The Dietary Approaches to Stop Hypertension (DASH) dietary pattern has been shown to reduce cardiometabolic risk. Little is understood about the relationship between objective diet quality and perceived diet quality (PDQ), a potential psychosocial barrier to appropriate dietary intake. We compared PDQ and diet quality measured by a nutrient-based DASH index score in the USA.

Cross-sectional study. Participants in the 2005–2006 National Health and Nutrition Examination Survey (NHANES) rated diet quality on a 5-point Likert scale and PDQ scores were generated (low, medium, high). A single 24 h dietary recall was used to estimate DASH index scores (range 0–9 points) by assigning 0, 0·5 or 1 point (optimal) for nine target nutrients: total fat, saturated fat, protein, cholesterol, fibre, Ca, Mg, K and Na.

Nationally representative sample of the US population.

Adults aged ≥19 years in 2005–2006 NHANES (n 4419).

Participants with high PDQ (33 %) had higher DASH index scores (mean 3·0 (sd 0·07)) than those with low PDQ (mean 2·5 (sd 0·06), P < 0·001), but average scores did not align with targets for intermediate or optimal DASH accordance. Adults with high PDQ reported higher total fat, saturated fat and Na intakes compared with optimal DASH nutrient goals. Differences between those with high v. low PDQ were similar for Whites and Blacks, but there was no difference between PDQ groups for Mexican Americans.

Among Whites and Blacks, but not Mexican Americans, high PDQ may be associated with higher diet quality, but not necessarily a diet meeting DASH nutrient goals. This disconnect between PDQ and actual diet quality may serve as a target in obesity prevention.

Health-beneficial effects of adhering to a healthy Nordic diet index have been suggested. However, it has not been examined to what extent the included dietary components are exclusively related to the Nordic countries or if they are part of other European diets as well, suggesting a broader preventive potential. The present study describes the intake of seven a priori defined healthy food items (apples/pears, berries, cabbages, dark bread, shellfish, fish and root vegetables) across ten countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) and examines their consumption across Europe.

Cross-sectional study. A 24 h dietary recall was administered through a software program containing country-specific recipes. Sex-specific mean food intake was calculated for each centre/country, as well as percentage of overall food groups consumed as healthy Nordic food items. All analyses were weighted by day and season of data collection.

Multi-centre, European study.

Persons (n 36 970) aged 35–74 years, constituting a random sample of 519 978 EPIC participants.

The highest intakes of the included diet components were: cabbages and berries in Central Europe; apples/pears in Southern Europe; dark bread in Norway, Denmark and Greece; fish in Southern and Northern countries; shellfish in Spain; and root vegetables in Northern and Central Europe. Large inter-centre variation, however, existed in some countries.

Dark bread, root vegetables and fish are strongly related to a Nordic dietary tradition. Apples/pears, berries, cabbages, fish, shellfish and root vegetables are broadly consumed in Europe, and may thus be included in regional public health campaigns.

Current indices of diet quality generally include intakes of specific foods or nutrients. We sought to develop an index that discriminates healthy and unhealthy eating choices for use in large surveys as a short questionnaire and as a measure in existing studies with adequate dietary data.

The Eating Choices Index (ECI) score included four components: (i) consumption of breakfast, (ii) consumption of two portions of fruit per day, (iii) type of milk consumed and (iv) type of bread consumed, each providing a score from 1 to 5. In analysis of 5 d food records, the ECI score was examined in relation to macronutrients, fibre, vitamin C, Fe, Ca and folate using Pearson correlations. Variation with sex, BMI, socio-economic status, marital status, smoking status and physical activity were also investigated.

Medical Research Council National Survey of Health and Development.

Individuals (n 2256) aged 43 years.

The ECI score (mean 12·3 (sd 3·5)) was significantly positively associated with protein, carbohydrate, fibre, vitamin C, Fe, Ca and folate (r = 0·2–0·5; P < 0·001) and significantly negatively associated with fat intake (r = –0·2; P < 0·001); ECI scores were not correlated with total energy intake. Individuals with a lower ECI score were more likely to be men (P < 0·001), overweight or obese (P < 0·001), have lower socio-economic status (P < 0·001), smoke more (P < 0·001) and be less physically active (P < 0·001).

