To use data from a published validation study concerning retention interval and school food-service production records to examine intrusions (uneaten items reported eaten) in the school-meal parts of 24 h recalls.

For that study, children were observed eating two school meals (breakfast, lunch) and interviewed under one of six conditions from two target periods (previous day (PDTP), prior 24 h (24TP)) crossed with three interview times (morning, afternoon (AIT), evening). For the present article, a catalogue was constructed of foods available for that study’s school meals. The study’s intrusions were classified as stretches (on children’s meal trays but uneaten), internal confabulations (in children’s school food-service environments for that meal but not on children’s trays) or external confabulations (not in children’s school food-service environments for that meal). Occurrence, types and amounts of intrusions were investigated.

Six schools; sixty fourth-grade children (ten per condition).

For breakfast, for the 24TP v. PDTP, reported items were less likely to be intrusions, internal confabulations and external confabulations; and intrusions were more likely to be stretches. For lunch, for the 24TP-AIT condition v. the other five conditions, reported items were less likely to be intrusions and external confabulations. Mean amounts reported eaten were smaller for stretches than for internal confabulations or external confabulations at breakfast, and for stretches than for internal confabulations at lunch.

Accuracy was better for the 24TP (with fewer intrusions of which proportionally more were stretches which had smaller amounts reported eaten) than for the PDTP. Studies with 24 h recalls should minimize retention interval to improve accuracy.

We explored the use of feedback in interactive web-based questionnaires for collecting data on lifestyle factors in epidemiological studies.

Here we report from a cohort study on lifestyle factors and upper respiratory tract infections among 1805 men and women. We introduced interactivity in the form of personalized feedback and feedback on a group level regarding dietary intake, physical activity and incidence of infections in web-based questionnaires as incentives for the respondents to continue answering questions and stay in the study.

The study was performed in Sweden.

All participants were randomly selected from the population registry.

Personalized feedback was offered in the baseline questionnaire and feedback on a group level in the five follow-up questionnaires. In total, 88 % of the participants actively chose to get personalized feedback at least once in the baseline questionnaire. The follow-up questionnaires were sent by email and the overall compliance at each follow-up was 83–84 %, despite only one reminder. In total, 74 % completed all five follow-ups. However, the compliance was higher among those who chose feedback in the baseline questionnaire compared with those who did not choose feedback.

The results show that it is possible to use feedback in web questionnaires and that it has the potential to increase compliance. The majority of the participants actively chose to take part in the personalized feedback in the baseline questionnaire and future research should focus on improving the design of the feedback, which may ultimately result in even higher compliance in research studies.

This umbrella review provides an overview of the consistency and gaps in the evidence base on eggs and cardiometabolic health.

PubMed, Web of Science, Cochrane Library, the Nutrition Evidence Systematic Review and Agency for Healthcare Research and Quality databases were screened for evidence-based reviews in English that assessed human studies on egg consumption and cardiometabolic outcomes.

Seven systematic reviews and fifteen meta-analyses were identified, with eighteen of these published since 2015. Overall, the systematic reviews were of low quality, while meta-analyses were of moderate- to high-quality. No association of increased egg intake and risks of heart disease or stroke in the general population were found in the meta-analyses. Increased risk of heart failure was noted in two meta-analyses that analysed the same three cohort studies. Five recent meta-analyses reported no increased risk of type 2 diabetes mellitus (T2DM) in the general population, although increased risk in US-based populations only has been reported. Older (<2013) meta-analyses reported increased risks of cardiovascular disease (CVD) or heart disease in T2DM populations, and no recent evidence-based reviews were identified. Finally, only one meta-analysis reported intervention studies specifically on eggs and biomarkers (i.e. lipids), and the results contradicted those from observation studies.

Recent evidence-based reviews conclude that increased egg consumption is not associated with CVD risk in the general population. More research is needed on the positive associations between egg consumption and heart failure and T2DM risk, as well as CVD risk in diabetics, before firm conclusions can be made.

