To estimate the contribution of television (TV) food advertising to the prevalence of obesity among 6–11-year-old children in Australia, Great Britain (England and Scotland only), Italy, The Netherlands, Sweden and the United States.

Data from contemporary representative studies on the prevalence of childhood obesity and on TV food advertising exposure in the above countries were entered into a mathematical simulation model. Two different effect estimators were used to calculate the reduction in prevalence of overweight and obesity in the absence of TV food advertising in each country; one based on literature and one based on experts’ estimates.

Six- to eleven-year-old children in six Western countries.

Estimates of the average exposure of children to TV food advertising range from 1·8 min/d in The Netherlands to 11·5 min/d in the United States. Its contribution to the prevalence of childhood obesity is estimated at 16 %–40 % in the United States, 10 %–28 % in Australia and Italy and 4 %–18 % in Great Britain, Sweden and The Netherlands.

The contribution of TV advertising of foods and drinks to the prevalence of childhood obesity differs distinctly by country and is likely to be significant in some countries.

To evaluate the level of compliance with the PAOS Code (Publicidad, Actividad, Obesidad y Salud), which establishes standards for the self-regulation of food marketing aimed at minors, in television advertising by food and beverage companies that have agreed to abide by the Code.

The study sample consisted of food and beverage advertisements targeting children during 80 h of programming by four Spanish television networks. The level of compliance with each standard of the PAOS Code was classified into three categories: ‘compliance’, ‘non-compliance’ and ‘uncertain compliance’. Overall, an advertisement was considered compliant with the PAOS Code if it met all the standards; non-compliant if it contravened one or more standards; and uncertain in all other cases.

Of a total of 203 television advertisements from companies that agreed to the PAOS Code, the overall prevalence of non-compliance was 49·3 % (v. 50·8 % among those that did not agree to the code), with 20·7 % of advertisements considered of uncertain compliance. Non-compliance was more frequent on Saturdays, in longer advertisements, in advertisements containing promotions or dairy products, and for advertisements from companies of French or US origin.

Non-compliance with the PAOS Code was very high and was similar for companies that did and did not agree to the Code, casting doubt on the Code’s effectiveness and oversight system. It seems the time has come to commit to statutory regulations that reduce the negative impact of advertising on children’s diets, as demanded by public health experts and consumer associations.

Poor diet in childhood increases risk of obesity but the relationship between access to food and children’s food choice is underexplored. We determined relationships between distance to and density of food outlets on children’s food choice.

Children (n 1721) aged 9–10 years who participated in a cross-sectional study from a sample of state and private schools across urban and rural areas. Food consumption was reported using a short validated FFQ. A Geographic Information System was used to determine proximity to local food outlets. Multivariable regression analyses were performed to determine associations between food consumption and distance to and density of local food outlets.

Norfolk, England.

Boys (n 754) and girls (n 967) aged 9–10 years.

The impact of distance to or density of food outlets on food choice was small after adjustment. Living further away from a supermarket increased portions of fruit (0·11 portions/week per 1 km increase in distance to nearest supermarket, P < 0·05) and vegetables (0·11 portions/week, P < 0·05) consumed. Living closer to convenience stores was also associated with an increased consumption of crisps, chocolate and white bread. Density of supermarkets was associated with both an increase in vegetable intake (0·31 portions/week, P < 0·05) and unhealthy foods.

Distance to and density of food outlets are both associated with children’s food choice, although the impact appears to be small and the relationship is complex. However, the effects of individual foods combined could be important, particularly as even small differences in intake can impact on body weight over time.

Given that small food stores may be important retail food sources in low-income urban communities, our objective was to examine cross-city comparative data documenting healthy food availability within such facilities, particularly those located in low-income areas and nearby schools.

Food stores in Baltimore, Maryland; Minneapolis/St. Paul, Minnesota; Oakland, California; and Philadelphia, Pennsylvania were selected for assessment based on proximity to low-income schools. Stores were defined as: (i) single-aisle (n 45); (ii) small (2–5 aisles; n 52); and (iii) large (≥6 aisles; n 8). Staff conducted in-store audits to assess the presence/absence of twenty-eight healthy items, organized within five categories: (i) fresh fruits/vegetables, (ii) processed fruits/vegetables, (iii) healthy beverages/low-fat dairy, (iv) healthy snacks and (v) other healthy staple foods.

The availability of healthy food items was low, particularly in single-aisle and small stores, and there was significant cross-site variability in the availability of healthy snacks (P < 0·0001) and other healthy staple foods (P < 0·0001). No cross-site differences existed for fruits/vegetables or healthy beverages/low-fat dairy availability. Healthy food availability scores increased significantly with store size for nearly all food/beverage categories (P < 0·01).

