To validate an FFQ designed to estimate energy intake in children against doubly labelled water (DLW). To investigate how quality control and standard beverage portion sizes affect the validity of the FFQ.

Thirty healthy children, aged 4–6 years, participated. Total energy expenditure (EE) was measured by the DLW method during an observation period of 15 d. At the end of this period parents filled out an FFQ designed to assess the child’s habitual energy intake (EI) of the preceding four weeks.

Validation study in The Netherlands.

Thirty healthy children (fifteen boys and fifteen girls), aged 4–6 years.

Mean EI (6117 (sd 1025) kJ/d) did not differ significantly from mean EE (6286 (sd 971) kJ/d; P = 0·15); the mean EI:EE ratio was 0·98. The Pearson correlation coefficient between EI and EE was 0·62. The Bland–Altman plot showed no systematic bias and a constant bias close to zero. Less intensive quality control of the FFQ maintained the mean EI:EE ratio and decreased the correlation slightly. Using standard instead of individually measured beverage portion sizes decreased the mean EI:EE ratio, but maintained the correlation.

It can be concluded that the developed FFQ is a valid instrument to estimate mean energy intake in a group of 4- to 6-year-old children and performs reasonably well to rank the subjects with respect to energy intake. It is therefore a useful instrument to estimate energy intake in children in surveys and epidemiological studies in The Netherlands.

Evidence of the effects of soft drinks consumption on BMI and lifestyle in adult populations is mixed and quite limited. The aim of the present study was to determine the association of soft drinks consumption with BMI and lifestyle in a representative Mediterranean population.

Two independent, population-based, cross-sectional (2000 and 2005) studies. Dietary intake was assessed using a validated FFQ. Weight and height were measured.

Girona, Spain.

Random sample of the 35- to 74-year-old population (3910 men and 4285 women).

Less than half (41·7 %) of the population consumed soft drinks; the mean consumption was 36·2 ml/d. The prevalence of sedentary lifestyle increased with the frequency of soft drinks consumption (P = 0·025). Daily soft drinks consumption significantly increased the risk of low adherence to the Mediterranean diet (OR = 0·57, 95 % CI 0·44, 0·74 v. top tertile of Mediterranean diet score). Multiple linear regression analyses, controlled for potential confounders, revealed that an increment in soft drinks consumption of 100 ml was associated with a 0·21 kg/m2 increase in BMI (P = 0·001). Only implausibly low reports of energy consumption showed a null association between soft drinks consumption and BMI.

Soft drinks consumption was not embedded in a healthy diet context and was positively associated with BMI and sedentary lifestyle in this Mediterranean population.

To determine the relative validity of the pre-coded food diary applied in the Danish National Survey of Dietary Habits and Physical Activity.

A cross-over study among seventy-two adults (aged 20 to 69 years) recording diet by means of a pre-coded food diary over 4 d and a 4 d weighed food record. Intakes of foods and drinks were estimated, and nutrient intakes were calculated. Means and medians of intake were compared, and cross-classification of individuals according to intake was performed. To assess agreement between the two methods, Pearson and Spearman's correlation coefficients and weighted kappa coefficients were calculated.

Validation study of the pre-coded food diary against a 4 d weighed food record.

Seventy-two volunteer, healthy free-living adults (thirty-five males, thirty-seven females).

Intakes of cereals and vegetables were higher, and intakes of fruit, coffee and tea were lower, in the weighed food record compared with the food diary. Intakes of nutrients were grossly the same in the two methods, except for protein, where a higher intake was recorded in the weighed record. In general, moderate agreement between the two methods was found.

Participants were classified moderately correct according to food and nutrient intakes assessed in the pre-coded food diary; however values of absolute food intakes should be used and interpreted with caution. Improvement of the methods to estimate portion size may increase the accuracy of the dietary intake estimates.

To assess the validity of FAO data on the availability of fish and vegetable oils as an indicator of national n-3 fatty acid (FA) intake and to estimate the worldwide population living in countries with low n-3 FA intake.

Levels of the essential FA α-linolenic acid (ALA) and DHA, measured by GC in adipose tissue from participants in the present study and from published studies in eleven other countries, were used to validate ALA and fish availability estimated from FAO food balance sheets. On the basis of the validated FAO data for ALA and fish availability, we estimated the global prevalence of low n-3 FA availability.

