To assess progress in the protection, promotion and support of breast-feeding in Europe.

Data for 2002 and 2007 were gathered with the same questionnaire. Of thirty countries, twenty-nine returned data for 2002, twenty-four for 2007.

The number of countries with national policies complying with WHO recommendations increased. In 2007, six countries lacked a national policy, three a national plan, four a national breast-feeding coordinator and committee. Little improvement was reported in pre-service training; however, the number of countries with good coverage in the provision of WHO/UNICEF courses for in-service training increased substantially, as reflected in a parallel increase in the number of Baby Friendly Hospitals and the proportion of births taking place in them. Little improvement was reported as far as implementation of the International Code on Marketing of Breastmilk Substitutes is concerned. Except for Ireland and the UK, where some improvement occurred, no changes were reported on maternity protection. Due to lack of standard methods, it was difficult to compare rates of breast-feeding among countries. With this in mind, slight improvements in the rates of initiation, exclusivity and duration were reported by countries where data at two points in time were available.

Breast-feeding rates continue to fall short of global recommendations. National policies are improving slowly but are hampered by the lack of action on maternity protection and the International Code. Pre-service training and standard monitoring of breast-feeding rates are the areas where more efforts are needed to accelerate progress.

To assess breast-feeding initiation and prevalence from birth to 6 months in a sample of mothers in Dublin, and to determine the factors associated with breast-feeding initiation and ‘any’ breast-feeding at 6 weeks in a sample of Irish-national mothers.

This prospective cross-sectional study involved the recruitment of women during the antenatal period, with subsequent follow-up of mothers who delivered healthy, term singleton infants, at 6 weeks and 6 months postpartum.

Participants were recruited from antenatal clinics in the Coombe Women and Infants University Hospital, Dublin.

In all, 401 Irish-national and forty-nine non-Irish-national mothers met the criteria for inclusion in the present study.

Breast-feeding initiation rates of the Irish-national and non-Irish-nationals were 47 % and 79·6 %, respectively. Factors that were significantly (P = 0·000) associated with both breast-feeding initiation and ‘any’ breast-feeding at 6 weeks included mothers who were ≥35 years, educated to third level, reported positive postnatal encouragement to breast-feed from their partners and had a positive antenatal intention to breast-feed. The maternal negative perception that breast-feeding is an embarrassing way to feed an infant was demonstrated as a major barrier to initiation.

Breast-feeding initiation and prevalence rates of the Irish-national population remain low and lag considerably behind national and international targets. Inclusion of the partner in breast-feeding promotional initiatives during the antenatal period may be crucial to increase breast-feeding rates in Ireland. Public health campaigns that focus on increasing the social acceptability of breast-feeding may prove effective in addressing this cultural barrier.

To examine the association between breast-feeding and blood pressure, anthropometry and plasma lipid profile in both adolescence and young adulthood.

Longitudinal study of biological and behavioural risk factors for CVD.

The Young Hearts Project, Northern Ireland.

Schoolchildren aged 12 years and 15 years who participated in a cross-sectional study of lifestyle and health, and who were followed up as young adults aged 20–25 years.

There was no significant difference in height, weight, BMI, skinfold thickness measurements, blood pressure or plasma lipid profile in adolescents who had been breast-fed compared with those who had not been breast-fed. However, by the time these adolescents had reached adulthood, those who had been breast-fed were significantly taller than those who had not been breast-fed (standing height, P = 0·013; leg length, P = 0·035). Specifically, the breast-fed group was on average taller by 1·7 cm (95 % CI 0·4, 3·0 cm) and had longer legs by 1·0 cm (95 % CI 0·1, 1·9 cm). There was no significant difference in other anthropometric measures, blood pressure or plasma lipid profile in adults who had been breast-fed compared with those who had not been breast-fed.

Compared with those who had not been breast-fed, individuals who had been breast-fed were taller in adulthood. Given the known association of increased adult height with improved life expectancy, the results from the present study support a beneficial effect of breast-feeding.

To provide HIV-positive mothers who opted for exclusive breastfeeding or formula feeding from birth to 6 months postpartum as a means of prevention of mother-to-child transmission (PMTCT) of HIV with a sustainable infant food support programme (FSP) from 6 to 12 months postpartum. We describe the implementation and assessment of this pilot initiative.

The FSP included a 6-month provision of locally produced infant fortified mix (IFM; 418 kJ/100 g of gruel) for non-breastfed infants coupled with infant-feeding and psychosocial counselling and support. Acceptability and feasibility were assessed in a subsample of sixty-eight mother–infant pairs.

