To examine the risk of CHD in relation to alcohol intake from three different instruments.

In the European Prospective Investigation into Cancer in Norfolk study, weekly alcohol intake was estimated from a single question in a mail-in health and lifestyle questionnaire (HLQ), a semi-quantitative FFQ, and a 7 d diet diary (7DD). Information on smoking status, physical activity, disease history, social class and medication use was reported in the HLQ. Height, weight, blood pressure and blood lipids were measured at a health check-up. The average length of follow-up was 11 years. The association between alcohol intake and incident fatal and non-fatal CHD in a nested case–control sample was calculated using logistic regression.

Norfolk, England.

A total of 2151 cases of incident fatal and non-fatal CHD and 5354 controls.

The Spearman correlation values between the 7DD, FFQ and HLQ alcohol estimates ranged from r = 0·70 to 0·82 (P < 0·0001 for all r values). Alcohol intake from all instruments was inversely associated with the risk of CHD in age- and multivariate-adjusted models. The relationships between the risk of CHD and alcohol intake from the 7DD, HLQ or FFQ were not significantly different from each other (P >0·10). A marginal difference between men and women was detected for the risk of CHD in relation to HLQ alcohol intake (P = 0·065).

In conclusion, while the instruments were not uniform in their assessment of alcohol intake levels, the 7DD, HLQ and FFQ yielded similar inverse associations between alcohol intake and risk of CHD.

The influence of moderate alcohol consumption on renal function is not clear in elderly people. The aim of the present study was to investigate the relationship between alcohol consumption and renal function, expressed as serum creatinine levels and glomerular filtration rates (GFR), in an elderly population.

Perspective cohort study.

Population-based study on an elderly Italian population.

A sample of 3404 Italian people (1619 women and 1785 men), aged 65–84 years, from the Italian Longitudinal Study on Aging (ILSA).

Prevalence and cumulative risk of impaired renal function (defined as GFR ≤ 60 ml/min) were estimated by sex and alcohol consumption groups. Logistic regression analysis adjusting for confounders (age, education, smoking, BMI and medications) and intermediate factors (blood cholesterol and fibrinogen, systolic hypertension and diabetes) showed that alcohol consumption level was not significantly related to the prevalence of mild renal impairment in elderly women. In men, both prevalence and incidence results seemed to suggest an inverse linear relationship between moderate alcohol consumption and the risk of mild renal impairment. A U-shaped association was shown for women at the incidence phase, suggesting a higher risk of developing renal impairment for women who drink more than 24 g alcohol/d.

Our results suggest that, in accordance with the recommendations on alcohol consumption in the elderly, moderate quantities of alcohol are not injurious to renal function in elderly men.

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

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

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

FOODS 2000 adult participants 18 years of age or older.

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

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

To place the Mediterranean diet (MedDi) in the context of the cultural history of the Middle East and emphasise the health effects of some of the biblical seven species – wheat, barley, grapes, figs, pomegranates, olives and date honey.

Review of the literature concerning the benefits of these foods.

Middle East and Mediterranean Basin.

Mediterranean populations and clinical studies utilising the MedDi.

The MedDi has been associated with lower rates of CVD, and epidemiological evidence promotes the benefits of consuming fruit and vegetables. Recommended foods for optimal health include whole grain, fish, wine, pomegranates, figs, walnuts and extra virgin olive oil. The biblical traditional diet, including the seven species and additional Mediterranean fruits, has great health advantages, especially for CVD. In addition to the diet, lifestyle adaptation that involves increasing physical activity and organised meals, together with healthy food choices, is consistent with the traditional MedDi. The MedDi is a manageable, lifestyle-friendly diet that, when fortified with its biblical antecedent attributes, may prove to be even more enjoyable and considerably healthier in combating the obesogenic environment and in decreasing the risks of the non-communicable diseases of modern life than conventional, modern dietary recommendations. The biblical seven species, together with other indigenous foods from the Middle East, are now scientifically recognised as healthy foods, and further improve the many beneficial effects of the MedDi.

To determine whether frequent vitamin C supplement use is associated with healthier behaviours, and a history of cancer and other illnesses in UK women.

The present cross-sectional analysis examines the odds of taking supplements containing vitamin C as recorded in 4 d food diaries, based on lifestyle characteristics and morbidity history self-reported by questionnaire.

A large national UK cohort study.

A total of 12 453 women aged between 37 and 79 years.

