The relation between several measures of body iron and atherosclerotic disease, particularly acute myocardial infarction (AMI), is debated. This is of specific interest since iron is frequently included in supplementation and fortification of foods. We assessed the relation between dietary iron intake and the risk of non-fatal AMI.

Case–control study. The information was collected by interviewers using a food-frequency questionnaire tested for validity and reproducibility. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were obtained by multiple unconditional logistic regression models, including terms for energy and alcohol intakea, as well as for sociodemographic factors, tobacco and other major recognised risk factors for AMI.

Milan, Italy, between 1995 and 1999.

Cases were 507 patients, below age 79 years, with a first episode of non-fatal AMI, and controls were 478 patients admitted to hospital for a wide spectrum of acute conditions unrelated to known or potential AMI risk factors.

Compared with patients in the lowest tertile of total iron intake, the OR was 0.48 (95% CI 0.29–0.82) for those in the highest tertile. The corresponding value for haem iron was 0.71 (95% CI 0.48–1.06), for non-haem, non-alcohol iron was 0.80 (95% CI 0.51–1.24) and for iron derived from alcoholic beverages was 0.60 (95% CI 0.40–0.90). Sex-specific OR for total iron intake were not heterogeneous.

In this Italian population dietary iron intake was inversely related to AMI risk. This inverse association may depend on other nutrients present in the major sources of iron in the Italian diet.

This study examines secular changes in diet-related greenhouse gas emissions (GHGE) in younger and older Swedish adults, since the turn of this century.

Two cross-sectional health examination surveys were conducted in 2001–2004 (T1) and 2014–2018 (T2). At both times, an eighty-six-item FFQ was embedded in the survey. From the food frequencies and age-standardised portion sizes, GHGE estimates (kg CO2e/year) were calculated. GHGE was modelled as a function of time period and covariates, for five distinct age groups.

The municipality of Gothenburg, in western Sweden.

Women and men aged 25–34, 35–44, 45–54, 55–64 and 65–75 years were randomly selected from the population registry and recruited for examinations. After exclusion of participants with incomplete dietary data, the analytic sample consisted of 2569 individuals at T1 and 2119 at T2.

Lower dietary GHGE scores were observed at T2 compared with T1, in each age group, adjusting for sex, BMI and education. The largest differences in GHGE were observed in the youngest age group (approximately 30 % reduction). Decreasing trends in GHGE from animal-based foods were observed at all ages and were accompanied by smaller increases from plant-based sources in younger groups only. At all ages, GHGE from discretionary foods decreased, and prevalence of overweight remained stable.

Optimal dietary trends should support both human health and planetary health. Our results suggest that Swedish adults have moved in this direction, e.g. through less intake of red meat products and stable weight status.

To assess the association between breakfast energy and total daily energy intake among individuals with type 2 diabetes.

Cross-sectional study. Daily energy intake was computed from a 24 h dietary recall. Multiple regression models were used to estimate the association between daily energy intake (dependent variable) and quartiles of energy intake at breakfast (independent variable), expressed in either absolute or relative (percentage of total daily energy intake) terms. Orthogonal polynomial contrasts were used to test for linear and quadratic trends. Models were controlled for sex, age, race/ethnicity, BMI, physical activity and smoking. In addition, we used separate multiple regression models to test the effect of quartiles of absolute and relative breakfast energy on energy intake at lunch, dinner and snacks.

The 1999–2004 National Health and Nutrition Examination Survey (NHANES).

Participants aged ≥30 years with self-reported history of diabetes (n 1146).

Daily energy intake increased as absolute breakfast energy intake increased (linear trend, P<0·0001; quadratic trend, P=0·02), but decreased as relative breakfast energy intake increased (linear trend, P<0·0001). In addition, while higher quartiles of absolute breakfast intake had no associations with energy intake at subsequent meals, higher quartiles of relative breakfast intake were associated with lower energy intake during all subsequent meals and snacks (P<0·05).

Consuming a breakfast that provided less energy or comprised a greater proportion of daily energy intake was associated with lower total daily energy intake in adults with type 2 diabetes.

Little is known about the prevalence of nutritional supplement use in European adolescents. We conducted the present study to analyse the prevalence of nutritional supplement use and factors associated with this use among Slovenian adolescents.

