To determine the reliability, validity and correlates of measures of food insecurity (FI) obtained using an individually focused food insecurity access scale (IFIAS) among pregnant women of mixed HIV status in northern Uganda.

A mixed-methods study involving cognitive interviews nested within a cross-sectional survey.

The antenatal care clinic of Gulu Regional Referral Hospital.

Survey respondents included 403 pregnant women, recruited in a ratio of one HIV-infected to two HIV-uninfected respondents, twenty-six (nine of them HIV-infected) of whom were asked to participate in the cognitive interviews.

Over 80 % of cognitive interview participants reported understanding the respective meanings of six of the nine items (i.e. items 4 to 9) on the IFIAS. Two main factors emerged from rotated exploratory factor analysis of the IFIAS: mild to moderate FI (IFIAS items 1–6) and severe FI (items 7–9). Together, they explained 90·4 % of the FI measure’s variance. The full IFIAS and the two subscales had moderate to high internal consistency (Cronbach’s α ranged from 0.75 to 0.87). Dose–response associations between IFIAS scores, and measures of socio-economic status and women’s diet quality, were observed. Multivariate linear regression revealed significant positive associations between IFIAS scores and HIV infection, maternal age, number of children and a history of internal displacement. IFIAS scores were negatively associated with women’s diet diversity score, asset index and being employed.

The IFIAS showed strong reliability, validity and contextual relevance among women attending antenatal care in northern Uganda.

To examine the association between household food insecurity score and Z-scores of childhood nutritional status indicators.

Population-based, cross-sectional survey, Nepal Demographic and Health Survey 2011.

A nationally representative sample of 11 085 households selected by a two-stage, stratified cluster sampling design to interview eligible men and women.

Children (n 2591) aged 0–60 months in a sub-sample of households selected for men’s interview.

Prevalence of moderate and severe household food insecurity was 23·2 % and 19·0 %, respectively, for children aged 0–60 months. Weighted prevalence rates for stunting (height-for-age Z-score (HAZ) <−2), wasting (weight-for-height Z-score (WHZ) <−2) and underweight (weight-for-age Z-score (WAZ) <−2) were 41·6 % (95 % CI 38·9, 44·3 %), 11·5 % (95 % CI 9·8, 13·2 %) and 30·1 % (95 % CI 27·5, 32·8 %), respectively. Prevalences of stunting, severe stunting (HAZ<−3) and underweight by level of household food insecurity were statistically significant (P<0·001). By multiple linear regression analyses and after adjustment for sociodemographic, child and environmental factors, household food access insecurity score was associated with HAZ (β=−0·02, P=0·01) and WAZ (β=−0·01, P=0·01) but was not associated with WHZ and BMI-for-age Z-score. A 10-point increase in household food access insecurity score was associated with a decrease in HAZ of 0·2 (95 % CI 0·05, 0·39) and decrease in WAZ of 0·1 (95 % CI 0·03, 0·27).

Our results from a nationally representative sample confirm the previously reported association of household food insecurity with stunting and underweight. Community nutrition interventions may use household food insecurity scales for identifying those households where children may be at risk of growth faltering.

Women (especially mothers) are theorized as critical to reducing household food insecurity through their work and caregiver roles. The present study tests these assumptions, assessing how maternal economic and social resources are associated with food insecurity in households with young children.

Data from a population-based sample of households was collected in León, Nicaragua (n 443). Data include a newly validated measure of household food insecurity (ELCSA), maternal resource measures, and household economic status and demographics. Regression analysis tests the statistical associations (P<0·05) of maternal resources with household, adult-specific and child-specific food insecurity.

Municipality of León, Nicaragua.

Households with children aged 3–11 years in rural and urban León.

Only 25 % of households with young children were food secure, with 50 % mildly food insecure and 25 % moderately/severely food insecure. When mothers contributed substantially to household income, the odds of moderate/severe household food insecurity were 34 % lower than when their spouse/partner was the main provider. The odds of food insecurity were 60 % lower when mothers managed household money, 48 % lower when mothers had a secondary (v. primary) education, 65 % higher among single mothers and 16 % lower with each indicator of social support. Results were similar for adult- and child-specific food insecurity.

