To evaluate the effectiveness of anthropometric measures and physical activity level in the prediction of metabolic syndrome (MetS) in children.

Cross-sectional study with children from public and private schools. Children underwent an anthropometric assessment, blood pressure measurement and biochemical evaluation of serum for determination of TAG, HDL-cholesterol and glucose. Physical activity level was calculated and number of steps per day obtained using a pedometer for seven consecutive days.

Viçosa, south-eastern Brazil.

Boys and girls (n 187), mean age 9·90 (sd 0·7) years.

Conicity index, sum of four skinfolds, physical activity level and number of steps per day were accurate in predicting MetS in boys. Anthropometric indicators were accurate in predicting MetS for girls, specifically BMI, waist circumference measured at the narrowest point and at the level of the umbilicus, four skinfold thickness measures evaluated separately, the sum of subscapular and triceps skinfold thickness, the sum of four skinfolds and body fat percentage.

The sum of four skinfolds was the most accurate method in predicting MetS in both genders.

The purpose was to examine the associations among body weight status, blood pressure and daily Na intake among grade 7 students from south-western Ontario, Canada.

Cross-sectional. Data were collected using the Food Behaviour Questionnaire, including a 24 h diet recall. Measured height and weight were used to determine BMI. Blood pressure was taken manually using mercury sphygmomanometers.

Twenty-six schools in south-western Ontario, Canada.

Grade 7 students (n 1068).

Body weight status indicated 1 % were underweight, 56 % normal weight, 23 % overweight and 20 % were obese. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 108·3 (sd 10·3) mmHg and 66·0 (sd 7·5) mmHg, respectively, and mean Na intake was 2799 (sd 1539) mg/d. Bivariate analyses suggested that SBP (P < 0·001) and DBP (P < 0·001) were significantly different by body weight status, yet no associations were observed for Na. Adjusted for gender, ethnicity and under-reporting, participants were more likely to be overweight/obese if they had higher SBP (v. lower: OR = 1·06, 95 % CI 1·05, 1·08, P < 0·001), higher DBP (v. lower: OR = 1·02, 95 % CI 1·00, 1·04, P = 0·043) and higher intakes of Na (3rd v. 1st quartile: OR = 1·72, 95 % CI 1·14, 2·59, P = 0·009; 4th v. 1st quartile: OR = 2·88, 95 % CI, 1·76, 4·73, P < 0·001).

High intakes of Na, coupled with high SBP and DBP, were associated with overweight and obesity status among the grade 7 sample from south-western Ontario, Canada.

To evaluate the association between weight gain in the first two years of life and the occurrence of wheezing, asthma, serum IgE, skin reactivity and pulmonary function.

Cohort study.

The metropolitan region of Salvador, Bahia, Brazil.

The association was studied between 1997 and 2005 in 669 children up to 11 years of age. Data were collected on asthma and risk factors, both current factors and those present in the first years of life. Weight gain was considered fast when the Z-score was >0·67. Poisson regression was used in the multivariate statistical analysis.

Wheezing was reported in 25·6 % of the children. Weight gain was considered fast (Z-score >0·67) in 29·6 % of the children and slow (Z-score <−0·67) in 13·9 %. Children in the slow weight gain group had 36 % fewer symptoms of asthma (prevalence ratio = 0·65; 95 % CI 0·42, 0·99).

Slower weight gain in the early years of life may constitute a protective factor against symptoms of asthma. The relevance of this finding for public health is not yet certain, since it is known that children with slow and fast weight gain may be more likely to develop adverse health consequences related to both these situations.

To investigate whether the recommended dietary intake of Ca in anaemic infants compromises the expected Hb response, via home fortification with a new Ca- and Fe-containing Sprinkles™ micronutrient powder (MNP).

A double-blind, randomized controlled, 2-month trial was conducted in Bangladesh. Infants were randomized to one of two MNP intervention groups containing Fe and other micronutrients, with or without Ca. Hb, anthropometrics and dietary intake were measured pre- and post-intervention while family demographics were collected at baseline.

Twenty-six rural villages in the Kaliganj sub-district of Gazipur, Bangladesh.

One hundred infants aged 6–11 months.

A significant increase in Hb (MNP, 13·3 (sd 12·6) g/l v. Ca-MNP, 7·6 (sd 11·6) g/l; P < 0·0001) was noted in infants from both groups. However, infants receiving MNP without Ca had a significantly higher end-point Hb concentration (P = 0·024) and rate of anaemia recovery (P = 0·008). Infants receiving MNP with Ca were more likely to remain anaemic (OR 3·2; 95 % CI 1·4, 7·5). Groups did not differ in dietary intake or demographic and anthropometric indicators.

