China’s internal migration has left 61 million children living apart from their parent(s) in rural areas. The present study aimed to examine whether the relative contributions of macronutrients (protein, fat and carbohydrate) to total energy intake differ between children left behind by the father or mother, compared with children from intact families.

Drawing on a longitudinal study, the China Health and Nutrition Survey (1997–2009), multilevel modelling analyses (level 1: occasions; level 2: children; level 3: villages) were performed.

Data from rural communities in nine provinces in China.

Rural children (n 975; 555 boys and 420 girls) from 140 villages.

Among boys of school age, being left behind by the father tended to reduce the relative protein intake by 0·70 % (P<0·01) compared with boys from intact families. Being left behind by at least the mother was more detrimental for young boys under the age of 6 years than paternal migration, reducing relative protein intake by 1·14 % (P<0·05). Parental migration was associated with a significant increase in young boys’ relative fat intake by 2·60 % (P<0·05). No significant associations were found for girls. Results suggest left-behind boys, especially in early life, are subject to a higher-fat and lower-protein diet compared with non-left-behind boys. This may put them at increased risk of being overweight or obese, or of suffering from stunted growth, when they grow up.

Public health policies should recognise the influences of parental migration on boys, especially maternal migration, and encourage a more balanced diet for children in rural China.

Public health experts raise concerns about marketing unhealthy products to young people through television (TV) product placements. Coca-Cola brand appearances (product placements) reached a substantial child and adolescent audience in 2008, but additional brands now sponsor popular programming. We aimed to quantify child and adolescent exposure to food and beverage appearances since 2008.

In 2015, we purchased Nielsen data on occurrences and child/adolescent exposure to food, beverage and restaurant brand appearances on US prime-time TV from 2009 to 2014, and analysed appearances by product category, company, brand and year. We compared exposure to appearances with exposure to traditional commercials for top brands.

Nationally representative panel of approximately 20 000 TV-viewing households.

Children (2–11 years) and adolescents (12–17 years).

Exposure to food and beverage brand appearances peaked in 2012 and declined through 2014. Whereas full-calorie soda brands dominated before 2012, other sugary drink and quick-serve restaurant brands contributed over one-third of appearances viewed by children in 2013 and 2014. Nine hundred and fifty-four companies had brand appearances from 2009 to 2014, but just four were responsible for over half of exposures: The Coca-Cola Company, Dr Pepper Snapple Group, PepsiCo and Starbucks. Approximately half were viewed on reality TV programmes and one sitcom. Each year from 2009 to 2013, brand appearance exposure exceeded traditional advertising exposure for at least one brand.

Despite recent reductions in brand appearances viewed by young people, some unhealthy branded products continue to be marketed via this method. We suggest policy options to reduce child and adolescent exposure to such appearances.

Nitrate and nitrite are probable human carcinogens when ingested under conditions that increase the formation of N-nitroso compounds. There have been limited efforts to develop US databases of dietary nitrate and nitrite for standard FFQ. Here we describe the development of a dietary nitrate and nitrite database and its calibration.

We analysed data from a calibration study of 1942 members of the NIH–AARP (NIH–AARP, National Institutes of Health–AARP) Diet and Health Study who reported all foods and beverages consumed on the preceding day in two non-consecutive 24 h dietary recalls (24HR) and completed an FFQ. Based on a literature review, we developed a database of nitrate and nitrite contents for foods reported on these 24HR and for food category line items on the FFQ. We calculated daily nitrate and nitrite intakes for both instruments, and used a measurement error model to compute correlation coefficients and attenuation factors for the FFQ-based intake estimates using 24HR-based values as reference data.

FFQ-based median nitrate intake was 68·9 and 74·1 mg/d, and nitrite intake was 1·3 and 1·0 mg/d, in men and women, respectively. These values were similar to 24HR-based intake estimates. Energy-adjusted correlation coefficients between FFQ- and 24HR-based values for men and women respectively were 0·59 and 0·57 for nitrate and 0·59 and 0·58 for nitrite; energy-adjusted attenuation factors were 0·59 and 0·57 for nitrate and 0·47 and 0·38 for nitrite.

The performance of the FFQ in assessing dietary nitrate and nitrite intakes is comparable to that for many other macro- and micronutrients.