The FSP was developed in collaboration with local partners to support participants in a PMTCT prevention study. Formula was provided for free from 0 to 6 months postpartum. Cessation by 6 months was recommended for breastfeeding mothers.

The FSP was positively received and greatly encouraged breastfeeding mothers to cease by 6 months. As recommended, most infants were given milk as an additional replacement food, mainly formula subsidised by safety networks. Among daily IFM consumers, feeding practices were satisfactory overall; however, the IFM was shared within the family by more than one-third of the mothers. Cessation of IFM consumption was observed among twenty-two infants, seventeen of whom were fed milk and five neither of these.

Without any food support most mothers would have been unable to provide appropriate replacement feeding. The food security of non-breastfed infants urgently needs to be addressed in HIV PMTCT programmes. Our findings on a simple cost-effective pioneer intervention provide an important foundation for this process.

To identify parental child-feeding strategies that may increase children’s fruit or vegetable intake, since the relationship between these strategies and children’s intake has never been investigated for fruit and vegetables as two separate food groups.

A survey study, where parents provided information about their practices in relation to feeding their children and about their own and their children’s fruit and vegetable intake. Children completed a preference questionnaire about fruit and vegetables. To find underlying parental child-feeding strategies, factor analysis was applied to parents’ practices in relation to fruit and vegetables separately. Regression analysis was used to predict the effect of these strategies on children’s fruit and vegetable intake. The impact of the strategies was further analysed by estimating children’s intake based on the frequency of use of specific strategies.

The study was conducted at three primary schools in The Netherlands.

A total of 259 children between 4 and 12 years old and their parents (n 242).

Parents used different strategies for fruit as compared with vegetables. The vegetable-eating context was more negative than the fruit-eating context. Parental intake and presenting the children with choice were positive predictors of children’s intake of both fruit and vegetables. The intake difference based on frequency of use of the strategy ‘Choice’ was 40 g/d for vegetables and 72 g/d for fruit (P < 0·001).

Future interventions should focus on presenting children with choice during fruit- and vegetable-eating situations, since this is a powerful strategy to stimulate children’s fruit and vegetable intake.

To explore mean food group intakes associated with central obesity anthropometry among children and adolescents enrolled in the Third National Health and Nutrition Examination Survey (NHANES III).

Cross-sectional study.

Representative sampling of the US population (1998–2002).

Subjects were 3761 children (5–11 years) and 1803 adolescents (12–16 years) with single 24 h dietary recalls and anthropometric measures of central body fat (waist circumference and sum of subscapular and suprailiac skinfold thicknesses).

Results were controlled for confounding by age, height, race/ethnicity, Tanner stage, television viewing and parental education. In younger children, there was no relationship between central adiposity and mean intakes of dairy, fruit, vegetables or grains, while a positive association with meat intake was found among boys. In adolescent boys and girls, central body fat measures were inversely associated with mean dairy and grain intakes. Adolescent boys in the highest quartile of central adiposity consumed less fruit and fewer vegetables; those in the lowest central adiposity quartile consumed less meat. Finally, adolescents who met the criteria for central obesity (waist circumference ≥85th percentile for age and sex) reported consuming significantly less total dairy (as well as milk and cheese separately), total grains (whole and refined) and total fruit and vegetables. There was no association with meat consumption. To test the stability of these findings, the final analysis was replicated in 2541 same-aged adolescents from NHANES 1999–2002; the results were very similar.

These cross-sectional analyses suggest that intakes of dairy, grains and total fruits and vegetables are inversely associated with central obesity among adolescents.

A national study in Switzerland in 2002 suggested nearly one in five schoolchildren was overweight. Since then, many programmes have been introduced in an attempt to control the problem. The aim of the present study was to determine the prevalence of childhood overweight in Switzerland five years later.

In both studies a cross-sectional, three-stage, probability-proportional-to-size cluster sampling of schools throughout Switzerland was used to obtain a representative sample of approximately 2500 children aged 6–13 years. Height and weight were measured and BMI calculated. The BMI references from the Centers for Disease Control and Prevention were used to determine the prevalences of underweight (<5th percentile), overweight (≥85th and <95th percentile) and obesity (≥95th percentile).

In 2007 the prevalences of underweight, overweight and obesity in boys were 3·5 %, 11·3 % and 5·4 %, respectively; in girls they were 2·6 %, 9·9 % and 3·2 %. Compared with 2002, there was a significant decrease in the prevalence of overweight in girls and of obesity in both genders. In contrast to 2002, where there were no differences, in 2007 the prevalence of paediatric obesity was significantly higher in communities with a population >100 000 compared with smaller communities (P < 0·05).

