To explore the everyday consumption of meals and snacks from the child’s perspective, among those with healthier v. less healthy dietary habits.

The sample in this qualitative study comprised two groups of Danish schoolchildren aged 10 to 11 years, one with a healthier diet (n 9) and the other with a less healthy diet (n 8). Both groups were recruited from respondents to a dietary survey. Semi-structured interviews took their starting point in photographs of their meals and snacks taken by the children themselves.

Both subgroups of children had a meal pattern with three main meals and two to four snacks. We found a connection between the nutritional quality of the diet and the social contexts of consumption, especially with regard to snacks. Among children with healthier eating habits, both snacks and meals tended to be shared social events and items of poor nutritional quality functioned as markers of a special social occasion. This was not the case among children with less healthy eating habits. All children described particular rules governing food consumption within their families. Although only some of them had participated in the development of these rules, and despite the fact that rules were different and were perceived as having been developed for different reasons, children from both subgroups tended to accept them.

The results of the study suggest that dietary interventions designed to promote children’s health should focus more on the different social contexts of consumption and more on the role of parents.

To analyse the nature and content of advertising during children’s popular television viewing times with the specific aims of (i) identifying the proportion of advertising time devoted to confectionery and potentially cariogenic products (those which readily give rise to dental caries, more commonly known as tooth decay); and (ii) determining whether there is a variation in the advertisement of confectionery and other high-sugar products within children’s school holiday time v. outside holiday time.

In five separate one-week periods, the output of the four most popular British children’s commercial television channels was video-recorded during the most popular viewing times for children. In total, 503 h of television were recorded and analysed.

Analysis of the recordings revealed that 16·4 % of advertising time was devoted to food products; 6·3 % of all advertising time was devoted to potentially cariogenic products. Sugared cereals were the most commonly advertised high-sugar product, followed by sweetened dairy products and confectionery (χ2 = 6524·8, df = 4, P < 0·001). The advertisement of confectionery and high-sugar foods appeared to be influenced by school holidays.

Health-care professionals should be aware of the shift away from the advertisement of confectionery towards the promotion of foods that might be considered healthier but contain large amounts of hidden sugar.

To study the effect of combining multiple (two or more) micronutrients with Fe supplementation on Hb response, when compared with placebo and with Fe supplementation, in children.

Electronic databases, personal files, hand search of reviews, bibliographies of books, and abstracts and proceedings of international conferences.

Randomized controlled trials evaluating change in Hb levels with interventions that included Fe and multiple-micronutrient supplementation in comparison to placebo alone or Fe alone were analysed in two systematic reviews.

Twenty-five trials were included in the review comparing Fe and micronutrient supplementation with placebo. The pooled estimate (random effects model) for change in Hb with Fe and micronutrient supplementation (weighted mean difference) was 0·65 g/dl (95 % CI 0·50, 0·80, P < 0·001). Lower baseline Hb, lower height-for-age Z score, non-intake of ‘other micronutrients’ and malarial non-hyperendemic region were significant predictors of greater Hb response and heterogeneity. Thirteen trials were included in the review comparing Fe and micronutrient supplementation with Fe alone. The pooled estimate for change in Hb with Fe and micronutrient supplementation (weighted mean difference) was 0·14 g/dl (95 % CI 0·00, 0·28, P = 0·04). None of the variables were found to be significant predictors of Hb response.

Synthesized evidence indicates that addition of multiple micronutrients to Fe supplementation may only marginally improve Hb response compared with Fe supplementation alone. However, addition of ‘other micronutrients’ may have a negative effect. Routine addition of unselected multiple micronutrients to Fe therefore appears unjustified for nutritional anaemia control programmes.

To describe the relationships between physical activity, lifestyle determinants and obesity in adolescent Israeli schoolchildren.

Cross-sectional survey.

The MABAT Youth Survey was a nationally representative, school-based study of youth in grades 7 to 12 (ages 11–19 years).

Self-administered questionnaires assessed health behaviours and anthropometric indices were measured. Logistic regression analysis was used to examine the associations between obesity, physical activity, socio-economic status and other lifestyle habits. One-way ANOVA was used to determine mean physical activity levels (MET values) by BMI categories.

