Showing papers in "Public Health Nutrition in 2009"

Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993-2005

Abstract: Objective To provide current global and regional estimates of anaemia prevalence and number of persons affected in the total population and by population subgroup. Setting and design We used anaemia prevalence data from the WHO Vitamin and Mineral Nutrition Information System for 1993-2005 to generate anaemia prevalence estimates for countries with data representative at the national level or at the first administrative level that is below the national level. For countries without eligible data, we employed regression-based estimates, which used the UN Human Development Index (HDI) and other health indicators. We combined country estimates, weighted by their population, to estimate anaemia prevalence at the global level, by UN Regions and by category of human development. Results Survey data covered 48.8 % of the global population, 76.1 % of preschool-aged children, 69.0 % of pregnant women and 73.5 % of non-pregnant women. The estimated global anaemia prevalence is 24.8 % (95 % CI 22.9, 26.7 %), affecting 1.62 billion people (95 % CI 1.50, 1.74 billion). Estimated anaemia prevalence is 47.4 % (95 % CI 45.7, 49.1 %) in preschool-aged children, 41.8 % (95 % CI 39.9, 43.8 %) in pregnant women and 30.2 % (95 % CI 28.7, 31.6 %) in non-pregnant women. In numbers, 293 million (95 % CI 282, 303 million) preschool-aged children, 56 million (95 % CI 54, 59 million) pregnant women and 468 million (95 % CI 446, 491 million) non-pregnant women are affected. Conclusion Anaemia affects one-quarter of the world's population and is concentrated in preschool-aged children and women, making it a global public health problem. Data on relative contributions of causal factors are lacking, however, which makes it difficult to effectively address the problem.

Family correlates of fruit and vegetable consumption in children and adolescents: a systematic review.

Abstract: Objectives: To review associations between the family environment and young people's fruit and vegetable consumption. Design: A systematic review. Published English-language (n 60) papers were identified using electronic databases and manual searches of personal files and reference lists. Observational research reporting a measure of fruit/vegetable intake for children (aged 6-11 years) and/or adolescents (aged 12-18 years) and at least one potential family correlate of dietary intake was included. Results: Parental modelling and parental intake were consistently and positively associated with children's fruit and fruit, juice and vegetable (FJV) consumption. There were also positive associations between home availability, family rules and parental encouragement and children's fruit and vegetable consumption. Parental intake was positively associated with adolescents' fruit and vegetable consumption. There were also positive associations between parental occupational status and adolescent fruit consumption and between parental education and adolescents' FJV consumption. Conclusions: Our findings highlight the importance of targeting the family environment for the promotion of healthy eating behaviours among children and adolescents. Future interventions should encourage parents to be positive role models by targeting parental intake and to create a supportive home environment through increased encouragement and availability of fruits and vegetables and employing rules to govern eating behaviours. For adolescents, indicators of family circumstances (e.g. parental education) should be used to identify target groups for interventions aimed at promoting healthy eating. Copyright

Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for Asians.

Abstract: Objectives: To assess whether overweight Asians, assessed on the basis of WHO criteria, are at greater mortality risk than overweight Caucasians, and to determine whether alternative cut-off points (BMI 5 23?0–24?9 kg/m 2 for overweight and BMI $ 25?0 kg/m 2 for obesity) suggested by the WHO Western Pacific Regional Office are appropriate. Design: The cohort was followed prospectively until the end of 2001. All-cause and CVD mortality risks of the overweight and obese group, relative to the reference group (BMI 5 18?5–24? 9o r 18?5–22? 9k g/m 2 ), were assessed using Cox regression analysis, adjusting for age, smoking and gender. Excess deaths were estimated with a method proposed by the US Centers for Disease Control and Prevention. Setting: National Health Interview Survey (NHIS 2001) and a middle-aged perspective cohort in Taiwan. Subjects: Subjects comprised 36 386 civil servants and school teachers, aged 40 years and older, who underwent a medical examination during 1989–1992. Results: In the WHO-defined overweight group, Asians showed a significant increase in all-cause mortality risk compared with Caucasians. Asians showed risks equivalent to Caucasians’ at lower BMI (around 5 units). Every unit of BMI increase, at 25?0 kg/m 2 or above, was associated with a 9 % increase in relative mortality risk from all causes. Applying a cut-off point of 25?0 kg/m 2 for obesity would result a prevalence of 27?1 %, while the traditional WHO cut-off point of 30?0 kg/m 2 yielded obesity prevalence of 4?1 %. Excess deaths due to obesity accounted for 8?6 % of all deaths and 21?1 % of CVD deaths, based on the alternative cut-offs. Conclusions: In this Asian population, significant mortality risks started at BMI $ 25?0 kg/m 2 , rather than at BMI $ 30?0 kg/m 2 . The study supports the use of BMI $ 25?0 kg/m 2 as a new cut-off point for obesity and BMI 5 23?0–24?9 kg/m 2 for overweight. The magnitude of obesity-attributable deaths has been hitherto under-appreciated among Asians.

Nutrition and health. The issue is not food, nor nutrients, so much as processing.

