To identify and assess actions by which the catering sector could be engaged in strategies for healthier eating out in Europe.

A SWOT analysis was used to assess the participation of the catering sector in actions for healthier eating out. Caterers subsequently shortlisted essential actions to overcome threats and weaknesses the sector may face when engaging in implementing these actions.

Analysis undertaken in the European Union-supported HECTOR project on ‘Eating Out: Habits, Determinants and Recommendations for Consumers and the European Catering Sector’.

Thirty-eight participants from sixteen European countries reflecting a broad multi-stakeholder panel on eating out in Europe.

The catering sector possesses strengths that allow direct involvement in health promotion strategies and could well capitalise on the opportunities offered. A focus on healthy eating may necessitate business re-orientations. The sector was perceived as being relatively weak in terms of its dependency on the supply of ingredients and lack of financial means, technical capacity, know-how and human resources. To foster participation in strategies for healthier eating out, caterers noted that guidelines should be simple, food-based and tailored to local culture. The focus could be on seasonal foods, traditional options and alternative dishes rather than just on ‘healthy eating’. Small-to-medium-sized enterprises have specific concerns and needs that should be considered in the implementation of such strategies.

The study highlights a number of possible policy actions that could be instrumental in improving dietary intake in Europe through healthier eating out.

To describe and compare food and nutrient intakes in New Zealand (NZ) children on schooldays and non-schooldays.

Secondary analysis of cross-sectional data from the NZ 2002 Children’s Nutrition Survey. Dietary intake was assessed using computer-assisted multi-pass 24 h dietary recalls in the home. Data were adjusted for survey weightings to be representative of the NZ population. The effect of day category on nutrient intake, and likelihood of consumption of food categories were determined using linear and logistic regression.

NZ homes and schools.

A total of 2572 children (538 non-schooldays and 2034 schooldays) at the age of 5–14 years.

There were differences in the proportion consuming some food groups between schooldays and non-schooldays, although the majority of nutrient intakes including energy did not differ by day category. Mean cholesterol intake was higher on non-schooldays; dietary fibre and available carbohydrate, in particular sucrose and fructose, were higher on schooldays. Hot chips were twice as likely to be consumed on a non-schoolday. Soft drink consumption was higher on non-schooldays for Māori/New Zealand European and others and powdered drinks/cordial consumption did not vary by day category. More children consumed snack bars (normal weight, obese), fruit, sandwiches, biscuits/crackers and snack foods on schooldays. There was no difference in consumption of pies/sausage rolls by day category.

The proportion of consumers of a variety of foods differed significantly between non-schooldays and schooldays; few nutrient intakes differed. The present study indicates that family food, wherever it is consumed, is the mainstay of nutrition for NZ schoolchildren.

To assess lunchtime provision of food and drink in English primary schools and to assess both choices and consumption of food and drink by pupils having school lunches. These findings were compared with similar data collected in 2005.

Cross-sectional data collected between February and April 2009. In each school, food and drink provision, including portion weights and number of portions of each item served at lunchtime, were recorded over five consecutive days. Caterers provided school lunchtime menus and recipes.

England.

A random selection of 6696 pupils having school lunches in a nationally representative sample of 136 primary schools in England.

Compared with 2005, schools in 2009 provided significantly more fruit, fruit-based desserts, vegetables and salad, water and fruit juice, and less ketchup, sauces and gravy, starchy foods cooked in fat, snacks and confectionery (P < 0·01). Pupils were also making healthier choices, choosing an average of 2·2 portions of fruit and vegetables from their ‘five a day’, but about one-third to two-fifths of these were wasted.

Lunchtime food provision and consumption in primary schools have improved substantially since 2005, following the introduction of new standards for school food in 2008. However, improvements still need to be made to increase the Fe and Zn content and to decrease the Na content of recipes, and in encouraging pupils to eat more of the fruits and vegetables taken at lunchtime.

The present study evaluated the impact of a national school programme of universal free healthy breakfast provision in Wales, UK.

A cluster randomised controlled trial with repeated cross-sectional design and a 12-month follow-up. Primary outcomes were breakfast skipping, breakfast diet and episodic memory. Secondary outcomes were frequency of eating breakfast at home and at school, breakfast attitudes, rest-of-day diet and class behaviour.

Primary schools in nine local education authority areas.

A total of 4350 students (aged 9–11 years) at baseline and 4472 at follow-up in 111 schools.