ECI scores correlated with nutrient profiles consistent with a healthy diet. It provides a simple method to rank diet healthiness in large observational studies.

To explore multiple methods of calculating diet diversity scores (DDS) to maximize associations with predicted dietary micronutrient adequacy among schoolchildren in rural Kenya.

Up to three 24 h recall interviews were administered for each child for a total of 1544 d of intake from all schoolchildren. Daily amounts of food consumed were assigned to one of eight food groups. Five DDS were developed based on various minimum intake amounts from each food group: (i) 1 g; (ii) 15 g; (iii) a variable minimum based on the content of a target nutrient for each group; (iv) the median intake level for each group; and (v) the 90th percentile intake level for each group. A diet was assigned 1 point towards the daily DDS if the food group intake was above the defined minimum level. Five scores were calculated for each child, and bivariate longitudinal random-effects models were used to assess the correlation between each DDS and the mean probability of adequacy for fourteen nutrients.

Embu District, Kenya.

Schoolchildren (n 529), mean age 7·00 (sd 1·41) years.

Only DDS based on a 15 g minimum and DDS based on nutrient content were significantly associated with mean probability of adequacy after adjusting for energy intake (0·21 and 0·41, respectively).

A DDS using minimum intakes based on nutrients contributed by a food group best predicted nutrient adequacy in this population. These analyses contribute to the continued search for simpler and more valid dietary quality indicators among low-income nations.

Data-driven approaches to dietary patterns are under-utilized; latent class analyses (LCA) are particularly rare. The present study used an LCA to identify subgroups of people with similar dietary patterns, explore changes in dietary patterns over a 10-year period and relate these dynamics to sociodemographic factors and health outcomes.

The 1998 baseline and 2008 follow-up of the Cork and Kerry Diabetes and Heart Disease Study. Diets were assessed with a standard FFQ. LCA, under the assumption of conditional independence, was used to identify mutually exclusive subgroups with different dietary patterns, based on food group consumption.

Republic of Ireland.

Men and women aged 50–69 years at baseline (n 923) and at 10-year follow-up (n 320).

Three dietary classes emerged: Western, Healthy and Low-Energy. Significant differences in demographic, lifestyle and health outcomes were associated with class membership. Between baseline and follow-up most people remained ‘stable’ in their dietary class. Most of those who changed class moved to the Healthy class. Higher education was associated with transition to a healthy diet; lower education was associated with stability in an unhealthy pattern. Transition to a healthy diet was associated with higher CVD risk factors at baseline: respondents were significantly more likely to be smokers, centrally obese and to have hypertension (non-significant).

LCA is useful for exploring dietary patterns transitions. Understanding the predictors of longitudinal stability/transitions in dietary patterns will help target public health initiatives by identifying subgroups most/least likely to change and most/least likely to sustain a change.

Due to rising rates of obesity globally, the present study aimed to examine differences in overweight and underweight prevalence in Western Australian schoolchildren in 2008 compared with 2003.

Cross-sectional study at two time points; using two-stage stratified sampling, primary and secondary schools in both metropolitan and non-metropolitan Western Australia; sample selected was representative of the State's population figures.

Seventeen primary and thirteen secondary (2008) and nineteen primary and seventeen secondary (2003) schools. Government and non-government funded schools in metropolitan and non-metropolitan (regional/rural) Western Australia were recruited.

Height and weight were measured for 1708 (961 primary and 747 secondary) students in 2008 and 1694 (876 primary and 817 secondary) students in 2003.

Overweight and obesity prevalence in primary students was similar in 2008 (22·9 %) to 2003 (23·2 %; P > 0·05). In secondary girls overweight and obesity prevalence dropped from 23·1 % (2003) to 15·9 % (2008; P = 0·002). Secondary boys showed a slight decrease in overweight and obesity prevalence; however, this was not statistically significant (P = 0·102). Higher proportions of underweight in primary girls were observed in 2008 (9·9 %) compared with 2003 (4·2 %; P < 0·001) and in secondary girls in 2008 (9·4 %) compared with 2003 (5·5 %; P < 0·001).