Abstract: Orthodox teaching and practice on nutrition and health almost always focuses on nutrients, or else on foods and drinks. Thus, diets that are high in folate and in green leafy vegetables are recommended, whereas diets high in saturated fat and in full-fat milk and other dairy products are not recommended. Food guides such as the US Food Guide Pyramid are designed to encourage consumption of healthier foods, by which is usually meant those higher in vitamins, minerals and other nutrients seen as desirable. What is generally overlooked in such approaches, which currently dominate official and other authoritative information and education programmes, and also food and nutrition public health policies, is food processing. It is now generally acknowledged that the current pandemic of obesity and related chronic diseases has as one of its important causes increased consumption of convenience including pre-prepared foods. However, the issue of food processing is largely ignored or minimised in education and information about food, nutrition and health, and also in public health policies. A short commentary cannot be comprehensive, and a general proposal such as that made here is bound to have some problems and exceptions. Also, the social, cultural, economic and environmental consequences of food processing are not discussed here. Readers’ comments and queries are invited.

Diet quality--what is it and does it matter?

Abstract: Objective Measures of diet quality have evolved with a number of scoring indices currently in use. They are increasingly being used to examine epidemiological associations between dietary intake and nutrition-related health outcomes. The present review aims to describe current diet quality tools and their applications, and to examine the relationship between diet quality and morbidity and mortality. Design A search was conducted of MEDLINE, Cochrane, EMBASE, CINAHL and ProQuest electronic databases. Inclusion criteria were: English language; published from 2004 on; conducted in adult populations; longitudinal/cohort/case-control or cross-sectional study; included a theoretically defined measure of diet quality. Results A total of twenty-five indices of overall diet quality and/or variety were found, with components ranging from nutrients only to adherence to recommended food group servings, to variety within healthful food groups. The majority of studies reviewed had methodological weaknesses but demonstrated that higher dietary quality was consistently inversely related to all-cause mortality, with a protective effect of moderate magnitude. The associations were stronger for men and for all-cause and CVD mortality. Conclusions The limitations of both the indices and the studies that use them need to be considered when interpreting and comparing results. However, diet quality indices do appear to be able to quantify risk of some health outcomes, including biomarkers of disease and risk of CVD, some cancers and mortality. Further research is needed to improve the validity of these tools and to adapt them for use in clinical dietetic practice.

The Italian National Food Consumption Survey INRAN-SCAI 2005-06: main results in terms of food consumption.

Abstract: Objective The current paper aims to present the main results of the Italian National Food Consumption Survey INRAN-SCAI 2005-06. Design A cross-sectional study was performed. Households were randomly selected after geographical stratification of the national territory. Food consumption was assessed on three consecutive days through individual estimated dietary records. Setting Italy. Subjects The final study sample comprised 3323 subjects (1501 males and 1822 females) aged 0.1 to 97.7 years belonging to 1329 households: fifty-two infants (0-2.9 years), 193 children (3-9.9 years), 247 teenagers (10-17.9 years), 2313 adults (18-64.9 years) and 518 elderly (65 years and above). Results Participation rate was 33 %. The mean ratio of estimated energy intake to estimated BMR was 1.41 in adults. Indicators of mean and high individual consumption are presented for fifteen large categories and fifty-one subcategories of foods and beverages, in the total population and in consumers, by age and sex categories. The overall consumption of fruit and vegetables was 418 g/d. The consumption of red meat was approximately 700 g/week, expressed as raw weight. Some specific aspects of the Italian food consumption pattern were confirmed: a large contribution from bread, pasta and pizza to cereals, from olive oil to fats and from wine to alcoholic beverages. Conclusions The database obtained from the survey will be the key reference for Italian food consumption during the coming years and will be utilized for a variety of purposes including the assessment of nutrient intakes and risk analysis.

Weight loss by mobile phone: a 1-year effectiveness study.

Abstract: Objective To investigate the short- and long-term effectiveness and the predictors of weight loss in a mobile phone weight-loss programme among healthy overweight adults. Design One hundred and twenty-five healthy, overweight (BMI = 26–36 kg/m 2 ), 25–44-year-old, screened volunteers were randomized to an experimental group ( n 62) to use a mobile phone-operated weight-loss programme or to a control group ( n 63) with no intervention. Via text messaging, the programme instructed a staggered reduction of food intake and daily weight reporting with immediate tailored feedback. Assessments were at 0, 3, 6, 9 and 12 months for the experimental group; at 0 and 12 months for the control group. Main outcome variables were changes in body weight and waist circumference. Results By 12 months the experimental group had lost significantly more weight than the control group (4·5 ( sd 5·0) v . 1·1 ( sd 5·8) kg; F (1,80) = 8·0, P = 0·006) and had a greater reduction in waist circumference (6·3 ( sd 5·3) v . 2·4 ( sd 5·4) cm; F (1,80) = 55·2, P = 0·0001). Early weight loss, self-efficacy, contact frequency, attitudes towards the medium, changes in work and family life and changes made in dietary habits were the strongest predictors of weight loss. Conclusions This mobile phone weight-loss programme was effective in short- and long-term weight loss. As a minimum-advice, maximal-contact programme, it offers ideas for future weight-loss programmes.

Worldwide variation of adherence to the Mediterranean diet, in 1961-1965 and 2000-2003.