Although both groups showed significant improvement in Hb status, the nutrient–nutrient interaction between Fe and Ca may have diminished the Hb response in infants receiving the Ca-containing MNP.

To examine the association between obesity and food group intakes, physical activity and socio-economic status in adolescents.

A cross-sectional study was carried out in 2008. Cole's cut-off points were used to categorize BMI. Abdominal obesity was defined by a waist circumference at or above the 90th percentile, as well as a waist-to-height ratio at or above 0·500. Diet was evaluated using an FFQ, and the food group consumption was categorized using sex-specific tertiles of each food group amount. Physical activity was assessed via a self-report questionnaire. Socio-economic status was assessed referring to parental education and employment status. Data were analysed separately for girls and boys and the associations among food consumption, physical activity, socio-economic status and BMI, waist circumference and waist-to-height ratio were evaluated using logistic regression analysis, adjusting the results for potential confounders.

Public schools in the Azorean Archipelago, Portugal.

Adolescents (n 1209) aged 15–18 years.

After adjustment, in boys, higher intake of ready-to-eat cereals was a negative predictor while vegetables were a positive predictor of overweight/obesity and abdominal obesity. Active boys had lower odds of abdominal obesity compared with inactive boys. Boys whose mother showed a low education level had higher odds of abdominal obesity compared with boys whose mother presented a high education level. Concerning girls, higher intake of sweets and pastries was a negative predictor of overweight/obesity and abdominal obesity. Girls in tertile 2 of milk intake had lower odds of abdominal obesity than those in tertile 1. Girls whose father had no relationship with employment displayed higher odds of abdominal obesity compared with girls whose father had high employment status.

We have found that different measures of obesity have distinct associations with food group intakes, physical activity and socio-economic status.

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.

To examine the extent to which the gendered division of labour persists within households in the USA in regard to meal planning/preparation and food shopping activities.

Secondary analysis of cross-sectional data.

2007–2008 US National Health and Nutrition Examination Survey.

Sub-sample of 3195 adults at least 20 years old who had a spouse or partner.

Analyses revealed that the majority of women and men reported they shared in both meal planning/preparing and food shopping activities (meal planning/preparation: women 54 % and men 56 %; food shopping: women 60 % and men 57 %). Results from multinomial logistic regression analyses indicated that, compared with men, women were more likely to take primary responsibility than to share this responsibility and less likely to report having no responsibility for these tasks. Gender differences were observed for age/cohort, education and household size.

This study may have implications for public health nutritional initiatives and the well-being of families in the USA.

To evaluate the adequacy and accuracy of cut-off values currently recommended by the WHO for assessment of cardiovascular risk in southern Brazil.

Population-based study aimed at determining the predictive ability of waist circumference for cardiovascular risk based on the use of previous medical diagnosis for hypertension, diabetes mellitus and/or dyslipidaemia. Descriptive analysis was used for the adequacy of current cut-off values of waist circumference, receiver operating characteristic curves were constructed and the most accurate criteria according to the Youden index and points of optimal sensitivity and specificity were identified.

Pelotas, southern Brazil.

Individuals (n 2112) aged ≥20 years living in the city were selected by multistage sampling, since these individuals did not report the presence of previous myocardial infarction, angina pectoris or stroke.

The cut-off values currently recommended by WHO were more appropriate in men than women, with overestimation of cardiovascular risk in women. The area under the receiver operating characteristic curve showed moderate predictive ability of waist circumference in men (0·74, 95 % CI 0·71, 0·76) and women (0·75, 95 % CI 0·73, 0·77). The method of optimal sensitivity and specificity showed better performance in assessing the accuracy, identifying the values of 95 cm in men and 87 cm in women as the best cut-off values of waist circumference to assess cardiovascular risk.

The cut-off values currently recommended for waist circumference are not suitable for women. Longitudinal studies should be conducted to evaluate the consistency of the findings.

The present study aimed to assess the effect of iodine deficiency on academic achievement of schoolchildren in Wolaita Sodo town, Southern Ethiopia.

School-based comparative cross-sectional study.

Primary school in Sodo town, Southern Ethiopia.

A sample population of 270 children with goitre and 264 without goitre. All students in each class were examined for the presence of goitre and classified based on WHO recommendations.