The aim of the present study was to validate figural drawing scales depicting extremely lean to extremely obese subjects to obtain proxies for BMI and waist circumference in postal surveys.

Reported figural scales and anthropometric data from a large population-based postal survey were validated with measured anthropometric data from the same individuals by means of receiver-operating characteristic curves and a BMI prediction model.

Adult participants in a Scandinavian cohort study first recruited in 1990 and followed up twice since.

Individuals aged 38–66 years with complete data for BMI (n 1580) and waist circumference (n 1017).

Median BMI and waist circumference increased exponentially with increasing figural scales. Receiver-operating characteristic curve analyses showed a high predictive ability to identify individuals with BMI > 25·0 kg/m2 in both sexes. The optimal figural scales for identifying overweight or obese individuals with a correct detection rate were 4 and 5 in women, and 5 and 6 in men, respectively. The prediction model explained 74 % of the variance among women and 62 % among men. Predicted BMI differed only marginally from objectively measured BMI.

Figural drawing scales explained a large part of the anthropometric variance in this population and showed a high predictive ability for identifying overweight/obese subjects. These figural scales can be used with confidence as proxies of BMI and waist circumference in settings where objective measures are not feasible.

The purpose of the present study was to investigate the impact of a school-based nutrition and media education intervention on the promotion of fruit and vegetable consumption to help prevent childhood obesity.

The 10-week-long intervention included sessions on nutrition education and media literacy. It also included a health communication media-based campaign workshop during which the children created posters, newsletters and video commercials related to fruits and vegetables targeted to their parents. For evaluation purposes, the study utilized a mixed-methods approach, including a quasi-experimental study (with one intervention group and one control group) and a focus group study.

Four different elementary schools in Treviso (Veneto Region of Italy) agreed to participate in the research.

The target population for the study included 10-year-old Italian children and their parents.

Data indicate that this intervention was effective for children but not for parents. Evaluation results show that the intervention was effective in significantly increasing children’s fruit and vegetable intake (P<0·05) and all psychosocial determinants (P<0·05).

The study results confirm the efficacy of a school-based health and media education intervention to address the children’s obesity issue and, in particular, to increase children’s fruit and vegetable intake. The study also opens a new perspective on the theoretical constructs investigated, because the development of ‘ability of expression’ could be considered one of the most important factors to determine the efficacy of the intervention.

To develop and validate a questionnaire to measure food-related and activity-related practices of child-care staff, based on existing, validated parenting practices questionnaires.

A selection of items from the Comprehensive Feeding Practices Questionnaire (CFPQ) and the Preschooler Physical Activity Parenting Practices (PPAPP) questionnaire was made to include items most suitable for the child-care setting. The converted questionnaire was pre-tested among child-care staff during cognitive interviews and pilot-tested among a larger sample of child-care staff. Factor analyses with Varimax rotation and internal consistencies were used to examine the scales. Spearman correlations, t tests and ANOVA were used to examine associations between the scales and staff’s background characteristics (e.g. years of experience, gender).

Child-care centres in the Netherlands.

The qualitative pre-test included ten child-care staff members. The quantitative pilot test included 178 child-care staff members.

The new questionnaire, the Child-care Food and Activity Practices Questionnaire (CFAPQ), consists of sixty-three items (forty food-related and twenty-three activity-related items), divided over twelve scales (seven food-related and five activity-related scales). The CFAPQ scales are to a large extent similar to the original CFPQ and PPAPP scales. The CFAPQ scales show sufficient internal consistency with Cronbach’s α ranging between 0·53 and 0·96, and average corrected item–total correlations within acceptable ranges (0·30–0·89). Several of the scales were significantly associated with child-care staff’s background characteristics.

Scale psychometrics of the CFAPQ indicate it is a valid questionnaire that assesses child-care staff’s practices related to both food and activities.

Habit has been defined as the automatic performance of a usual behaviour. The present paper reports the relationships of variables from a Model of Goal Directed Behavior to four scales in regard to parents’ habits when feeding their children: habit of (i) actively involving child in selection of vegetables; (ii) maintaining a positive vegetable environment; (iii) positive communications about vegetables; and (iv) controlling vegetable practices. We tested the hypothesis that the primary predictor of each habit variable would be the measure of the corresponding parenting practice.

