To examine the association of meat consumption with diabetes risk in the Hawaii component of the Multiethnic Cohort and to assess effect modification by ethnicity.

A prospective cohort study. Baseline information on diet and lifestyle was assessed by questionnaire. The cohort was followed up for incident cases of diabetes, which were identified through self-reports, medication questionnaires, or health plan linkages. Cox regression was used to calculate hazard ratios (HR) and 95 % confidence intervals for diabetes associated with quintile of meat consumption.

Hawaii, USA.

A total of 29 759 Caucasian, 35 244 Japanese-American and 10 509 Native Hawaiian men and women, aged 45–75 years at baseline.

During a mean follow-up time of 14 years, 8587 incident diabetes cases were identified. Intake of red meat was positively associated with diabetes risk in men (fifth v. first quintile: HR = 1·43; 95 % CI 1·29, 1·59) and women (fifth v. first quintile: HR = 1·30; 95 % CI 1·17, 1·45) in adjusted models. The respective HR for processed red meat intake were 1·57 (95 % CI 1·42, 1·75) and 1·45 (95 % CI 1·30, 1·62). The association for processed poultry was weaker than for processed red meat, and fresh poultry intake was not associated with diabetes risk. For men only, we observed significant interactions of ethnicity with the red and processed red meat associations, with Caucasians experiencing slightly higher risks than Japanese-Americans.

Our findings support the growing evidence that red and processed meat intake increase risk for diabetes irrespective of ethnicity and level of BMI.

To characterize the trends, distribution, potential determinants and public health implications of meat consumption within the USA.

We examined temporal trends in meat consumption using food availability data from the FAO and US Department of Agriculture (USDA), and further evaluated the meat intake by type (red, white, processed) in the National Health and Nutrition Examination Surveys (NHANES) linked to the MyPyramid Equivalents Database (MPED).

Overall meat consumption has continued to rise in the USA and the rest of the developed world. Despite a shift towards higher poultry consumption, red meat still represents the largest proportion of meat consumed in the USA (58 %). Twenty-two per cent of the meat consumed in the USA is processed. According to the NHANES 2003–2004, total meat intake averaged 128 g/d. The type and quantities of meat reported varied by education, race, age and gender.

Given the plausible epidemiological evidence for red and processed meat intake in cancer and chronic disease risk, understanding the trends and determinants of meat consumption in the USA, where meat is consumed at more than three times the global average, should be particularly pertinent to researchers and other public health professionals aiming to reduce the global burden of chronic disease.

To examine the association between cereal consumption and cardiovascular risk factors including waist, height, total cholesterol, LDL cholesterol and HDL cholesterol in a sample of adolescent girls.

Longitudinal study.

The study was conducted from 1987 to 1997 and data were collected at three study sites (University of California at Berkeley, University of Cincinnati and Westat Inc., Rockville, MD, USA). Mixed models were used to estimate the association between the number of days of eating cereal and these four outcome variables.

Girls (n 2371) who participated in the 10-year National Heart, Lung, and Blood Growth and Health Study (NGHS) and completed a 3 d food diary in years 1–5 and 7, 8 and 10.

Adolescent girls who ate cereal more often had lower waist-to-height ratio (P < 0·005), lower total cholesterol (P < 0·05) and lower LDL cholesterol (P < 0·05), taking into account sociodemographic variables, physical activity levels and total energy intake.

Findings suggest that cereal consumption is associated with markers of cardiovascular risk and that childhood patterns of consumption may influence the development of risk factors later in adolescence.

Few dietary surveys have been done with reference to chronic diseases, such as diabetes, in India, which is considered to be the diabetes capital of the world. We report on the dietary intake of urban adults living in Chennai, South India.

A population-based cross-sectional study.

A representative population of urban Chennai in southern India.

The study population comprised 2042 individuals aged ≥20 years selected from the Chennai Urban Rural Epidemiological Study (CURES). Dietary intake was measured using a validated and previously published interviewer-administered semi-quantitative meal-based FFQ.

The mean daily energy intake was 10 393 (sd 2347) kJ (male: 10953 (sd 2364) kJ v. female: 9832 (sd 233) kJ). Carbohydrates were the major source of energy (64 %), followed by fat (24 %) and protein (12 %). Refined cereals contributed to the bulk of the energy (45·8 %), followed by visible fats and oils (12·4 %) and pulses and legumes (7·8 %). However, energy supply from sugar and sweetened beverages was within the recommended levels. Intake of micronutrient-rich foods, such as fruit and vegetable consumption (265 g/d), and fish and seafoods (20 g/d), was far below the FAO/WHO recommendation. Dairy and meat products intake was within the national recommended intake.

