To build up sufficient knowledge of a ‘healthy diet’. Here, we report on the assessment of nutritional knowledge using a uniform method in a large sample of adolescents across Europe.

A cross-sectional study.

The European multicentre HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study conducted in 2006–2007 in ten cities in Austria, Belgium, France, Germany, Greece (one inland and one island city), Hungary, Italy, Spain and Sweden.

A total of 3546 adolescents (aged 12·5–17·5 years) completed a validated nutritional knowledge test (NKT). Socio-economic variables and anthropometric data were considered as potential confounders.

NKT scores increased with age and girls had higher scores compared with boys (62 % v. 59 %; P < 0·0001). Scores were approximately 10 % lower in ‘immigrant’ adolescents or in adolescents with ‘immigrant’ mothers. Misconceptions with respect to the sugar content in food or in beverages were found. Overall, there was no correlation between BMI values and NKT scores. After categorization according to BMI, scores increased significantly with BMI group only in boys. These differences disappeared after controlling for socio-economic status (SES). Smoking status and educational level of the mother influenced the NKT scores significantly in boys, as well as the educational levels of both parents in girls.

Nutritional knowledge was modest in our sample. Interventions should be focused on the lower SES segments of the population. They should be initiated at a younger age and should be combined with environmental prevention (e.g. healthy meals in school canteens).

To explore how the quality of school lunch consumed reflected overall eating patterns in school-aged children.

Children filled in an Internet-based questionnaire about their eating patterns. The children were then divided into balanced and imbalanced school lunch eaters on the basis of their responses in the questionnaire. A balanced school lunch consisted of, by the definition used in the present study, a main dish, salad and bread.

Eleven primary schools and one middle school in eastern Finland.

A total of 531 schoolchildren (247 boys and 284 girls) aged 11–16 years.

The school lunch was balanced in 46·5 % of children. Eating a balanced school lunch was associated with overall healthier eating patterns outside school. Children who ate a balanced school lunch had more regular meal times and consumed healthier snacks. They ate fruit or berries and vegetables, dairy products and wholegrain foods more often, consumed fewer salty snacks, pizzas, meat pies and drank fewer soft drinks and energy drinks. Their eating patterns at home were also healthier, with vegetables being offered at every family dinner and fruit being offered daily, whereas soft drinks were offered seldom.

The choices made by children in their school lunch reflect the overall eating patterns among school-aged children. Eating a balanced school lunch is associated with more regular meal patterns, the availability of healthier foods at home and an overall healthier diet, suggesting that healthy eating patterns are learnt at home.

The objectives of the present study were to evaluate diet quality among Lower Mississippi Delta (LMD) residents using the Healthy Eating Index-2005 (HEI-2005) and to identify the top five dietary sources contributing to HEI-2005 components. Demographic differences in HEI-2005 scores were also explored.

Diet quality was evaluated using HEI-2005. Demographic differences in HEI-2005 scores were investigated using multivariable regression models adjusting for multiple comparisons. The top five dietary sources contributing to HEI-2005 components were identified by estimating and ranking mean MyPyramid equivalents overall and by demographic characteristics.

Dietary data, based on a single 24 h recall, from the Foods of Our Delta Study 2000 (FOODS 2000) were used in the analyses.

FOODS 2000 adult participants 18 years of age or older.

Younger age was the largest determinant of low diet quality in the LMD with HEI-2005 total and seven component scores declining with decreasing age. Income was not a significant factor for HEI-2005 total or component scores. The top five dietary sources differed by all five of the demographic variables, particularly for total vegetables and energy from solid fats, alcoholic beverages and added sugars (SoFAAS). Soft drinks were the leading source of SoFAAS energy intake for all demographic groups.

The assessment of diet quality and identification of top dietary sources revealed the presence of demographic differences for selected HEI-2005 components. These findings allow identification of food patterns and culturally appropriate messaging and highlight the difficulties of treating this region as a homogeneous population.

To determine the relative validity of the pre-coded food diary applied in the Danish National Survey of Dietary Habits and Physical Activity.