The nutritional supplementation practices of 818 adolescents were studied using an anonymous questionnaire. Information was sought on the type of supplements used, frequency of use and sources of information.

The region of north-west Slovenia.

Schoolchildren from twenty primary schools and twelve secondary schools.

Some 19·3% of all adolescents reported using at least one nutritional supplement and the prevalence of use was significantly higher in adolescents who were members of sports clubs. Multivitamins were the most common nutritional supplement. Older adolescents were significantly more likely to be supplementing with iron, protein and minerals. Less than 16 % of supplement users in our study sought information from health-care professionals. Nearly 62 % obtained information from parents and coaches, and many adolescents appear to decide on nutritional supplementation themselves, without advice. Older adolescents were significantly more likely to combine supplements than younger adolescents.

One-fifth of Slovenian adolescents use nutritional supplements. There are clear differences in supplement use between younger (age 12 years) and older (age 17 years) adolescents. Multiple use of supplements, coupled with self-managed supplementation in older adolescents, is concerning. Hence, there is an urgent need to provide accurate information regarding nutritional supplements, which will help adolescents, their parents and coaches to make informed choices about their use.

To estimate the prevalence of underweight and overweight among Bangladeshi adults and to determine if the double burden of underweight and overweight differs by gender and other socio-economic characteristics of individuals.

We used data from the Bangladesh Demographic and Health Survey 2011. Multinominal logistic regression was used to examine associations between the different nutritional statuses of individuals and related determinants. Interaction effect was checked between gender and various socio-economic factors.

Nationwide, covering the whole of Bangladesh.

Individuals aged >18 years (women, n 16 052; men, n 5090).

Underweight was observed among 28·3 % of men and 24·4 % of women, whereas overweight was observed among 8·4 % of men and 16·9 % of women. The odds of being overweight were significantly lower among urban men (OR=0·46; 95 % CI 0·37, 0·57) compared with urban women, whereas the odds of being underweight were significantly higher among urban men (OR=1·33; 95 % CI 1·07, 1·64) compared with urban women. The odds of being overweight were lower among higher educated men (OR=0·48; 95 % CI 0·39, 0·58) and men of rich households (OR=0·45; 95 % CI 0·37, 0·54) compared with higher educated women and women of rich households, respectively.

There are important gender differences in the prevalence of underweight and overweight among the adult population in Bangladesh. Women with higher education, in rich and urban households have higher chances of being overweight and lower chances of being underweight compared with their male counterparts.

The present study aimed to examine the key influences on infant and child feeding practices among a Marshallese community at each social ecological level. It is the first study to examine the key influences on infant and child feeding practices with Marshallese immigrant women in the USA and helps fill a gap in the previous literature that has included other immigrant women.

Community-based participatory research design with twenty-seven participants taking part in four qualitative focus groups.

The study took place within the Marshallese community in Arkansas, USA.

Participants included Marshallese women with children aged 1–3 years and/or caregivers. Caregivers were defined as someone other than the parent who cares for children. Caregivers were often older women in the Marshallese community.

There were five primary themes within multiple levels of the Social Ecological Model. At the intrapersonal level, mothers’ and caregivers’ autonomy emerged. At the interpersonal level, child-led and familial influences emerged. At the organizational level, health-care provider influences emerged; and at the policy level, the Special Supplemental Nutrition Program for Women, Infants, and Children emerged as the most salient influence.

Marshallese immigrant women’s infant and child feeding practices are influenced at intrapersonal, interpersonal, organizational and policy levels. Understanding these multidimensional influences is necessary to inform the creation of culturally tailored interventions to reduce health disparities within the Marshallese community.

To assess efforts of the Brazilian legislature to regulate ultra-processed food industry practices related to obesity and diet-related non-communicable diseases during the first 4 years of the United Nations’ Decade of Action on Nutrition.

We searched the Chamber of Deputies and Federal Senate internal databases to identify bills under consideration between 2016 and December 2019. Keywords related to the main recommendations of international organisations regarding the regulation of food industry practices were used. Descriptive and content analysis of the bills were carried out.

Brazilian legislature (Chamber of Deputies and Federal Senate).

None.