Overall, healthy food availability in these venues was limited. Region-specific factors may be important to consider in understanding factors influencing healthy food availability in small urban markets. Data suggest that efforts to promote healthy diets in low-income communities may be compromised by a lack of available healthy foods. Interventions targeting small stores need to be developed and tailored for use in urban areas across the USA.

To assess the nutrient profile of yoghurts and dairy desserts.

Nutrition information panels and product labels on yoghurts and dairy desserts offered for sale were surveyed in 2005 and 2008 and nutrients analysed by two nutrient profiling systems.

A large supermarket in metropolitan Melbourne, Australia.

In total, 248 and 140 dairy snacks (yoghurt, fromage frais or dairy desserts) were surveyed in 2005 and 2008, respectively. Over this time, median packet size rose significantly (P ≤ 0·001). In yoghurts, median energy and total fat content also increased while protein decreased (all P < 0·05). The proportion of ‘full-fat’ products rose from 36 % to 46 %. Because of the addition of sugar, most ‘reduced-fat’ yoghurts had energy content similar to many ‘full-fat’ yoghurts. Overall, the proportion of yoghurts and dairy desserts that were ‘less healthy’ (i.e. displaying one or more ‘red traffic lights’ for high fat, saturated fat, salt and sugar content) rose from 12 % in 2005 to 23 % in 2008. Only 1–2 % could be deemed ‘healthy’ by the most stringent criterion (displaying four ‘green traffic lights’), while 21 % (2005) or 28 % (2008) were ‘healthy’ by a nutrient profiling system that included a score for protein. Sucrose, the most common sweetener, was found in levels up to 29 g/100 g. Claims on packaging mainly related to Ca, fat or protein content. Few labels referred to sugar content.

The deterioration in nutrient quality of yoghurts needs to be redressed.

Low birth weight is associated with increased lifelong morbidity. Kerala has a renowned, low-cost, maternal–child health system in which is couched universal access to the Integrated Child Development Scheme (ICDS), central to which is community-based maternal–infant nutritional supplementation. We assessed whether children in this environment showed enhanced birth weight and postnatal growth and whether the evolution of early markers of CVD was attenuated in comparison to contemporaries from other states.

A part retrospective, part prospective cohort study in which children (n 286) born in 1998–2000 in Calicut were identified from Anganwadi records. They were traced at 6 years and underwent full anthropometry and blood pressure measurements at 6 and 8 years.

Mean birth weight (2·86 (sd 0·40) kg) was greater than in Indian contemporaries but consistently <−1sd below the National Center for Health Statistics reference median throughout childhood. Birth weight significantly predicted body mass (BMI) at 8 years. Lower birth weight was strongly predictive of a higher waist:hip ratio (WHR) indicative of adverse central (coelomic) fat distribution (P < 0·01). Faster weight gain in infancy was weakly predictive of a lower WHR (P = 0·59), but faster late childhood growth at 6–8 years was non-significantly predictive of adverse WHR.

At 8 years of age, children in Calicut participating in the ICDS have greater birth weight and relative attenuation of the evolution of early CVD markers compared with children in apparently comparable states. The relative contributions of the ICDS and other factors inherent to Kerala cannot be inferred from the present study.

Uptake of advice for lifestyle change for obesity and diabetes prevention requires access to affordable ‘healthy’ foods (high in fibre/low in sugar and fat). The present study aimed to examine the availability and accessibility of ‘healthy’ foods in rural and urban New Zealand.

We identified and visited (‘mapped’) 1230 food outlets (473 urban, 757 rural) across the Waikato/Lakes areas (162 census areas within twelve regions) in New Zealand, where the Te Wai O Rona: Diabetes Prevention Strategy was underway. At each site, we assessed the availability of ‘healthy’ foods (e.g. wholemeal bread) and compared their cost with those of comparable ‘regular’ foods (e.g. white bread).

Healthy foods were generally more available in urban than rural areas. In both urban and rural areas, ‘healthy’ foods were more expensive than ‘regular’ foods after adjusting for the population and income level of each area. For instance, there was an increasing price difference across bread, meat, poultry, with the highest difference for sugar substitutes. The weekly family cost of a ‘healthy’ food basket (without sugar) was 29·1 % more expensive than the ‘regular’ basket ($NZ 176·72 v. $NZ 136·84). The difference between the ‘healthy’ and ‘regular’ basket was greater in urban ($NZ 49·18) than rural areas ($NZ 36·27) in adjusted analysis.

