The role of school lunches in diet quality has not been well studied. Here, we aimed to determine the contribution of school lunches to overall nutrient intake in Japanese schoolchildren.

The study was conducted nationwide under a cross-sectional design. A non-consecutive, three-day diet record was performed on two school days and a non-school day separately. The prevalence of inadequate nutrient intake was estimated for intakes on one of the school days and the non-school day, and for daily habitual intake estimated by the best-power method. The relationship between food intake and nutrient intake adequacy was examined.

Fourteen elementary and thirteen junior high schools in Japan.

Elementary-school children (n 629) and junior high-school children (n 281).

Intakes between the school and non-school days were significantly different for ≥60 % of nutrients. Almost all inadequacies were more prevalent on the non-school day. Regarding habitual intake, a high prevalence of inadequacy was observed for fat (29·9–47·7 %), dietary fibre (18·1–76·1 %) and salt (97·0–100 %). Inadequate habitual intake of vitamins and minerals (except Na) was infrequent in elementary-school children, but was observed in junior high-school children, particularly boys.

School lunches appear to improve total diet quality, particularly intake of most vitamins and minerals in Japanese children. However, excess intakes of fat and salt and insufficient intake of dietary fibre were major problems in this population. The contribution of school lunches to improving the intakes of these three nutrients was considered insufficient.

To describe the caffeine and sugar content of all energy drinks available on the island of Ireland.

Two retail outlets were selected from each of: multinational, convenience and discount stores in Northern Ireland and the Republic of Ireland, and all available single-serve energy drinks were purchased. The cross-sectional survey was conducted in February 2015 and brand name, price, volume, caffeine and sugar content were recorded for each product. Descriptive analysis was performed.

Seventy-eight products were identified on the island of Ireland (regular, n 59; diet/sugar-free/light, n 19). Caffeine and sugar content was in the range of 14–35 mg and 2·9–15·6 g per 100 ml, respectively. Mean caffeine content of 102·2 mg per serving represents 25·6 % of the maximum intake advised for adults by the European Food Safety Authority. Per serving, mean sugar content of regular energy drinks was 37 g. This exceeds WHO recommendations for maximum daily sugar intake of <5 % of total energy intake (25 g for adults consuming 8368 kJ (2000 kcal) diet). If displaying front-of-pack labelling, fifty-seven of the fifty-nine regular energy drinks would receive a Food Standards Agency ‘red’ colour-coded label for sugar.

Energy drinks are freely available on the island of Ireland and all products surveyed can be defined as highly caffeinated products. This has potential health issues particularly for children and adolescents where safe limits of caffeine have not been determined. Energy drinks surveyed also contained high levels of sugar and could potentially contribute to weight gain and adverse dental health effects.

To describe: household dietary diversity across four zones in Ethiopia; the relationship between household dietary diversity and consumption of vitamin A-rich foods; and the relationship between household dietary diversity and food security status.

This was a cross-sectional survey. Data were collected using structured questionnaires in the local language. Household dietary diversity scores measured types of foods households consumed, and households were classified by food security status using a modified version of the Household Food Insecurity Access Scale. An ordinal logistics regression model was created to assess the relationship between three tiers of dietary diversity (low, medium and high) and food security while controlling for agricultural zone, educational variables and household characteristics.

Rural households in Tigray, Ethiopia.

Three hundred households in Tigray, Ethiopia, were interviewed.

Of the households, 23, 47 and 30 % had low, medium and high dietary diversity, respectively. Among households with high dietary diversity, eggs and fruit were the most common foods added to the diet. In the fully adjusted model, participants who reported being food secure had 1·8 increased odds of greater dietary diversity (95 % CI 1·0, 3·2) compared with participants who were food insecure.

Food security was positively associated with dietary diversity. In order to enhance health, interventions that improve dietary diversity and vitamin A consumption should remain important areas of focus for health leaders in the region.

To determine whether exposure to child-targeted fast-food (FF) television (TV) advertising is associated with children’s FF intake in a non-experimental setting.

Cross-sectional survey conducted April–December 2013. Parents reported their pre-school child’s TV viewing time, channels watched and past-week FF consumption. Responses were combined with a list of FF commercials (ads) aired on children’s TV channels during the same period to calculate children’s exposure to child-targeted TV ads for the following chain FF restaurants: McDonald’s, Subway and Wendy’s (MSW).

Paediatric and Women, Infants, and Children (WIC) clinics in New Hampshire, USA.

Parents (n 548) with a child of pre-school age.