In summary, over the past 5 years, the prevalence of adiposity has decreased in Swiss children. These findings suggest that increased awareness combined with mainly school-based programmes aimed at physical activity and healthy nutrition may have helped to control this public health problem. Future monitoring in Switzerland will determine if these findings are sustained.

To validate a 204-item quantitative FFQ for measurement of nutrient intake in the Adventist Health Study-2 (AHS-2).

Calibration study participants were randomly selected from the AHS-2 cohort by church, and then subject-within-church. Each participant provided two sets of three weighted 24 h dietary recalls and a 204-item FFQ. Race-specific correlation coefficients (r), corrected for attenuation from within-person variation in the recalls, were calculated for selected energy-adjusted macro- and micronutrients.

Adult members of the AHS-2 cohort geographically spread throughout the USA and Canada.

Calibration study participants included 461 blacks of American and Caribbean origin and 550 whites.

Calibration study subjects represented the total cohort very well with respect to demographic variables. Approximately 33 % were males. Whites were older, had higher education and lower BMI compared with blacks. Across fifty-one variables, average deattenuated energy-adjusted validity correlations were 0·60 in whites and 0·52 in blacks. Individual components of protein had validity ranging from 0·40 to 0·68 in blacks and from 0·63 to 0·85 in whites; for total fat and fatty acids, validity ranged from 0·43 to 0·75 in blacks and from 0·46 to 0·77 in whites. Of the eighteen micronutrients assessed, sixteen in blacks and sixteen in whites had deattenuated energy-adjusted correlations ≥0·4, averaging 0·60 and 0·53 in whites and blacks, respectively.

With few exceptions validity coefficients were moderate to high for macronutrients, fatty acids, vitamins, minerals and fibre. We expect to successfully use these data for measurement error correction in analyses of diet and disease risk.

The purpose was to update the Healthy Eating Index-C (HEI-C) with Canada’s new food guide recommendations (HEIC-2009) and compare scores and ratings among a small sample of grade 6 students.

Updates to the HEI-C were completed with Canada’s new food guide recommendations for daily number of servings. HEI-C and HEIC-2009 scores were computed for a small sample (n 405) of grade 6 students utilizing nutrition data that were collected using the Food Behaviour Questionnaire, a validated web-based dietary assessment tool (including a 24 h dietary recall, FFQ, and food and physical activity behavioural questions).

Data were collected in fifteen schools in the Region of Waterloo District School Board, Ontario, Canada.

A total of 405 students (48 % males and 52 % females) from grade 6 classrooms completed the web-based survey.

The index scores revealed that participants scored higher (74·5 v. 69·6, P < 0·001) using the HEIC-2009 compared with the HEI-C, even though both index scores are rated in the ‘needs improvement’ category (HEIC-2009, 75 %; HEI-C, 71 %). A small group of participants (n 14), who were previously rated (using the HEI-C) in the ‘poor’ category, were rated in the ‘needs improvement’ category using the HEIC-2009 (χ2 = 589·647, df = 4, P < 0·001).

The HEIC-2009 has the potential to be used as a population-level diet quality index in Canada.

To date, only a few nutritional assessment methods have been validated against the biomarker of urinary-N excretion for use in children and adolescents. The aim of the present study was to validate protein intake from one day of a weighed dietary record against protein intake estimated from a simultaneously collected 24 h urine sample.

Cross-sectional analyses including 439 participants of the Dortmund Nutritional and Longitudinally Designed (DONALD) Study from four age groups (3–4, 7–8, 11–13 and 18–23 years). Mean differences, Pearson correlation coefficients (r), cross-classifications and Bland–Altman plots were used to assess agreement between methods.

Weighed dietary records significantly underestimated mean protein intake by −6·4 (95 % CI −8·2, −4·7) g/d or –11 %, with the difference increasing across the age groups from −0·6 (95 % CI −2·7, 1·5) g/d at age 3–4 years to –13·5 (95 % CI –18·7, –8·3) g/d at age 18–23 years. Correlation coefficients were r = 0·7 for the total study sample and ranged from r = 0·5 to 0·6 in the different age groups. Both methods classified 85 % into the same/adjacent quartile for the whole study group (83–86 % for the different age groups) and 2·5 % into the opposite quartile (1·9–3·1 % for the different age groups). Bland–Altman plots for the total sample indicated that differences in protein intake increased across the range of protein intake, while this bias was not obvious within the age groups.

Protein intake in children and adolescents can be estimated with acceptable validity by weighed dietary records. In this age-heterogeneous sample, validity was lower among adolescents and young adults.

To examine the relationship between sweetened beverage consumption and components of the metabolic syndrome in a Mexican population.