Among children with goitre, a higher proportion (54·8 %) was female and the proportion increased with age. The odds of scoring low on school performance was higher among children whose fathers were illiterate (adjusted OR = 1·9; 95 % CI 1·1, 3·5) and those who were absent for more than 5 d in the last academic year (adjusted OR = 1·5; 95 % CI 1·1, 2·3). Goitre was significantly associated with low academic achievement (adjusted OR = 1·8; 95 % CI 1·2, 2·5).

The study showed that the presence of goitre has a negative effect on academic achievement even after accounting for parental education and absenteeism from school. Awareness of endemic goitre and its impact on school performance, and an emphasis on prevention and control by concerned bodies, are recommended to alleviate the problem.

To examine the association between adherence to the Dutch Guidelines for a Healthy Diet created by the Dutch Health Council in 2006 and overall and smoking-related cancer incidence.

Prospective cohort study.

Adherence to the guidelines, which includes one recommendation on physical activity and nine on diet, was measured using an adapted version of the Dutch Healthy Diet (DHD) index. The score ranged from 0 to 90 with a higher score indicating greater adherence to the guidelines. We estimated the hazard ratios (HR) and 95 % confidence intervals for the association between the DHD index (in tertiles and per 20-point increment) at baseline and cancer incidence at follow-up.

We studied 35 608 men and women aged 20–70 years recruited into the European Prospective Investigation into Cancer and Nutrition–Netherlands (EPIC-NL) study during 1993–1997.

After an average follow-up of 12·7 years, 3027 cancer cases were documented. We found no significant association between the DHD index (tertile 3 v. tertile 1) and overall (HR = 0·97; 95 % CI 0·88, 1·07) and smoking-related cancer incidence (HR = 0·89; 95 % CI 0·76, 1·06) after adjustment for relevant confounders. Excluding the components physical activity or alcohol from the score did not change the results. None of the individual components of the DHD index was significantly associated with cancer incidence.

In the present study, participants with a high adherence to the Dutch Guidelines for a Healthy Diet were not at lower risk of overall or smoking-related cancer. This does not exclude that other components not included in the DHD index may be associated with overall cancer risk.

To examine the association between calculated maternal dietary exposure to Hg in pregnancy and infant birth weight in the Norwegian Mother and Child Cohort Study (MoBa).

Exposure was calculated with use of a constructed database of Hg in food items and reported dietary intake during pregnancy. Multivariable regression models were used to explore the association between maternal Hg exposure and infant birth weight, and to model associations with small-for-gestational-age offspring.

The study is based on data from MoBa.

The study sample consisted of 62 941 women who answered a validated FFQ which covered the habitual diet during the first five months of pregnancy.

Median exposure to Hg was 0·15 μg/kg body weight per week and the contribution from seafood intake was 88 % of total Hg exposure. Women in the highest quintile compared with the lowest quintile of Hg exposure delivered offspring with 34 g lower birth weight (95 % CI −46 g, −22 g) and had an increased risk of giving birth to small-for-gestational-age offspring, adjusted OR = 1·19 (95 % CI 1·08, 1·30). Although seafood intake was positively associated with increased birth weight, stratified analyses showed negative associations between Hg exposure and birth weight within strata of seafood intake.

Although seafood intake in pregnancy is positively associated with birth weight, Hg exposure is negatively associated with birth weight. Seafood consumption during pregnancy should not be avoided, but clarification is needed to identify at what level of Hg exposure this risk might exceed the benefits of seafood.

To estimate the prevalence of physical activity and sedentary behaviours in European children, and to evaluate the relationship between media availability in personal space and physical activity in relation to total screen time.

Data from the baseline IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) cross-sectional survey. Information on hours of television/digital video disk/video viewing and computer/games-console use (weekday and weekend days), media device availability in personal space, sports club membership, hours of active organized play and commuting (to and from school) were assessed via a self-reported parental questionnaire. Total screen time was defined as the sum of daily media use and subsequently dichotomized into meeting or not meeting the guidelines of the American Academy of Pediatrics.

Eight survey centres (Italy, Estonia, Cyprus, Belgium, Sweden, Germany, Hungary and Spain).

Children (n 15 330; 51 % males) aged 2–10 years.

Percentage of children engaged in total screen time for >2 h/d was higher on weekend days (52 % v. 20 % on weekdays) and in the older group (71 % in males; 57 % in females), varying by country. Children with a television set in their bedroom were more likely not to meet the screen time recommendations (OR = 1·54; 95 % CI 1·60, 1·74).

Approximately a third of the children failed to meet current screen time recommendations. Availability of a television set in personal space increased the risk of excess total screen time. This information could be used to identify potential targets for public health promotion actions of young population groups.