Students in intervention schools reported significantly higher numbers of healthy food items consumed at breakfast and more positive attitudes towards breakfast eating at 12 months. Parents in intervention schools reported significantly higher rates of consumption of breakfast at school and correspondingly lower rates of breakfast consumption at home. No other significant differences were found.

The intervention did not reduce breakfast skipping; rather, pupils substituted breakfast at home for breakfast at school. However, there were improvements in children’s nutritional intake at breakfast time, if not the rest of the day, and more positive attitudes to breakfast, which may have implications for life-course dietary behaviours. There was no impact on episodic memory or classroom behaviour, which may require targeting breakfast skippers.

To assess school canteen attendance in a French nationally representative sample of children and to analyse its association with the socio-economic and demographic characteristics of the children and their families.

Data from the second French national cross-sectional food consumption survey (INCA2), performed in 2006–2007, were used. Information on usual weekly school canteen attendance was collected through a self-reported questionnaire, and demographic and socio-economic variables through a face-to-face questionnaire. The associations between school canteen attendance and the socio-economic and demographic variables were investigated by multivariate logistic regression analyses.

The INCA2 sample was representative of the children aged 3–17 years in France.

Analysis was performed on 1413 schoolchildren who completed the school canteen attendance questions.

Some 65·6 % of schoolchildren aged 3–17 years had school lunch at least once weekly. This rate of attendance was positively correlated with age. Whatever the school level, school canteen attendance was positively associated with the educational level of the caregiver/parent. In pre- and elementary-school children, enrolment at the school canteen was also higher when the caregiver/parent worked, or in single-parent families. In secondary-school children, school lunch participation decreased with children living in more densely populated areas and increased with the level of the household’s living standards.

School canteen attendance was positively associated with children’s socio-economic background. This could reduce the effectiveness of the forthcoming school meal composition regulations designed to improve the diet of children from deprived backgrounds, who are more likely to have unhealthy food habits.

The ready-meal market has grown considerably in recent years. At the same time, a degradation of traditional cooking skills has been observed. Ready meals are often rich in energy, fat and sugar and lack vegetables; however, studies investigating associations between ready-meal consumption, overweight and cooking skills are lacking. The present study examines whether demographic factors, overweight, beliefs about the nutritional value and taste of ready meals and cooking skills are associated with ready-meal consumption.

Cross-sectional survey.

Ready-meal consumption, weight status, cooking skills, beliefs about the taste and nutritional value of ready meals and demographic variables were assessed with self-administered questionnaires. Data were analysed with one-way ANOVA and multiple regression analysis.

A total of 1017 adults from the German-speaking part of Switzerland.

Men reported being more positive about ready meals and having fewer cooking skills compared with women. Overweight adults (BMI > 25 kg/m2) were more positive about nutrients and vitamins in ready meals compared with normal-weight adults. Ready-meal consumption was associated with cooking skills (β = −0·192), age (β =− 0·228), overweight (β = 0·129), nutritional value (β = −0·131), taste (β = −0·126), working status (β = 0·096) and gender (β = 0·084).

Cooking skills were identified as a strong predictor of ready-meal consumption. The importance of cooking skills as a barrier to healthy eating should be explored, as it is plausible that cooking skills will further decrease in the future. Next, the study provided evidence for an association between ready-meal consumption and overweight. Further research should examine the importance of ready meals for the overweight epidemic.

To describe self-reported physical activity (PA) patterns in the various domains (school, home, transport, leisure time) and intensity categories (walking, moderate PA, vigorous PA) in European adolescents. Furthermore, self-reported PA patterns were evaluated in relation to gender, age category, weight status category and socio-economic status (SES).

Cross-sectional study.

Ten European cities.

In total, 3051 adolescents (47·6 % boys, mean age 14·8 (sd 1·2) years) completed an adolescent-adapted version of the validated International Physical Activity Questionnaire.

The total sample reported most PA during leisure time (485 min/week) and least PA at home (140 min/week). Boys reported significantly more school-based PA (P < 0·001), leisure-time PA (P = 0·003), vigorous PA (P < 0·001) and total PA (P = 0·002) than girls, while girls reported more home-based PA (P < 0·001) and walking (P = 0·002) than boys. Self-reported PA at school (P < 0·001), moderate PA (P < 0·001), vigorous PA (P < 0·001) and total PA (P < 0·001) were significantly higher in younger age groups than in older groups. Groups based on weight status differed significantly only in leisure-time PA (P = 0·004) and total PA (P = 0·003), while groups based on SES differed in all PA domains and intensities except transport-related PA and total PA.

