Despite a rapidly growing economy and rising income levels in India, improvements in child malnutrition have lagged. Data from the most recent National Family Health Survey reveal that the infant and young child feeding (IYCF) practices recommended by the WHO and the Indian Government, including the timely introduction of solid food, are not being followed by a majority of mothers in India. It is puzzling that even among rich households children are not being fed adequately. The present study analyses the socio-economic factors that contribute to this phenomenon, including the role of nutritional information.

IYCF practices from the latest National Family Health Survey (2005–2006) were analysed. Multivariate logistic regression analyses were performed to establish the determinants of poor feeding practices. The indicators recommended by the WHO were used to assess the IYCF practices.

India.

Children (n 9241) aged 6–18 months.

Wealth was shown to have only a small effect on feeding practices. For children aged 6–8 months, the mother's wealth status was not found to be a significant determinant of sound feeding practices. Strikingly, nutritional advice on infant feeding practices provided by health professionals (including anganwadi workers) was strongly correlated with improved practices across all age groups. Exposure to the media was also found to be a significant determinant.

Providing appropriate information may be a crucial determinant of sound feeding practices. Efforts to eradicate malnutrition should include the broader goals of improving knowledge related to childhood nutrition and IYCF practices.

To determine the impact of facility-based semi-intensive and home-based intensive counselling in improving exclusive breast-feeding (EBF) in a low-resource urban setting in Kenya.

A cluster randomized controlled trial in which nine villages were assigned on a 1:1:1 ratio, by computer, to two intervention groups and a control group. The home-based intensive counselling group (HBICG) received seven counselling sessions at home by trained peers, one prenatally and six postnatally. The facility-based semi-intensive counselling group (FBSICG) received only one counselling session prenatally. The control group (CG) received no counselling from the research team. Information on infant feeding practices was collected monthly for 6 months after delivery. The data-gathering team was blinded to the intervention allocation. The outcome was EBF prevalence at 6 months.

Kibera slum, Nairobi.

A total of 360 HIV-negative women, 34–36 weeks pregnant, were selected from an antenatal clinic in Kibera; 120 per study group.

Of the 360 women enrolled, 265 completed the study and were included in the analysis (CG n 89; FBSICG n 87; HBICG n 89). Analysis was by intention to treat. The prevalence of EBF at 6 months was 23·6 % in HBICG, 9·2 % in FBSICG and 5·6 % in CG. HBICG mothers had four times increased likelihood to practise EBF compared with those in the CG (adjusted relative risk = 4·01; 95 % CI 2·30, 7·01; P = 0·001). There was no significant difference between EBF rates in FBSICG and CG.

EBF can be promoted in low socio-economic conditions using home-based intensive counselling. One session of facility-based counselling is not sufficient to sustain EBF.

To characterize current feeding practices and to evaluate the adequacy of energy and nutrient intakes of young children in subsistence farming rural households in North Wollo, Ethiopia.

A cross-sectional study examining sociodemographic status, anthropometry, breast-feeding and complementary feeding practices using two in-home non-consecutive 24 h recalls.

Two rural villages in the highlands and lowlands of Gobalafto district, North Wollo.

Seventy-six young children aged 12–23 months, thirty-nine from the lowlands and thirty-seven from the highlands.

About 33 % of the children, ∼46 % in the highlands and 24 % in the lowlands (P = 0·05), were stunted. Complementary diets were low in animal products, fruits and vegetables. Cereals and legumes were the major sources of energy, protein, Ca, Fe, Zn and vitamin A. Legumes with potentially toxic components (grass pea, broad beans) and low nutrient-dense beverages such as tea were frequently consumed. Intakes of energy, Ca, Zn, vitamin A and vitamin C from complementary foods were below WHO recommendations assuming average breast-milk intakes. In contrast, Fe and protein intakes and densities met WHO recommendations. Although vitamin C intakes and densities were higher (P < 0·05) for the lowlands, they remained far below WHO recommendations.

Interventions promoting the WHO guiding principles for complementary feeding practices and behaviours that take the agro-ecological contexts into account are needed here. Furthermore, specific recommendations should be formulated to discourage the consumption of grass pea, broad beans and low nutrient-dense beverages such as tea.