Eighty-four bills were identified. The most frequently addressed topics were: nutrition labelling (38·1 %), marketing of unhealthy products (30·9 %), availability of unhealthy products (26·2 %) and critical nutrients content (14·3 %). Only 9·5 % of bills have proposed taxation on unhealthy products. No bill was passed during that period; 2·4 % were rejected and 10·7 % archived. Among the bills still under consideration, 52·4 % have not been passed in any Committee.

Although many bills have been introduced, no regulation of ultra-processed food industry practices has been enacted by the Brazilian legislature by 2020. It is likely that no positive impact on population nutrition in Brazil will be achieved by the end of the United Nation’s Decade of Action on Nutrition, in 2025 – especially regarding those goals set by the Brazilian government which were supposed to have been achieved by 2019.

Governments worldwide have been implementing interventions aimed at improving citizens’ dietary habits. Examining how individuals perceive these interventions is relevant for promoting future policies in this area, as well as informing the way they are designed and implemented. In the current study, we focused on interventions aimed at reducing sugar intake in Portugal, given the current high sugar consumption patterns in the population.

Online survey to assess which interventions are the most salient and receive greater public support.

Portugal.

1010 (76·7 % female, MAge 36·33, sd 13·22).

Data from a free-recall task showed that only about one-third of participants reported knowing about these interventions, namely those related to taxation, weight restrictions in individual sugar packets and limited availability of products with high sugar content. We also found evidence of high support for the eight interventions presented (except for replacing sugar by artificial sweeteners), positive attitudes towards the need of reducing sugar intake in the Portuguese population and high agreement with the importance of reducing sugar intake across all age groups, particularly among children. Participants also indicated paying attention to the amount of sugar in their diets and a low self-reported frequency of consumption of high sugary foods and beverages. A hierarchical regression analysis suggested that these variables were significantly associated with the overall acceptance of interventions, independently of social-demographic variables (i.e., age, education and sex).

By examining how people perceive and accept different interventions targeting the reduction of sugar intake, the current work aims to support policymaking in this domain.

The aim of the study is to elucidate differences in adults’ diet by education, and to analyse the associations between dietary facilitators, education and dietary fat quality.

In all, one-third of subjects from the national FINRISK health survey were invited to participate in the FINDIET 2007 Survey. A 48 h dietary interview was used for dietary data and personal background data were collected by the health survey questionnaire.

Representative sample from five regions in Finland in spring 2007.

A total of 1576 adults, participation rate 60 %.

Oil used in cooking differed by education. Instead perception of cardiovascular risk, or the following of a cholesterol-lowering diet, were equal across all educational categories. The diet of men with low education contained less protein and carbohydrates, more fat and more SFA and MUFA than that of highly educated men. The diet of women with low education contained less PUFA, vitamin C and vitamin E than in the highly educated category. High education remained a significant determinant for the lower intake of SFA in men, and for the higher intake of PUFA in women, after adjusting for the determinants and facilitators of dietary behaviour and age. The lower intake of SFA was also associated with following a cholesterol-lowering diet in both genders. In addition to education, the intake of unsaturated fatty acids was determined by the oil used in cooking by women, and by frequent lunches served by caterers for men.

In dietary behaviour, awareness and reporting of cholesterol-lowering diet seem to indicate a tendency to control the intake of saturated fat. Health messages are likely to enhance tools for increasing the intake of PUFA, in addition to reducing the intake of SFA.

A school environment that encourages students to opt for food with sound nutritional value is both essential and formative in ensuring that young people adopt healthy eating habits. The present study explored the associations between the socio-economic characteristics of the school environment and the school food environment.

A cross-sectional survey was conducted in 2008–2009. Descriptive and bivariate analyses were performed on data from public primary and secondary schools.

Quebec, Canada. The school food offering was observed directly and systematically by trained research assistants. Interviews were conducted to fully describe food offerings in the schools and schools’ child-care services.

A two-stage stratified sampling was used to build a representative sample of 143 French-speaking public schools. The response rate was 66·2 %.

The primary and secondary schools in low-density areas were more likely to be located near diners (primary: P=0·018; secondary: P=0·007). The secondary schools in deprived areas were less likely to have a regular food committee (P=0·004), to seek student input on menu choices (P=0·001) or to have a long lunch period (P=0·010). The primary schools in deprived areas were less likely to have a food service (P=0·025) and their meal periods were shorter (P=0·033).

