To examine the association between BMI and folate concentrations in serum and red blood cells (RBC) in pregnant women.

A cross-sectional comparison of folate concentrations in serum and RBC sampled simultaneously from the same individual.

The Ottawa Hospital and Kingston General Hospital, Ontario, Canada.

Pregnant women recruited between 12 and 20 weeks of gestation.

A total of 869 pregnant women recruited from April 2008 to April 2009 were included in the final analysis. Serum folate was inversely associated and RBC folate positively associated with BMI, after adjusting for folic acid supplementation, age, gestational age at blood sample collection, race, maternal education, annual income, smoking and MTHFR 677C→T genotype. In stratified analyses, this differential association was significant in women with the MTHFR CC variant. In women with the CT and TT variants, the differential associations were in the same direction but not significant. Folic acid supplementation during pregnancy did not alter the differential association of BMI with serum and RBC folate concentration. This indicates that the current RBC folate cut-off approach for assessing risk of neural tube defects in obese women may be limited.

BMI is inversely associated with serum folate and positively associated with RBC folate in pregnant women, especially for those with the MTHFR CC variant.

School lunch programmes are one strategy to promote healthier dietary habits in children, but better evaluation tools for assessing the dietary quality of such programmes are needed. The aim of the present study was to develop and validate a simple index to assess the dietary quality of school lunches for children aged 7–13 years.

A Meal Index of dietary Quality (Meal IQ) was developed to consist of seven components (nutrients and food groups) based on dietary issues for children aged 7–13 years, which were identified in a national dietary survey. The Meal IQ was validated against calculated nutrient contents of school lunches both provided by the school and brought from home.

At eight public schools from all over Denmark, data were collected on 191 individual lunches brought from home (which is most common in Denmark) and thirty-one lunches provided as part of a school food programme. In addition thirty-two lunches provided at eighteen other public schools were included.

A total of 254 school lunches.

A higher Meal IQ score was associated with a higher overall dietary quality, including lower contents of fat, saturated fat and added sugars, higher contents of fibre, various vitamins and minerals, and more fruits, vegetables and fish.

The Meal IQ is a valid and useful evaluation tool for assessing the dietary quality of lunches provided by schools or brought to school from home.

Despite the trend of increasing prevalence of childhood anaemia in Armenia, no studies exploring its risk factors have been conducted in the country. The present study aimed to investigate the prevalence and determinants of childhood anaemia in rural Armenia.

Blood Hb level was measured among a representative sample of children using the HemoCue Hb201+ analyser. The revealed cases with anaemia were compared with randomly selected non-anaemic controls. Mothers of cases and controls were interviewed. Logistic and linear regression models were fitted to identify the risk factors of anaemia and low Hb level, respectively.

Talin communities, Aragatsotn Province, Armenia.

Children under 5 years of age in Talin region.

Of the 729 studied children, 32·4 % were anaemic with 14·7 % having moderate/severe anaemia. Infants were the most affected group with 51·1 % being anaemic before 6 months and 67·9 % at 6–12 months of age. Fitted regression models identified the following predictors of anaemia: younger age, male gender, shorter birth length, anaemia during pregnancy, lower meal frequency per day, lack of meat in the diet, using dung cakes for heating and living in a community that received an incomplete set of nutrition interventions.

The study identified several modifiable risk factors that could be targeted to reduce childhood anaemia in rural Armenia and, possibly, in rural areas in other low-/middle-income countries. The suggested interventions include prevention and treatment of anaemia during pregnancy, provision of adequate complementary feeding to children with inclusion of meat in their daily diet and reduction of their exposure to biomass fuel smoke.

Nutrition evaluation tools should be developed both for scientific purposes and to encourage and facilitate healthy nutritional practices. The purpose of the present study was to develop and validate a simple food-based Healthy Meal Index (HMI) reflecting the nutritional profile of individual canteen meals.

The development process included overall model selection, setting nutritional goals and defining scoring systems and thresholds. Three index components were included: (i) contents of fruit and vegetables, (ii) fat content and quality and (iii) contents of wholegrain products and potatoes. The development was built on the principles embodied by the Plate Model, but providing more specificity in some areas. The simple HMI was validated against weighed and chemically analysed food and nutrient content of a representative sample of canteen meals. The sample was split into four categories according to the total index score and compared across categories.

A total of 180 meals from fifteen worksite canteens.