To describe trends in the prevalence of anaemia and Fe deficiency in children under 2 years of age living in a town in western Brazilian Amazonia.

Temporal analysis of two cross-sectional population-based surveys. Information on socio-economic status, morbidity and breast-feeding was obtained using a structured questionnaire. Child weight and length were measured for anthropometric evaluation. Concentrations of blood Hb, plasma ferritin and soluble transferrin receptor were measured.

The town of Acrelândia, state of Acre, north-west Brazil.

A total of 170 and 224 participants of the 2003 and 2007 surveys, respectively.

Comparison between the 2003 and 2007 surveys revealed no statistically significant differences in the prevalence of anaemia (48 (95 % CI 39, 56) % to 40 (95 % CI 33, 47) %) or Fe-deficiency anaemia (39 (95 % CI 30, 48) % to 37 (95 % CI 30, 45) %), respectively. However, an increase in the overall prevalence of Fe deficiency from 62 (95 % CI 51, 68) % to 81 (95 % CI 75, 86) % was observed (χ2 test, P ≤ 0·001). In age- and sex-adjusted analyses for risk of Fe deficiency, only early introduction of cow's milk (<90 d) was associated with Fe deficiency in 2003 (prevalence ratio (PR) = 0·76; 95 % CI 0·57, 1·01), while caesarean section (PR = 1·18; 95 % CI 1·03, 1·35) and birth weight <3500 g (PR = 1·15; 95 % CI 1·00, 1·34) were associated with Fe deficiency in 2007.

No improvements were observed in the prevalence of anaemia, exposing a worrying scenario for public health, while a significant increase was found in the prevalence of Fe deficiency in the studied infants and toddlers.

To determine risk factors for consumption of soda and other sugar-sweetened beverages (SSB) among 2-year-old children.

The analysis was performed using three linked data sets: the 2004–2005 Oregon Pregnancy Risk Assessment Monitoring Survey (PRAMS); its longitudinal follow-up, 2006–2007 Oregon PRAMS-2; and 2004–2005 Oregon birth certificates.

PRAMS is a surveillance programme supported by the federal Centers for Disease Control and Prevention and implemented by participating state health departments. Using mixed methods, PRAMS surveys women 2–6 months after a live birth. Oregon PRAMS-2 re-interviews respondents shortly after the index child's second birthday. Oregon PRAMS oversamples minority women.

Using monthly cohorts, we randomly selected 5851 women from the 2004–2005 birth certificates. In total 1911 women completed both PRAMS and PRAMS-2. The weighted response rate of PRAMS-2 was 43·5 %.

Almost half of mothers (49·9 %) reported that their child drank SSB on at least 1 d/week. Mothers whose children drank SSB at least once weekly were more likely to have low income (adjusted OR = 2·83, 95 % CI 2·09, 3·83) and to eat out on ≥2 d/week (OR = 2·11 %, 95 % CI 1·66, 2·70). Hispanic and non-Hispanic black women were most likely to report that their child drank SSB at least once weekly.

Half of mothers reported that their 2-year-old children drank SSB at least once weekly. Public health interventions and policies should address childhood SSB consumption including educating health-care providers and parents.

The aims were to collect data on consumption of different food supplements in a sample of the adult Italian population and to characterize users by demographic, physical and health-related characteristics, lifestyle and behaviour.

Cross-sectional survey.

The study was conducted in 2008 in ten towns of Italy (two towns from each of the five macro-areas: Northwest, Northeast, Centre, South and Islands).

Adults (n 10 000) aged ≥18 years were randomly selected and asked to fill in a self-administered questionnaire regarding their use of food supplements and the above variables. The effect of these variables on food supplement use was evaluated by univariate and multivariate logistic regression.

Of the 1723 individuals who returned the questionnaire, 49 % were users of food supplements. A large proportion (54 %) of users used more than one category of food supplement: vitamin and/or mineral supplements were the most used (61 %), followed by supplements with botanicals and botanical extracts (28 %). The results obtained by logistic regression showed that gender, town size, education level, sports practice, regular use of wholemeal cereal-based foods and presence of a low stress level were determinants for the use of food supplements in the examined population. However, these determinants were not shared by all categories of supplements.

