There is increasing evidence that both black and green tea are beneficial for prevention of cardiovascular disease (CVD). We conducted a systematic review and meta-analysis evaluating the effects of tea flavonoids on cardiovascular (CVD) and all-cause mortality outcomes.Searches across five databases including PubMed and Embase were conducted through November 2018 to identify randomized controlled trials (RCTs) and prospective cohort studies reporting cardiovascular and all-cause mortality outcomes. Two investigators independently conducted abstract and full-text screenings, data extractions, and risk of bias (ROB) assessments using the Nutrition Evidence Library Bias Assessment Tool (NEL BAT). Mixed-effects dose-response meta-regression and standard random-effects meta-analyses for outcomes with ≥ 4 studies were performed. 0 RCTs and 38 prospective cohort studies were included in the systematic review. NEL BAT scores ranged from 0–15 (0 being the lowest risk). Our linear meta-regression model showed that each cup increase in daily tea consumption (about 280 mg and 338 mg of total flavonoids for black and green tea, respectively) was associated with 3–4% lower risk of CVD mortality (predicted adjusted RR = 0.96; CI 0.93–0.99 for green tea and RR = 0.97; CI 0.94–0.99 for black tea). Furthermore, eachcup increase in daily tea consumption was associated a 2% lower risk of all-cause mortality (predicted adjusted relative risk (RR) = 0.98; 95% CI 0.97–0.99 for black tea and RR = 0.98; CI 0.96–0.99 for green tea, respectively). Two studies reported multivariable Cox regression analysis results for the relationship between black tea intake and risks of all-cause mortality outcomes. The results from these two studies were combined with our linear meta-regression result in a random-effects model meta-analysis and showed that each cup increase in daily black tea consumption was associated with an average of 3% lower risk of all-cause mortality (pooled adjusted RR = 0.97; 95% CI 0.87- 1.00) with large heterogeneity (I2 = 81.4%; p = 0.005). Current evidence indicates that increased tea consumption may reduce cardiovascular and all-cause mortality in a dose-response manner. This systematic review was registered on PROSPERO.

Prevalence of childhood stunting in Myanmar is one of the highest in the South-East Asia countries. Cross-sectional data from the Demographic Health Survey 2015–16 were used to examine risk factors for stunting, wasting, and underweight among children aged 0–59 months. The prevalence of stunting (height-for-age z-score < -2), wasting (weight-for-height z-score < -2), and underweight (weight-for-age z-score < -2) was 29.0%, 7.3%, and 19.2%, respectively. Accounting for cluster design and sampling weights, multivariable logistic regression was conducted with 35 household, maternal, and child characteristics. Current pregnancy and maternal height < 145 cm, and child's small birth size recalled by mother, home delivery, and older child age (ref: 0–5 months) predicted both stunting and underweight. Child's large birth size was protective for all stunting, wasting, and underweight. Maternal BMI < 18.5 kg/m2 was a common risk factor for wasting and underweight. Lower wealth quintiles, maternal engagement in non-agricultural occupation, and male child predicted stunting only. Younger child age and not receiving vitamin-A supplementation in the last 6-month was risk factor for wasting only. Regional variation was also seen with a higher odds of stunting in West-South Region, North-East States, and West States, compared to Central Regions. In Myanmar, socioeconomic-demographic factors, poor maternal nutritional status, and living in certain geographic location are affecting children's undernutrition. It is recommended that intervening growth faltering focusing on the 1000 days of life; ensuring optimum maternal nutrition during and before pregnancy and at adolescence; societal support for mothers in poverty or engaged in non-agriculture; and understanding region-specific undernutrition pathways.

Data from observational and interventional studies demonstrate the key role of diet on both human health and environmental sustainability. However, there is a lack of studies investigating the environmental impact of children's dietary behavior. In this regard, detailed information on population-level intakes is required to translate these findings into possible recommendations.