The total sample of adolescents reported different scores for the different PA domains and intensity categories. Furthermore, patterns were different according the adolescents’ gender, age, weight status and SES.

The present study was undertaken to assess the status of vitamins A and E (VA and VE, respectively) and their main determinants in Tunisian children.

Cross-sectional population-based study.

Kasserine Governorate in the centre west of Tunisia.

A total of 7407 children attending the first grade of elementary school were included. VA and VE were assessed by HPLC.

The prevalence of moderate VA deficiency (VAD; <0·70 μmol/l) was 2·3 % and VE deficiency (VED; <6·97 μmol/l) was 5·4 %. Low status in VA (0·70–1·05 μmol/l) and VE (6·97–11·61 μmol/l) was observed in 17 % and 20·2 % of children, respectively. No child exhibited severe VA or VE deficiency (<0·35 and <2·32 μmol/l, respectively). The main predictors of VAD were advanced age (OR = 1·65; 95 % CI 1·13, 2·41; P = 0·05) and sickness within the past 2 weeks (OR = 1·51; 95 % CI 1·09, 2·09; P = 0·01). Predictors of VED were living in the peri-urban region (OR = 1·60; 95 % CI 1·28, 2·01; P < 0·001) and sickness within the past 2 weeks (OR = 0·75; 95 % CI 0·60, 0·94; P = 0·01).

Moderate VAD and VED were uncommon in Tunisian children. However, low status in VA and/or VE remains frequent. A reinforcement of the national strategies for children's nutrition and health is needed, particularly in disadvantaged regions. Supplementation of VA and VE is not necessary in Tunisia, but food fortification may be beneficial.

To evaluate the relationship between egg consumption and CHD and stroke mortality using the Third National Health and Nutrition Examination Survey 1988–1994 (NHANES III) and follow-up survey.

A cross-sectional survey using a stratified, multi-stage probability sample was analysed, adjusting for survey design. Egg consumption was obtained from the FFQ and separated into categories of egg intake. Hazard ratios (HR) were calculated for CHD and stroke mortality using multivariate Cox regression models.

A health and nutrition survey conducted in the USA from 1988 to 1994 with follow-up through 31 December 2000.

The study population included men and women who were free of CVD and had completed a FFQ at baseline.

Multivariate models adjusting for health, lifestyle and dietary factors indicated that ‘high’ egg consumption (≥7 times/week v. <1 time/week) was not associated with significantly increased CHD mortality (HR = 1·13, 95 % CI 0·61, 2·11 (men); HR = 0·92, 95 % CI 0·27, 3·11 (women)). There was a statistically significant inverse association between ‘high’ egg consumption and stroke mortality among men (HR = 0·27, 95 % CI 0·10, 0·73), but the estimate was imprecise because of sparse data. We did not observe a statistically significant positive association between ‘high’ egg consumption and CHD or stroke mortality in analyses restricted to individuals with diabetes, but these analyses may be limited due to the small number of diabetics.

We did not find a significant positive association between egg consumption and increased risk of mortality from CHD or stroke in the US population. These results corroborate the findings of previous studies.

To describe the lunchtime choices and nutritional intake of primary-school-aged children in England 4 months after the introduction of interim food-based standards for school lunches.

Cross-sectional 2 d weighed food records collected in January and February 2007.

Six primary schools in Sheffield, England.

One hundred and twenty-three pupils aged 8–10 years.

Vegetables (81 % v. 8 %) and cakes and biscuits (43 % v. 23 %) were chosen more frequently by pupils consuming a school lunch, while fruit (40 % v. 36 %), meat products (18 % v. 14 %), confectionery (72 % v. 0 %), savoury snacks (69 % v. 0 %) and drinks not meeting the school food standards (40 % v. 0 %) were chosen more often by pupils eating a packed lunch. Mean energy intake was lower in the school lunch group compared with the packed lunch group (1402 (sd 573) v. 2192 (sd 619), P = 0·005). Nutrient density (per MJ energy) was significantly better in school meals for key nutrients including protein (9·8 (sd 2·7) v. 6·3 (sd 1·9) g), fat (7·4 (sd 2·7) v. 10·6 (sd 2·8) g), NSP (2·8 (sd 1·3) v. 1·1 (sd 0·4) g), vitamin A (151·3 (sd 192·8) v. 69·1 (sd 55·6) μg), folate (29·6 (sd 11·6) v. 17·0 (sd 7·0) μg), iron (1·3 (sd 0·3) v. 0·9 (sd 0·3) mg) and zinc (1·1 (sd 0·4) v. 0·7 (sd 0·3) mg).

