The involvement of consumers in the development of dietary guidelines has been promoted by national and international bodies. Yet, few best practice guidelines have been established to assist with such involvement.

Qualitative semi-structured interviews explored stakeholders’ beliefs about consumer involvement in dietary guideline development.

Interviews were conducted in six European countries: the Czech Republic, Germany, Norway, Serbia, Spain and the UK.

Seventy-seven stakeholders were interviewed. Stakeholders were grouped as government, scientific advisory body, professional and academic, industry or non-government organisations. Response rate ranged from 45 % to 95 %.

Thematic analysis was conducted with the assistance of NVivo qualitative software. Analysis identified two main themes: (i) type of consumer involvement and (ii) pros and cons of consumer involvement. Direct consumer involvement (e.g. consumer organisations) in the decision-making process was discussed as a facilitator to guideline communication towards the end of the process. Indirect consumer involvement (e.g. consumer research data) was considered at both the beginning and the end of the process. Cons to consumer involvement included the effect of vested interests on objectivity; consumer disinterest; and complications in terms of time, finance and technical understanding. Pros related to increased credibility and trust in the process.

Stakeholders acknowledged benefits to consumer involvement during the development of dietary guidelines, but remained unclear on the advantage of direct contributions to the scientific content of guidelines. In the absence of established best practice, clarity on the type and reasons for consumer involvement would benefit all actors.

To describe the dietary composition of the New Nordic Diet (NND) and to compare it with the Nordic Nutrition Recommendations (NNR)/Danish Food-based Dietary Guidelines (DFDG) and with the average Danish diet.

Dietary components with clear health-promoting properties included in the DFDG were included in the NND in amounts at least equivalent to those prescribed by the DFDG. The quantities of the other dietary components in the NND were based on scientific arguments for their potential health-promoting properties together with considerations of acceptability, toxicological concerns, availability and the environment. Calculations were conducted for quantifying the dietary and nutrient composition of the NND.

Denmark.

None.

The NND is characterized by a high content of fruits and vegetables (especially berries, cabbages, root vegetables and legumes), fresh herbs, potatoes, plants and mushrooms from the wild countryside, whole grains, nuts, fish and shellfish, seaweed, free-range livestock (including pigs and poultry) and game. Overall, the average daily intakes of macro- and micronutrients in the NND meet the NNR with small adjustments based on evidence of their health-promoting properties.

The NND is a prototype regional diet that takes palatability, health, food culture and the environment into consideration. Regionally appropriate healthy diets could be created on similar principles anywhere in the world.

Recently, the general public opinion is that nutritional recommendations promote obesity rather than prevent it. We created the Recommended Finnish Diet Score (RFDS) that illustrates the Finnish nutrition recommendations and assessed whether this score is associated with BMI, waist circumference (WC) and body fat percentage (BF%).

Cross-sectional study included two phases of the National FINRISK 2007 Study. Diet was assessed using a validated FFQ. Height, weight, WC and BF% were measured, and BMI values were calculated. The RFDS was developed based on the national nutrition recommendations.

A large representative sample of the Finnish population.

Men (n 2190) and women (n 2530) aged 25–74 years.

The RFDS was inversely associated with WC in men (OR = 0·48, 95 % CI 0·28, 0·81, P < 0·05) and BF% in both men (OR = 0·44, 95 % CI 0·24, 0·82, P-trend < 0·05) and women (OR = 0·63, 95 % CI 0·37, 1·08, P-trend < 0·05). The inverse association of RFDS and BF% appeared stronger among older age groups (men: OR = 0·21 CI 0·07, 0·64, P-trend < 0·01; women: OR = 0·56, 95 % CI 0·25, 1·27, P-trend < 0·05) and among women with normal BMI (OR = 0·62, 95 % CI 0·36, 1·09, P-trend < 0·05). The RFDS was not associated with BMI.

A diet following nutrition recommendations is likely to help to maintain normal WC and BF%. These findings could be useful for dietary counselling and the prevention of obesity.

To develop a menu and resource to illustrate to consumers and health professionals what a healthy balanced diet looks like over the course of a week.