A cross-over study among seventy-two adults (aged 20 to 69 years) recording diet by means of a pre-coded food diary over 4 d and a 4 d weighed food record. Intakes of foods and drinks were estimated, and nutrient intakes were calculated. Means and medians of intake were compared, and cross-classification of individuals according to intake was performed. To assess agreement between the two methods, Pearson and Spearman's correlation coefficients and weighted kappa coefficients were calculated.

Validation study of the pre-coded food diary against a 4 d weighed food record.

Seventy-two volunteer, healthy free-living adults (thirty-five males, thirty-seven females).

Intakes of cereals and vegetables were higher, and intakes of fruit, coffee and tea were lower, in the weighed food record compared with the food diary. Intakes of nutrients were grossly the same in the two methods, except for protein, where a higher intake was recorded in the weighed record. In general, moderate agreement between the two methods was found.

Participants were classified moderately correct according to food and nutrient intakes assessed in the pre-coded food diary; however values of absolute food intakes should be used and interpreted with caution. Improvement of the methods to estimate portion size may increase the accuracy of the dietary intake estimates.

In malnourished populations, the weight-for-height Z-score (WHZ) distribution is shifted to the left. The aim of nutrition interventions should be to restore a normal WHZ distribution for the whole population. The present paper examines the WHZ change needed by each individual to achieve this objective.

We developed a mathematical model of required individual change in WHZ as a function of characteristics of the initial population to restore a normal distribution. This model was then tested by simulating WHZ change needed to restore a normal WHZ distribution in a test population.

A rural area of Democratic Republic of the Congo with a high prevalence of undernutrition.

Children under 5 years of age.

To restore a normal distribution for the whole population, the WHZ of all children should be shifted. The desired WHZ change of each individual should be higher when the individual's initial WHZ is low, when the mean WHZ of the whole population is low and, for the most wasted individual, when the variance of WHZ and WHZ change in the population are high. Using the suggested model in a simulation on the test population resulted in a WHZ distribution close to the growth standard.

To restore a normal WHZ distribution in wasted populations, nutritional programmes should cover the whole population with a higher weight gain in areas where mean WHZ is low.

The present study aimed to examine the impact of non-wear activities registered in diaries when using accelerometers to assess physical activity (PA) in young adolescents.

Data arise from a large-scale cross-sectional study on PA. PA was objectively assessed using Actigraph™ accelerometers (Actigraph MTI, Manufacturing Technology Inc., Pensacola, FL, USA) during seven consecutive days. Non-wear time activity diaries were provided to register the activities for which the accelerometer was removed. After correction to deal with over-reporting, the registered minutes of PA were used to replace periods of non-wear time measured by the accelerometer.

Between October 2008 and May 2009 adolescents were recruited by home visits in Ghent (Belgium).

Young adolescents (n 513; 48·6 % boys) aged 13 to 15 years.

Of the total sample, 49·9 % registered at least one activity of moderate to vigorous intensity in the non-wear time activity diary. More adolescents registered an activity performed on a weekday than on a weekend day and the registered mean number of minutes of moderate to vigorous PA were higher on weekend days. Repeated-measures (M)ANOVA tests revealed a significant difference between the mean minutes with and without non-wear activities for all PA intensities, regardless of adolescents’ socio-economic status or gender. More adolescents achieved the PA recommendations after inclusion of the non-wear activities irrespective of accelerometer thresholds used.

The collection of information regarding non-wear time by non-wear time activity diaries when using accelerometers in 13–15-year-old adolescents can lead to different PA outcomes at the individual level and therefore can improve the ability to accurately measure PA.

To identify child and parental factors associated with screen time in 3-year-old children.

Observational study.

Participants were recruited from a large primary-care paediatric group practice in Toronto, Canada.

Healthy 3-year-old children were included. A questionnaire was completed by their parents on screen time. Descriptive statistics and linear regression models were used to assess associations between child screen time and selected factors. Multivariable models included factors from the univariate analysis with P < 0·1. Estimated effects and 95 % CI are reported.