Average energy density decreased significantly across categories (from 876 kJ/100 g to 537 kJ/100 g, P < 0·001). Also, the content of total and saturated fat, carbohydrate and fruit and vegetables varied across categories with higher score values being closer to dietary guidelines (P < 0·001).

The simple HMI was successful in ranking canteen meals according to their nutritional quality. The index provides a valuable tool to both researchers and food and nutrition professionals, e.g. caterers and dietitians, who wish to evaluate nutritional quality of meals in line with the recommendations for healthier eating without the use of nutrition calculation programs.

To investigate the magnitude and distribution of concurrent overweight/obesity and anaemia among adult women, adolescent girls and children living in low- and middle-income countries (LMIC).

We selected the most recent Demographic and Health Surveys with anthropometric and Hb level measures. Prevalence estimates and 95 % CI of concurrent overweight/obesity and anaemia were calculated for every country, overall and stratified by household wealth quintile, education level, area of residence and sex (for children only). Regional and overall pooled prevalences were estimated using a random-effects model. We measured gaps, expressed in percentage points, to display inequalities in the distribution of the double burden of malnutrition (DBM).

Nationally representative surveys from fifty-two LMIC.

Adult women (n 825 769) aged 20–49 years, adolescent girls (n 192 631) aged 15–19 years and children (n 391 963) aged 6–59 months.

The pooled prevalence of concurrent overweight/obesity and anaemia was 12·4 % (95 % CI 11·1, 13·7) among adult women, 4·5 % (95 % CI 4·0, 5·0) among adolescent girls and 3·0 % (95 % CI 2·7, 3·3) among children. Overall, the DBM followed an inverse social gradient, with a higher prevalence among the richest quintile, most educated groups and in urban areas; however, important variations exist. The largest inequality gaps were observed among adult women in Yemen by household wealth (24·0 percentage-points) and in Niger by education level (19·6 percentage-points) and area of residence (11·9 percentage-points). Differences were predominantly significant among adult women, but less among girls and children.

Context-specific, multifaceted, responses with an equity lens are needed to reduce all forms of malnutrition.

With the intention to inform future public health initiatives, we aimed to determine the extent to which typical childhood dietary trajectories predict adolescent cardiovascular phenotypes.

Longitudinal study. Exposure was determined by a 4 d food diary repeated over eight waves (ages 4–15 years), coded by Australian Dietary Guidelines and summed into a continuous diet score (0–14). Outcomes were adolescent (Wave 8, age 15 years) blood pressure, resting heart rate, pulse wave velocity, carotid intima-media thickness, retinal arteriole-to-venule ratio. Latent class analysis identified ‘typical’ dietary trajectories from childhood to adolescence. Adjusted linear regression models assessed relationships between trajectories and cardiovascular outcomes, adjusted for a priori potential confounders.

Community sample, Melbourne, Australia.

Children (n 188) followed from age 4 to 15 years.

Four dietary trajectories were identified: unhealthy (8 %); moderately unhealthy (25 %); moderately healthy (46 %); healthy (21 %). There was little evidence that vascular phenotypes associated with the trajectories. However, resting heart rate (beats/min) increased (β; 95 % CI) across the healthy (reference), moderately healthy (4·1; −0·6, 8·9; P=0·08), moderately unhealthy (4·5; −0·7, 9·7; P=0·09) and unhealthy (10·5; 2·9, 18·0; P=0·01) trajectories.

Decade-long dietary trajectories did not appear to influence macro- or microvascular structure or stiffness by mid-adolescence, but were associated with resting heart rate, suggesting an early-life window for prevention. Larger studies are needed to confirm these findings, the threshold of diet quality associated with these physiological changes and whether functional changes in heart rate are followed by phenotypic change.

Availability of confectionery from vending machines in secondary schools provides a convenient point of purchase. There is concern that this may lead to ‘over-indulgence’ and hence an increase in susceptibility to obesity and poor ‘dietary quality’. The study objective was to investigate the association between the frequency of consumption of confectionery purchased from vending machines and other sources and related lifestyle factors in adolescent boys and girls.

A secondary school-based, cross-sectional study.

