To assess the effects of a school-based intervention on the diets of 7–9-year-olds.

Dietary intake of children in second and fourth grades was assessed with 3d weighed dietary records in autumn 2006 and autumn 2008, before and after a school-based intervention that started in the middle of second grade, and compared with control schools with no intervention. The diet was evaluated by comparison with food-based dietary guidelines (FBDG) and reference values for nutrient intake. The intervention aimed at several determinants of intake: knowledge, awareness, preferences/taste, self-efficacy and parental influence. Nutrition education material was developed for the intervention and implemented in collaboration with teachers. The main focus of the intervention was on fruit and vegetable intake as the children’s intake was far from meeting the FBDG on fruit and vegetables at baseline.

Elementary schools in Reykjavik, Iceland.

Complete dietary records were available for 106 children both at baseline and follow-up.

Total fruit and vegetable intake increased by 47 % in the intervention schools (mean: 61·3 (sd 126·4) g/d) and decreased by 27 % in the control schools (mean: 46·5 (sd 105·3) g/d; P < 0·001). The majority of the children in the intervention schools did still not meet the FBDG on fruits and vegetables at follow-up. Fibre intake increased significantly in the intervention schools, as well as that of potassium, magnesium, β-carotene and vitamin C (borderline).

The school-based intervention in 7–9-year-olds was effective in increasing fruit and vegetable intake, by 47 % increase from baseline, which was mirrored in nutrient intake.

The aim of the present study was to examine to what extent children and adolescents in Greenland comply with the national dietary guidelines, and to analyse the influence of habitation and family affluence on the compliance with dietary guidelines.

Data were from the Health Behaviour in School-aged Children (HBSC) survey in Greenland. The 2006 survey included 2462 students aged 11 to 17 years.

The proportion of students complying with the national dietary guidelines varied from 14 % to 87 % depending on the food item. Sweets and soft drinks had the lowest compliance. The oldest children had the following characteristics compared with the younger children: fewer ate traditional Greenlandic foods, fewer ate fruit, fewer ate breakfast daily on school days and more drank soft drinks frequently. More boys than girls ate traditional Greenlandic foods often, while more girls ate vegetables daily. The least favourable eating habits in general were found among children from low affluent families and children in villages.

Many Greenlandic schoolchildren did not comply with the national dietary guidelines. Despite a higher intake of traditional foods as a whole, children in villages and less affluent children were less likely to comply with guidelines. A strong relationship between diet, family affluence and availability was found. The study findings indicate that factors such as availability, cost and seasonal variation are important to the intake of both imported and traditional Greenlandic foods. The findings should be taken into consideration when promoting the national guidelines.

To assess the dietary quality of older women with and without rheumatoid arthritis (RA) using the Healthy Eating Index-2005 (HEI-2005) to identify potential strategies to improve the nutritional status.

Cross-sectional. Diet was assessed using 7 d food records and analysed for nutrient composition (Food Processor v. 7·11). Diet quality was determined using the HEI-2005, a measure of compliance with 2005 US Dietary Guidelines. Individuals with RA completed a self-reported evaluation of arthritis (pain scale and disability index). Independent two-tailed t tests or Mann–Whitney tests compared the differences between groups and correlations were computed between HEI-2005 and measures of disease reactivity.

Arizona, USA.

Older (≥ 55 years) women (n 108) with RA (n 52) and healthy controls (HC; n 56).

There were no differences between groups in age, weight, or BMI (kg/m2). HC participants had higher mean HEI-2005 scores for whole fruit (cups; P = 0·02), total fruit (cups; P = 0·05), whole grains (oz; P = 0·004), oil (g; P = 0·05) and total HEI score (P = 0·04) than the RA group. In the RA group, these same HEI components were inversely correlated with disability index (r = −0·20, P = 0·04). Participants with RA reported lower mean intakes of carbohydrate (g; P = 0·02), fibre (g; P = 0·01) and vitamin C (mg; P = 0·04).

This is the first study examining the dietary quality in older women with and without RA using the HEI-2005. Living with RA was associated with significantly lower dietary quality. Since even small changes in dietary quality can translate into better nutritional status, future interventions should focus on increasing dietary quality in this high-risk group.