Children’s mean age was 4·4 years; 43·2 % ate MSW in the past week. Among the 40·8 % exposed to MSW ads, 23·3 % had low, 34·2 % moderate and 42·5 % high exposure. McDonald’s accounted for over 70 % of children’s MSW ad exposure and consumption. Children’s MSW consumption was significantly associated with their ad exposure, but not overall TV viewing time. After adjusting for demographics, socio-economic status and other screen time, moderate MSW ad exposure was associated with a 31 % (95 % CI 1·12, 1·53) increase and high MSW ad exposure with a 26 % (95 % CI 1·13, 1·41) increase in the likelihood of consuming MSW in the past week. Further adjustment for parent FF consumption did not change the findings substantially.

Exposure to child-targeted FF TV advertising is positively associated with FF consumption among children of pre-school age, highlighting the vulnerability of young children to persuasive advertising and supporting recommendations to limit child-directed FF marketing.

To determine the prevalence of high weight at different characteristics, understand the perceptions and behaviours towards high body weight, and determine potential influencing factors of body weight misperception among high-weight adults in Jilin Province.

A cross-sectional survey with complex sampling design was conducted. We described the prevalence and perception of high body weight.

Northeast China in 2012.

Adults (n 20 552) aged 18–79 years.

Of overweight individuals, 37·4 % considered themselves as ‘normal weight’, 4·8 % reported themselves as being ‘very thin’ and only 53·1 % were aware of their own weight being ‘overweight’. About 1·8 % of both male and female obese individuals perceived themselves as ‘very thin’. Only 29·1 % of obese people thought of themselves as ‘too fat’. Nearly 30·0 % of centrally obese men and women perceived that their waist circumference was about right and they were of ‘normal weight’; 5·7 % of the centrally obese even perceived themselves as being ‘very thin’. Only 51·8 and 12·5 % of centrally obese individuals reported themselves to be ‘overweight’ or ‘too fat’. Body weight misperception was more common in rural residents (OR; 95 % CI: 1·340; 1·191, 1·509). The prevalence of body weight misperception increased with age (middle age: 1·826; 1·605, 2·078; old people: 3·101; 2·648, 3·632) and declined with increased education level (junior middle school: 0·628; 0·545, 0·723; senior middle school: 0·498; 0·426, 0·583; undergraduate and above: 0·395; 0·320, 0·487).

Body weight misperception was common among adults from Jilin Province.

To compare diet quality scores between adult non-meat eaters and meat eaters, and to compare the consumption of diet components across quintiles of diet quality.

Cross-sectional analysis. The Healthy Eating Index-2010 (HEI-2010) and Alternative Healthy Eating Index-2010 (AHEI-2010) were used to assess mean diet quality. Differences in consumption of diet components between quintiles of diet quality were tested using post hoc Wald tests and z tests.

The National Health and Nutrition Examination Survey (NHANES), 2007–2012.

The sample consisted of 16810 respondents aged≥18 years, including 280 individuals who reported not consuming meat, poultry, game birds or seafood on two non-consecutive days of dietary recall. Dietary data were obtained from one dietary recall per individual.

Non-meat eaters had substantially greater HEI-2010 and AHEI-2010 scores than meat eaters (P<0·05). Among non-meat eaters, mean consumption across HEI-2010 quintiles demonstrated different (P<0·05) amounts of empty calories and unsaturated:saturated fatty acids. Mean consumption across AHEI-2010 quintiles demonstrated different (P<0·05) amounts of nuts and legumes, vegetables and PUFA.

Public health messages targeted at vegetarians and others who may choose to eat meat-free on certain days should emphasize decreased consumption of empty calories, and increased consumption of nuts and legumes, PUFA and vegetables, as a way to improve overall dietary quality.

To identify individual and contextual socio-economic factors associated with a healthy diet.

Dietary data from a large cohort study were used to derive two mutually exclusive dietary patterns through a latent class analysis. Associations between dietary patterns and socio-economic factors were studied with logistic regression.

E3N, a French prospective cohort study composed of women recruited from a national health insurance plan covering people working in the national education system.

E3N participants (n 73 031) with dietary and socio-economic data available.

The ‘Healthy’ pattern was characterized by a large consumption of fruits and vegetables and the ‘Less Healthy’ pattern by a large consumption of pizza and processed meat. When all socio-economic factors were analysed together, all of the individual factors considered were associated with a healthy diet (e.g. women with three or more children were less likely to follow a healthy diet v. women with no children, OR (95 % CI): 0·70 (0·66, 0·75)) while the contextual factors associated with a healthy diet included the size of the agglomeration of residence and the area of birth and residence (e.g. women living in the West of France were less likely to follow a healthy diet v. those living in the South of France: 0·78 (0·72, 0·83)).

