The present review aimed to examine the association of eating frequency with body weight or body composition in adults of both sexes.

PubMed, EMBASE and Scopus databases were searched. PRISMA and MOOSE protocols were followed. Observational studies published up to August 2016 were included. The methodological quality of the studies was assessed with the Downs and Black checklist.

A systematic review of the literature.

Adults (n 136 052); the majority of studies were developed in the USA and Europe.

Thirty-one articles were included in the review: two prospective and twenty-nine cross-sectional studies. Thirteen per cent of the studies received quality scores above 80 %. The assessment of eating frequency and body composition or body weight varied widely across the studies. Potential confounders were included in 73 % of the studies. Fourteen studies reported an inverse association between eating frequency and body weight or body composition, and seven studies found a positive association. The majority of studies applied multiple analyses adjusted for potential confounders, such as sex, age, education, income, smoking, physical activity and alcohol intake. Six studies took into account under-reporting of eating frequency and/or energy intake in the analysis, and one investigated the mediation effect of energy intake.

There is not sufficient evidence confirming the association between eating frequency and body weight or body composition when misreporting bias is taken into account. However, in men, a potential protective effect of high eating frequency was observed on BMI and visceral obesity.

Childhood obesity has increased rapidly in China, but understanding is limited on how parents perceive their child’s weight status and how this perception affects weight-related parenting practices. We examined maternal perception of her child’s weight status and its association with demographics, subsequent weight-related parenting practices, the child’s health behaviours and weight change.

Maternal perception of child’s weight status and health behaviours from the China Health and Nutrition Surveys were assessed at baseline and in follow-up surveys for 816 children aged 6–18 years during 2004–2011. Associations were tested using mixed models.

Overall, maternal and child perceptions of the child’s weight status were fairly consistent (κw=0·56), 63·8 % of mothers had correct perception. While 9·6 % of mothers perceived their child as overweight, 10·9 % of children did so, and 13·6 % of children were indeed overweight. Compared with mothers who viewed their children as normal weight, mothers who thought their children were overweight were more likely to encourage their children to increase their physical activity (OR; 95 % CI: 1·8; 1·0, 3·3) and to diet (4·3; 2·3, 7·8). Children perceived as overweight by their mothers were more likely to have insufficient physical activity (2·8; 1·6, 4·7) and gain more weight during follow-up (BMI Z-score, β (se): 1·0 (0·1); P<0·01) than children perceived by their mothers as normal weight.

In China, mothers who perceive their child as overweight are more likely to encourage their child to exercise and modify their diet for weight management, but this encouragement does not seem to improve the child’s health behaviours and weight status.

To (i) systematically review the literature to determine the factors influencing diet and dietary behaviour in women living in urban Africa; (ii) present these in a visual map; and (iii) utilize this to identify potentially important areas for future research.

Systematic mapping review. The review protocol was registered at PROSPERO (http://www.crd.york.ac.uk/PROSPERO/; registration number CRD42015017749). Six databases were systematically searched, followed by reference and citation searching. Eligibility criteria included women aged 18–70 years living in urban Africa, any design/methodology, exploring any driver, using any measure of dietary behaviour. Quality appraisal occurred parallel with data extraction. Twelve predominantly cross-sectional quantitative studies were included; reported in seventeen publications. Determinants were synthesized narratively and compiled into a map adapted from an existing ecological model based on research in high-income countries.

Urban Africa.

African women aged 18–70 years.

Determinants significantly associated with unhealthy dietary behaviour ranged from the individual to macro level, comprising negative body image perception, perceptions of insufficient food quantity and poorer quality, poorer food knowledge, skipping meals, snacking less, higher alcohol consumption, unhealthy overall lifestyle, older age, higher socio-economic status, having an education, lower household food expenditure, frequent eating outside the home and media influence. Marital status and strong cultural and religious beliefs were also identified as possible determinants.

Few studies have investigated drivers of dietary behaviours in urban African settings. Predominantly individual-level factors were reported. Gaps in the literature identified a need for research into the neglected areas: social, physical and macro-level drivers of food choice.

To examine associations between grandmothers’ knowledge and infant and young child feeding (IYCF) practices and to test whether the associations are independent of or operate via maternal knowledge.