Abstract: Objective The present study aimed to analyse the worldwide trends of adherence to the Mediterranean diet (MD), in 1961–1965 and 2000–2003. Design Data were obtained from the FAO food balance sheets in two periods: 1961–1965 and 2000–2003. In order to have a sample from across the world, forty-one countries were selected. The average of available energy for different food groups was calculated for all selected countries. These values were used to evaluate the adherence to the MD through a variation of Mediterranean Adequacy Index (MAI). Results The majority of the forty-one countries in this study have tended to drift away from a Mediterranean-like dietary pattern. Mediterranean Europe and the Other Mediterranean country groups suffered a significant decrease in their MAI values. The Mediterranean European group, especially Greece, experienced the greatest decrease in MAI value. In both periods, the Other Mediterranean countries showed the highest MAI values. In an analysis by countries, Iran had the highest increase in MAI across the time periods, and Egypt occupied the first place in the ranking in 2000–2003. The Northern European group was the only one that registered an increase in MAI, although this was not statistically significant. Conclusions Many countries in the Mediterranean basin are drifting away from the Mediterranean dietary pattern (MDP). However, countries in Northern Europe and some other countries around the world are taking on a Mediterranean-like dietary pattern. The Other Mediterranean countries have the closest adherence to the MDP, currently and in the 1960s. Nutrition policy actions to tackle dietary westernisation and preserve the healthy prudent MDP are required.

The art of grocery shopping on a food stamp budget: factors influencing the food choices of low-income women as they try to make ends meet

Abstract: Objective Amidst a hunger–obesity paradox, the purpose of the present study was to examine the grocery shopping behaviour and food stamp usage of low-income women with children to identify factors influencing their food choices on a limited budget. Design Focus groups, which included questions based on Social Cognitive Theory constructs, examined food choice in the context of personal, behavioural and environmental factors. A quantitative grocery shopping activity required participants to prioritize food purchases from a 177-item list on a budget of $US 50 for a one-week period, an amount chosen based on the average household food stamp allotment in 2005. Subjects Ninety-two low-income women, with at least one child aged 9–13 years in their household, residing in the Twin Cities, Minnesota, USA. Results Participants' mean age was 37 years, and 76% were overweight or obese (BMI≥25·0kg/m 2 ). Key findings suggest that their food choices and grocery shopping behaviour were shaped by not only individual and family preferences, but also their economic and environmental situation. Transportation and store accessibility were major determinants of shopping frequency, and they used various strategies to make their food dollars stretch (e.g. shopping based on prices, in-store specials). Generally, meat was the most important food group for purchase and consumption, according to both the qualitative and quantitative data. Conclusions Efforts to improve food budgeting skills, increase nutrition knowledge, and develop meal preparation strategies involving less meat and more fruits and vegetables, could be valuable in helping low-income families nutritionally make the best use of their food dollars.

Downward trends in the prevalence of childhood overweight in the setting of 12-year school- and community-based programmes

Abstract: Objective: A school-based nutrition information programme was initiated in 1992 in two towns in northern France (Fleurbaix and Laventie, FL) and was followed by a number of community-based interventions. We took the opportunity to measure the outcomes in terms of childhood obesity and overweight over the next 12 years. Design: Repeated, cross-sectional, school-based survey. For the school years beginning in 1992, 2000, 2002, 2003 and 2004, the height and weight of all 5- to 12-year-old children attending school were measured in FL. In 2004, the same assessments were made in two comparison towns with similar socio-economic characteristics but no intervention. Setting: Fleurbaix and Laventie (intervention towns), Bois-Grenier and Violaines (comparison towns), northern France. Subjects: In 2002, 2003 and 2004, respectively 515, 592 and 633 children were measured in FL (participation rate of 95–98 % of all eligible individuals); in the comparison towns, 349 children were measured in the 2004 school year (98 % of the towns’ school population). Results: After an initial increase, trends in mean BMI and prevalence of overweight started to reverse. Compared with 2002, the age-adjusted OR for overweight in FL was significantly lower in 2003 and 2004 (but for girls only). In the 2004 school year, the overweight prevalence was significantly lower in FL (8? 8% ) than in the comparison towns (17? 8% ,P , 0?0001). Conclusion: These data suggest that, over a long period of time, interventions targeting a variety of population groups can have synergistic effects on overweight prevalence. This gives hope that it is possible to reverse trends towards increasing overweight by actions at the community level.

Food insecurity prevalence among college students at the University of Hawai'i at Mānoa.

Abstract: ObjectivesTo assess the prevalence and identify possible predictors of food insecurity among college students at the University of Hawai’i at Mānoa.DesignCross-sectional survey, including the US Department of Agriculture’s Household Food Security Survey Module, demographic and spending variables.SettingUniversity of Hawai’i at Mānoa, Honolulu, Hawai’i (USA).SubjectsFour hundred and forty-one non-freshmen students from thirty-one randomly selected classes.ResultsTwenty-one per cent of students surveyed were food-insecure, while 24 % were at risk of food insecurity. Students at higher risk of food insecurity included those who reported living on campus and those living off-campus with room mates. Those identifying themselves as Hawaiians and Pacific Islanders, Filipinos and mixed were also at increased risk of food insecurity.ConclusionsFood insecurity is a significant problem among college students at the University of Hawai’i at Mānoa. Food availability and accessibility should be increased for these students through the establishment of on-campus food banks and student gardens. Future studies should assess the prevalence of food insecurity in other college campuses nationwide.

