0·023).

Patterns of SFP determinants may be more informative than individual characteristics in relation to dietary outcomes. Results have public health implications on the healthfulness of meals eaten out of home and in takeaways, as well as the need to reduce diet inequality in larger households with lower socio-economic status.

To assess how the frequency of low fruit and vegetable consumption has changed in countries of the former Soviet Union (FSU) between 2001 and 2010 and to identify factors associated with low consumption.

Cross-sectional surveys. A standard questionnaire was administered at both time points to examine fruit and vegetable consumption frequency. Logistic regression analysis was used to examine the relationship between demographic, socio-economic and health behavioural variables and low fruit and vegetable consumption in 2010.

Nationally representative population samples from Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine.

Adults aged 18 years and older.

Between 2001 and 2010 notable changes occurred in fruit and vegetable consumption in many countries resulting in a slight overall deterioration in diet. By 2010 in six countries about 40 % of the population was eating fruit once weekly or less often, while for vegetables the corresponding figure was in excess of 20 % in every country except Azerbaijan. A worse socio-economic situation, negative health behaviours (smoking and alcohol consumption) and rural residence were all associated with low levels of fruit and vegetable consumption.

International dietary guidelines emphasise the importance of fruit and vegetable consumption. The scale of inadequate consumption of these food groups among much of the population in many FSU countries and its link to socio-economic disadvantage are deeply worrying. This highlights the urgent need for a greater focus to be placed on population nutrition policies to avoid nutrition-related diseases in the FSU countries.

Intake of white potatoes in and out of school was estimated to provide context for a recent proposal by the US Department of Agriculture to limit provision of white potatoes in US school meals.

Mean daily servings of white potatoes and other vegetables consumed in and out of school for school-aged children were estimated from two days of 24 h dietary recall data from the National Health and Nutrition Examination Surveys (NHANES). Total energy intake and percentage energy contribution from discretionary oils and solid fats were also estimated for all white potato dishes consumed.

The NHANES is nationally representative of the US civilian non-institutionalized population.

Children and adolescents aged 6–19 years (n 8466) from three combined NHANES cycles (2003–2004, 2005–2006 and 2007–2008).

White potatoes represented 32 % of all vegetable servings consumed by US children and adolescents. Preparations high in fats and oils, including French fries, were most popular both in and out of school. Mean consumption of white potatoes obtained from school cafeterias was approximately 0·05 servings/d among all children and adolescents, and about 0·15 servings/d among children and adolescents acquiring at least one item from the school cafeteria, implying current weekly intake levels well below the limit of 2 servings/week proposed by the US Department of Agriculture.

Although white potatoes represent a substantial proportion of vegetable consumption among school-aged children, it is unclear that proposed limits would influence white potato intake from school cafeterias. Policy makers should consider targeting preparation methods to improve the healthfulness of white potato dishes.

To examine how increasing vegetable consumption from foods prepared at home (FAH) and foods prepared away from home (FAFH) would impact energy, dietary fibre and Na (sodium) intakes in the USA.

Using data from the 2003–2004 US National Health and Nutrition Examination Survey, dietary intake data from two separate days were fitted with a first-difference (fixed-effects) model. Vegetables consumed from all sources, including mixed foods and juices, were disaggregated and expressed as amounts equivalent to one cup of whole vegetables.

Nationally representative sample of the US population.

Individuals aged 2 years and above reporting 2 d of dietary intake data in 2003–2004 (n 7647).

Holding constant the total amount of food consumed, consuming an additional cup of tomatoes and potatoes from FAFH increases energy intake by respectively 1522 and 665 kJ, as compared with 246 and 367 kJ for FAH. Each additional cup of tomatoes from FAH is associated with an additional 179 mg of Na, compared with 113 mg for FAFH. All vegetable consumption increases fibre intake, except for potatoes and tomatoes from FAFH. Dark green and orange vegetables from FAH add the largest amount of fibre (1·38 g/cup).

Because US consumers frequently consume vegetables as part of mixed foods that add energy and Na, heavier consumption of vegetables as currently prepared raises the energy content and Na density of the overall diet. This is particularly true for vegetables prepared away from home.