The aim of this study was to investigate the nutritional composition of the diet and its related environmental impact in a sample of Italian primary school children (n = 200, 8–11 years, 52% F - 48% M).

Children completed a 3-day food record twice, in winter and spring. Dietary records were processed to obtain mean daily data on food group intakes. Mean daily energy and nutrient intakes were computed applying the Italian food database of the European Institute of Oncology, while (poly)phenolic compound contents were estimated from the Phenol-Explorer or by specific searches in the most up to date scientific literature. The mean daily environmental impact was estimated through the Barilla Center for Food and Nutrition environmental database taking into account the carbon footprint and ecological footprint. Children's BMI was calculated by measuring height and weight at the beginning of each assessment week.

No differences in children's BMI as well as in the consumption of food groups were found between the two seasons. The intra-individual variability was low but a high inter-individual variability was registered. Energy and nutrient intakes were similar between the two seasons and were found to be in line with national data referred to school age children. Adherence to the Italian nutritional recommendations (LARN) was not satisfied for total fats, sugars, and some vitamins and minerals. The main contributors to the phenolic intake were flavonoids and phenolic acids, while the most representative subclasses were flavan-3-ols and hydroxycinnamic acids. Main dietary sources of (poly)phenolic compounds were fruit juices, apples, pears, potatoes, and tomatoes. Carbon and ecological footprints were higher during winter and the main dietary contributors were red meat; milk, yogurt and dairies; pizza and focaccia, for both indexes.

This study provided the first comprehensive analysis of the nutritional composition and the environmental impact of Italian primary school children diet. Further research is needed to evaluate children habitual diet for investigating a possible relationship between health and environmental sustainability. Moreover, school education programs have to be implemented for promoting healthy and sustainable dietary behaviors.

In the last few decades the prevalence of overweight and obesity has reached epidemic levels worldwide affecting over 2.1 billion people, including a large proportion of women of childbearing age. An adverse intrauterine environment resulting from conditions such as maternal obesity or gestational diabetes, can have long-term negative effect on the child's health later in life. This study focuses on maternal pre-pregnancy BMIs and their association with biochemical profile in pregnancy, delivery mode and size of neonates in the Croatian Islands’ Birth cohort Study (CRIBS). A total of 301 mother-child dyads were included in this study. The classification of the pre-pregnancy nutritional status followed WHO BMI cut-offs. Blood samples of women were taken in the second trimester of pregnancy and analysed for fasting blood glucose level, urates, creatinine, uric acid, total protein, bilirubin, triglycerides, total cholesterol, HDL and LDL cholesterol, potassium, sodium, aspartate transaminase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), homocysteine, fibrinogen and lipoprotein A. The neonates’ length in cm and weight in gm were measured immediately after delivery at the University Hospital Split. Differences in mean values of biochemical parameters and neonates’ size between pre-pregnancy BMI categories were tested using One-way ANOVA (p < 0.05) and differences in prevalence of delivery mode using the Chi-square test. Nutritional status before pregnancy showed that 4% of women were underweight (BMI < 18.5 kg.m2), 75.1 % had normal weight (BMI 18.5–24.9 kg.m2), 14.6% were overweight (BMI 25–29.9 kg.m2) and 6.3% were obese (BMI ≥ 30.0 kg.m2). Pre-pregnancy obesity and overweight were significantly associated with elevated fasting glucose (p = 0.02), triglycerides (p = 0.01), and uric acid (p = 0.001) levels, and with decreased protective HDL cholesterol (p = 0.01) during pregnancy. Also, in comparison with normal weight and underweight women, obese pregnant women more often gave birth to heavier (p = 0.01) and longer babies (p = 0.036) and there was a strong correlation between higher pre-pregnancy BMI and delivery mode (p = 0.004). Obese women had 50% chance of giving birth by caesarean section in comparison with 20.1% in normal weight women. Our study confirmed that high maternal pre-pregnancy BMI could be a significant risk factor for both mother's health during pregnancy and different adverse birth outcomes, such as elevated risk of caesarean section delivery and child macrosomia. Therefore, women should be advised to attain normal weight before starting the pregnancy.