Cross-sectional household survey data from households with a child under 5 years (n 4080). We used multivariate regression analyses, adjusted for child, maternal, grandmother and household characteristics, and district-level clustering, to test associations between grandmothers’ knowledge and IYCF practices for children aged 6–24 months living with a grandmother. We used causal mediation to formally test the direct effect of grandmothers’ knowledge on IYCF practices v. maternal knowledge mediating these associations.

Two hundred and forty rural communities, sixteen districts of Nepal.

Children aged 6–24 months (n1399), including those living with grandmothers (n 748).

We found that the odds of optimal breast-feeding practices were higher (early breast-feeding initiation: 2·2 times, P=0·002; colostrum feeding: 4·2 times, P<0·001) in households where grandmothers had correct knowledge v. those with incorrect knowledge. The same pattern was found for correct timing of introduction of water (2·6), milk (2·4), semi-solids (3·2), solids (2·9), eggs (2·6) and meat (2·5 times; all P<0·001). For the two pathways we were able to test, mothers’ correct knowledge mediated these associations between grandmothers’ knowledge and IYCF practices: colostrum feeding (b=10·91, P<0·001) and the introduction of complementary foods (b=5·18, P<0·001).

Grandmothers’ correct knowledge translated into mothers’ correct knowledge and, therefore, optimal IYCF practices. Given grandmothers’ influence in childcare, engagement of grandmothers in health and nutrition interventions could improve mothers’ knowledge and facilitate better child feeding.

To examine the associations between parental feeding styles and children’s dietary intakes and the modifying effect of maternal education and children’s ethnicity on these associations.

Cross-sectional study of parental feeding styles, assessed by the Parental Feeding Style Questionnaire, and children’s dietary intakes. Multiple regression analyses were carried out to assess the associations between the parental feeding styles studied (‘control’, ‘emotional feeding’, ‘encouragement to eat’ and ‘instrumental feeding’) and children’s dietary intakes (consumption of fruit, vegetables, water and sugar-sweetened beverages (SSB)). The modifying effect of maternal education and children’s ethnicity on these associations was explored.

North-western part of the Netherlands.

Children aged 3–7 years (n 5926).

Both ‘encouragement’ and ‘control’ were associated with higher consumption of vegetables and lower consumption of SSB, but only ‘encouragement’ was positively associated with fruit and water intakes. ‘Instrumental feeding’ showed a positive association with SSB and negative associations with fruit, vegetable and water consumption. No significant associations were found for ‘emotional feeding’. Maternal educational level and children’s ethnicity moderated some associations; for example, ‘control’ was beneficial for vegetable intake in all subgroups, whereas the association with SSB was beneficial only in highly educated mothers.

The study shows that both encouraging and controlling feeding styles may improve children’s dietary behaviour, while ‘instrumental feeding’ may have a detrimental effect. Furthermore, maternal educational level and children’s ethnicity influence these associations. The study’s findings could provide a basis for development of interventions to improve parental feeding styles.

To find out how the consumption of organic food during pregnancy is associated with consumer characteristics, dietary patterns and macro- and micronutrient intakes.

Cross-sectional description of consumer characteristics, dietary patterns and macro- and micronutrient intakes associated with consumption of organic food during pregnancy.

Healthy, pregnant women recruited to a prospective cohort study at midwives’ practices in the southern part of the Netherlands; to enrich the study with participants adhering to alternative lifestyles, pregnant women were recruited through various specific channels.

Participants who filled in questionnaires on food frequency in gestational week 34 (n 2786). Participant groups were defined based on the share of organic products within various food types.

Consumers of organic food more often adhere to specific lifestyle rules, such as vegetarianism or anthroposophy, than do participants who consume conventional food only (reference group). Consumption of organic food is associated with food patterns comprising more products of vegetable origin (soya/vegetarian products, vegetables, cereal products, bread, fruits, and legumes) and fewer animal products (milk and meat), sugar and potatoes than consumed in conventional diets. These differences translate into distinct intakes of macro- and micronutrients, including higher retinol, carotene, tocopherol and folate intakes, lower intakes of vitamin D and B12 and specific types of trans-fatty acids in the organic groups. These differences are seen even in groups with low consumption of organic food.

Various consumer characteristics, specific dietary patterns and types of food intake are associated with the consumption of organic food during pregnancy.

To investigate the associations of organic food consumption with maternal pre-pregnancy BMI, hypertension and diabetes in pregnancy, and several blood biomarkers of pregnant women.

Prospective cohort study.

Pregnant women were recruited at midwives’ practices and through channels related to consumption of food from organic origin.

