To examine the trends in BMI and adiposity among schoolchildren from Cuenca, Spain, during 2004–2010.

Two methodologically comparable surveys were carried out in 2004 and 2010.

Primary schools in Cuenca, a province in the middle of Spain.

All schoolchildren aged 8–11 years, belonging to 4th and 5th grades from twenty schools in the Province of Cuenca, were invited to participate in both cross-sectional studies. Weight, height and body fat percentage (BF%) from bioelectrical impedance were measured with standardized procedures.

The study included 550 boys and 539 girls in 2004, and 569 boys and 531 girls in 2010. In 2010, 8·1 % of children were underweight, 25·9 % overweight and 9·5 % obese. From 2004 to 2010, the prevalence of overweight rose from 21·6 % to 28·0 % (P = 0·004) and BF % increased from 22·6 % to 24·0 % (P = 0·001) among boys. No change was observed in overweight and BF % in girls, or in underweight and obesity in either sex. In boys, most of the distribution of BMI and BF % shifted to the right; in contrast, among girls no substantial change was apparent in the distribution of BMI and BF %.

From 2004 to 2010 the prevalence of overweight and adiposity has continued to increase among boys. However, the obesity epidemic may have levelled off in girls. Given that the prevalence of childhood excess weight is still very high, the current evidence-based efforts to halt the obesity epidemic in Spain should be strengthened.

To investigate the beverage intake patterns of Canadian adults and explore characteristics of participants in different beverage clusters.

Analyses of nationally representative data with cross-sectional complex stratified design.

Canadian Community Health Survey, Cycle 2·2 (2004).

A total of 14 277 participants aged 19–65 years, in whom dietary intake was assessed using a single 24 h recall, were included in the study. After determining total intake and the contribution of beverages to total energy intake among age/sex groups, cluster analysis (K-means method) was used to classify males and females into distinct clusters based on the dominant pattern of beverage intakes. To test differences across clusters, χ2 tests and 95 % confidence intervals of the mean intakes were used.

Six beverage clusters in women and seven beverage clusters in men were identified. ‘Sugar-sweetened’ beverage clusters – regular soft drinks and fruit drinks – as well as a ‘beer’ cluster, appeared for both men and women. No ‘milk’ cluster appeared among women. The mean consumption of the dominant beverage in each cluster was higher among men than women. The ‘soft drink’ cluster in men had the lowest proportion of the higher levels of education, and in women the highest proportion of inactivity, compared with other beverage clusters.

Patterns of beverage intake in Canadian women indicate high consumption of sugar-sweetened beverages particularly fruit drinks, low intake of milk and high intake of beer. These patterns in women have implications for poor bone health, risk of obesity and other morbidities.

The present research aimed to analyse the nutrient density (ND), nutrient adequacy score (NAS) and energy density (ED) of Indonesian foods and to formulate a balanced diet using linear programming.

Data on typical Indonesian diets were obtained from the Indonesian Socio-Economic Survey 2008. ND was investigated for 122 Indonesian foods. NAS was calculated for single nutrients such as Fe, Zn and vitamin A. Correlation analysis was performed between ND and ED, as well as between monthly expenditure class and food consumption pattern in Indonesia. Linear programming calculations were performed using the software POM-QM for Windows version 3.

Republic of Indonesia, 2008.

Public households (n 68 800).

Vegetables had the highest ND of the food groups, followed by animal-based foods, fruits and staple foods. Based on NAS, the top ten food items for each food group were identified. Most of the staple foods had high ED and contributed towards daily energy fulfillment, followed by animal-based foods, vegetables and fruits. Commodities with high ND tended to have low ED. Linear programming could be used to formulate a balanced diet. In contrast to staple foods, purchases of fruit, vegetables and animal-based foods increased with the rise of monthly expenditure.

People should select food items based on ND and NAS to alleviate micronutrient deficiencies in Indonesia. Dietary formulation calculated using linear programming to achieve RDA levels for micronutrients could be recommended for different age groups of the Indonesian population.

