To develop a framework to guide action in the public health nutrition workforce to develop policies and practices addressing factors contributing to climate change.

Action/consultative research.

Interviews – South Australia, questionnaire – Australia.

Interviews – key informants (n 6) were from various government, academic and non-government positions, invited through email. Questionnaire – participants were members of the public health nutrition workforce (n 186), recruited to the study through emails from public health nutrition contacts for each State in Australia (with the exception of South Australia).

Support by participants for climate change as a valid role for dietitians and nutritionists was high (78 %). However, climate change was ranked low against other public health nutrition priorities. Support of participants to conduct programmes to address climate change from professional and work organisations was low. The final framework developed included elements of advocacy/lobbying, policy, professional recognition/support, organisational support, knowledge/skills, partnerships and programmes.

This research demonstrates a need for public health nutrition to address climate change, which requires support by organisations, policy, improved knowledge and increased professional development opportunities.

The aim of the present study was to develop reference data for the Iranian population for anthropometric values and cardiometabolic data in comparison with those in Americans, as representative of a Western population.

The present cross-sectional survey, conducted as part of the baseline survey of a community-based interventional study (the Isfahan Healthy Heart Programme), used a two-stage clustering design and was conducted in 12 600 randomly selected adults (≥19 years of age) and 2000 adolescents (aged 11–18 years) living in three cities in the central part of Iran. For comparison with a Western population, comparable data for Americans were derived from the data sets of the Second and Third National Health and Nutrition Examination Surveys (NHANES II and NHANES III).

Iranian women had significantly higher mean BMI, waist circumference (WC), hip circumference (HC) and waist:hip ratio (WHR) than Iranian men and American women; but the mean BMI of Iranian men was lower than that of American men. The mean serum TAG level of Iranian men was significantly higher than that of Iranian women, whereas the mean serum total cholesterol (TC), LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C) levels were significantly higher in Iranian women than in men. The Iranian population had lower mean TC, LDL-C and TAG levels than the Americans, but such difference was not documented for HDL-C. Iranian adolescents had significantly lower mean BMI and higher mean TAG than did American adolescents.

Our findings provide serious evidence for health professionals and policy makers about the very high prevalence of generalized and abdominal obesity in Iran. Controlling this emerging health problem, notably in women, should become a national priority in Iran and necessitates comprehensive public health programmes.

To explore the food intake of young migrants living in Germany.

Children and adolescents aged 0 to 17 years living in Germany, including 17·1 % with a migration background, were examined in a representative health survey. Food frequency data of 7186 boys and 6919 girls, aged 3 to 17 years, were analysed separately for Turkish, Russian Germans, other migrants and non-migrants. Daily food intake was calculated and a healthy diet score was used to allow an overall interpretation of the diet. Using stepwise linear regression, the association between migrant status and healthy diet score was analysed.

Turkish participants (4·8 %) consumed significantly more soft drinks, fried potatoes, chocolate cream and snacks than all other groups and significantly less meat than other migrants and non-migrants. Turkish as well as other migrants (8·8 %) ate more poultry, fish and pasta/rice, and less sausage/bacon and cooked potatoes, than Russian Germans and non-migrants. Russian Germans (3·5 %) consumed less cooked vegetables than non-migrants and other migrants. Non-migrants had a better mean dietary score than Russian Germans and other migrants. A less preferable diet score was associated with higher age, male sex, being a migrant from Russia, low or middle socio-economic status, and living in rural or provincial areas.

The study showed considerable differences in dietary habits between young persons of different origin. This underlines the importance of focusing on ethnic groups in dietary interventions.

To establish the Fe status of pregnant women and their neonates in the Republic of Seychelles.

A prospective study.

Republic of Seychelles.

Pregnant women were recruited and blood samples taken at enrolment and post-delivery along with cord blood samples. Ferritin and soluble transferrin receptor (sTfR) were measured in maternal (n 220) and cord blood (n 123) samples.

Maternal Fe deficiency (ferritin < 15 ng/ml, sTfR > 28 nmol/l) was present in 6 % of subjects at enrolment and in 20 % at delivery. There was no significant decrease in maternal ferritin. A significant increase in sTfR was observed between enrolment and delivery (P < 0·001). Maternal BMI and use of Fe supplements at 28 weeks’ gestation were associated with improved maternal Fe status at delivery, whereas parity had a negative effect on sTfR and ferritin at delivery.