Pregnant women who filled in FFQ and donated a blood sample (n 1339). Participant groups were defined based on the share of consumed organic products; to discriminate between effects of food origin and food patterns, healthy diet indicators were considered in some statistical models.

Consumption of organic food was associated with a more favourable pre-pregnancy BMI and lower prevalence of gestational diabetes. Compared with participants consuming no organic food (reference group), a marker of dairy products intake (pentadecanoic acid) and trans-fatty acids from natural origin (vaccenic and rumenic acids) were higher among participants consuming organic food (organic groups), whereas elaidic acid, a marker of the intake of trans-fatty acids found in industrially hydrogenated fats, was lower. Plasma levels of homocysteine and 25-hydroxyvitamin D were lower in the organic groups than in the reference group. Differences in pentadecanoic acid, vaccenic acid and vitamin D retained statistical significance when correcting for indicators of the healthy diet pattern associated with the consumption of organic food.

Consumption of organic food during pregnancy is associated with several health-related characteristics and blood biomarkers. Part of the observed associations is explained by food patterns accompanying the consumption of organic food.

The study of meal patterns and overall diet in relation to health outcomes may be more important than focusing on single nutrients or food groups. The present study aimed to explore the composition of main meals and snacks in the Australian population and examine associations between meat/poultry/fish and other foods.

The study utilised 24 h recalls. Meal composition was defined based on average intakes of food groups per meal disaggregated from all food sources.

2011–12 National Nutrition and Physical Activity Survey.

Australian people (n12153) aged 2 years or above.

Overall, breakfast was the smallest meal of the day, typically consisting of grains, dairy products and fruit. Lunch was the second largest meal, consisting mostly of grains, non-starchy vegetables and meat/poultry/fish. The largest meal was dinner, comprising meat/poultry/fish, vegetables (starchy and non-starchy), grains and often including discretionary beverages (children) or alcohol (adults). The main food groups consumed at snacking occasions were dairy, fruit, discretionary foods and beverages (including alcohol for adults). The most frequently consumed meat types were beef and chicken at dinner and ham at lunch. Non-starchy vegetables were accompanying foods for red meat, poultry and fish/seafood consumed in varying portion sizes, but did not accompany processed meat.

The present study considered meat, poultry and fish as the meal centre and their accompaniments of other food groups at different eating occasions. These findings expand the background evidence for health professionals developing meal-based framework/guidelines and public health messages.

The Australian Dietary Guidelines recommend Australians choose mostly whole-grain and/or high-fibre varieties within the grains (cereal) foods category, with other groups specifying a whole grain Daily Target Intake of 48 g for Australians aged 9 years or above. The USA and UK report estimates of whole grain intake that are low and declining, and no comprehensive studies on whole grain intake in the Australian population are available. The present study aimed to determine national estimates of whole grain intake, compared with current recommendations.

A recently updated whole grain database was applied to the most current population dietary intake data. Single 24 h dietary recall intake data were reviewed against age group, sex, relative to energy intake and whole grain recommendations.

Australia.

Australians (2–85 years) participating in the 2011–13 Australian Health Survey (n 12 153).

The median daily whole grain intake was 21 g for adults (19–85 years) and 17 g for children/adolescents (2–18 years), or 28 and 23 g/10 MJ per d, respectively. Approximately 30 % of children/adolescents consumed no whole grains on the day of the survey. Whole grain intake was lowest for the age group 14–18 years (8·7 g/d). Of all participants aged ≥9 years, 73 % did not reach the recommended Daily Target Intake of 48 g.

Whole grain intake in Australia is below recommendations in all age groups. Adolescents may be a key target for campaigns to increase whole grain consumption. This study provides the first quantification of absolute whole grain intake from all food sources in a national sample of Australians.

To characterise German vitamin and mineral supplement users differentiated by their motives for supplement use.

Data were obtained from the German National Nutrition Monitoring (2010/11) via two 24 h dietary recalls and a telephone interview. Motive-based subgroups of supplement users were identified by factor and cluster analysis. Sociodemographic, lifestyle, health and dietary characteristics and supplement use were examined. Differences were analysed using χ2 tests, logistic and linear regression models.

Germany, nationwide.

Individuals (n 1589) aged 18–80 years.