School randomised trial on prevention of excessive weight gain by discouraging students from drinking sodas.

Abstract: Objective: To determine whether an educational programme aimed at discouraging students from drinking sugar-sweetened beverages could prevent excessive weight gain. Design: Forty-seven classes in twenty-two schools were randomised as intervention or control. Subjects: Participants were 1140, 9–12-year-old fourth graders (435 in the intervention group and 608 in the control group). Sugar-sweetened beverages and juice intake were measured through one 24 h recall at baseline and another at the end of the trial. The main outcome was the change in BMI (BMI 5 weight (kg)/height (m 2 )), measured at the beginning and at the end of the school year. Intentionto-treat analysis was performed taking into account the cluster (classes) effect. Results: A statistically significant decrease in the daily consumption of carbonated drinks in the intervention compared to control (mean difference 52 56 ml; 95 % CI 2119, 27 ml) was followed by a non-significant overall reduction in BMI, P 5 0?33. However, among those students overweight at baseline, the intervention group showed greater BMI reduction (20? 4k g/m 2 compared with 20? 2k g/m 2 in the control group (P 5 0?11)), and this difference was statistically significant among girls (P 5 0?009). Fruit juice consumption was slightly increased in the intervention group (P 5 0?08), but not among girls. Conclusion: Decreasing sugar-sweetened beverages intake significantly reduced BMI among overweight children, and mainly among girls. Efforts to reduce energy intake through liquids need to emphasise overall sweetened beverages and addition of sugar on juices.

Prevalence and sociodemographic risk factors related to household food security in Aboriginal peoples in Canada

Abstract: Objective Canada's Aboriginal population is vulnerable to food insecurity and increasingly lives off-reserve. The Canadian Community Health Survey, Cycle 2.2 Nutrition, was used to compare the prevalence and sociodemographic correlates of food insecurity between non-Aboriginal and off-reserve Aboriginal households. Design Food insecurity status was based on Health Canada's revised interpretation of responses to the US Household Food Security Survey Module. Logistic regression was used to assess if Aboriginal households were at higher risk for food insecurity than non-Aboriginal households, adjusting for household sociodemographic factors. Setting Canada. Subjects Households (n 35,107), 1528 Aboriginal and 33 579 non-Aboriginal. Results Thirty-three per cent of Aboriginal households were food insecure as compared with 9 % of non-Aboriginal households (univariate OR 5.2, 95 % CI 4.2, 6.3). Whereas 14 % of Aboriginal households had severe food insecurity, 3 % of non-Aboriginal households did. The prevalence of sociodemographic risk factors for household food insecurity was higher for Aboriginal households. Aboriginal households were more likely to have three or more children (14 % v. 5 %), be lone-parent households (2 1 % v. 5 %), not have home ownership (52 % v. 31 %), have educational attainment of secondary school or less (43 % v. 26 %), have income from sources other than wages or salaries (38 % v. 29 %), and be in the lowest income adequacy category (33 % v. 12 %). Adjusted for these sociodemographic factors, Aboriginal households retained a higher risk for food insecurity than non-Aboriginal households (OR 2.6, 95 % CI 2.1, 3.2). Conclusions Off-reserve Aboriginal households in Canada merit special attention for income security and poverty alleviation initiatives.

A commentary on current practice in mediating variable analyses in behavioural nutrition and physical activity.

Abstract: Objective: To critique current practice in, and provide recommendations for, mediating variable analyses (MVA) of nutrition and physical activity behaviour change. Strategy: Theory-based behavioural nutrition and physical activity interventions aim at changing mediating variables that are hypothesized to be responsible for changes in the outcome of interest. MVA are useful because they help to identify the most promising theoretical approaches, mediators and intervention components for behaviour change. However, the current literature suggests that MVA are often inappropriately conducted, poorly understood and inadequately presented. Main problems encountered in the published literature are explained and suggestions for overcoming weaknesses of current practice are proposed. Conclusion: The use of the most appropriate, currently available methods of MVA, and a correct, comprehensive presentation and interpretation of their findings, is of paramount importance for understanding how obesity can be treated and prevented.

Food insecurity and maternal depression in rural, low-income families: a longitudinal investigation.

Abstract: Objective: The purpose of the present study was to examine the relationship between household food insecurity and maternal depression in a rural sample to determine whether food insecurity predicted mothers’ depression over time or vice versa. Design: The study employed a prospective design using three waves of data from ‘Rural Families Speak’, a multi-state study of low-income rural families in the USA. Food insecurity was measured using the Core Food Security Module and depression was measured using the Center for Epidemiologic Studies–Depression Scale. A structural equation model was fit to the data using the AMOS software package. Setting: Sixteen states in the USA (California, Indiana, Kentucky, Louisiana, Massachusetts, Maryland, Michigan, Minnesota, Nebraska, New Hampshire, New York, Ohio, Oregon, South Dakota, West Virginia, Wyoming) between 2000 and 2002. Subjects: Subjects included 413 women with at least one child under the age of 13 years living in the home. Results: Findings based on the 184 subjects with complete data indicated that the causal relationship between household food insecurity and depression is bidirectional (P 5 0?034 for causation from depression to food insecurity, P 5 0?003 for causation from food insecurity to depression,x 2 /df 5 1?835, root-mean-square error of approximation 5 0?068, comparative fit index 5 0?989). Findings based on all 413 subjects after imputation of missing values also indicated bidirectionality. Conclusions: The recursive relationship between food insecurity and depression has implications for US nutrition, mental health and poverty policies. The study highlights the need to integrate programmes addressing food insecurity and poor mental health for the population of rural, low-income women.