The results of this preliminary study highlight that associations between demographic, dietary and lifestyle factors and use of different categories of food supplements differ according to products, and cannot be accounted for simply by dichotomizing individuals as users or non-users.

FFQ are commonly used to rank individuals by their food and nutrient intakes in large epidemiological studies. The purpose of the present study was to develop and validate an FFQ to rank individuals participating in an ongoing Prospective Urban and Rural Epidemiological (PURE) study in Chile.

An FFQ and four 24 h dietary recalls were completed over 1 year. Pearson correlation coefficients, energy-adjusted and de-attenuated correlations and weighted kappa were computed between the dietary recalls and the FFQ. The level of agreement between the two dietary assessment methods was evaluated by Bland–Altman analysis.

Temuco, Chile.

Overall, 166 women and men enrolled in the present study. One hundred men and women participated in FFQ development and sixty-six individuals participated in FFQ validation.

The FFQ consisted of 109 food items. For nutrients, the crude correlation coefficients between the dietary recalls and FFQ varied from 0·14 (protein) to 0·44 (fat). Energy adjustment and de-attenuation improved correlation coefficients and almost all correlation coefficients exceeded 0·40. Similar correlation coefficients were observed for food groups; the highest de-attenuated energy-adjusted correlation coefficient was found for margarine and butter (0·75) and the lowest for potatoes (0·12).

The FFQ showed moderate to high agreement for most nutrients and food groups, and can be used to rank individuals based on energy, nutrient and food intakes. The validation study was conducted in a unique setting and indicated that the tool is valid for use by adults in Chile.

To measure total daily salt intake using 24 h urinary Na excretion within a sample of Victorian schoolchildren aged 5–13 years and to assess discretionary salt use habits of children and parents.

Cross-sectional study.

Completed within a convenience sample of independent primary schools (n 9) located in Victoria, Australia.

Two hundred and sixty children completed a 24 h urine collection over a school (34 %) or non-school day (66 %). Samples deemed incomplete (n 18), an over-collection (n 1) or that were incorrectly processed at the laboratory (n 3) were excluded.

The sample comprised 120 boys and 118 girls with a mean age of 9·8 (sd 1·7) years. The average 24 h urinary Na excretion (n 238) was 103 (sd 43) mmol/24 h (salt equivalent 6·0 (sd 2·5) g/d). Daily Na excretion did not differ by sex; boys 105 (sd 46) mmol/24 h (salt equivalent 6·1 (sd 2·7) g/d) and girls 100 (sd 41) mmol/24 h (salt equivalent 5·9 (sd 2·4) g/d; P = 0·38). Sixty-nine per cent of children (n 164) exceeded the recommended daily Upper Limit for Na. Reported discretionary salt use was common: two-thirds of parents reported adding salt during cooking and almost half of children reported adding salt at the table.

The majority of children had salt intakes exceeding the recommended daily Upper Limit. Strategies to lower salt intake in children are urgently required, and should include product reformulation of lower-sodium food products combined with interventions targeting discretionary salt use within the home.

Health-care access is associated with improved control of multiple chronic diseases, but the association between health-care access and weight change is unclear. The present study aims to test the association between health-care access and weight change.

The Coronary Artery Risk Development in Young Adults (CARDIA) Study is a multicentre population-based prospective study. Weight change was calculated at 3 and 13 years after CARDIA year 7 (1992–1993). Health-care access was defined as no barriers or one or more barriers to access (health insurance gap, no usual source of care, not seeking care due to expense). Intermediary variables evaluated included history of dieting and use of diet pills, meal replacements or weight-control programmes.

Four cities in the USA.

Participants were aged 18–30 years at baseline (1985–1986). Analyses include 3922 black and white men and women with relevant data from CARDIA years 7, 10 and 20 (1992–1993, 1995–1996 and 2005–2006, respectively).

Mean weight change was +2·22 kg (+4·9 lb) by 3 years and +8·48 kg (+18·7 lb) by 13 years, with no differences by health-care access. Being on a weight-reducing diet was not consistently associated with health-care access across examinations. Use of diet pills, meal replacements or organized weight-control programmes was low, and did not vary by health-care access.

Weight gain was high irrespective of health-care access. Public health and clinical approaches are needed to address weight gain.

To examine how the dietary patterns of children at various time points throughout childhood relate to estimated nutrient intakes.