The diet of this urban South Indian population consists mainly of refined cereals with low intake of fish, fruit and vegetables, and all of these could possibly contribute to the risk of non-communicable diseases such as diabetes in this population.

To determine the nutrition transition stage of female Jordanian college students.

A cross-sectional survey was used to assess eating styles, disordered eating attitudes and behaviours, body esteem and dissatisfaction, and media influence.

Public and private universities in Jordan.

A total of 255 subjects were recruited through a government-initiated youth campaign.

The majority of participants had a normal BMI (70·6 %) with almost all (99·4 %) reporting restrained eating behaviour. Scores on the Eating Attitudes Test (EAT-26) indicated that 45·2 % of these female college students should be screening for eating disorders. Subscales of the Body Esteem Scale (BES) showed that these women did not have substantial body esteem issues and mean scores on the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ-3) indicated that overall these women did not feel the media was dictating the way their body should look. Where Jordanian women did feel pressure from Western media, there was a 6·7-fold increase in the likelihood that they wanted to lose weight. In addition, 48·2 % of the female college students desired to lose weight and 14·4 % desired weight gain, indicating a certain level of body dissatisfaction.

With low levels of overweight and obesity and a propensity towards eating based on external hunger cues, college-aged Jordanian women may be less advanced in their development through the nutrition transition than the general population of women. However, high levels of restrained eating and disordered eating attitudes and behaviours indicate the need for an intervention to address healthy weight-loss strategies, assess eating disorders and help maintain healthy body esteem.

To assess the national prevalence of short stature, underweight, overweight and obesity in 6-year-old Iranian children before school entry.

Cross-sectional nationwide survey.

Mandatory national screening programme before entrance to elementary school in 2008 in Iran.

All Iranian children entering public and private elementary schools.

The study population comprised 862 433 children (48·4 % girls, 77·2 % urban resident). Overall, 6·5 % of children had short stature, 19·1 % were underweight, 12·8 % were overweight and 3·4 % were obese. There was no significant difference in terms of gender, but considerably larger differences were documented among various provinces.

The double burden of nutritional disorders among young children warrants a multi-faceted national policy with evidence-based local programmes. Such planning needs a comprehensive surveillance system and centralized data registry for children’s growth.

To examine the adequacy and inadequacy of dietary patterns in pregnant women for which information is absolutely lacking.

Diet was assessed by a validated, self-administered diet history questionnaire (DHQ). Dietary patterns were extracted from the intake of thirty-three food groups (g/4184 kJ (1000 kcal)), which were summarized from 147 foods assessed with the DHQ, by cluster analysis. Nutritional inadequacy for selected twenty nutrients in each dietary pattern was examined using the reference values given in the Dietary Reference Intakes (DRI) for Japanese as the temporal gold standard.

Japan.

Nine hundred and ninety-seven pregnant Japanese women aged 18–43 years.

The three dietary patterns identified were labelled as ‘meat and eggs’ (n 423), ‘wheat products’ (n 371) and ‘rice, fish and vegetables’ (n 203). The ‘rice, fish and vegetables’ pattern characterized by high intake of rice, vegetables, potatoes, pulses, fruits, seaweed, fish and miso soup showed significantly the lowest prevalence of inadequate intake for fifteen nutrients and significantly the highest prevalence of inadequate sodium intake. In contrast, the ‘wheat products’ pattern characterized by high intake of bread, noodles, confectioneries and soft drinks showed the highest prevalence of inadequate intake for fourteen nutrients. The median number of nutrients not meeting the DRI as a marker of overall nutritional inadequacy was eight in the ‘rice, fish and vegetables’ pattern. It was significantly lower at ten in the ‘meat and eggs’ and eleven in the ‘wheat products’ patterns (P < 0·001).

In pregnant Japanese women, the dietary pattern high in rice, fish, vegetables, fruit and some others showed a better profile of nutritional adequacy except for sodium.

The purpose of the present study was to analyse the evolution of the Spanish population’s global and regional adherence to the Mediterranean diet (MD) since 1987.

A cross-sectional study was conducted analysing food consumption from the Spanish Household Consumption Surveys administered by the Spanish Ministry of Agriculture, Fisheries and Food.

The Mediterranean Adequacy Index (MAI) was applied to measure the adherence to the MD. The significance of the MAI trend was evaluated using a regression model.

The sample comprises a household consumption data set, which consisted of 2500 households in 1987 and increased to 6200 in 2005.