Development and analysis of an illustrative 7 d ‘eatwell week’ menu to meet current UK recommendations for nutrients with a Dietary Reference Value, with a daily energy base of 8368 kJ (2000 kcal). Foods were selected using market research data on meals and snacks commonly consumed by UK adults. Analysis used the food composition data set from year 1 (2008) of the UK National Diet and Nutrition Survey rolling programme. The eatwell week menu was developed using an iterative process of nutritional analysis with adjustments made to portion sizes and the inclusion/exclusion of foods in order to achieve the target macronutrient composition.

Three main meals and two snacks were presented as interchangeable within the weekdays and two weekend days to achieve adult food and nutrient recommendations. Main meals were based on potatoes, rice or pasta with fish (two meals; one oily), red meat (two meals), poultry or vegetarian accompaniments. The 5-a-day target for fruit and vegetables (range 5–6·7 portions) was achieved daily. Mean salt content was below recommended maximum levels (<6 g/d). All key macro- and micronutrient values were achieved.

Affordable foods, and those widely consumed by British adults, can be incorporated within a 7 d healthy balanced menu. Future research should investigate the effect of using the eatwell week on adults’ dietary habits and health-related outcomes.

To develop meal plans using grain-based foods demonstrating how to incorporate wholegrain foods into a balanced diet for weight maintenance for different cuisines. The present study examines the ability of meal plans with ≥4 grain-based servings daily to meet nutrient recommendations using lacto-ovo vegetarian and rice-based cuisines.

Eighteen plans from each cuisine for three age brackets for both genders were developed. Plans aimed for ≥4 servings of grain-based foods daily, with separate plans for all wholegrain, all refined-grain and half wholegrain–half refined-grain foods. Meal plans followed an isoenergetic approach and were designed to meet specific Australian nutrient reference values and serving sizes.

All plans met the Recommended Dietary Intake or Adequate Intake for targeted nutrients except for Fe in the rice-based meal plan for females aged ≥19 years (17 mg). In the plans for 14–18 year and ≥19 year age groups, four servings of grain-based foods could be accommodated. In the plans for 9–13 years, increasing the number of grain-based food servings to four reduced micronutrients levels delivered by the total diet. Specific food choices were made to ensure nutrient targets were met across each category for wholegrain and refined-grain plans. The major difference in nutrients between wholegrain and refined-grain foods was found in the vegetarian cuisine, where the meal plans containing whole grains produced on average 30 % higher fibre (38–53 g) levels than those with refined grains (27–40 g).

With careful food selection, meal plans with ≥4 servings of grain-based foods daily can meet nutrient reference values for lacto-ovo vegetarian and rice-based cuisines.

Little is known about how public entities can partner with industry to achieve public health goals. We investigated industry's perspective of factors that influenced their adoption and implementation of voluntary, government-issued nutrition guidelines (Alberta Nutrition Guidelines for Children and Youth, ANGCY) in recreational facilities.

In-depth semi-structured interviews were conducted. Data were analysed using directed content analysis.

Food services in recreational facilities.

Seven managers from industry participated; five from companies that had adopted and implemented the ANGCY (adopters) in recreational facilities and two from companies that had not (non-adopters).

Industry views nutrition guidelines through the lens of profitability. Non-adopters were unwilling to implement the ANGCY for fear of sacrificing short-term profitability, whereas adopters adhered to them in an attempt to position themselves for long-term profitability. Adopters faced barriers including few resources, no training, complex guidelines, low availability of and demand for ANGCY-compliant products, competitive pressures and substantial declines in revenue. Managers believed widespread voluntary adoption of the ANGCY was unlikely without government incentives and/or a mandate, as the environmental context for voluntary action was poor. All managers supported government-mandated implementation of the ANGCY to level the playing field upon which companies compete.

Public–private partnerships in recreational facilities can embrace public health goals in the short term, provided industry perceives potential for long-term financial gain. Widespread uptake of voluntary nutrition guidelines in this setting is unlikely, however, as market mechanisms do not encourage industry to sell and promote healthier options. Government legislation may therefore be warranted.

To compare micronutrient intakes and status in Central and Eastern Europe (CEE) with those in other European countries and with reference values.