A total of 157 children were enrolled (91 % recruitment). The mean screen time per weekday was 104 min (similar for weekend day). In all, 10 % of children had a television (TV) in their bedroom; 59 % consumed at least one meal while watching TV; and 81 % of parents had household rules about screen time. Controlling for maternal education and age, eating lunch and dinner in front of the screen and mother being employed were associated with an increase in child weekday screen time of 96 (95 % CI 30, 192), 42 (95 % CI 12, 90) and 36 (95 % CI 6, 72) min/d, respectively. Eating lunch in front of the screen and an increase of 1 h of parental screen time were associated with an increase of 78 (95 % CI 36, 132) and 12 (95 % CI 6, 18) min/d in child weekend screen time. Family rules decreased child weekend screen time by 30 (95 % CI 6, 54) min/d.

Interventions that include these important parental factors should be evaluated for their effectiveness in reducing screen time.

To examine the prevalence and correlates of fruit and vegetable (FV) consumption in Cypriot adolescents.

A cross-sectional study.

The Republic of Cyprus.

A total of 1966 adolescents with a mean age of 14·7 (sd 2·2) years from nine elementary (n 448), six middle (n 657), five high (n 475) and five technical/vocational schools (n 386) in Cyprus. Participants completed a questionnaire assessing FV consumption using a two-item screening measure and a number of social, attitudinal and behavioural correlates of FV consumption.

Overall, 19·3 % of adolescents reported consuming five or more portions of FV daily, with elementary and middle school students more likely to meet recommendations (23·8 % and 24·4 %, respectively) compared with high and technical/vocational school students (14·0 % and 12·5 %, respectively). Consuming five or more portions of FV was associated with preference for FV (OR = 2·2), family eating patterns (OR = 1·5), friends’ FV consumption (OR = 1·2) and school support for FV consumption (OR = 0·8). Consuming at least one portion of fruit daily was significantly associated with preference for FV (OR = 2·0) and family eating patterns (OR = 1·7). Consuming at least one portion of vegetables daily was associated with preference for FV (OR = 4·2) and eating while watching television (OR = 0·8).

Targeting individual and family-based components may enhance the effectiveness of intervention programmes to promote FV consumption.

To investigate the role of severe physical violence during pregnancy (SPVP) between intimate partners in early cessation of exclusive breast-feeding (EBF).

A health services survey. The revised Conflict Tactics Scale was used to characterize SPVP; premature breast-feeding cessation was identified using a current status data approach, which was based on the information reported from food recall during the preceding 7 d. The cumulative hazard function was estimated by complementary log–log transformation models, which allowed the ensuing estimation of early breast-feeding cessation rates in different age groups and the ratio of rates of weaning between women exposed and not exposed to violence.

Five large public primary health-care facilities of Rio de Janeiro, Brazil.

The sample comprised 811 randomly selected mothers of children under 5 months of age who were waiting to be consulted.

SPVP is an independent risk factor of cessation of EBF since, after controlling for socio-economic, demographic, reproductive and lifestyle variables, women exposed to violence presented an incidence density that was 31 % higher than those who were not exposed (hazard ratio = 1·30, 95 % CI 1·01, 1·69).

The findings corroborate the hypothesis that SPVP is an important risk factor for EBF. This indicates the need for incentives to adequately train health-care personnel in dealing with lactating women in order to gain a broader view of breast-feeding beyond the biological aspects of lactation, including the maternal psychological dimension.

To investigate the intakes of sugar-sweetened beverages (SSB), fruit and vegetables (FV) among adolescents and their parents and to explore differences in the perceived availability by gender and parental education.

Baseline data from the HEIA (HEalth In Adolescents) study.

Data on intake of SSB were collected assessing frequency and amounts, whereas consumption of FV was assessed on the basis of frequency. Further, perceived availability at home and at school (taken from home) was reported.

Participants were 1528 Norwegian adolescents aged 11 years, as well as 1200 mothers and 1057 fathers.