Women frequently taking supplements containing vitamin C, compared to those who did not, had healthier behaviours, including higher consumption of fruit and vegetables. Frequent high-dose vitamin C users (≥1000 mg) had a higher socio-economic status, visited alternative practitioners more often than family or private doctors, and were more likely to be ex-smokers and to drink little or no alcohol. Women who self-reported having had cancer (OR = 1·33, 95 % CI 1·00, 1·76) or specifically breast cancer (OR = 1·70, 95 % CI 1·14, 2·55), or reported a family history of cancer (OR = 1·16, 95 % CI 0·95, 1·41) or breast cancer (OR = 1·26, 95 % CI 1·01, 1·58) had increased odds of being frequent high-dose users after adjusting for sociodemographic and health behaviours. Women with personal or family histories of some cardiovascular or intestinal disorders were more likely to take supplements containing vitamin C, though not necessarily at high doses.

High-dose vitamin C intake by UK women was associated with healthier behaviours and a history of breast cancer, total cancer and other illnesses. Consequences of high-dose vitamin C supplement intake are not clear at the population level.

The nutritional intake of schoolchildren is affected not only by what is consumed at school but also by what is available in food outlets near schools. The present study surveys the range of food outlets around schools and examines how the availability of healthy food in the food stores encountered varies by income status of the school and by store participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food assistance programme.

Network buffer zones were created to reflect a quarter-mile (400 m) walk from elementary schools with lower- and higher-income student populations in Oakland, CA, USA. All food outlets within these zones were categorised by type, and audits were conducted within food stores using a checklist to assess for the presence or absence of twenty-eight healthy items (in five domains).

Mid-sized city in the USA.

Food outlets near public elementary schools.

There were considerably more food outlets around lower-income schools. Food stores near higher-income schools had higher scores in two of the five domains (healthy beverages/low-fat dairy and healthy snacks). However, there were more food stores near lower-income schools that accepted WIC vouchers. Stratification showed that WIC stores scored higher than non-WIC stores on four of the five domains.

Although higher-income students have more access to healthy food in the environment surrounding their school, this disparity appears to be mitigated by stores that accept WIC and offer more healthy snacking options. Federal programmes such as this may be particularly valuable for children in lower-income areas.

To estimate the prevalence of overweight and obesity in schoolchildren from Aveiro, Portugal, according to two criteria: the International Obesity Task Force (IOTF) and the US Centers for Disease Control and Prevention (CDC) cut-offs.

Weight, height and waist circumference were measured. Using the BMI, gender- and age-specific prevalences of overweight and obesity were determined according to the IOTF cut-offs extrapolated from an adult BMI of 25 and 30 kg/m2 and the CDC cut-off values of 85th and 95th BMI percentile.

Aveiro, Portugal.

A random representative sample of 905 children (457 boys; 448 girls) aged 7–9 years.

The prevalence of excess weight (overweight and obesity) was lowest according to IOTF cut-offs compared to CDC (28·1 % v. 31·2 %), especially obesity (8·1 % v. 14·0 %). However, the CDC and IOTF criteria have a strong agreement (Cohen’s k = 0·755; P < 0·001). There were significant differences in excess weight between boys and girls according to the CDC (26·9 % v. 35·7 %; P = 0·003). Obese children are younger and the majority present abdominal obesity.

The present study shows a high prevalence of excess weight in Aveiro children, similar to other Portuguese regions and among the highest in Europe, especially in the female gender. The IOTF cut-off values give a lower prevalence of excess weight, namely obesity.

To describe regional differences between eastern and western Germany with regard to food, nutrient and supplement intake in 9–12-year-old children, and analyse its association with parental education and equivalent income.

Data were obtained from the 10-year follow-up of the two prospective birth cohort studies – GINIplus and LISAplus. Data on food consumption and supplement intake were collected using an FFQ, which had been designed for the specific study population. Information on parental educational level and equivalent income was derived from questionnaires. Logistic regression modelling was used to analyse the effect of parental education, equivalent income and region on food intake, after adjusting for potential confounders.

Germany.

A total of 3435 children aged 9–12 years.

Substantial regional differences in food intake were observed between eastern and western Germany. Intakes of bread, butter, eggs, pasta, vegetables/salad and fruit showed a significant direct relationship with the level of parental education after adjusting for potential confounders, whereas intakes of margarine, meat products, pizza, desserts and soft drinks were inversely associated with parental education. Equivalent income had a weaker influence on the child's food intake.

Nutritional education programmes for school-age children should therefore account for regional differences and parental education.

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.