The prevalence of overweight was 13–15 % and of obesity 4–9 % depending on gender and ethnicity, and was higher among the non-Jewish sectors. Thirty-six per cent and 57 % of Jewish girls and boys, and 40 % and 58 % of non-Jewish girls and boys, respectively, were optimally active. Boys from low socio-economic schools and those who slept for less than 6 h at night were less active. Girls from middle school were found to be 53 % more optimally physically active among Jews, and 89 % more among non-Jews, compared with girls from high school (P = 0·001); girls with less educated parents were also less physically active. No clear relationship was found between the level of obesity and physical activity.

Physical inactivity was strongly related to gender, age, social status, sleeping habits, hookah smoking, and parental educational status. Education and intervention programmes should focus on these risk factors.

To prospectively evaluate growth parameters assessed by weight and length in infected and uninfected infants born to HIV-1-infected mothers and followed from birth to 18 months.

A cohort consisting of ninety-seven uninfected and forty-two infected infants born to HIV-infected mothers enrolled from 1995 to 2004, and admitted during their first 3 months of life at a referral Pediatric AIDS Clinic in Belo Horizonte, Brazil. Infants were followed until 18 months of age. Data were analysed using mixed-effects linear regression models for weight and length fitted by restricted maximum likelihood.

Infected infants contributed to 466 weight and 411 recumbent length measurements. Uninfected infants provided 924 weight and 907 length measurements. Mean birth weight and length were similar in both groups, 3·1 (sd 0·4) and 3·0 (sd 0·5) kg, and 48·7 (sd 1·4) and 48·8 (sd 2·9) cm for uninfected and infected infants, respectively. However, HIV-1 infection had an early impact in growth impairment: at 6 months of age, HIV-infected children were 1 kg lighter and 2 cm shorter than the uninfected.

Growth faltering in weight, but not length, in HIV-infected children in Brazil is more marked than that reported in a European cohort, probably reflecting background nutritional deficiencies and concomitant infections. In these settings, early and aggressive nutritional management in HIV-1-infected infants should be a priority intervention associated with the antiretroviral therapy.

To identify determinants of low birth weight (LBW) in Karachi, Pakistan, including environmental exposures and nutritional status of the mother during pregnancy.

Cross-sectional study.

Five hundred and forty mother–infant pairs. We interviewed mothers about obstetric history, diet and exposure to Pb. We measured birth weight and blood lead level (BLL). We performed multiple log binomial regression analysis to identify factors related to LBW.

Of 540 infants, 100 (18·5 %) weighed ≤2·5 kg. Umbilical cord BLL was not significantly associated with LBW. Maternal poor self-rated health (adjusted prevalence ratio (adjPR) = 1·83; 95 % CI 1·09, 3·07) and none or one prenatal visit (adjPR = 2·18; 95 % CI 1·39, 3·43) were associated with LBW. A statistically significant interaction between mothers’ mid upper-arm circumference (MUAC) and dietary vitamin C intake was noted. Compared with mothers with MUAC above the median and dietary vitamin C intake above the 3rd quartile (>208·7 mg/d), infants of mothers with MUAC less than or equal to the median and dietary vitamin C intake >208·7 mg/d (adjPR = 10·80; 95 % CI 1·46, 79·76), mothers with MUAC above the median and vitamin C intake ≤208.7 mg/d (adjPR = 10·67; 95 % CI 1·50, 76·02) and mothers with MUAC less than or equal to the median and vitamin C intake ≤208·7 mg/d (adjPR = 13·19; 95 % CI 1·85, 93·79) more likely to give birth to an LBW infant.

In Pakistan, poor nutritional status and inadequate prenatal care were major determinants of LBW in this setting. Environmental factors including umbilical cord BLL were not significantly associated with LBW.

To investigate the relative efficacy of four popular weight-loss programmes on plasma lipids and lipoproteins as measures of CVD risk.