The adolescents’ intake of SSB was low on weekdays but doubled during weekend days. This pattern was observed among parents as well. There were significant differences in intake between boys, girls, mothers and fathers, except for vegetables. Fathers reported the lowest frequency of FV intake. Compared with adolescents, mothers reported lower availability of SSB and higher availability of FV. Compared with their sons, fathers reported higher availability of vegetables and lower availability of sugar-sweetened fruit drinks at school. Significant differences in adolescents’ intake of SSB and in the perceived availability of both SSB and FV by parental education were found.

The intake of SSB was higher during weekend days than during weekdays, whereas the frequency of FV intake was low. Differences in adolescents’ perceived availability of both SSB and FV on the basis of parental education were found, whereas the differences in intake were significant only for SSB. Increasing parental awareness of availability and their potential as role models across parental gender and educational level could improve adolescents’ dietary habits.

Poor-quality diet, regarded as an important contributor to health inequalities, is linked to adverse health outcomes. We investigated sociodemographic and lifestyle predictors of poor-quality diet in a population sample.

A cross-sectional analysis of the Survey of Lifestyle, Attitudes and Nutrition (SLÁN). Diet was assessed using an FFQ (n 9223, response rate = 89 %), from which a dietary score (the DASH (Dietary Approaches to Stop Hypertension) score) was constructed.

General population of the Republic of Ireland.

The SLÁN survey is a two-stage clustered sample of 10 364 individuals aged 18 years.

Adjusting for age and gender, a number of sociodemographic, lifestyle and health-related variables were associated with poor-quality diet: social class, education, marital status, social support, food poverty (FP), smoking status, alcohol consumption, underweight and self-perceived general health. These associations persisted when adjusted for age, gender and social class. They were not significantly altered in the multivariate analysis, although the association with social support was attenuated and that with FP was borderline significant (OR = 1·2, 95 % CI 1·03, 1·45). A classical U-shaped relationship between alcohol consumption and dietary quality was observed. Dietary quality was associated with social class, educational attainment, FP and related core determinants of health.

The extent to which social inequalities in health can be explained by socially determined differences in dietary intake is probably underestimated. The use of composite dietary quality scores such as the DASH score to address the issue of confounding by diet in the relationship between alcohol consumption and health merits further study.

To estimate dietary habits and other factors associated with inadequate blood pressure (BP) control in hypertensive patients adherent to antihypertensive drug treatment assisted by a Brazilian Family Doctor Program (FDP).

A cross-sectional study.

FDP units, Niterói, Rio de Janeiro, Brazil.

We included data from both male and female participants aged ≥20 years. Participants completed a standardized questionnaire containing questions related to demographics, socio-economic factors, comorbidities and lifestyle, as well as a validated FFQ and eleven additional qualitative questions to investigate dietary habits. Food items were divided into sixteen groups. Medical consultations were performed, BP measurements were taken, blood and urine samples were assessed and anthropometric and nutritional status was evaluated.

Individuals with inadequate BP control presented higher BMI values (prevalence ratio (PR) = 1·027, 95 % CI 1·009, 1·045) and also consumed more meat (PR = 1·091, 95 % CI 1·022, 1·165), which are potentially modifiable variables. Higher levels of serum creatinine (PR = 1·894, 95 % CI 1·241, 2·892) were also associated with inadequate BP control, as were skin colour (white). After inclusion of the Na excretion index, which is an indirect measure of salt intake, a slight decrease was observed in the PR for meat, which resulted in loss of statistical significance.

The results indicate that salt consumption, skin colour, BMI and serum creatinine are associated with inadequate BP control.

Increasing the consumption of Fe-rich foods and thus improving Fe bioavailability without significantly increasing diet cost is the most sustainable intervention for improving Fe intake. We assessed the effect of supplementary food consisting of fermented soyabean (tempeh) and vitamin C-rich fruit consumed during pregnancy on maternal iron deficiency (ID).

Pregnant women were randomly allocated by village into optimized diet and control groups. Supplementary food was given 6 d/week at home. The average weekly food provided comprised 600 g of tempeh, 30 g of meat, 350 g of guava, 300 g of papaya and 100 g of orange. Hb, ferritin and transferrin receptor (TfR) concentrations were measured at 12–20 and at 32–36 weeks of gestation.