Rural and urban areas of Bulgaria.

Fifty men and fifty-eight women.

Adipose tissue ALA and DHA levels (0·34 % and 0·11 % of total FA, respectively) in Bulgaria were lower than those of the eleven other countries with available data. A strong positive correlation was found between adipose tissue DHA and fish availability (r = 0·88) and between adipose tissue ALA and ALA availability (r = 0·92). Approximately half of the world's population lived in middle- and low-income countries with limited access to n-3 FA (fish < 400 g/week and ALA < 4 % of total vegetable oils), with the largest proportion being in South-East Asia (53·6 %), followed by Africa (27·1 %) and Eastern Europe (8·5 %). Of this half, 33 % lived in countries such as Bulgaria where n-3 FA was almost unavailable (fish < 200 g/week and ALA < 2 % of total vegetable oils).

Very low availability of n-3 FA is extensive worldwide.

To derive age- and sex-specific reference values for waist circumference (WC) and waist-to-height ratio (WHtR) for Han Chinese children and adolescents and to establish the prevalence of excess central adiposity in our study population.

Cross-sectional study of schoolchildren attending randomly selected primary and secondary schools in south-west China in October 2003 and April 2004. Anthropometry was measured using standard procedures. The LMS method was used to construct smoothed WC and WHtR percentile curves. Overweight and obesity were defined by the International Obesity Task Force (IOTF) criteria and the Working Group on Obesity in Children. Excess central adiposity fat was defined by previously published WC cut-points and a WHtR ≥ 0·5.

Primary and secondary schools in Chongqing, south-west China.

A total of 7326 (49·2 % boys) Han Chinese students at 5–17 years old.

On the basis of the IOTF criteria, 26·4 % of boys were overweight or obese compared with 16·4 % of girls (P < 0·001). WC cut-points identified 31 % of boys and 28 % of girls as having excess central adiposity, whereas using the WHtR criterion, 14·8 % of boys and 5·6 % of girls were identified. Young boys (5–12 years) had a significantly (P < 0·001) higher WHtR than girls.

We have constructed WC and WHtR percentile curves for Han Chinese children and adolescents living in Chongqing. Our measurements were based on a student population with a relatively high rate of overweight and obesity. These data will provide a point of reference for future studies measuring the prevalence of overweight and obesity in China.

To determine the postprandial lipaemia response before and after intervention with healthy diets in the Medi-RIVAGE cohort of subjects with moderate risk factors of CVD.

One hundred and thirty-five adults (fifty-two men and eighty-three women) followed either a Mediterranean-type (MED) diet or a low-fat American Heart Association-type diet in a parallel design for 3 months. At entry and after 3 months, lipids, glucose and insulin were measured in the fasting samples; TAG and apolipoprotein B48 (ApoB48; a marker of intestinally derived chylomicrons) levels were measured in the fasting and postprandial samples after a standard test meal.

The MED diet only lowered (P < 0·028) fasting TAG and both diets reduced TAG and ApoB48 levels 5 h after the test meal. The overall 5 h postprandial ApoB48 response (area under curve (AUC)/incremental AUC) was lowered after both diets but this effect was more marked after the MED-diet intervention. Whatever the TAG level at entry, normo- and hyper TAG subjects showed a reduction in the postprandial ApoB48 levels after 3-month diets. BMI at entry did not impact the effect of diets given subjects with BMI < or >25 kg/m2 showed reduced postprandial ApoB48. Men and women displayed comparable postprandial changes after dietary challenges.

A MED diet appears efficient to improve postprandial lipaemia, a recently acknowledged CVD risk, in men and women at moderate cardiovascular risk.

Our physical environment influences our daily food choices unconsciously. Strategic changes in the food environment might therefore be potential measures to influence consumers’ food selection towards better nutrition, without affecting the consumers’ freedom of choice. The present study aimed to examine whether increased vegetable variety enhances healthy food choices and improves meal composition.

A randomised experiment.

Participants were instructed to serve themselves a lunch from a buffet of food replicas. Individuals were randomly assigned to one of three food combinations: condition A – cooked carrots, pasta and chicken; condition B – cooked green garden beans, pasta and chicken; condition AB – carrot sticks, green garden beans, pasta and chicken. Two one-vegetable conditions were compared with one two-vegetable condition. Data from Zurich, Switzerland, were analysed using one-way ANOVA.