Nutritious yet inexpensive foods do exist. However, many such foods are rejected by the low-income consumer. Is it because their use violates unspoken social norms? The present study was designed to assess the variety and cost of the lowest-cost market basket of foods that simultaneously met required dietary standards and progressively stricter consumption constraints.

A mathematical optimisation model was used to develop the lowest-cost food plans to meet three levels of nutritional requirements and seven levels of consumption constraints.

The nationally representative INCA (National Individual Survey of Food Consumption) dietary survey study of 1332 adults provided population estimates of food consumption patterns in France. Food plan costs were based on retail food prices.

The lowest-cost food plans that provided 9204 kJ/d (2200 kcal/d) for men and 7531 kJ/d (1800 kcal/d) for women and met specified dietary standards could be obtained for <1·50 €/d. The progressive imposition of consumption constraints designed to create more mainstream French diets sharply increased food plan costs, without improving nutritional value.

Minimising diet costs, while meeting nutrition standards only, led to food plans that provided little variety and deviated substantially from social norms. Aligning the food plan with mainstream consumption led to higher costs. Food plans designed for low-income groups need to be socially acceptable as well as affordable and nutritious.

To study dietary glycaemic index (GI) and glycaemic load (GL) in association with physical performance in elderly Europeans.

Cross-sectional and prospective study. Physical performance was measured using the Physical Performance Test (PPT) score on a scale from 0 to 27, where high scores indicate a better physical performance. Habitual diets were measured using diet history interviews and dietary GI and GL were estimated from table values.

Eight towns/centres from the Survey in Europe on Nutrition and the Elderly, a Concerted Action (SENECA) in 1993 and 1999.

Seven hundred and sixty-five men and women, 75–80 years old, were examined in 1993; of these, 357 (47 %) were followed up in 1999, at age 80–85 years.

At baseline, both dietary GI and GL were significantly inversely associated with PPT scores (P = 0·03 and P = 0·05, respectively). When adjusted for age, BMI, physical activity, self-perceived health, chronic diseases and town/centre, the strength of the associations was attenuated and became non-significant (GI, P = 0·08; GL, P = 0·92). Dietary GI/GL were not associated with PPT scores 6 years later.

Among elderly Europeans, a high glycaemic diet was associated with a low physical performance at baseline but not 6 years later. Cross-sectional associations may in part be caused by variations in age, BMI, physical activity, self-perceived health, chronic diseases and geographic location.

There are few studies regarding vitamin B12 deficiency in developing countries. In Brazil, a late diagnosis of vitamin B12 deficiency progressing to severe neurological damage is common. Thus, the aim of the present study was to verify the frequency of vitamin B12 deficiency in two Brazilian populations (elderly and adult participants) and to compare different methods of vitamin B12 deficiency detection.

Five hundred participants were recruited from health centres from south-east Brazil and were separated into two groups: 60 years old or more and 30–59 years old. Vitamin B12 and folate concentrations were measured using electrochemiluminescence immunoassay (ECI) and RIA. Methylmalonic acid (MMA) was measured by LC coupled to tandem MS. Full blood counts were acquired using standard methods.

All participants had normal blood count results and mean cell volume less than 99 fl; none of them presented folate deficiency according to the results, which were all greater than 3 ng/ml. Cobalamin levels less than 200 pmol/l were identified by one of the two or by both methods in 7·2 % of the participants aged 60 years or more and 6·4 % of the participants aged 30–59 years. MMA levels were higher in older subjects (P = 0·007) compared with younger subjects. A greater correlation of MMA v. RIA was observed than of MMA v. ECI (P = 0·0017 v. P = 0·014). MMA quantification estimated that cobalamin deficiency was present in more than 11 % of the subjects for both studied groups.

The study shows that vitamin B12 deficiency is frequent in Brazilian adults and suggests that RIA is more sensitive than ECl for measuring cobalamin levels.

Legumes have been recommended as staple foods in the anticipation of disease prevention. However, the scientific evidence of their benefits, particularly on mental well-being, remains preliminary. We longitudinally assessed the association between legume consumption and the risk of severe depressed mood (SDM) among a national cohort.