To produce study-specific portion sizes for 11-year-old children in a population-based birth cohort and to compare these study-specific portion sizes with previously published children's portion sizes, to assess their relevance today.

Two multiple-pass 24 h dietary recalls were taken. The Food Standard Agency's photographic food atlas was used to quantify intakes. Study-specific food portion sizes were calculated for each food group. Portion sizes were calculated for all children and separately for boys and girls. The nutrient intake from the 24 h dietary recalls was analysed using study-specific and published portion sizes for individual participants. Agreement was assessed using Pearson's correlation, intra-class correlation coefficients and the Bland–Altman method.

Birth cohort study, UK.

Children (mean age 11·3 years, n 264) and parents/guardians.

A total of 124 food portion sizes were calculated. Differences in portion weights between boys and girls were seen only for seven food items. There was a significant positive relationship (P < 0·001) between intakes of each nutrient as determined by the two sets of portion sizes. Correlation coefficients ranged from 0·77 (protein) to 0·98 (β-carotene). The intra-class correlation coefficients showed good agreement between nutrient intakes determined by the study-specific and published portion sizes (P < 0·001).

Nutrient intakes calculated using portion sizes from our population were similar to those calculated from portion size data collected in a national survey, despite being collected over a decade later. The present study adds to the small amount of evidence regarding portion sizes in UK children and shows agreement with previously published paediatric portion sizes.

To evaluate the impact of adherence to public health recommendations on Listeria monocytogenes food safety to limit exposure to potential food sources on micronutrient intakes of pregnant women and whether more frequent consumption of ‘high-risk’ foods increases risk for adverse pregnancy outcomes.

A cohort study in women assessing Listeria exposure from an FFQ based on consumption of potential Listeria-containing food sources, the Listeria Food Exposure Score (LFES). Pregnancy status was defined as pregnant, trying to conceive, had a baby within the previous 12 months, or other. Nutrient intakes were compared with Nutrient Reference Values and self-reported pregnancy outcome history three years later.

Australia.

Women aged 25–30 years (n 7486) participating in the Australian Longitudinal Study on Women's Health.

There were weak positive correlations (r = 0·13–0·37, P < 0·001) between LFES and all nutrients, with fibre, folate, Fe and vitamin E intakes consistently below the Nutrient Reference Values in every quintile of LFES. Women in the highest quintile of LFES reported 19 % more miscarriages (rate ratio = 1·19; 95 % CI 1·02, 1·38) than those in the lowest quintile, after adjusting for important confounding factors.

More frequent consumption of foods potentially containing L. monocytogenes is associated with higher nutrient intakes, but an increased risk of miscarriage. L. monocytogenes pregnancy recommendations require review and should include the list of ‘risky’ food items in addition to low-risk alternatives that would adequately replace nutrient intakes which may be reduced through avoidance strategies.

To document the double burden of malnutrition and cardiometabolic risk factors (CMRF) in adults and its occurrence according to different sociodemographic parameters.

Population-based cross-sectional observational study. We first randomly selected 330 households stratified by tertile of the income levels proxy as low, middle and high income.

Northern district of Ouagadougou, the capital city of Burkina Faso.

In each income stratum, 110 individuals aged 25–60 years and who had lived permanently in Ouagadougou for at least 6 months were randomly selected, followed with collection of anthropometric, socio-economic and clinical data, and blood samples.

The overall obesity/overweight prevalence was 24·2 % and it was twice as high in women as in men (34·1 % v. 15·5 %, P < 0·001). Hypertension, hyperglycaemia and low HDL cholesterol prevalence was 21·9 %, 22·3 % and 30·0 %, respectively, without gender difference. The prevalence of the metabolic syndrome was 10·3 %. Iron depletion and vitamin A deficiency affected 15·7 % and 25·7 % of participants, respectively, with higher rates in women. Coexistence of at least one nutritional deficiency and one CMRF was observed in 23·5 % of participants, and this ‘double burden’ was significantly higher in women than in men (30·4 % v. 16·1 %, P = 0·008) and in the low income group.