Fe status of pregnant Seychellois women was, on average, within normal ranges. The incidence of Fe deficiency throughout pregnancy in this population was similar to that in a Westernised population. Increased awareness of the importance of adequate Fe intake during pregnancy, particularly in multiparous women, is warranted.

To study the association between adherence to several a priori-defined healthy food patterns and the risk of hypertension.

Prospective, multipurpose, dynamic cohort study (recruitment permanently open). We followed up 10 800 men and women (all of them university graduates), who were initially free of hypertension, for a variable period (range 2–6 years, median 4·6 years). During follow-up, 640 participants reported a new medical diagnosis of hypertension. Baseline diet was assessed using a validated 136-item FFQ. Validated information about non-dietary potential confounders was also gathered. We calculated adherence to fifteen different hypothesis-oriented food patterns and assessed the association between each of them and incident hypertension using multivariable Cox models.

The SUN (Seguimiento Universidad de Navarra – University of Navarra Follow-up) Project, Spain.

Participants recruited to the SUN cohort before October 2005 were eligible for inclusion; after excluding those with self-reported hypertension or CVD at baseline, or with extreme total energy intake, data of 10 800 were analysed.

Higher adherence to the DASH (Dietary Approaches to Stop Hypertension) diet (range of the score: 0 to 5) was significantly associated with a lower risk for developing hypertension (P for trend = 0·02). The other food patterns showed no significant association with incident hypertension.

Our results support a long-term protection of the DASH diet against the incidence of hypertension, but we found no evidence of a similar inverse association with hypertension for any other a priori-defined healthy food pattern.

To characterize dietary intake for Navajo adults, to identify foods for a nutritional intervention programme and to develop a culturally appropriate quantitative FFQ (QFFQ) for evaluating the impact of the intervention programme.

A cross-sectional study was conducted using 24 h dietary recalls.

Navajo Nation, USA.

Seventy-nine (forty men, thirty-nine women) aged 18–71 years completed 24 h dietary recalls.

The median daily energy intake was 11 585 kJ (2769 kcal) for men and 8519 kJ (2036 kcal) for women. The greatest contributors to energy were fried potato dishes, sweetened juices/drinks, regular pop, bread, tortillas and burritos (contributing approximately 30 % of total energy intake). The mean number of meat servings was over twice that recommended (2–3 servings recommended v. 7·4 consumed by men and 5·3 by women). The mean servings of vegetables were well below the recommendation of 3–5 servings (1·0 serving for men and 1·2 servings for women). The final QFFQ contains 177 food and drink items.

Our study found that major contributors to total energy, fat and sugar intakes in the Navajo Nation included mostly processed meats and sweetened drinks. A nutritional intervention will target these foods and promote acceptable and healthier alternatives. In addition, we were able to identify foods and beverages for inclusion on a culturally appropriate QFFQ to assess dietary intake. This QFFQ will be used to evaluate the effectiveness of our intervention on food and food group consumption and nutrient intake.

The purpose of the present study was to test the construct validity, internal consistency and convergent validity of the Household Food Insecurity Access Scale (HFIAS) in measuring household food insecurity in rural Tanzania, and to determine socio-economic characteristics associated with household food insecurity.

Key informant interviews and a cross-sectional survey were conducted in February and March 2008.

Rural Iringa, Tanzania.

Key informant interviews were conducted with twenty-one purposively selected male and female village leaders. For the household surveys, a sample of 237 households with mothers (caregivers) and at least one child between 1 and 5 years of age were included.

Approximately 20·7 % of the households were categorized as food-secure, 8·4 % as mildly food-insecure, 22·8 % as moderately food-secure and 48·1 % as severely food-insecure. Two main factors emerged from the rotated principal component factor analysis: (i) insufficient food quality; and (ii) insufficient food intake. Both factors explained 69 % of the total variance. The full food insecurity scale and the two subscales had good internal consistency (Cronbach’s α = 0·83–0·90). Food security, as measured by HFIAS, was positively associated with maternal education, husband’s education, household wealth status, being of an agricultural rather than pastoral tribe and animal-source food consumption; it was negatively associated with maternal age and household size.

The HFIAS measurement instrument shows validity and reliability in measuring household food insecurity among poor households in rural Tanzania.

The present study evaluates the reliability and validity of an FFQ designed for use with adolescents in urban Vietnam.