Internet survey data from a mostly female sample. Primary analyses employed regression modelling with backward deletion, controlling for demographics and parenting practices behaviour.

Houston, Texas, USA.

Parents of 307 pre-school (3–5-year-old) children.

Three of the four models accounted for about 50 % of the variance in the parenting practices habit scales. Each habit scale was primarily predicted by the corresponding parenting practices scale (suggesting validity). The habit of active child involvement in vegetable selection was also most strongly predicted by two barriers and rudimentary self-efficacy; the habit of maintaining a positive vegetable environment by one barrier; the habit of maintaining positive communications about vegetables by an emotional scale; and the habit of controlling vegetable practices by a perceived behavioural control scale.

The predictiveness of the psychosocial variables beyond parenting practices behaviour was modest. Discontinuing the habit of ineffective controlling parenting practices may require increasing the parent’s perceived control of parenting practices, perhaps through simulated parent–child interactions.

Both physical activity (PA) and diet are important contributors to health and well-being; however, there is limited information on the association of these behaviours and whether observed associations differ by weight. The present study aimed to evaluate whether nutrient intake is associated with PA and if this association varies by weight in young adults.

Cross-sectional study to analyse the association between PA and nutrient intake.

Participants were stratified as normal weight (18·5 kg/m2 <BMI <25·0 kg/m2) and overweight/obese (BMI≥25·0 kg/m2). PA level (PAL) was calculated (PAL=total daily energy expenditure/RMR) and used to stratify groups (PAL<1·6, 1·6≤PAL<1·9, PAL≥1·9).

Adults (n 407; age 27·6 (sd 3·8) years, 48 % male), with BMI between 20 and 35 kg/m2, having at least two 24 h diet recalls and at least 5 d (including two weekend days) of valid, objectively measured PA data were included in the analysis.

In normal-weight participants, higher PAL was associated with higher intakes of minerals (except Ca, Fe and Zn), B-vitamins and choline (P for trend <0·05). In the overweight/obese group, higher PAL was associated with higher intakes of fibre, K, Na and Cu (P for trend <0·05). These differences, however, were no longer significant after additionally controlling for total energy intake.

More active young adults have higher intakes of essential micronutrients. The benefits of PA may be predominantly due to a higher overall food intake while maintaining energy balance rather than a healthier diet.

To identify the use of ultra-processed foods – vectors of salt, sugar and fats – in the Norwegian diet through an assessment of food sales.

Sales data from a representative sample of food retailers in Norway, collected in September 2005 (n 150) and September 2013 (n 170), were analysed. Data consisted of barcode scans of individual food item purchases, reporting type of food, price, geographical region and retail concept. Foods were categorized as minimally processed, culinary ingredients, processed products and ultra-processed. Indicators were share of purchases and share of expenditure on food categories.

Six geographical regions in Norway.

The barcode data included 296 121 observations in 2005 and 501 938 observations in 2013.

Ultra-processed products represented 58·8 % of purchases and 48·8 % of expenditure in 2013. Minimally processed foods accounted for 17·2 % of purchases and 33·0 % of expenditure. Every third purchase was a sweet ultra-processed product. Food sales changed marginally in favour of minimally processed foods and in disfavour of processed products between 2005 and 2013 (χ2 (3)=203 195, P<0·001, Cramer’s V=0·017, P<0·001).

Ultra-processed products accounted for the majority of food sales in Norway, indicating a high consumption of such products. This could be contributing to rising rates of overweight, obesity and non-communicable diseases in the country, as findings from other countries indicate. Policy measures should aim at decreasing consumption of ultra-processed products and facilitating access (including economic) to minimally processed foods.

We aimed to investigate the prevalence of grade 1, 2 and 3 thinness among Chinese children and to explore their associations with socio-economic status (SES).

A population, school-based cross-sectional study using multistage, stratified cluster random sampling. Grade 1, 2 and 3 thinness, overweight, obesity and severe obesity were defined by the International Obesity Task Force BMI cut-offs.

Seven districts of Shanghai, China.

Chinese children aged 3–12 years (n 84 075).

