To describe the Food Standards Agency's (FSA) Food Acceptability & Choice and Food Choice Inequalities research programmes and the context for the FSA seminar on peer-led approaches to dietary change held in July 2006.

The aims of the FSA's food choice research programmes are to identify the social, psychological and physical barriers to achieving a healthier diet and how they might be addressed. Results of the research provide the scientific basis for some FSA advice on healthy eating. An important element of both programmes is the output of practical tools and resources that can be used by health professionals, nutritionists, teachers and others to encourage people to eat a healthy diet. The FSA held a seminar in July 2006 in order to identify the specific and general learning points from three peer-led intervention studies and to discuss how these could best be communicated to various audiences, including practitioners, researchers and policy-makers.

The seminar provided a useful forum for discussion. The FSA will ensure that lessons learned from these peer-led intervention studies are taken account of in the planning, appraisal and management of future research projects, in the communication of project results and in the dissemination of resources.

To summarise the discussions of a seminar on peer-led approaches to dietary change held at the Food Standards Agency (FSA) on 19 July 2006.

Following presentations on three FSA-commissioned research projects involving peer-led dietary interventions, discussions in small workshop groups identified learning points for researchers, policy-makers and practitioners and considered how the findings of such studies can be effectively communicated to each of these groups. The target groups in the three separate projects were: older people living in sheltered accommodation; mothers and babies during the weaning period; and people with diabetes.

The projects discussed here were quite different from one another, involving three separate populations, having different aims and approaches and different styles of peer leading. Their effectiveness in achieving quantitative dietary change was disappointing. However, results for some of the qualitative outcomes (social, psychological, behavioural) were more positive. Process evaluation, whether built in or post hoc, provided useful learning to inform future projects and potentially improve their effectiveness and usefulness for researchers, policy-makers and health promotion practitioners.

The projects discussed here showed that peer-led interventions can achieve positive changes in outcomes such as knowledge, confidence and attitudes, as well as small improvements in diet. They also demonstrated that there is a need for a more sophisticated analysis of peer-led interventions that recognises the diversity of approaches and their suitability in different situations.

The introduction of voluntary fortification of some foods with folic acid in Australia has been implemented since evidence of the prevention of neural tube defects with periconceptional folic acid was published. Our objectives were to determine how many women were aware of folate and when they became aware, what was the awareness of labels on foods that mentioned folate, and how much folate-fortified food women ate.

To address these objectives we collected data by self-administered questionnaire from a random sample of 578 recently pregnant women in Western Australia between September 1997 and March 2000.

Overall, 89% of women had heard, seen or read anything about the link between folate and birth defects such as spina bifida, 62% first became aware of the folate message before their recent pregnancy and 42% of women noticed any labels on foods that mention folate before or during their recent pregnancy. Overall, 53% of women were aware of foods that have folate added to them and 33% usually or always read the labels on food packaging. The folate-fortified foods most often consumed by women were cereals (69%), breads (34%) and milk (15%). Of the women who consumed folate-fortified foods (78%), the earlier they became aware of the folate message and noticed labels on food, the more fortified foods they consumed.

These results indicate that staple foods fortified with folate are consumed by almost 80% of women in the population. Therefore, mandatory fortification of staple foods may reach most women, providing improved opportunity for the prevention of neural tube defects in Australia.

To develop a composite index to describe the overall breast-feeding performance of infants < 6 months of age; and, using this index, to identify the factors associated with poor breast-feeding practices and the association between breast-feeding and infant morbidity.

The 2003 Demographic and Health Survey was a multi-stage cluster sample survey of 4320 households in Timor-Leste which covered 573 infants aged < 6 months. Breast-feeding Performance Index (BPI) was constructed by allocating one point for each of seven infant feeding practices: first suckling within an hour of birth; absence of prelacteals; non-use of feeding bottles; current breast-feeding; not receiving liquids; not receiving formula or other milk; and not receiving solids in the last 24 hours. BPI was treated as the dependent variable in univariate and multivariate analyses to identify the factors associated with poor breast-feeding.

Exclusive breast-feeding rate was 29.9%. The BPI (mean 4.4, standard deviation 1.77) was categorised as low, average and high according to tertiles. Multivariate analysis indicated that infants from the richest households were 1.70 (95% confidence interval (CI) 1.04–2.77) times more likely to have ‘low BPI’ than the poorest. Maternal BMI < 18.5 kg m− 2 was predictive of poor breast-feeding (odds ratio = 1.79; 95% CI 1.27–2.52). In the ‘low’ BPI group, the incidence of diarrhoea (13.4%) and acute respiratory infections (20.7%) during the previous two weeks was significantly higher than in ‘average’ (4.3 and 9.3%) and ‘high’ BPI groups (4.6 and 5.5%).