We examined associations between access to food venues (farmers’ markets and supermarkets), shopping patterns, fruit and vegetable consumption and health indicators among women of reproductive age in eastern North Carolina, USA.

Access to food venues was measured using a Geographic Information System incorporating distance, seasonality and business hours, to quantify access to farmers’ markets. Produce consumption was assessed by self-report of eating five or more fruits and vegetables daily. BMI and blood pressure were assessed by clinical measurements. Poisson regression with robust variance was used for dichotomous outcomes and multiple linear regression was used for continuous outcomes. As the study occurred in a university town and university students are likely to have different shopping patterns from non-students, we stratified analyses by student status.

Eastern North Carolina.

Low-income women of reproductive age (18–44 years) with valid address information accessing family planning services at a local health department (n 400).

Over a quarter reported ever shopping at farmers’ markets (114/400). A larger percentage of women who shopped at farmers’ markets consumed five or more fruits and vegetables daily (42·1 %) than those who did not (24·0 %; P < 0·001). The mean objectively measured distance to the farmers’ markets where women reported shopping was 11·4 (sd 9·0) km (7·1 (sd 5·6) miles), while the mean distance to the farmers’ market closest to the residence was 4·0 (sd 3·7) km (2·5 (sd 2·3) miles).

Among non-students, those who shopped at farmers’ markets were more likely to consume five or more servings of fruits and vegetables daily. Future research should further explore potential health benefits of farmers’ markets.

The present store-based intervention was designed to promote sales of fruits and vegetables (F&V) to increase intake among store customers – specifically customers of tiendas, small-to-medium-sized Latino food stores.

Four tiendas were randomized to a 2-month environmental change intervention or a delayed treatment control condition. Employees and managers were trained to promote F&V sales, including how to implement a food marketing campaign and installing store equipment to promote fresh fruits and vegetables. The primary outcome was self-reported daily intake of F&V among a convenience sample of customers (at least forty per store) collected at baseline prior to randomization and then 4 months later. In addition, changes in availability of F&V in the tiendas, using unobtrusive observational methods, provided evidence of intervention fidelity.

Tiendas in central North Carolina.

Participants included 179 customers who were recent immigrants from Mexico and Central America.

A group-by-time interaction approached significance on daily servings of F&V; intervention customers reported an increase in F&V intake over time and as a function of the intervention (P ≤ 0·06). Unexpectedly, self-efficacy for consuming more fruits (P ≤ 0·01) and more vegetables (P ≤ 0·06) decreased. In our store-level analyses, a group-by-time interaction was observed for availability of fresh and canned vegetables; the intervention increased availability of vegetables but not fruit.

Environmental change strategies to promote healthy eating are needed given the rates of obesity and diabetes in the Latino population. A store-based intervention was moderately effective at increasing customers’ reported F&V intake. Such strategies can have a public health impact on underserved populations.

To determine if localised programmes that are successful in engaging the community can add value to larger fruit and vegetable mass-media campaigns by evaluating the results of the Eat It To Beat It programme.

The Eat It To Beat It programme is a multi-strategy intervention that uses community-based education and ‘below the line’ social marketing to increase fruit and vegetable consumption in parents. This programme was evaluated by a controlled before-and-after study with repeat cross-sectional data collected via computer-assisted telephone interviews with 1403 parents before the intervention (2008) and 1401 following intervention delivery (2011).

The intervention area was the Hunter region and the control area was the New England region of New South Wales, Australia.

Parents of primary school-aged children (Kindergarten to Year 6).

The programme achieved improvements in knowledge of recommended intakes for fruit and vegetables and some positive changes in knowledge of serving size for vegetables. Exposure to the programme resulted in a net increase of 0·5 servings of fruit and vegetables daily for those who recalled the programme compared with those who did not (P = 0·004). Increased intake of fruit and vegetables was significantly associated with increasing exposure to programme strategies.

The Eat It To Beat It programme demonstrates that an increase in consumption of fruit and vegetables can be achieved by programmes that build on the successes of larger mass-media and social-marketing campaigns. This suggests that funding for localised, community-based programmes should be increased.