CMRF are becoming a leading nutritional problem in adults of Ouagadougou, while nutritional deficiencies persist. The double nutritional burden exacerbates health inequities and calls for action addressing both malnutrition and nutrition-related chronic diseases.

The present study evaluated the contribution of 100 % orange juice (OJ) consumption to the intakes of macronutrients and energy and its impact on body composition.

A cross-sectional study was conducted. The main exposure was OJ consumption based on two non-consecutive 24 h diet recalls. Macronutrient and energy intakes and body composition parameters were outcome measures. All statistical analyses were carried out using SAS and SUDAAN statistical software packages to allow for multistage sample designs.

The US population and its subgroups.

The US population aged ≥4 years (n 13 971) from the National Health and Nutrition Examination Survey 2003–2006, conducted by the National Center for Health Statistics.

In this US population, OJ consumers had lower BMI and healthier lifestyle behaviours (including lower alcohol consumption and smoking as well as higher exercise level) than non-consumers (P < 0·05). After adjusting for covariates, OJ consumers had higher daily intakes of carbohydrate, total sugar, total fat and energy than non-consumers (P < 0·01). However, these linear trends still remained even after OJ was removed from the food list of items consumed. Adult OJ consumers had lower BMI, waist circumference and percentage body fat than non-consumers (P < 0·01), as well as lower odds ratio for overweight and obesity (P < 0·01). These effects were not seen in children and adolescents, where there was no significant difference in BMI, waist circumference and percentage body fat in OJ consumers compared with non-consumers.

OJ consumption was associated with healthier body composition in adults; while there were no significant associations between OJ consumption and body composition in children and adolescents.

A high prevalence of food insecurity has persisted in the USA for the past two decades. Previous studies suggest that the association between food insecurity and obesity may vary by gender and race/ethnicity. We examined whether food insecurity was associated with BMI and obesity within gender and racial/ethnic groups in a large, diverse sample of low-income adults.

A cross-sectional analysis of a large population-based health survey. We compared the distribution of BMI and obesity by food security levels within gender and racial/ethnic categories.

Data were derived from the 2003–2009 waves of the California Health Interview Survey.

The study sample included 35 747 non-elderly adults with households ≤200 % of the federal poverty level.

Among Hispanic men, very low food security was associated with a 1·0 kg/m2 higher BMI (95 % CI 0·3, 1·7 kg/m2) and a 36 % higher prevalence of obesity (95 % CI 17, 58 %) after multivariate adjustment. Among Hispanic women, very low food security was associated with a 1·1 kg/m2 higher BMI (95 % CI 0·4, 1·9 kg/m2) and a 22 % higher prevalence of obesity (95 % CI 8, 38 %). Positive associations were also observed for Asian women and multi-racial men. No significant associations were observed for non-Hispanic whites, African Americans, Asian men or multi-racial women.

Our results suggest that the association of food insecurity and obesity is limited to individuals of certain low-income, minority racial/ethnic groups. Whether targeted interventions to address food insecurity in these individuals may also decrease obesity risk deserves further investigation.

To investigate the predictors of change in physical activity (PA) from early to mid adolescence in a cohort of adolescents.

Prospective, population-based birth cohort study. PA level was evaluated by means of questionnaire, and was analysed in continuous form (min/week) and as a trajectory (inactive–inactive, inactive–active, active–inactive, active–active) based on the cut-off point of 300 min/week.

Pelotas, a city of 340 000 inhabitants in southern Brazil.

Adolescents (n 4120) followed from 11 to 15 years of age.

Maternal PA change and more exposure to outdoors were directly associated with a positive change in PA level (min/week) for both genders. Higher maturation status (among boys) and later menarche were also associated with positive PA change in min/week. Predictors to remain inactive were: maternal PA change (inverse association), more exposure to outdoors, higher socio-economic level, fear of living in the neighbourhood and non-overweight girls. Predictors to become inactive were higher socio-economic level among boys and increase in screen time among girls.