A cohort study was conducted between December 2003 and June 2004. The FFQ was administered three times over a 6-month period (FFQ 1–3) and nutrient intakes were compared to those obtained from four 24 h recalls collected over the same period (24 h recalls 1–4) using crude, energy-adjusted and de-attenuated correlation coefficients. The level of agreement between the two measurements was also evaluated with Bland–Altman analysis. The percentage of nutrient intakes classified within one quintile, as well as quadratic-weighted kappa statistics, were calculated.

Ho Chi Minh City, Vietnam.

A total of 180 students were recruited in three junior high schools.

Coefficients ranged from 0·22 for retinol to 0·78 for fibre for short-term reliability, and from 0·30 for retinol to 0·81 for zinc for long-term reliability. Coefficients for nutrient intakes between the mean of the three FFQ and mean of four 24 h recalls were mostly around 0·40, but higher for energy-adjusted nutrients. After allowing for within-person variation, the mean coefficient was 0·52 for macronutrients and 0·46 for micronutrients. There were a relatively high proportion of nutrient intakes classified within one quintile and a small number grossly misclassified. Kappa values shows ‘fair’ to ‘good’ agreement for all food/nutrient categories, while the Bland–Altman plots indicated that the FFQ is accurate in assessing nutrient intake at a group level.

This newly developed FFQ is a valid tool for measuring nutrient intake in adolescents in urban Vietnam.

To investigate the dietary intake and physical activity of boys and girls aged 9–13 years, and the influence of peers on these behaviours.

Cross-sectional study.

Nine primary and secondary schools in south-west London.

A total of 315 children wore sealed pedometers, provided self-report measures of dietary intake and answered a questionnaire relating to peer influence. Anthropometric measures of height and weight were also obtained.

Obese children had the lowest reported energy intakes and the lowest step counts per day. Boys took significantly more steps per day than girls, however girls were closer to achieving their recommended cut-offs for physical activity. Girls had lower energy intakes per day and lower BMI Z-scores than boys, however both genders, across all age groups, had higher than recommended intakes of saturated fat. There were significant associations between peer influence and physical activity levels but not between peer influence and dietary intake.

Low energy intake and physical activity levels but high saturated fat intakes among boys and girls across all age groups highlight the importance of promoting both physical activity and healthy food choices. The finding that peers have a significant effect on physical activity levels but not on dietary intake offers an important approach for the design of health promotion interventions and obesity prevention programmes. Such designs may be particularly beneficial for obese youth, since the low physical activity levels found could be a major contributing factor to the maintenance of the condition.

To explore the relationship between children and their parents in terms of various anthropometric parameters and obesity-related hormone levels and to identify early indicators for child obesity.

Cross-sectional observational study.

Urban areas of Korea in 2005.

A total 124 families with 7-year-old children participated. Anthropometric and blood biochemistry data and information concerning the children’s lifestyles, dietary habits and parental and grandparental weight status were obtained.

The mean values for all anthropometric parameters were greater in overweight children than in children of normal weight. Very close relationships existed between the anthropometric parameters of children and their parents. Children with two overweight parents showed the highest odds for being overweight (OR 7·62). The strong relationship between overweight children and grandparental and parental overweight, especially on the maternal side, suggests gender differences in the intergenerational transmission of body weight. We also noted a greater risk of being overweight in children with a parent with high serum leptin level.

Grandparental and parental weight status and parental serum leptin levels enable us to identify childhood obesity at an early age and may help to counter the current epidemic of adult obesity.

Magazines targeted at children under 12 years old are growing in popularity; past studies have asserted that food items are rarely exposed, but methodological issues may have covered the true extent of covert promotion. The primary purpose of the present study was to quantify the nature and extent of the promotion of branded food products in Australian children’s magazines.

We conducted a content analysis of possible food promotions in seven top-selling Australian children’s magazines published in 2005. In addition to regular food advertisements, the number of advertisements for premiums, editorials, puzzles or games, competitions and branded non-food promotions by food companies was recorded. Category frequencies are reported with a detailed description of the promotions present during September 2005.

Only fifty-eight out of the 444 items identified could be classed as regular food advertisements. Several advertisements appeared to be in breach of codes regarding advertising to children and premiums.

The pervasiveness of covert food marketing in the present study was contrary to previous findings and raises questions about the effectiveness of legal restrictions and self-regulation of advertising in protecting children from commercial food messages that may not be regarded as advertising.