Optimum gestational weight gain (GWG) is vital for successful pregnancy outcomes. However, pregnant women often feel misinformed or that interventions will not meet their needs; hence, many services report poor attendance and/or engagement [1]. PPI aims to empower those affected by an intervention, to participate in shaping the intervention [2,]. The aim of this study was to conduct PPI to gain insight into the experiences of weight management advice received during pregnancy - to inform future interventions.

We recruited two PPI representatives (PLRs) - former patients, who assisted in all aspects of the study: design, interview questions, recruitment of PPI participants and collection/analysis of feedback. The PLRs approached pregnant/postnatal women to participate. During the PPI workshop procedure, women gave verbal consent for their views and possible verbatim quotes to be used in publications/grant applications. Feedback was collected via notetaking during four group discussions (approximately 1 hour in duration), all held in community locations - two in Liverpool (n = 10 & 5), two in Derry (n = 7 & 9) and an interview (n = 1, in Derry). The research team collated the transcripts, subjected them to repeated reading and thematic analysis, informed by Braun and Clarke's step-by-step guide [3].

Three themes were identified: 1) Weight gain is inevitable in pregnancy; 2) Healthy eating advice is important but lacks consistency and depth; 3) Expectations regarding knowledge/support. Regarding theme 1: Most women viewed weight gain as an inevitable part of pregnancy, with variable amounts of weight gain being reported. Some women viewed pregnancy as an opportunity to ‘relax’ previous diets - using pregnancy as an excuse to gain weight ‘without feeling guilty’. Women were only weighed at their initial appointment but had no opposition to routine weighing throughout pregnancy or for research, providing they were informed about its significance and importance:

However, they were opposed to ‘weight watching’:

Despite known risks associated with excess GWG, women considered weight gain ‘inevitable’, so deemed weight monitoring unnecessary. NICE guidance [4] advises against routine weighing which ‘may produce unnecessary anxiety with no added benefit’.However, regular weighing may help to avert excessive GWG, if conducted sensitively and with appropriate dietary/lifestyle support, versus weighing without intervention, which may cause ‘stress’.

Near 20% of the Portuguese population is aged 65 years or above, a value similar to most developed countries. This older adult population also suffers from obesity and obesity-related pathologies. The environment encompasses a set of obesity determinants and knowing the associations between the environment and obesity may help health professionals and caregivers to provide for the older adults.

In this study, we aimed to relate anthropometric measures with socio-demographic data in older adults.

This is a cross-sectional study using data from the Pronutrisenior project, collected in Vila Nova de Gaia, Portugal. The sample consists of 456 older adults, aged 65 to 92 years without cognitive impairment. The sample consisted of older adults living at their homes. Socio-demographic, clinical, geographical, and anthropometric data was collected. The statistical analysis used IBM-SPSS-22.0 and consisted on descriptive statistics, Pearson correlations and UniANOVA. Significantly results (p < 0.05) are reported.

These older adults were mostly females (54.2%) with a mean age of 73.8 years (sd = 6.3), mean body mass index (BMI) of 29.1kg/m2 (sd = 4.8), mean waist-to-height ratio (WHtR) of 0.623 (sd = 0.073) and mean percentage of body fat mass (%BFM) of 40.7% (sd = 8.9%) for females and 30.2% (sd = 8.5%) for males. BMI, WHtR and %BFM were positively correlated. In this sample of older adults, higher values of these measures were associated to being female, younger, less educated; to having articular pains and respiratory problems, and not having insomnia, hypertension, chewing problems nor hearing problems; to drink more liquids but not consuming dairy products daily; to not take nutritional supplements but to take more medicines; to be without somebody to talk to and to be more dependent; and to live in a house without stairs to climb and to live near other older adults, and in a more urbanized area with streets with steeper slopes.