Three motive-based subgroups were identified: a ‘Prevention’ subgroup (n 324), characterised by the motive to prevent nutrient deficiencies; a ‘Prevention and additional benefits’ subgroup (n 166), characterised by motives to prevent health problems and improve well-being and performance; and a ‘Treatment’ subgroup (n 136), characterised by motives to treat nutrient deficiencies or diseases. Members of the two prevention subgroups had a higher Healthy Eating Index score and tended to be more physically active than non-users. Those in the ‘Prevention and additional benefits’ subgroup supplemented with a greater number of micronutrients. Members of the ‘Treatment’ subgroup tended to be older and have a lower self-reported health status than non-users, and supplemented with a smaller number of micronutrients.

The majority of supplement users take supplements for preventive purposes and they are more health conscious than non-users of supplements due to their concerns about developing health problems. Those supplementing for treatment purposes may have underlying health indications and may be more likely to benefit from supplementation than those supplementing for preventive purposes.

To estimate the prevalence of underweight and overweight among Bangladeshi adults and to determine if the double burden of underweight and overweight differs by gender and other socio-economic characteristics of individuals.

We used data from the Bangladesh Demographic and Health Survey 2011. Multinominal logistic regression was used to examine associations between the different nutritional statuses of individuals and related determinants. Interaction effect was checked between gender and various socio-economic factors.

Nationwide, covering the whole of Bangladesh.

Individuals aged >18 years (women, n 16 052; men, n 5090).

Underweight was observed among 28·3 % of men and 24·4 % of women, whereas overweight was observed among 8·4 % of men and 16·9 % of women. The odds of being overweight were significantly lower among urban men (OR=0·46; 95 % CI 0·37, 0·57) compared with urban women, whereas the odds of being underweight were significantly higher among urban men (OR=1·33; 95 % CI 1·07, 1·64) compared with urban women. The odds of being overweight were lower among higher educated men (OR=0·48; 95 % CI 0·39, 0·58) and men of rich households (OR=0·45; 95 % CI 0·37, 0·54) compared with higher educated women and women of rich households, respectively.

There are important gender differences in the prevalence of underweight and overweight among the adult population in Bangladesh. Women with higher education, in rich and urban households have higher chances of being overweight and lower chances of being underweight compared with their male counterparts.

Abdominal obesity is associated with obesity-related health risks regardless of body weight. The present study aimed to determine whether alcohol drinking pattern is associated with abdominal obesity in normal-weight, middle-aged adults.

Cross-sectional study using complex sampling design analyses.

The Korea National Health and Nutrition Examination Survey, which was conducted from 2008 to 2013.

Normal-weight participants aged 40–69 years with BMI of 18·5–25·0 kg/m2 (n 11 289, 4491 men and 6798 women) were included. Abdominal obesity was defined as waist circumference ≥90 cm for men or ≥85 cm for women. Alcohol drinking pattern was assessed by self-report on questionnaires.

Among 11 289 normal-weight participants, 7·9 % (n 379) of men and 7·6 % (n 609) of women had abdominal obesity. Both men and women who consumed a higher quantity of alcohol per drinking occasion had higher odds (OR; 95 % CI) for abdominal obesity compared with individuals who consumed fewer than 2 drinks (1·86; 1·04, 3·32 for ≥10 drinks/typical occasion in men; and 3·28; 1·13, 9·46 in women). Men who binge drink every day had higher odds for abdominal obesity (2·10; 1·21, 3·63). In both sexes, frequency of alcohol drinking was not associated with normal-weight abdominal obesity.

Our study showed that the amount of alcohol drinking per occasion influenced abdominal obesity in normal-weight, middle-aged individuals that may have impacted obesity-related health risks. Healthy alcohol drinking habits need to be controlled for prevention of abdominal obesity even among persons with normal weight.

The beneficial role of breast-feeding for maternal and child health is now well established. Its possible role in helping to prevent diabetes and obesity in children in later life means that more attention must be given to understanding how patterns of infant feeding are changing. The present study describes breast-feeding profiles and associated factors in Kuwait.

Interviews with 1484 recent mothers were undertaken at immunisation clinics across Kuwait. Descriptive analysis and binary logistic regression of results were performed.