Breakfast skipping is associated with differences in meal patterns, macronutrient intakes and overweight among pre-school children.

Abstract: Objectives: To examine the association between skipping breakfast, daily energy, macronutrients and food intakes, and BMI in pre-school children. Design: A cross-sectional study using information on children’s food consumption and measured height and weight. Energy and macronutrient intakes of the children were derived from parent/day-care attendant’s responses to 24 h recall interviews and eating behaviour questionnaires. Setting: Data obtained from a representative sample (n 2103) of children born in Quebec (Canada) in 1998. Subjects: One thousand five hundred and forty-nine children, with a mean age of 49 (SD 3?12) months. Results: Ten per cent of children ate breakfast on fewer than 7 days per week. This behaviour was associated with a lower diet quality and concentrated energy intakes through higher protein intakes at lunch and the consumption of snacks higher in energy and carbohydrate in the afternoon and evening; yet total daily energy intakes were not significantly different from those of pre-school children who ate breakfast every day. Breakfast skippers’ mean BMI increased as intake of energy, carbohydrates or servings of grain products increased; however, this was not the case for breakfast eaters. When Cole’s cut-off for overweight/obesity was used, overweight/obesity in breakfast skippers was related to the dinner-time consumption of approximately 3000 kJ (700 kcal) or more for energy intake, approximately 100 g or more of carbohydrates, or approximately 3 servings or more of grain products. Conclusions: Eating breakfast every day is associated with having a healthy body weight, likely due to a more even distribution of energy intake across meals throughout the day.

A corner store intervention in a low-income urban community is associated with increased availability and sales of some healthy foods

Abstract: Objective While corner store-based nutrition interventions have emerged as a potential strategy to increase healthy food availability in low-income communities, few evaluation studies exist. We present the results of a trial in Baltimore City to increase the availability and sales of healthier food options in local stores.

Adolescent dietary patterns are associated with lifestyle and family psycho-social factors

Abstract: Objective: Dietary intake during adolescence contributes to lifelong eating habits and the development of early risk factors for disease in adulthood. Few studies have examined the dietary patterns of adolescents and the social and environmental factors that may affect them during this life stage. The present study describes dietary patterns in a cohort of adolescents and examines their associations with socioeconomic factors, as well as parental and adolescent risk factor behaviours. Design: A semi-quantitative FFQ was used to assess study adolescents’ usual dietary intake over the previous year. Information was collected on family functioning and various socio-economic and risk factor variables via questionnaire. Adolescents visited the study clinic for anthropometric measurements. Setting: The Western Australian Pregnancy Cohort Study (Raine Study), Perth, Western Australia. Subjects: Adolescents (n 1631) aged 14 years from a pregnancy cohort study. Results: Factor analysis identified two distinct dietary patterns that differed predominantly in fat and sugar intakes. The ‘Western’ pattern consisted of high intakes of take-away foods, soft drinks, confectionery, French fries, refined grains, full-fat dairy products and processed meats. The ‘healthy’ pattern included high intakes of whole grains, fruit, vegetables, legumes and fish. ANOVA showed that the ‘Western’ dietary pattern was positively associated with greater television viewing and having a parent who smoked, and was inversely associated with family income. The ‘healthy’ pattern was positively associated with female gender, greater maternal education, better family functioning and being in a twoparent family, and was inversely associated with television viewing. Conclusions: The study suggests that both lifestyle factors and family psychosocial environment are related to dietary patterns in Australian adolescents.

Mediterranean diet and metabolic syndrome: the evidence

Abstract: Background: The Mediterranean diet has long been related to a lower cardiovascular disease risk; however, more recent evidences also indicate that it has a favourable effect on adiposity and type 2 diabetes. Design: Review of the available literature in relation to Mediterranean diet and metabolic syndrome. Results: Several components of Mediterranean diet patterns have been inversely related with body mass index. They are considered to be modulators of insulin resistance, can exert beneficial effects on blood pressure, improve atherogenic dyslipidemia or attenuate the inflammatory burden associated with metabolic syndrome. Furthermore, a lower prevalence of metabolic syndrome has been associated with dietary patterns rich in fruits and vegetables, nuts, olive oil, legumes and fish, moderate in alcohol and low in red meat, processed meat, refined carbohydrates and whole-fat dairy products. Conclusions: There is much evidence suggesting that the Mediterranean diet could serve as an anti-inflammatory dietary pattern, which could help to fight diseases related to chronic inflammation, including metabolic syndrome.