This research provides new evidence that maternal economic and social resources are important for reducing household food insecurity and adult- and child-specific food insecurity. Women’s social status, social support and access to economic resources need to be enhanced as a part of policies aimed to reduce food insecurity in high-poverty settings.

To verify the association between perceived social support and household food insecurity (HFI).

A cross-sectional survey.

A population-based study with a representative sample of households from a metropolitan area of Rio de Janeiro, Brazil, conducted in 2010. HFI was estimated with the Brazilian Food Insecurity Scale (EBIA). Social support was assessed using the adapted and validated Brazilian version of the Medical Outcomes Study Social Support Survey. Multinomial logistic regression was used to evaluate the association between social support and HFI, adjusting for potential confounders.

Adults (n 1022) aged 19–60 years old (27 % men, 73 % women) who were responsible for feeding the household.

Individuals with high scores of social support were less likely to experience moderate HFI (OR=0·96; 95 % CI 0·94, 0·99) and severe HFI (OR=0·96; 95 % CI 0·94, 0·98).

These findings indicate that social support may contribute to reducing HFI in populations vulnerable to poverty. Strategies to increase social relationships should be encouraged in this group to enhance their perceived social support.

The present paper investigated the impact of the 2008 financial crisis on food security in Mexico and how it disproportionally affected vulnerable households.

A generalized ordered logistic regression was estimated to assess the impact of the crisis on households’ food security status. An ordinary least squares and a quantile regression were estimated to evaluate the effect of the financial crisis on a continuous proxy measure of food security defined as the share of a household’s current income devoted to food expenditures.

Both analyses were performed using pooled cross-sectional data from the Mexican National Household Income and Expenditure Survey 2008 and 2010.

The analytical sample included 29 468 households in 2008 and 27 654 in 2010.

The generalized ordered logistic model showed that the financial crisis significantly (P<0·05) decreased the probability of being food secure, mildly or moderately food insecure, compared with being severely food insecure (OR=0·74). A similar but smaller effect was found when comparing severely and moderately food-insecure households with mildly food-insecure and food-secure households (OR=0·81). The ordinary least squares model showed that the crisis significantly (P<0·05) increased the share of total income spent on food (β coefficient of 0·02). The quantile regression confirmed the findings suggested by the generalized ordered logistic model, showing that the effects of the crisis were more profound among poorer households.

The results suggest that households that were more vulnerable before the financial crisis saw a worsened effect in terms of food insecurity with the crisis. Findings were consistent with both measures of food security – one based on self-reported experience and the other based on food spending.

Food security (FS) exists when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their needs. The present research sought to determine whether students from households experiencing moderate or severe food insecurity (FI) had poorer diet quality, higher body weights and poorer psychosocial outcomes than students from households classed as having high FS or marginal FI status.

Population-based survey conducted in schools. Multiple regression analysis was used to explore associations between FS status (high FS; marginal, moderate, severe FI), dietary behaviours and intake, and health-related outcomes (body weight, quality of life, mood, peer relationships, externalizing problems).

Nova Scotia, Canada.

Grade 5 students (n 5853), aged 10–11 years, with complete information on FS status and student outcomes.

In this sample, rates of household FS were 73·5 % (high FS), 8·3 % (marginal FI) 10·2 % (moderate FI) and 7·1 % (severe FI status). Students living in households experiencing moderate or severe FI had poorer diet quality, higher BMI and poorer psychosocial outcomes than students classed as having high FS or marginal FI.

These findings provide important evidence for policy makers on the prevalence of FI among families in Nova Scotia with grade 5 children and its relationship with childhood nutrition, psychosocial and quality of life factors, and weight status.

To assess the prevalence of household food insecurity (FI) in France and to describe its associations with socio-economic factors, health behaviours, diet quality and cost (estimated using mean food prices).

Cross-sectional nationally representative survey. FI was assessed using an adapted version of the US Department of Agriculture’s Food Insufficiency Indicator; dietary intake was assessed using a 7 d open-ended food record; and individual demographic, socio-economic and behavioural variables were assessed using self-administered questionnaires and interviews. Individuals experiencing FI were compared with food-secure individuals, the latter being divided into four categories according to quartiles of their income per consumption unit (FS1 to FS4). Differences among categories were analysed using χ2 tests, ANOVA and tests for trend.