Prevalence of overweight and obesity in Western Australian primary students was stable; however, it declined in secondary students. Both primary and secondary girls showed an increase in underweight prevalence. Public health interventions are needed for the high percentage of youth still overweight, whereas the observed increase in underweight girls warrants attention and further investigation.

To explore the influences of migration to a Western country on obesity and related risk factors by comparing measures of body composition and energy balance-related behaviours between Turkish adolescents in Turkey (TR-TR) and adolescents from Turkish immigrant ethnicity in the Netherlands (TR-NL).

Cross-sectional survey or baseline intervention data from six Dutch school-based studies and one Turkish study.

Primary and secondary schools.

A total of 915 (49 % girls; mean age 13·1 (sd 0·8) years) TR-TR adolescents and 433 (51 % girls; mean age 11·7 (sd 1·3) years) TR-NL adolescents were included. Outcome measures were self-reported sugar-containing beverage consumption, fruit and vegetable intake, screen time, physical activity, measured body height and weight, BMI, waist and hip circumferences, and skinfold thicknesses.

Our data showed that more TR-NL adolescents were overweight (31 % v. 26 %) and obese (9 % v. 6 %) and had significantly higher mean BMI (21·1 v. 20·0 kg/m2), waist circumference (72·2 v. 71·3 cm) and suprailiac skinfold thickness (19·8 v. 13·1 mm) than TR-TR adolescents. TR-NL adolescents reported significantly higher sugar-containing beverage consumption (1173 v. 115 ml/d), less fruit and vegetable intake (295 v. 647 g/d), less screen time (253 v. 467 min/d) and higher physical activity levels (61 v. 27 min/d) than TR-TR adolescents.

Immigrant adolescents in the Netherlands were more often overweight and had a less favourable dietary pattern than their peers in Turkey, while their physical activity and screen time patterns were more favourable. These results suggest that adolescents from Turkish immigrant ethnicity in the Netherlands have adopted lifestyles towards the host culture.

The aim of the present work was to determine what dietary assessment method can provide a valid and accurate estimate of nutrient intake by comparison with the gold standard.

A MEDLINE, EMBASE, ISI Web of Science, Cochrane and related references literature review was conducted on dietary assessment methods for adolescents reporting the validity and/or reproducibility values. A study quality assessment on the retrieved FFQ was carried out according to two different scoring systems, judging respectively the quality of FFQ nutrition information and of FFQ validation and calibration.

The present review considered adolescents attending high schools and recruited in hospitals or at home.

The target of the review was the healthy adolescent population in the age range 13–17 years.

Thirty-two eligible papers were included and analysed separately as ‘original articles’ (n 20) and ‘reviews’ (n 12). The majority (n 17) assessed the validation and reproducibility of FFQ. Almost all studies found the questionnaires to be valid and reproducible (r > 0·4), except for some food groups and nutrients. Different design and validation issues were highlighted, such as portion-size estimation, number of food items and statistics used.

The present review offers new insights in relation to the characteristics of assessment methods for dietary intake in adolescents. Further meta-analysis is required although the current review provides important indications on the development of a new FFQ, addressing the need for a valid, reproducible, user-friendly, cost-effective method of accurately assessing nutrient intakes in adolescents.

To simplify body weight measurement and, particularly, to encourage children and their parents to participate in the Italian nutritional surveillance system OKkio alla SALUTE, children were measured with clothes and then the weight was corrected for the estimated weight of the clothes. In the present study we compared the children's weight measured in underwear, as recommended by the WHO (WWHO), with that obtained using the OKkio alla SALUTE protocol (WOK) and investigated how the latter affects the calculation of BMI and the assessment of overweight and obesity prevalence.

Weight (twice in close sequence, with and without clothing) and height were measured. A checklist was used to describe the type of clothing worn. The estimated weight of clothing was subtracted from the WOK. BMI was calculated considering both values of weight and height; ponderal status was defined using both the International Obesity Task Force and WHO BMI cut-offs.

Thirty-seven third grade classes of thirteen primary schools in Rome and in two towns in the Lazio Region were recruited.

