The present study examines the relationships of household food security status with Fe deficiency (ID) and Fe-deficiency anaemia (IDA) among children less than 3 years of age, and associated factors that contribute to ID and IDA.

Cross-sectional study and chart review. The US Food Security Survey Module was administered to adult caregivers as part of the Children’s Sentinel Nutrition Assessment Project (C-SNAP). Haematological data were obtained from medical records.

A large metropolitan medical centre in Minneapolis, Minnesota, USA.

A multi-ethnic sample of 2853 low-income children aged <36 months who received care at the medical centre.

Among the caregivers, 23·3 % reported low household food security and 11·6 % reported very low household food security (VLFS). After controlling for background factors, children from households with VLFS were almost twice as likely to have IDA than were children from households with high or marginal food security (OR = 1·98, 95 % CI 1·11, 3·53); the corresponding associations for ID were not statistically significant.

The prevalence of IDA in early childhood is significantly larger in low-income infants and toddlers living in VLFS households. Asian, Hispanic and African-American children have elevated prevalences of ID and IDA. Breast-feeding may be associated with elevated ID and IDA, while participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) may be protective for ID.

To validate a two-item food security questionnaire (FSQ) for use in a clinical setting to screen HIV-1 infected patients for food insecurity.

The present study was a questionnaire-based survey of forty-nine subjects attending an HIV clinic. Subjects completed a two-item questionnaire and a six-item validated FSQ contemporaneously.

A strong correlation was found between the two-item and six-item FSQ (ρ = 0·895; 95 % CI 0·821, 0·940; P < 0·0001). Cronbach's α coefficient was found to be 0·94 and 0·90 for the two-item and six-item FSQ, respectively. The two-item FSQ yielded a sensitivity of 100 % (95 % CI 75, 100) and a specificity of 78 % (95 % CI 61, 90). The negative predictive value was found to be 100 % (95 % CI 88, 100).

The results of the present study suggest that the two-item FSQ is a valid, reliable and sensitive screening tool of food insecurity in people living with HIV in a clinical setting.

Dietary intake and nutritional status of antioxidant vitamins have been reported to protect against some cancers. The objective of the present study was to assess the correlations between serum levels of carotenoids (including β-, α- and γ-carotene), lycopene, retinol, α- and γ-tocopherols, and dietary intakes estimated by an FFQ, among low-income women in the Brazilian Investigation into Nutrition and Cervical Cancer Prevention (BRINCA) study.

Cross-sectional study of data for 918 women aged 21–65 years participating in the BRINCA study in São Paulo city. Multiple linear regression models were used with serum nutrient levels as the dependent variable and dietary intake levels as the independent variable, adjusted for confounding factors.

In energy-adjusted analyses, the intakes of dark green and deep yellow vegetables and fruits (partial R2 = 4·8 %), total fruits and juices (partial R2 = 1·8 %), vegetables and fruits (partial R2 = 1·8 %), carrots (partial R2 = 1·4 %) and citrus fruits and juices only (partial R2 = 0·8 %) were positively correlated only with serum total carotene levels, after adjusting for serum total cholesterol concentration, age, hospital attended, smoking status, BMI and presence of cervical lesions. Multiple-adjusted serum levels of carotenoids were positively correlated with intake quartiles of dark green and deep yellow vegetables and fruits and total fruits and juices independent of smoking status.

The intake of specific fruits and vegetables was an independent predictor of serum total carotene levels in low-income women living in São Paulo.

To document nutritional status and health behaviours of young indigenous women of childbearing age in rural communities in north Queensland.

Cross-sectional survey of 424 Aboriginal and 232 Torres Strait Islander (TSI) women aged 15–34 years, conducted in twenty-three rural and remote communities of far north Queensland in 1999–2000, with follow-up of a smaller cohort (n 132) in 2006–2007.

Weight, waist circumference, intake of fruit and vegetables, smoking, alcohol intake, fasting blood glucose, blood pressure, HDL cholesterol, γ-glutamyltransferase, red cell folate (RCF), interval weight and waist gain and incidence of diabetes.

Forty-one per cent of Aboriginal and 69 % of TSI had central obesity, 62 % were smokers, 71 % drank alcohol regularly and of those, 60 % did so at harmful levels. One third of Aboriginal and 16 % of TSI women had very low RCF levels. In the group followed up, there was a mean annual waist gain of 1·6 cm in Aboriginal women and 1·2 cm in TSI, 0·5 kg/m2 in BMI and 1·5 kg in weight. Incidence of new type 2 diabetes mellitus in this cohort was 29·1 per 1000 person-years (py) (95 % CI 14·0, 52·8) in Aboriginal women and 13·9 per 1000 py (95 % CI 5·6, 28·5) among TSI.