The study included adults aged 25–74 years who were examined in 1971–1975 as a part of the National Health and Nutrition Examination Survey. Legume consumption at baseline was obtained from a 3-month FFQ and categorised as infrequent (<1 time/week), moderate (1–2 times/week) and frequent (≥3 times/week). SDM was defined as Center for Epidemiologic Studies Depression Scale score ≥22 or taking anti-depression medication after an average of 10·6 years of follow-up (from 8·0 to 12·5 years).

Among women, the proportion of individuals with SDM was 17·75 %. For premenopausal women (n 1778), a significant linear trend of deleterious effect from legume consumption was observed (P for trend = 0·0148). The relative risks (RR) for infrequent, moderate and frequent consumptions were 1 (reference), 1·24 (95 % CI = 0·91, 1·70) and 1·75 (1·12, 2·75), respectively. However, moderate consumption showed a significant protective effect (RR = 0·52 (0·27, 1·00)) among women undergoing the menopausal transition (n 454). No association was obtained from either postmenopausal women (n 601) or men (n 2036).

These findings suggest that gender and menopausal status were effect modifiers of the association between legume consumption and SDM. Detrimental effects of frequent consumption of legumes may exist among premenopausal women; moderate consumption, however, may protect perimenopausal women against SDM.

To explore gender-specific variations related to activity intensity in the relationship between physical activity (PA) and mental health (MH). Evaluating whether psychological well-being enhances with increases in PA at recommended levels and above, in the general population.

Cross-sectional.

Population-based, representative for Belgium.

A total of 6803 adults aged 25–64 years from the Belgian National Health Interview Survey.

Multiple logistic regression analyses showed that clearly different intensity levels characterised the PA that associated with MH in women and men. In men, inverse associations existed between participation in vigorous-intensity PA and feelings of depression (OR = 0·580; 95 % CI 0·405, 0·830), anxiety (OR = 0·547; 95 % CI 0·364, 0·821) and symptoms of somatisation (OR = 0·590; 95 % CI 0·398, 0·874). In women, positive associations existed between walking and emotional well-being (OR = 1·202; 95 % CI 1·038, 1·394) and inverse associations between participation in moderate-intensity PA and symptoms of somatisation (OR = 0·737; 95 % CI 0·556, 0·977). Secondary analyses confirmed that differences in psychological complaints were significant for vigorous PA in men, and for moderate PA in women, whereas differences in emotional well-being were significant for walking exclusively in women.

In the general population, the PA–MH relationship is always positive, regardless of activity intensity. In men, it addresses complaints (symptoms, palpable discomfort) and the optimal PA intensity is high. In women, it addresses complaints, but also distress (lowered mood, disturbing anxiety, altered well-being) and the PA intensity is mild.

Only a few cross-sectional studies have assessed the association between coffee, tea and caffeine and the risk of depression. Our aim was to determine the association in a population-based cohort study.

The population-based Kuopio Ischaemic Heart Disease Risk Factor Study cohort was recruited between 1984 and 1989 and followed until the end of 2006. We investigated the association between the intake of coffee, tea and caffeine and depression.

Eastern Finland.

Middle-aged men (n 2232).

Altogether, forty-nine men received a discharge diagnosis of depression. We classified subjects into quartiles according to their mean daily coffee intake: non-drinkers (n 82), light drinkers (<375 ml/d, n 517), moderate drinkers (375–813 ml/d, n 1243) and heavy drinkers (>813 ml/d, n 390). Heavy drinkers had a decreased risk (RR = 0·28, 95 % CI 0·08, 0·98) for depression when compared with non-drinkers, after adjustment for age and examination years. Further adjustment for socio-economic status, alcohol consumption, smoking, maximal oxygen uptake, BMI and the energy-adjusted daily intakes of folate and PUFA did not attenuate this association (relative risk (RR) = 0·23, 95 % CI 0·06, 0·83). No associations were observed between depression and intake of tea (drinkers v. non-drinkers; RR = 1·19, 95 % CI 0·54, 2·23) or caffeine (highest quartile v. lowest quartile; RR = 0·99, 95 % CI 0·40, 2·45).