The anthropometric measurements were taken on 524 children aged 8–9 years.

The error in the calculation of BMI from WOK was very low, 0·005 kg/m2 (95 % CI −0·185, 0·195 kg/m2); the agreement between the percentages of overweight (not including obesity) and obese children calculated with the two methods was very close to 1 (κ = 0·98).

The error in BMI and in nutritional classification can be considered minor in a surveillance system for monitoring overweight/obesity, but eases the procedure for measuring children.

The current study characterizes associations between physical and social contexts of self-reported primary episodes of eating/drinking and sociodemographic and obesity-related variables in US adults.

Multinomial logistic regression was used to analyse a nationally representative sample of adults from the 2006–2008 American Time Use Survey. Models identifying physical (where) and social (whom) contexts of primary eating/drinking episodes at the population level, controlling for demographic characteristics, weight status and time of eating, were conducted.

USA.

A nationally representative sample of US adults (n 21 315).

Eating/drinking with immediate family was positively associated with age (OR = 1·15 (95 % CI 1·04, 1·27) to 1·23 (95 % CI 1·09, 1·39)), education level (OR = 1·16 (95 % CI 1·03, 1·30) to 1·36 (95 % CI 1·21, 1·54)), obesity (OR = 1·13 (95 % CI 1·04, 1·22)), children in the household (OR = 3·39 (95 % CI 3·14, 3·66)) and time of day (OR = 1·70 (95 % CI 1·39, 2·07) to 5·73 (95 % CI 4·70, 6·99)). Eating in the workplace was negatively associated with female gender (OR = 0·65 (95 % CI 0·60, 0·70)) and children in the household (OR = 0·90 (95 % CI 0·83, 0·98)), while positively associated with non-white status (OR = 1·14 (95 % CI 1·01, 1·29) to 1·47 (95 % CI 1·32, 1·65)) and time of day (OR = 0·25 (95 % CI 0·28, 0·30) to 5·65 (95 % CI 4·66, 6·85)). Women (OR = 0·80 (95 % CI 0·74, 0·86)), those aged >34 years (OR = 0·48 (95 % CI 0·43, 0·54) to 0·83 (95 % CI 0·74, 0·93)) and respondents with children (OR = 0·69 (95 % CI 0·63, 0·75)) were less likely to eat in a restaurant/bar/retail than at home. Overweight and obese respondents had a greater odds of reporting an episode of eating in social situations v. alone (e.g. immediate family and extended family; OR = 1·13 (95 % CI 1·04, 1·22)) and episodes occurring in restaurant/bar/retail locations (OR = 1·12 (95 % CI 1·03, 1·23) to 1·14 (95 % CI 1·05, 1·24)).

Findings underscore the multidimensional nature of describing eating/drinking episodes. Social and physical contexts for eating/drinking and their demographic correlates suggest opportunities for tailoring interventions related to diet and may inform intervention targeting and scope.

We compared the dietary behaviour of three different household types and explored developmental trends in food choices following a life event.

The study is based on data from three Swiss Food Panel survey periods. A cross-sectional comparison between household types was conducted by using a one-way independent ANOVA. Repeated measures were analysed with a mixed ANCOVA to examine changes in dietary behaviour following a life event.

Participants in the survey filled in a questionnaire in the years 2010, 2011 and 2012.

The final sample consisted of 3559 persons with a mean age of 56 years (range 22–94 years; 46 % men). Seventy-two people moved in with their partner and sixty-five people reported the birth of their first child.

Cross-sectional evidence confirmed that women living in households with a partner reported higher consumption frequencies for meat and processed meats compared with those living alone. Men living in cohabitation had a higher vegetable intake. The transitional effect of moving in with a partner, however, resulted in a higher intake of processed meats for both genders and a higher intake of pork and savoury items for men. Transition to motherhood was linked to an increase in vegetable consumption, while the transition to fatherhood did not change consumption patterns significantly.

Individuals in life-stage transitions are more likely to change their nutritional strategies and life events can be a window of opportunity for changes towards better food choices.

To verify associations of income and education with nutrient intakes in Brazilian adults.