The study demonstrates that social, family, biological, behavioural and environmental factors exert an important role in the PA change among youngsters as they move into adolescence. These findings may be relevant to the design of policies and intervention programmes aimed at promoting PA in teenagers.

The objective of the present study was to investigate the prevalences of overweight and obesity and their association with physical activity pattern among adolescents in northern Iran.

A cross-sectional study.

Babol, northern Iran.

A representative sample of 1200 adolescents aged 12–17 years was recruited. All selected adolescents were interviewed, their leisure-time and sport physical activities were collected by a standard Baecke questionnaire and their height and weight were measured by standard methods. The diagnosis of overweight and obesity was determined by comparing BMI values with the BMI index for age and sex percentiles set by the US Centers for Disease Control and Prevention in 2000.

The prevalences of overweight and obesity were 15·1 % and 8·3 %, respectively. The proportion of obesity was significantly higher in boys than in girls (10·2 % v. 6·5 %, P = 0·028). Overall, the levels of high, moderate and low leisure-time physical activity were 2·9 %, 79·4 % and 17·7 %, respectively. The corresponding levels of high, moderate and low sport physical activity were 17·4 %, 75·2 % and 7·4 %. The levels of leisure-time and sport physical activities were significantly higher among the boys than the girls (P < 0·001). There was also a significant association of studying in private schools and playing computer games with overweight/obesity (P < 0·001). Moderate leisure-time physical activity was unexpectedly associated with a greater risk of overweight/obesity compared with the low level (P = 0·002).

The findings indicate a high prevalence of overweight/obesity in these Iranian adolescents, particularly the boys. The influence of physical activity and diet on overweight/obesity requires further prospective studies.

To examine the association between diet quality and the diagnosis of an internalizing disorder in children and adolescents.

A prospective study examining the relationship between diet quality and mental health. FFQ responses of 3757 children were used to calculate a composite score for diet quality and its four components: variety, adequacy, moderation and balance. Physicians’ diagnoses on internalizing disorders were obtained by linking the children's dietary information to administrative health data. Negative binomial regression models were used to examine the association between diet quality and diagnosis of an internalizing disorder.

The Canadian province of Nova Scotia.

A provincially representative sample of grade 5 students (age 10–11 years).

Diet quality was not found to be associated with internalizing disorder in a statistically significant manner (incidence rate ratio = 1·09; 95 % CI 0·73, 1·63). However, relative to children with little variety in their diets, children with greater variety in their diet had statistically significant lower rates of internalizing disorder in subsequent years (incidence rate ratio = 0·45; 95 % CI 0·25, 0·82).

These findings suggest the importance of variety in children's diet and opportunities in the prevention of adolescent depression and anxiety.

To assess the nutritional quality of lunchtime food consumption among elementary-school children on Prince Edward Island according to the source of food consumed (home v. school).

Students completed a lunchtime food record during an in-class survey. Dietary adequacy was assessed by comparing median micronutrient intakes with one-third of the Estimated Average Requirement; median macronutrient intakes were compared with the Acceptable Macronutrient Distribution Ranges. The Wilcoxon signed rank test was used to assess differences in nutrient intakes according to source of food consumed.

Elementary schools in Prince Edward Island, Canada.

Grade 5 and 6 students (n 1980).

Foods purchased at school were higher in nutrient density for ten micronutrients (Ca, Mg, K, Zn, vitamin A, vitamin D, riboflavin, niacin, vitamin B6 and vitamin B12) compared with packed lunch foods from home, which were higher in three micronutrients (Fe, vitamin C and folate). School lunches provided sufficient protein but were higher in sugar and fat than home lunches. Foods brought from home were higher in carbohydrates, fibre and Na than foods purchased at school.

The overall nutritional quality of lunches was poor, regardless of source. A significant proportion of foods consumed by the students came from home sources; these were lower nutritional quality and were higher in Na than foods offered at school. Findings suggest that improving the dietary habits of school-aged children will require a collaborative effort from multiple stakeholders, including parents.