Coffee consumption may decrease the risk of depression, whereas no association was found for tea and caffeine intake.

To identify parents’ concerns and attitudes towards children’s diets, activity habits and weight status.

Computer-assisted telephone interviewing administration of a 37-item survey. Data were weighted for parental education level. Descriptive results are presented, and comparisons are made by the age, gender and parental characteristics of the child.

Online research panel of Australian parents.

A total of 1202 randomly selected parents of children aged 2–16 years, broadly representative of the Australian population.

Parents were concerned about their child’s education (reported by 35 % of respondents), child’s health and well-being (25 %), and violence, drugs and alcohol (20 %). Concern about nutrition was indicated by 14 % of respondents and concern about fitness/exercise was indicated by 3 % of the sample. Factors perceived as making a healthy diet difficult to achieve for their child were child resistance (89 %), the availability of healthy food (72 %), a busy lifestyle (67 %) and the influence of food advertising (63 %). Ninety-two per cent of parents thought that it was realistic for their child to be active for at least 1 h/d, with 75 % of parents feeling that it was realistic for their child to have less than 2 h recreational screen time per d. Despite this, common barriers to achieving the activity guidelines were lack of time, weather and keeping children occupied.

Insights into parental concerns from the current study may be useful in guiding development of interventions to improve children’s nutrition and physical activity habits by framing messages in a way that are most likely to resonate with parents.

To investigate the relationships between weight reduction behaviour among non-overweight schoolchildren and dietary habits, perception of health, well-being and health complaints.

Analysis of the 2006 Health Behaviour in School-aged Children survey, a cross-sectional study involving schoolchildren aged 10–17 years.

Schools in the Republic of Ireland.

The proportion of children (n 3599) engaged in weight reduction behaviour (‘dieting’ among non-overweight students) was 10·3 %. Older children, females and those from higher social classes (SC) were more likely to report such behaviour. Non-overweight schoolchildren who reported weight reduction behaviour were less likely than those not engaged in such behaviour to frequently consume sweets, soft drinks, crisps and chips/fried potatoes (OR from 0·39 (95 % CI 0·17, 0·89) to 0·72 (95 % CI 0·53, 0·99)); were more likely to consume diet soft drinks (OR 1·50 (95 % CI 1·03, 2·18); and were more likely to miss breakfast during the week (OR 0·62 (95 % CI 0·48, 0·80). The risk of subjective health complaints increased (OR from 1·47 (95 % CI 1·13, 1·91) to 1·92 (95 % CI 1·48, 2·49)); as did body dissatisfaction (OR 9·17 (95 % CI 6·99, 12·02)), while perception of health and well-being decreased (OR 0·47 (95 % CI 0·36, 0·61)) to 0·54 (95 % CI 0·41, 0·70)). All analyses were controlled for age, gender and SC.

Weight reduction behaviour among non-overweight schoolchildren is associated with considerable risk to physical health and emotional well-being. Since the risks associated with such behaviour varies by weight status, health professionals and researchers need to consider these issues in parallel.

The purpose of the study was to test the moderating influence of two risk factors, maternal depression and socio-economic status (SES), on the association between authoritarian and permissive parenting styles and child obesity.

Correlational, cross-sectional study. Parenting style was measured with the Parenting Styles and Dimensions Questionnaire (PSDQ). Maternal depression was measured using the Center for Epidemiologic Studies Depression Scale (CES-D). BMI-for-age percentile was used to categorize children by weight status (children with BMI-for-age ≥95th percentile were classified as obese). SES was computed from parent education and occupational status using the four-factor Hollingshead index.

Rural public schools in a mid-western state in the USA.

One hundred and seventy-six mothers of first-grade children (ninety-one boys, eighty-five girls) enrolled in rural public schools.

Both maternal depression and SES were found to moderate the permissive parenting style/child obesity association, but not the authoritarian/child obesity association. For depressed mothers, but not for non-depressed mothers, more permissive parenting was predictive of child obesity. Similarly more permissive parenting was predictive of child obesity among higher SES mothers, but not for lower SES mothers.