Individual and National Dietary Survey (INCA2), 2006–2007.

Adults aged 18–79 years (n 2624).

Individuals experiencing FI represented 12·2 % of the population. They were on average younger, more frequently women and single parents with children compared with those in the other four categories. Their mean income per consumption unit was higher than that in the FS1 category, but they reported poorer material and housing conditions. The prevalence of smoking and the mean daily time spent watching television were also higher in the FI category. No significant difference among categories was found for energy intake, but mean intakes of fruits, vegetables and fish were lower, and diet quality was slightly but significantly poorer in the FI category. Daily diet cost was also lower in the FI category.

France is not spared by FI. FI should be routinely monitored at the national level and research should be promoted to identify effective strategies to reduce nutrition inequalities in France.

Fast foods are often energy dense and offered in large serving sizes. Observational data have linked the consumption of fast foods to an increased risk of obesity and related diseases.

We surveyed the reported energy, total fat and saturated fat contents, and serving sizes, of fast-food items from five major chains across ten countries, comparing product categories as well as specific food items available in most countries.

MRC Human Nutrition Research, Cambridge, UK.

Data for 2961 food and drink products were collected, with most from Canada (n 550) and fewest from the United Arab Emirates (n 106).

There was considerable variability in energy and fat contents of fast foods across countries, reflecting both the portfolio of products and serving size variability. Differences in total energy between countries were particularly noted for chicken dishes (649–1197 kJ/100 g) and sandwiches (552–1050 kJ/100g). When comparing the same product between countries variations were consistently observed in total energy and fat contents (g/100 g); for example, extreme variation in McDonald’s Chicken McNuggets with 12 g total fat/100 g in Germany compared with 21·1 g/100 g in New Zealand.

These cross-country variations highlight the possibility for further product reformulation in many countries to reduce nutrients of concern and improve the nutritional profiles of fast-food products around the world. Standardisation of serving sizes towards the lower end of the range would also help to reduce the risk of overconsumption.

To explore the association between diet and socio-economic position for 2007–2009 and investigate trends in socio-economic inequalities in the Scottish diet between 2001 and 2009.

UK food purchase data (collected annually from 2001 to 2009) were used to estimate household-level consumption data. Population mean food consumption, nutrient intakes and energy density were estimated by quintiles of an area-based index of multiple deprivation. Food and nutrient intakes estimated were those targeted for change in Scotland and others indicative of diet quality. The slope and relative indices of inequality were used to assess trends in inequalities in consumption over time.

Scotland.

Scottish households (n 5020).

Daily consumption of fruit and vegetables (200 g, 348 g), brown/wholemeal bread (17 g, 26·5 g), breakfast cereals (16 g, 27 g) and oil-rich (21 g, 40 g) and white fish (77 g, 112 g) were lowest, and that of total bread highest (105 g, 91·5 g) in the most deprived compared with the least deprived households, respectively, for the period 2007–2009. With regard to nutrients, there was no association between deprivation and the percentage of food energy from total fat and saturated fat; however, non-milk extrinsic sugar intakes (15·5 %, 14·3 %) and energy density (741 kJ/100 g, 701 kJ/100 g) were significantly higher in the most deprived households. The slope and relative indices of inequality showed that inequalities in intakes between 2001 and 2009 have changed very little.

There was no evidence to suggest that the difference in targeted food and nutrient intakes between the least and most deprived has decreased compared with previous years.

Some recent studies have shown stablity or declining trends in obesity while others still report increasing trends. The present study aimed to investigate the trends of obesity and abdominal obesity in Tehranian adults during a median follow-up of 10 years.

Prospective cohort study.

Community-based data collection from the Tehran Lipid and Glucose Study (TLGS).

Participants from four phases of the TLGS from 1999 to 2011 (n 10 368), aged ≥20 years.

The crude prevalence of obesity and abdominal obesity increased from 23·1 % and 47·9 % at baseline to 34·1 % and 71·1 % at the end of follow-up, respectively. Generalized estimating equation (GEE) models were used to analyse the correlated data and calculate the relative risks (RR). Risks of obesity and abdominal obesity increased over the whole study period for men (RR=1·62; 95 % CI 1·49, 1·76 and RR=1·46; 95 % CI 1·41, 1·52, respectively) and women (RR=1·24; 95 % CI 1·19, 1·29 and RR=1·22; 95 % CI 1·18, 1·27, respectively). These rising trends were observed in all subgroups regardless of age, marital status and educational level.