In this sample of older adults, obesity is related with health characteristics and those are related with socio-demographic and geographical characteristics of the area of residence. Besides the identification of risk factors for the older adult population, this information may help designing health care policies that takes in consideration the physical and geographical characteristics of the neighbourhood of the area of residence of the older adults.

Malnutrition is a serious health problem among older adults. The Mini Nutritional Assessment (MNA) is the most used tool to assess malnutrition among older adults. It was proposed that the Screening section could be used as a short form of the MNA (MNA-SF), but the study of the two forms show a wide range of agreement (71.8 to 93.3% and Cohen's kappa from 0.52 to 0.78). Nevertheless, most of the studies recommend the use of the MNA-SF, but in some this conclusion is not completely congruent with the results. The aims of this work were to study the agreement between the nutritional status classification using the MNA-SF and the MNA-FF among Portuguese older adults living in the community, to compare the scores in each question of the MNA-FF between participants correctly or incorrectly classified using the MNA-SF, and to develop a more sensible version of the MNA-SF. The current study is part of the PRONUTRISENIOR project. Data from 456 older adults (54.2% females) aged 65 to 92 years (mean = 73; SD = 6) living in the community (Vila Nova de Gaia, Portugal) were analyzed. The agreement between the two classifications is 82.7%, but Cohen's k shows a weak agreement (weighted k = 0.497; p < 0,001). MNA-SF showed a very low sensitivity (42.6%) detecting participants malnourished or at risk of malnutrition. Participants classified as normal using the MNA-SF despite at risk using the MNA-SF presented lower scores in two items from the Assessment section: number of full meals eaten daily and amount of fluid consumed per day. These two items were included in MNA-SF to obtain an extended short-version (MNA-SF8), which presented a sensitivity of 91.8% (and a specificity of 79.9%). The areas under the ROC curves were 0.858 and 0.929, respectively for MNA-SF and MNA-SF8. The addition of two items to the MNA-SF provides a more sensible tool to detect risk of malnutrition among elderly. These findings suggest that, among the studied population, general eating-related questions regarding (full meals and fluid intake) are relevant to assess malnutrition. Similar studies should be carried out among other populations in order to verify the possibility of their generalization. [The PRONUTRISENIOR project was financed by Iceland, Liechtenstein and Norway through the EEA Grants (PT06 – Public Health Initiatives, reference 81NU5).]

A randomized controlled intervention study was undertaken to increase egg and protein intake in community-dwelling adults over 55 years old. During a 12 week intervention, recipes for protein-rich egg-based meals and single-use herbs/spice packets were provided to 53 individuals in the intervention group to promote the addition of flavour and variety to the diet. Egg intakes increased by 20%, and this increase was sustained up to 12 weeks after the end of the intervention. Exploratory analyses however revealed some individual differences within the intervention group, where some participants increased their egg intake and others did not.

We compared the participants who increased their egg intake to those who did not on several demographic characteristics and baseline outcomes, and explored the qualitative feedback related to recipe use collected after the intervention.

Results show that the participants who increased their egg intake during the intervention (n = 27) had a significantly higher BMI (U = 402, p = .035), a lower health-related quality of life (U = 198, p = .047), and take external reports and recommendations about eggs and health from media and health professionals more seriously (U = 399, p = .038) than those who did not increase egg intake. Those who increased their egg intake during the 12 week follow up period (n = 19) reported a lower availability of eggs during their upbringing (U = 371, p = .041), with no other differences between the groups.

Feedback from the whole group showed that reasons for choosing to use or not use the recipes were based on preferences, culinary skills, time/effort to prepare the meal, having ingredients already in the cupboard, the importance of variety, habits and familiarity, and the portion sizes, which were generally considered too large. The recipes used most often included ingredients that are more traditionally combined with eggs in the English diet (e.g. cheese/ham), while the recipes used least often were more unfamiliar (e.g. Turkish eggs with yoghurt).

