To determine the factors associated with sugar-sweetened soft drink consumption in adolescents from Sri Lanka.

A cross-sectional study where the data were collected by means of a self-administered questionnaire.

Government, private and international schools in the Colombo district of Sri Lanka.

Adolescents aged 17 years attending sixty-five schools.

Overall 82 % consumed sugar-sweetened soft drinks once weekly or more often, while 77 % and 48 % consumed sugar-sweetened carbonated drinks and sugar-sweetened fruit drinks once weekly or more often. Being a boy (OR = 1·44; 95 % CI 1·02, 2·03), attending a private/international school (OR = 4·12; 95 % CI 1·94, 8·75), mother's level of education (OR = 1·53; 95 % CI 1·03, 2·28) and father's occupation (middle level: OR = 2·39; 95 % CI 1·63, 3·52; upper level: OR = 2·48; 95 % CI 1·35, 4·56) were independently associated with the consumption of sugar-sweetened soft drinks.

The majority of adolescents in this sample consumed sugar-sweetened beverages once weekly or more often. It was evident that some sociodemographic factors were associated with the consumption of these drinks.

To identify sociodemographic and environmental correlates of sweetened beverages (regular soft drinks, fruit juice) among children of pre-school age.

Children's dietary intake, food behaviours and screen time were measured by parental report. A Geographic Informational System was used to assess the number of grocery stores and fast-food restaurants available within 1 km of the children's residence. Multivariate log-binomial regression models were constructed to determine correlates of drinking soft drinks during the previous week.

Edmonton region, Canada.

Children aged 4 and 5 years (n 2114) attending a public health unit for immunization were recruited for a cohort study on determinants of childhood obesity, between 2005 and 2007.

Children from neighbourhoods with low socio-economic status (relative risk (RR) = 1·17, 95 % CI 0·98, 1·40) or who participated in >2 h of screen time daily (RR = 1·28, 95 % CI 1·13, 1·45) were significantly more likely to have consumed regular soft drinks within the last week. Those who lived within 1 km of a grocery store were significantly less likely to consume regular soft drinks (RR = 0·84, 95 % CI 0·73, 0·96). Children who participated in >2 h of screen time daily (RR = 1·16, 95 % CI 1·06, 1·27) were more likely to exceed the recommended weekly number of servings of fruit juice.

Socio-economic and built environment factors are associated with soft drink consumption in children of pre-school age. These findings may help health professionals to advocate for policies that reduce soft drink consumption among children.

Increasing trends in the consumption of commercial sugar-sweetened beverages (SSB) have occurred in parallel with rising levels of obesity in Latin America, but data showing the relationship between these SSB and obesity are limited. The current study examined the association between commercial and traditional SSB and measures of adiposity in Costa Rica.

A cross-sectional analysis was conducted in which the exposure, SSB intake, was defined as frequency of daily servings of ‘fresco’ (a traditional home-made beverage), fruit drink (commercially available SSB), soda and fruit juice (made from fruits at home). Multivariate linear regression was used to estimate associations between SSB intake and BMI, waist-to-hip ratio and skinfold thickness.

Central Valley, Costa Rica.

Controls (n 2045) of a case–control study on diet and heart disease in Costa Rica.

Fresco, fruit drink, soda and fruit juice were consumed ≥1 time/d by 47 %, 14 %, 4 % and 14 % of the population, respectively. One serving/d of soda, fruit drink and fresco was associated with 0·89, 0·49 and 0·21 kg/m2 higher BMI, respectively (all P < 0·05). Fruit drink (≥1 serving/d) was associated with higher waist-to-hip ratio (P = 0·004), while soda and fresco were associated with higher skinfold thickness (P = 0·02 and 0·01, respectively). Associations with fruit juice intake were modest and not statistically significant. Other factors associated with higher BMI were higher income and less education, smoking and physical inactivity (all P < 0·05).

Increasing intake of commercially available SSB could be in part responsible for the high prevalence of obesity among Hispanic adults.

