Past research has identified increases in national income and urbanization as key drivers of the global obesity epidemic. That work further identified educational attainment and urban residence as important moderators of the effects of national income. However, such work has tended to assume that children and adults respond in the same way to these factors. In the present paper, we evaluate how the socio-economic and country-level factors associated with obesity differ between children and their mothers.

We modelled the associations between maternal education, country-level income and urban residence with mother's and children's weight status.

We analysed ninety-five nationally representative health and nutrition surveys conducted between 1990 and 2008 from thirty-three less developed countries.

Our sample included children aged 2–4 years (n 253 442) and their mothers (n 228 655).

Consistent with prior research, we found that mothers’ risk of overweight was positively associated with economic development, urban residence and maternal education. Additionally, economic development was associated with steeper increases in mothers’ risk of overweight among those with low (v. high) levels of education and among those living in rural (v. urban) areas. However, these associations were different for children. Child overweight was not associated with maternal education and urban residence, and negatively associated with national income.

We speculate that the distinctive patterns for children may arise from conditions in low- and middle-income developing countries that increase the risk of child underweight and poor nutrition.

To determine the prevalence of metabolic syndrome (MetS) and its components and to evaluate the relationship between this diagnosis and cardiovascular risk factors, demographic and socio-economic variables.

A cross-sectional study using a questionnaire including information on sociodemographic and CVD risk factors. Blood pressure, anthropometric indices, fasting glucose and lipid profile were measured. MetS was defined according to the criteria of the National Cholesterol Education Program, Adult Treatment Panel III.

The whole Tunisian territory; Transition and Health Impact in North Africa (TAHINA) project.

A total of 4654 individuals (1840 men and 2814 women), aged 35 to 74 years, who participated in the Tunisian national survey.

The overall prevalence of MetS was 30·0 %, higher in women (36·1 %) than in men (20·6 %; P < 0·001). In both genders MetS prevalence increased significantly with age (P < 0·001), but this increase was more important in women. Multiple regression analyses showed that the odds for MetS increased significantly with urban area for both men and women (P < 0·05 and P < 0·001, respectively). The multivariate models showed also that the odds for MetS increased significantly with increasing level of education and in those with a family history of CVD for men (both P < 0·05) and after the menopausal transition for women (P < 0·05).

The study highlights the MetS problem in a middle-income developing country. There is an urgent need for a comprehensive, integrated, population-based intervention programme to ameliorate the growing problem of MetS in Tunisians.

The study aimed to highlight the determinants of overnutrition (overweight plus obesity) in fishing communities and establish if these were the same as reported elsewhere in Ghana.

Cross-sectional study.

The study was conducted in Idun, Ola and Duakor fishing communities in Cape Coast, Ghana.

Adults (n 252) aged 20 to 50 years.

Results showed that 32 % of participants were overweight/obese (BMI ≥ 25·0 kg/m2). Participants’ mean age was 31·7 (sd 1·0) years, they had 13·7 (sd 8·1) mean years of formal education, their median monthly income was $US 7·4 (interquartile range $US 3·3, 20·0) and their median daily energy intake was 7·3 (interquartile range 5·3, 9·8) MJ. Significant associations (P < 0·05) were found between BMI and gender, age, years of education, fat intake and marital status. Females were almost eight times more likely to be overweight/obese than males (adjusted OR = 7·7; 95 % CI 3·6, 16·4). Persons aged ≥40 years were about six times more likely to be overweight/obese than those aged 20–29 years (adjusted OR = 6·1; 95 % CI 2·6, 14·1). Married people were nearly three times more likely to be overweight/obese than singles (adjusted OR = 2·8; 95 % Cl 1·4, 5·7). People with more than 13 years of formal education (adjusted OR = 0·3; 95 % CI 0·1, 0·9) and people with >30 % fat contribution to daily energy intake (adjusted OR = 0·3; 95 % CI 0·1, 0·6) had reduced odds of being overweight/obese.

Overnutrition was prevalent in the fishing communities and associated with factors such as age, gender, marital status, educational status and fat intake.