Thirty-nine villages in Indonesia.

Pregnant women (12–20 weeks of gestation, n 252).

At baseline, mean Hb, ferritin and TfR concentrations and body Fe concentration were within the normal range and did not differ between groups. At near term, mean Hb, ferritin and body Fe decreased, whereas mean TfR increased significantly in both groups. The mean changes in Fe status were similar in both groups. In Fe-deficient women, consumption of an optimized diet was associated with smaller decreases in Hb (1·02 (95 % CI 0·98, 1·07) g/l; P = 0·058), ferritin (1·42 (95 % CI 1·16, 1·75) μg/l; P = 0·046) and body Fe (2·57 (95 % CI 1·71, 3·43) mg/kg; P = 0·073) concentrations, compared with a state of no intervention. Fe-deficient women at baseline benefited more from supplementary food compared with Fe-replete women.

Daily supplementary food containing tempeh and vitamin C-rich fruits during pregnancy might have positive effects on maternal ID.

To determine whether prenatal vitamin A and/or Zn supplementation affects postnatal growth.

Follow-up of a randomized controlled trial monitoring growth in children from birth up to 24 months of age.

Central Java, Indonesia.

Children (n 343) of mothers participating in a double-blinded, randomized controlled study of vitamin A and/or Zn supplementation during pregnancy. We report the effects of prenatal supplementation on infant growth, measured as weight-for-age Z-scores (WAZ), height-for-age Z-scores (HAZ) and weight-for-height Z-scores (WHZ ), from 0 to 24 months, as well as differences in growth faltering among the supplementation groups.

For HAZ, the absolute differences between the vitamin A-only and vitamin A + Zn groups at 3 and 9 months were 0·34 sd and 0·37 sd, respectively, and the absolute difference between the vitamin A-only and Zn-only groups at 18 months was 0·31 sd. Compared with placebo, none of the supplements affected growth. Defining growth faltering as a downward crossing of two or more major percentile lines, 50–75 % of the children were found to be growth faltering within 9 months of age, whereas 17 % and 8 % scored <−2 sd for WAZ and HAZ, respectively. Prenatal supplementation did not reduce the prevalence of growth faltering.

Prenatal vitamin A supplementation had a small but significant effect on postnatal growth of children's length until 18 months of age compared with supplementation with either vitamin A + Zn or Zn alone, but not compared with placebo. It had no effects on other anthropometric measures and did not reduce the prevalence of growth faltering. Future studies should duplicate these findings before recommendations can be made.

To examine parents’ beliefs about the meaning of common front-of-package nutrition-related claims on children's cereals and determine whether the claims would make them more willing to buy the cereals.

Parents viewed images of box fronts for children's cereals of below-average nutritional quality, as assessed by a validated nutrient profiling model. These boxes featured various nutrition-related claims including ‘supports your child's immunity’, ‘whole grain’, ‘fibre’, ‘calcium and vitamin D’ and ‘organic’. Participants were provided possible meanings for these claims and asked to select any that applied with the option to write in additional meanings. They also indicated how the claim would affect their willingness to buy the product.

Online survey.

Parents with children between the ages of 2 and 11 years (n 306) recruited through an online panel.

The majority of parents misinterpreted the meaning of claims commonly used on children's cereals. They inferred that cereals with claims were more nutritious overall and might provide specific health-related benefits for their children; and these beliefs predicted greater willingness to buy the cereals.

These findings indicate that common front-of-package nutrition-related claims are potentially misleading, especially when placed on products with high levels of nutrients to limit (e.g. sugar, sodium) and low levels of other nutrients to encourage (e.g. fibre, protein). Additional regulation is needed to protect consumers in the USA.

To investigate Irish consumers’ use and understanding of and their belief in nutrition and health (NH) claims in the context of the European Union (EU) legislation (Regulation no. 1924/2006), which permits a number of NH claims on food products.

An interview-assisted questionnaire was administered to consumers (n 400). Preference for three types of NH claims across six products was tested. Perception of NH claims was assessed across a further eight food products. Claims were categorised as content, structure–function and disease–risk factor reduction claims.