Despite the benefits of fruit and vegetable intake, many young Americans do not consume them at adequate levels. The present study sought to determine the beliefs that children have about asking their parents to have fruits and vegetables available at home in order to better understand the role children may play in influencing their own fruit and vegetable consumption.

An instrument utilizing the Reasoned Action Approach, with closed-ended questions on demographic and behavioural variables and open-ended questions eliciting the belief structure underlying asking parents to make fruits and vegetables available, was distributed. Thematic and frequency analyses were performed for open-ended questions. Statistical analyses were conducted to assess differences between children who had v. had not asked for fruits and vegetables.

Three middle schools in rural Indiana, USA.

A sub-sample of sixty students aged 12–15 years from a larger study of 344 students.

Qualitative analysis identified benefits (i.e. make me healthier; make parents happy), disadvantages (i.e. will upset my parents) and strategies (i.e. asking when you are at the store) that could be used to improve fruit and vegetable intake. Findings also revealed that students who asked their parents for fruits and vegetables were significantly more likely to perform several healthy eating and physical activity behaviours.

Data suggest that young people's view of parental reactions is critical. While additional research is necessary, the findings support a role for children in shaping their own environment and suggest multilevel interventions that simultaneously address parents and children.

During the early years, parents have a major influence on children's diets and developing food choices. We investigated parenting styles as predictors of 2–5-year-old children's diets and whether general nutrition knowledge (GNK) mediated these influences.

Cross-sectional research. Questionnaires measured demographic and lifestyle variables, family environment, parenting styles and feeding practices, child diet and GNK. Regression models tested GNK as a mediator of relationships between parenting variables and child diet (fruit/vegetable and non-core food consumption), controlling for confounders and family environment.

Questionnaires were completed by main caregivers at home.

Parents of children aged 2–5 years (n 269).

Higher child fruit/vegetable consumption was associated with lower over-reactive parenting and restriction, higher authoritative parenting and dining together as a family; with lax parenting approaching statistical significance (P = 0·083) and 19 % of variance explained by the model. GNK was not a significant predictor. Conversely, non-core food consumption was associated with higher over-reactive and lax parenting as well as child age, increased takeaway food consumption and higher television viewing; GNK had a small effect (P = 0·043) and 28 % of variance was explained by the model. GNK was a significant mediator only for authoritative parenting on non-core food (effect = −0·005).

These findings highlight that young children's diets may be improved by interventions targeting a range of positive and supportive parenting practices in conjunction with nutrition knowledge education for parents of young children. Further insights will come from closer attention to the nature and role of restrictive feeding practices v. laxness and longitudinal research.

Although most parents know that vegetables are healthful, vegetables are served at only 23 % of American dinners. If added nutrition is not a sufficient motivation, might a parent be more inspired to serve vegetables if doing so improved either the taste of the entrée or how loving and thoughtful the server would be perceived? The present paper details two studies which investigated whether serving vegetables changes the perception of the cook and the perception of an entrée's taste.

In Study 1, people evaluated the personality of a cook who either did or did not include a vegetable in a family dinner. In Study 2, five different meals that either included or did not include a vegetable were rated in terms of the taste of the entrée and of the whole meal.

US-based online survey.

American mothers (n 500), ranging in age from 18 to 65 years (mean age 38·4 years), with at least two children under the age of 18 years living at home.

Serving vegetables improved taste expectations for the entrée as well as for the whole meal. Additionally, serving a vegetable with a meal also enhanced perceptions of the meal preparer. They were evaluated as being more thoughtful and attentive as well as less lazy, boring and self-absorbed.

These two studies show new hedonic and heroic motivations for serving vegetables: (i) they increase the hedonic appeal of the meal and (ii) they increase the heroic appeal of the cook. More vegetables are likely to be served with a meal if preparers know that the addition of vegetables makes them appear to be both a better cook and a better person.

To evaluate the validity and reproducibility of a 122-item interviewer-administered quantitative FFQ developed to determine food and nutrient intakes of adults in Botswana.

Relative validity of the FFQ was evaluated by comparing nutrient and food group intakes against four non-consecutive 24 h recalls administered over 12 months. The FFQ was repeated after 1 year to assess reproducibility.