Trends of obesity and abdominal obesity are increasing in Tehranian adults during a decade of follow-up in both genders and in all study subgroups. These results underscore the still growing obesity epidemic in the capital of Iran, calling for urgent action to educate people in lifestyle modifications and the need for effective preventive and educational strategies on obesity.

Low iodine intake during pregnancy may cause thyroid dysfunction, which results in inadequate fetal brain development. In the absence of a universal salt iodization programme, we conducted a nationwide survey of iodine deficiency in pregnant women in Latvia.

A countrywide twenty-cluster survey, with at least twenty women per cluster. Participants completed a questionnaire on dietary habits concerning iodine intake (n 739). Thyroid function (thyroid-stimulating hormone, free thyroxine and thyroperoxidase antibodies) was measured (n 550). Urinary iodine was measured using the ammonium persulfate method (n 696).

The survey was performed in all regions of Latvia during the spring and autumn seasons in 2013.

Pregnant women (n 829).

The median creatinine (Cr)-standardized urinary iodine concentration (UIC) was 80·8 (interquartile range (IQR) 46·1–130·6) µg/g Cr or 69·4 (IQR 53·9–92·6) µg/l during pregnancy, and 81 % of pregnant women had UIC levels below the WHO recommended range of 150–250 µg/g Cr. The UIC was lowest during the first trimester of pregnancy, 56·0 (IQR 36·4–100·6) µg/g Cr, reaching higher concentrations of 87·5 (IQR 46·4–141·7) µg/g Cr and 86·9 (IQR 53·8–140·6) µg/g Cr in the second and third trimesters, respectively. Women taking supplements containing ≥150 µg iodine (6·8 % of respondents) had non-significantly higher UIC than did women without supplementation (96·2 v. 80·3 µg/g Cr, respectively, P=NS). Thyroperoxidase antibody concentration did not correlate significantly with UIC: Spearman’s ρ=−0·012, P=0·78.

The median UIC indicates iodine deficiency in pregnant women in Latvia. Iodine supplementation (150 µg daily) and regular UIC monitoring should be suggested to overcome iodine deficiency and to reach the recommended levels without inducing autoimmune processes.

To investigate the associations of household and neighbourhood socio-economic position (SEP) with indicators of both under- and overnutrition in adolescents and to explore sex differences.

Analysis of anthropometric, household and neighbourhood SEP data from the Birth to Twenty Plus cohort born in 1990. Anthropometric outcomes were BMI (thinness, overweight and obesity) and percentage body fat (%BF; low, high). Associations between these and the household wealth index, caregiver education and neighbourhood SEP tertile measures were examined using binary logistic regression.

Johannesburg–Soweto, South Africa.

Adolescents aged 17–19 years (n 2019; 48·2 % men).

Women had a significantly higher combined prevalence of overweight/obesity (26·2 %) than men (8·2 %) whereas men had a significantly higher prevalence of thinness than women (22·2 % v. 10·6 %, respectively). Having a low neighbourhood social support index was associated with higher odds of high %BF in women (OR=1·59; 95 % CI 1·03, 2·44). A low household wealth index was associated with lower odds of both overweight (OR=0·31; 95 % CI 0·12, 0·76) and high %BF in men (OR=0·28; 95 % CI 0·10, 0·78). A low or middle household wealth index was associated with higher odds of being thin in men (OR=1·90; 95 % CI 1·09, 3·31 and OR=1·80; 95 % CI 1·03, 3·15, respectively). For women, a low household wealth index was associated with lower odds of being thin (OR=0·49; 95 % CI 0·25, 0·96).

The study highlights that even within a relatively small urban area the nutrition transition manifests itself differently in men and women and across SEP indicators. Understanding the challenges for different sexes at different ages is vital in helping to plan public health services.

Breakfast skipping has been reported to be associated with type 2 diabetes (T2D), but the results are inconsistent. No meta-analyses have applied quantitative techniques to compute summary risk estimates. The present study aimed to conduct a meta-analysis of observational studies summarizing the evidence on the association between breakfast skipping and the risk of T2D.