To analyse the association between waist-to-height ratio (WtHR) and body fat and to develop predictive adiposity equations that will simplify the diagnosis of obesity in the paediatric age group.

Cross-sectional study conducted in Spain during 2007 and 2008. Anthropometric dimensions were taken according to the International Biology Program. The children were classified as underweight, normal weight, overweight or obese according to national standards of percentage body fat (%BF). WtHR differences among nutritional status categories were evaluated using ANOVA. Correlation analysis and regression analysis were carried out using WtHR as a predictor variable for %BF. A t test was applied to the results obtained by the regression model and by the Siri equation. The degree of agreement between both methods was evaluated by estimating the intra-class correlation coefficient.

Elementary and secondary schools in Madrid (Spain).

Girls (n 1158) and boys (n 1161) from 6 to 14 years old.

WtHR differed significantly (P < 0·001) depending on nutritional status category. This index was correlated (P < 0·001) with all adiposity indicators. The mean %BF values estimated by the regression model (boys: %BF = 106·50 × WtHR – 28·36; girls: %BF = 89·73 × WtHR – 15·40) did not differ from those obtained by the Siri equation. The intra-class correlation coefficient (0·85 in boys, 0·79 in girls) showed a high degree of concordance between both methods.

WtHR proved to be an effective method for predicting relative adiposity in 6–14-year-olds. The developed equations can help to simplify the diagnosis of obesity in schoolchildren.

To investigate the association between macronutrient intake and type 2 diabetes risk in middle-aged Australian women.

A prospective cohort study, with 6 years (2002–2007) of follow up. Dietary intake was assessed with a validated FFQ. Relative risks with 95 % confidence intervals were used to examine risk associations.

Australian Longitudinal Study on Women's Health, Australia.

Australian women (n 8370) from the Australian Longitudinal Study on Women's Health aged 45–50 years and free of type 2 diabetes at baseline.

After 6 years of follow-up, 311 women developed type 2 diabetes. After adjusting for sociodemographic, lifestyle and other dietary risk factors, MUFA, total n-3 PUFA, α-linolenic acid and total n-6 PUFA intakes were positively associated with the incidence of type 2 diabetes. The relative risks for type 2 diabetes for the highest compared with the lowest quintiles were 1·64 (95 % CI 1·06, 2·54), P = 0·04 for MUFA; 1·55 (95 % CI 1·03, 2·32), P = 0·01 for n-3 PUFA; 1·84 (95 % CI 1·25, 2·71), P < 0·01 for α-linolenic acid; and 1·60 (95 % CI 1·03, 2·48), P = 0·04 for n-6 PUFA. Other dietary macronutrients were not significantly associated with diabetes risk.

The data indicate that consumption of MUFA, n-3 PUFA and n-6 PUFA may influence the risk of developing type 2 diabetes in women.

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.

To evaluate the relationship between dietary habits, physical activity and cognitive views and the risk of gestational diabetes mellitus (GDM) in Chinese women.

A cross-sectional study to explore the potential risk factors of GMD through the International Physical Activity Questionnaire, an FFQ and a self-designed structured questionnaire, respectively.

Guangzhou, Guangdong Province, China.

Chinese pregnant women (n 571) who underwent a 75-g oral glucose tolerance test at their 24th to 28th gestational week.

Thirteen per cent of the investigated women were identified as having GDM, and an increased intake of local featured foods and lower physical activity were observed in the GDM-positive group v. the GDM-negative group. Women who regarded early-pregnancy morning sickness as relevant to fetal abnormalities and those with unlimited dietary intake after the ending of morning sickness both had an increased risk for GDM (P = 0·018 and P = 0·038, respectively). After multiple logistic regression analysis, cognitive views for unlimited food intake subsequent to morning sickness, increased consumption of energy-dense snack foods and high-glycaemic-index fruits were strongly associated with the risk of GDM (OR = 1·911, P = 0·032; OR = 1·050, P = 0·001; and OR = 1·002, P = 0·017, respectively).

Local featured foods and incorrect cognitive views on pregnancy-related health were closely related to the risk of GDM in Chinese women. Intensive health education about pregnancy physiology and reasonable dietary and physical exercise behaviours should be strengthened for the control of GDM.

The aim of the present study was to review the methodological literature regarding evaluation methods for complex public health interventions broadly and, based on such methods, to critically reflect on the evaluation of contemporary community-based obesity prevention programmes.