Owing to modern lifestyles, individuals are dependent on out-of-home eating. The catering sector can have a pivotal role in influencing our food choices. The objective of the present study was to examine the impact of a structured catering initiative on food choices in a public sector workplace setting.

A cross-sectional comparison study in two hospitals, one of which had implemented a catering initiative designed to provide nutritious food while reducing sugar, fat and salt intakes.

Two public sector hospitals in Cork, Ireland.

A total of 100 random participants aged 18–64 years (fifty intervention, fifty non-intervention) who consumed at least one main meal in the hospital staff canteen daily. Each respondent was asked to complete one anonymous 24 h dietary recall and questionnaire. Food and nutrient analysis was conducted using WISP (Weighed Intake Software Program).

Reported mean intakes of total sugars (P < 0·001), total fat (P < 0·000), saturated fat (P < 0·000) and salt (P < 0·046) were significantly lower in the intervention hospital when adjusted for age and gender. In the intervention hospital, 72 % of respondents, compared with 42 % in the non-intervention hospital, complied with the recommended under-3 daily servings of food high in fat and sugar (P < 0·005). In the intervention hospital, 43 % of respondents exceeded the recommended salt intake of 4–6 g/d, compared with 57 % in the non-intervention hospital.

Structured catering initiatives in the workplace are a potentially important option in the promotion of healthy food choices. Targeted public health programmes and health policy changes are needed to motivate caterers in the public sector and other industries to develop interventions that promote a healthy diet.

Migrants tend to present higher overweight and obesity levels, but whether this relationship applies to all nationalities has seldom been studied. The present study aimed to assess the prevalence of overweight and obesity according to nationality in adults.

Cross-sectional population-based samples.

Five-year nationwide interview surveys (Swiss Health Surveys – SHS) from 1992 to 2007 (n 63 766) and a local examination survey (CoLaus Study in Lausanne 2004–2006, n 6743).

Participants were separated into Swiss, French, German, Italian, Portuguese, Spanish nationals, those from the former Republic of Yugoslavia and from other European and other countries.

Compared with Swiss nationals, German and French nationals presented a lower prevalence of overweight and obesity, whereas nationals from Italy, Spain, Portugal and the former Republic of Yugoslavia presented higher levels. Adjusting the SHS data for age, gender, education, smoking, leisure-time physical activity and survey year, a lower risk for overweight and obesity was found for German (OR = 0·80, 95 % CI 0·70, 0·92) and French (OR = 0·74, 95 % CI 0·61, 0·89) nationals, whereas higher risks were found for participants from Italy (OR = 1·45, 95 % CI 1·33, 1·58), Spain (OR = 1·36, 95 % CI 1·15, 1·61), Portugal (OR = 1·25, 95 % CI 1·06, 1·47) and the former Republic of Yugoslavia (OR = 1·98, 95 % CI 1·69, 2·32). Similar findings were observed in the CoLaus Study for Italian (OR = 1·63, 95 % CI 1·29, 2·06), Spanish (OR = 1·54, 95 % CI 1·17, 2·04) and Portuguese (OR = 1·49, 95 % CI 1·16, 1·91) participants and for those from the former Republic of Yugoslavia (OR = 5·34, 95 % CI 3·00, 9·50).

Overweight and obesity are unevenly distributed among migrants in Switzerland. Migrants from Southern Europe and from the former Republic of Yugoslavia present higher prevalence rates. This suggests that preventive messages should be tailored to these specific populations.

To characterize the trends, distribution, potential determinants and public health implications of meat consumption within the USA.

We examined temporal trends in meat consumption using food availability data from the FAO and US Department of Agriculture (USDA), and further evaluated the meat intake by type (red, white, processed) in the National Health and Nutrition Examination Surveys (NHANES) linked to the MyPyramid Equivalents Database (MPED).

Overall meat consumption has continued to rise in the USA and the rest of the developed world. Despite a shift towards higher poultry consumption, red meat still represents the largest proportion of meat consumed in the USA (58 %). Twenty-two per cent of the meat consumed in the USA is processed. According to the NHANES 2003–2004, total meat intake averaged 128 g/d. The type and quantities of meat reported varied by education, race, age and gender.

Given the plausible epidemiological evidence for red and processed meat intake in cancer and chronic disease risk, understanding the trends and determinants of meat consumption in the USA, where meat is consumed at more than three times the global average, should be particularly pertinent to researchers and other public health professionals aiming to reduce the global burden of chronic disease.