High prevalence and incidence of central obesity and diabetes, poor nutrition, high rates of alcohol use and tobacco smoking together with young maternal age, provide a poor intra-uterine environment for many indigenous Australian babies, and contribute to high perinatal morbidity and future disability. Community level interventions to improve pre-pregnancy nutrition and health behaviours in young women are urgent.

To describe pathways through which trade liberalisation affects the food environment, relevant to the nutrition transition, in order to enable public health nutritionists to understand trade policy as a macro-level influence on food consumption.

The pathways mapped in the present paper are based on the agreements of the World Trade Organization, which shape national policy. Implications for nutrition are presented based on a comprehensive literature review, and case studies are used to illustrate the various pathways.

Developing countries are currently experiencing a nutrition transition, resulting in dietary patterns associated with chronic disease. Chronic diseases are amenable to prevention, and trade policy has been highlighted as a potential avenue for nutrition-related prevention.

Trade liberalisation influences the food environment through facilitating trade in goods and services, enabling investment and decreasing support/protection for domestic industry. These policy outcomes facilitate the nutrition transition particularly through increasing the availability and affordability of processed foods and animal products. The framework highlights the complex relationship between trade policy and the nutrition transition, with both negative and positive outcomes arising from different aspects of trade liberalisation.

Policy change associated with trade liberalisation has created incentives for consumption patterns associated with the nutrition transition, but has also had some positive nutritional outcomes. As a result, it is important for public health nutritionists to consider the implications of trade policy decisions in their efforts to prevent and control diet-related chronic diseases.

The aim of the present study was to develop (phase 1) and validate (phase 2) a screening questionnaire to assess the adequacy of micronutrient intake of economically active South African adults.

For identification of indicator foods to be included in the screening questionnaire (phase 1), a comprehensive, eighty-six-item, quantified FFQ that reflected the food sources of thirteen selected micronutrients associated with the nutrition-related health status of South Africans was developed and completed by 554 adults of all four major ethnic groups. Resulting dietary data were subjected to stepwise regression analyses to identify indicator foods to be included in the final screening questionnaire. For validation of frequency of intake reporting of specific food items included in the screening questionnaire (phase 2), a sample of sixty-six African and eighty-four white adult volunteers of both genders completed a 7 d record as well as the screening questionnaire. The frequency of intake of specific food items derived from the two methods was then compared using Spearman correlation coefficients.

Phase 1 identified thirty indicator foods that formed the basis of the screening questionnaire. In phase 2, significant correlations were found for the total group for twenty-two out of the thirty items in the questionnaire, with correlations being the best for white females and the poorest for African males and females.

A screening questionnaire (thirty-item FFQ) that can be used by researchers and health professionals to assess an individual’s risk of inadequate micronutrient intake was developed and validated.

To assess the reliability and validity of an FFQ to evaluate dietary patterns of Na consumption among low-income and low-literacy Brazilian hypertensive subjects.

The initial FFQ was submitted to content analysis with the pre-test administered to fifteen subjects. Reliability was evaluated according to the reproducibility criterion, with interviewer administration of the FFQ twice within a 15 d interval. Validity was assessed against a 24 h recall (132 subjects), a 3 d diet record (121 subjects) and a biomarker (24 h urinary Na; 121 subjects). To test the correlation with the biomarker, discretionary salt was added to the FFQ Na values.

A large urban teaching hospital in south-eastern Brazil.

The study was based on 132 randomly selected subjects (eighty-three women and forty-nine men) aged 18 to 85 years.

Kappa coefficients ranged from 0·79 to 0·98, confirming the reproducibility of the FFQ. There was no correlation between urinary Na excretion, the FFQ and the 24 h recall for the general sample, although significant correlations had been observed when methods were summed up (24 h recall + discretionary salt + FFQ; 0·32, P = 0·01). The addition of discretionary salt significantly improved the biomarker-based FFQ validity, with correlation coefficients varying from 0·19 (general sample) to 0·31 (female sub-sample).

The developed FFQ demonstrated satisfactory evidence of validity and reliability and can be used as an important complementary tool for the evaluation of Na intake among Brazilian hypertensive subjects.

The relationship of socio-economic status and vegetable consumption is examined in nine European countries. The aim is to analyse whether the pattern of socio-economic variation with regard to vegetable consumption is similar in all studied countries with high v. low vegetable availability and affordability, and whether education has an independent effect on vegetable consumption once the effects of other socio-economic factors have been taken into account.

The data for the study were obtained from national surveys conducted in Finland, Denmark, Germany, Estonia, Latvia, Lithuania, France, Italy and Spain, in 1998 or later. These surveys included data on the frequency of use of vegetables. Food Balance Sheets indicated that the availability of vegetables was best in the Mediterranean countries. The prices of vegetables were lowest in the Mediterranean countries and Germany.