To assess current beverage consumption patterns and anticipated reaction to an added 20 % tax on these products.

A random-digit dialled telephone interview lasting 20 min was administered to assess demographics, beverage consumption behaviours and intentions regarding consumption of sugar-sweetened beverages in the event of an additional tax on these beverages.

Respondents were recruited throughout the USA.

The study included 592 adults.

Sixty-nine per cent of respondents reported consuming at least one pre-packaged sugar-sweetened beverage in the past week; those who consumed sugar-sweetened beverages averaged seven pre-packaged beverages per week. Ninety-one per cent knew that frequent consumption of soft drinks increases risk of obesity. Thirty-six per cent supported a tax on sugar-sweetened beverages with greatest support among those aged 18–24 years, those with BMI < 30 kg/m2 and those with higher levels of education (P < 0·05). Over one-third of respondents said that they would cut back on their sweetened beverage consumption in the event of an added 20 % tax on these beverages.

Our findings suggest that an added tax on these beverages could influence some to cut down on their consumption, reducing their risk of obesity and related illnesses.

To assess the impact of the complex survey design used in the 2007 Australian National Children's Nutrition and Physical Activity Survey (ANCNPAS07) on prevalence estimates for intakes of groups of foods in the population of children.

The impacts on prevalence estimates were determined by calculating design effects for values for food group consumption. The implications of ignoring elements of the sample design including stratification, clustering and weighting are discussed.

The ANCNPAS07 used a complex sample design involving stratification, a high degree of clustering and estimation weights.

Australian children aged 2–16 years.

Design effects ranging from <1 to 5 were found for the values of mean consumption and proportion of the population consuming the food groups. When survey weights were ignored, prevalence estimates were also biased.

Ignoring the complex survey design used in the ANCNPAS07 could result in underestimating the width of confidence intervals, higher mean square errors and biased estimators. The magnitude of these effects depends on both the parameter under consideration and the chosen estimator.

The current systematic review aimed to identify and critically appraise research on food environments in sports settings, including research into the types of food and beverages available, the extent and impact of food and beverage sponsorship and marketing, and views about food environments among key stakeholders.

A systematic review. Fourteen English-language studies (two were papers describing different facets of the same study), published between 1985 and 2011, were identified from searches of electronic databases and bibliographies of primary studies.

Most studies originated from Australia (n 10), with the remaining studies originating in the UK (n 1), New Zealand (n 1), the USA (n 1) and Canada (n 1). Data were collected from observations in stadia, websites and televised sports events, through in-depth interviews, focus groups and surveys with sports club members, parents and quick serve restaurant managers.

Literature exploring food environments in sports settings was limited and had some important methodological limitations. No studies comprehensively described foods available at clubs or stadia, and only one explored the association between food and beverage sponsorship and club incomes. Club policies focused on the impact of health promotion funding rather than the impact of sponsorship or food availability in sports settings.

Further research, including comprehensive studies of the food environment in sports settings, is required to document the availability, sponsorship and marketing of food and beverages at national, regional and club levels and to estimate how sports settings may influence children's diets.

To identify family- and school-based correlates of specific energy balance-related behaviours (physical activity, sedentary behaviour, breakfast consumption, soft drink consumption) among 10–12-year-olds, using the EnRG framework (Environmental Research framework for weight Gain prevention).

A literature review to identify observational studies exploring at least one family- or school-based correlate of the specific behaviours, resulting in seventy-six articles.

Eighteen studies were conducted in Europe, forty-one studies in North America and seventeen studies in Australasia.

Healthy children aged 10–12 years.

Parental and maternal physical activity, doing physical activities with parents and parental logistic support were identified as the most important, positive correlates of physical activity. Parental rules was the most important correlate of sedentary behaviour and was inversely related to it. School socio-economic status was positively related to physical activity and inversely related to sedentary behaviour. The available studies suggested a positive relationship between soft drink availability at home and consumption. Soft drink availability and consumption at school were the most important school-based correlates of soft drink consumption. A permissive parenting style was related to more soft drink consumption and less breakfast consumption.