The schools in areas with lower socio-economic status provided an environment less favourable for a healthy diet. From a public health perspective, the results of this analysis could assist policy makers and managers to identify actions to support the creation of favourable school environments.

The present study was conducted to examine barriers to and facilitators of serving reduced-sodium meals (RSM) in worksite cafeterias.

We conducted in-depth interviews with key stakeholders in food catering companies.

Food catering companies at various customer sites in South Korea.

A total of nineteen interviews with twenty-five participants from ten catering companies were conducted. Sixteen on-site dietitians and nine managers from the catering companies’ headquarters participated in the interviews.

Four main themes emerged from the interviews. First, key stakeholders’ psychosocial characteristics (perception, intention and knowledge) are important in serving RSM in worksite cafeterias. Second, skills and techniques related to measuring sodium content and preparing RSM were emphasized by the interviewees. Third, the lack of various delicious low-sodium menus is a barrier to serving RSM. Lastly, a number of environmental factors were addressed, which include social support for reduced-sodium diets (a facilitator) and pressure to maintain profit margins (a barrier), that contribute to serving meals with less salt. Based on these factors, various recommendations for future sodium reduction policies and programmes were suggested.

It is important to implement population-wide sodium reduction as a means of preventing CVD and stroke. The study provided important facilitators of and barriers to serving RSM in worksite cafeterias, which could be helpful in developing environmental interventions that promote low-sodium diets.

To complete a description of the dietary intakes of New Zealand schoolchildren by describing afternoon and evening foods and nutrients.

Twenty-four hour dietary recall data from the 2002 Children's Nutrition Survey were analysed to describe food and nutrient intakes during the afternoon (14.00 to 16.59 hours) and evening (17.00 to 23.59 hours).

New Zealand homes and schools.

Children (n 2875) aged 5–14 years.

Most children consumed something during the afternoon (79 %) and evening (98 %). Children were less likely to consume something during non-school day afternoons; if 11–14 years of age; and when of Pacific ethnicity. Afternoon food consumers had higher daily intakes for most nutrients. Afternoon intake accounted for much of this difference. In the afternoon, children consumed fruit (26 %) and biscuits/crackers (21 %). Evening eating contributed to daily intakes of energy (40 %), fat (43 %), carbohydrate (35 %), sucrose (20 %), glucose (24 %), vitamin A (47 %), Ca (26 %) and Fe (40 %). Children aged 5–6 years consumed a lower proportion of their daily energy intake during the evening than older children. In the evening, just one-third of children consumed vegetables (45 % if including potato/kumara/taro), 19 % fruit and 17 % ate hot chips. Children were more likely to consume vegetables if they also consumed potato/kumara/taro. Twenty-three per cent of children had powdered drinks/cordials, 21 % had soft drinks and 19 % had milk.

Consuming foods/drinks in the afternoon positively influenced macronutrient distribution, increasing the carbohydrate proportion. During the evening 40 % of energy intake was consumed but less than one-half of children consumed vegetables; thus inclusion of vegetables in the evening is important, particularly in meals without potato/kumara/taro.

Western studies have suggested cultural differences in food and nutrient intake patterns associated with dietary glycaemic index (GI) and glycaemic load (GL). Here, we conducted a cross-sectional study to examine the GI and GL of Japanese diets in relation to food and nutrient intakes.

Dietary intake was assessed using a validated, self-administered, diet history questionnaire.

A total of thirty-five of forty-seven prefectures in Japan.

Young (age 18 years), middle-aged (mean age 48 years) and older (mean age 74 years) Japanese women (n 3961, 3800 and 2202, respectively).

Irrespective of age, a positive association with dietary GI was seen for white rice only, which contributed most (37–42 %) to the variation in dietary GI. Conversely, all other food groups (such as fruit and vegetable juice, dairy products, noodles and fruit) were negative predictors of dietary GI. For dietary GL, 95–96 % of variation was explained by carbohydrate-rich food groups, all of which were positive predictors of GL. After adjustment for potential confounding factors, only carbohydrate intake was positively associated with dietary GI and GL, irrespective of age. Conversely, dietary GI and GL were inversely associated with intakes of all other nutrients examined (including SFA and Na).