In 1976, the Royal College of Physicians and the British Cardiac Society recommended eating less fatty red meat and more poultry instead because it was lean. However, the situation has changed since that time, with a striking increase in fat content of the standard broiler chicken. The aim of the present study was to report a snapshot of data on fat in chickens now sold to the public.

Samples were obtained randomly between 2004 and 2008 from UK supermarkets, farm shops and a football club. The amount of chicken fat was estimated by emulsification and chloroform/methanol extraction.

Food sold in supermarkets and farms in England.

Chicken samples.

The fat energy exceeded that of protein. There has been a loss of n-3 fatty acids. The n-6:n-3 ratio was found to be as high as 9:1, as opposed to the recommendation of about 2:1. Moreover, the TAG level in the meat and whole bird mostly exceeded the proportion of phospholipids, which should be the higher for muscle function. The n-3 fatty acid docosapentaenoic acid (DPA, 22 : 5n-3) was in excess of DHA (22 : 6n-3). Previous analyses had, as usual for birds, more DHA than DPA.

Traditional poultry and eggs were one of the few land-based sources of long-chain n-3 fatty acids, especially DHA, which is synthesized from its parent precursor in the green food chain. In view of the obesity epidemic, chickens that provide several times the fat energy compared with protein seem illogical. This type of chicken husbandry needs to be reviewed with regard to its implications for animal welfare and human nutrition.

To analyse cross-promotions targeted to children and adolescents on packaging in the supermarket.

On three occasions from 2006 to 2008, researchers purchased all foods in a large supermarket that included a cross-promotion on the package. A total of 397 products were categorized by promotional partner, food category, targeted age group, promotion type, product nutrition, and company policies on marketing to children.

The number of products with youth-oriented cross-promotions increased by 78 % during the period examined. Overall, 71 % of cross-promotions involved third-party licensed characters and 57 % appealed primarily to children under 12 years of age; however, the use of other forms of promotions increased from 5 % of the total in 2006 to 53 % in 2008, and promotions targeting pre-school and general audiences increased from 23 % to 54 % of the total. Only 18 % of products met accepted nutrition standards for foods sold to youth, and nutritional quality declined during the period examined. Food manufacturers with policies limiting marketing to children represented 65 % of all youth-oriented cross-promotions, their use of cross-promotions increased significantly, and the nutritional quality of their products did not improve. Some media companies did reduce the use of their properties on food promotions.

Overall, the supermarket environment worsened due to an increase in cross-promotions targeted to children and adolescents and a decline in the nutritional quality of these products. This analysis failed to find improvements in food marketing to youth and highlights the need to expand current industry self-regulatory pledges.

Despite public health campaigns based on Fe and folic acid supplements, Fe-deficiency anaemia remains highly prevalent among women in India. We investigated leaf concentrate as an alternative to Fe and folic acid supplements for treating anaemia in adolescent girls.

Randomised controlled two-arm trial over 3 months: one group received daily Fe and folic acid (IFA; 60 mg Fe, 500 μg folic acid); the other daily leaf concentrate (LC; 5 mg Fe, 13 μg folic acid). Hb concentration, mean cell volume, serum Fe, serum ferritin and total Fe-binding capacity were measured pre- and post-intervention.

Jaipur, India.

One hundred and two adolescent girls aged 14–18 years.

Of the 102 girls randomized to the two arms of the trial, four (3·9 %) were severely anaemic (Hb < 7 g/dl), twenty-eight (27·5 %) were moderately anaemic (Hb ≥ 7 g/dl, <10 g/dl) and seventy (68·6 %) were mildly anaemic (Hb ≥ 10 g/dl, <12 g/dl). In the IFA group, eleven girls (20·4 %) withdrew due to side-effects, compared with one girl (2·1 %) in the LC group (P = 0·005). Total losses to follow-up were 14/54 in the IFA group and 2/48 in the LC group. At the end of the trial, none of the eighty-six remaining girls were severely anaemic, nine (10·5 %) were moderately anaemic and twenty-six (30·2 %) were mildly anaemic; fifty-one (59·3 %) had normal Hb levels (≥12 g/dl). After adjustment for baseline values, LC was as effective as IFA in improving serum Fe parameters and treating anaemia.