An important role has been awarded to parents, suggesting parents should be involved in obesity prevention programmes. Despite the opportunities a school can offer, little research has been done to identify school-environmental correlates of energy balance-related behaviours in this age group. Obesity prevention programmes can focus on the most important correlates to maximize the effectiveness of the programme. Future research should aim at longitudinal studies.

Maternal nutrition knowledge has frequently been identified as an important target for nutrition promotion interventions. The aim of the present study was to investigate whether maternal nutrition knowledge is more strongly associated with the mother's own diet or that of her child.

Cross-sectional multivariate linear regression with interactions analyses of survey data.

Socio-economically disadvantaged neighbourhoods in Victoria, Australia.

Five hundred and twenty-three mothers and their children who participated in the Resilience for Eating and Physical Activity Despite Inequality (READI) study, a cross-sectional survey study conducted in 2009 among women and their children residing in socio-economically disadvantaged neighbourhoods.

In adjusted models, for three (vegetable, chocolate/lollies and soft drink consumption) out of the seven dietary outcomes assessed, there was a significant association between maternal nutrition knowledge and maternal diet, whereas for the children's diets none of the seven outcomes were associated with maternal nutrition knowledge. Statistical comparison of regression coefficients showed no difference between the maternal nutrition knowledge–maternal diet association and the maternal nutrition knowledge–child diet association.

Promoting maternal nutrition knowledge may represent an important avenue for improving diet in mothers from socio-economically disadvantaged neighbourhoods, but more information is needed on how and when this knowledge is translated to benefits for their children's diet.

The current study examined clustering of dietary intake and activity behaviours (i.e. physical activity (PA) and sedentary behaviour) in 5-year-old children, as well as the longitudinal association with BMI and overweight development.

Principal component analysis (PCA) was used to identify behavioural patterns. Backward regression analyses were used to examine the association of behavioural patterns with parent and child background characteristics, as well as the association of the patterns with BMI Z-score and overweight development up to ages 7 and 8 years.

The Netherlands.

Data originated from the KOALA Birth Cohort Study (n 2074 at age 5 years).

Four patterns emerged: a ‘sedentary-snacking’ pattern (including television viewing and snack consumption), a ‘healthy intake’ pattern (including healthy items such as fruit, vegetables and fish), a ‘sandwich’ pattern (including bread and sandwich fillings) and a ‘sporty-traditional meal’ pattern (including sports, meat and potatoes). The patterns were related to child gender, general appetite and various parental characteristics. The sedentary-snacking pattern was positively associated with longitudinal BMI development.

Cross-behavioural energy balance-related behavioural patterns exist at age 5 years. Different activity types (e.g. sports, television viewing) clustered differently with the behavioural patterns, indicating the need to incorporate these different types instead of one general PA measure in energy balance-related pattern analyses. The clustering and potential synergy between activity behaviours and dietary intake, as well as the associations with weight status development, stress the importance of an integrated approach to PA and healthy nutrition promotion in preventing childhood overweight.

To evaluate the successes and shortcomings of the community service programme implemented by the Department of Health (DOH) in South Africa by evaluating community service dietitians’ experiences and challenges during the 2009 community service year.

The study employed both quantitative and qualitative research designs. A national survey was conducted using a questionnaire to illicit information on community service dietitians’ working environments and the challenges they experienced. Furthermore individual interviews were conducted with a purposively selected subsample of community service dietitians to further explore issues that arose in the survey.

Data were collected from community service dietitians in the public health sector in South Africa.

Dietitians completing their community service year in 2009.

Of the 168 community service dietitians placed in 2009, 134 (80 %) participated in the survey, while five community service dietitians in each province (n 45) were interviewed. Overall the community service dietitians were positive about the community service year and reported that it improved their confidence, skills and competencies. However, they experienced challenges related to the orientation programme, supervision/mentoring, resources available, patient referrals and communication.