Ninety-eight students (fifty-three men; mean age 22·8 (sd 2·2) years, minimum = 19 years, maximum = 29 years).

Participants who could choose from two vegetables derived significantly more energy (141 kJ) from vegetables compared with participants in the one-vegetable condition (104 and 84 kJ, respectively). Furthermore, in the two-vegetable condition, the relative energy of the meal derived from vegetables (10·9 %) increased significantly compared with the one-vegetable condition (8 % and 6·1 %, respectively). The total energy content of the meal (mean 1472 (sd 468) kJ) was not affected by the experimental manipulation.

Having a choice of vegetables increases a person's tendency to choose vegetables and leads to the selection of a more balanced meal. Serving an assortment of vegetables as side dishes might be a simple and effective strategy to improve food selection.

In malnourished populations, the weight-for-height Z-score (WHZ) distribution is shifted to the left. The aim of nutrition interventions should be to restore a normal WHZ distribution for the whole population. The present paper examines the WHZ change needed by each individual to achieve this objective.

We developed a mathematical model of required individual change in WHZ as a function of characteristics of the initial population to restore a normal distribution. This model was then tested by simulating WHZ change needed to restore a normal WHZ distribution in a test population.

A rural area of Democratic Republic of the Congo with a high prevalence of undernutrition.

Children under 5 years of age.

To restore a normal distribution for the whole population, the WHZ of all children should be shifted. The desired WHZ change of each individual should be higher when the individual's initial WHZ is low, when the mean WHZ of the whole population is low and, for the most wasted individual, when the variance of WHZ and WHZ change in the population are high. Using the suggested model in a simulation on the test population resulted in a WHZ distribution close to the growth standard.

To restore a normal WHZ distribution in wasted populations, nutritional programmes should cover the whole population with a higher weight gain in areas where mean WHZ is low.

To assess convergent validity, factorial validity, test–retest reliability and internal consistency of a diet quality food behaviour checklist (FBC) for low-literate, low-income Spanish speakers.

Participants (n 90) completed three dietary recalls, the Spanish-language version of the US Department of Agriculture (USDA) Household Food Security Survey Module (HFSSM) and the Spanish-language FBC. Factor structure was examined using principal component analysis. Spearman correlation coefficients between FBC item responses and nutrient intakes from 24 h recalls were used to estimate convergent validity. Correlation coefficients were also calculated between FBC item responses at two time points in another group of participants (n 71) to examine test–retest reliability. Cronbach's α coefficient was determined for items within each sub-scale.

Non-profit community agencies serving low-income clients, migrant farm worker camps and low-income housing sites in four California counties.

Spanish-speaking women (n 161) who met income eligibility for the SNAP-Ed (Supplemental Nutrition Assistance Program–Education).

Factor analysis resulted in six sub-scales. Responses to nineteen food behaviour items were significantly correlated with hypothesized 24 h recall data (with a maximum correlation of 0·44 for drinking milk and calcium) or the USDA HFSSM (0·42 with the food security item). Coefficients for test–retest reliability ranged from 0·35 to 0·79. Cronbach's α ranged from 0·49 for the diet quality sub-scale to 0·80 for the fruit and vegetable sub-scale.

The twenty-two-item FBC and instruction guide will be used to evaluate USDA community nutrition education interventions with low-literate Spanish speakers. This research contributes to the body of knowledge about this at-risk population in California.

The present study aimed to analyse changes in meal pattern among Norwegian children from 2001 to 2008 in general; to analyse associations between meal pattern and gender, parental educational level and number of parents in the household; and to analyse the association between intake of unhealthy snacks, meal pattern and the mentioned variables.

Within the Fruits and Vegetables Make the Marks (FVMM) project, two cross-sectional studies were conducted, one in 2001 and one in 2008, where participants from the same schools filled in a questionnaire on meals eaten the previous day.

Participants were 6th and 7th grade pupils, n 1488 in 2001 and n 1339 in 2008.

Twenty-seven elementary schools in two Norwegian counties.