To investigate iodine status and fish consumption of schoolchildren living in the Red Sea and White Nile regions of Sudan.

Cross-sectional study to determine urinary iodine concentration, visible goitre rate, iodine content of salt and fish consumption.

Port Sudan (Red Sea) and Jabal Awliya (White Nile), Sudan.

Two hundred eighty (n 280) children aged 6–12 years (142 boys, 138 girls).

The median urinary iodine concentration in children from Port Sudan and Jabal Awliya was 553 and 160 μg/l, respectively. Goitre was detected in 17·1 % of children from Port Sudan but only in 1·4 % from Jabal Awliya, The salt samples from Port Sudan contained 150–360 mg iodine (KOI3)/kg salt, whereas those from Jabal Awliya had levels below the detection limit. Despite consuming salt devoid of iodine, children from Jabal Awliya had optimal iodine status. It is plausible that consumption of Nile fish from Jabal Awliya Reservoir, which is a good source of iodine and favoured by the locals, might have provided sufficient iodine. In contrast, children from Port Sudan were at higher risk of iodine-induced hyperthyroidism resulting from consumption of excessively iodised salt.

The findings of the study clearly demonstrated that (i) Sudan still has a problem with iodine nutrition and quality control and monitoring of salt iodisation and (ii) including fish in the diet could provide a sufficient amount of iodine for schoolchildren.

To examine the association between eating in response to hunger and satiety signals (intuitive eating) and BMI. A second objective was to determine whether the hypothesized higher BMI in less intuitive eaters could be explained by the intake of specific foods, speed of eating or binge eating.

Cross-sectional survey. Participants were randomly selected from a nationally representative sampling frame. Eating in response to hunger and satiety signals (termed ‘intuitive eating’), self-reported height and weight, frequency of binge eating, speed of eating and usual intakes of fruits, vegetables and selected high-fat and/or high-sugar foods were measured.

Nationwide study, New Zealand.

Women (n 2500) aged 40–50 years randomly selected from New Zealand electoral rolls, including Māori rolls (66 % response rate; n 1601).

Intuitive Eating Scale (IES) scores were significantly associated with BMI in an inverse direction, after adjusting for potential confounding variables. When controlling for confounding variables, as well as potential mediators, the inverse association between intuitive eating (potential range of IES score: 21–105) and BMI was only slightly attenuated and remained statistically significant (5·1 % decrease in BMI for every 10-unit increase in intuitive eating; 95 % CI 4·2, 6·1 %; P < 0·0 0 1). The relationship between intuitive eating and BMI was partially mediated by frequency of binge eating.

Eating in response to hunger and satiety signals is strongly associated with lower BMI in mid-age women. The direction of causality needs to be investigated in longitudinal studies and randomized controlled trials.

Consuming a variety of fruit and vegetables provides many different micronutrients and bioactive compounds. Whether this contributes to the beneficial association between fruit and vegetables and incident CHD and stroke is unknown.

Prospective population-based cohort study.

The Netherlands.

Men and women (n 20 069) aged 20–65 years. Participants completed a validated 178-item FFQ, including nine fruit and thirteen vegetable items. Variety in fruit and vegetables was defined as the sum of different items consumed at least once per 2 weeks over the previous year. Hazard ratios (HR) for variety in relation to incident CHD and stroke were calculated using multivariable Cox proportional hazards models additionally adjusted for quantity of fruit and vegetables.

Variety and quantity in fruit and vegetables were highly correlated (r = 0·81). Variety was not associated with total energy intake (r = −0·01) and positively associated with nutrient intakes, particularly vitamin C (r = 0·70). During 10 years of follow-up, 245 cases of CHD and 233 cases of stroke occurred. Variety in vegetables (HR per 2 items = 1·05; 95 % CI 0·94, 1·17) and in fruit (HR per 2 items = 1·00; 95 % CI 0·87, 1·15) were not related to incident CHD. Variety in vegetables (HR per 2 items = 0·93; 95 % CI 0·83, 1·04) and in fruit (HR per 2 items = 1·03; 95 % CI 0·89, 1·18) were also not related to incident stroke.