A systematic review of the methods and community-based literature was performed by one reviewer.

The review identified that there is considerable scope to improve the rigour of community-based obesity prevention programmes through: prospective trial registration; the use of more rigorous research designs, particularly where routine databases including an objective measure of adiposity are available; implementing strategies to quantify and reduce the risk of selective non-participation bias; the development and use of validated instruments to assess intervention impacts; reporting of intervention process and context information; and more comprehensive analyses of trial outcomes.

To maximise the quality and utility of community-based obesity prevention evaluations, programme implementers and evaluators need to carefully examine the strengths and pitfalls of evaluation decisions and seek to maximise evaluation rigour in the context of political, resource and practical constraints.

To determine the effectiveness of nutrition education intervention based on Pender's Health Promotion Model in improving the frequency and nutrient intake of breakfast consumption among female Iranian students.

The quasi-experimental study based on Pender's Health Promotion Model was conducted during April–June 2011. Information (data) was collected by self-administered questionnaire. In addition, a 3 d breakfast record was analysed. P < 0·05 was considered significant.

Two middle schools in average-income areas of Qom, Iran.

One hundred female middle-school students.

There was a significant reduction in immediate competing demands and preferences, perceived barriers and negative activity-related affect constructs in the experimental group after education compared with the control group. In addition, perceived benefit, perceived self-efficacy, positive activity-related affect, interpersonal influences, situational influences, commitment to a plan of action, frequency and intakes of macronutrients and most micronutrients of breakfast consumption were also significantly higher in the experimental group compared with the control group after the nutrition education intervention.

Constructs of Pender's Health Promotion Model provide a suitable source for designing strategies and content of a nutrition education intervention for improving the frequency and nutrient intake of breakfast consumption among female students.

The prevalence of obesity has increased in the last decades in the Western world. The aim of the present study was to examine the association between risk-taking behaviour in adolescence and adult obesity in men and women. Furthermore, we wished to describe social differences in obesity in Denmark.

Two population-based questionnaire studies (2004–2005 and 2006–2007) were used to collect information on weight and height, sociodemographic factors and factors regarding risk-taking behaviour during adolescence. Data were analysed using multivariate logistic regression.

Denmark.

Individuals aged 18–45 years (men: n 22 827, participation rate 71·0 %; women: n 20 870, participation rate 81·4 %).

The prevalence of overweight and obesity was respectively 37·8 % and 10·6 % in men and 20·1 % and 9·7 % in women. In both sexes, obesity was found to be associated with older age, low level of schooling and living outside the capital centre. In relation to risk-taking behaviour, young age (≤13 years) at first intercourse significantly increased the odds of being obese in adulthood (men: OR = 1·34, 95 % CI 1·04, 1·71; women: OR = 1·66, 95 % CI 1·27, 1·99). In women specifically, young age at start drinking alcohol (≤12 years) was associated with obesity.

Sociodemographic factors, in particular age, level of schooling and area of residence, are associated with obesity in both men and women. Risk-taking behaviour during adolescence seems to cluster in both obese men and obese women, however most convincingly in women.

To document iodine status in Indian pregnancies, associations with maternal diet and demographics, and offspring developmental measures.

Longitudinal study following mothers through pregnancy and offspring up to 24 months.

Rural health-care centre (Vadu) and urban antenatal clinic (Pune) in the Maharashtra region of India.

Pregnant mothers at 17 (n 132) and 34 weeks’ (n 151) gestation and their infants from birth to the age of 24 months.

Median urinary iodine concentration (UIC) was 203 and 211 μg/l at 17 and 34 weeks of pregnancy, respectively (range 26–800 μg/l). Using the UIC distribution adjusted for within-person variation, extreme UIC quartiles were compared for predictors and outcomes. There was no correlation between UIC at 17 and 34 weeks, but 24 % of those with UIC in the lowest quartile at 17 weeks had UIC in the same lowest quartile at 34 weeks. Maternal educational, socio-economic status and milk products consumption (frequency) were different between the lowest and highest quartile of UIC at 34 weeks. Selected offspring developmental outcomes differed between the lowest and highest UIC quartiles (abdominal circumference at 24 months, subscapular and triceps skinfolds at 12 and 24 months). However, UIC was only a weak predictor of subscapular skinfold at 12 months and of triceps skinfold at 24 months.

Median UIC in this pregnant population suggested adequate dietary provision at both gestational stages studied. Occasional high results found in spot samples may indicate intermittent consumption of iodine-rich foods. Maternal UIC had limited influence on offspring developmental outcomes.