‘Healthy’ foods were more expensive than ‘regular’ choices in both urban and rural areas. Although urban areas had higher availability of ‘healthy’ foods, the cost of changing to a healthy diet in urban areas was also greater. Improvement in the food environment is needed to support people in adopting healthy food choices.

The FAO has developed an approach for estimating the prevalence of undernourishment. Based on the FAO method Taiwan has a prevalence of undernourishment of 3·98 %, which is higher than that of some developing countries. As this is not a true reflection of the status of undernourishment in our nation, the purpose of the present study was to modify the FAO methodology for Taiwan.

Two factors were considered in the modified version. As the minimum dietary energy requirement was the main factor contributing to the inflated prevalence in Taiwan, we adjusted for a lighter physical activity level, based on the average BMI of the Taiwanese population, and calculated a new minimum dietary energy requirement. We then fitted a second-order polynomial regression model for prediction of per capita dietary energy supply.

The adjusted minimum dietary energy requirement was reduced to 7648 kJ/d or 7765 kJ/d compared with the original value of 8054 kJ/d. This resulted in a decrease of the prevalence of undernourishment in Taiwan to 2·5 % or 3·0 %, which is much closer to that of other countries with the same level of economic development. The second-order polynomial regression model efficiently reduced the variation in dietary energy consumption and resulted in an undernourishment prevalence of less than 2·5 %.

This new adapted method is more appropriate for Taiwan. It is recommended that each country evaluates the appropriateness of the FAO approach for its population.

To describe how the time spent in food-related activities by Americans has changed over the past 30 years.

Data from four national time diary surveys, spanning 1975–2006, are used to construct estimates of trends in American adults’ time spent in food-related activities. Multivariate Tobits assess how food-related activities have changed over time controlling for sociodemographic and economic covariates.

Both bivariate and multivariate estimates reveal that between 1975 and 2006, American women’s time spent in food preparation declined substantially, whereas the time spent in these activities by American men changed very little. On the contrary, grocery shopping time increased modestly for both men and women. The primary eating time (i.e. time when eating/drinking was the respondent’s main focus) declined for both men and women over this historical period, and the composition of this time changed with less primary eating time being done alone. Concurrently, secondary eating time (i.e. time when something else had the respondent’s primary attention, but eating/drinking simultaneously occurred) rose precipitously for both women and men between 1975 and 1998.

The total time spent in eating (i.e. primary plus secondary eating time) has increased over the past 30 years, and the composition of this time has shifted from situations in which energy intake can be easily monitored to those in which energy intake may be more difficult to gauge. Less time is also being spent in food preparation and clean-up activities. Future research should explore possible links between these trends and Americans’ growing obesity risk.

To examine the association between soft drink consumption and mental health problems, including self-reported doctor-diagnosed anxiety, stress-related problem and depression, suicidal ideation and psychological distress, among adults in South Australia.

Data were collected using a risk factor surveillance system. Each month a representative random sample of South Australians was selected from the Electronic White Pages with interviews conducted using computer-assisted telephone interviewing.

South Australia.

Participants were aged 16 years and above.

Among 4741 participants, 12·5 % reported daily soft drink consumption of more than half a litre. High levels of soft drink consumption were positively associated with depression, stress-related problem, suicidal ideation, psychological distress and a current mental health condition, but not anxiety. Overall, 24·0 % of those having suicidal ideation reported consuming more than half a litre of soft drink per day. In the multivariate analysis, after adjusting for sociodemographic and lifestyle factors, those who consumed more than half a litre of soft drink per day had approximately 60 % greater risk of having depression, stress-related problem, suicidal ideation, psychological distress or a current mental health condition, compared with those not consuming soft drinks. The soft drink to total fluid consumption ratio had similar associations with mental health problems.

There is a positive association between consumption of soft drinks and mental health problems among adults in South Australia.

Although dietary pattern approaches derived from dietary assessment questionnaires are widely used, only a few studies in Western countries have reported the validity of this approach. We examined the relative validity of dietary patterns derived from a self-administered diet history questionnaire (DHQ) among Japanese adults.

The DHQ, assessing diet during the preceding month, and 4 d dietary records (DR) were collected in each season over one year. To derive dietary patterns, 145 food items in the DHQ and 1259 in the DR were classified into thirty-three predefined food groups, and entered into a factor analysis.

Three areas in Japan; Osaka (urban), Nagano (rural inland) and Tottori (rural coastal).

A total of ninety-two Japanese women and ninety-two Japanese men aged 31–76 years.