The increasing prevalence of obesity among youth has elicited calls for schools to become more active in promoting healthy weight. The present study examined associations between various aspects of school food environments (specifically the availability of snack- and beverage-vending machines and the presence of snack and beverage logos) and students’ weight status, as well as potential influences of indices of diet and food behaviours.

A cross-sectional, self-administered web-based survey. A series of multinomial logistic regressions with generalized estimating equations (GEE) were constructed to examine associations between school environment variables (i.e. the reported presence of beverage- and snack-vending machines and logos) and self-reported weight- and diet-related behaviours.

Secondary schools in Alberta, Canada.

A total of 4936 students from grades 7 to 10.

The presence of beverage-vending machines in schools was associated with the weight status of students. The presence of snack-vending machines and logos was associated with students’ frequency of consuming vended goods. The presence of snack-vending machines and logos was associated with the frequency of salty snack consumption.

The reported presence of snack- and beverage-vending machines and logos in schools is related to some indices of weight status, diet and meal behaviours but not to others. The present study supported the general hypothesis that the presence of vending machines in schools may affect students’ weight through increased consumption of vended goods, but notes that the frequency of ‘junk’ food consumption does not seem to be related to the presence of vending machines, perhaps reflecting the ubiquity of these foods in the daily lives of students.

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 consider historical aspects of nuts in relation to origin and distribution, attributed medicinal benefits, symbolism, legends and superstitions.

Review of historical aspects of nuts.

Mediterranean region.

The varieties reviewed include almonds, walnuts, hazelnuts, pine nuts and pistachios.

Like other foods, nuts have a wide variety of cultural connections to the areas where they grow and to the people who live there or eat them. History, symbolism and legends reveal the ancient tradition of nuts and how they are related to the lives of our ancestors. Archaeological excavations in eastern Turkey have uncovered the existence of a non-migratory society whose economy centred on harvesting nuts. This shows that nuts have been a staple in the human diet since the beginnings of history. Moreover, since ancient times nuts have been used for their medicinal properties. They also play a role in many old legends and traditions.

To analyse dietary compliance with WHO/FAO nutritional objectives, identify food subgroups that contribute to discrepancies between dietary intakes and recommendations, and assess food patterns and risk factor profiles at common nutritional targets.

The study was a population-based, cross-sectional assessment of the dietary patterns of Tehranian adults. Usual dietary intake was assessed in relation to common nutritional targets of public health (fat, saturated fat, dietary fibre, fruit and vegetables) using a validated FFQ. Metabolic syndrome (MetS) risk factors were diagnosed based on the Iranian-modified diagnostic criteria of the National Cholesterol Education Program Adult Treatment Panel III.

The Tehran Lipid and Glucose Study (2005–2008).

A total of 2510 individuals (1121 men and 1389 women), aged between 19 and 70 years.

Generally, 68·5 % of total grain ounce-equivalents were derived from refined grains, with rice making up 36·6 % of all grains consumed. Solid fat (61·1 %) contributed more to discretionary energy than did added sugars (38·9 %). There was a twofold difference in fruit and vegetable consumption between the lowest and highest quartile categories of dietary fibre intake. The probability of having MetS was significantly lower in the highest quartile of fibre intake v. the lowest (OR = 0·69, 95 % CI 0·58, 0·84 v. OR = 0·92, 95 % CI 0·80, 1·03; P -trend < 0·001), whereas it was higher in the highest quartile of SFA intake v. the lowest (OR = 0·92, 95 % CI 0·78, 0·98 v. OR = 0·71, 95 % CI 0·62, 0·89; P-trend = 0·01).

Complying with common nutritional targets of public health is inversely associated with MetS risk factors in Tehranian adults. These results may initiate measures for future development of regional food-based dietary guidelines.

To examine the association between cereal consumption and cardiovascular risk factors including waist, height, total cholesterol, LDL cholesterol and HDL cholesterol in a sample of adolescent girls.

Longitudinal study.

The study was conducted from 1987 to 1997 and data were collected at three study sites (University of California at Berkeley, University of Cincinnati and Westat Inc., Rockville, MD, USA). Mixed models were used to estimate the association between the number of days of eating cereal and these four outcome variables.

Girls (n 2371) who participated in the 10-year National Heart, Lung, and Blood Growth and Health Study (NGHS) and completed a 3 d food diary in years 1–5 and 7, 8 and 10.

Adolescent girls who ate cereal more often had lower waist-to-height ratio (P < 0·005), lower total cholesterol (P < 0·05) and lower LDL cholesterol (P < 0·05), taking into account sociodemographic variables, physical activity levels and total energy intake.