There were no significant changes in children's meal pattern from 2001 to 2008. For both years more than 90 % of the participants reported that they had breakfast yesterday, while 95 % had lunch, 94 % had dinner and 82 % had supper. More girls than boys reported that they had lunch yesterday (96 % v. 94 %, P = 0·03). More children with higher v. lower educated parents reported that they had breakfast yesterday (93 % v. 88 %, P < 0·001). More children living with two parents v. one parent had breakfast (93 % v. 88 %, P = 0·001) and lunch yesterday (97 % v. 93 %, P < 0·001).

There were no changes in meal pattern from 2001 to 2008 among Norwegian children. Characteristics associated with skipping meals were living in a one-parent family and having lower educated parents.

To explore the extent to which appetite status influences portion size estimation in men under laboratory conditions and to quantify how much participants’ portion estimates differed from the recommended portion sizes defined by authoritative bodies (i.e. government and health professionals’ reference amounts).

Repeated, randomized cross-over trial with each participant attending the laboratory on four separate occasions. At each session, participants rated the number of portions of eight foods and beverages displayed in front of them. Participants rated portions twice after consuming breakfast (full conditions) and twice after an overnight fast (hungry conditions). Portion estimates were compared with reference amounts from the British and American Dietetic Associations, from the UK Food Standards Agency and from the US Food and Drug Administration.

Food skills laboratory, University of Chester, UK.

Twenty-seven non-obese men (mean age 24·9 (sd 6·5) years).

Portion size estimates for all items were significantly smaller under hungry than under full conditions (P < 0·01). Relative to reference instruments, estimates were significantly smaller for all foods except banana, irrespective of appetite status (P < 0·001).

In this data set, appetite status altered the perception of food amounts. There were large discrepancies between participants’ perception of a portion and recommendations from health professionals and government standards. Nutritional educational strategies should take into account the role of hunger along with a person's familiarity with existing portion size systems when advising on portion sizes.

To build a comprehensive overview of the potential role of fish in improving nutrition with respect to certain micronutrient deficiencies in developing countries.

A comprehensive literature review was completed. For this the electronic library databases ASFA, CABD and Scopus were systematically searched and relevant references cited in these sources were carefully analysed. The search terms used were ‘fish’, ‘small fish species’, ‘micronutrients’, ‘food-based strategies’, ‘fish consumption’ and ‘developing countries’. The quality of data on nutritional analyses was carefully reviewed and data that lacked proper information on methods, units and samples were excluded.

The evidence collected confirmed the high levels of vitamin A, Fe and Zn in some of the small fish species in developing countries. These small fish are reported to be more affordable and accessible than the larger fish and other usual animal-source foods and vegetables. Evidence suggests that these locally available small fish have considerable potential as cost-effective food-based strategies to enhance micronutrient intakes or as a complementary food for undernourished children. However, the present review shows that only a few studies have been able to rigorously assess the impact of fish consumption on improved nutritional status in developing countries.

Further research is required in areas such as determination of fish consumption patterns of poor households, the nutritional value of local fish and other aquatic animals and the impact of fish intake on improved nutritional status in developing countries where undernutrition is a major public health problem.

To test the effect of image size and presence of size cues on the accuracy of portion size estimation by children.

Children were randomly assigned to seeing images with or without food size cues (utensils and checked tablecloth) and were presented with sixteen food models (foods commonly eaten by children) in varying portion sizes, one at a time. They estimated each food model’s portion size by selecting a digital food image. The same food images were presented in two ways: (i) as small, graduated portion size images all on one screen or (ii) by scrolling across large, graduated portion size images, one per sequential screen.

Laboratory-based with computer and food models.

Volunteer multi-ethnic sample of 120 children, equally distributed by gender and ages (8 to 13 years) in 2008–2009.

Average percentage of correctly classified foods was 60·3 %. There were no differences in accuracy by any design factor or demographic characteristic. Multiple small pictures on the screen at once took half the time to estimate portion size compared with scrolling through large pictures. Larger pictures had more overestimation of size.

Multiple images of successively larger portion sizes of a food on one computer screen facilitated quicker portion size responses with no decrease in accuracy. This is the method of choice for portion size estimation on a computer.

To describe trends in the prevalence of obesity and overweight in English adults.