Six supermarkets in the Republic of Ireland.

Four hundred adult Irish supermarket consumers.

Older (P < 0·001), female (P < 0·01) consumers were more likely to seek NH claims. Structure–function and content claims were preferred across six products. Consumers’ perception was associated with the health benefit claimed rather than with the strength of the claim itself. Preference for claim type and claim perception differed with gender, age and educational level.

Irish consumers prefer content and simpler NH claims rather than more complex disease–risk factor reduction claims. The food industry may thus be better served using these types of claims. Although the reported levels of understanding were high, evidence of positivity bias and misinterpretation was found. Thus, with regard to Regulation 1924/2006, consumers need more information on both simpler and more complex claims. Public health messages should be targeted according to gender, age and educational level.

To study differences in the role of price and value in food choice between low-income and higher-income consumers and to study the perception of consumers about pricing strategies that are of relevance during grocery shopping.

A cross-sectional study was conducted using structured, written questionnaires. Food choice motives as well as price perceptions and opinion on pricing strategies were measured.

The study was carried out in point-of-purchase settings, i.e. supermarkets, fast-food restaurants and sports canteens.

Adults (n 159) visiting a point-of-purchase setting were included.

Price is an important factor in food choice, especially for low-income consumers. Low-income consumers were significantly more conscious of value and price than higher-income consumers. The most attractive strategies, according to the consumers, were discounting healthy food more often and applying a lower VAT (Value Added Tax) rate on healthy food. Low-income consumers differ in their preferences for pricing strategies.

Since price is more important for low-income consumers we recommend mainly focusing on their preferences and needs.

To use an innovative mixed-method approach to analyse and describe 8–10-year-olds’ home and school food environments.

A mixed-method approach to collect qualitative and quantitative data was used, in which pupils took photographs over four days to record their food intake and food environment. The photographs were discussed in focus groups. A combination of lunchtime observations and questionnaires completed by parents were used to build up a picture of the children's home and school food environments.

A primary school in a suburb of Newcastle upon Tyne, UK.

Twenty-seven children aged 8–10 years consented to take part in the study. Twenty-four returned cameras, and eighteen parents completed questionnaires.

Photographs illustrated a range of locations throughout the home where children consumed food. Children's photographs revealed they ate less often with family and more often in front of the television than reported in parental questionnaires. Emergent themes during focus group discussions revealed a strong preference for packed lunches and dissatisfaction with school dinners. In this small sample, children's eating habits and preferences showed few associations with either gender or the deprivation level of the area in which they lived.

The children's home food environments showed a great deal of variation, with parents being key moderators of food availability and consumption. While the school's food provisions met national nutritional standards, the social aspects of having a packed lunch appeared to be a positive aspect of eating at school.

To examine the associations between near and distant visual acuity and biomarkers of Hg, Pb, n-3 fatty acids and Se from the local diet of fish-eating communities of the Tapajós River in the Brazilian Amazon.

Visuo-ocular health and biomarkers of Hg (hair, whole blood, plasma), Pb (whole blood), Se (whole blood and plasma) and n-3 fatty acids (plasma total phospholipids) were assessed in a cross-sectional study.

Lower Tapajós River Basin (State of Pará, Brazil), May to July 2006.

Two hundred and forty-three adults (≥15 years) without diagnosed age-related cataracts or ocular pathologies.

Near visual acuity was negatively associated with hair Hg and positively associated with %DHA, with a highly significant Log Hg × age interaction term. Stratifying for age showed that while young people presented good acuity, for those aged ≥40 years, clinical presbyopia was associated with hair Hg ≥ 15 μg/g (OR = 3·93, 95 % CI 1·25, 14·18) and %DHA (OR = 0·37, 95 % CI 0·11, 1·11). A similar age-related pattern was observed for distant visual acuity in relation to blood Pb, but the evidence was weaker.

These findings suggest that Hg and Pb may affect visual acuity in older persons, while DHA appears to be protective for near visual acuity loss. In this population, with little access to eye care, diet may have an important influence on visuo-ocular ageing.