Schools were largely compliant with the interim food-based standards for school meals 4 months after their introduction. Within the context of the new standards, children taking a school lunch are more likely to eat a more nutritious lunch, in terms of less high-fat/salt/sugar foods and nutrient density. The introduction of nutrient-based standards is warranted. Efforts to improve the lunchtime intake of children taking a packed lunch are also required.

To assess the public health significance of premature weaning of infants from breast milk on later-life risk of chronic illness.

A review and summary of recent meta-analyses of studies linking premature weaning from breast milk with later-life chronic disease risk is presented followed by an estimation of the approximate exposure in a developed Western country, based on historical breast-feeding prevalence data for Australia since 1927. The population-attributable proportion of chronic disease associated with current patterns of artificial feeding in infancy is estimated.

After adjustment for major confounding variables, current research suggests that the risks of chronic disease are 30–200 % higher in those who were not breast-fed compared to those who were breast-fed in infancy. Exposure to premature weaning ranges from 20 % to 90 % in post-World War II age cohorts. Overall, the attributable proportion of chronic disease in the population is estimated at 6–24 % for a 30 % exposure to premature weaning.

Breast-feeding is of public health significance in preventing chronic disease. There is a small but consistent effect of premature weaning from breast milk in increasing later-life chronic disease risk. Risk exposure in the Australian population is substantial. Approximately 90 % of current 35–45-year-olds were weaned from breast-feeding by 6 months of age. Encouraging greater duration and exclusivity of breast-feeding is a potential avenue for reducing future chronic disease burden and health system costs.

To assess differences in the Healthy Eating Index (HEI) during pregnancy with the pre-gravid and gravid weight status of women.

Cross-sectional.

Athens, Greece.

One hundred pregnant women, inhabitants of Athens.

The mean raw HEI score of the sample was 66·9 (sd 7·6) and the mean HEI adjusted for energy intake was 66·9 (sd 0·6). No difference was recorded between the adjusted HEI and different gravidities, the embryo’s sex, different income categories or education. When HEI was categorised as low, average and adequate, living in an urban residence increased the odds for demonstrating low HEI score (OR = 10·231, 95 % CI 1·300, 80·487). HEI score during pregnancy was significantly higher in participants who were either pre-gravidly underweight or of normal body weight (BW). In relation to the gestational weight status, the highest HEI scores and protein intake were shown in the underweight and of normal BW participants compared with the obese. According to the simple correspondence analysis, adequate HEI was associated with rural residence and being underweight or having normal BW during pregnancy. Low HEI was associated with overweight and obesity during pregnancy, with obesity before pregnancy and living in an urban environment. HEI was negatively correlated to the pre-conceptional and gestational BMI (r = −0·298, P ≤ 0·003 and r = −0·345, P ≤ 0·001) and to the week of gestation (r = −0·285, P ≤ 0·004).

Overall, the HEI of the sample was mediocre. Women who were underweight or of normal BW exhibited a better diet quality compared with obese women; thus the latter consist a population in greater need for supervised nutrition and dietary counselling during pregnancy.

To assess the validity and reproducibility of a self-administered FFQ with eighty-two food items (FFQW82) for assessing the habitual diet in female adolescents.

The validity of the FFQW82 for assessment of nutrient intake was evaluated by comparison with a 7 d weighed food record (7d-FRRI) reported as ‘gold standard’. Reproducibility of the FFQW82 was assessed at an interval of 1 month (test–retest method). The first survey (FFQW82 and 7d-FRRI) was conducted in April 2007 and the second FFQW82 survey was conducted in May 2007. Daily consumption of energy from eleven food groups and nine nutrients were calculated from both instruments for breakfast, lunch, dinner and the whole day. Crude and energy-adjusted Pearson correlation coefficients were calculated using log-transformed data.

Middle school, Tokyo, Japan.

Female adolescents aged 12–13 years.

Sixty-three female adolescents completed both surveys. The relative difference between the energy intake calculated by the FFQW82 and the 7d-FRRI for the whole day, breakfast, lunch and dinner was 8 %, 10 %, 15 % and 10 %, respectively. As for validity, the correlation coefficient of total energy intake for the whole day was 0·31. The result for breakfast was relatively higher (0·59) compared with that for lunch (0·40) and dinner (0·32). For macronutrients, the energy-adjusted correlation coefficient ranged from 0·28 (carbohydrates) to 0·53 (protein). Reproducibility of total energy intake was 0·62 and ranged from 0·46 (fat) to 0·69 (carbohydrate) for macronutrients.