We performed a cross-sectional analysis of data from selected adults participating in the baseline assessment of the Health Workers Cohort Study. Information on participants’ sociodemographic characteristics, dietary patterns and physical activity were collected via self-administered questionnaires. Sweetened beverage consumption was evaluated through a validated semi-quantitative FFQ. Anthropometric and clinical measures were assessed with standardized procedures. The definition of metabolic syndrome was determined using criteria from the National Cholesterol Education Program Adult Treatment Panel III. The associations of interest were evaluated by means of linear and logistic regression models.

The Mexican states of Morelos and Mexico.

A total of 5240 individuals aged 20 to 70 years (mean 39·4 (sd 11·5) years) were evaluated.

Overweight/obesity prevalence was 56·6 %. The prevalence of metabolic syndrome in this sample was 26·6 %. We found that for each additional daily sweetened beverage serving consumed, participants experienced an average increase of 0·49 mmol/l in TAG and a decrease in HDL cholesterol of 0·31 mmol/l. Subjects consuming more than two servings of sweetened beverages daily were at 2·0 times greater risk of metabolic syndrome than those who did not consume sweetened beverages. We also observed that higher sweetened beverage consumption increased the risk of all components of the metabolic syndrome.

Our data support the hypothesis that sweetened beverage consumption increases the risk of metabolic syndrome in Mexican adults, possibly by providing excess energy and large amounts of rapidly absorbable sugars.

The current study examined proxy efficacy, which was defined as youth’s confidence to influence their parents to provide fruits and vegetables. The overall objective was to examine change in middle-school youth’s proxy efficacy over time, and to determine if changes were moderated by gender and socio-economic status.

Longitudinal cohort nested within schools.

Eight middle schools located in urban, suburban and rural areas of a mid-western US state.

Seven hundred and twelve youth followed across their 6th, 7th and 8th grade years. The sample was 51·8 % female, 30·5 % low socio-economic status and 89·5 % Caucasian, non-Hispanic.

Males and lower socio-economic status youth were significantly lower in proxy efficacy at each assessment year compared with females and high socio-economic youth, respectively.

Proxy efficacy to influence parents to provide fruits and vegetables may be an important construct to target in future interventions.

Larger food portion sizes lead to increased energy intake levels and might contribute to the current obesity epidemic. Only a very limited number of studies are available on the actual development of food portion sizes during past decades. The present study aims to reveal trends in portion sizes of some high-energy-dense food products during recent decades in The Netherlands.

The data were collected from manufacturers and from information found in professional journals, marketing and advertising materials, and on manufacturers’ websites.

A number of trends in food portion sizes were observed. Larger sizes have been added to the portion size portfolio. The portion sizes of a number of products have also increased since their introduction, although this did not apply to all the products included. Finally, multi-packs have been introduced and the number of products within a multi-pack has also increased.

A trend towards larger portion sizes was observed, which is relevant to the public health debate regarding the prevention of overweight and obesity. It is recommended that developments in food portion sizes continue to be monitored over the coming years, and the effects of the newly introduced portion sizes on food intake be studied.

Pakistani women in Oslo have high risk of overweight and type 2 diabetes. The objective is to present the effect of an intervention study on Pakistani women’s intentions to change dietary behaviour and changes made in dietary intake.

The intervention group received culturally adapted lifestyle education, including diet and physical activity. The questionnaire, applied before and after the 7-month intervention, included FFQ and questions on intentions to change.

Oslo, Norway.

A total of 198 Pakistani women, aged 25–63 years, randomised into control and intervention groups.

There was a shift in distribution of intentions to change the intake of selected foods in the intervention group after the intervention, resulting in significant differences between the groups. The daily intake of vegetables, fruits and fruit juice had increased (P = 0·043), and the intake of red meats (P = 0·001), full fat milk/yoghurt (P = 0·027) and sugar-rich drinks (P ≤ 0·007) was reduced in the intervention group. The differences between intervention and control after the intervention were significant for sugar-rich drinks (P ≤ 0·022). More women in the intervention group used olive and rapeseed oil and fewer used ‘vegetable’ oil after than before intervention (P < 0·011). Differences between intervention and control were significant (P = 0·001) for rapeseed oil. Comparing those who attended at least 60 % of the group sessions with the control group resulted in minor changes in these estimates.

Culturally adapted education has the potential to change Norwegian–Pakistani women`s intentions to make their diet healthier, and also to induce some beneficial, however modest, self-reported changes in diet.

To estimate associations between the length of residence and overweight among US immigrants by region of birth and age at arrival.

Cross-sectional data from the National Health Interview Survey 1997–2005 were pooled. Multivariate-adjusted prevalence and OR were computed to test associations of length of residence and overweight.