A total of 504 subjects were investigated (age range 12–15 years), from three schools in southern and northern England. Using a lifestyle questionnaire, frequency of confectionery consumption (CC) from all sources (AS) and vending machines (VM) was recorded for a typical school week. Subjects were categorised into non-consumers, low, medium and high consumers using the following criteria: none, 0 times per week; low, 1–5 times per week; medium, 6–9 times per week; high, 10 times per week or greater.

No differences were found in the frequency of CC from AS or VM between those who consumed breakfast and lunch and those who did not. No differences were found in the frequency of fruit and vegetable intake in high VM CC vs. none VM CC groups, or in any of the VM CC groups. Confectionery consumption from AS (but not VM) was found to be higher in subjects who were physically active on the journey to school (P <0.01) but also higher in those who spent more time watching television and playing computer games (P <0.01). No associations were found between smoking habits or alcohol consumption and frequency of CC.

These results do not show a link between consumption of confectionery purchased from vending machines and ‘poor’ dietary practice or ‘undesirable’ lifestyle habits. Findings for total confectionery consumption showed some interesting trends, but the results were not consistent, either for a negative or positive effect.

To assess the nutritional status and risk factors of undernutrition in post-menarcheal girls in rural northern Bangladesh.

Cross-sectional data on anthropometric measurements, dietary intake, work activity, morbidity and socio-economic status were collected from 12- to 19-year-old primigravidae (n 209) and never-pregnant adolescents (n 456) matched on age and time since menarche. Multiple regression analyses were conducted to determine predictors of stunting, thinness, upper-arm muscle (UAMZ) and fat area Z-scores (UAFZ) among the adolescent girls.

A large proportion of adolescents (49 %) were stunted (height-for-age Z-score <−2) and underweight (40 %; weight-for-age Z-score <−2), but not thin (BMI-for-age <5th percentile; ∼10 %). The mean (sd) UAMZ and UAFZ of the adolescent girls was −0·3 (0·64) and −0·9 (0·40), respectively. Lean mass increased whereas fat mass declined with age. Both stunting and thinness were positively associated with age and time since menarche (P < 0·05). Young age (12–14 years) and literacy were protective against stunting among pregnant adolescents (OR = 0·29, 95 % CI 0·09, 0·88 and OR = 0·50, 95 % CI 0·26, 0·96, respectively). Having symptoms of diarrhoea or dysentery (OR = 7·40, 95 % CI 1·43, 38·29) predicted thinness and was associated with lower UAMZ and UAFZ among never-pregnant girls (both P < 0·05). Performing light-to-moderate activities was protective against thinness among never-pregnant girls (OR = 0·43, 95 % CI 0·22, 0·82), whereas pregnant adolescents who performed high levels of strenuous activities had greater UAMZ (P < 0·05).

Undernutrition was widespread among this post-menarcheal adolescent population. Younger and literate adolescents were less likely to be stunted, whereas thinness and body composition were associated with morbidity and work activity.

To analyse the alcohol consumption behaviour of the German adult population, with a focus on the characteristics of persons drinking more than the tolerable upper alcohol intake level (TUAL) of 10–12 g day−1 for healthy adult women and 20–24 g day−1 for healthy adult men.

Design and setting: For the German National Health Interview and Examination Survey 1998, a representative sample of free-living adults was drawn. A total of 7124 participants were interviewed comprehensively about their sociodemographic background, lifestyle and eating habits including alcohol consumption.

A sub-sample of 4030 women and men, 18–79 years old, who were involved in the integrated German Nutrition Survey.

About 16% of women and 31% of men had mean alcohol consumption above the TUAL. Among other factors, the inclination to exceed the TUAL was related to middle-age, high socio-economic status, smoking and use of soft drugs. Among both women and men, a high proportion of persons drinking above the TUAL was observed among those consuming low amounts of soft drinks, fruit, poultry, milk products, bread and cake/biscuits. Women preferred to drink wine, whereas men preferred to drink beer.

Many Germans have an alcohol consumption level above the TUAL and thus are supposed to be at increased risk for alcohol-associated diseases.

To identify correlates of anaemia during the first trimester of pregnancy among 366 urban South Indian pregnant women.

Cross-sectional study evaluating demographic, socio-economic, anthropometric and dietary intake data on haematological outcomes.

A government maternity health-care centre catering predominantly to the needs of pregnant women from the lower socio-economic strata of urban Bangalore.

Pregnant women (n 366) aged ≥18 and ≤40 years, who registered for antenatal screening at ≤14 weeks of gestation.