Educational level was positively associated with vegetable consumption in the Nordic and Baltic countries. In the Mediterranean countries, education was not directly associated with the use of vegetables but, after adjusting for place of residence and occupation, it was found that those with a lower educational level consumed vegetables slightly more often. Manual workers consumed vegetables less often than non-manual workers, but otherwise there was no systematic association with occupation.

The Mediterranean countries did not show a positive association between educational level and vegetable consumption. The positive association found in the Northern European countries is linked to the lower availability and affordability of vegetables there and their everyday cooking habits with no long-standing cultural tradition of using vegetables.

To examine the sociodemographic determinants of fruit and vegetable (F&V) consumption in England and determine the differential effects of socio-economic variables at various parts of the intake distribution, with a special focus on severely inadequate intakes.

Quantile regression, expressing F&V intake as a function of sociodemographic variables, is employed. Here, quantile regression flexibly allows variables such as ethnicity to exert effects on F&V intake that vary depending on existing levels of intake.

The 2003 Health Survey of England.

Data were from 11 044 adult individuals.

The influence of particular sociodemographic variables is found to vary significantly across the intake distribution. We conclude that women consume more F&V than men; Asians and blacks more than whites; co-habiting individuals more than single-living ones. Increased incomes and education also boost intake. However, the key general finding of the present study is that the influence of most variables is relatively weak in the area of greatest concern, i.e. among those with the most inadequate intakes in any reference group.

Our findings emphasise the importance of allowing the effects of socio-economic drivers to vary across the intake distribution. The main finding, that variables which exert significant influence on F&V intake at other parts of the conditional distribution have a relatively weak influence at the lower tail, is cause for concern. It implies that in any defined group, those consuming the least F&V are hard to influence using campaigns or policy levers.

To examine the fruit and vegetable consumption in Thailand, the percentage of Thais meeting recommended intakes and the association with sociodemographic factors.

Cross-sectional survey with a stratified, three-stage, cluster probability sampling design.

Community-dwelling men and women participating in the Thailand National Health Examination Survey III.

A total of 39 290 individuals aged ≥15 years were interviewed using a questionnaire to obtain information on sociodemographic characteristics and fruit and vegetable consumption. Daily fruit and vegetable consumption was estimated through the use of a short semi-qualitative FFQ.

Overall, participants had average frequencies of fruit and vegetable consumption equal to 4·56 and 5·97 d/week, respectively. Average daily number of servings of fruit, vegetables and fruit plus vegetables were 1·46, 1·78 and 3·24, respectively. Intake amounts of fruit, vegetables and fruit plus vegetables varied by marital status and region, and were lower among males (except for vegetable intake), those of older age, those with low educational attainment, those with low monthly household income and those living in a rural area. Only 1/3, 1/4 and 1/4 of the population consumed the recommended ≥2, ≥3 and ≥5 servings/d for fruit, vegetables and fruit plus vegetables. Sociodemographic factors related to meeting the recommended intake of ≥5 servings/d for fruit plus vegetables included being female (OR = 1·13) and household income ≥50 000 Baht/month (OR = 1·66).

The amounts of fruit and vegetables consumed by Thai participants were far below the level of current recommendations. Public education and campaigns on adequate consumption of fruits and vegetables should be targeted more towards low socio-economic groups.

The purpose of this impact evaluation was to measure the influence of a government of Ontario, Canada health promotion initiative, the Northern Fruit and Vegetable Pilot Programme (NFVPP), on elementary school-aged children’s psychosocial variables regarding fruit and vegetables, and fruit and vegetable consumption patterns.

A cluster-randomised controlled trial design was used. The NFVPP consisted of three intervention arms: (i) Intervention I: Free Fruit and Vegetable Snack (FFVS) + Enhanced Nutrition Education; (ii) Intervention II: FFVS-alone; and (iii) Control group. Using the Pro-Children Questionnaire, the primary outcome measure was children’s fruit and vegetable consumption, and the secondary outcome measures included differences in children’s awareness, knowledge, self-efficacy, preference, intention and willingness to increase fruit and vegetable consumption.

Twenty-six elementary schools in a defined area of Northern Ontario were eligible to participate in the impact evaluation. A final sample size of 1277 students in grades five to eight was achieved.

Intervention I students consumed more fruit and vegetables at school than their Control counterparts by 0·49 serving/d (P < 0·05). Similarly, Intervention II students consumed more fruit and vegetables at school than Control students by 0·42 serving/d, although this difference was not statistically significant. Among students in both intervention groups, preferences for certain fruit and vegetables shifted from ‘never tried it’ towards ‘like it’.

The NFVPP resulted in positive changes in elementary school-aged children’s fruit and vegetable consumption at school, and favourable preference changes for certain fruit and vegetables.

To investigate the correlation between the consumption of refined carbohydrates and fats and the prevalence of obesity in the state capitals of Brazil.