Review of the micronutrient intake/status data from open access and grey literature sources from CEE.

Micronutrients studied were folate, iodine, Fe, vitamin B12 and Zn (for intake and status) and Ca, Cu, Se, vitamin C and vitamin D (for intake). Intake data were based on validated dietary assessment methods; mean intakes were compared with average nutrient requirements set by the Nordic countries or the US Institute of Medicine. Nutritional status was assessed using the status biomarkers and cut-off levels recommended primarily by the WHO.

For all population groups in CEE, the mean intake and mean/median status levels were compared between countries and regions: CEE, Scandinavia, Western Europe and Mediterranean.

Mean micronutrient intakes of adults in the CEE region were in the same range as those from other European regions, with exception of Ca (lower in CEE). CEE children and adolescents had poorer iodine status, and intakes of Ca, folate and vitamin D were below the reference values.

CEE countries are lacking comparable studies on micronutrient intake/status across all age ranges, especially in children. Available evidence showed no differences in micronutrient intake/status in CEE populations in comparison with other European regions, except for Ca intake in adults and iodine and Fe status in children. The identified knowledge gaps urge further research on micronutrient intake/status of CEE populations to make a basis for evidence-based nutrition policy.

To report trends in underweight, overweight and obesity in 12–15-year-old adolescents and examine changes in dieting behaviour, which have been less well documented.

Comparison of two independent representative cross-sectional surveys.

Northern Ireland.

Weight and height were objectively measured in 1324 boys and 1160 girls in 1996 and 1274 boys and 1374 girls in 2007. Participants reported whether they were following any particular diet including a self-proposed or prescribed weight-reduction diet.

Overweight and obesity increased in girls from 15 % to 23 % and 2 % to 6 %, respectively. Increases were more modest in boys with overweight increasing from 13 % to 18 % and obesity from 3 % to 6 %. The proportion of underweight adolescents decreased from 9 % to 6 % in girls and 8 % to 5 % in boys. Evidence of social disparity was observed in girls from a manual socio-economic background, with overweight/obesity prevalence rates increasing from 21 % to 36 % compared with 15 % to 26 % in girls from a non-manual background. Despite these trends fewer adolescents, in particular girls, reported following weight-reduction diets (14 % of overweight/obese girls in 2007 v. 21 % in 1996; 8 % of boys in 2007 v. 13 % in 1996). Of these girls, the proportion from a manual background following weight-reduction diets decreased from 25 % to 11 %.

Overweight and obesity are continuing to increase in adolescents despite government and media awareness strategies. There also appears to be reduced dieting behaviour, despite increasing body weight, particularly in girls from manual socio-economic backgrounds.

Pattern analysis of adolescent diets may provide an important basis for nutritional health promotion. The aims of the present study were to examine and compare dietary patterns in adolescents using cluster analysis and principal component analysis (PCA) and to examine the impact of the format of the dietary variables on the solutions.

Analysis was based on the Irish National Teens Food Survey, in which food intake data were collected using a semi-quantitative 7 d food diary. Thirty-two food groups were created and were expressed as either g/d or percentage contribution to total energy. Dietary patterns were identified using cluster analysis (k-means) and PCA.

Republic of Ireland, 2005–2006.

A representative sample of 441 adolescents aged 13–17 years.

Five clusters based on percentage contribution to total energy were identified, ‘Healthy’, ‘Unhealthy’, ‘Rice/Pasta dishes’, ‘Sandwich’ and ‘Breakfast cereal & Main meal-type foods’. Four principal components based on g/d were identified which explained 28 % of total variance: ‘Healthy foods’, ‘Traditional foods’, ‘Sandwich foods’ and ‘Unhealthy foods’.

A ‘Sandwich’ and an ‘Unhealthy’ pattern are the main dietary patterns in this sample. Patterns derived from either cluster analysis or PCA were comparable, although it appears that cluster analysis also identifies dietary patterns not identified through PCA, such as a ‘Breakfast cereal & Main meal-type foods’ pattern. Consideration of the format of the dietary variable is important as it can directly impact on the patterns obtained for both cluster analysis and PCA.