Kanye, Botswana.

Seventy-nine adults aged 18–75 years.

Spearman correlation coefficients for the validity of energy-adjusted nutrients ranged from 0·42 (carbohydrate) to 0·49 (protein) for macronutrients and from 0·23 (Fe) to 0·44 (PUFA) for micronutrients. Exact agreement of quartile distribution for nutrients between the FFQ and recalls ranged from 27 % to 72 %. Weighted kappa values were lowest for retinol (0·13), Fe (0·22) and β-carotene (0·25) and ranged from 0·33 (SFA) to 0·59 (folate) for other nutrients (energy, carbohydrate, protein, fat, Ca and vitamin E). Spearman correlation coefficients between the recalls and FFQ for food groups ranged from 0·18 (dark green leafy and yellow vegetables) to 0·58 (poultry). Reproducibility correlation coefficients (energy-adjusted) varied between 0·39 for retinol and 0·66 for vitamin E, with most values falling between 0·50 and 0·60.

The FFQ had good relative validity for estimating habitual food group and nutrient intakes, but was poor for some micronutrients (Fe, retinol and β-carotene) and foods (fruits and dark green leafy vegetables).

A variety of methods are available for defining undernutrition (thinness/underweight/under-fat) and overnutrition (overweight/obesity/over-fat). The extent to which these definitions agree is unclear. The present cross-sectional study aimed to assess agreement between widely used methods of assessing nutritional status in children and adolescents, and to examine the benefit of body composition estimates.

The main objective of the cross-sectional study was to assess underweight, overweight and obesity using four methods: (i) BMI-for-age using WHO (2007) reference data; (ii) BMI-for-age using Cole et al. and International Obesity Taskforce cut-offs; (iii) weight-for-age using the National Centre for Health Statistics/WHO growth reference 1977; and (iv) body fat percentage estimated by bio-impedance (body fat reference curves for children of McCarthy et al., 2006). Comparisons were made between methods using weighted kappa analyses.

Rural South Africa.

Individuals (n 1519) in three age groups (school grade 1, mean age 7 years; grade 5, mean age 11 years; grade 9, mean age 15 years).

In boys, prevalence of unhealthy weight status (both under- and overnutrition) was much higher at all ages with body fatness measures than with simple anthropometric proxies for body fatness; agreement between fatness and weight-based measures was fair or slight using Landis and Koch categories. In girls, prevalence of unhealthy weight status was also higher with body fatness than with proxies, although agreement between measures ranged from fair to substantial.

Methods for defining under- and overnutrition should not be considered equivalent. Weight-based measures provide highly conservative estimates of unhealthy weight status, possibly more conservative in boys. Simple body composition measures may be more informative than anthropometry for nutritional surveillance of children and adolescents.

The purpose of the present study was to assess the nutritional quality of foods and beverages listed on menus serving children in government-sponsored child-care centres throughout Mexico.

For this cross-sectional menu assessment, we compared (i) food groups and portion sizes of foods and beverages on the menus with MyPlate recommendations and (ii) macronutrients, sugar and fibre with Daily Reference Intake standards.

Menus reflected foods and beverages served to children attending one of 142 government-sponsored child-care centres throughout Mexico.

There were fifty-four distinct menus for children aged 4–6 months, 7–9 months, 10–12 months, 13–23 months, 24–47 months and 48–72 months.

Menus included a variety of foods meeting minimum MyPlate recommendations for each food category except whole grains for children aged 48–72 months. Menus listed excessive amounts of high-energy beverages, including full-fat milk, fruit juice and sugar-sweetened beverages for children of all ages. The mean daily energy content of menu items yielded an average of 2·76 MJ for infants, 4·77 MJ for children aged 13–23 months, 5·36 MJ for children aged 24–47 months and 5·87 MJ for children aged 48–72 months. Foods and beverages on menus provided sufficient grams of carbohydrate and fat, but excessive protein.

Menus provided a variety of foods but excessive energy. Whole grains were limited, and high-energy beverages were prevalent. Both may be appropriate targets for nutrition intervention. Future studies should move beyond menus and assess what children actually consume in child care.