A multi-centred, randomised, controlled trial of four diets – Dr Atkins’ New Diet Revolution, The Slim-Fast Plan, Weight Watchers Pure Points programme and Rosemary Conley’s ‘Eat yourself Slim’ Diet and Fitness Plan – against a control diet, in parallel for 6 months.

The trial was conducted at five universities across the UK (Surrey, Nottingham, Ulster (Coleraine), Bristol and Edinburgh (Queen Margaret University College)) and involved the participation of 300 overweight and obese males and females aged 21–60 years in a community setting.

Significant weight loss was achieved by all dieting groups (5–9 kg at 6 months) but no significant difference was observed between diets at 6 months. The Weight Watchers and Rosemary Conley (low-fat) diets were followed by significant reductions in plasma LDL cholesterol (both −12·2 % after 6 months, P < 0·01), whereas the Atkins (low-carbohydrate) and Weight Watchers diets were followed by marked reductions in plasma TAG (–38·2 % and –22·6 % at 6 months respectively, P < 0·01). These latter two diets were associated with an increase in LDL particle size, a change that has been linked to reduced CVD risk.

Overall, these results demonstrate the favourable effects of weight loss on lipid-mediated CVD risk factors that can be achieved through commercially available weight-loss programmes. No detrimental effects on lipid-based CVD risk factors were observed in participants consuming a low-carbohydrate diet.

Consumers are increasingly relying on low-cost foods, although it is not clear if the nutritional quality of these foods is fully maintained. The aim of the present work was to analyse the relationship between cost and quality within a given food category.

The relationship was analysed between nutritional quality and cost for 220 food products belonging to seventeen different categories, controlling for package type and package size. Given that a summary of nutrient information was not available on the product label, a novel ingredient quality score was developed based on listed product ingredients.

Within a given category, the lowest-priced foods were not different from the equivalent branded products in terms of overall energy or total fat content. Nevertheless, a positive relationship, small but significant, was observed between the price and the ingredient quality score. On average, the branded products cost 2·5 times more than the low-cost products, for an equivalent energy and lipid content, and had a slightly higher (1·3 times) ingredient quality score.

More studies are necessary to evaluate the nutritional quality of low-cost foods. This evaluation would be facilitated if nutrition labelling was mandatory. Yet in view of the present results, it does not seem to be justified to divert consumers, especially the poorest, from low-cost foods because this may have an adverse effect on the nutritional quality of their diet, by reducing further the fraction of their food budget spent on fresh fruit and vegetables.

To compare the differences in hyperlipidaemia prevalence and its risk factors between the Guangxi Bai Ku Yao and Han populations.

Cross-sectional study of hyperlipidaemia.

Both populations were from Lihu and Baxu villages in Nandan County, Guangxi Zhuang Autonomous Region, People’s Republic of China.

A total of 1170 healthy subjects of Bai Ku Yao and 1173 participants of Han Chinese aged 15–89 years were surveyed by a stratified randomized cluster sampling. Information on demographic, dietary and lifestyle characteristics was collected by standard questionnaires. Blood pressure, height, weight, waist circumference, serum lipids and apolipoproteins were measured, and BMI (kg/m2) was calculated as weight divided by the square of height.

The prevalence rates of hypercholesterolaemia, hypertriacylglycerolaemia and hyperlipidaemia in Bai Ku Yao and Han were 12·4 % v. 26·2 % (P < 0·001), 15·0 % v. 14·8 % (P > 0·05) and 24·4 % v. 33·9 % (P < 0·001), respectively. Hyperlipidaemia was positively correlated with BMI, waist circumference, total energy and total fat intakes, and negatively associated with physical activity and total dietary fibre intake in Bai Ku Yao (P < 0·05 to 0·001). Hyperlipidaemia was positively associated with age, alcohol consumption, BMI, waist circumference, total energy and total fat intakes, and inversely correlated with physical activity and total dietary fibre intake in Han (P < 0·05 to 0·001).

The prevalence of hypercholesterolaemia and hyperlipidaemia was significantly lower in the Bai Ku Yao than in the Han population, which might result from different dietary habits, lifestyle choices and physical activity level, as well as genetic factors between the two ethnic groups.