Rates of breast-feeding initiation in Kuwait were high (98·1 %) but by the time of discharge from hospital, only 36·5 % of mothers were fully breast-feeding, 37·0 % were partially breast-feeding and 26·5 % were already fully formula-feeding. Multiple social and health reasons were given for weaning the child, with 87·6 % of mothers who had stopped breast-feeding completely doing so within 3 months postpartum. Nationality (P<0·001), employment status 6 months prior to delivery (P<0·001), mode of delivery (P=0·01), sex of the child (P=0·026) and breast-feeding information given by nurses (P=0·026) were all found to be significantly associated with breast-feeding. Few women (5·6 %) got information on infant nutrition and feeding from nursing staff, but those who did were 2·54 times more likely to be still breast-feeding at discharge from hospital. Over 70 % of mothers had enjoyed breast-feeding and 74 % said they would be very likely to breast-feed again.

In Kuwait where the prevalence of both obesity and type 2 diabetes is growing rapidly, the public health role of breast-feeding must be recognised and acted upon more than it has in the past.

The current descriptive study aimed to: (i) quantify the number and type of advertisements (ads) located in a Chinese-American neighbourhood in a large, urban city; and (ii) catalogue the targeted marketing themes used in the food/beverage ads.

Ten pairs of trained research assistants photographed all outdoor ads in a 0·6 mile2 (1·6 km2) area where more than 60·0 % of residents identify as Chinese American. We used content analysis to assess the marketing themes of ads, including references to: Asian cultures; health; various languages; children; food or beverage type (e.g. sugar-sweetened soda).

Lower East Side, a neighbourhood located in the borough of Manhattan in New York City, USA.

Ads (n 1366) in the designated neighbourhood.

Food/beverage ads were the largest ad category (29·7 %, n 407), followed by services (e.g. mobile phone services; 21·0 %, n 288). Sixty-seven per cent (66·9 %) of beverages featured were sugar-sweetened, and 50·8 % of food ads promoted fast food. Fifty-five per cent (54·9 %) of food/beverage ads targeted Asian Americans through language, ethnicity of person(s) in the ad or inclusion of culturally relevant images. Fifty per cent (50·2 %) of ads were associated with local/small brands.

Food/beverage marketing practices are known to promote unhealthy food and beverage products. Research shows that increased exposure leads to excessive short-term consumption among consumers and influences children’s food preferences and purchase requests. Given the frequency of racially targeted ads for unhealthy products in the current study and increasing rates of obesity-related diseases among Asian Americans, research and policies should address the implications of food and beverage ads on health.

To examine the nutrition and young child feeding (YCF) education and training of nurses in public health clinics of Ghana’s Komenda-Edina-Eguafo-Abrem region (KEEA) in relation to global health guidelines, and how nurses served as educators for caregivers with children aged 0–5 years.

A qualitative study of semi-structured one-on-one and group interviews (n 21) following a questionnaire of closed- and open-ended questions addressing child feeding, nutrition and global health recommendations. Interviews were conducted in English, audio-recorded, transcribed and coded. Descriptive data were tabulated. Content analysis identified themes from open-ended questions.

KEEA public health clinics (n 12).

Nurses (n 41) purposefully recruited from KEEA clinics.

A model capturing nurses’ nutrition and YCF education emerged with five major themes: (i) adequacy of nurses’ basic knowledge in breast-feeding, complementary feeding, iron-deficiency anaemia, YCF and hygiene; (ii) nurses’ delivery of nutrition and YCF information; (iii) nurses’ evaluation of children’s health status to measure education effectiveness; (iv) nurses’ perceived barriers of caregivers’ ability to implement nutrition and YCF education; and (v) a gap in global health recommendations on YCF practices for children aged 2–5 years.

Nurses demonstrated adequate nutrition and YCF knowledge, but reported a lack of in-depth nutrition knowledge and YCF education for children 2–5 years of age, specifically education and knowledge of YCF beyond complementary feeding. To optimize child health outcomes, a greater depth of nutrition and YCF education is needed in international health guidelines.

To apply the Theory of Planned Behaviour to examine the relationship between the constructs of background factors and beliefs towards using policy, systems and environmental (PSE) strategies and reported use of PSE strategies to prevent obesity by a group of professional nutrition educators.

Cross-sectional study using self-reported survey.

Cooperative Extension in New York, USA.

Nutrition educators (n 58); survey response rate 100 %.

Nutrition educators’ reported use of PSE strategies to prevent obesity were positively associated with background factors of their community networking and number of staff they managed, their belief of other people’s expectations of them to make PSE changes and the belief that their communities were ready to use PSE strategies; and negatively associated with their belief that individual-level factors contributed to obesity. The relationships among these variables were complicated and their use of PSE strategies occurred only when they utilized their professional networks at a moderately high level (above mean of 5·3 on a scale of 1–7), given that their community was also ready to use PSE strategies.