Is the perception of time pressure a barrier to healthy eating and physical activity among women

Abstract: Objectives: To describe the proportion of women reporting time is a barrier to healthy eating and physical activity, the characteristics of these women and the perceived causes of time pressure, and to examine associations between perceptions of time as a barrier and consumption of fruit, vegetables and fast food, and physical activity. Design: A cross-sectional survey of food intake, physical activity and perceived causes of time pressure. Setting: A randomly selected community sample. Subjects: A sample of 1580 women self-reported their food intake and their perceptions of the causes of time pressure in relation to healthy eating. An additional 1521 women self-reported their leisure-time physical activity and their perceptions of the causes of time pressure in relation to physical activity. Results: Time pressure was reported as a barrier to healthy eating by 41% of the women and as a barrier to physical activity by 73%. Those who reported time pressure as a barrier to healthy eating were significantly less likely to meet fruit, vegetable and physical activity recommendations, and more likely to eat fast food more frequently. Conclusions: Women reporting time pressure as a barrier to healthy eating and physical activity are less likely to meet recommendations than are women who do not see time pressure as a barrier. Further research is required to understand the perception of time pressure issues among women and devise strategies to improve women’s food and physical activity behaviours.

Nutrition labels: a survey of use, understanding and preferences among ethnically diverse shoppers in New Zealand.

Abstract: ObjectiveEffective nutrition labels are part of a supportive environment that encourages healthier food choices. The present study examined the use, understanding and preferences regarding nutrition labels among ethnically diverse shoppers in New Zealand.Design and settingA survey was carried out at twenty-five supermarkets in Auckland, New Zealand, between February and April 2007. Recruitment was stratified by ethnicity. Questions assessed nutrition label use, understanding of the mandatory Nutrition Information Panel (NIP), and preference for and understanding of four nutrition label formats: multiple traffic light (MTL), simple traffic light (STL), NIP and percentage of daily intake (%DI).SubjectsIn total 1525 shoppers completed the survey: 401 Maori, 347 Pacific, 372 Asian and 395 New Zealand European and Other ethnicities (ten did not state ethnicity).ResultsReported use of nutrition labels (always, regularly, sometimes) ranged from 66 % to 87 % by ethnicity. There was little difference in ability to obtain information from the NIP according to ethnicity or income. However, there were marked ethnic differences in ability to use the NIP to determine if a food was healthy, with lesser differences by income. Of the four label formats tested, STL and MTL labels were best understood across all ethnic and income groups, and MTL labels were most frequently preferred.ConclusionsThere are clear ethnic and income disparities in ability to use the current mandatory food labels in New Zealand (NIP) to determine if foods are healthy. Conversely, MTL and STL label formats demonstrated high levels of understanding and acceptance across ethnic and income groups.

Nutritional assessment interpretation on 22,007 Spanish community-dwelling elders through the Mini Nutritional Assessment test.

Abstract: Objectives: To evaluate the prevalence of undernutrition among communitydwelling elderly people in Spain using the Mini Nutritional Assessment (MNA) and to analyse its distribution according to age, gender and residence region. Design: Cross-sectional study assessing the nutritional status of elderly persons through both the short form and the full version of the MNA test. Setting: Pharmacy offices across the whole country (Spain) were enrolled to recruit participants. Subjects: A total of 22007 participants (8014 men and 13993 women), aged $65 years, assessed during the last two months of 2005. Results: According to MNA screening, 4?3% subjects were classified as undernourished (MNA score ,17) and 25?4% were at risk of undernutrition (MNA score $17 to #23?5). The MNA short form correlated strongly with the full MNA version (r 50?85). MNA total score was significantly higher in men than in women (25?4 (SD 3?7) v .2 4? 6( SD 3?9); P ,0?001) and lower in the oldest than in the youngest subjects (P ,0?001) in both genders. According to regional distribution, the best nutritional status was found in elderly from the north of Spain excluding the north-west area. Conclusions: Female gender, older age and living in the south half or northwest of the country were associated with higher rates of undernutrition among community-dwelling elderly persons in Spain.

Dietary patterns associated with metabolic syndrome, sociodemographic and lifestyle factors in young adults: the Bogalusa Heart Study.