There was a significant decrease in the MAI (P = 0·001) during the past two decades in Spanish households. From 1987 to 1997, MD adherence significantly decreased, but since 1998 it appears to have stabilised. In recent years, the daily household availability of several of the food components of the MD has increased. The MAI was observed to be significantly higher during the entire period in some Mediterranean regions, such as Andalusia, and significantly lower in more inland regions, such as Castile-Leon.

During the past two decades, Spain has experienced a significant downward trend in adherence to the predominant dietary pattern, likely as a result of numerous socio-economic changes. However, a stabilisation and a recent slight recovery have been observed during the past decade.

The aim of the present study was to investigate the relationship between area-level socio-economic status and healthy and less healthy eating behaviours among adolescents and to determine whether the relationship between area-level socio-economic status and dietary behaviours was related to the relevant attitudes and environments.

Data were collected as part of Youth’07, a nationally representative survey of the health and well-being of New Zealand youth.

New Zealand secondary schools, 2007.

A total of 9107 secondary-school students in New Zealand.

Students from more deprived areas perceived more supportive school environments and cared as much about healthy eating as students in more affluent areas. However, these students were significantly more likely to report consuming fast food, soft drinks and chocolates.

Addressing area-level socio-economic disparities in healthy eating requires addressing the availability, affordability and marketing of unhealthy snack foods, particularly in economically deprived areas.

Health logos are introduced to distinguish foods with ‘healthier’ nutrient composition from regular foods. In the present study, we evaluated the effects of changed food compositions according to health logo criteria on the intake of saturated fat, sugar and sodium in a Dutch population of young adults.

Foods in the Dutch food composition table were evaluated against nutrient criteria for logo eligibility. Three replacement scenarios were compared with the nutrient intake ‘as measured’ in the Dutch consumption survey. The foods not complying with health logo criteria were replaced either by ‘virtual’ foods exactly complying with the health logo criteria, with real 2007 market shares (scenario I) and 100 % market shares (scenario II), or by existing similar foods with a composition that already complied with the health logo criteria (scenario III).

The percentage reduction in nutrient intake with the current 2007 market shares of ‘health logo foods’ was −2·5 % for SFA, 0 % for sodium and −1 % for sugar. With a 100 % market share these reductions would be −10 % for SFA, −4 % for sodium and −6 % for sugar. This may lead to a reduction of −40 % for SFA, −23 % for sodium and −36 % for sugar in the most optimal replacement scenario.

With ‘health logo foods’, available in 2007 and current consumption patterns, small reductions can be achieved for SFA and sugar. For additional reductions, lowering the fat/sodium content of meat (products) towards health logo criteria and drinks without sugar towards limits far below health logo criteria would be the most effective reformulation strategy.

Public assistance programmes may increase risk of obesity among adults. The current study assessed whether participation in the Supplemental Nutrition Assistance Program (SNAP; formerly the Food Stamp Program), Supplemental Security Income (SSI) or California Work Opportunities and Responsibilities to Kids (CalWorks) was associated with obesity, independent of socio-economic status and food insecurity.

A cross-sectional analysis of the 2007 Adult California Health Interview Survey. Outcome measures included BMI and obesity. Distribution of BMI and prevalence of obesity were compared by participation in each programme, using weighted linear and binomial regression models in which BMI or obesity was the outcome, respectively, and programme participation was the predictor.

A population survey of various health measures.

Non-institutionalized adults (n 7741) whose household income was ≤130 % of the federal poverty level.

The prevalence of obesity was 27·4 %. After adjusting for sociodemographic characteristics, food insecurity and participation in other programmes, the prevalence of obesity was 30 % higher in SNAP participants (95 % CI 6 %, 59 %; P = 0·01) than in non-participants. This association was more pronounced among men than women. SSI participation was related to an adjusted 50 % higher prevalence of obesity (95 % CI 27 %, 77 %; P < 0·0001) compared with no participation. SNAP and SSI participants also reported higher soda consumption than non-participants of any programme. CalWorks participation was not associated with obesity after multivariable adjustment.

Participation in SNAP or SSI was associated with obesity independent of food insecurity or socio-economic status. The suggestion that these associations may be mediated by dietary quality warrants further investigation among low-income populations.

India is experiencing increased consumption of sugar-sweetened carbonated drinks, consumption that may be associated with increased risk of type 2 diabetes and obesity. The aim of the study was to determine the availability, price and quantity sold of ‘Pepsi’ and ‘Coca Cola’ in their ‘regular’ and ‘diet’ forms in Delhi and London.