Data from the population-based National Dietary Survey conducted in 2008–2009. Family per capita income and education levels were categorized into quartiles. Prevalences of inadequate nutrient intakes and excessive intakes of saturated fat and Na were calculated by using the method prescribed by the National Cancer Institute. The Estimated Average Requirement was used as a reference for micronutrient intake. Linear regression models for both the independent and the mutually adjusted associations of education and income with nutrient intakes were tested. Interaction between education and income was tested.

Households (n 13 569) selected using a two-stage cluster sampling design.

Food records for two non-consecutive days were obtained for 21 003 Brazilian adults (aged 20–59 years).

For most of eleven nutrients, the prevalence of inadequate intake declined with increasing income and education levels; however, it remained high across all income and education quartiles. Excessive intake of saturated fat and low fibre intake increased with both variables. Most nutrients were independently associated with income and education in both sexes. Fe, vitamin B12 and Na intakes among women were associated only with education. There was an interaction between income and education for Na intake in men, P intake in women and Ca intake in both sexes.

Education is one important step to improve nutrient intakes in Brazil. Emphasis should be laid on enhancing dietary knowledge and formulating economic strategies that would allow lower-income individuals to adopt a healthy diet.

To assess the association between socio-economic position (SEP) and poor eating behaviours in a large representative sample of Australian secondary-school students.

Cross-sectional survey of students’ vegetable, fruit, sugar-sweetened beverage and fast-food consumption assessed using validated instruments and collected via a web-based self-report format.

Secondary schools across all Australian states and territories.

Secondary-school students (n 12 188; response rate: 54 %) aged 12–17 years participating in the 2009–10 National Secondary Students’ Diet and Activity (NaSSDA) survey.

Overall, 25 % of students reported consuming ≤1 serving of vegetables/d and 29 % reported eating ≤1 serving of fruit/d. Fourteen per cent of students reported drinking at least 1–2 cups of sugar-sweetened beverages/d while 9 % reported eating fast food ≥3 times/week. After adjusting for other demographic factors, students of lower-SEP areas were more likely to report low intake of vegetables (F(4, 231) = 3·61, P = 0·007) and high frequency of consumption of sugar-sweetened beverages (F(4, 231) = 8·41, P < 0·001) and fast food (F(4, 231) = 4·59, P = 0·001) compared with students of high-SEP neighbourhoods. A positive SEP association was found for fruit consumption among female students only (F(4, 231) = 4·20, P = 0·003). Those from lower-SEP areas were also more likely to engage in multiple poor eating behaviours (F(4, 231)=5·80, P < 0·001).

Results suggest that socio-economic disparities in Australian adolescents’ eating behaviours do exist, with students residing in lower-SEP neighbourhoods faring less well than those from high-SEP neighbourhoods. Reducing social inequalities in eating behaviours among young people should be a key consideration of future preventive strategies.

Maternal depressive symptoms negatively impact mothers’ parenting practices and children's development, but the evidence linking these symptoms to children's obesity is mixed.

We use a large sample to examine contemporaneous and lagged associations between maternal depressive symptoms and children's BMI, obesity and food consumption, controlling for background characteristics.

Data from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), a longitudinal study of children from infancy through kindergarten in the USA, were collected at four waves from 2001 to 2007, when children were 9 months, 2 years, 4 years and 5½years of age, through surveys, child assessments and observations.

A sub-sample of children from the ECLS-B is used (n 6500).

Between 17 % and 19 % of mothers reported experiencing depressive symptoms; 17 % to 20 % of children were obese. Maternal depressive symptoms were associated with a small decrease in the likelihood her child was obese (0·8 percentage points) and with lower consumption of healthy foods. The duration of maternal depressive symptoms was associated with higher BMI (0·02 sd) among children whose parents lacked college degrees.

Results indicate that mothers’ depressive symptoms have small associations with children's food consumption and obesity. Among children whose parents lack college degrees, persistent maternal depressive symptoms are associated with slightly higher child BMI. Findings highlight the need to control for depression in analyses of children's weight. Interventions that consider maternal depression early may be useful in promoting healthy weight outcomes and eating habits among children.