Creating a composite index to assess the overall breast-feeding performance among infants < 6 months of age is feasible. BPI can be effectively used to identify target groups for breast-feeding promotion interventions.

To review the literature examining associations between environmental factors, energy and fat intakes among adults, and to identify issues for future research.

Literature searches of studies published between 1980 and 2004 were conducted in major databases (i.e. PubMed, Human Nutrition, Web of Science, PsychInfo, Sociofile). Additional articles were located by citation tracking.

Twenty-one articles met the inclusion criteria. No study provided a clear conceptualisation of how environmental factors may influence these dietary intakes. Availability, social, cultural and material aspects of the environment were relatively understudied compared with other factors such as seasonal/day of the week variation and work-related factors. Few studies examined the specific environmental factors implicated in the obesity epidemic, and there was little study replication. All studies were observational and cross-sectional.

It is too premature to conclude whether or not environmental factors play a role in obesogenic and unhealthy dietary intakes. More studies need to examine associations with those environmental factors thought to contribute to obesogenic environments. There needs to be more development in theories that conceptualise the relationship between environmental factors and dietary intakes.

To assess changes in carotenoid intake based on the variations in the consumption of fresh fruit and vegetables in the Spanish population over the period 1964–2004.

Consumption data of fresh fruit and vegetables from Family Budget Surveys carried out in 1964, 1980, 1990 and 2004. Consumption data (g per person per day) accounted for >90% of fruit and vegetable consumption at each time point. Quality controlled high-performance liquid chromatography analysis of the carotenoid composition of Spanish fruit and vegetable was used.

Randomly selected, private households throughout Spain (20 800 households in 1964, 30 311 households in 1980, 21 155 households in 1990 and 6000 households in 2004). Twelve vegetables and 16 fruits representing 89–96% of the total consumption of fresh fruit and vegetables were used.

Individual consumption of fruit and vegetables has changed over this period, altering the total and individual intake of carotenoids. Total carotenoid intake increased from 2.5 mg per person per day in 1964 to 4.1 mg per person per day in 1990, with a decrease to 3.3 mg per person per day in 2004. These increments are due to an increase in lycopene, α- and β-carotene, while a decrease in lutein and zeaxanthin is observed during the last decade. A continuous and consistent decrease in the relative contribution of lutein in the diet is observed over the period studied.

Although the consumption of fruit and vegetables is still consistent with a Mediterranean-type pattern, modifications in the consumption of individual fruits and vegetables have provoked changes in total and specific carotenoid intake with potential relevance in human health.

To examine the nature of the link between food advertising in UK magazines aimed at children and young people and Internet food marketing, to establish whether consideration should be given to tightening existing controls.

A review and descriptive analysis of food advertising found in a sample of the top five magazine titles aimed at a range of ages of children and young people between November 2004 and August 2005 and of the Internet food marketing sites to which readers were directed.

Food advertising appeared as ‘cover-mount’ free gifts and as part of the main bound issue. Children aged 6–10 years were the most frequent recipients of food-based free gifts, all of which were confectionery. No food advertising was found in magazines aimed at pre-school children and it formed a small percentage of total advertising in the magazines aimed at children of school age and above. Most food advertisements were for ‘less healthy’ foods, although advertisements for ‘healthier’ food products did appear infrequently. Almost half of food advertisements directed readers towards Internet food marketing sites. We found evidence that these sites are using at least some of the ‘marketing tricks’ which have been identified as a cause for concern.

Proposed restrictions on broadcast media may lead to more food advertising via other non-broadcast means. We suggest monitoring the effect of such changes in print and online advertising and that consideration be given to restricting marketing techniques used on websites aimed at children and young people.

To determine iodine levels in salt and iodine deficiency prevalence in school-aged children in 16 districts in Tanzania with previous severe iodine deficiency.

A cross-sectional study in schoolchildren. Systematic probability sampling was used to select schools and subjects for goitre assessment and urinary iodine determination.

Sixteen districts randomly selected from the 27 categorised as severely iodine-deficient in Tanzania.

The study population was primary-school children aged 6–18 years who were examined for goitre prevalence and urinary iodine concentration (UIC). Salt samples from schoolchildren's homes and from shops were tested for iodine content.