We demonstrated that individual and contextual factors are both associated with diet. Rather than focusing only on individual factors, we recommend future studies or public health and nutritional strategies on diet to consider both types of factors.

To explore eating patterns and snacking among US infants, toddlers and pre-school children.

The Feeding Infants and Toddlers Study (FITS) 2008 was a cross-sectional national survey of children aged 6–47 months, weighted to reflect US age and racial/ethnic distributions. Dietary data were collected using one multiple-pass 24h recall. Eating occasions were categorized as meals, snacks or other (comprised of all feedings of breast milk and/or infant formula). The percentage of children consuming meals and snacks and their contribution to total energy, the number of snacks consumed per day, energy and nutrients coming from snacks and the most commonly consumed snacks were evaluated by age.

A national sample of US infants, toddlers and pre-school children.

A total of 2891 children in five age groups: 6–8 months (n 249), 9–11 months (n 256), 12–23 months (n 925), 24–35 months (n 736) and 36–47 months (n 725).

Snacks were already consumed by 37 % of infants beginning at 6 months; by 12 months of age, nearly 95 % were consuming at least one snack per day. Snacks provided 25 % of daily energy from the age of 12 months. Approximately 40 % of toddlers and pre-school children consumed fruit and cow’s milk during snacks; about 25 % consumed 100 % fruit juice. Cookies were introduced early; by 24 months, 57 % consumed cookies or candy in a given day.

Snacking is common, contributing significantly to daily energy and nutrient needs of toddlers and pre-school children. There is room for improvement, however, with many popular snacking choices contributing to excess sugar.

To investigate dietary sources of Ca and vitamin D (VitD) intakes, and the associated sociodemographic and lifestyle factors, among European adolescents.

Linear regression mixed models were used to examine sex-specific associations of Ca and VitD intakes with parental education, family affluence (FAS), physical activity and television (TV) watching while controlling for age, Tanner stage, energy intake and diet quality.

The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA)Cross-Sectional Study.

Adolescents aged 12·5–17·5 years (n 1804).

Milk and cheese were the main sources of Ca (23 and 19 % contribution to overall Ca intake, respectively). Fish products were the main VitD source (30 % contribution to overall VitD intake). Ca intake was positively associated with maternal education (β=56·41; 95 % CI 1·98, 110·82) and negatively associated with TV viewing in boys (β=–0·43; 95 % CI −0·79, −0·07); however, the significance of these associations disappeared when adjusting for diet quality. In girls, Ca intake was positively associated with mother’s (β=73·08; 95 % CI 34·41, 111·74) and father’s education (β=43·29; 95 % CI 5·44, 81·14) and FAS (β=37·45; 95 % CI 2·25, 72·65). This association between Ca intake and mother’s education remained significant after further adjustment for diet quality (β=41·66; 95 % CI 0·94, 82·38). Girls with high-educated mothers had higher Ca intake.

Low-educated families with poor diet quality may be targeted when strategizing health promotion programmes to enhance dietary Ca.

Although many studies worldwide have focused on the relationship between vitamin D and insulin resistance, results remain controversial. Furthermore, concentrations of serum 25-hydroxyvitamin D (25(OH)D) in the Chinese population are unclear. We aimed to investigate vitamin D status and its correlation with insulin resistance among a Chinese adult population.

Serum 25(OH)D, fasting blood glucose, fasting insulin, glycated Hb (HbA1c) and other metabolic parameters were assessed. Neck circumference, waist circumference, hip circumference, weight and height were also measured. Lifestyle factors including smoking and drinking status were obtained. Diabetes mellitus was diagnosed by HbA1c according to the 2010 American Diabetes Association criteria.

Eastern China.

Of 7200 residents included, 6597 individuals were ultimately analysed.

We enrolled 2813 males (mean age 52·7 (sd 13·5) years) and 3784 females (52·3 (sd 13·5) years); mean serum 25(OH)D concentration was 43·1 (sd 11·6) and 39·6 (sd 9·8) nmol/l, respectively. Additionally, 83·3 % of participants were 25(OH)D deficient. A significant difference in 25(OH)D was observed between males and females in winter and spring (P<0·001). Furthermore, 25(OH)D concentrations were inversely associated with the homeostasis model assessment of insulin resistance (HOMA-IR) in the overweight and pre-diabetic populations. After adjusting for several variables, 25(OH)D was significantly associated with HOMA-IR in winter. When 25(OH)D values were categorized into quartiles, HOMA-IR was significantly associated with decreasing 25(OH)D.