Analysis of nationally representative cross-sectional population surveys. Sociodemographic information was gathered by an interviewer-administered questionnaire and measurements of height and weight were used to calculate the prevalence of obesity and overweight.

A total of 61 515 men and 69 733 women aged 16–65 years participating in the annual Health Survey for England between 1991 and 2006.

When the 4-year periods 1991/94 and 2003/06 were compared, male and female obesity had risen by 8·2 % and 6·0 %, and male and female overweight had risen by 8·8 % and 7·4 %. However, the rate of increase appears to be slowing down: the increases between 1995/98 and 1999/02 were greater than those between 1999/02 and 2003/06. There was relatively little variation across the age range in the average changes in obesity or overweight prevalence between time periods, except that the increase in male obesity between periods was significantly greater for older than younger males. When the subjects were divided into 10-year pseudo birth cohorts, it was seen that the prevalence of obesity and overweight was consistently higher at a given average age for pseudo cohorts born more recently. This agreed with data from two British cohort studies.

Obesity and overweight continued to rise over the study period, but there are signs that the rate of increase is slowing down, even though the prevalence is consistently higher for a given age in cohorts born more recently.

Few dietary surveys have been done with reference to chronic diseases, such as diabetes, in India, which is considered to be the diabetes capital of the world. We report on the dietary intake of urban adults living in Chennai, South India.

A population-based cross-sectional study.

A representative population of urban Chennai in southern India.

The study population comprised 2042 individuals aged ≥20 years selected from the Chennai Urban Rural Epidemiological Study (CURES). Dietary intake was measured using a validated and previously published interviewer-administered semi-quantitative meal-based FFQ.

The mean daily energy intake was 10 393 (sd 2347) kJ (male: 10953 (sd 2364) kJ v. female: 9832 (sd 233) kJ). Carbohydrates were the major source of energy (64 %), followed by fat (24 %) and protein (12 %). Refined cereals contributed to the bulk of the energy (45·8 %), followed by visible fats and oils (12·4 %) and pulses and legumes (7·8 %). However, energy supply from sugar and sweetened beverages was within the recommended levels. Intake of micronutrient-rich foods, such as fruit and vegetable consumption (265 g/d), and fish and seafoods (20 g/d), was far below the FAO/WHO recommendation. Dairy and meat products intake was within the national recommended intake.

The diet of this urban South Indian population consists mainly of refined cereals with low intake of fish, fruit and vegetables, and all of these could possibly contribute to the risk of non-communicable diseases such as diabetes in this population.

To analyse changes and predictors of change in self-reported food intake among Brazilian families that benefitted from conditional cash transfer (CCT) implemented in the Programa Bolsa Família of the Brazilian Federal Government.

A cross-sectional survey.

The study was conducted from September to October 2007 in a nationwide representative household sample of families included in the CCT. Socio-economic variables, perception of food consumption and food insecurity were evaluated via questionnaire, which was completed during face-to-face interviews.

Five thousand households were selected from the CCT registry.

Families reported increased consumption of all food groups analysed, mainly cereals, processed foods, meat, milk and dairy, beans and sugar. The degree of dependence on income from the CCT was positively associated with increased self-reported intake of food items such as sugar and soft drinks. A Poisson regression revealed that the fourth quartile of CCT dependence demonstrated a twofold increase in the self-reported intake of soft drinks (relative risk (RR) = 2·3, 95 % CI 1·8, 2·9) and sugar (RR = 2·5, 95 % CI 2·1, 3·1) compared with the first quartile of CCT dependence.

Greater purchasing power of poor families increases unhealthy food choices; thus public policies should emphasise the availability of healthy food.

To evaluate the impact of an educational and environmental intervention on the availability and consumption of fruits and vegetables in workplace cafeterias.

This was a randomized intervention study involving a sample of companies that were divided into intervention and control groups. The intervention, which focused on change in the work environment, was based on an ecological model for health promotion. It involved several different aspects including menu planning, food presentation and motivational strategies to encourage the consumption of fruits and vegetables. The impact of the intervention was measured by changes (between baseline and follow-up) in the availability of fruits and vegetables that were eaten per consumer in meals and the consumption of fruits and vegetables in the workplace by workers. We also evaluated the availability of energy, macronutrients and fibre.

Companies of São Paulo, Brazil.