Findings suggest that cereal consumption is associated with markers of cardiovascular risk and that childhood patterns of consumption may influence the development of risk factors later in adolescence.

To examine absolute socio-economic differences in food habits and their changes over time.

A longitudinal study using the cohort baseline mail surveys conducted in 2000–2002 (n 8960, response rate 67 %) and the follow-up in 2007 (n 7332, response rate 83 %), including data on seven food habits recommended in the national dietary guidelines, as well as socio-economic and sociodemographic variables.

Data from the Helsinki Health Study survey, followed up for 5–7 years.

Municipal employees of the City of Helsinki, Finland.

Apart from fish and vegetable-based margarine on bread, the proportions of the recommended food items were higher for women than for men. The consumption of the recommended food items either increased or remained stable over the follow-up period. On the basis of the slope index of inequality (SII) it was observed that socio-economic differences widened with regard to the consumption of fresh vegetables and fish and use of vegetable-based margarine or oil in cooking, with the upper classes consuming these foods more often. The largest differences were observed in the consumption of fresh vegetables, for which the SII value among women was 2·38 (95 % CI 1·93, 2·95) at baseline and 2·47 (95 % CI 2·01, 3·03) at follow-up, and 3·36 (95 % CI 1·80, 6·28) and 3·47 (95 % CI 1·95, 6·19) for men, respectively. Socio-economic differences were non-existent for milk, and the reverse was observed for dark bread and vegetable-based margarine on bread.

Consumption of the recommended food items increased in the examined cohort over time. This increase was mostly similar throughout the socio-economic groups and thus the socio-economic differences remained stable. The upper classes followed the guidelines better with regard to the consumption of vegetables and fish and in the use of vegetable-based margarine or oil in cooking.

To determine the number of 24 h dietary recalls required to adequately estimate nutrient intake in overweight and obese adults using the US Department of Agriculture's (USDA) automated multiple-pass method (AMPM). In addition, the study quantified sources of variation in dietary intake, such as day of the week, season, sequence of diet interviews (training effect), diet interviewer, body weight and within- and between-subject variances in the intake of selected nutrients.

Adults having a BMI of ≥ 28 but <38 kg/m2 were included in the study. The USDA's AMPM was used to obtain 24 h dietary recalls every 10 d for 6 months. Dietary intake data were analysed to adequately estimate the number of 24 h recalls necessary to assess nutrient intake. Variance component estimates were made by using a mixed-model procedure.

The greater Washington, DC, metropolitan area.

Adults (34 men and 39 women) aged 35–65 years.

Overweight and obese adults completed fourteen 24 h dietary recalls. Utilizing within- and between-subject variances requires 5–10 and 12–15 d of 24 h dietary recalls in men and women, respectively, to estimate energy and macronutrient intakes in a 6-month period. Within- and between-subject variances were the major contributors to variance in nutrient intakes. Day of the week, season, sequence, diet interviewer and body weight had little impact on variance.

This information is valuable for researchers planning to conduct studies on free-living individuals that include the collection of dietary intake data.

To examine the impact of a 6-month participatory and empowerment-based intervention study on employees’ dietary habits and on changes in the canteen nutrition environment.

Worksites were stratified by company type and by the presence or absence of an in-house canteen, and randomly allocated to either an intervention group (five worksites) or a minimum intervention control group (three worksites). The study was carried out in partnership with a trade union and guided by an ecological framework targeting both individual and environment levels. Outcome measures included: (i) changes in employees’ dietary habits derived from 4 d pre-coded food diaries of a group of employees at the worksites (paired-data structure); and (ii) the canteen nutrition environment as identified by aggregating chemical nutritional analysis of individual canteen lunches (different participants at baseline and at endpoint).

Eight blue-collar worksites (five of these with canteens).

Employees.

In the intervention group (n 102), several significant positive nutritional effects were observed among employees, including a median daily decrease in intake of fat (−2·2 %E, P = 0·002) and cake and sweets (−18 g/10 MJ, P = 0·002) and a median increase in intake of dietary fibre (3 g/10 MJ, P < 0·001) and fruit (55 g/d, P = 0·007 and 74 g/10 MJ, P = 0·009). With regard to the canteen nutrition environment, a significant reduction in the percentage of energy obtained from fat was found in the intervention group (median difference 11 %E, P < 0·001, n 144).

The present study shows that moderate positive changes in dietary patterns can be achieved among employees in blue-collar worksites.