To perform an evaluation of selected phytochemicals intake and breast cancer (BC) risk in Mexican women.

We conducted hospital-based case–control study.

Mexico City between 1994 and 1996.

A total of 141 histologically confirmed BC cases were age-matched (±3 years) to an equal number of hospital controls. The reproductive history of each woman was obtained by direct interview. The dietary consumption of flavonols, flavones, flavan-3-ols, cinnamic acid, lariciresinol, pinoresinol, secoisolariciresinol, matairesinol and coumestrol was obtained by means of a validated FFQ.

Among postmenopausal women, high dietary intake of flavonols and flavones was associated with a significant reduction of BC risk (high v. low tertile: OR = 0·21, 95 % CI 0·07, 0·60, P for trend = 0·004 and OR = 0·29, 95 % CI 0·10, 0·82, P for trend = 0·025, respectively); consumption of lignans (lariciresinol and pinoresinol) showed a similar effect, but only among premenopausal women (high v. low tertile: OR = 0·32, 95 % CI 0·10, 0·99, P for trend = 0·051 and OR = 0·19, 95 % CI 0·06, 0·62, P for trend = 0·006, respectively).

Our results support a protective role of specific dietary phytochemicals in BC risk by menopausal status, independent of other reproductive factors.

To study how dietary patterns and physical activity vary with acculturation and with past and current exposure to socio-cultural norms of the home country among Tunisian migrants.

A retrospective cohort study was conducted using quota sampling (n 150) based on age and residence. Dietary intake was assessed using a validated FFQ. Physical activity level and dietary aspects were compared according to length of residence (acculturation), age at migration (past exposure) and social ties with the home country (current exposure).

Tunisian migrant men residing in the South of France.

Migrants who had lived in France for more than 9 years had a higher percentage contribution of meat to energy intake (P = 0·04), a higher Na intake (P = 0·04), a lower percentage contribution of sugar and sweets (P = 0·04) and a lower percentage of carbohydrates (P = 0·03) than short-term migrants. Men who migrated before 21 years of age had a higher Na intake than ‘late’ migrants (P = 0·02). Men who had distant social ties with Tunisia had a lower physical activity level (P = 0·01) whereas men who had close ties had a higher percentage of fat (P = 0·01) and a higher ratio of MUFA to SFA (P = 0·02).

Acculturation led to a convergence of some characteristics to those of the host population, while some results (meat and salt consumption) were at variance with other acculturation studies. Past and current exposure to the home country helped maintain some positive aspects of the diet. Nevertheless, present dietary changes in Tunisia could soon lessen these features.

To study prospectively the association of coffee intake with incident diabetes in the Puerto Rico Heart Health Program cohort, comprising 9824 middle-aged men (aged 35–79 years).

Of 9824 men, 3869 did not provide a fasting blood sample at baseline, 1095 had prevalent diabetes and 131 were not given fasting glucose tests at any subsequent study visit. Thus, the present analysis includes 4685 participants. Diabetes was ascertained at baseline and at two study visits between 1968 and 1975 using fasting glucose tests and self-reports of physician-diagnosed diabetes or use of insulin or hypoglycaemic medication. Logistic regression analysis was used to assess the association of coffee intake with risk of incident diabetes while adjusting for covariates (age, BMI, physical activity, smoking, education, alcohol intake, family history of diabetes, intakes of milk and sugar).

Five hundred and nineteen participants met the criteria for incident diabetes. Compared with those reporting intake of 1–2 servings of coffee/d, coffee abstainers were at reduced risk (OR = 0·64; 95 % CI 0·43, 0·94). Among coffee drinkers, there was a significant trend of decreasing risk by intake (P = 0·02); intake of ≥4 servings/d was associated with an odds ratio of 0·75 (95 % CI 0·58, 0·97).

Study findings support a protective effect of coffee intake on diabetes risk, while also suggesting that abstainers may be at reduced risk.

The aim of the present study was to evaluate the urinary I excretion of pregnant women in Malatya Province, eastern Turkey.

A cross-sectional study was performed on pregnant women in urban and rural settlements of Malatya Province.