The study revealed that 83.3% of households (n = 21 160) in the surveyed districts used iodised salt. Also, 94% of sampled shops (n = 397) sold iodised salt, with a median iodine level of 37.0 ppm (range 4.2–240 ppm). Median UIC in 2089 schoolchildren was 235.0 μg l− 1 and 9.3% had UIC values below 50 μg l− 1. The overall unweighted mean visible and total goitre prevalence was 6.7% and 24.3%, respectively (n = 16 222). The age group 6–12 years had the lowest goitre prevalence (3.6% visible and 18.0% total goitre, n = 7147). The total goitre prevalence had decreased significantly in all districts from an unweighted mean of 65.4% in the 1980s to 24.3% in 1999 (P < 0.05). We believe this difference was also biologically significant.

These findings indicate that iodine deficiency is largely eliminated in the 16 districts categorised as severely iodine-deficient in Tanzania, and that the iodine content of salt purchased from shops is highly variable.

To identify the impact of body mass index (BMI) and Western advertising and media on the stage of the nutrition transition among Jordanian women, and to evaluate their impact on eating styles and body image.

A randomised cross-sectional survey that included a variety of culturally measured Likert-type scales and body size images. In addition, BMI was calculated based on measured height and weight.

In the homes of the participants. The data were collected by female interviewers who worked for the Jordan Department of Statistics.

The sample was based on a random and representative selection of 800 mostly urban Jordanian women. A pre-test sample of 100 women was also used to validate the instruments.

Women tended to agree that they ate based on emotional cues. They had high levels of disordered eating attitudes and behaviours and 42.1% were considered restrained eaters. However, these women also had higher than expected body esteem levels and desired a healthy body size. As expected, being obese was associated with a desire to lose weight, being a restrained and emotional eater, and having more disordered eating attitudes and behaviours. Similarly, Western advertising and media were associated with restrained and emotional eating, desired weight loss, and disordered eating attitudes and behaviours.

There is a need to develop health education materials that explain the influence of obesity on health and the negative psychological and physical consequences of restrained and emotional eating, building on the current cultural preferences of healthy body size. Further implications and suggestions for future research are discussed.

It is known that stunting and obesity affect a large proportion of children in the world, and these can be affected by the physical activity levels of the children. In the present study, we evaluated the association between physical activity, physical development and body composition in black adolescent children.

Cross-sectional study.

Black township schools in the North West Province, South Africa.

Three-hundred and thirteen grade 8 children were included in the Physical Activity in Youth study. Anthropometric measurements, body composition measures and maturity level as assessed by Tanner stages were determined in these children. In addition, Previous Day Physical Activity Recall questionnaires were administered on the children to record the various activities they undertake daily.

The demographic characteristics of the children showed a high level of homogeneity. A high prevalence of stunting (16.3%) was observed in the children, which was higher in boys than in girls (21.6 vs. 12.3%). Also prevalent was overweight/obesity (8.6%), but this was higher in girls than in boys (13.4 vs. 1.6%). The children also showed a reduction in levels of physical activity with advancement in maturity; furthermore, boys showed a more central form of fat deposition whilst girls showed more gynoid deposition.

The study revealed that physical activity plays a role in determining body composition, and further indicated that physical activity is associated with favourable body composition measures. Children who were more active were likely to have less fat deposits.

To investigate the effect of observing school meals on children's dietary reports.

One hundred and twenty children randomly selected, but with half girls, from usual school-meal eaters among 312 volunteers (from all 443 fourth-grade children in six schools in one district).

Children were assigned randomly to one of 12 conditions yielded by crossing observation status (observed; not observed), target period (previous day; prior 24 hours), and interview time (morning; afternoon; evening).

Response variables included interview length, number of meals and snacks reported for the target period, and, for two school meals, number of meal components reported, importance-weighted number of items reported and kilocalories reported. These variables were transformed to principal components; two were retained (1, the school meal variables; 2, interview length and number of meals and snacks). Analyses of variance on principal component scores tested effects of observation status, target period, interview time and all interactions. Observation status did not affect scores on either retained principal component. Scores on Component 2 showed that more intake was reported in prior-24-hours interviews than in previous-day interviews.

The effect of target period on reported intake indicates that the response variables were sufficiently reliable to detect manipulations. This, together with the finding that response variables did not depend on observation status, suggests that observation of school meals does not affect fourth-grade children's dietary reports, and that conclusions about dietary reports by fourth-grade children observed eating school meals in validation studies may be generalised to dietary reports by comparable children not observed.

To estimate the impact of foetal nutritional status on cardiovascular risk among children with the Foetal Nutritional Status Index (FNSI), calculated by dividing the child's birth weight (BW, kg) by the mother's height (m2).