To determine (i) the importance of parents’ motives for everyday family food choices; and (ii) the relationship between parental food choice motives and eating patterns of 12- to 13-year-old children.

Cross-sectional study. A modified version of the Food Choice Questionnaire was used to determine parental motives for food choices. The children's food and drink intake was reported by their parents using a retrospective FFQ. Eating patterns were derived using principal component analysis. The association between food choice motives and eating patterns was examined using multiple linear regression analysis.

Primary schools, Telemark County, Norway.

In total, 1095 children aged 12–13 years and their parents.

The parental motive ‘sensory appeal’ was the most important for food choice, followed by ‘health’, ‘convenience’, ‘natural content’ and ‘weight control’. The food choice motives were associated with the eating patterns of the children, independent of background variables. The motive ‘health’ was most strongly associated with a ‘varied Norwegian’ eating pattern, representing a diverse diet and regular meals, while the motive ‘convenience’ appeared to be the most important barrier to this eating pattern. ‘Weight control’ was not associated with the ‘varied Norwegian’ eating pattern.

To encourage parents to make healthy food choices for their children, health promotion activities should focus on the health benefits of a diverse diet and regular meals, rather than weight control. Recommended food products should be made more convenient and easily available for families with children.

To evaluate self-assessed knowledge about diabetes mellitus, to assess determinants of health knowledge and to evaluate consequences of health knowledge on appraisal about consequences of the disease.

Population-based computer-assisted web interview survey, supplemented with a paper-and-pencil survey via post.

Representative sample of the general Austrian population aged 15 years and older.

Men (n 1935) and women (n 2065) with and without diabetes mellitus.

Some 20·5 % of men and 17·7 % of women with diabetes, and 46·2 % of men and 36·7 % of women without diabetes, rated their knowledge about diabetes mellitus to be ‘very bad’ or ‘rather bad’. Individuals with diabetes and individuals with a family member with diabetes rated their information level more often as ‘very good’ or ‘rather good’, with adjusted OR (95 % CI) of 1·7 (1·1, 2·8) and 2·1 (1·6, 2·7), respectively, in men and 2·7 (1·5, 4·8) and 2·7 (2·1, 3·5), respectively, in women. Additional significant influencing factors on diabetes knowledge were age and educational level in both sexes, and city size in men. Independent of personal diabetes status, diabetes knowledge was associated with a lower perception of restrictions on daily life of diabetes patients and with a lower probability of underestimating health consequences of diabetes.

Health knowledge is associated with fewer misconceptions and less underestimation of health consequences in individuals both with and without diabetes mellitus. Thus health information about diabetes is important on the individual level towards disease management as well as on the public health level towards disease prevention.

Increasing childhood asthma rates may be due to changing dietary lifestyle. We investigated the association of dietary intake of antioxidant vitamins and fatty acids with asthma in Japanese pre-school children.

Cross-sectional study.

School-based survey on lifestyle/diet and health status in children in Japan.

Parents of 452 children aged 3–6 years completed a questionnaire on the children's and parents’ lifestyle and demographics. Children were classified into asthma cases and non-asthma cases in accordance with the ATS-DLD (American Thoracic Society and Division of Lung Diseases of the National Heart, Lung, and Blood Institute) questionnaire. Children's diet was assessed using a 3 d dietary record completed by parents. Children's age, sex, BMI, history of food allergy, maternal age, parental history of allergy, maternal education, family size and second-hand smoking were included as covariates. Logistic regression models were used to examine the association between children's diet and asthma.

Compared with children with the lowest intake tertile for vitamin C and vitamin E, those in the highest were significantly inversely associated with asthma; adjusted OR (95 % CI) were 0·35 (0·14, 0·88) and 0·32 (0·12, 0·85), respectively. A statistically significant trend was also observed. Fruit intake showed an inverse but insignificant association with asthma. There were no associations of any type of fatty acids with asthma.

These data suggest that children with high intakes of vitamins C and E may be associated with a reduced prevalence of asthma.