Our study used recipes that specifically focus on eggs, but our findings suggest that recipe based interventions in this age group may be particularly beneficial for those with a higher BMI, those who may feel their health could be improved, those who are more likely to respect external advice, and those who have less early experience with the included foods. Greater future benefit may also be obtained from recipes that are for smaller dishes, using familiar ingredients, and that cater to a range of culinary skills and preferences.

There is convincing evidence that sugar-sweetened beverages increase the risk of body weight (BW) gain and higher body mass index. In contrast, observational studies on regular consumption of 100% fruit juice provide conflicting results, with most indicating a neutral impact on BW and body mass index, while others suggest positive or even inverse associations. The lack of agreement may be due to confounding factors, or studies incorrectly grouping sugar-sweetened juice drinks with 100% fruit juice, which by law does not contain added sugars.

Intervention studies provide an opportunity to investigate the short-to-medium term impact of daily 100% orange juice (OJ) on BW. From 17 available studies (none of which individually reported statistically significant BW gain following OJ consumption), 6 randomised controlled trials in adults (n = 236) were selected for a meta-analysis. Inclusion criteria were an OJ intervention group and a non-OJ control group. Comparison with a control group was essential as some were weight loss studies with additional BW loss components, and for consistency this comparison between groups was used for all studies.

The meta-analysis focussed on the differences in BW change between OJ and control arms of each study. Where the standard deviation (SD) or standard error (SE) of the change was not reported and could not be obtained from the authors, it was imputed by using the mean SD from studies where it was available. The combined effect estimate was obtained from a random effects model using the DerSimonian-Laird estimator. Cochran's Q statistic was used to test for study heterogeneity.

The resulting forest plot revealed no statistically significant change in BW following OJ intakes of 250–500 ml per day for 4 to 12 weeks (which would theoretically provide 102–205 kcal on average). The Q statistic was 10.6 (I2 = 53%, p = 0.059) while the combined effect estimate was -0.34 kg (95% CI -1.11, 0.43). Interestingly, a similar finding was noted in a meta-analysis (Onakpoya et al. 2017) investigating BW change and daily grapefruit juice consumption from 3 intervention studies (n = 233); mean difference -0.45 kg [95% CI:-1.06 to 0.16; I2 = 53%].

In conclusion, daily consumption of OJ does not appear to have an adverse impact on BW. This may be due to dietary energy compensation (conscious or unconscious) or a satiety effect linked with the low glycemic index of OJ (GI = 50).

Onakpoya I et al. (2017) Crit Rev Food Sci Nutr 57: 602–612.

A survey made worldwide (including South Africa) revealed that most teenagers are overweight and obese and that they eat little nutritious food. Obesity and overweight are public health problems and need to be addressed from a community perspective. The reason for exploring this problem in this study was that South Africa has one of the highest rates of overweight and obesity in the world among urban and rural black women. The objective was to investigate the eating and lifestyle habits of overweight and obese female teenagers in Thulamela Local Municipality, Limpopo province, South Africa. This was an exploratory, descriptive study conducted amongst 125 female teenagers aged 13 to 18 years from rural schools in Thulamela Local Municipality. Eating and lifestyle habits, physical activity, meaning of healthy and unhealthy dietary habits, weight, height and body mass index were measured. A hundred and twenty-five questionnaires were completed and data were gathered on the demographics, anthropometry, social and lifestyle habits, nutrition-related problems, dietary patterns and dietary history of the participants. The BMI revealed that 34.4% were of normal weight, 39.2% overweight and 26.4 obese. Seventy percent of the respondents actively consumed meals in a day, 83% consumed starchy snacks, whilst 72% of the respondents carried lunchboxes to school. Regarding lifestyle habits, 88% of the respondents slept more hours than recommended (8 hours) while 88% performed sedentary activities and 66% did physical activities such as walking. The results pointed out unhealthy eating and lifestyle habits influencing teenagers’ weight and provided information on which of these must be considered in order to develop tailored nutrition interventions, improving teenagers’ consciousness about s adopting a healthy lifestyle.