Abstract: Studies involving dietary patterns (DP) and their association with diseases have several benefits over the conventional approach, which has focused largely on the effects of single nutrients or individual foods(1,2). As the measurement of diet is complex, and foods are typically consumed in combinations, the combined effect of nutrients and foods can be observed only when DP are examined(1,2). Moreover, results from DP analyses are more helpful in disseminating diet-related messages to consumers that they may be more likely to adhere to rather than those related to single foods or nutrients(3). DP have also been related to selected biomarkers of dietary exposure(1,2) and have been reported to contribute in the development or prevention of CHD and type 2 diabetes mellitus (T2DM)(4). Recent focus has been on the occurrence of metabolic syndrome (MetS), a constellation of metabolic abnormalities including central obesity, elevated blood levels of CHD-promoting lipids, hypertension, insulin resistance and hyperglycaemia(5). In adults, MetS increases the risk of CHD by two-fold and the risk for T2DM by five-fold(5–7). The age-adjusted prevalence of MetS in US adults (≥20 years) participating in the 2003–2006(8) National Health and Nutrition Examination Survey (NHANES) was 34 % v. 29·2 % reported in the 1988–1994 NHANES(9). Among young adults (20–39 years), the prevalence of MetS has increased from 10·8 % (in 1988–1994)(9) to 15·6 % (in 2003–2006) in females(8), and from 15·7 % (in 1988–1994)(9) to 20·3 % (in 2003–2006)(8) in males. Young adulthood is an important period of transition from adolescence into adulthood, when individuals begin to live an independent life. Pressures of independence, hurried lifestyles and providing support for new families may lead to shifts in their dietary and lifestyle patterns. Consequently, unhealthy dietary habits such as skipping breakfast(10), relying on fast food(11) and eating outside home(12) are prevalent among young adults. Moreover, individuals from rural and semi-rural US communities tend to have poorer dietary and health habits because of their lower socio-economic status (SES)(13–15). It is therefore critical to examine the DP of young adults and their relation to risk factors for chronic diseases in order to administer effective dietary and lifestyle prevention and treatment programmes for metabolic disorders such as the MetS, in this age group. Despite the rising prevalence of MetS, few recent studies have examined the role of DP and their relationship with MetS(16–20); their results, in general, showed that healthy DP were inversely associated with the occurrence of MetS in adults(16–20). However, to date only one Bogalusa Heart Study (BHS)(21) has examined the relationship of diet with MetS in young adults, and showed that lower fruit and vegetable consumption and higher sweetened beverage consumption were independently associated with one to two risk factors for MetS(21). Yet, the above-mentioned BHS explored the association of only single food groups rather than DP with MetS. The present study, although an extension of the previous BHS(21), had two additional objectives. First, it aimed to identify various DP among young adults and to examine the association of these DP with the risk factors of MetS. Second, because food consumption differs by SES and demographic factors such as gender and ethnicity(13), and the occurrence of MetS is related to lifestyle factors such as physical inactivity, smoking and alcohol consumption(22), the present study also assessed SES, and demographic and lifestyle differences among the DP in these young adults.

Factors influencing eating a varied diet in old age

Abstract: Objective: To investigate the influences of resources and food-related goals on the variety of food choice among older people. Design: A questionnaire-based survey in eight European countries: Poland, Portugal, United Kingdom, Germany, Sweden, Denmark, Italy and Spain. Subjects: Participants (n 3200) were above 65 years of age and living in their own homes. The samples were quota samples, eight groups of fifty in each country, based on gender, age and living circumstances, reflecting the diversity of each of the national populations based on education, income and urbanization of living environment. Results: Hierarchical multiple regression analysis showed that income, health status, access to a car and living arrangement affected the level of dietary variety. The perceived level of different food-related resources impacted the consumption of a varied diet over and above actual resource levels. Food-related goals contributed to variety of food intake that was not accounted for by the amount of material resources possessed or the social and other resources perceived to be possessed. Conclusions: Older people’s variety of food intake depended on material resources (e.g. monthly income, access to a car, living arrangement, physical and mental health). However, in addition to these variables, the way older people perceived other resources, such as their level of appetite, their food knowledge, their perception of the distance to the shops, access to high-quality products, having better kitchen facilities, access to good service providers and support from friends and neighbours, all contributed to how varied a diet they ate.

Perceived access to fruits and vegetables associated with increased consumption.

Abstract: ObjectiveTo examine the association between fruit and vegetable access in the community and change in fruit and vegetable consumption among participants in community-based health promotion programmes.DesignFruit and vegetable consumption and perceived access to fresh fruit and vegetables were measured by self-administered questionnaires at programme start, end and 1-year follow-up. Community produce availability was determined by grocery store assessments measuring the display space devoted to fruit and vegetable offerings, as well as price, variety and freshness. A total of nine communities were studied; 130 participants completed the fruit and vegetable portions of the questionnaires and could be linked to grocery store assessments.ResultsParticipants made modest but significant increases in fruit and vegetable consumption from programme start to end: the average increase was 2·88 (95 % CI 1·52, 4·25) servings weekly; the average increase from start to follow-up was 2·52 (95 % CI 1·09, 3·95) servings weekly. Greater perceived access to fruits and vegetables was significantly associated with higher increases in fruit and vegetable consumption from programme start to programme end. Greater availability of produce was associated with greater increases in fruit and vegetable servings from programme start to programme end as measured by store assessments.ConclusionsEnvironmental factors, such as access to fruits and vegetables, can modify the effects of community interventions. Interventions with the goal of increasing fruit and vegetable consumption should consider focusing on increasing access to fresh fruits and vegetables in target communities. Similarly, researchers may want to study access as an intervention, not just a contextual variable.

Eating out of home and obesity: a Brazilian nationwide survey

Abstract: OBJECTIVE The aim of the present study was to investigate the relationship between out-of-home (OH) eating and overweight and obesity among adults in Brazil. DESIGN Data were based on the 2002-2003 Household Budget Survey (48,470 households) conducted by The Brazilian Census Bureau. Foods and drinks purchased for OH eating during a one-week period were recorded by each participant. We considered OH eating as the purchase of at least one food or drink item for OH consumption during this period. We classified items as: soft drinks, deep-fried snacks, fast foods, sweets and sit-down meals. SETTING Urban areas in Brazil. SUBJECTS 56,178 participants (26,225 men and 29,953 women), aged 25-65 years. RESULTS The weighted prevalence of OH eating was 40.3 %. Overall, OH eating was positively associated with overweight (OR = 1.21; 95 % CI 1.10, 1.33) and obesity (OR = 1.35; 95 % CI 1.16, 1.57) among men, but not among women. Sit-down meals and soft drinks were the most frequently reported food groups. Both were positively associated with overweight (OR = 1.34 for meals; OR = 1.17 for soft drinks, P < 0.05) and obesity (OR = 1.51 for meals; OR = 1.39 for soft drinks, P < 0.05) among men, but negatively associated with overweight and obesity among women. CONCLUSIONS OH eating was associated with overweight and obesity only among men, whereas, among women, eating sit-down meals out of home was protective for obesity, suggesting that women make healthier food choices when they eat out of home.