To describe nutrient intakes and prevalence of overweight and obesity in a nationally representative sample of Kuwaitis and to compare intakes with reference values.

Cross-sectional, multistage stratified, cluster sample.

National nutrition survey covering all geographical areas of the country.

Kuwaitis (n 1704) between 3 and 86 years of age.

Obesity was more prevalent among women than men (50 % and 70 % for females aged 19–50 years and ≥51 years, respectively, v. 29 % and 42 % for their male counterparts). Boys were more obese than girls, with the highest obesity rate among those aged 9–13 years (37 % and 24 % of males and females, respectively). Energy intake was higher than the estimated energy requirements for almost half of Kuwaiti children and one-third of adults. The Estimated Average Requirement was exceeded by 78–100 % of the recommendation for protein and carbohydrates. More than two-thirds of males aged ≥4 years exceeded the Tolerable Upper Intake Level for Na. Conversely, less than 20 % of Kuwaitis, regardless of age, consumed 100 % or more of the Estimated Average Requirement for vitamin D, vitamin E, Ca, n-3 and n-6 fatty acids. Less than 20 % of children met the recommended level for fibre.

Nutrition transition among Kuwaitis was demonstrated by the increased prevalence of obesity and overweight, increased intakes of energy and macronutrients and decreased intakes of fibre and micronutrients. Interventions to increase awareness about healthy foods combined with modifications in subsidy policies are clearly warranted to increase consumption of low-energy, nutrient-dense foods.

To investigate evolving food retail systems in Thailand.

Rapid assessment procedures based on qualitative research methods including interviews, focus groups discussions and site visits.

Seven fresh markets located in the four main regions of Thailand.

Managers, food specialists, vendors and shoppers from seven fresh markets who participated in interviews and focus group discussions.

Fresh markets are under economic pressure and are declining in number. They are attempting to resist the competition from supermarkets by improving convenience, food diversity, quality and safety.

Obesity has increased in Thailand at the same time as rapid growth of modern food retail formats has occurred. As fresh markets are overtaken by supermarkets there is a likely loss of fresh, healthy, affordable food for poorer Thais, and a diminution of regional culinary culture, women's jobs and social capital, with implications for the health and nutrition transition in Thailand.

To test a surveillance system on diet and physical activity based on data gathered at well-child visits.

Cross-sectional data collection on growth, diet, physical activity and sociodemographic variables.

Offices of 179 paediatricians in three Italian regions.

26 898 children for a total of 32 915 well-child visits at 1, 3, 5–6, 8–9, 12, 18, 24, 36 and 60–72 months of age.

The BMI Z-score was lower than the WHO standard at 1 and 3 months but higher from 8–9 months onwards. The rates of breast-feeding at 1, 3, 5–6, 8–9 and 12 months were 88 %, 75 %, 64 %, 52 % and 32 %, respectively, with 5 % and 3 % continuing up to 24 and 36 months. Exclusive breast-feeding was 64 %, 54 % and 20 % at 1, 3 and 5–6 months, respectively; 57 % at 5 months and 85 % at 6 months were given complementary foods. Only 8 % and 10 % of children were taking five portions of fruit and vegetables daily, while 47 % and 51 % were consuming sugar-sweetened beverages at 36 and 60–72 months, respectively. At 60–72 months, less than 10 % reported at least 1 h of moderate-to-vigorous physical activity on 5–7 d/week, and 32 % watched television or played videogames for more than 2 h/d, every day. The majority of paediatricians rated the surveillance system as reliable and feasible.

Surveillance for diet and physical activity in pre-school children, with data gathered during well-child visits, is feasible and potentially useful to plan and evaluate activities for the prevention of obesity.

To examine the association between cardiovascular risk and childhood overweight and obesity using the BMI cut-offs recommended by the WHO.