Cross-sectional survey analysis.

A sample of children from the US Third National Health and Nutrition Examination Survey.

A total of 3109 children who were 5–11 years of age and had data on BW and mother's height. Non-fasting blood samples were included.

Overall, the FNSI was positively associated with BW and negatively associated with mother's height (P < 0.0001). Within sex-specific quintiles of FNSI (third quintile as reference) adjusted for potential confounding variables, cardiovascular risk factors tended to be ‘higher’ in the lower quintiles for males while the opposite was true for females. Multivariate logistic regression analyses indicated that the odds for males in quintile 1 was 2.4 for having a low level of high-density lipoprotein cholesterol (P < 0.01) and 2.1 for having a cluster of cardiovascular risk factors (P = 0.01); for females, the odds of having a cluster of cardiovascular risk factors was approximately two times higher for those in the first and fifth quintiles, who also had a significantly higher prevalence of central obesity.

The FNSI may be a potential proxy indicator of foetal nutritional status and it may be used to test specific hypotheses of whether foetal nutrition restriction or overnutrition programmes future cardiovascular risk.

There is some evidence that plasma insulin levels might influence ovarian cancer risk. Glyacemic index (GI) and glycaemic load (GL) are measures that allow the carbohydrate content of individual foods to be classified according to their postprandial glycaemic effects and hence their effects on circulating insulin levels. Therefore, we examined ovarian cancer risk in association with GI and GL, and intake of dietary carbohydrate and sugar.

The study was conducted in a prospective cohort of 49 613 Canadian women enrolled in the National Breast Screening Study (NBSS) who completed a self-administered food-frequency questionnaire (FFQ) between 1980 and 1985. Linkages to national mortality and cancer databases yielded data on deaths and cancer incidence, with follow-up ending between 1998 and 2000. Data from the FFQ were used to estimate overall GI and GL, and Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between energy-adjusted quartile levels of GL, overall GI, total carbohydrates, total sugar and ovarian cancer risk.

During a mean 16.4 years of follow-up, we observed 264 incident ovarian cancer cases. GI and total carbohydrate and sugar intakes were not associated with ovarian cancer risk in the total cohort. GL was positively associated with a 72% increase in risk of ovarian cancer (HR = 1.72, 95% CI = 1.13–2.62, Ptrend = 0.01) and the magnitude of the association was slightly greater among postmenopausal (HR = 1.89, 95% CI = 0.98–3.65, Ptrend = 0.03) than among premenopausal women (HR = 1.64, 95% CI = 0.95–2.88, Ptrend = 0.07).

Our data suggest that consumption of diets with high GL values may be associated with increased risk of ovarian cancer.

To determine missed opportunities and problems relating to implementation of the Vitamin A Supplementation Programme in urban and rural regions of the Western Cape Province of South Africa.

A cross-sectional survey was conducted at primary health-care (PHC) clinics in Cape Metropole, an urban region, and West Coast Winelands, a rural region, of the Western Cape. A purposive sample of clinics where more than 30 children were seen per day was drawn from 10 of the 11 districts in the Cape Metropole region and the two districts of the West Coast Winelands region. The number of children selected from each district was weighted in terms of population size for the two regions. At each clinic visited, the first five to 10 children seen on a day, and meeting the inclusion criteria for vitamin A supplementation (VAS) based on the vitamin A provincial policy guidelines, were selected. These included children with low birth weight (LBW), growth faltering, underweight and severe undernutrition, recurrent diarrhoea and lower respiratory tract infection (LRTI), tuberculosis, measles, HIV/AIDS and eye signs of vitamin A deficiency. Clinic records were reviewed following consultation with the PHC nurse to identify if the child required vitamin A, exit interviews were conducted with mothers/caregivers, and Road to Health Charts (RTHCs) were reviewed. At the end of the study, PHC managers were interviewed to determine if problems could be identified with the Programme.