These results suggest that the FFQW82 has proved to have some potential with regard to reproducibility among our study population.

To develop and evaluate a method for calculating the Healthy Eating Index-2005 (HEI-2005) with the widely used Nutrition Data System for Research (NDSR) based on the method developed for use with the US Department of Agriculture’s (USDA) Food and Nutrient Dietary Data System (FNDDS) and MyPyramid Equivalents Database (MPED).

Cross-sectional.

Non-institutionalized, community-dwelling adults aged 70 years and above.

Two hundred and seventy-one adults participating in the Geisinger Rural Aging Study (GRAS) and 620 age- and race-matched adults from the National Health and Nutrition Examination Survey 2001–2002 (NHANES) were included in the analysis. The HEI-2005 scores were generated using NDSR in GRAS and compared to scores generated using FNDDS and MPED in NHANES.

Similar total HEI-2005 scores (mean 62·0 (se 0·75) in GRAS v. 57·4 (se 0·55) in NHANES) were estimated, and the individual components most strongly correlated with total score in both samples were compared. Cronbach’s coefficient α values of HEI-2005 were 0·52 in GRAS and 0·43 in NHANES.

Since NDSR is commonly used for educational purposes, in clinical settings and in nutrition research, it is important to develop methodology for assessing diet quality through the use of HEI-2005 with this dietary analysis software application and its accompanying food and nutrient database. Results from the present study show that HEI-2005 scores can be generated with NDSR using the method described in the present study and the detailed USDA Center for Nutrition Policy and Promotion technical report as guidance.

We aimed to develop, test and describe the Exhaustive Home Food Inventory (EHFI), which measures foods in the home using scanning of the universal product code (UPC) and EHFI software to link codes to food identities and energy values.

Observational design with up to three repeated measures in each household yielded a total of 218 inventories.

Eighty private households in North Carolina.

Low-income African-American women with an infant between the ages of 12 and 18 months. Recruitment rate was 71 %.

Approximately 12 200 different food items were successfully recorded using the EHFI method. The average number of food items within a household was 147. The time required for the first measurement in a home declined from 157 to 136 min (P < 0·05) for the first third compared to the last third of homes measured. In the sixty-four households in which three assessments were performed, the time required decreased from 145 to 97 min as did the time per item from 1·10 to 0·73 min.

It is feasible to record all foods and drinks in the home using UPC scanning. Further development and enhancement of databases linking UPC to food identification, nutrients and other information are needed.

Nutrition is one of the modifiable risk factors of atherosclerosis vascular diseases (VD). We aimed to (i) evaluate the dietary patterns associated with VD in clinical practice using a validated FFQ; and (ii) determine potential independent sociodemographic and behavioural factors that are involved in such dietary patterns. The FFQ determined the vascular dietary score (VDS; ranges from −17 to 19) for each subject.

Cross-sectional study.

A general practitioner's (GP) office in 2009.

A total of 250 French subjects (18–84 years old).

A total of 21 % had a favourable vascular diet (VDS ≥ 8), 79 % needed to improve their diet (VDS < 8) and 21 % had a risky vascular diet (VDS ≤ −1). A step-by-step multivariate linear regression analysis with stepwise selection was performed using the VDS as a dependent variable. Significant variables were: age (β = 0·495, P < 0·0001), men (β = −0·282, P < 0·0001), ‘sport ≥1 h/week’ (β = 0·253, P = 0·001), ‘walking 20 min/d’ (β = 0·161, P = 0·012), ‘former smoker’ (β = 0·118, P = 0·029), previous nutritional advice (β = 0·105, P = 0·049), ‘alcohol ≥20 g/d’ (β = −0·216, P < 0·0001) and ‘primary school’ (β = −0·156, P = 0·010). The R2 coefficient of this model was 0·347 (P < 0·0001). In all, 88·7 % of the subjects found the evaluation very interesting and 89·6 % believed that the GP should perform it.

Simple dietary assessment for VD prevention can be easily performed in clinical practice to allow physicians to give objective and rapid advice for each patient. Age, educational status, alcohol consumption, gender and physical activity are associated with the VDS. Compliance with such evaluation was found to be very high, which should encourage larger dietary screening in the population in order to reduce the impact of VD.