Systematic review and meta-analysis.

Relevant studies were identified by a search of PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI) and SINOMED up to 9 August 2014. We also reviewed reference lists from retrieved articles. We included studies that reported risk estimates (including relative risks, odds ratios and hazard ratios) with 95 % confidence intervals for the association between breakfast skipping and the risk of T2D.

Eight studies involving 106 935 participants and 7419 patients with T2D were included in the meta-analysis.

A pooled adjusted relative risk for the association between exposure to breakfast skipping and T2D risk was 1·21 (95 % CI 1·12, 1·31; P=0·984; I2=0·0 %) in cohort studies and the pooled OR was 1·15 (95 % CI, 1·05, 1·24; P=0·770; I2=0·0 %) in cross-sectional studies. Visual inspection of a funnel plot and Begg’s test indicated no evidence of publication bias.

Breakfast skipping is associated with a significantly increased risk of T2D. Regular breakfast consumption is potentially important for the prevention of T2D.

To evaluate dietary intake based on the Chinese Food Pagoda (CFP) and to determine what factors may be associated with adherence to CFP guidelines for older Chinese.

This cross-sectional population-based study used 24 h recall over three consecutive days to assess dietary intake and adherence to CFP among older Chinese participating in the China Health and Nutrition Survey 2009.

Nine provinces across four diverse regions (Northeast, East Coast, Central and West).

A total of 2745 older Chinese, aged 60–69 years (n 1563) and ≥70 years (n 1182), with dietary data.

None of the participants reached all ten food group recommendations. More than half of the participants exceeded the recommended amount for grains (63 %), oil (62·8 %) and salt (55·7 %). Ten per cent of the participants consumed dairy, while merely 0·5 % met the recommended amount. Average Chinese Food Pagoda Score (CFPS) was 3·3 in men and 3·5 in women, far below the maximum possible score of 10. Women had 0·26 higher CFPS than men (P<0·001; 95 % CI 0·16, 0·36). People living in medium and high urbanicity areas had significantly higher scores than those living in low urbanicity areas (P<0·001). Also, there were significant differences in CFPS according to gender, BMI, work status, education level and region.

Few older Chinese are meeting the intake of the various food groups based on the recommendations in the CFP guidelines, thus increasing the risk of malnutrition and non-communicable diseases. Action is needed to increase dissemination and uptake of nutrition education, with interventions targeted at socio-economic regions. Moreover, specific dietary guidelines for older Chinese people should be developed.

Obesity is a growing problem in India, the dietary determinants of which have been studied using an ‘individual food/nutrient’ approach. Examining dietary patterns may provide more coherent findings, but few studies in developing countries have adopted this approach. The present study aimed to identify dietary patterns in an Indian population and assess their relationship with anthropometric risk factors.

FFQ data from the cross-sectional sib-pair Indian Migration Study (IMS; n 7067) were used to identify dietary patterns using principal component analysis. Mixed-effects logistic regression was used to examine associations with obesity and central obesity.

The IMS was conducted at four factory locations across India: Lucknow, Nagpur, Hyderabad and Bangalore.

The participants were rural-to-urban migrant and urban non-migrant factory workers, their rural and urban resident siblings, and their co-resident spouses.

Three dietary patterns were identified: ‘cereals–savoury foods’ (cooked grains, rice/rice-based dishes, snacks, condiments, soups, nuts), ‘fruit–veg–sweets–snacks’ (Western cereals, vegetables, fruit, fruit juices, cooked milk products, snacks, sugars, sweets) and ‘animal-food’ (red meat, poultry, fish/seafood, eggs). In adjusted analysis, positive graded associations were found between the ‘animal-food’ pattern and both anthropometric risk factors. Moderate intake of the ‘cereals–savoury foods’ pattern was associated with reduced odds of obesity and central obesity.

Distinct dietary patterns were identified in a large Indian sample, which were different from those identified in previous literature. A clear ‘plant food-based/animal food-based pattern’ dichotomy emerged, with the latter being associated with higher odds of anthropometric risk factors. Longitudinal studies are needed to further clarify this relationship in India.

The present paper examines the influence of age and gender on food patterns of Latino children.