More variety in fruit and vegetable consumption was associated with higher intakes of fruit and vegetables and micronutrients. Independently of quantity, variety in fruit and vegetables was related neither to incident CHD nor to incident stroke.

To review the epidemiological evidence for vegetarian diets, low-meat dietary patterns and their association with health status in adults.

Published literature review focusing primarily on prospective studies and meta-analyses examining the association between vegetarian diets and health outcomes.

Both vegetarian diets and prudent diets allowing small amounts of red meat are associated with reduced risk of diseases, particularly CHD and type 2 diabetes. There is limited evidence of an association between vegetarian diets and cancer prevention. Evidence linking red meat intake, particularly processed meat, and increased risk of CHD, cancer and type 2 diabetes is convincing and provides indirect support for consumption of a plant-based diet.

The health benefits of vegetarian diets are not unique. Prudent plant-based dietary patterns which also allow small intakes of red meat, fish and dairy products have demonstrated significant improvements in health status as well. At this time an optimal dietary intake for health status is unknown. Plant-based diets contain a host of food and nutrients known to have independent health benefits. While vegetarian diets have not shown any adverse effects on health, restrictive and monotonous vegetarian diets may result in nutrient deficiencies with deleterious effects on health. For this reason, appropriate advice is important to ensure a vegetarian diet is nutritionally adequate especially for vulnerable groups.

The serious consequences of obesity and eating disorders (ED), difficulties encountered in treatment and the high prevalence of these conditions are important reasons to develop efforts aimed at their prevention. The implementation of integrated interventions aimed at preventing risk factors for both obesity and ED constitutes a very exciting development. In the present paper we discuss and review the main reasons for an integrated approach to the spectrum of eating- and weight-related problems, which include anorexia nervosa, bulimia nervosa, anorexic and bulimic behaviours, unhealthy dieting practices, body dissatisfaction, binge-eating disorder, overweight and obesity. Given differences between the fields with regard to current perspectives and objectives, key barriers to an integrated approach to prevention are discussed. In order to show the possibilities of development of this approach, we review the main contributions made to date in the fields of both obesity and ED prevention. In particular, environmental approaches in the prevention of obesity and ED are reviewed, given their potential for preventing a broad spectrum of eating- and weight-related problems. Furthermore, several examples of initiatives that have utilized an integrated approach to prevention are discussed.

Narrative review.

We recommend a scenario in which the two fields share knowledge to enhance the difficult work of preventing and treating both ED and obesity.

Following the adoption of food policies replacing unhealthy products by healthy foods in school, the present study tested the effectiveness of an intervention aimed at encouraging high-school students to stay in school for lunch instead of eating in fast-food restaurants.

A 12-week multi-strategy intervention targeting specific determinants of behaviour was evaluated via a quasi-experimental pre- and post-intervention design. A self-administered questionnaire was employed based on the theory of planned behaviour.

An experimental (n 129) and a control school (n 112) in central Canada.

High-school students aged 12 to 17 years.

Compared with control school students, those in the experimental school significantly increased the mean number of days that they stayed in school for lunch (relative risk = 1·55; 95 % CI 1·06, 2·27; P = 0·024), as well as the proportion who remained in school for lunch every day (relative risk = 1·21; 95 % CI 1·04, 1·40; P = 0·014). Among the psychosocial variables targeted, only self-efficacy appeared to be influenced by the intervention, mainly because of a decline in control group values. Mediation analysis indicated a significant mediating effect of self-efficacy on the mean number of days that students stayed in school for lunch (bias-corrected and accelerated point estimate = 0·079; 95 % CI 0·0059, 0·1958).

These results suggest that interventions aimed at enhancing self-efficacy can successfully contribute to students staying in school during lunch time. Such interventions should be considered in obesity prevention programmes adapted to high-school students.