We identified three dietary patterns (‘healthy’, ‘Western’ and ‘Japanese traditional’) in women and two (‘healthy’ and ‘Western’) in men, which showed a relatively similar direction and magnitude of factor loadings of food groups across the first and mean of four DHQ (DHQ1 and mDHQ, respectively) and 16 d DR. The Pearson correlation coefficients between DHQ1 and 16 d DR for the healthy, Western and Japanese traditional patterns in women were 0·57, 0·36 and 0·44, and for the healthy and Western patterns in men were 0·62 and 0·56, respectively. When mDHQ was examined, the correlation coefficients improved for women (0·45–0·69).

Dietary patterns derived from the DHQ could be used for epidemiological studies as surrogates of those derived from DR.

To study the demographic and clinical parameters of three different categories of obesity, with particular focus on a cohort of individuals with BMI ≥ 50 kg/m2, the fastest growing category of obesity.

Over 700 obese individuals were studied (186 with BMI = 30–39 kg/m2, 316 with BMI = 40–49 kg/m2 and 290 with BMI ≥ 50 kg/m2).

Median BMI was 51 kg/m2 for patients who reported onset of overweight before 15 years of age, 47 kg/m2 for patients who reported onset between 15 and 30 years, and 42 kg/m2 for patients who became overweight after 30 years of age. The BMI ≥ 50 kg/m2 group was notably younger than the group with BMI = 30–39 kg/m2 (44 (sd 11) years v. 50 (sd 15) years; P < 0·0001). Eighteen per cent of obese patients studied were considered metabolically healthy according to standard cut-off points for blood pressure, fasting glucose and lipid profiles. However, the proportion of metabolically healthy individuals was significantly higher in the BMI = 30–39 kg/m2 group than in the BMI = 40–49 kg/m2 and BMI ≥ 50 kg/m2 groups (31 % v. 17 % and 12 % respectively; P < 0·05 and P < 0·005). When compared with people of similar age in the general population, individuals with BMI ≥ 50 kg/m2 had lower rates of marriage (51 % v. 72 %) and a higher prevalence of unemployment (14 % v. 5 %).

The current study suggests that the increasing prevalence of childhood obesity worldwide will lead to many more individuals achieving a higher BMI at a younger age. Furthermore, an earlier onset of overweight does not appear to prevent the adverse metabolic health outcomes associated with extreme obesity.

In the present study we investigated consumers’ visual attention to nutrition information on food products using an indirect instrument, an eye tracker. In addition, we looked at whether people with a health motivation focus on nutrition information on food products more than people with a taste motivation.

Respondents were instructed to choose one of five cereals for either the kindergarten (health motivation) or the student cafeteria (taste motivation). The eye tracker measured their visual attention during this task. Then respondents completed a short questionnaire.

Laboratory of the ETH Zurich, Switzerland.

Videos and questionnaires from thirty-two students (seventeen males; mean age 24·91 years) were analysed.

Respondents with a health motivation viewed the nutrition information on the food products for longer and more often than respondents with a taste motivation. Health motivation also seemed to stimulate deeper processing of the nutrition information. The student cafeteria group focused primarily on the other information and did this for longer and more often than the health motivation group. Additionally, the package design affected participants’ nutrition information search.

Two factors appear to influence whether people pay attention to nutrition information on food products: their motivation and the product’s design. If the package design does not sufficiently facilitate the localization of nutrition information, health motivation can stimulate consumers to look for nutrition information so that they may make a more deliberate food choice.

We conducted a hospital-based, case–control study to examine the association between dietary patterns and the risk of oesophageal squamous cell carcinoma in Iran.

A total of forty-seven patients with oesophageal squamous cell carcinoma and ninety-six controls underwent face-to-face interviews. Factor analysis was used to detect dietary patterns. Multivariate logistic regression was used to estimate OR and 95 % CI.

We defined two major dietary patterns in this population: ‘healthy diet’ (high in vegetables, nuts, fruits, low-fat dairy and fish) and ‘western diet’ (high in solid oil, sugar, sweets, tea, eggs, pickles and processed meat). Both healthy and western pattern scores were divided into two categories (based on medians). Higher healthy pattern scores were significantly associated with decreased risk of oesophageal squamous cell carcinoma (high: second median v. low: first median, OR = 0·17, 95 % CI 0·19, 0·98). An increased risk of oesophageal squamous cell carcinoma was observed with the western pattern (high: second median v. low: first median, OR = 10·13, 95 % CI 8·45, 43·68).

The results of the present study suggested that diet might be associated with oesophageal carcinoma.

The purpose of the present paper is to provide an integrated overview of the research methodology and key findings from a decade of research on family meals as part of Project EAT (Eating Among Teens), a large, population-based study of adolescents.