The majority of the Chinese population was vitamin D deficient and this deficiency was negatively associated with insulin resistance, particularly in the overweight and pre-diabetic populations. Moreover, these associations might be more evident in the winter.

The Dietary Inflammatory Index (DII)TM, which was developed to characterize the inflammatory potential of a person’s diet, has been shown to be associated with inflammatory conditions such as cancer. The present study aimed to investigate the association between DII scores and colorectal adenoma (CRA), a pre-cancerous condition.

Responses to baseline dietary questionnaires were used calculate DII scores. In a cross-sectional study design, the association between DII scores and CRA prevalence was determined in men and women separately using logistic regression models.

Ten cancer screening centres across the USA.

Participants were those included in the screening arm of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial.

Among the 44 278 individuals included in these analyses, men with diets in the most inflammatory quartile of DII scores had higher odds of all types of CRA (advanced, non-advanced and multiple (>1)) compared with those with diets in the least inflammatory quartile of DII scores. In fully adjusted models, compared with those with DII scores in quartile 1 (least inflammatory), males with DII scores in quartile 3 (adjusted odds ratio (aOR)=1·28; 95 % CI 1·12, 1·47) and quartile 4 (aOR=1·41; 95 % CI 1·23, 1·62) were more likely to have prevalent distal CRA. Higher DII scores, representing a more inflammatory diet, also were weakly associated with a higher prevalence of CRA in women.

Implementing an anti-inflammatory diet may be an effective means of primary prevention of CRA, especially in men.

Dietary fatty acid composition likely affects prediabetic conditions such as isolated impaired fasting glucose (IFG) or impaired glucose tolerance (IGT); however, this risk has not been evaluated in a large population nor has it been followed prospectively.

Diet, physical activity, anthropometric, socio-economic and blood glucose data from the Atherosclerosis Risk in Communities (ARIC) study were obtained from BioLINCC. Cox proportional hazards regression models were used to evaluate associations of dietary SFA, MUFA, PUFA, n-3 fatty acid (FA) and n-6 FA intakes with incidence of one (isolated IFG) or two (IFG with IGT) prediabetic conditions at the end of 12-year follow-up.

Study volunteers were from counties in North Carolina, Mississippi, Minnesota and Maryland, USA.

Data from 5288 volunteers who participated in the ARIC study were used for all analyses reported herein.

The study population was 62% male and 84 % white, mean age 53·5 (sd 5·7) years and mean BMI 26·2 (sd 4·6) kg/m2. A moderately high intake of dietary MUFA (10–15 % of total daily energy) was associated with a 10 % reduced risk of isolated IFG incidence, while a high intake of n-3 FA (>0·15 % of total daily energy) was associated with a 10 % increase in risk. Curiously, moderately high intake of n-6 PUFA (4–5 % of total daily energy) was associated with a 12 % reduction in IFG and IGT incidence.

MUFA, n-3 and n-6 FA contribute differently to the development of isolated IFG v. IFG with IGT; and their mechanism may be more complex than originally proposed.

To investigate spatial heterogeneity of stunting prevalence among children in Côte d’Ivoire and examine changes in stunting between 1994 and 2011, to assess the impact of the 2002–2011 civil war that led to temporary partitioning of the country.

Data from 1994, 1998 and 2011 Côte d’Ivoire Demographic and Health Surveys (DHS) were analysed using a geostatistical approach taking into account spatial autocorrelation. Stunting data were interpolated using ordinary kriging; spatial clusters with high and low stunting prevalence were identified using Kulldorff spatial scan statistics. Multilevel multivariable logistic regression was then carried out, with year of survey as the main independent variable and an interaction term for time by geographic zone (Abidjan, South, North).

Côte d’Ivoire, West Africa.

Children aged 0–35 months included in three DHS (n 6709).

Overall stunting prevalence was 30·7, 28·7 and 27·8 % in 1994, 1998 and 2011, respectively (P=0·32). Clusters with high prevalence were found in 1994 (in the West region, P<0·001) and 1998 (in the West and North-West regions, P<0·01 and P=0·01, respectively), but not in 2011. Abidjan was included in a cluster with low prevalence in all surveys (P<0·05). Risk of stunting did not change between 1994 and 2011 at national level (adjusted OR; 95 % CI: 1·39; 0·72, 2·64), but decreased in the South (0·74; 0·58, 0·94) and increased from 1998 to 2011 in Abidjan (1·96; 1·06, 3·64).