Lycopene is a potent antioxidant, and it has been suggested that intake of tomatoes and tomato products containing lycopene is associated with a decreased risk of various chronic diseases. The aim of the present study was to evaluate the distribution of dietary lycopene intake in the Belgian population and to determine the most important contributors to lycopene intake.

Cross-sectional study.

National food consumption data from the Belgian Food Consumption Survey (BFCS) 2004 were used for the intake assessment. Determination of the lycopene content in foods was performed with HPLC-UV. Individual food consumption data were multiplied by the actual mean concentrations of lycopene per food.

Individuals (n 3083) aged 15 years and older participated in the study and provided two 24 h recalls.

The mean lycopene intake among Belgian adults was 4·1 (sd 2·3) mg/d or 0·059 (sd 0·033) mg/kg body weight per d. Lycopene intake among men (4·6 (sd 2·6) mg/d) was higher than among women (3·6 (sd 2·1) mg/d), and was higher in the younger compared with the older age groups. Cis-lycopene intake represented about one-third of the total lycopene intake. Tomatoes and tomato products (43 %) and sauces and ready-to-eat meals containing tomato sauces (41 %) were the main contributors to lycopene intake in Belgium.

The lycopene intake of the Belgian adult population was comparable to intakes reported in neighbouring countries and was below the acceptable daily intake.

Low Ca intake is common among Japanese women, but its effect on bone metabolism has not been fully elucidated. The aim of the present study was to determine the relationship between Ca intake and serum markers of bone turnover in postmenopausal Japanese women.

A cross-sectional study.

A community setting.

Subjects were 595 home-dwelling postmenopausal Japanese women. Ca intake was assessed by a validated FFQ. Serum type I collagen cross-linked N-telopeptides (NTX) and osteocalcin were measured as markers of bone turnover. The relationships between demographic characteristics, lifestyles, serum Ca, vitamin D and intact serum parathyroid hormone and bone turnover were also assessed.

The average age of the subjects was 64·5 (sd 5·8) years and the mean Ca intake was 527 (sd 160) mg/d. Ca intake was significantly associated with serum NTX (P = 0·0104), but not with serum osteocalcin. Mean serum NTX concentration in the lowest quartile of Ca intake (<417 mg/d) was significantly higher than in the fourth, referent quartile. Among these Japanese postmenopausal women, very low Ca intake (less than ∼400 mg/d) was associated with increased bone resorption but not bone formation.

Increased bone resorption may be one mechanism by which this Ca-depleted population normalizes bone metabolism and prevents osteoporosis.

To provide HIV-positive mothers who opted for exclusive breastfeeding or formula feeding from birth to 6 months postpartum as a means of prevention of mother-to-child transmission (PMTCT) of HIV with a sustainable infant food support programme (FSP) from 6 to 12 months postpartum. We describe the implementation and assessment of this pilot initiative.

The FSP included a 6-month provision of locally produced infant fortified mix (IFM; 418 kJ/100 g of gruel) for non-breastfed infants coupled with infant-feeding and psychosocial counselling and support. Acceptability and feasibility were assessed in a subsample of sixty-eight mother–infant pairs.

The FSP was developed in collaboration with local partners to support participants in a PMTCT prevention study. Formula was provided for free from 0 to 6 months postpartum. Cessation by 6 months was recommended for breastfeeding mothers.

The FSP was positively received and greatly encouraged breastfeeding mothers to cease by 6 months. As recommended, most infants were given milk as an additional replacement food, mainly formula subsidised by safety networks. Among daily IFM consumers, feeding practices were satisfactory overall; however, the IFM was shared within the family by more than one-third of the mothers. Cessation of IFM consumption was observed among twenty-two infants, seventeen of whom were fed milk and five neither of these.