Focus groups conducted with 141 middle-school and high-school adolescents suggested the importance of family meals in influencing adolescents’ food choices. These findings led to the inclusion of questions on family meals in the Project EAT-I survey, completed by 4746 middle-school and high-school students, and in the Project EAT-II longitudinal survey, completed by 2516 of the original participants five years later. A subset of 902 parents also participated in telephone interviews as part of Project EAT-I.

Findings indicate that many adolescents and parents view family meals in a positive light, but there is great diversity in the context and frequency of family meal patterns in the homes of adolescents. Findings further suggest that family meals may have benefits in terms of dietary intake, disordered eating behaviours, substance use and psychosocial health.

Findings from Project EAT, in conjunction with other research studies on family meals, suggest the importance of working with families to increase the frequency and improve the quality of family meals. Further research is needed in order to elucidate the pathways that underpin the relationships between family meals and health outcomes. Suggestions for a future research agenda based on what was learned from Project EAT are provided.

To examine the sociodemographic, parental and child factors that predict fruit and vegetable consumption in 7-year-old children.

Diet was assessed using three 1d unweighed food diaries. The child’s daily fruit and vegetable consumption was calculated by summing the weight of each type of fruit, fruit juice and vegetable consumed. The various others factors measured were assessed by a questionnaire at different time points.

The Avon Longitudinal Study of Parents and Children (ALSPAC).

A total of 7285 children aged 7 years residing in the south-west of England during 1999–2000.

Median daily fruit and vegetable consumption (201 g) was below the recommendations for this age group (320 g). Girls ate more fruit and vegetables per unit energy (30·3 g/MJ) than boys (26·7 g/MJ; P =< 0·001). The predictors of fruit and vegetable consumption were mostly similar. Fruit and vegetable consumption was associated with maternal consumption, maternal education status and parental rules about serving fruit/vegetables every day, food expenditure per person and whether the child was choosy about food. Vegetable consumption was also associated with the other characteristics of the child, such as whether the child enjoyed food and whether the child tried a variety of foods.

Children are not eating recommended amounts of fruit and vegetables, particularly boys. Consumption of fruit and vegetables appears to be influenced by parental rules about daily consumption and parental consumption and by the child’s choosiness. Parent’s actions could influence this. These findings may prove useful for those planning healthy eating campaigns for children.

To estimate the physical activity level among Mexican adults and to establish the sociodemographic variables that may be linked to active lifestyles.

Data from a cross-sectional survey were analysed. Physical activity was assessed using the short version of the International Physical Activity Questionnaire. The independent variables were sex, age, socio-economic status and size of town. Ordinal regression models were fitted to assess the association of physical activity levels with sociodemographic factors.

Fieldwork was conducted from November 2002 through April 2003; the non-response rate was 3·1 %.

Data from a national representative sample (n 38 746) of Mexican adults aged >18 years old were analysed.

Almost 60 % of the population was classified into the high physical activity level. Women were less active than men in rural areas; in urban areas, the opposite trend was observed. In women, higher socio-economic status was associated with less physical activity, while among men there were no differences. People from rural and urban areas had a higher probability of engaging in physical activity than those from cities. In urban localities and cities, respondents of low socio-economic status had a lower probability of engaging in physical activity.

Using a validated instrument to measure physical activity, we found that the prevalence of active lifestyle among Mexican adults was high. The socio-economic and gender inequalities are different according to size of town (i.e. an effect modifier), which must be considered in the design of policies and programmes to promote physical activity.

Although the sociodemographic characteristics of food-insecure households have been well documented, there has been little examination of neighbourhood characteristics in relation to this problem. In the present study we examined the association between household food security and neighbourhood features including geographic food access and perceived neighbourhood social capital.

Cross-sectional survey and mapping of discount supermarkets and community food programmes.

Twelve high-poverty neighbourhoods in Toronto, Ontario, Canada.

Respondents from 484 low-income families who had children and who lived in rental accommodations.

Food insecurity was pervasive, affecting two-thirds of families with about a quarter categorized as severely food insecure, indicative of food deprivation. Food insecurity was associated with household factors including income and income source. However, food security did not appear to be mitigated by proximity to food retail or community food programmes, and high rates of food insecurity were observed in neighbourhoods with good geographic food access. While low perceived neighbourhood social capital was associated with higher odds of food insecurity, this effect did not persist once we accounted for household sociodemographic factors.

Our findings raise questions about the extent to which neighbourhood-level interventions to improve factors such as food access or social cohesion can mitigate problems of food insecurity that are rooted in resource constraints. In contrast, the results reinforce the importance of household-level characteristics and highlight the need for interventions to address the financial constraints that underlie problems of food insecurity.