A questionnaire about the availability, price and quantity sold per day of both regular and diet Pepsi and Coca Cola was devised and piloted. Using this, a survey of food and drink outlets within a 100 m radius of randomly selected Metro stations was conducted in both cities.

Store vendors, owners and staff of food and drink outlets.

Delhi, India; London, United Kingdom.

In Delhi, of the outlets stocking regular Pepsi and Coca Cola, only 34 % sold diet versions and these were more readily available in the most affluent areas than in the poorest areas (34 % v. 6 %, Z = 3·67, P < 0·001). This social patterning was not observed in London. Little price differential between regular and diet versions of Pepsi and Coca Cola was observed in Delhi; however, profit margins were better for regular, relative to diet, Coca Cola. Sales of regular products were significantly greater than those of diet products (P < 0·002).

Low availability of diet versions of Pepsi and Coca Cola in less affluent areas of Delhi is likely to exacerbate the obesity and diabetes trends. Price differentials to promote diet versions and other healthier or traditional low-energy drinks may be beneficial.

To assess the dependence on fish consumption of families and its impact on nutritional status and neurodevelopment of pre-school children.

Cross-sectional study that measured children’s hair mercury (HHg) as an indicator of family fish consumption, growth (anthropometric Z-scores, WHO standards) and neurological (Gesell developmental scores (GDS)) development.

Traditional living conditions among families residing in the area adjacent to the Samuel Dam (Western Amazon) hydroelectric reservoir.

Two hundred and forty-nine pre-school children (1–59 months of age) from families transitioning from the traditional Amazonian lifestyle.

Family fish consumption was significantly correlated with children’s HHg concentration (Spearman’s r = 0·246, P < 0·0001); however, HHg had no significant association with growth (Z-scores). Overall, the prevalence of severe malnutrition, i.e. stunting (height-for-age Z-score (HAZ) ≤ −3), underweight (weight-for-age Z-score (WAZ) ≤ −3) and wasting (weight-for-height Z-score (WHZ) ≤ −3) was 5·2 % (n 13), 0 % and 0·8 % (n 2), respectively. The prevalence of moderate stunting (HAZ ≥ −3 to ≤ −2), underweight (WAZ ≥ −3 to ≤ −2) and wasting (WHZ ≥ −3 to ≤ −2) was 8·8 % (n 22), 2·4 % (n 6) and 4·8 % (n 12), respectively. Although 76 % of the children showed adequate GDS (>85), multiple regression analysis showed that fish consumption (as HHg) had no impact on GDS, but that some variables did interact significantly with specific domains (motor and language development).

The study showed that the families’ shift in fish consumption had no negative impact on the growth of young children and that ensuing methylmercury exposure has not been a noticeable neurodevelopmental hindrance.

To examine how factors related to the home food environment and individual characteristics are associated with healthy food purchasing among low-income African American (AA) youth.

A total of 206 AA youth (ninety-one boys and 115 girls), aged 10–14 years, and their primary adult caregivers.

Fourteen Baltimore recreation centres in low-income neighbourhoods.

Cross-sectional study. We collected information about food purchasing, the home food environment, sociodemographic and psychosocial factors drawn from social cognitive theory. Multivariable logistic regression was used to examine the factors associated with the frequency and proportion of healthy food purchases in all youth and stratified by gender. Low-fat or low-sugar foods were defined as healthy.

Youth purchased an average of 1·5 healthy foods (range = 0–15) in the week before the interview, comprising an average of 11·6 % (range = 0–80 %) of total food purchases. The most commonly purchased healthy foods included water and sunflower seeds/nuts. Healthier food-related behavioural intentions were associated with a higher frequency of healthy foods purchased (OR = 1·4, P < 0·05), which was stronger in girls (OR = 1·9, P < 0·01). Greater caregiver self-efficacy for healthy food purchasing/preparation was associated with increased frequency of healthy purchasing among girls (OR = 1·3, P < 0·05). Among girls, more frequent food preparation by a family member (OR = 6·6, P < 0·01) was associated with purchasing a higher proportion of healthy foods. No significant associations were observed for boys.

Interventions focused on AA girls should emphasize increasing food-related behavioural intentions. For girls, associations between caregiver self-efficacy and home food preparation suggest the importance of the caregiver in healthy food purchasing.

To assess the relationship between several socio-economic indicators and frequency of consumption of seven predefined healthy foods (consumption of fruit, vegetables, wholegrain bread, vegetable-fat spread, vegetable cooking fat, low-fat milk and low-fat cheese) in populations from Eastern, Central and Western Europe.

Analysis of baseline data collected in two cross-sectional cohort studies between 2000 and 2005: the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study and the Finnish Helsinki Health Study (HHS).