Children were classified as normal weight, overweight and obese according to the WHO BMI-for-age reference. Blood pressure, lipids, glucose, insulin, homeostasis model assessment–insulin resistance (HOMA-IR) and uric acid levels were compared across BMI groups. ANOVA and tests of linearity were used to assess overall mean differences across groups. Crude and adjusted odds ratios were calculated for adverse plasma levels of biochemical variables.

Paediatric care centres.

Children (n 149) aged 8–18 years.

About 37 %, 22 % and 41 % of children were classified respectively as normal weight, overweight and obese. There were significant linear mean differences between BMI groups in systolic blood pressure, HDL-cholesterol, TAG, insulin, HOMA-IR and uric acid. Obese children were 10·6 times more likely than normal-weight children to have hypertension; OR for other associations were 60·2 (high insulin), 39·5 (HOMA-IR), 27·9 (TAG), 16·0 (HDL-cholesterol), 4·3 (LDL-cholesterol) and 3·6 (uric acid). Overweight children were more likely than normal-weight children to have hypertension (OR = 3·5), high insulin (OR = 28·2), high HOMA-IR (OR = 23·3) and high TAG (OR = 16·1). Nearly 92 % and 57 % of the obese and overweight children, respectively, had one or more risk factor.

Obesity and overweight defined using the WHO BMI-for-age cut-offs identified children with higher metabolic and vascular risk. These results emphasize the importance of prevention of overweight and obesity in childhood to reduce cardiovascular risk.

Dietary patterns capture the overall diet and thereby provide information on how nutrients are consumed in combinations, and have been suggested to be a better method than studying single nutrients. The present study explored the relationship between dietary patterns at baseline and incidence of obesity at 10-year follow-up in women.

A longitudinal study using baseline measurements from 1992–1996, including food intake, medication, heredity, socio-economic status, lifestyle and measured body composition, and follow-up data collected in 2002–2006 including measured body composition.

Data from the Västerbotten Intervention Programme (VIP) in Sweden.

A total of 6545 initially non-obese women aged 30–50 years.

Among women reporting plausible energy intakes, the ‘Fruit and vegetables cluster’ predicted the highest incidence of obesity (OR = 1·76, 95 % CI 1·11, 2·76; P = 0·015) compared with women in the other food pattern groups combined. When adjusting for metabolic factors and BMI at baseline, the risk for obesity in the ‘Fruit and vegetables cluster’ was attenuated to non-significance. In contrast, high intake of fruit per se was associated with a decreased risk of developing obesity (OR = 0·69, 95 % CI 0·51, 0·91; P = 0·010).

Dietary pattern groups identified by cluster analysis are likely to reflect characteristics in addition to diet, including lifestyle, previous and current health status and risk factors for future disease, whereas intake of fruit per se was a stable indicator and less affected by baseline characteristics. These results underscore the need for complementary methods in understanding diet–disease relationships.

To propose and apply an instrument to assess the breakfast quality of children and adolescents in the Mediterranean area.

Randomized, cross-sectional survey of breakfast consumption using a validated semi-quantitative FFQ administered at school by trained dietitians between Tuesday and Friday. A Breakfast Quality Index (BQI) score was developed, assigning a positive value to the consumption of cereals, fruit, vegetables, dairy products, MUFA, Ca and compliance with energy recommendations, and to the absence of SFA and trans-rich fats. Data were analysed by Student's t test and ANOVA.

Schools in Granada and Balearic Islands (Spain).

All schoolchildren (n 4332) aged 8–17 years at randomly selected and representative schools between 2006 and 2008, stratified by age and sex.

Breakfast was not consumed by 6·5 % of participants. BQI score was highest for children aged 7–9 years and decreased with age (P = 0·001). Females scored higher in all age groups. The lowest score was in males aged 14–17 years and the highest in females aged 7–9 years (P = 0·006).

The proposed BQI appears useful to estimate the breakfast quality of schoolchildren and to form a basis for nutrition education.

To determine the relative validity of a 3 d estimated food record (EFR) used to assess energy and nutrient intakes in toddlers, using a 3 d weighed food record (WDR) as the reference method.