In Côte d’Ivoire, significant changes in stunting prevalence were observed at the sub-national level between 1994 and 2011.

To examine a library-based approach to addressing food insecurity through a child and adult summer meal programme. The study examines: (i) risk of household food insecurity among participants; (ii) perspectives on the library meal programme; and (iii) barriers to utilizing other community food resources.

Quantitative surveys with adult participants and qualitative semi-structured interviews with a sub-sample of adult participants.

Ten libraries using public and private funding to serve meals to children and adults for six to eight weeks in low-income Silicon Valley communities (California, USA) during summer 2015.

Adult survey participants (≥18 years) were recruited to obtain maximum capture, while a sub-sample of interview participants was recruited through maximum variation purposeful sampling.

Survey participants (n 161) were largely Latino (71 %) and Asian (23 %). Forty-one per cent of participants screened positive for risk of food insecurity in the past 12 months. A sub-sample of programme participants engaged in qualitative interviews (n 67). Interviewees reported appreciating the library’s child enrichment programmes, resources, and open and welcoming atmosphere. Provision of adult meals was described as building community among library patrons, neighbours and staff. Participants emphasized lack of awareness, misinformation about programmes, structural barriers (i.e. transportation), immigration fears and stigma as barriers to utilizing community food resources.

Food insecurity remains high in our study population. Public libraries are ideal locations for community-based meal programmes due to their welcoming and stigma-free environment. Libraries are well positioned to link individuals to other social services given their reputation as trusted community organizations.

Childhood cancer survivors (CCS) have been shown to practise suboptimal dietary intake and may benefit from nutrition interventions during and after treatment. Cooking classes have become popular for encouraging healthy eating behaviours in community-based programming and academic research; however, literature on teaching cooking classes in CCS is limited. The purpose of the present study was to address the development and implementation of classes for CCS based on a recently developed framework of healthy cooking behaviour.

A conceptual framework was developed from a systematic literature review and used to guide healthy cooking classes for CCS in different settings.

One paediatric cancer hospital inpatient unit, one paediatric cancer in-hospital camp programme and two off-site paediatric cancer summer camp programmes.

One hundred and eighty-nine CCS of varying ages and thirteen parents of CCS.

Seventeen classes were taught at camps and seven classes in the hospital inpatient unit. Healthy cooking classes based on the conceptual framework are feasible and were well received by CCS.

Cooking classes for CCS, both at the hospital and at camp, reinforced the principles of the conceptual framework. Future trials should assess the dietary and anthropometric impact of evidence-based healthy cooking classes in CCS.

The current qualitative study aimed to identify gender, social and cultural influences on the management and use of unconditional cash transfers as part of a prospective intervention study in Niger.

In February to March 2012, focus group discussions and semi-structured individual interviews were conducted with female caregivers of children aged 6 to 23 months who received unconditional cash transfers. Discussion and interview transcripts were analysed using content thematic analysis.

The study was conducted in the Madarounfa district in Maradi region of Niger.

Among forty-eight intervention villages, fourteen were selected for the qualitative study. Participants were randomly selected from eligible households.

In total, 124 women participated in focus group discussions or interviews. The majority reported giving the cash transfer to the male head of household who primarily managed cash at the household level. Women reported using a portion of the money to purchase foods for the target child. Feeding the household was the primary use of the cash transfer, followed by health care, clothing, gifts or ceremonies.

Gender, social and cultural norms influenced management and usage of the cash transfer at the household level. The results highlight the importance of integrating gender-sensitive indicators into interventions. Information and awareness sessions should be an integral component of large-scale distributions with a special emphasis on gender equality and the importance of women’s empowerment to improve agriculture and family health.

Gaining too much or too little weight in pregnancy (according to Institute of Medicine (IOM) guidelines) negatively affects both mother and child, but many women find it difficult to manage their gestational weight gain (GWG). Here we describe the use of the intervention mapping protocol to design ‘Come On!’, an intervention to promote adequate GWG among healthy pregnant women.

We used the six steps of intervention mapping: (i) needs assessment; (ii) formulation of change objectives; (iii) selection of theory-based methods and practical strategies; (iv) development of the intervention programme; (v) development of an adoption and implementation plan; and (vi) development of an evaluation plan. A consortium of users and related professionals guided the process of development.