Despite the overall success of the community service year there are still challenges which the DOH needs to address in order to provide the best nutrition service possible for its patients.

To evaluate the effects on anencephaly risk of the interaction between the maternal profile of folate, vitamin B12 and homocysteine and the 677C→T polymorphism in the gene encoding methylenetetrahydrofolate reductase (MTHFR).

Case–control study paired (1:1) on maternity clinic, date of birth and state of residence. Cases of anencephaly were identified using the Registry of the Mexican Neural Tube Defect Epidemiological Surveillance System. Case and control mothers were selected from the same maternity departments. All mothers completed a structured questionnaire and blood samples were obtained to determine the MTHFR 677C→T polymorphism and biochemical profile.

Mexico, Puebla and Guerrero states, Mexico.

A total of 151 mothers of cases and controls were enrolled from March 2000 to February 2001. We had complete information on biochemical profile and MTHFR C677T polymorphism for ninety-eight mothers of cases and ninety-one mothers of controls.

The adjusted models show that the risk of anencephaly in mothers with 677TT genotype was reduced by 18 % (OR = 0·82; 95 % CI 0·72, 0·94) for each 1 ng/ml increment in serum folate. In terms of tertiles, mothers with 677TT genotype with serum folate levels in the upper tertile (>14·1 ng/ml) had a 95 % lower risk to have a child with anencephaly than mothers with serum folate levels in the first and second tertiles (P trend = 0·012).

Our data agree with the hypothesis of a gene–nutrient interaction between MTHFR 677C→T polymorphism and folate status. We observed a protective effect on anencephaly risk only in mothers with 677TT genotype as serum folate levels increased.

To evaluate Zn utilization and status among a sample of Spanish boys consuming a diet based on Mediterranean patterns.

Dietary Zn balance was assessed by means of Zn intake in food and Zn output in faeces and urine as measured by flame atomic absorption spectrophotometry. In addition, biomarkers of Zn status were analysed.

Province of Granada, Spain.

Twenty healthy male adolescents aged 11–14 years, selected based on medical questionnaire, physical examination and nutritional survey of food habits and lifestyle.

Mean Zn intake was 11·36 (se 0·31) mg/d, 76% of the recommended value for Spanish adolescents. Zn absorption (2·53 (se 0·55) mg/d) was close to the value of 3·0 mg/d required for the growth spurt. Zn status biomarkers and growth parameters were within the normal values for this age group.

Although a diet based on Mediterranean patterns is associated with factors which can affect Zn absorption, such as high consumption of phytate, its consumption in adequate amounts allows Zn status to be maintained during adolescence. Due to the importance of Zn in preventing growth and behavioural disorders among adolescents, long-term intervention trials to investigate the suitability of the Mediterranean diet with respect to Zn requirements at this time of life are needed.

Type 2 diabetes mellitus appears to involve an interaction between susceptible genetic backgrounds and environmental factors including highly calorific diets. As it is important to identify modifiable risk factors that may help reduce the risk of type 2 diabetes mellitus, the aim of the present study was to determine the association between egg consumption and the risk of type 2 diabetes mellitus.

A specifically designed questionnaire was used to collect information on possible risk factors of type 2 diabetes mellitus. The odds ratios and 95 % confidence intervals for type 2 diabetes mellitus were calculated by conditional logistic regression.

A case–control study in a Lithuanian out-patient clinic was performed in 2001.

A total of 234 cases with a newly confirmed diagnosis of type 2 diabetes mellitus and 468 controls free of the disease.

Variables such as BMI, family history of diabetes, cigarette smoking, education, morning exercise and plasma TAG level were retained in multivariate logistic regression models as confounders because their inclusion changed the value of the odds ratio by more than 10 % in any exposure category. After adjustment for possible confounders more than twofold increased risk of type 2 diabetes mellitus was determined for individuals consuming 3–4·9 eggs/week (OR = 2·60; 95 % CI 1·34, 5·08) and threefold increased risk of the disease was determined for individuals consuming ≥5 eggs/week (OR = 3·02; 95 % CI 1·14, 7·98) compared with those eating <1 egg/week.