Urinary I excretion was measured for 824 pregnant women who were randomly selected using a probability-proportional-to-size sampling methodology.

Median urinary I concentration (UIC) of pregnant women was 77·4 μg/l. The percentage of pregnant women with UIC below 100 μg/l was 83·3.

These results indicate that I deficiency disorders (IDD) is still a problem in Malatya Province and most certainly in other parts of the country. Proper monitoring of I content of the salt sold or used in the area, in order to strengthen the IDD intervention programme, is suggested.

To investigate and report the diet quality of young Australian women by pregnancy status.

Pregnancy status was defined as pregnant (n 606), trying to conceive (n 454), had a baby in the last 12 months (n 829) and other (n 5597). The Dietary Questionnaire for Epidemiological Studies was used to calculate diet quality using the Australian Recommended Food Score (ARFS) methodology. Nutrient intakes were compared with the Nutrient Reference Values for Australia and New Zealand.

A population-based cohort participating in the Australian Longitudinal Study on Women’s Health (ALSWH).

A nationally representative sample of Australian women, aged 25 to 30 years, who completed Survey 3 of the ALSWH. The 7486 women with biologically plausible energy intake estimates, defined as >4·5 but <20·0 MJ/d, were included in the analyses.

Pregnancy status was not significantly predictive of diet quality, before or after adjusting for area of residence and socio-economic status. Pregnant women and those who had given birth in the previous 12 months had marginally higher ARFS (mean (se): 30·2 (0·4) and 30·2 (0·3), respectively) than ‘other’ women (29·1 (0·1)). No single food group accounted for this small difference. Across all pregnancy categories there were important nutrients that did not meet the current nationally recommended levels of intake, including dietary folate and fibre.

Women do not appear to consume a wider variety of nutritious foods when planning to become pregnant or during pregnancy. Many young Australian women are failing to meet key nutrient targets as nationally recommended.

To study the development of body weight with ageing, in a general adult population, taking into account possible period and cohort effects.

A prospective cohort study with 11 years of follow-up. At baseline and after 6 and 11 years, body weight and height were measured.

The Doetinchem Cohort Study, consisting of inhabitants of Doetinchem, a town in a rural area of The Netherlands.

In total, 4070 healthy men and women aged 20–59 years at baseline.

Increase in BMI with ageing was less profound based on cross-sectional data than based on longitudinal data. More recent-born cohorts had a higher BMI at a given age than cohorts who were born earlier. Increase in mean BMI with ageing was observed in all age groups and was similar for groups with a different educational level. Highest increase in BMI over 11 years was observed in the youngest group, aged 20–29 years at baseline (2·2 [95 % CL 2·0, 2·3] kg/m2), and lowest increase in the oldest group, aged 50–59 years at baseline (1·1 [1·0, 1·3] kg/m2).

Findings of the present study using longitudinal data suggest that increase in BMI with ageing is underestimated in all age groups by studying cross-sectional data only. Further, weight gain is present in all educational levels and does not stop at middle age.

To examine the potential public health impact on CHD and stroke mortality of replacing one ‘unhealthy’ snack with one ‘healthy’ snack per person, per day, across the UK population.

Nutritional information was obtained for different ‘unhealthy’ (such as crisps, chocolate bars, cakes and pastries) and ‘healthy’ snack products (such as fresh fruit, dried fruit, unsalted nuts or seeds). Expected changes in dietary intake were calculated. The mean change in total blood cholesterol levels was estimated using the Keys equation. The effect of changing cholesterol and salt levels on CHD deaths and on stroke deaths was calculated using the appropriate equations from the Law and He meta-analyses. The estimated reductions in cardiovascular deaths were then tested in a sensitivity analysis.

Substituting one ‘healthy’ snack would reduce saturated fat intake by approximately 4·4 g per person per day, resulting in approximately 2400 fewer CHD deaths and 425 fewer stroke deaths per year. The associated 500 mg decrease in salt intake would result in approximately 1790 fewer CHD deaths and 1330 fewer stroke deaths.

Simply replacing one unhealthy snack with one healthy snack per day might prevent approximately 6000 cardiovascular deaths every year in the UK.