Maternal depression and SES interact with permissive parenting style to predict child obesity. Future research should examine the relationship among these variables using a longitudinal design.

To examine associations between parenting styles, family structure and aspects of adolescent dietary behaviour.

Cross-sectional study.

Secondary schools in the East Midlands, UK.

Adolescents aged 12–16 years (n 328, 57 % boys) completed an FFQ assessing their consumption of fruit, vegetables, unhealthy snacks and breakfast. Adolescents provided information on parental and sibling status and completed a seventeen-item instrument measuring the general parenting style dimensions of involvement and strictness, from which four styles were derived: indulgent, neglectful, authoritarian, authoritative.

After controlling for adolescent gender and age, analysis of covariance revealed no significant interactions between parenting style and family structure variables for any of the dietary behaviours assessed. Significant main effects for family structure were observed only for breakfast consumption, with adolescents from dual-parent families (P < 0·01) and those with no brothers (P < 0·05) eating breakfast on more days per week than those from single-parent families and those with one or more brother, respectively. Significant main effects for parenting style were observed for all dietary behaviours apart from vegetable consumption. Adolescents who described their parents as authoritative ate more fruit per day, fewer unhealthy snacks per day, and ate breakfast on more days per week than those who described their parents as neglectful.

The positive associations between authoritative parenting style and adolescent dietary behaviour transcend family structure. Future research should be food-specific and assess the efficacy of strategies promoting the central attributes of an authoritative parenting style on the dietary behaviours of adolescents from a variety of family structures.

To describe the ‘Smart Lunch Box’ intervention and provide details on feedback from the participants on the acceptability and usability of the intervention materials.

A cluster randomised controlled trial, randomised by school. English schools were stratified on percentage free-school-meals eligibility and attainment at Key Stage 2. A ‘Smart Lunch Box’ with supporting materials and activities on healthy eating was delivered to parents and children via schools in the intervention group. Feedback forms containing information on a total of fifteen intervention items were filled out by the parents and/or children participating in the intervention and were collected after each of the three phases of the intervention.

Eighty-nine primary schools in England, Scotland, Wales and Northern Ireland, randomly selected; forty-four schools in the intervention arm.

A total of 1294 children, aged 9–10 years, took part in the trial. Of the 604 children in the intervention arm, 343 provided feedback after at least one of the three phases.

A median of twelve items out of a total of fifteen were used by responders. The two intervention items most likely to be used were the individual food boxes and the cooler bags. Whether a participant liked an item significantly affected whether they used it for all items except the cooler bag, fruity face and individual food boxes.

Practical intervention items aimed at parents are likely to be used in the longer term and therefore may be appropriate for use in an intervention strategy to improve packed lunches.

To describe the rationale, development and implementation of the quantitative component of evaluation of a multi-setting, multi-strategy, community-based childhood obesity prevention project (the eat well be active (ewba) Community Programs) and the challenges associated with this process and some potential solutions.

ewba has a quasi-experimental design with intervention and comparison communities. Baseline data were collected in 2006 and post-intervention measures will be taken from a non-matched cohort in 2009. Schoolchildren aged 10–12 years were chosen as one litmus group for evaluation purposes.

Thirty-nine primary schools in two metropolitan and two rural communities in South Australia.

A total of 1732 10–12-year-old school students completed a nutrition and/or a physical activity questionnaire and 1637 had anthropometric measures taken; 983 parents, 286 teachers, thirty-six principals, twenty-six canteen and thirteen out-of-school-hours care (OSHC) workers completed Program-specific questionnaires developed for each of these target groups.

The overall child response rate for the study was 49 %. Sixty-five per cent, 43 %, 90 %, 90 % and 68 % of parent, teachers, principals, canteen and OSHC workers respectively, completed and returned questionnaires. A number of practical, logistical and methodological challenges were experienced when undertaking this data collection.

Learnings from the process of quantitative baseline data collection for the ewba Community Programs can provide insights for other researchers planning similar studies with similar methods, particularly those evaluating multi-strategy programmes across multiple settings.