Our data support a possible relationship of egg consumption and increased risk of type 2 diabetes mellitus.

To study the clinico-immunological, nutritional and growth characteristics of HIV-infected children and the impact of antiretroviral therapy (ART) on these parameters.

Retrospective study.

Out-patient department of a paediatric ART centre, Delhi, India.

HIV-positive children registered at the paediatric ART centre of the hospital were enrolled (n 130). Anthropometric measurements were used to classify children into the type of malnutrition according to definitions of the WHO and US Centers for Disease Control and Prevention. Clinical and immunological status of the children was recorded as per WHO guidelines. First-line ART was started based on guidelines of the National AIDS Control Organization. Nutritional status and clinico-immunological characteristics were followed up annually in children receiving ART.

Of children ≤5 years of age (n 54), stunting was noted in 42·5 % contrary to wasting seen in only 12·9 %. In children >5 years of age (n 76), short stature (40·7 %) and underweight (39·4 %) were seen in almost equal proportions. Asymptomatic presentation was noted in 60·0 %. Following ART, a reduction in wasting was noted in 75·0 % of children ≤5 years of age, whereas only 44·4 % of underweight children >5 years of age showed an improvement after therapy. Stunting and short stature continued to persist in all in children (≤5 years and >5 years, respectively). Clinico-immunologically, 67·5 % improved in clinical status and 62·5 % showed immunological improvement.

ART improves the acute parameters of nutritional status like wasting. It also improves the clinical outcome and restores the immune system. At present first-line ART is effective in HIV-positive children.

To assess the effectiveness of a brief face-to-face health promotion intervention which included a ‘pledge’ using brief negotiation techniques, compared with standard advice-giving techniques, delivered in a community setting.

A parallel group pre–post design using randomised matched groups. Lifestyle helpers delivered the intervention (one consultation per participant). Diet, physical activity and anthropometric measurements were collected at baseline, 6 months and 12 months. Qualitative data were also collected.

Middlesbrough (UK).

Adults living in low socio-economic areas.

Recruitment and engagement of lifestyle helpers was difficult, and initial expectations that local health authority staff working in the community and community champions would act as lifestyle helpers were not realised. As a consequence, recruitment of participants was lower than anticipated. One hundred and twenty-eight adults were recruited and the retention rate was 48 % at 12 months. Barriers to participation included poor health and competing commitments. No significant differences in change in diet or physical activity behaviours, or BMI, between the intervention and control groups were observed. The control group had a significantly greater decrease in waist circumference at 12 months compared with the intervention group.

This exploratory trial provides important insights in terms of recruiting lifestyle helpers for community-based health promotion interventions, specifically (i) the priorities and limitations in terms of time (regardless of their general enthusiasm) for staff employed by the local health authority, and (ii) the willingness of potential community champions to serve their local community in areas where community identity and ‘spirit’ are seen as lacking.

To describe ready-to-eat (RTE) cereal purchases in 2008 in the USA according to cereal nutritional quality and marketing strategy and household sociodemographic characteristics.

Cross-sectional study of purchases in one year. Each type of cereal was assigned to one of four nutrition quality categories (based on Nutrient Profile Index, NPI) and one of four advertising categories based on television exposure and analysis of packaging (child-targeted, family-targeted, adult-targeted and no television advertising). Medians and distributions of purchase indicators were calculated for the cereal categories and the distributions were compared across sociodemographic groups.

RTE cereals (n 249) with complete label and nutritional content.

RTE cereal purchases according to household sociodemographic characteristics obtained from Nielsen Homescan, a nationally representative panel of households.