To examine the association between 24 h urinary water-soluble vitamin levels and their intakes in free-living Japanese schoolchildren.

All foods consumed for four consecutive days were recorded accurately by a weighed food record. A single 24 h urine sample was collected on the fourth day, and the urinary levels of water-soluble vitamins were measured.

An elementary school in Inazawa City, Japan.

A total of 114 healthy, free-living, Japanese elementary-school children aged 10–12 years.

The urinary level of each water-soluble vitamin was correlated positively to its mean intake in the past 2–4 d (vitamin B1: r = 0·42, P < 0·001; vitamin B2: r = 0·43, P < 0·001; vitamin B6: r = 0·49, P < 0·001; niacin: r = 0·32, P < 0·001; niacin equivalents: r = 0·32, P < 0·001; pantothenic acid: r = 0·32, P < 0·001; folic acid: r = 0·27, P < 0·01; vitamin C: r = 0·39, P < 0.001), except for vitamin B12 (r = 0·10, P = NS). Estimated mean intakes of water-soluble vitamins calculated using urinary levels and recovery rates were 97–102 % of their 3 d mean intake, except for vitamin B12 (79 %).

The results show that urinary levels of water-soluble vitamins, except for vitamin B12, reflected their recent intakes in free-living Japanese schoolchildren and could be used as a potential biomarker to estimate mean vitamin intake.

Assessment of vitamin D status in a cohort of healthy 10-year-old urban children and the factors that influence vitamin D status in these children.

A cross-sectional study. Blood samples were collected across four seasons of the year for the biochemical determination of serum 25-hydroxyvitamin D [25(OH)D]. Anthropometric measurements (height and weight), BMI and total fat and lean mass (determined by the dual energy X-ray absorptiometry) were measured. 25(OH)D concentrations were assessed by chemiluminescent assay.

Study of children in the Greater Johannesburg area of South Africa who form the Bone Health sub-cohort of the longitudinal Birth to Twenty cohort.

Three hundred and eighty-five children who form the Bone Health sub-cohort of the longitudinal Birth to Twenty cohort.

White children had significantly higher 25(OH)D than their black peers (120·0 (sd 36·6) nmol/l v. 93·3 (sd 34·0) nmol/l, respectively). Seasonal variations in 25(OH)D levels were found only in white children, with 25(OH)D levels being significantly higher in white than in black children during the autumn and summer months. In multiple regression analysis, season, ethnicity, sex and total fat mass were the factors found to have an influence on 25(OH)D. Vitamin D deficiency (7 %) and insufficiency (19 %) were uncommon among the 10-year-old children.

Vitamin D supplementation or fortification is not warranted in healthy children living in Johannesburg. However, further studies need to confirm this in other regions of the country, especially in those living further south and with less sunshine during the winter months.

Vegetarians and vegans exclude certain food sources of vitamin D from their diet, but it is not clear to what extent this affects plasma concentrations of 25-hydroxyvitamin D (25(OH)D). The objective was to investigate differences in vitamin D intake and plasma concentrations of 25(OH)D among meat eaters, fish eaters, vegetarians and vegans.

A cross-sectional analysis.

United Kingdom.

Plasma 25(OH)D concentrations were measured in 2107 white men and women (1388 meat eaters, 210 fish eaters, 420 vegetarians and eighty-nine vegans) aged 20–76 years from the European Prospective Investigation into Cancer and Nutrition (EPIC)–Oxford cohort.

Plasma 25(OH)D concentrations reflected the degree of animal product exclusion and, hence, dietary intake of vitamin D; meat eaters had the highest mean intake of vitamin D (3·1 (95 % CI 3·0, 3·2) μg/d) and mean plasma 25(OH)D concentrations (77·0 (95 % CI 75·4, 78·8) nmol/l) and vegans the lowest (0·7 (95 % CI 0·6, 0·8) μg/d and 55·8 (95 % CI 51·0, 61·0) nmol/l, respectively). The magnitude of difference in 25(OH)D concentrations between meat eaters and vegans was smaller (20 %) among those participants who had a blood sample collected during the summer months (July–September) compared with the winter months (38 %; January–March). The prevalence of low plasma concentrations of 25(OH)D (<25 nmol/l) during the winter and spring ranged from <1 % to 8 % across the diet groups.

Plasma 25(OH)D concentrations were lower in vegetarians and vegans than in meat and fish eaters; diet is an important determinant of plasma 25(OH)D in this British population.