In boys and girls, respectively, the prevalence of grade 1 thinness was 8·89 % and 11·78 %, of grade 2 thinness was 2·80 % and 3·74 %, and of grade 3 thinness was 2·23 % and 2·93 %. Compared with urban children, suburban children had higher prevalence of thinness. Children whose parent had low education had higher prevalence of grade 1, 2 and 3 thinness than those whose parent had high education. The prevalence of grade 2 and 3 thinness, obesity and severe obesity in low-SES children was higher than that in high-SES children, and the prevalence of grade 1 thinness was lower than that in high-SES children. Particular patterns of prevalence of grade 1, 2 and 3 thinness appeared in low-, middle- and high-SES children.

The study describes associations of SES with grade 1, 2 and 3 thinness, overweight, obesity and severe obesity in Shanghai children. The patterns of thinness and obesity in Shanghai provide further insights into BMI patterns in mega-cities in developing countries.

Globally, the Na consumption of most people exceeds the WHO recommendation. To be effective, salt reduction programmes require assessment of the dietary sources of Na. Due to methodological difficulties however, comprehensive assessments are rare. Here, we identified Na sources in the Japanese diet using a 4 d diet record that was specifically designed for Na source description.

A cross-sectional study.

Apparently healthy men (n 196) and women (n 196) aged 20–69 years.

The subjects were recruited from twenty-three of forty-seven prefectures in Japan.

The proportion of discretionary Na intake in total Na intake was 52·3 % in men and 57·1 % in women, and was significantly lower in younger subjects. The two major food groups contributing to Na intake were seasonings such as salt or soya sauce (61·7 % of total Na intake in men, 62·9 % in women) and fish and shellfish (6·7 % in men, 6·6 % in women). The third major contributor differed between men and women (noodles in men, 4·9 %; bread in women, 5·0 %). Further, the contribution of each food group to total Na intake differed among age groups.

While individual efforts to decrease Na intake remain important, population approaches to reducing Na content in processed foods are already equally important and will assume greater importance in the future even in Japan, an Asian country facing a rapid Westernization in dietary habits.

In women, the risk for non-communicable diseases increases after menopause. We aimed to identify major dietary patterns and study their associations with nutrient intake, sociodemographic factors and risk factors for non-communicable diseases among women aged 50–69 years.

A cross-sectional study. Food intake was recorded by a 253-item FFQ. Dietary patterns were identified using principal component analysis. The associations between the dietary patterns and nutrients were described by Pearson’s correlation coefficients and multiple regression analysis was used to examine the associations between the dietary patterns and age, education, BMI, physical activity and smoking.

The Norwegian Breast Cancer Screening Programme.

Women (n 6298) aged 50–69 years.

Three dietary patterns were identified: ‘Prudent’, ‘Western’ and ‘Continental’. Adherence to the ‘Prudent’ pattern was related to older age, higher education, higher BMI, more physical activity (Ptrend<0·001) and being a non-smoker (P<0·001). Adherence to the ‘Western’ pattern was related to older age, lower education, higher BMI, less physical activity (0·001≤Ptrend≤0·006) and lower alcohol intake (r =−0·28). Adherence to the ‘Continental’ pattern was related to younger age, higher education, higher BMI, less physical activity, (Ptrend<0·001), being a smoker (P<0·001) and higher alcohol intake (r=0·36).

Three distinct dietary patterns were identified. High adherence to a ‘Prudent’ pattern was associated with a healthy lifestyle, while high adherence to a ‘Western’ or ‘Continental’ pattern was associated with an unhealthy lifestyle. These findings are valuable knowledge for health authorities when forming strategies to promote a healthier lifestyle among women.

To examine associations between dietary intakes of fathers and their children at child age 20 months, 3·5 years and 5 years, and to determine if fathers’ intake predicts change in children’s intake between 20 months and 3·5 and 5 years of age.

The diets of fathers and their first-born children participating in the longitudinal Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program were assessed using FFQ and three 24 h recalls, respectively.

Sixty-two pre-existing first-time parent groups were selected from fourteen local government areas within a 60 km radius of Deakin University Burwood, Victoria, Australia.

Fathers and their first-born children at 20 months (n 317), 3·5 years (n 214) and 5 years of age (n 208).