A low-GI and -GL diet, which was characterized principally by a low intake of white rice, was associated with both favourable (higher intakes of dietary fibre and key vitamins and minerals) and unfavourable (higher intakes of SFA and Na) aspects of dietary intake patterns in three generations of Japanese women.

Urbanization is generally associated with increased CVD risk and accompanying dietary changes. Little is known regarding the association between increased CVD risk and dietary changes using approaches such as diet quality. The relevance of predefined diet quality scores (DQS) in non-Western developing countries has not yet been established.

The association between dietary intakes and CVD risk factors was investigated using two DQS, adapted to the black South African diet. Dietary intake data were collected using a quantitative FFQ. CVD risk was determined by analysing known CVD risk factors.

Urban and rural areas in North West Province, South Africa.

Apparently healthy volunteers from the South African Prospective Urban and Rural Epidemiological (PURE) study population (n 1710).

CVD risk factors were significantly increased in the urban participants, especially women. Urban men and women had significantly higher intakes of both macro- and micronutrients with macronutrient intakes well within the recommended CVD guidelines. While micronutrient intakes were generally higher in the urban groups than in the rural groups, intakes of selected micronutrients were low in both groups. Both DQS indicated improved diet quality in the urban groups and good agreement was shown between the scores, although they seemed to measure different aspects of diet quality.

The apparent paradox between improved diet quality and increased CVD risk in the urban groups can be explained when interpreting the cut-offs used in the scores against the absolute intakes of individual nutrients. Predefined DQS as well as current guidelines for CVD prevention should be interpreted with caution in non-Western developing countries.

Assessing the level of adherence and its determinants is important in appraising the overall effectiveness of trials. The present study aimed to evaluate the extent of adherence and its determinants in a pragmatic randomized controlled trial of Fe prophylaxis during pregnancy in Maputo, Mozambique.

A pragmatic randomized controlled trial.

Two health centres (1o de Maio and Machava) in Maputo, Mozambique.

Pregnant women (≥12 weeks’ gestation, ≥18 years old, non-high-risk pregnancy; n 4326) attending prenatal care consultations at two health centres were randomized to receive routine Fe (n 2184; 60 mg ferrous sulfate plus 400 μg folic acid daily throughout pregnancy) or selective Fe (n 2142; screening and treatment for anaemia and daily intake of 1 mg folic acid).

The level of adherence was 79 % for having two or more visits, 53 % for adequate prenatal care and 67 % for complete intake of Fe/folic acid tablets during the trial. The correlation between the adherence measures ranged between 0·151 and 0·739. Adherence did not differ by trial arm, but there were centre differences in adequate prenatal visits and intake of tablets. Older women (>20 years) and those with a history of abortion were more likely to achieve greater adherence, whereas an increased number of previous births decreased the likelihood of adherence. HIV positivity decreased the likelihood of adherence in one trial centre and increased it in the other.

The variation in adherence by trial centre, women’s characteristics and outcome measures suggests that adherence in trials fully depends on participants’ behaviour and can be increased by paying attention to contextual factors.

Nutritionists in the UK are at the start of an exciting time of professional development. The establishment of the Association for Nutrition in 2010 has presented an opportunity to review, revitalize and expand the UK Voluntary Register of Nutritionists. In the UK and elsewhere, there is a need for a specialist register of nutritionists with title protection as a public safeguard.

The new structure will base professional registration on demonstration of knowledge and application in five core competencies. Initially, there will be five specialist areas: animal; public health; nutritional scientist; food; sports and exercise. The wording and requirements linking the specialist areas to the competencies have been carefully defined by leading individuals currently on the existing register in these specialist areas. These have been evaluated by a random sample of existing registrants to check for accuracy of definitions and examples. Other work aims to establish a clear quality assurance framework in nutrition for workers in the health and social care sectors (UK Public Health Skills and Career Framework Levels 1–4) who contribute to nutrition activity, such as community food workers, nutrition assistants and pharmacists. Students, co-professional affiliates and senior fellows will also find a place in the new Association. The title ‘nutritionist’ is not currently legally protected in the UK and it is used freely to cover a range of unregulated practice.

The establishment of a professional register to protect the public and to provide a clear identity for nutritionists is a vital step forward.