FFQ at 3, 4, 7 and 9 years of age were completed by mothers. Dietary patterns were identified cross-sectionally using principal component analysis; ‘processed’, ‘health conscious’ and ‘traditional’ patterns were consistently obtained. Correlations between pattern scores and nutrient intakes and proportions of variance in nutrients explained by the patterns were calculated.

Avon Longitudinal Study of Parents and Children (ALSPAC), Bristol, UK.

Children provided data between 3 and 9 years of age (n 8010 to 10 023).

Dietary patterns explained substantial proportions of the variance of the absolute intake for most nutrients (>25 % at 3 years of age, >40 % other ages). After energy adjustment, protein, fibre, K, Mg, Fe, Zn, folate, thiamin and vitamin B6 continued to be well explained. Strong correlations were observed between the ‘processed’ pattern and macronutrients including energy (r = 0·481–0·619), total fat (r = 0·529–0·662) and total sugar (r = 0·475–0·693). However correlations with most micronutrients were reversed after energy adjustment, suggesting that the ‘processed’ pattern is energy-dense but nutrient-poor. The ‘health conscious’ and ‘traditional’ patterns were strongly positively correlated with protein, fibre and most micronutrients, whether energy adjusted or not. Higher scores on these patterns were associated with a better nutrient profile.

Dietary patterns explain a reasonable amount of the variation in the nutrient content of diets. Higher scores on the ‘health conscious’ and ‘traditional’ dietary patterns were related to better nutrient profiles; conversely, with higher scores on the ‘processed’ pattern the nutrient profile was poorer.

To develop a basis for building models that can examine the impact of organic food (OF) choices on maternal and offspring health, including identification of factors associated with OF consumption and underlying dietary patterns.

Dietary intake was collected for the preceding month from an FFQ in mid-pregnancy and information on sociodemographic characteristics was collected from telephone interviews during pregnancy. From a question about OF consumption in the FFQ, including six food categories, an OF preference index was calculated. Latent variables that captured the variability in OF choices in relation to dietary intake were defined.

The Danish National Birth Cohort (DNBC), 1996–2002.

Pregnant women from DNBC (n 60 773).

We found that frequent OF use was highly associated with age, occupational status, urbanization, smoking and vegetarianism. By principal components analysis we identified two eating patterns, a ‘Western dietary pattern’ and a ‘Prudent dietary pattern’, that explained 14·2 % of the variability in data. Frequent OF users consumed a more ‘prudent’ diet compared with non-users and had significantly higher intakes of vegetables (+67 %), fibre (+13 %) and n-3 fatty acids (+11 %) and less saturated fat (−8 %).

Frequent OF users seemed to have a healthier lifestyle than non-users. These findings highlight a major challenge in observational studies examining the impact of OF consumption on health due to potentially irremediable confounding factors.

The present study investigated Guarani village interviewees’ diet changes over time, their perceptions about the changes and the effects of these changes on their health.

The study employed qualitative methods with a sample of Guarani Indians selected by snowball sampling. Ethnographic methods and techniques included field diaries, informal and unstructured interviews and participant observation.

The Tenondé Porã Guarani village is located in the district of Parelheiros, São Paulo, Brazil. Interviews were conducted from July 2008 to December 2009.

Fifteen Guarani Indians, males and females in age categories ranging from youths to elders, took part in the study.

The interviewees reported changes in how food was obtained, the occurrence of food substitutions and food species abandonment, recipe changes and the introduction of new foods. Some ritual use of plants was maintained. Disease frequency was found to increase because of this change and a lack of obedience to Nhanderu (the Guarani God). A lack of space for daily traditional activities (e.g. farming, hunting) was found to result in sedentary lifestyles.

The village location was a key factor in the Guarani diet change, although some rituals related to available plants were preserved.

The study aimed to test the reliability of a nutrition questionnaire and to assess potential associations between nutrition knowledge, food consumption and lifestyle behaviours, controlling for sociodemographic factors.

Cross-sectional survey.

Comprehensive school in the municipality of Butera, a rural area of Sicily, South Italy.

The survey was conducted between March and May 2010 on 445 students (4–16 years).