United States.

Immigrant adults aged 18–74 years.

The odds of being overweight were three times higher in migrants from Mexico, South America, Europe, Russia, Africa and the Middle East residing in the US for >15 years than their counterparts residing in the United States for <5 years. On the other hand, migrants from the Indian subcontinent and Southeast (SE) Asia had no association between the length of residence and overweight prevalence. Among both men and women, weight differences emerged as early as 5 years after arrival among those arriving at 18–24 years of age (OR 1·5–1·8). The odds of being overweight was higher among Hispanic men arriving before the age of 18 years than the European migrants (Mexico OR 1·7, 95 % CI 1·3, 2·2; South America OR 1·5, 95 % CI 1·0, 2·3), whereas the odds of being overweight among those from Africa and SE Asia was lower (OR 0·5, 95 % CI 0·3, 0·9 and OR 0·5, 95 % CI 0·4, 0·8, respectively). Among women who arrived at 25–44 years of age, the odds of being overweight among those from Africa and the Indian subcontinent was higher than the European migrants (OR 2·9, 95 % CI 1·7, 5·0 and OR 1·8, 95 % CI 1·8, 2·8, respectively).

We found associations between the length of residence and overweight to vary by region of birth and age at arrival, highlighting the importance of these characteristics in assessing overweight risk among the US immigrants.

To evaluate the feasibility and effectiveness of a pilot family-based newsletter intervention to increase fruit and vegetable (FV) consumption among adolescents.

Family-based, two-group randomised control trial with baseline, post-intervention and follow-up measures. The intervention group received two FV newsletter packs over a 1 month period by postal mail. Social cognitive and behavioural choice theories provide the theoretical framework for the design and development of intervention materials. Control families were provided with all intervention materials at the end of the study. Adolescent FV consumption was assessed by an FFQ. Adolescent-reported barriers to eating FV, FV habits and preferences were the secondary outcomes, along with parent FV consumption, and parents reported knowledge, encouragement, home availability and accessibility of FV. Repeated-measures ANOVA was used to detect differences in behavioural and psychosocial outcomes between groups, time and group-by-time.

East Midlands, UK.

Forty-nine parents and adolescents aged 12–14 years.

Process evaluation indicated high reach, dose acceptability and fidelity of the intervention. At post-intervention and 6 weeks later at follow-up, adolescents in the intervention group had significantly higher fruit: (P < 0·01) and vegetable (P < 0·05) consumption and higher preferences for vegetables (P < 0·01), compared with the control group. At post-intervention and follow-up, parents in the intervention group had significantly higher fruit (P < 0·001) and vegetable (P < 0·01) consumption and reported higher accessibility of fruit and vegetables (P < 0·001), compared with those in the control group.

Family-based, newsletter interventions promoting FV consumption to adolescents appear to be feasible and effective at increasing FV consumption.

To implement a systematic evidence-informed process to enable Fiji and Tonga to identify the most feasible and targeted policy interventions which would have most impact on diet-related non-communicable diseases.

A multisectoral stakeholder group of policy advisers was formed in each country. They used participatory approaches to identify the problem policies and gaps contributing to an unhealthy food environment. Potential solutions to these problems were then identified, and were assessed by them for feasibility, effectiveness, cost-effectiveness and side-effects. Data were gathered on the food and policy environment to support the assessments. A shortlist of preferred policy interventions for action was then developed.

Sixty to eighty policy problems were identified in each country, affecting areas such as trade, agriculture, fisheries and pricing. Up to 100 specific potential policy solutions were then developed in each country. Assessment of the policies highlighted relevant problem areas including poor feasibility, limited effectiveness or cost-effectiveness and serious side-effects. A shortlist of twenty to twenty-three preferred new policy options for action in each country was identified.

Policy environments in these two countries were not conducive to supporting healthy eating. Substantial areas of potential action are possible, but some represent better choices. It is important for countries to consider the impact of non-health policies on diets.

A preliminary investigation into different eating patterns among Thai consumers who shop at fresh markets as opposed to supermarkets in Chiang Mai.

A short questionnaire adopted from a previous study was administered to the forty-four participants, who comprised supermarket users, fresh market users and people who consistently shopped at both supermarkets and fresh markets.

Participants were recruited within four fresh markets and two food courts attached to supermarkets in Chiang Mai.

Chiang Mai residents who agreed to participate in the study. Equal numbers were regular fresh market and supermarket users.

Initial results suggest an association between shopping at supermarkets and attributing bread with culinary value.

Supermarkets may be potentially significant players in the ‘nutrition transition’, providing Thais more convenient shopping at some cost to their healthy food choices.