Nutrition educators’ use of PSE strategies depends on several internal and external factors. Community networking needs to be emphasized as one of the most significant factors contributing to nutrition educators’ work in this area. Organizational and community support should be in place in order to facilitate nutrition educators’ effective use of PSE strategies.

To assess the evidence of the impact of new food store (supermarket/grocery store) interventions on selected health-related outcomes.

A systematic review following the Effective Public Health Practice Project guidelines. All quantitative studies were assessed for their methodological quality. Results were synthesized narratively.

Eight electronic databases – MEDLINE, EMBASE, CINAHL, ProQuest Public Health, Web of Science, Scopus, PsycINFO and Cochrane Library – were searched to identify relevant records.

Peer-reviewed scholarly journal articles on new grocery store/supermarket interventions with adult study populations, published in the English language after 1995.

Eleven records representing seven new grocery store interventions were identified. Six were assessed having ‘weak’ methodological quality, one as ‘moderate’ and two as ‘strong’. All studies reported fruit and vegetable consumption but results were not consistent, some studies reporting significantly more and others no increase in consumption. BMI and self-rated health did not show significant improvements. Perceptions of food access, neighbourhood satisfaction and psychological health showed significant improvements.

Improved food access through establishment of a full-service food retailer, by itself, does not show strong evidence towards enhancing health-related outcomes over short durations. Presently the field is developing and the complex linking pathways/mechanisms are yet to be elucidated. Further evidence, in the form of high-quality research in different communities with longer follow-up periods, is needed to inform policy decisions.

Investments have been made to alter the food environment of neighbourhoods that have a disproportionate number of unhealthy food venues. Corner store conversions are one strategy to increase access to fruits and vegetables (F&V). Although the literature shows modest success, the effectiveness of these interventions remains equivocal. The present paper reports on the evaluation of Proyecto MercadoFRESCO, a corner store conversion intervention in two Latino communities.

A repeated cross-sectional design was employed. Data were stratified by intervention arm and bivariate tests assessed changes over time. Logistic and multiple regression models with intervention arm, time and the interaction of intervention and time were conducted. Supplementary analyses account for clustering of patrons within stores and staggering of store conversions.

Three stores were converted and five stores served as comparisons in East Los Angeles and Boyle Heights, California, USA.

Store patrons were interviewed before (n550) and after (n407) the intervention.

Relative to patrons of comparison stores, patrons of intervention stores demonstrated more favourable perceptions of corner stores and increased purchasing of F&V during that store visit. Changes were not detected in store patronage, percentage of weekly dollars spent on food for F&V or daily consumption of F&V.

Consistent with some extant food environment literature, findings demonstrate limited effects. Investments should be made in multilevel, comprehensive interventions that target a variety retail food outlets rather than focusing on corner stores exclusively. Complementary policies limiting the availability, affordability and marketing of energy-dense, nutrient-poor foods should also be pursued.

Orofacial clefts (OFC) are the most prevalent craniofacial birth defect. Folic acid (FA) supplementation has been demonstrated as an effective intervention to reduce risk of OFC occurrence. However, the effect of mandatory FA fortification of wheat and/or maize flour on OFC prevalence has shown controversial results among countries adopting this policy. Thus, we performed a meta-analysis to synthesize the available evidence evaluating the global impact of this mandatory policy on OFC occurrence.

Literature search in conventional and grey medical/scientific databases showed fifteen studies considering OFC prevalence in pre- and post-fortification periods with FA. The effect of this policy was evaluated by computing relative risk (RR) and separating samples into total OFC, non-syndromic forms, cleft lip with or without cleft palate (CL/P) and cleft palate only (CPO).

We found a significant effect of FA fortification only on non-syndromic CL/P (RR=0·88; 95 % CI 0·81, 0·96), whereas neutral effects were detected for total OFC (syndromic plus non-syndromic) and CPO.

Our results may reflect the different aetiology of syndromic OFC with respect to non-syndromic forms and the CL/P related to CPO. Although the number of non-syndromic CL/P samples was lower than that for total OFC, the absence of both between-study heterogeneity and publication bias leads us to conclude that FA fortification may have beneficial effects on non-syndromic CL/P.