Prevalence of acute malnutrition is classically estimated by the proportion of children meeting a case definition in a representative population sample. In 1995 the WHO proposed the PROBIT method, based on converting parameters of a normally distributed variable to cumulative probability, as an alternative method requiring a smaller sample size. The present study compares classical and PROBIT methods for estimating the prevalence of global, moderate and severe acute malnutrition (GAM, MAM and SAM) defined by weight-for-height Z-score (WHZ) or mid-upper arm circumference (MUAC).

Bias and precision of classical and PROBIT methods were compared by simulating a total of 1·26 million surveys generated from 560 nutrition surveys.

Data used for simulation were derived from nutritional surveys of children aged 6–59 months carried out in thirty-one countries around the world.

Data of 459 036 children aged 6–59 months from representative samples were used to generate simulated populations.

The PROBIT method provided an estimate of GAM, MAM and SAM using WHZ or MUAC proportional to the true prevalence with a small systematic overestimation. The PROBIT method was more precise than the classical method for estimating the prevalence for GAM, MAM and SAM by WHZ or MUAC for small sample sizes (i.e. n<150 for SAM and GAM; n<300 for MAM), but lost this advantage when sample sizes increased.

The classical method is preferred for estimating acute malnutrition prevalence from large sample surveys. The PROBIT method may be useful in sentinel-site surveillance systems with small sample sizes.

Few studies have investigated the association between adolescents’ socio-economic status (SES) and health behaviours in developing countries. Socio-economic differences in breakfast eating, fruit and vegetable consumption and physical activity were investigated among Ghanaian adolescents.

A school-based survey of 12–18-year-olds (n 1195, response rate 89·7 %) was conducted in 2008. Logistic regression analyses were applied to study the associations between breakfast eating, fruit and vegetable consumption and physical activity, and SES.

Southern Ghana, West Africa.

School pupils aged 12–18 years.

Of all adolescents, 31 % took breakfast less than 4 d/week, over half (56 %) and 48 %, respectively, rarely ate fruits and vegetables. Younger adolescents (12–15-year-olds) consumed fruits and vegetables frequently compared with older ones (16–18-year-olds). Boys were more likely to participate in physical activity than girls. The probability of frequent breakfast eating was higher in adolescents from more affluent backgrounds than in those from less affluent ones. Compared with those whose mothers were illiterate, both tertiary and primary maternal educational attainment increased the probability of frequent fruit intake. Similarly, tertiary educational attainment increased the likelihood of frequent vegetable intake. Compared with those with unemployed mothers, mothers’ low employment grade was related to higher probability of frequent fruit intake. High school performance was associated with frequent fruit intake, whereas high or medium school performance increased the likelihood of vegetable intake compared with low school performance.

Interventions are needed to improve breakfast intake, fruit and vegetable consumption and physical activity in order to prevent degenerative diseases among Ghanaian adolescents.

A low socio-economic status (SES) is related to less healthy dietary habits, but the reasons for this remain unclear. We examined whether the absolute or relative importance of various food choice motives contributed to SES disparities in vegetable/fruit and energy-dense food intake.

We analysed cross-sectional data from the FINRISK Study 2007 by means of structural equation modelling and used a shortened version of the Food Choice Questionnaire to assess the absolute importance of health, pleasure, convenience, price, familiarity and ethicality motives. We calculated the relative importance of each motive by dividing the participant's rating of it by his/her mean score on all motives. Dietary intake was measured with an FFQ.

A population-based survey in Finland.

Men (n 1691) and women (n 2059) aged 25–64 years.

Higher education and income were related to a greater vegetable/fruit intake (β = 0·12, P < 0·001), while education was associated negatively with the consumption of energy-dense foods (β = −0·09, P < 0·001). Socio-economically disadvantaged individuals considered price and/or familiarity more important in their food choices in both absolute and relative terms. A higher income was related to a greater relative importance of health considerations. Relative motives were more strongly associated with vegetable/fruit and energy-dense food consumption than absolute motives and the relative importance of price, familiarity and health partly mediated the effects of the SES indicators on the consumption of these food items.

Individual priorities in food choice motives, rather than the absolute importance of single motives, play a role in producing SES disparities in diet.