To explore adherence to a plant-based diet from the perspective of goals- and motivations-based systems.

A cross-sectional, survey-based study was conducted regarding eating patterns, goals and motivations for current eating habits.

Data were collected using an online survey platform, including the Goal Systems Assessment Battery (GSAB) and other survey tools.

University students were recruited, including thirty-three students reporting successful maintenance of a plant-based diet (Adherents) and sixty-three students trying to adhere to a plant-based diet (Non-adherents).

Using GSAB subscale scores, discriminant function analyses significantly differentiated adherents v. non-adherents, accounting for 49·0 % of between-group variance (χ2 (13) = 42·03, P < 0·000). It correctly classified 72·7 % of adherents and 88·9 % of non-adherents. Constructs including value, self-efficacy, planning/stimulus control and positive affect were significant and included in the discriminant function. Logistic regression results suggested that participants who successfully adhered to a plant-based diet were seventeen times more likely to report ‘To manage or treat a medical condition’ as motivation and almost seven times more likely to report ‘To align with my ethical beliefs’ as motivation compared with non-adherents. However, these participants were 94 % less likely to report ‘To maintain and/or improve my health’ as motivation compared with non-adherents. Controlling for motivations, hierarchical logistic regression showed that only planning as part of the GSAB self-regulatory system predicted adherence to a plant-based diet.

Values-based approaches to plant-based diets, including consideration for ethical beliefs, self-efficacy and proper planning, may be key for successful maintenance of this diet long-term.

To document the infant feeding practices of Maldivian mothers.

A cross-sectional survey of 251 Maldivian mothers recruited in 2004 from the ‘well baby’ or ‘well child’ clinics on the island of Male' and including 75 mothers from three other islands, Hura, Himmafushi and Thulusdhoo.

The full breast-feeding rate at hospital discharge was 93% but declined to 41% at 4 months. Any breast-feeding rates were high among Maldivian mothers: 100% at 1 month and 85% were still breast-feeding at 6 months. The median duration of breast-feeding was 24 months.

Breast-feeding rates are high and the average duration of breast-feeding is more than 2 years in the Maldives. Health promotion activities should be directed towards maintaining the already high ‘any breast-feeding’ rates and increasing the proportion of infants exclusively breast-fed to 6 months.

To compare the effects on serum lipoproteins of three isocaloric diets with reduced total fat and saturated fatty acid (SFA) contents but with different proportions of monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA).

A low-fat diet (LF) provided 20 en% fat, 7.9% SFA, 7.8% MUFA, 3.0% PUFA; a high-PUFA diet (HP) 26 en% fat, 7.5% SFA, 8.2% MUFA, 8.1% PUFA; and a high-MUFA diet (HM) 26 en% fat, 7.3% SFA, 14.1% MUFA, 3.2% PUFA. Diets were consumed for 8 weeks in a parallel design, after 2 weeks on a habitual diet with 33–34 en% fat, 13–14% SFA, 12% MUFA, 6% PUFA, and followed by an 8-week period on habitual diet. Compliance to diet was monitored by repeated food records and weekly visits to a nutritionist.

45 free-living, middle-aged couples who were randomly allocated into the three diet groups; 43 men and 44 women completed the study.

During the diet periods, a small but significant reduction in body weight of 0.4–1.0kg was observed in all groups. Similar and significantreductions of mean weight-adjusted serum total cholesterol (4–8%), low-density lipoprotein (LDL) cholesterol (7–11%), and high-densitylipoprotein (HDL) cholesterol (8–11%) were observed during the diets. HDL2-cholesterol and apoprotein (apo) A-I levels were reduced whereas HDL3-cholesterol and apoA-II increased. ApoB was significantly decreased during the HM diet only. Serum triglycerides increased significantly during diets LF (25%, P< 0.01) and HP (19%, P< 0.05) but not during diet HM (5%, NS).

Reduction in the intake of total fat and saturated fatty acids reduced serum LDL-cholesterol and HDL2-cholesterol concentrations irrespective of the relative proportions of MUFA and PUFA in the diets. The results suggest that there might be some advantage in increasing the proportion of MUFA in low-fat diets, since the HM diet rich in MUFA reduced apoB and slightly attenuated the increase in serum triglycerides that is commonly associated with dietary fat reduction.