Positive associations were found between fathers’ and children’s intakes of fruit and sweet snacks at 20 months (P=0·001) and 5 years of age (P=0·012). Fathers’ intake at child age 20 months was associated with change in children’s intake for fruit, sweet snacks and sugar-sweetened beverages between child age 20 months and 3·5 years, and for sweet snacks and sugar-sweetened beverages between child age 20 months and 5 years (all P<0·05). After adjustment for maternal intake, fathers’ intake of sweet snacks remained a predictor of change in children’s sweet snack intake between 20 months and 3·5 years of age (P=0·03).

Associations between the dietary intakes of fathers and their children commence at a young age and continue through early childhood. Fathers should be included in future interventions aimed at improving children’s diets.

Diabetes is a growing public health problem, and the environment in which people live and work may affect diabetes risk. The goal of the present study was to examine the association between multiple aspects of environment and diabetes risk in an employee population.

This was a retrospective cross-sectional analysis. Home environment variables were derived using employees’ zip code. Descriptive statistics were run on all individual- and zip-code-level variables, stratified by diabetes risk and worksite. A multivariable logistic regression analysis was then conducted to determine the strongest associations with diabetes risk.

Data were collected from employee health fairs in a Midwestern health system, 2009–2012.

The data set contains 25 227 unique individuals across four years of data. From this group, using an individual’s first entry into the database, 15 522 individuals had complete data for analysis.

The prevalence of high diabetes risk in this population was 2·3 %. There was significant variability in individual- and zip-code-level variables across worksites. From the multivariable analysis, living in a zip code with higher percentage of poverty and higher walk score was positively associated with high diabetes risk, while living in a zip code with higher supermarket density was associated with a reduction in high diabetes risk.

Our study underscores the important relationship between poverty, home neighbourhood environment and diabetes risk, even in a relatively healthy employed population, and suggests a role for the employer in promoting health.

‘DASH for Asthma’ (n 90) was a 6-month randomized controlled trial that demonstrated potential benefits of a DASH (Dietary Approaches to Stop Hypertension) behavioural intervention for improving diet quality and asthma control by comparing intervention to usual care in adults with uncontrolled asthma. The present study examined acceptability and feasibility of the intervention from the perspective of intervention participants and lifestyle coaches.

Grounded in Social Cognitive Theory, the 3-month intensive stage, including three individual and eight group sessions, focused on diet modifications and behavioural self-regulation. The 3-month maintenance stage contained telephone consultations. Participants and lifestyle coaches completed surveys including 5-point Likert scales and open-ended questions. We analysed data using descriptive and inductive content analyses.

Forty-six intervention participants (survey response rate was 65–72 %) and two lifestyle coaches.

Participants and lifestyle coaches were highly satisfied (all mean ratings >4) with individual and group sessions. Participants identified mastery of knowledge and skills (awareness, goal setting, self-monitoring, problem solving), social learning (class members sharing experiences and ideas) and good coaching skills (reflective listening, empathy, motivational counselling) as important contributors to self-efficacy and programme satisfaction. Participants also valued personalized feedback received in individual sessions. Lifestyle coaches viewed participant engagement as a facilitator to effective sessions. Finally, participants and lifestyle coaches identified food tasting as beneficial for observational learning and facilitation of participant engagement. High class attendance and self-monitoring rate also reflected the high engagement among participants.

The DASH behavioural intervention was feasible and highly acceptable to participants with uncontrolled asthma and lifestyle coaches.

Evaluating an intervention’s theoretical basis can inform design modifications to produce more effective interventions. Hence the present study’s purpose was to determine if effects from a multicomponent lifestyle intervention were mediated by changes in the psychosocial constructs decisional balance, self-efficacy and social support.

Delta Body and Soul III, conducted from August 2011 to May 2012, was a 6-month, church-based, lifestyle intervention designed to improve diet quality and increase physical activity. Primary outcomes, diet quality and aerobic and strength/flexibility physical activity, as well as psychosocial constructs, were assessed via self-report, interviewer-administered surveys at baseline and post intervention. Mediation analyses were conducted using ordinary least squares (continuous outcomes) and maximum likelihood logistic (dichotomous outcomes) regression path analysis.

Churches (five intervention and three control) were recruited from four counties in the Lower Mississippi Delta region of the USA.