All constructs of the questionnaire had statistically significant Cronbach's α and Pearson's correlation coefficients, showing good internal consistency and temporal stability. After controlling for covariates, nutrition knowledge was positively associated with pasta/rice, fish, vegetable and fruit intakes, and negatively with sweets, snacks, fried foods and sugary drinks consumption. Moreover, students whose parents were in the highest educational and occupational categories reported eating significantly more fruits and vegetables and less meat, sweets, snacks, fried foods and sugary drinks. Students with higher nutrition knowledge scores were less likely to have two or more snacks daily and to spend more than 3 h in sedentary activities daily (OR = 0·89, 95 % CI 0·83, 0·97 and OR = 0·92, 95 % CI 0·86, 0·99, respectively). High parental education was associated with less frequent snacking and more frequent weekly physical activity, compared with lower categories, whereas high parental occupational category was associated with daily breakfast.

Improving nutrition knowledge in children and young adolescents may translate into educating them in good dietary habits. Moreover, nutrition intervention programmes should also involve parents to improve dietary quality and nutritional habits of the entire family.

To identify food sources of Na in a group of community-dwelling women in Adelaide, South Australia. A secondary aim was to measure Na excretion in this group.

Survey.

Community setting, Adelaide, South Australia.

Seventy healthy women (mean age 48·6 (sd 8·1) years, mean BMI 28·6 (sd 6·3) kg/m2) living in metropolitan Adelaide, South Australia and participating in a validation study of an FFQ. Dietary intake was derived from two 4 d weighed food records. Foods from the 4 d weighed food records were grouped according to foods or food groups to establish contributors to Na intake. Na excretion was measured in two 24 h urine samples. Completeness of urine collections was verified using creatinine excretion.

Bread alone contributed 19·0 % of Na intake, with an overall contribution from the breads and cereals group of 32·5 %. Meat products contributed 14·4 % of intake, the dairy and eggs group (excluding cheese) 9·6 % and combination dishes (e.g. pizza, quiche, sandwiches and stir fry dishes) 8·4 %. Na excretion was 126 (sd 42) mmol/d, i.e. approximately 7·6 (sd 2.5) g salt/d. Seventy per cent of participants (n 48) had Na excretion ≥100 mmol/d (146 (sd 34) mmol/d).

Effective Na reduction could be achieved by reducing the amount in staple foods such as bread and meat products.

To review evidence on the associations between vitamin B12 intake and its biomarkers, vitamin B12 intake and its functional health outcomes, and vitamin B12 biomarkers and functional health outcomes.

A systematic review was conducted by searching electronic databases, until January 2012, using a standardized strategy developed in the EURRECA network. Relevant articles were screened and sorted based on title and abstract, then based on full text, and finally included if they met inclusion criteria. A total of sixteen articles were included in the review.

Articles covered four continents: America (n 4), Europe (n 8), Africa (n 1) and Asia (n 3).

Population groups included healthy infants, children and adolescents, and pregnant and lactating women.

From the total number of 5815 papers retrieved from the initial search, only sixteen were eligible according to the inclusion criteria: five for infants, five for children and adolescents, and six for pregnant and lactating women.

Only one main conclusion could be extracted from this scarce number of references: a positive association between vitamin B12 intake and serum vitamin B12 in the infant group. Other associations were not reported in the eligible papers or the results were not provided in a consistent manner. The low number of papers that could be included in our systematic review is probably due to the attention that is currently given to research on vitamin B12 in elderly people. Our observations in the current systematic review justify the idea of performing well-designed studies on vitamin B12 in young populations.

According to the Family Ecological Model (FEM), parenting behaviours are shaped by the contexts in which families are embedded. In the present study, we utilize the FEM to guide a mixed-methods community assessment and summarize the results. Additionally, we discuss the utility of the FEM and outline possible improvements.

Using a cross-sectional design, qualitative and quantitative methods were used to examine the ecologies of parents' cognitions and behaviours specific to children's diet, physical activity and screen-based behaviours. Results were mapped onto constructs outlined in the FEM.

The study took place in five Head Start centres in a small north-eastern city. The community assessment was part of a larger study to develop and evaluate a family-centred obesity prevention programme for low-income families.

Participants included eighty-nine low-income parents/caregivers of children enrolled in Head Start.