Mean age was 22·6 (sd 3·4) years, mean BMI was 20·4 (sd 3·3) kg/m2 and 236 (64·5 %) of the pregnant women were primiparous. The prevalence of anaemia (Hb <11·0 g/dl) was 30·3 % and of microcytic anaemia (anaemia with mean corpuscular volume <80 fl) 20·2 %. Mean dietary intakes of energy, Ca, Fe and folate were well below the Indian RDA. In multivariable log-binomial regression analysis, anaemia was independently associated with high dietary intakes of Ca (relative risk; 95 % CI: 1·79; 1·16, 2·76) and P (1·96; 1·31, 2·96) and high intake of meat, fish and poultry (1·94; 1·29, 2·91).

Low dietary intake of multiple micronutrients, but higher intakes of nutrients that inhibit Fe absorption such as Ca and P, may help explain high rates of maternal anaemia in India.

To determine the relative validity of a 3 d estimated food record (EFR) used to assess energy and nutrient intakes in toddlers, using a 3 d weighed food record (WDR) as the reference method.

Parents reported the food and beverage intakes of their children using an EFR concurrently with a WDR over three consecutive days. Estimation of mean differences, Spearman correlation coefficients, cross-classifications and Bland–Altman plots were used to assess the agreement between the intakes of energy and fourteen nutrients obtained from the EFR and the WDR.

Data obtained from a representative sample of infants or toddlers in Germany.

Sixty-seven toddlers aged 10–36 months who had completed an EFR for a 3 d recording period that corresponded to the WDR were included in the present analysis.

Energy and nutrient intakes did not differ between the EFR and the WDR, except for linoleic acid and retinol. For all dietary intakes, Spearman rank correlation coefficients between the EFR and the WDR ranged from 0·35 to 0·80 (P ≤ 0·004). The proportion of participants correctly classified into quartiles ranged from 75 % for ascorbic acid intake to 96 % for Fe intake, and the percentage of misclassification was 9 % or less. The weighed κ values ranking the participants ranged from 0·23 for ascorbic acid intake to 0·59 for Fe intake. The Bland–Altman plots indicated a good agreement for all dietary intakes estimated from the EFR.

Our study suggests that this EFR is a valid assessment instrument for estimating the energy and nutrient intakes among toddlers at the group level.

To examine associations among diet quality and dairy group membership, membership duration and non-member status for women and school-aged children in rural Kenya.

A cross-sectional survey, using chain referral sampling, was conducted and diet quality indices and prevalence of inadequate intake (PII) were estimated using the ‘estimated average requirement’ cut-off point method from single 24 h recalls, using a Kenyan nutrient database. PII was compared among members and non-members and among membership-duration groups.

Women and children of dairy group members (n 88), across membership-duration groups (1–3, 4–6, 7–9 and 10+ years), and non-members (n 23) living among members.

Small farms in central Kenya.

Members had higher energy, percentage of energy from animal-source foods and dietary diversity. Member women and children had lower PII for respectively seven and three of eleven micronutrients. Reduced PII for milk-source micronutrients was associated with membership duration for women. Many member women (38 %) had inadequate vitamin A intake and 39 % of member children had inadequate Zn intake. Members’ PII was also high (>45 %) for Fe, Ca and vitamin B12. A higher prevalence of being overweight among member women compared with non-member women suggested nutrition transition effects of higher farm productivity.

Dairy group membership was positively associated with adequate quantity and quality of diets for women and children. Long-term membership was insufficient to address micronutrient deficiencies. Understanding and addressing barriers to better diet quality and strategies to mitigate negative nutrition transition effects are needed to optimize nutritional outcomes of dairy group membership.

The present study aimed to compare Household Budget Survey (HBS) data on food purchasing and individual food consumption, collected in the same nationwide survey.

Food purchase information for each household was collected by a seven-day collective acquisition diary, applied to 55 970 households. Food consumption information was obtained from household members over 10 years old by the application of two non-consecutive food records in a sub-sample of the HBS. Cooking and correction factors were applied when necessary, and all food items reported were grouped into twelve main food groups. Food purchase and consumption data were presented as absolute weight (g/person per d) and as relative contribution to energy intake (%) for the overall study population, which was stratified according to household income.

Brazil.

National estimates of food consumption and purchase for Brazil.