Forty-three of 123 (35%) and 13 of 40 (33%) of the fixed PHC clinics in the Cape Metropole and West Coast Winelands regions were visited, and a total of 300 children (234 from Cape Metropole, 66 from West Coast Winelands) with a mean (standard deviation) age of 24.3 (16.3) months and who met the inclusion criteria for VAS were selected. Of the total sample of children, 198 (66%) had multiple (i.e. more than one) indication and 102 (34%) had a single indication for VAS. There were a total of 617 indications for VAS in the two regions; 238 (39%) for growth faltering, 119 (19%) for underweight, 98 (16%) for LBW, 70 (11%) for LRTI, 51 (8%) for diarrhoea, 21 (3%) for HIV/AIDS and 20 (3%) for tuberculosis. A total of 102 (34%) of the children in the two regions received vitamin A supplements (Cape Metropole 29%; West Coast Winelands 52%). A record was made on the RTHC of 79 (77%) of the children who received VAS (Cape Metropole 76%; West Coast Winelands 79%). Twenty-four per cent of the mothers knew why their child had been given vitamin A (Cape Metropole 29%; West Coast Winelands 12%). Eleven per cent of the mothers had previously heard about the Vitamin A Supplementation Programme (Cape Metropole 12%; West Coast Winelands 6%). More than 81% of PHC managers indicated that health staff had been trained to implement the Vitamin A Supplementation Programme. The main problems identified by health staff in the two regions were lack of vitamin A capsules, inadequate training and difficulties in implementing the Programme.

Opportunities to administer vitamin A were underutilised in both regions. Recommendations such as improving mothers' awareness of the benefits of vitamin A and training of PHC nurses were made to the provincial Department of Health and are being implemented to improve the effectiveness of the Programme.

To study the relationship between exercise by the mother and breast-feeding initiation and duration, and its effect on infant growth.

A cohort study of mothers and infants, recruited at birth. Infant feeding methods were recorded in detail and breast-feeding was categorised as ‘any’ or ‘full’. Exercise levels were categorised using the metabolic equivalent tasks approach based on details of physical activity recorded in questionnaires.

Perth, Western Australia.

A total of 587 mothers were interviewed on seven occasions over a period of 12 months.

There was no difference in the means of infant weight and length changes, indicating that exercise appeared to have no significant influence on infant growth up to 52 weeks after birth (P = 0.236 and 0.974, respectively). The mother's level of exercise was not significantly associated with breast-feeding to 6 or 12 months. This applied to ‘full’ and ‘any’ categories of breast-feeding.

Exercise does not affect breast-feeding outcomes at the usual levels of activity undertaken by mothers. Breast-feeding and exercise are important for maintaining and promoting health, and this study provides reassurance to health professionals wishing to encourage mothers to continue both behaviours.

To compare diet measures from a food-frequency questionnaire (FFQ) with measures from 24-hour dietary recalls (24HDRs).

The participants answered an FFQ after completing four, repeated 24HDRs during a year.

Norway, nationwide.

Of 500 women randomly selected from The Norwegian Women and Cancer Study (the Norwegian arm of the European Prospective Investigation into Cancer and Nutrition), 286 agreed to participate and 238 completed the study.

On the group level, the FFQ overestimated absolute intake in seven and underestimated intake in six of 21 food groups. Intakes of energy, fat, added sugar and alcohol were lower in the FFQ than in the 24HDRs, whereas intake of fibre was higher. Spearman's rank correlation coefficient ranged from 0.13 (desserts) to 0.82 (coffee) for foods, and from 0.25 (β-carotene) to 0.67 (alcohol) for nutrients. Three per cent of the observations on nutrient intake fell in the opposite quintile when classified according to the FFQ as compared with the 24HDR. The median calibration coefficient, calculated by regression of the 24HDR data on the FFQ data, was 0.57 for foods and 0.38 for nutrients.

The FFQ's ability to rank subjects was good for foods eaten frequently and fairly good for macronutrients in terms of energy percentages. Weaker ranking abilities were seen for foods eaten infrequently and for some micronutrients. The results underline the necessity of performing measurement error corrections.

To evaluate compliance with the national recommendation on supplemental iron to all pregnant women in Denmark and to explore differences between compliers and non-compliers with respect to dietary habits and other lifestyle factors.

Intake of supplemental iron from pure iron supplements and from multivitamin and mineral preparations was estimated in mid-pregnancy.

Nationwide cohort study, the Danish National Birth Cohort (DNBC), comprising more than 100 000 women recruited in early pregnancy.

Information on diet and dietary supplements was available for 54 371 women. Of these, information on lifestyle factors was available for 50 902 women.

A high compliance with the recommendation was found, as approximately 77% of the women reported use of iron supplements during pregnancy. However, many of the compliers did not obtain the recommended doses of iron, which can partly be explained by the lack of iron preparations of appropriate doses available on the Danish market. Compliance with the recommendation was associated with age above 20 years, primiparity, body mass index < 30 kg m− 2, non-smoking and long education. No major differences were seen in dietary intake between compliers and non-compliers.

Overall, a high compliance rate was found among participants of the DNBC but a clarification on daily dose is needed, and more concern should be paid to vulnerable groups such as young, smoking women and women with no or short education.