Rural, Southern, primarily African-American adults (n 321).

Based upon results from the multiple mediation models, there was no evidence that treatment (intervention v. control) indirectly influenced changes in diet quality or physical activity through its effects on decisional balance, self-efficacy and social support. However, there was evidence for direct effects of social support for exercise on physical activity and of self-efficacy for sugar-sweetened beverages on diet quality.

Results do not support the hypothesis that the psychosocial constructs decisional balance, self-efficacy and social support were the theoretical mechanisms by which the Delta Body and Soul III intervention influenced changes in diet quality and physical activity.

Poor dietary intake is the most important behavioural risk factor affecting health globally. Despite this, there has been little investment in public health nutrition policy actions. Policy process theories from the field of political science can aid understanding why policy decisions have occurred and identify how to influence ongoing or future initiatives. The present review aims to examine public health nutrition policy literature and identify whether a policy process theory has been used to analyse the process.

Electronic databases were searched systematically for studies examining policy making in public health nutrition in high-income, democratic countries.

International, national, state and local government jurisdictions within high-income, democratic countries.

Individuals and organisations involved in the nutrition policy-making process.

Sixty-three studies met the eligibility criteria, most were conducted in the USA and a majority focused on obesity. The analysis demonstrates an accelerating trend in the number of nutrition policy papers published annually and an increase in the diversity of nutrition topics examined. The use of policy process theory was observed from 2003; however, it was utilised by only 14 % of the reviewed papers.

There is limited research into the nutrition policy process in high-income countries. While there has been a small increase in the use of policy process theory from 2003, an opportunity to expand its use is evident. We suggest that nutrition policy making would benefit from a pragmatic approach that ensures those trying to influence or understand the policy-making process are equipped with basic knowledge around these theories.

Almost no previous research has examined the impact of the US Department of Agriculture’s (USDA) Summer Food Service Program and related Seamless Summer Option, which provide meals and snacks to low-income children over the summer. The present study investigated whether geographic accessibility of summer meals programme sites (a proxy for programme participation) was associated with food insecurity for low-income households.

The study used data from the California Health Interview Survey (CHIS) and administrative data on summer meals sites in California. Geocoding was used to calculate driving time between CHIS households and nearby summer meals sites. Geographic accessibility was measured using a gravity model, which accounted for the spatially distributed supply of and demand for summer meals. Food insecurity and very low food security were measured using a standard six-item measure from the USDA.

Low-income families with children (n 5394).

A representative surveillance study of non-institutionalized households in California.

Geographic accessibility was not associated with food insecurity. However, geographic accessibility was associated with a significantly lower probability of very low food security in the full sample and among households with younger children and those living in less urban areas.

The USDA’s summer meals programme may be effective at reducing the most severe form of food insecurity for low-income households with children. Expanding the number of summer meals sites, the number of meals served at sites and sites’ hours of operation may be effective strategies to promote nutritional health over the summer months.

To describe why and how capacity-building systems for scaling up nutrition programmes should be constructed in low- and middle-income countries (LMIC).

Position paper with task force recommendations based on literature review and joint experience of global nutrition programmes, public health nutrition (PHN) workforce size, organization, and pre-service and in-service training.

The review is global but the recommendations are made for LMIC scaling up multisectoral nutrition programmes.

The multitude of PHN workers, be they in the health, agriculture, education, social welfare, or water and sanitation sector, as well as the community workers who ensure outreach and coverage of nutrition-specific and -sensitive interventions.

Overnutrition and undernutrition problems affect at least half of the global population, especially those in LMIC. Programme guidance exists for undernutrition and overnutrition, and priority for scaling up multisectoral programmes for tackling undernutrition in LMIC is growing. Guidance on how to organize and scale up such programmes is scarce however, and estimates of existing PHN workforce numbers – although poor – suggest they are also inadequate. Pre-service nutrition training for a PHN workforce is mostly clinical and/or food science oriented and in-service nutrition training is largely restricted to infant and young child nutrition.

Unless increased priority and funding is given to building capacity for scaling up nutrition programmes in LMIC, maternal and child undernutrition rates are likely to remain high and nutrition-related non-communicable diseases to escalate. A hybrid distance learning model for PHN workforce managers’ in-service training is urgently needed in LMIC.