To evaluate the effectiveness of a computer-generated tailored intervention leaflet compared with a generic leaflet aimed at increasing brown bread, wholegrain cereal, fruit and vegetable intakes in adolescent girls.

Clustered randomised controlled trial. Dietary intake was assessed via three 24 h dietary recalls.

Eight secondary schools in areas of low income and/or high ethnic diversity, five in London and three in the West Midlands, UK.

Girls aged 12–16 years participated (n 823) and were randomised by school class to receive either the tailored intervention (n 406) or a generic leaflet (n 417).

At follow-up 637 (77 %) participants completed both baseline and follow-up dietary recalls. The tailored intervention leaflet had a statistically significant effect on brown bread intake (increasing from 0·39 to 0·51 servings/d) with a smaller but significant increase in the control group also (increasing from 0·28 to 0·35 servings/d). The intervention group achieved 0·05 more servings of brown bread daily than the control group (P < 0·05), which is equivalent to 0·35 servings/week. For the other foods there were no significant effects of the tailored intervention.

The intervention group consumed approximately 0·35 more servings of brown bread weekly than the control group from baseline. Although this change between groups was statistically significant the magnitude was small. Evaluation of the intervention was disappointing but the tailored leaflet was received more positively in some respects than the control leaflet. More needs to be done to increase motivation to change dietary intake in adolescent girls.

In the Netherlands, a supplementation of 10 μg vitamin D is recommended for children (aged 0–4 years), given that vitamin D contributes to the development of healthy bones and deficiency during childhood is a risk factor for osteoporosis at a later age. However, only 60 % of the Dutch children receive sufficient vitamin D supplementation a day. In order to develop interventions to improve supplementation intake, it is necessary to gain insight into the behaviour of parents in giving their children vitamin D supplementation and its association with variables of the Theory of Planned Behaviour, moral and descriptive norms and habits.

A cross-sectional survey to assess present supplementation-related behaviour, knowledge, received information, intention, attitude, subjective norm, perceived behavioural control, moral norm, descriptive norm and habit.

Data obtained from a representative Internet Panel by means of electronic questionnaires.

Parents (n 270) of children aged 0–4 years.

Half of the parents (48·9 %) gave their child sufficient vitamin D supplementation. Giving the supplement at a fixed time, a positive intention and habit were significantly associated with actual behaviour. The higher age of the child, first-born status, a fixed time for taking vitamin supplementation, descriptive norm and moral obligation were significantly associated with intention.

These results indicate that because many parents do not give their children adequate vitamin D supplementation, the promotion of supplementation during the first years of life is a necessity. Effective yet simple strategies should be developed, focused on improving moral obligation, descriptive norms and habit formation.

To assess the intake and sources of non-milk extrinsic sugars (NMES) and fat among children in Scotland in relation to socio-economic status, and to estimate the changes in diet required to achieve recommended levels of intake.

Cross-sectional survey with diet assessed by semi-quantitative FFQ.

Eighty postcode sectors across Scotland.

Children (n 1398) aged 3–17 years recruited from the Child Benefit register (76 % of those contacted).

The mean intake of NMES of 17·4 (95 % CI 17·0, 17·8) % food energy was considerably higher than the UK recommended population average of 11 % food energy. The mean intake of total fat of 32·9 (95 % CI 32·7, 33·2) % food energy met the recommended population average of no more than 35 % food energy, while the mean intake of SFA of 13·8 (95 % CI 13·7, 14·0) % food energy was above the recommended population average of no more than 11 % food energy. Despite clear socio-economic gradients in the mean daily consumption of many ‘healthy’ and ‘unhealthy’ food groups, socio-economic differences in NMES as a percentage of food energy were limited and there was no significant variation in the intake of total fat or SFA as a percentage of food energy with socio-economic status. Modelling of the data showed that removing sugar-sweetened soft drinks and increasing fruit and vegetable intake by 50 % would not restore the intake of NMES and SFA to recommended levels.

Major changes in the intake of many food groups will be required to bring the NMES and saturated fat intake in line with current dietary recommendations.