Parents reported a broad range of factors affecting their parenting cognitions and behaviours. Intrafamilial factors included educational and cultural backgrounds, family size and a lack of social support from partners. Organizational factors included staff stability at key organizations, a lack of service integration and differing school routines. Community factors included social connectedness to neighbours/friends, shared norms around parenting and the availability of safe public housing and play spaces. Policy- and media-related factors included requirements of public assistance programmes, back-to-work policies and children's exposure to food advertisements.

Based on these findings, the FEM was refined to create an evidence-based, temporally structured logic model to support and guide family-centred research in childhood obesity prevention.

Healthy Eating Nova Scotia represents the first provincial comprehensive healthy eating strategy in Canada and a strategy that is framed within a population-health model. Five years after strategy launch, our objective was to evaluate Healthy Eating Nova Scotia to determine perceptions of strategy implementation and strategy outputs. The focus of the current paper is on the findings of this evaluation.

We conducted an evaluation of the strategy through three activities that included a document review, survey of key stakeholders and in-depth interviews with key strategy informants. The findings from each of the activities were integrated to determine what has worked well with strategy implementation, what could be improved and what outputs have resulted.

The evaluation was conducted in the Canadian province of Nova Scotia.

Participants for this evaluation included survey respondents (n 120) and key informants (n 16). A total of 156 documents were also reviewed.

Significant investments have been made towards inter-sectoral partnerships and resourcing that has provided the necessary leadership and momentum for the strategy. Policy development has been leveraged through the strategy primarily in the health and education sectors and is perceived as a visible success. Clarity of human resource roles and funding within the context of a provincial strategy may be beneficial for continued strategy implementation, as is expansion of policy development.

Known to be the first evaluation of its kind, these findings and related considerations will be of interest to policy makers developing and implementing similar strategies in their own jurisdictions.

To identify lessons learned from 30 years of implementing the International Code of Marketing of Breast-milk Substitutes (‘the Code’) and identify lessons learned for the regulation of marketing foods and beverages to children.

Historical analysis of 30 years of implementing the Code.

Latin America and the Caribbean.

None.

Legislation to restrict marketing of breast-milk substitutes is necessary but not sufficient; equally important are the promulgation of implementing regulations, effective enforcement and public monitoring of compliance. A system of funding for regular monitoring of compliance with legislation should be explicitly developed and funded from the beginning. Economic sanctions, while important, are likely to be less effective than reports that affect a company's public image negatively. Non-governmental organizations play a critical role in leveraging public opinion and galvanizing consumer pressure to ensure that governments adopt regulations and companies adhere to them. Continual clinical, epidemiological and policy research showing the link between marketing and health outcomes and between policy and better health is essential.

Implementation of the Code has not come easily as it places the interests of underfinanced national governments and international and non-governmental organizations promoting breast-feeding against those of multinational corporations that make hundreds of millions of dollars annually marketing infant formulas. Efforts to protect, promote and support breast-feeding have been successful with indicators of breast-feeding practices increasing globally. The lessons learned can inform current efforts to regulate the marketing of foods and beverages to children.

To evaluate if and how the current degree of scientific uncertainty about the safety of fish consumption is incorporated at the media level.

We used a dedicated software (TalTac®) to investigate the content of 169 news articles related to ‘mercury and fish consumption’ that appeared from 1990 to 2010 in the two Italian broadsheets with the highest circulation figures, in order to identify journalistic frames used in the coverage of benefits v. risks associated with fish consumption. Hypotheses were made on how the public might change fish consumption patterns as a result of media coverage.

Italy.

The two newspapers have different agendas in covering the issue. La Repubblica appears to support the view that, besides health benefits, there may be risks associated with fish consumption, while Corriere della Sera emphasizes health benefits more than possible risks. Depending on the preferred information source, the public could: (i) reduce its fish intake; (ii) increase its fish intake; or (iii) become confused about the problem and sceptical towards the media, as a result of conflicting journalistic frames.

The Italian media, in cooperation with scientists, public health nutritionists and dietitians, should place more emphasis on the existence of a few fish species with high to very high Hg levels and relatively low contents of beneficial n-3 fatty acids (e.g. swordfish and shark). This would enable consumers to make more educated purchasing decisions to maximize the benefits of n-3 intake while reducing possible risks from consuming Hg-contaminated fish.