Twenty-nine companies and 2510 workers.

After the intervention we found an average increase in the availability of fruits and vegetables of 49 g in the intervention group, an increase of approximately 15 %, whereas the results for the control group remained practically equal to baseline levels. During the follow-up period, the intervention group also showed reduced total fat and an increase in fibre in the meals offered. The results showed a slight but still positive increase in the workers’ consumption of fruits and vegetables (about 11 g) in the meals offered by the companies.

Interventions focused on the work environment can be effective in promoting the consumption of healthy foods.

To assess school canteen attendance in a French nationally representative sample of children and to analyse its association with the socio-economic and demographic characteristics of the children and their families.

Data from the second French national cross-sectional food consumption survey (INCA2), performed in 2006–2007, were used. Information on usual weekly school canteen attendance was collected through a self-reported questionnaire, and demographic and socio-economic variables through a face-to-face questionnaire. The associations between school canteen attendance and the socio-economic and demographic variables were investigated by multivariate logistic regression analyses.

The INCA2 sample was representative of the children aged 3–17 years in France.

Analysis was performed on 1413 schoolchildren who completed the school canteen attendance questions.

Some 65·6 % of schoolchildren aged 3–17 years had school lunch at least once weekly. This rate of attendance was positively correlated with age. Whatever the school level, school canteen attendance was positively associated with the educational level of the caregiver/parent. In pre- and elementary-school children, enrolment at the school canteen was also higher when the caregiver/parent worked, or in single-parent families. In secondary-school children, school lunch participation decreased with children living in more densely populated areas and increased with the level of the household’s living standards.

School canteen attendance was positively associated with children’s socio-economic background. This could reduce the effectiveness of the forthcoming school meal composition regulations designed to improve the diet of children from deprived backgrounds, who are more likely to have unhealthy food habits.

To determine the nutrition transition stage of female Jordanian college students.

A cross-sectional survey was used to assess eating styles, disordered eating attitudes and behaviours, body esteem and dissatisfaction, and media influence.

Public and private universities in Jordan.

A total of 255 subjects were recruited through a government-initiated youth campaign.

The majority of participants had a normal BMI (70·6 %) with almost all (99·4 %) reporting restrained eating behaviour. Scores on the Eating Attitudes Test (EAT-26) indicated that 45·2 % of these female college students should be screening for eating disorders. Subscales of the Body Esteem Scale (BES) showed that these women did not have substantial body esteem issues and mean scores on the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ-3) indicated that overall these women did not feel the media was dictating the way their body should look. Where Jordanian women did feel pressure from Western media, there was a 6·7-fold increase in the likelihood that they wanted to lose weight. In addition, 48·2 % of the female college students desired to lose weight and 14·4 % desired weight gain, indicating a certain level of body dissatisfaction.

With low levels of overweight and obesity and a propensity towards eating based on external hunger cues, college-aged Jordanian women may be less advanced in their development through the nutrition transition than the general population of women. However, high levels of restrained eating and disordered eating attitudes and behaviours indicate the need for an intervention to address healthy weight-loss strategies, assess eating disorders and help maintain healthy body esteem.

In the early years of life, influential attributes are formed and may be difficult to change later in life. Early childhood is now recognised as a key target in the prevention of overweight and obesity, and the knowledge that children gain at this time about food and its health benefits may have an important influence on their dietary choices and preferences in later life. Therefore, an activity was designed using age-appropriate methods to assess nutrition knowledge of young children.

The Healthy Food Knowledge Activity was developed using a list of thirty healthy and unhealthy foods and drinks generated from the Australian Guide to Healthy Eating.

The activity was conducted with individual children from reception classes of South Australian schools.

Children aged 5–6 years undertook the activity in a pilot study (n 13) and in the main study (n 192).

Pilot data indicated good test–retest reliability of the activity (r = 0·84, P < 0·01). In the main study, there was a good distribution of scores with acceptable skewness and kurtosis statistics. A breakdown of responses indicated good face validity, with more obvious foods being more correctly classified.

Children as young as 5–6 years of age can correctly identify healthy foods, and this can be measured objectively. This activity also provides interesting insights regarding misconceptions about foods that could be attributed to influences such as media advertising and that can be addressed by educators of this age group.