Cardiorespiratory fitness is known to be cardioprotective and its association with the components of the metabolic syndrome in children is becoming clearer. The aim of the present study was to examine the extent to which cardiorespiratory fitness may offset the weight-related association with mean arterial pressure (MAP) in schoolchildren.

Cross-sectional study.

Schoolchildren from the East of England, UK.

A total of 5983 (48 % females) schoolchildren, 10 to 16 years of age, had height, weight and blood pressure measured by standard procedures and cardiorespiratory fitness assessed by the 20 m shuttle-run test. Participants were classified as fit or unfit using internationally accepted fitness cut-off points; and as normal weight, overweight or obese based on BMI, again using international cut-off points. Age-adjusted ANCOVA was used to determine the main effects and interaction of fitness and BMI on MAP Z-score. Logistic regression models were used to estimate odds ratios of elevated MAP.

Prevalence of elevated MAP in schoolchildren was 14·8 % overall and 35·7 % in those who were obese-unfit. Approximately 21 % of participants were overweight and 5 % obese, while 23 % were classified as unfit. MAP generally increased across BMI categories and was higher in the aerobically unfit participants. Obese-fit males had lower MAP compared with obese-unfit males (P < 0·001); this trend was similar in females (P = 0·05).

Increasing fitness level may have a positive impact on the weight-related elevations of MAP seen in obese and overweight schoolchildren.

Studies examining the association of dairy consumption with incident CHD have yielded inconsistent results. The current prospective study examined the association between dairy consumption and CHD in a population-based sample of older community-dwelling adults.

Baseline CHD risk factors were assessed and an FFQ was self-administered. Participants were followed for morbidity and mortality with periodic clinic visits and annual mailed questionnaires for an average of 16·2 years, with a 96 % follow-up rate for fatal and non-fatal CHD.

Community.

Participants were 751 men and 1008 women aged 50–93 years who attended a clinic visit in 1984–1987.

At baseline the mean age was 70·6 (sd 9·8) years for men and 70·1 (sd 9·3) years for women. Participants who developed CHD during follow-up were significantly older (P < 0·001), had higher BMI (P = 0·035) and higher total cholesterol (P = 0·050), and were more likely to be male (P < 0·001), diabetic (P = 0·011) and hypertensive (P < 0·001), than those who did not develop CHD. Multivariate regression analyses adjusting for age, BMI, diabetes, hypertension, LDL-cholesterol and oestrogen use (in women) indicated that women who consumed low-fat cheese ‘sometimes/often’ and women who consumed non-fat milk ‘sometimes/often’ had an increased risk of incident CHD (hazard ratio = 2·32; 95 % CI 1·57, 3·41) and CHD (hazard ratio = 1·48; 95 % CI 1·02, 2·16) compared with women who ‘never/rarely’ ate these dairy products.

Woman with higher intake of low-fat cheese and non-fat milk seem to have a higher risk of incident CHD. This needs further investigation considering recent evidence of cardiovascular benefits from certain dairy fat.

To assess the long-term relationship between tree nut consumption and the risk of developing metabolic syndrome (MetS).

Nut consumption was collected using a validated 136-item FFQ. The MetS was defined according to the International Diabetes Federation and American Heart Association/National Heart, Lung, and Blood Institute harmonizing definition. The association between nut consumption and MetS was assessed with logistic regression models adjusting for potential confounders. We compared the incidence of MetS between extreme categories of nut intake (≥2 servings/week v. never/almost never) after 6 years of follow-up.

The SUN Project (Seguimiento Universidad de Navarra, University of Navarra Follow-up) is a prospective cohort study, formed of Spanish university graduates. Information is gathered by mailed questionnaires collected biennially. Nut consumption and MetS information was collected by self-reported data.

Participants (n 9887) initially free of MetS or diabetes and followed up for a minimum of 6 years were included.

We observed 567 new cases of MetS during follow-up. Participants who consumed nuts ≥2 servings/week presented a 32 % lower risk of developing MetS than those who never/almost never consumed (adjusted OR = 0·68, 95 % CI 0·50, 0·92). The inverse association was stronger among participants who were health professionals.

Nut consumption was significantly associated with lower risk of developing MetS after a 6-year follow-up period in a cohort of Spanish graduates.