To describe shared meal patterns and examine associations with dietary intake among young adults.

Population-based, longitudinal cohort study (Project EAT: Eating and Activity in Teens and Young Adults).

Participants completed surveys and FFQ in high-school classrooms in Minneapolis/St. Paul, MN, USA in 1998–1999 (mean age = 15·0 years, ‘adolescence’) and follow-up measures online or by mail in 2008–2009 (mean age = 25·3 years, ‘young adulthood’).

There were 2052 participants who responded to the 10-year follow-up survey and reported on frequency of having shared meals.

Among young adults, the frequency of shared meals during the past week was as follows: never (9·9 %), one or two times (24·7 %), three to six times (39·1 %) and seven or more times (26·3 %). Having more frequent family meals during adolescence predicted a higher frequency of shared meals in young adulthood above and beyond other relevant sociodemographic factors such as household composition and parental status. Compared with young adults who never had family meals during adolescence, those young adults who reported seven or more family meals per week during adolescence had an average of one additional shared meal per week. Having more frequent shared meals in young adulthood was associated with greater intake of fruit among males and females, and with higher intakes of vegetables, milk products and some key nutrients among females.

Nutrition professionals should encourage families of adolescents to share meals often and establish the tradition of eating together, and work with young adults to ensure that healthy food and beverage choices are offered at mealtimes.

Food cost is an important factor influencing the consumption of nutritious foods and subsequent chronic disease risk. The present study compared the cost of branded food products with their generic equivalents across a range of food categories.

The survey was conducted within two major supermarket chains across six locations in Sydney, Australia (n 12).

Price differences were calculated for ‘core’ (nutrient dense and low in energy) and ‘extra’ (high in undesirable nutrients and/or energy) packaged foods (n 22) between generic and branded items.

A cost saving of 44 % was found by purchasing generic over branded products across all food categories. The most significant savings were for core foods, such as bread and cereals, and the smallest cost savings were seen for fruit products. There was little variation in cost saving between branded and generic products by socio-economic status of the supermarket location.

The large price differential between branded and generic food products implies that consumers, particularly those on lower incomes, could benefit financially from purchasing generic items. The promotion of core generic products may be an effective strategy to assist people on lower incomes to meet dietary guidelines.

To review the impact of folic acid fortification of flour on the prevalence of neural tube defects (NTD).

Systematic review of the literature on MEDLINE via PubMed, Scopus, OvidSP and LILACS (Latin American and Caribbean Health Sciences Literature) reporting the impact of folic acid fortification of flour on the prevalence of NTD in 2000–2011. Focusing on Santiago of Chile's birth defects registry (1999–2009) and the monitoring of flour fortification, we analysed the prevalence (NTD cases/10 000 births) pre and post flour fortification and the percentile distribution of folic acid content in flour (2005–2009). We explored the potential association between median folic acid in flour (mg/kg) and the prevalence of NTD.

Chile, Argentina, Brazil, Canada, Costa Rica, Iran, Jordan, South Africa and the USA.

Live births and stillbirths.

Twenty-seven studies that met inclusion criteria were evaluated. Costa Rica showed a significant reduction in NTD (∼60 %). Prevalence in Chile decreased from 18·6 to 7·3/10 000 births from 1999 to 2007 and showed a slight increase to 8·5 in 2008–2009, possibly due to changes in fortification limits. When we related the prevalence of NTD with levels of flour fortification, the lowest prevalence was observed at a folic acid level of 1·5 mg/kg.

Fortification of flour with folic acid has had a major impact on NTD in all countries where this has been reported. Chile showed a 55 % reduction in NTD prevalence between 1999 and 2009. There is a need to constantly monitor the levels of flour fortification to maximize benefits and prevent the potential risk of folic acid excess, moreover to be vigilant for any new adverse effects associated with excess.

Hispanics with lower acculturation may be at higher risk for neural tube defects compared with those with higher acculturation due to lower total folic acid intake or other undetermined factors. Modelling has indicated that fortification of corn masa flour with folic acid could selectively target Mexican Americans more than other race/ethnicities. We assessed whether fortification of corn masa flour with folic acid could selectively increase folic acid intake among Mexican-American women with lower acculturation, as indicated by specific factors (language preference, country of origin, time living in the USA).