Leaf concentrate is an effective, and more palatable, alternative to Fe and folic acid supplements for treating anaemia in adolescent girls.

The aim of the present study was to determine the impact of universal salt iodization (USI) on the prevalence of iodine deficiency in the population of an area previously known to have severe iodine deficiency in India.

In a cross-sectional survey, a total of 2860 subjects residing in fifty-three villages of four sub-districts of Gonda District were examined for goitre and urinary iodine concentration. Free thyroxine and thyroid-stimulating hormone levels were also measured. Salt samples from households were collected for estimation of iodine content.

A reduction in goitre prevalence was observed from 69 % reported in 1982 to 27·7 % assessed in 2007. However, 34 % of villages still had very high endemicity of goitre (goitre prevalence >30 %). Twenty-three per cent of households consumed a negligible amount (<5 ppm) and 56 % of households consumed an insufficient amount (5–15 ppm) of iodine from salt.

Although there was an overall improvement in iodine nutrition as revealed by decreased goitre prevalence and increased median urinary iodine levels, there were several pockets of severe deficiency that require a more targeted approach. Poor coverage, the use of unpackaged crystal salt with inadequate iodine and the washing of salt before use by 90 % of rural households are the major causes of persisting iodine-deficiency disorders. This demonstrates lapses in USI implementation, lack of monitoring and the need to identify hot spots. We advocate strengthening the USI programme with a mass education component, the supply of adequately iodized salt and the implementation of complementary strategies for vulnerable groups, particularly neonates and lactating mothers.

To demonstrate the use of four different qualitative methods in creating content, including text and graphic design for print interventions to support better nutrition in low-income households that rely on charitable pantries.

Four methods were used for measuring household cooks’ responses to the content and design of recipes and food-use tips especially designed for low-income households: (i) focus groups with pantry clients; (ii) questionnaires administered at sites where the Women, Infants and Children (WIC) programme beneficiaries gather, to survey cooks’ judgements about the appeal of recipes; (iii) recruitment of WIC clients to prepare recipes at home, followed by phone interviews about the cooks’ actual experiences preparing and serving dishes; and (iv) a new technique to gauge pantry clients’ preferred ordering of print information, using bits of content backed by Velcro™ strips that participants applied to felt boards. Ten sets of illustrated recipes and food-use tips were prepared, each set focusing on a different fresh vegetable that is periodically available from charitable sources.

Low-income recipients of food from community pantries in the USA, and beneficiaries of the WIC programme.

Illustrative findings show how the four types of qualitative evaluations can inform decisions about content and about graphic design. Discoveries from this formative research illuminate challenges of supporting better nutrition among households that depend on charitable sources of food supply.

These multi-method evaluation techniques can be adapted to the development of any print material, whether intended for widespread dissemination or for field research into nutrition behaviour.

To determine whether interventions tailored specifically to particular immigrant groups from developing to developed countries decrease the risk of obesity and obesity-related diseases.

Databases searched were MEDLINE (1966–September 2008), CINAHL (1982–September 2008) and PsychINFO (1960–September 2008), as well as Sociological Abstracts, PsychARTICLES, Science Direct, Web of Knowledge and Google Scholar. Studies were included if they were randomised control trials, ‘quasi-randomised’ trials or controlled before-and-after studies. Due to the heterogeneity of study characteristics only a narrative synthesis was undertaken, describing the target population, type and reported impact of the intervention and the effect size.

Thirteen studies met the inclusion criteria. Ten out of thirteen (77 %) studies focused on diabetes, seven (70 %) of which showed significant improvement in addressing diabetes-related behaviours and glycaemic control. The effect on diabetes was greater in culturally tailored and facilitated interventions that encompassed multiple strategies. Six out of the thirteen studies (46 %) incorporated anthropometric data, physical activity and healthy eating as ways to minimise weight gain and diabetes-related outcomes. Of the six interventions that included anthropometric data, only two (33 %) reported improvement in BMI Z-scores, total skinfold thickness or proportion of body fat. Only one in three (33 %) of the studies that included cardiovascular risk factors reported improvement in diastolic blood pressure after adjusting for baseline characteristics. All studies, except four, were of poor quality (small sample size, poor internal consistency of scale, not controlling for baseline characteristics).

Due to the small number of studies included in the present review, the findings that culturally tailored and facilitated interventions produce better outcomes than generalised interventions, and that intervention content is more important than the duration or venue, require further investigation.