To update previous meta-analyses of cohort studies that investigated the association between the Mediterranean diet and health status and to utilize data coming from all of the cohort studies for proposing a literature-based adherence score to the Mediterranean diet.

We conducted a comprehensive literature search through all electronic databases up to June 2013.

Cohort prospective studies investigating adherence to the Mediterranean diet and health outcomes. Cut-off values of food groups used to compute the adherence score were obtained.

The updated search was performed in an overall population of 4 172 412 subjects, with eighteen recent studies that were not present in the previous meta-analyses.

A 2-point increase in adherence score to the Mediterranean diet was reported to determine an 8 % reduction of overall mortality (relative risk = 0·92; 95 % CI 0·91, 0·93), a 10 % reduced risk of CVD (relative risk = 0·90; 95 % CI 0·87, 0·92) and a 4 % reduction of neoplastic disease (relative risk = 0·96; 95 % CI 0·95, 0·97). We utilized data coming from all cohort studies available in the literature for proposing a literature-based adherence score. Such a score ranges from 0 (minimal adherence) to 18 (maximal adherence) points and includes three different categories of consumption for each food group composing the Mediterranean diet.

The Mediterranean diet was found to be a healthy dietary pattern in terms of morbidity and mortality. By using data from the cohort studies we proposed a literature-based adherence score that can represent an easy tool for the estimation of adherence to the Mediterranean diet also at the individual level.

The present research aimed to compare historic participation in the US National School Lunch Program (NSLP) during childhood and subsequent prevalence of overweight and obesity among adults at the population level.

Regression models examined cross-sectional, state- and age-based panel data constructed from multiple sources, including the Behavioural Risk Factor Surveillance System, US Congressional Record, US Census and the US Department of Agriculture. Models controlled for cohorts’ racial/ethnic composition and state poverty rates.

Adult-age cohorts (18–34, 35–49, 50–64 and 18–64 years) by US state over a 25-year period (1984–2008).

The cohorts’ prevalence of overweight and obesity was compared with the cohorts’ estimated NSLP participation during schooling (1925–2007; the NSLP began in 1946).

Among adults aged 18–64 years, a one percentage-point increase in estimated NSLP participation during schooling between 1925 and 2007 was significantly associated with a 0·29 percentage-point increase in the cohort's later prevalence of overweight and obesity. Analysis of narrower age cohorts and different schooling periods produced mixed results.

The NSLP might have influenced population health historically. Longitudinal analysis of individuals from studies now underway will likely facilitate more robust conclusions about the NSLP's long-term health impact based on more recent experiences.

Insulin resistance is a significant cross-point for the manifestation of several chronic diseases in children and adults. The aim of the present study was to investigate the possible relationship of certain dietary patterns and breakfast consumption habits with insulin resistance in children.

A representative sample of 1912 schoolchildren (aged 9–13 years) participated in a cross-sectional epidemiological study, the Healthy Growth Study, which was initiated in May 2007 and completed in June 2009.

It was conducted in seventy-seven primary schools in four large regions in Greece.

Dietary intake, breakfast consumption, anthropometric and physical examination data, biochemical indices and socio-economic information collected from parents were assessed in all children. Principal components analysis was used to identify dietary patterns.

A dietary pattern of increased consumption of margarine, sweets (candies, lollipops, jellies, traditional fruit in heavy syrup) and savoury snacks (chips, cheese puffs and not home-made popcorn) was associated with homeostasis model assessment of insulin resistance index (HOMA-IR; β = 0·08, P < 0·001) in multivariate models. Children in the third tertile of this dietary pattern had a 2·51 (95 % CI 1·30, 4·90) times higher risk of insulin resistance (HOMA-IR > 3·16) than those in the first tertile. Breakfast consumption had an inverse correlation with insulin resistance, but the correlation lost its significance after adjustments for waist circumference, birth weight, parental BMI and socio-economic status.

Increased consumption of margarine, sweets and savoury snacks, which is a common dietary pattern in childhood, was positively associated with insulin resistance, while breakfast consumption had an inverse association with HOMA-IR, in schoolchildren (aged 9–13 years). Identification of dietary behaviours that might affect insulin resistance in children offers valuable advice in cardiometabolic risk prevention strategies.