The greatest differences between purchase and consumption data (purchase minus consumption) were observed for meat (−168 g), beans/legumes (−48 g), roots/tubers (−36 g) and fruits (−31 g). When expressed in terms of energy contribution, the highest differences were found for cereals (13 %) and oils and fats (11 %). Differences between purchase and consumption data were generally lower in the highest compared with the lowest household income quintile; and were lower for most main food groups when considering only foods reported as being eaten at home.

With few exceptions, food purchase expressed as relative energy contribution, as opposed to absolute weight, can provide a good picture of actual consumption in the Brazilian population.

Household food access remains a concern among primarily agricultural households in lower- and middle-income countries. We examined the associations among domains representing livelihood assets (human capital, social capital, natural capital, physical capital and financial capital) and household food access.

Cross-sectional survey (two questionnaires) on livelihood assets.

Metropolitan Pillaro, Ecuador; Cochabamba, Bolivia; and Huancayo, Peru.

Households (n 570) involved in small-scale agricultural production in 2008.

Food access, defined as the number of months of adequate food provisioning in the previous year, was relatively good; 41 % of the respondents indicated to have had no difficulty in obtaining food for their household in the past year. Using bivariate analysis, key livelihood assets indicators associated with better household food access were identified as: age of household survey respondent (P = 0·05), participation in agricultural associations (P = 0·09), church membership (P = 0·08), area of irrigated land (P = 0·08), housing material (P = 0·06), space within the household residence (P = 0·02) and satisfaction with health status (P = 0·02). In path models both direct and indirect effects were observed, underscoring the complexity of the relationships between livelihood assets and household food access. Paths significantly associated with better household food access included: better housing conditions (P = 0·01), more space within the household residence (P = 0·001) and greater satisfaction with health status (P = 0·001).

Multiple factors were associated with household food access in these peri-urban agricultural households. Food security intervention programmes focusing on food access need to deal with both agricultural factors and determinants of health to bolster household food security in challenging lower- and middle-income country contexts.

The present study compared foods and beverages provided to and consumed by children at child-care centres in New York City (NYC) with national nutrition recommendations.

The study used survey, observational and centre record data collected from child-care centres. Food and beverage intakes from two days of observation and amounts of energy and nutrients were estimated using the US National Cancer Institute’s Automated Self-Administered 24 h Recall system.

Meal and snack time at 108 child-care centres in low-income communities in NYC.

Children aged 3–4 years old in classrooms selected by the directors of the participating child-care centres.

Foods and beverages provided to and consumed by children (n 630) met >50 % of the Dietary Reference Intake (DRI) for most nutrients. Intakes of fibre and vitamins D and E were <30 % of the DRI. Foods and beverages provided >50 % of the recommended average daily intake amounts for total grains, fruits and fruit juices, and dairy, but <50 % of the recommended amounts for whole grains, protein foods and vegetables. Intake of oils was below the allowance for energy levels, but foods and beverages with solid fats and added sugars exceeded the limits by 68 %.

Providing more whole grains, vegetables and low-fat dairy and fewer foods with solid fats and added sugars may improve children’s diet quality when at child-care centres. Centre staff may need training, resources and strategies in order to meet the nutrition recommendations.

According to the 2007–2008 National Health and Nutrition Examination Survey, the prevalence of obesity in the US population was 33·8 %; 34·3 % and 38·2 %, respectively, in middle-aged men and women. We asked whether available blood donor data could be used for obesity surveillance.

Cross-sectional study of BMI and obesity, defined as BMI ≥ 30·0 kg/m2. Adjusted odds ratios (aOR) were calculated with logistic regression.

A network of six US blood centres.

Existing data on self-reported height and weight from blood donors, excluding persons deferred for very low body weight.

Among 1 042 817 donors between January 2007 and December 2008, the prevalence of obesity was 25·1 %; 25·7 % in men and 24·4 % in women. Obesity was associated with middle age (age 50–59 years v. <20 years: aOR = 1·92 for men and 1·81 for women), black (aOR = 1·57 for men and 2·35 for women) and Hispanic (aOR = 1·47 for men and 1·49 for women) race/ethnicity compared with white race/ethnicity, and inversely associated with higher educational attainment (college degree v. high school or lower: aOR = 0·56 for men and 0·48 for women) and double red cell donation and platelet donation.