An ecological evaluation of obesity and dietary risk factors was carried out in twenty-six state capitals of Brazil.

Analysis was based on the age-standardized prevalence of obesity (BMI ≥ 30·0 kg/m2) among adults aged 20–59 years. Both intake and obesity prevalence were obtained from the last National Family Household Budget Survey (HBS). The survey was conducted from July 2002 to June 2003, based on a probabilistic national sample of 48 470 households. In each household, during seven consecutive days, all monetary and non-monetary expenses for food and beverages for family consumption were transformed into energy. The relative contribution of foods and food groups was expressed as the proportion (%) of total energy. Fruits and vegetables were also measured by the quantity bought in grams.

Prevalence of obesity varied from 5·1 % to 13·6 % among women and from 5·2 % to 17·6 % among men. For women, there were statistically significant correlations between obesity and intake of sugar and soft drinks (rS = 0·60; P = 0·001), ready-to-eat meals (rS = 0·39; P = 0·05) and potatoes (rS = 0·40; P = 0·04). For men there were no such associations.

Increasing intake of refined carbohydrates, mainly soft drinks, may play a role in the prevalence of obesity among women in Brazil. Effecting changes in family purchase patterns may be a strategy to reduce obesity.

The present study describes the trajectory of the energy gap (energy imbalance) in the Canadian population from 1976 to 2003, its temporal relationship to adult obesity, and estimates the relative contribution of energy availability and expenditure to the energy gap. It also assesses which foods contributed the most to changes in available energy over the study period.

Annual estimates of the energy gap were derived by subtracting population-adjusted per capita daily estimated energy requirements (derived from Dietary Reference Intakes) from per capita daily estimated energy available (obtained from food balance sheets). Food balance sheets were used to assess which foods contributed to changes in energy availability. Adult obesity rates were derived from six national surveys. The relationship to the energy gap was assessed through regression analysis.

Between 1976 and 2003, per capita daily estimated energy availability increased by 18 % (1744 kJ), and increased energy availability was the major driver of the increased energy gap. Salad oils, wheat flour, soft drinks and shortening accounted for the majority of the net increase in energy availability. Adult obesity was significantly correlated with the energy gap over the study period.

The widening energy gap is being driven primarily by increased energy availability. The food commodities driving the widening energy gap are major ingredients in many energy-dense convenience foods, which are being consumed with increasing frequency in Canada. Policies to address population obesity must have a strong nutritional focus with the objective of decreasing energy consumption at the population level.

Obesity is an increasingly prevalent nutritional disorder throughout the world. In particular, abdominal obesity is associated with cardiovascular and metabolic risk. The present study aimed to evaluate the effects of skin colour and life-course socio-economic indicators on waist circumference (WC), hip circumference (HC) and waist:hip ratio (WHR) in young adults.

Population-based birth cohort study. Individuals born in 1982 in Pelotas (southern Brazil) were visited on a number of occasions from birth to age 23–24 years. A sample of the cohort was sought in 2006 and 972 individuals were located. The analysis was restricted to individuals with complete data available (442 males, 414 females).

In men, family income at birth and in 2004–5 were positively associated with WC and HC, but not with WHR. Regardless of current income, men born to wealthier families had larger WC and HC as adults. Skin colour was not associated with any of the outcomes. In women, early poverty was associated with smaller HC, and current poverty with larger WC. Poverty at any age thus led to higher WHR. Black women had larger WC and HC than white women, but there were no differences in WHR. All the associations were partially mediated by education and behavioural variables.

The effects of early socio-economic position on WC and HC persist even after adjustment for adult socio-economic position, highlighting the importance of interventions during the first years of life.

The WHO has recommended that prevention of overweight and obesity should begin early and target adults, including those with an acceptable BMI. The aim of the present paper was to systematically review published interventions with a specific stated aim to prevent weight gain.

Five databases were searched to July 2008. The reference lists of review articles and obesity society meetings abstracts were hand searched. Interventions were included if the primary aim was to prevent weight gain and they included a comparison group.

Ten publications were included, describing nine separate interventions in adults of various ages and target populations. All interventions incorporated diet and physical activity with behaviour change strategies. Most studies were between 1 and 3 years in duration. Five studies reported a significant difference in weight between intervention and control subjects of between 1·0 and 3·5 kg, due largely to an increase in weight in the control group. However, there was a lack of consistent, clear, psychological models and a failure to identify successful components. More intensive interventions were not always successful, nor were mail-only or clinic-based interventions. In contrast, interventions that included mixed modes of delivery with some personal contact were successful.

There were relatively few trials aimed at the prevention of weight gain. Existing trials varied by intensity, delivery methods, target groups and study components, and therefore provide limited opportunities for comparison of effect size. Further large, effective, evidence-based programmes are urgently needed in the general population as well as high-risk groups.