We used dietary intake and dietary supplement data from the National Health and Nutrition Examination Survey 2001–2008, to estimate the amount of additional total folic acid that could be consumed if products considered to contain corn masa flour were fortified at 140 μg of folic acid per 100 g of corn masa flour.

USA.

Non-pregnant women aged 15–44 years (n 5369).

Mexican-American women who reported speaking Spanish had a relative percentage change in usual daily total folic acid intake of 30·5 (95 % CI 27·8, 33·4) %, compared with 8·3 (95 % CI 7·3, 9·4) % for Mexican-American women who reported speaking English. We observed similar results for other acculturation factors. An increase of 6·0 percentage points in the number of Mexican-American women who would achieve the recommended intake of ≥400 μg folic acid/d occurred with fortification of corn masa flour; compared with increases of 1·1 percentage points for non-Hispanic whites and 1·3 percentage points for non-Hispanic blacks. An even greater percentage point increase was observed among Mexican-American women who reported speaking Spanish (8·2).

Fortification of corn masa flour could selectively increase total folic acid intake among Mexican-American women, especially targeting Mexican-American women with lower acculturation, and result in a decrease in the number of pregnancies affected by neural tube defects.

To determine the prevalence of and associated factors for overweight, especially to determine the relationship between the intake of monosodium glutamate (MSG) as a seasoning and overweight in Vietnam.

A cross-sectional survey was conducted of Vietnamese adults aged ≥20 years in 2008. Dietary intake was assessed by the 24 h recall method for 3 d. MSG intake was evaluated by the weighing method on three consecutive days. Physical activity was assessed based on the Global Physical Activity Questionnaire recommended by the WHO. Overweight was defined as BMI ≥ 23·0 kg/m2. Other characteristics such as age and lifelong occupation were determined by a structured questionnaire.

Some rural and urban areas of Hanoi, Thua Thien Hue Province and Ho Chi Minh City, Vietnam.

A total of 1528 adults living in surveyed areas were randomly selected by the multistage cluster sampling method.

The prevalence of overweight was 27·9 %, and 81·0 % of participants were MSG users. Average MSG intake was 2·2 (sd 1·8) g/d. Multiple logistic regression analysis revealed that factors associated with overweight were age, region of residence, lifelong occupation, physical activity and intakes of energy, carbohydrates, saturated fat and animal protein. There was no significant association between MSG intake and overweight.

The study demonstrated that overweight was not associated with MSG intake in Vietnamese adults. Further longitudinal studies should be done in different populations to determine the relationship between MSG and overweight.

To investigate the association between dietary behaviours and colorectal cancer (CRC) in the context of the Mediterranean diet.

Case–control study.

All patients (cases) were recruited from Saint Savvas Cancer Hospital and Alexandra General Hospital in Athens, Greece. Controls were voluntarily selected from the general population and matched to cases by age group (±10 years) and sex.

Two hundred and fifty cases with newly diagnosed CRC (mean age 63 (sd 12) years, 59·6 % males) and 250 controls matched on age and sex were studied. A standardized questionnaire assessing sociodemographic, clinical, lifestyle, dietary characteristics and nutritional behaviours was applied. Multiple logistic regression analysis was used to evaluate the aforementioned factors in addition to the MedDietScore (an index that evaluates adherence to the Mediterranean diet) on CRC development.

The higher the daily number of meals, the lower the likelihood of having CRC (OR = 0·74, 95 % CI 0·61, 0·89); coffee drinking was associated with higher likelihood of having CRC (OR = 3·27, 95 % CI 1·09, 9·8); the use of non-stick cookware was positively associated with CRC (OR = 1·57, 95 % CI 1·02, 2·4). However, these associations slightly lost their significance when adherence to the Mediterranean diet was taken into account. Moreover, a 1/75 increase in the modified-MedDietScore plus the aforementioned nutritional behaviours was associated with 13 % lower odds (95 % CI 0·83, 0·91, P < 0·001) of having CRC.

Nutritional behaviours in addition to dietary habits should be taken into account in detecting individuals prone to the development of CRC.