Parents reported the food and beverage intakes of their children using an EFR concurrently with a WDR over three consecutive days. Estimation of mean differences, Spearman correlation coefficients, cross-classifications and Bland–Altman plots were used to assess the agreement between the intakes of energy and fourteen nutrients obtained from the EFR and the WDR.

Data obtained from a representative sample of infants or toddlers in Germany.

Sixty-seven toddlers aged 10–36 months who had completed an EFR for a 3 d recording period that corresponded to the WDR were included in the present analysis.

Energy and nutrient intakes did not differ between the EFR and the WDR, except for linoleic acid and retinol. For all dietary intakes, Spearman rank correlation coefficients between the EFR and the WDR ranged from 0·35 to 0·80 (P ≤ 0·004). The proportion of participants correctly classified into quartiles ranged from 75 % for ascorbic acid intake to 96 % for Fe intake, and the percentage of misclassification was 9 % or less. The weighed κ values ranking the participants ranged from 0·23 for ascorbic acid intake to 0·59 for Fe intake. The Bland–Altman plots indicated a good agreement for all dietary intakes estimated from the EFR.

Our study suggests that this EFR is a valid assessment instrument for estimating the energy and nutrient intakes among toddlers at the group level.

The main aim of the present study was to identify food consumption in Sri Lankan adults based on serving characteristics.

Cross-sectional study. Fruits, vegetables, starch, meat, pulses, dairy products and added sugars in the diet were assessed with portion sizes estimated using standard methods.

Twelve randomly selected clusters from the Sri Lanka Diabetes and Cardiovascular Study.

Six hundred non-institutionalized adults.

The daily intake of fruit (0·43), vegetable (1·73) and dairy (0·39) portions were well below national recommendations. Only 3·5 % of adults consumed the recommended 5 portions of fruits and vegetables/d; over a third of the population consumed no dairy products and fewer than 1 % of adults consumed 2 portions/d. In contrast, Sri Lankan adults consumed over 14 portions of starch and 3·5 portions of added sugars daily. Almost 70 % of those studied exceeded the upper limit of the recommendations for starch intake. The total daily number of meat and pulse portions was 2·78.

Dietary guidelines emphasize the importance of a balanced and varied diet; however, a substantial proportion of the Sri Lankan population studied failed to achieve such a recommendation. Nutrition-related diseases in the country may be closely correlated with unhealthy eating habits.

Exclusive breast-feeding is estimated to reduce infant mortality in low-income countries by up to 13 %. The aim of the present study was to determine the risk factors associated with suboptimal breast-feeding practices in Pakistan.

A cross-sectional study using data extracted from the multistage cluster sample survey of the Pakistan Demographic and Health Survey 2006–2007.

A nationally representative sample of households.

Last-born alive children aged 0–23 months (total weighted sample size 3103).

The prevalences of timely initiation of breast-feeding, bottle-feeding in children aged 0–23 months, exclusive breast-feeding and predominant breast-feeding in infants aged 0–5 months were 27·3 %, 32·1 %, 37·1 % and 18·7 %, respectively. Multivariate analysis indicated that working mothers (OR = 1·48, 95 % CI 1·16, 1·87; P = 0·001) and mothers who delivered by Caesarean section (OR = 1·95, 95 % CI 1·30, 2·90; P = 0·001) had significantly higher odds for no timely initiation of breast-feeding. Mothers from North West Frontier Province were significantly less likely (OR = 0·37, 95 % CI 0·23, 0·59; P < 0·001) not to breast-feed their babies exclusively. Mothers delivered by traditional birth attendants had significantly higher odds to predominantly breast-feed their babies (OR = 1·96, 95 % CI 1·18, 3·24; P = 0·009). The odds of being bottle-fed was significantly higher in infants whose mothers had four or more antenatal clinic visits (OR = 1·93, 95 % CI 1·46, 2·55; P < 0·001) and belonged to the richest wealth quintile (OR = 2·41, 95 % CI 1·62, 3·58; P < 0·001).