As a result of the needs assessment, two goals for the intervention were formulated: (i) helping healthy pregnant women to stay within the IOM guidelines for GWG; and (ii) getting midwives to adequately support the efforts of healthy pregnant women to gain weight within the IOM guidelines. To reach these goals, change objectives and determinants influencing the change objectives were formulated. Theories used were the Transtheoretical Model, Social Cognitive Theory and the Elaboration Likelihood Model. Practical strategies to use the theories were the foundation for the development of ‘Come On!’, a comprehensive programme that included a tailored Internet programme for pregnant women, training for midwives, an information card for midwives, and a scheduled discussion between the midwife and the pregnant woman during pregnancy. The programme was pre-tested and evaluated in an effect study.

Despite the promising results related to intuitive eating, few studies have attempted to explain the processes encouraging this adaptive eating behaviour. The focus of the present study was on exploring mechanisms of change in intuitive eating and weight in acceptance and commitment therapy (ACT) interventions. Mediation provides important information regarding the treatment processes and theoretical models related to specific treatment approaches. The study investigates whether psychological flexibility, mindfulness skills and sense of coherence mediated the interventions’ effect on intuitive eating and weight.

Secondary analysis of a randomized control trial. Mediation analysis compared two ACT interventions – face-to-face (in a group) and mobile (individually) – with a control group using a latent difference score model.

Data were collected in three Finnish towns.

The participants were overweight or obese (n 219), reporting symptoms of perceived stress.

The effect of the interventions on participants’ (i) BMI, (ii) intuitive eating and its subscales, (iii) eating for physical rather than emotional reasons and (iv) reliance on internal hunger and satiety cues was mediated by changes in weight-related psychological flexibility in both ACT groups.

These findings suggest that ACT interventions aiming for lifestyle changes mediate the intervention effects through the enhanced ability to continue with valued activities even when confronted with negative emotions and thoughts related to weight.

The National Early Care and Education Learning Collaboratives (ECELC) Project aims to promote healthy physical activity and nutrition environments, policies and practices in early care and education (ECE) programmes across multiple states. The present pilot study sought to assess changes to the physical activity and nutrition practices in a sub-sample of ECE programmes participating in the ECELC using the Environment and Policy Assessment and Observation (EPAO). Additionally, it sought to compare results with the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC).

Quasi-experimental pre–post pilot study where paired-sample t tests examined changes to physical activity and nutrition practices from pre-assessment to post-assessment (P<0·05). Pearson correlation coefficients examined change scores from EPAO compared with NAP SACC with statistical significance set at a two-sided α level of P<0·10 to account for sample size.

The study occurred among ECE programmes.

Pre-school classrooms in nineteen ECE programmes across four US states were observed.

EPAO data demonstrated an increase in total score from pre-assessment to post-assessment (150 (sd 30) to 176 (sd 35)). NAP SACC change scores demonstrated little relationship with EPAO domain change scores, with exceptions in Nutrition Policy and Physical Activity Policy (r=−0·4 and −0·6, respectively).

The overall improvements reported through the EPAO suggest participation in the ECELC resulted in changes in critical nutrition- and physical activity-related practices. However, considerable differences in data reported using the NAP SACC compared with the EPAO suggest subjective data should be interpreted with caution and objective measurement should be used when feasible.

To find diets optimised on nutrition and environmental impact close to the current Dutch diet and to identify the most effective and acceptable options for mitigating environmental impact.

Linear programming was used to optimise diets of Dutch men and women aged 9–69 years, divided into ten age–gender groups. The analysis included nutrient composition, a metric for popularity and life cycle assessments of 207 food products. Greenhouse gas emissions, fossil energy use and land occupation were used to calculate a weighted score for the overall environmental impact. Optimised diets were solutions that minimised changes to the current diet while satisfying all nutritional constraints, with stepwise reductions in environmental impact.

The Netherlands.

Dutch children and adults aged 9–69 years.

Meat was always reduced. Vegetable, fruit and dairy contents remained similar, while bread, fatty fish and legumes increased. The extent of changes depended on age and gender. Beverages were not heavily reduced. Nutrients critical for the outcome were α-linoleic acid, retinol, Ca, Na, Se, dietary fibre, SFA, thiamin and Fe (women of childbearing age). Total protein, essential amino acids and carbohydrates were not critical.

Reducing meat is the most effective option for lowering the environmental impact of diets in all age–gender groups. Reducing alcoholic and non-alcoholic beverages is another option. Leaving out fish and dairy products are not. The differences in nutritional requirements related to age and gender have a significant effect on the composition of the optimised diets.