Urban populations in the Czech Republic, Russia, Poland and Finland.

In the HAPIEE study, random samples of men and women aged 45–69 years were drawn from population registers and electoral lists of selected cities. In the HHS, men and women aged 40–60 years employed by the City of Helsinki were recruited. Data on 21 326 working subjects from both cohorts were analysed.

Healthy food habits were, in general, positively associated with higher education, occupational position and fewer economic difficulties, but there were differences in the strength of the gradient by food and country. Fruit consumption showed the most consistent gradients, especially in relation to socio-economic status among men (country-specific relative index of inequality (RII) = 2·02–5·17) and women (RII = 2·09–3·57).

The associations between socio-economic indicators and healthy food habits showed heterogeneity between countries. Future studies of dietary behaviours should consider multiple measures of socio-economic position.

The present paper presents a synthesis of available evidence to support action on the interventions that can effectively address the main drivers of child undernutrition in developing countries. It also discusses how interventions should be designed and identifies policy-relevant areas for further research.

A structured literature review of fifty-eight controlled evaluations and studies in developing countries were selected because they are methodologically sound, recent (reported within the past 10 years), report on nutritional status, cover a wide range of interventions and are implemented by a range of different agencies.

Indirect interventions in developing countries, which address the underlying and basic causes of child undernutrition and can potentially be implemented in the short to medium term.

Children under 5 years of age and their mothers across a range of developing countries.

Evidence has now accumulated to guide action on a range of indirect interventions that can reduce child undernutrition, but for all these interventions context is all-important. There is less evidence on how these interventions can be effectively implemented on a large scale.

Efforts should be directed towards improving implementation of effective interventions on a large scale. Donors need to keep commitments both in dollar terms and in terms of the Paris Declaration so that the push for improved nutrition does not become donor driven. At the country level, there is a need for enabling governance structures, institutions and evidence-based decision making. Within countries there is a need for well-trained personnel with delegated authority, accountable to local people. It is essential for chains of accountability to be transparent and for active involvement of households in decision-making processes.

The aim of the present study was to investigate whether fruit and vegetables should be treated as separate groups in health promotion programmes by examining consumption levels, barriers, knowledge and the association between stage of change and potential predictors of fruit and vegetable intake.

Computer-assisted telephone interview survey of the target population.

Hunter and New England regions of New South Wales, Australia.

A total of 1403 parents and carers of primary-school-aged children.

Consumption levels and knowledge of recommended intakes and serving size were greater for fruit than for vegetables. There were some differences in the main barriers to the consumption of fruit compared with those cited for vegetables. There was little congruence between the stages of change for fruit consumption and those for vegetable consumption. For fruit, knowledge of serving size and recommended intake, perceptions of adequate consumption, changes made to family intake and educational attainment were all correlated with stage of change categorisation. For vegetables, knowledge of recommended intake, perceptions of adequate consumption and changes made to family intake were correlated with stage of change categorisation.

Significant differences in consumption levels, barriers, knowledge and stages of readiness for change can be shown when fruit and vegetables are treated as separate groups. Health promotion planners may need to consider interventions that focus on improving vegetable consumption in preference to fruit consumption. Messages about the recommended number of servings and serving size must be simplified and this may be achieved by targeting messages towards vegetable consumption.

The number of extremely thin young women has increased and education at school on maintaining an optimal weight has become important. The aim of the present study was to assess the effectiveness of a group-based home-collaborative dietary education (HCDE) programme to maintain appropriate dietary intake compared to conventional school classroom education.

Two-arm cluster randomized controlled trial. Twelve classes were randomly assigned as clusters to either the HCDE group or the control group. Each participant in the HCDE group received twelve sessions of group counselling aimed at increasing energy intake at breakfast by modifying dietary intake and adopting appropriate habits. The hypothesis underlying the study was that after 6 months of HCDE the total energy intake would be increased by 627 kJ from baseline (primary endpoint). Secondary outcomes were differences in intake of various nutrients from baseline. Outcome measures after log transformation were examined by t tests and linear mixed models (crude and baseline-adjusted).

Young women among Japanese female adolescents in Tokyo.

Four hundred and seventy-four participants aged 13–15 years.

Students in twelve classes were used for analysis (n 459). Energy intake was decreased in many of the classes during the 6-month period, especially for those in the control group. After adjustment for the baseline value, significant increases in energy intake and protein, calcium, magnesium and iron intakes at breakfast were observed (P < 0·05)

Although energy intake was increased in the HCDE group compared to the control group, further study of the HCDE is warranted.