The majority of Pakistani mothers have suboptimal breast-feeding practices. To gain the full benefits of breast-feeding for child health and nutrition, there is an urgent need to develop interventions to improve the rates of exclusive breast-feeding.

The present study investigates the changes and tracking of dietary behaviours in Norwegian 11-year-olds and examines the association between parental education and dietary tracking over a time period of 20 months.

Longitudinal data from the Norwegian HEalth In Adolescents (HEIA) cohort study followed up at three time points (2007–2009).

Intakes of fruits, vegetables and snacks were assessed by frequency and intakes of sugar-sweetened soft drinks and squash were assessed by frequency and amount. Tracking of dietary behaviours was assessed by adolescents’ relative position in rank over time and Cohen's kappa was used to measure tracking coefficients. Multinomial logistic regression analyses were performed to assess the association between parental education and the tracking of dietary behaviours.

In total, 885 adolescents from the HEIA cohort study participated by answering Internet-based questionnaires at three time points.

The results indicated that boys and girls maintained their relative position in rank of dietary intake over time, when grouped by baseline consumption. Fair to moderate tracking coefficients of dietary variables were observed. An inverse association was found between parental education and stability of soft drink and squash consumption during the 20 months.

The observed tracking pattern indicates the importance of promoting healthy dietary behaviours at an even earlier age. Furthermore, interventions should focus particularly on adolescents from families with low parental education and their consumption of sugar-sweetened beverages.

To assess change in the 4-year prevalence (2006–2009) of the use of food in school fundraising and as rewards and incentives for students, following implementation of federal legislation in the USA in 2006.

Serial cross-sectional design using trend analysis to assess school-level data collected over four consecutive years from 2006/2007 to 2009/2010.

Minneapolis/St. Paul, MN.

Convenience sample of middle and high schools participating in two longitudinal, aetiological studies that examined youth, their environment and obesity-related factors.

A significant and sustained decrease was demonstrated in the use of low-nutrient, energy-dense foods in school fundraising activities and the use of food and food coupons as rewards and incentives by teachers and school staff.

Results support the utility of policy and legislative action as a tool for creating healthy, sustainable environmental change.

To evaluate the prevalence of vitamin D deficiency in pregnant women and their newborns in Beijing, China and the influence of vitamin D deficiency on birth size.

A cross-sectional study.

Data were collected from pregnant women who delivered during April to May 2010 at 306 Hospital of PLA in Beijing, China.

Participants in the study were seventy healthy nulliparous pregnant women with singleton pregnancies who delivered healthy babies at full term and their newborns.

Severe vitamin D deficiency (25-hydroxyvitamin D (25(OH)D) < 25 nmol/l) was detected in 54·5 % of mothers and 46·6 % of newborns. Neither mothers nor newborns had serum 25(OH)D concentrations that reached the normal level (>75 nmol/l). The concentration of 25(OH)D in mothers was positively correlated with that in cord blood (r = 0·89, P < 0·001). Newborns of mothers with severe vitamin D deficiency had lower birth length and birth weight. The head circumference and birth weight were lower in vitamin D-deficient newborns.

The study indicates that pregnant women and neonates residing in Beijing are at high risk of vitamin D deficiency. Neonatal 25(OH)D concentrations are dependently related to maternal 25(OH)D levels. Maternal and neonatal vitamin D status influences newborn size.

The present study aimed to assess the relationship between dietary habits, change in socio-economic status and BMI Z-score and fat mass in a cohort of South African adolescents.

In the longitudinal study, data were collected at ages 13, 15 and 17 years on a birth cohort who have been followed since 1990. Black participants with complete dietary habits data (breakfast consumption during the week and at weekends, snacking while watching television, eating main meal with family, lunchbox use, number of tuck shop purchases, fast-food consumption, confectionery consumption and sweetened beverage consumption) at all three ages and body composition data at age 17 years were included in the analyses. Generalized estimating equations were used to test the associations between individual longitudinal dietary habits and obesity (denoted by BMI Z-score and fat mass) with adjustments for change in socio-economic status between birth and age 12 years.