Obesity is common among US blood donors, although of modestly lower prevalence than in the general population, and is associated with recognized demographic factors. Blood donors with higher BMI are specifically recruited for certain blood collection procedures. Blood centres can play a public health role in obesity surveillance and interventions.

India spans the spectrum of under- and overnutrition disorders and does so in generous proportions. India also tops the charts globally in the prevalence of risk factors for several chronic diseases. Although Public Health Nutrition (PHN) – both as an academic field as well as a means to improved health – has been around for two centuries in developed countries, it is only now coming to the fore as a conduit for tackling nutrition-related disorders in developing countries. In the light of these issues, we undertook an exercise to map the existing educational initiatives for nutrition, and in particular PHN, in India.

This situational analysis of PHN across India was conducted using a combination of Internet search, telephone calls as well as interviews with experts. Information collected was pooled and tabulated using a snowball approach.

India.

Not applicable.

Currently, there are nearly 190 institutes in India that offer one or more nutrition courses, with the majority offering full-time courses. Of these, PHN was offered in less than five institutes across India and opportunities were confined to specialization options/modules.

This situational analysis reveals the huge gap in existing nutrition ventures and points towards the urgent need to undertake newer academic initiatives especially in the field of PHN in India. Reforms in the education and employment sector need to be brought in which may include working towards making the field of nutrition attractive for career pursuit. The focus of this discipline needs to be broadened to, but not limited to, span the entire spectrum from dietetics to research and teaching. Strong synergistic collaborations and academic partnerships with other developed countries should be encouraged to catalyse finding solutions to emerging and/or existing threats to public health problems.

To examine how factors related to the home food environment and individual characteristics are associated with healthy food purchasing among low-income African American (AA) youth.

A total of 206 AA youth (ninety-one boys and 115 girls), aged 10–14 years, and their primary adult caregivers.

Fourteen Baltimore recreation centres in low-income neighbourhoods.

Cross-sectional study. We collected information about food purchasing, the home food environment, sociodemographic and psychosocial factors drawn from social cognitive theory. Multivariable logistic regression was used to examine the factors associated with the frequency and proportion of healthy food purchases in all youth and stratified by gender. Low-fat or low-sugar foods were defined as healthy.

Youth purchased an average of 1·5 healthy foods (range = 0–15) in the week before the interview, comprising an average of 11·6 % (range = 0–80 %) of total food purchases. The most commonly purchased healthy foods included water and sunflower seeds/nuts. Healthier food-related behavioural intentions were associated with a higher frequency of healthy foods purchased (OR = 1·4, P < 0·05), which was stronger in girls (OR = 1·9, P < 0·01). Greater caregiver self-efficacy for healthy food purchasing/preparation was associated with increased frequency of healthy purchasing among girls (OR = 1·3, P < 0·05). Among girls, more frequent food preparation by a family member (OR = 6·6, P < 0·01) was associated with purchasing a higher proportion of healthy foods. No significant associations were observed for boys.

Interventions focused on AA girls should emphasize increasing food-related behavioural intentions. For girls, associations between caregiver self-efficacy and home food preparation suggest the importance of the caregiver in healthy food purchasing.

To determine the potential predictors of body size dissatisfaction in Chinese children.

The Child’s Body Image Scale was used to assess body size perception and dissatisfaction. BMI was calculated from objectively measured height and weight. Predictors of body size dissatisfaction were examined by logistic regression analysis.

Hong Kong, China.

Six hundred and twenty children (53 % boys, aged 6·1–12·9 years) from a state-run primary school.

Female sex (adjusted OR (AOR)=1·91; 95 % CI 1·32, 2·76), age (AOR=2·62; 95 % CI 1·65, 4·16 for 8–10 years; AOR=2·16; 95 % CI 1·38, 3·38 for >10 years), overweight (AOR=6·23; 95 % CI 3·66, 10·60) and obesity (AOR=19·04; 95 % CI 5·64, 64·32) were positively associated with desire to be thinner. Size misperception was a strong predictor of body size dissatisfaction, irrespective of actual weight status (AOR=1·90; 95 % CI 1·02, 3·54 for overestimation; AOR=0·43; 95 % CI 0·27, 0·67 for underestimation).

Body size dissatisfaction is prevalent among Chinese children as young as 6 years. Female sex, age, overweight, obesity and overestimation of size were associated with increased desire to be thinner. These findings emphasise the importance of preventing body image issues from an early age.