Evaluation of the Mediterranean Diet Quality Index (KIDMED) in children and adolescents in Southern Spain

Abstract: Objective: The Mediterranean diet is considered one of the healthiest dietary models. Recent changes in the actual Mediterranean diet include a reduction in energy intake and a higher consumption of foods with low nutrient density (e.g. soft drinks, candy, sweets, etc.). In Spain, in association with cultural and lifestyle changes, there has been a reduction in the intake of antioxidants and vitamins, an increase in the proportion of SFA and a decrease in the consumption of fibre, among other changes. Children and adolescents may be the age groups with the most deteriorated Mediterranean diet. The current paper presents the results of applying the Mediterranean Diet Quality Index for children and adolescents (KIDMED) to a large sample of Spanish schoolchildren. Design: Data from questionnaires were used to calculate the KIDMED index. Setting: Granada, Southern Spain. Subjects: Schoolchildren (n 3190) aged 8‐16 years. Results: Among the 8‐10-year-olds, the KIDMED index classification was ‘good’ in 48?6% of the population, ‘average’ in 49?5% and ‘poor’ in 1?6%. Among the 10‐16-year-olds, the KIDMED index classification was good in 46?9% of the population, average in 51?1% and poor in 2?0%. Conclusions: The nutritional behaviour of the present population of schoolchildren is similar to that found in the earlier KIDMED study.

Trade liberalisation and the nutrition transition: mapping the pathways for public health nutritionists.

Abstract: Objective 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. Design 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. Setting 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. Results 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. Conclusions 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.

Association between commercial television exposure and fast-food consumption among adults.

Abstract: ObjectiveTo examine the association between television advertising exposure and adults’ consumption of fast foods.DesignCross-sectional telephone survey. Questions included measures of frequency of fast-food consumption at different meal times and average daily hours spent watching commercial television.Subjects/settingSubjects comprised 1495 adults (41 % response rate) aged ≥18 years from Victoria, Australia.ResultsTwenty-three per cent of respondents usually ate fast food for dinner at least once weekly, while 17 % consumed fast food for lunch on a weekly basis. The majority of respondents reported never eating fast food for breakfast (73 %) or snacks (65 %). Forty-one per cent of respondents estimated watching commercial television for ≤1 h/d (low viewers); 29 % watched for 2 h/d (moderate viewers); 30 % watched for ≥3 h/d (high viewers). After adjusting for demographic variables, high viewers were more likely to eat fast food for dinner at least once weekly compared with low viewers (OR = 1·45; 95 % CI 1·04, 2·03). Both moderate viewers (OR = 1·53; 95 % CI 1·01, 2·31) and high viewers (OR = 1·81; 95 % CI 1·20, 2·72) were more likely to eat fast food for snacks at least once weekly compared with low viewers. Commercial television viewing was not significantly related (P > 0·05) to fast-food consumption at breakfast or lunch.ConclusionsThe results of the present study provide evidence to suggest that cumulative exposure to television food advertising is linked to adults’ fast-food consumption. Additional research that systematically assesses adults’ behavioural responses to fast-food advertisements is needed to gain a greater understanding of the mechanisms driving this association.

Impact of a school-based food garden on attitudes and identification skills regarding vegetables and fruit: a 12-month intervention trial

Abstract: Objective To determine changes in ability to identify specific vegetables and fruits, and attitudes towards vegetables and fruit, associated with the introduction of a school-based food garden. Design A 12-month intervention trial using a historical control (control n 132, intervention n 120), class-based, self-administered questionnaires requiring one-word answers and 3-point Likert scale responses. Setting A state primary school (grades 4 to 7) in a low socio-economic area of Brisbane, Australia. Intervention The introduction of a school-based food garden, including the funding of a teacher coordinator for 11 h/week to facilitate integration of garden activities into the curriculum. Main outcome measures Ability to identify a series of vegetables and fruits, attitudes towards vegetables and fruit. Analysis Frequency distributions for each item were generated and χ2 analyses were used to determine statistical significance. Exploratory factor analysis was employed to detect major trends in data. Results The intervention led to enhanced ability to identify individual vegetables and fruits, greater attention to origins of produce (garden-grown and fresh), changes to perceived consumption of vegetables and fruits, and enhanced confidence in preparing fruit and vegetable snacks, but decreased interest in trying new fruits. Conclusions The introduction of this school-based food garden was associated with skill and attitudinal changes conducive to enhancing vegetable and fruit consumption. The ways in which such changes might impact on dietary behaviours and intake require further analysis.