Birth to Twenty (Bt20) study, Soweto-Johannesburg, South Africa.

Adolescents (n 1298; 49·7 % male).

In males, the multivariable analyses showed that soft drink consumption was positively associated with both BMI Z-score and fat mass (P < 0·05). Furthermore, these relationships remained the same after adjustment for socio-economic indicators (P < 0·05). No associations were found in females.

Longitudinal soft drink consumption was associated with increased BMI Z-score and fat mass in males only. Fridge ownership at birth (a proxy for greater household disposable income in this cohort) was shown to be associated with both BMI Z-score and fat mass.

Findings regarding alcohol consumption and bone mineral density (BMD) in elderly women have been inconsistent. The objective of the present study was to explore the association of alcohol intake with BMD in elderly women.

This cohort study included women from the population-based Kuopio Osteoporosis Risk Factor and Prevention – Fracture Prevention Study (OSTPRE-FPS). Alcohol intake and potential confounders were assessed at baseline and after 3 years of follow-up using a lifestyle questionnaire. In addition, an FFQ was distributed in the third year to measure dietary intake, including alcohol. Women underwent BMD measurements at the femoral neck and lumbar spine at baseline and after 3 years of follow-up.

Kuopio Province, Finland.

Three hundred elderly women (mean age 67·8 years) who provided both BMD measurements and FFQ data.

Alcohol consumption estimated from the FFQ and lifestyle questionnaire was significantly associated with BMD at both measurement sites after adjustment for potential confounders, including lifestyle and dietary factors (P < 0·05). Using the FFQ, women drinking >3 alcoholic drinks/week had significantly higher BMD than abstainers, 12·0 % at the femoral neck and 9·2 % at the lumbar spine. Results based on the lifestyle questionnaire showed higher BMD values for all alcohol-consuming women at the femoral neck and for women drinking 1–3 alcoholic beverages/week at the lumbar spine, compared with non-users.

The results from OSTPRE-FPS suggest that low to moderate alcohol intake may exert protective effects on bone health in elderly women.

To examine changes in energy intake along with markers of dietary quality (animal-source energy and protein intakes) among household members in the presence of supplementary school feeding in rural Kenya.

A 2-year, longitudinal, randomized controlled feeding intervention study.

Kyeni South Division, Embu District, Kenya.

A total of 182 schoolchildren and selected household members.

There was no evidence that schoolchildren who received supplementary snacks at school experienced reduced intakes at home or that intakes by other family members were increased at the expense of the schoolchild's intake.

This analysis highlights a number of factors useful in planning for supplementary feeding interventions in rural Kenya and similar communities.

Formative research to facilitate the development, packaging and delivery of a culturally acceptable nutrition intervention for HIV-infected women in rural Kenya for an intervention trial.

Focus group discussion on three areas: (i) ingredients and form of the nutrition intervention, (ii) packaging and delivery and (iii) monitoring of adherence. Two single-blind taste tests with eleven different porridge formulations of various combinations of maize flour, soyabeans, peanuts, sorghum, mung beans, dried fish, raisins and dried whole milk. Follow-up acceptability focus group discussion was also conducted.

Voi, Kenya, community based.

Focus group discussion and two taste tests (twenty-one women aged 16–55 years). Follow-up acceptability focus group discussion (four women enrolled in intervention trial).

The preferred porridge for taste consisted of maize, soyabeans and peanuts. For animal protein, dried whole milk and dried fish were used. Although the women disliked the taste of dried fish, it was acceptable if added in small undetectable quantities. Sugar over lime was favoured for taste. Women believed they could consume at least two cups of porridge per day without displacing their usual meals. The optimal delivery interval was believed to be every two weeks in individual serving packages. Women who had been consuming porridge for several weeks felt the taste was acceptable for long-term consumption.

This formative research resulted in the development, packaging and delivery of a nutrient-dense food supplement using local ingredients to meet the dietary needs of the population and acceptable for daily consumption by women in Kenya for evaluation in an intervention trial.