Data are from baseline of a 5-year, quasi-experimental obesity prevention study: Niños Sanos, Familia Sana (NSFS; Healthy Children, Healthy Families). In 2012, the researchers interviewed Latino parents, using a thirty-item questionnaire to ask about their children’s food consumption and feeding practices. Statistical tests included t tests and ANCOVA.

Rural communities in California’s Central Valley, USA.

Two hundred and seventeen parents (87–89 % born in Mexico) and their children (aged 2–8 years).

Fifty-one per cent of the children were overweight or obese (≥85th percentile of BMI for age and gender). Mean BMI Z-scores were not significantly different in boys (1·10 (sd 1·07)) and girls (0·92 (sd 1·04); P=0·12). In bivariate analysis, children aged 2–4 years consumed fast and convenience foods less often (P=0·04) and WIC (Supplemental Nutrition Program for Women, Infants, and Children)-allowable foods more often than children aged 5–8 years (P=0·01). In ANCOVA, neither age nor gender was significantly related to food patterns. Mother’s acculturation level was positively related to children’s consumption of fast and convenience foods (P=0·0002) and negatively related to consumption of WIC foods (P=0·01). Providing role modelling and structure in scheduling meals and snacks had a positive effect on the vegetable pattern (P=0·0007), whereas meal skipping was associated with more frequent fast and convenience food consumption (P=0·04).

Acculturation and child feeding practices jointly influence food patterns in Latino immigrant children and indicate a need for interventions that maintain diet quality as children transition to school.

Patients with overweight or obesity increasingly attend general practice, which is an ideal setting for weight-loss counselling. The present study is the first to investigate the quality of weight-loss counselling provided by practice nurses in general practice to patients with overweight or obesity, in order to identify points for improvement.

An observational checklist was developed to assess goal and implementation intentions and ‘missed opportunities for lifestyle counselling’. Comparisons were made with overall consultation goals set by practice nurses, as measured in a post-visit questionnaire.

Dutch general practice.

One hundred video-taped consultations (2010/2011) between practice nurses and patients with overweight or obesity.

Half of the consultations contained a goal intention, of which the majority aimed to change eating behaviour. Only part of these goal intentions could be considered implementation intentions. It appeared that actions (how elements) were not often included here. Lifestyle change was more often perceived as an overall consultation goal than weight change. Regarding patterns of overall consultation goals, the majority addressed only one lifestyle factor at a time. If practice nurses formulated weight change in their overall consultation goal, they also used goal or implementation intentions, especially for weight change. In a quarter of the consultations, practice nurses did not ask any further questions about weight, nutrition or physical activity to gain insight, which is an important ‘missed opportunity for lifestyle counselling’.

Matching implementation intentions to the broader overall consultation goals of practice nurses would be meaningful, leading to desired goal-directed behaviours and subsequent goal attainment.

To document food acquisition experiences during Iraqi military occupation in Kuwait.

Retrospective cross-sectional study.

Urban areas in Kuwait during occupation.

Those living in Kuwait during the period of occupation, and aged between 15 to 50 years at the time of occupation, recruited by snowball sampling. A total of 390 completed questionnaires (response rate 78 %, 202 female and 188 male) were returned.

During the occupation, food became increasingly difficult to acquire. Two food systems emerged: (i) an underground Kuwaiti network linked to foods recovered from local food cooperatives and (ii) a black market supplied by food imported through Iraq or stolen locally. Food shortages led to reductions in meal size and frequency. Some respondents (47·7 %) reported not having sufficient income to purchase food and 22·1 % had to sell capital items to purchase food. There was a significant increase (P<0·01) in home production, with 23·1 % of people growing vegetables and 39·0 % raising animals to supplement food needs. Reduction in food wastage also emerged as a significant self-reported behaviour change. Respondents reported deterioration in the quality and availability of fish, milk, and fruit in particular. Despite a decrease in opportunities for physical activity, most respondents reported that they lost weight during the occupation.

Although the Kuwaiti population fell by about 90 % and domestic food production increased during the 7-month occupation, the local population continued to rely heavily on imported food to meet population needs. The high prevalence of self-reported weight loss indicates the inadequacies of this food supply. High apparent food security in systems which significantly exceed the ecological carrying capacity of the local environment and rely on mass food importation remains vulnerable.