Purchases of RTE cereals were highest in households with one or more child and lowest in African-American and Asian households, as well as those earning <$US 30 000 per annum. The lowest-quality products were purchased by four times as many households as the highest-quality cereals, but loyalty to these products was lower. Purchases of cereals by households with children and in African-American and Hispanic households increased as cereal nutritional quality declined. Compared with non-advertised products, advertised child-targeted cereals were purchased thirteen times more frequently; family-targeted brand purchases were ten times higher; and adult-targeted cereals were purchased four times more frequently.

Our findings suggest that improving the nutritional quality of RTE cereals with advertising targeted to children could also lead to increased consumption of healthier products by young people.

To examine whether the German food industry directs commercials for unhealthy products to children and whether self-administered voluntary restrictions on the promotion of less healthy foods (the EU Pledge) are effective to mitigate this exposure.

By analysing German data from television (TV) channels, advertised products were categorized and food products classified as core foods (healthy) and non-core foods (less healthy). Marketing techniques were documented. Food commercials were furthermore compared with commercials for toy products, and comparisons were made between advertising patterns before and after the EU Pledge.

Data for ten German TV channels were recorded for two weekdays and two weekend days from 06.00 to 22.00 hours in 2007 and 2008. A second sample containing one weekday and one weekend day of three German TV channels was recorded again in 2010 for comparison in the same time period.

In total 16 062 advertisements from 2007–2008 and 2657 from 2010 were analysed.

In 2007–2008 19·9 % of TV commercials were for food products, of which 73 % were for non-core foods, 21 % for core foods and 6 % not classified. In three specified channels widely viewed by children and youth, 14·5 % of commercials were for food products, of which 88·2 % were for non-core foods. Commercials for unhealthy foods were broadcast significantly more often during children's peak viewing and in children's programmes, with a higher use of promotional characters and premiums than found in commercials for non-food products. In 2010, analysis of the three specified channels found that 18·5 % of commercials were for food products, of which 98·2 % were for non-core foods. While the use of premiums decreased compared with other commercials, the use of promotional characters in non-core food commercials increased, especially during children's programmes.

Children in Germany are exposed to large numbers of food commercials. The exposure to commercials for non-core foods and the use of techniques attractive to children are widespread and appear to have remained unaffected by the announcement of the EU Pledge in December 2007. We conclude that the industry's voluntary agreement has failed to fulfil its declared purpose.

To investigate the relative importance of specific health knowledge and taste on acceptance of Brassica vegetables (broccoli, red and green cabbages, broccolini, cauliflower, Brussels sprouts).

In a sample of adults all reporting medium–high physical activity (as a marker/control of health behaviour) and reporting either low (≤2 portions/d) or high (≥3 portions/d) vegetable intake, half of those with low vegetable consumption (Li group) and half of those with high vegetable consumption (Hi group) received cancer protection information, while the other half did not (Ln and Hn groups), before hedonic (9-point), perceived taste and flavour impact responses (100 mm scales) to samples of six Brassica vegetables were elicited. Additionally, attitudes towards foods for health, pleasure and reward, sociodemographics, intentions to consume the vegetables in the near future and recall of health information were also measured.

Adult males and females (n 200) aged 18–55 years.

Central location testing, Adelaide, Australia.

Information groups Li and Hi reported specific cancer protection information knowledge, in contrast to Ln and Hn groups (P < 0·000). Information independently influenced responses to (the least liked) Brussels sprouts only. Multivariate regression analysis found sensory perception tended to predict liking and intentions to consume Brassica vegetables. For example, broccoli hedonics (adjusted R2 = 0·37) were predicted (P < 0·05) by bitterness (β = −0·38), flavour (β = 0·31), sweetness (β = 0·17) and female gender (β = 0·19) and intentions to consume (adjusted R2 = 0·20) were predicted (P < 0·05) by bitterness (β = −0·38), flavour (β = 0·24), female gender (β = 0·20) and vegetable intake (β = 0·14).

Addressing taste dimensions (while retaining healthy compounds) may be more important than promoting health information in order to increase the popularity of Brassica vegetables.