Without any food support most mothers would have been unable to provide appropriate replacement feeding. The food security of non-breastfed infants urgently needs to be addressed in HIV PMTCT programmes. Our findings on a simple cost-effective pioneer intervention provide an important foundation for this process.

To assess the association between socio-economic position (SEP) and poor eating behaviours in a large representative sample of Australian secondary-school students.

Cross-sectional survey of students’ vegetable, fruit, sugar-sweetened beverage and fast-food consumption assessed using validated instruments and collected via a web-based self-report format.

Secondary schools across all Australian states and territories.

Secondary-school students (n 12 188; response rate: 54 %) aged 12–17 years participating in the 2009–10 National Secondary Students’ Diet and Activity (NaSSDA) survey.

Overall, 25 % of students reported consuming ≤1 serving of vegetables/d and 29 % reported eating ≤1 serving of fruit/d. Fourteen per cent of students reported drinking at least 1–2 cups of sugar-sweetened beverages/d while 9 % reported eating fast food ≥3 times/week. After adjusting for other demographic factors, students of lower-SEP areas were more likely to report low intake of vegetables (F(4, 231) = 3·61, P = 0·007) and high frequency of consumption of sugar-sweetened beverages (F(4, 231) = 8·41, P < 0·001) and fast food (F(4, 231) = 4·59, P = 0·001) compared with students of high-SEP neighbourhoods. A positive SEP association was found for fruit consumption among female students only (F(4, 231) = 4·20, P = 0·003). Those from lower-SEP areas were also more likely to engage in multiple poor eating behaviours (F(4, 231)=5·80, P < 0·001).

Results suggest that socio-economic disparities in Australian adolescents’ eating behaviours do exist, with students residing in lower-SEP neighbourhoods faring less well than those from high-SEP neighbourhoods. Reducing social inequalities in eating behaviours among young people should be a key consideration of future preventive strategies.

To investigate key risk factors associated with undernutrition in the first few years of life.

A cross-sectional household survey was conducted in January 2018 collecting anthropometric data and other information on household, caregiver and child characteristics. Crude and adjusted odds ratios were calculated to assess the association of these characteristics with stunting and underweight outcomes.

Kitui and Machakos counties in south-east Kenya.

Caregivers and their children aged 0–23 months in 967 beneficiary households of the Government of Kenya’s cash for orphans and vulnerable children (CT-OVC) social protection scheme.

Twenty-three per cent of the 1004 children with anthropometric data were stunted, 10 % were underweight and 6 % experienced wasting. The strongest predictors of stunting and underweight were being in the second year of life and being born with a low birth weight. Residing in a poor household and having more than one child under 2 years of age in the household were also significant risk factors for being underweight. Although 43 % of children did not receive the minimal acceptable diet, this was not a significant factor associated with undernutrition. When age was removed as a covariate in children aged 12–23 months, being male resulted in a significantly higher risk of being stunted.

While only 9 % of children were born with a low birth weight, these were four to five times more likely to be stunted and underweight, suggesting that preventive measures during pregnancy could have significant nutrition and health benefits for young children in this study area.

To provide accurate estimates of the commencement time, duration and dosage of folic acid (FA) supplementation taken by Irish women in the periconceptional period. The study also aimed to establish the factors associated with optimal FA supplementation practices.

Cross-sectional observational study. Women’s clinical and sociodemographic details were computerised. Maternal weight and height were measured before calculating BMI. Detailed FA supplementation questionnaires were completed under the supervision of a trained researcher.

A large university maternity hospital, Republic of Ireland, January 2014–April 2016.

Women (n 856) recruited at their convenience in the first trimester.

While almost all of the women (97 %) were taking FA at enrolment, only one in four women took FA for at least 12 weeks preconceptionally (n 208). Among the 44 % of women who were supplementing with FA preconceptionally, 44 % (162/370) reported taking FA for less than the 12 weeks required to achieve optimal red-blood-cell folate levels for prevention of neural tube defects. On multivariate analysis, only planned pregnancy and nulliparity were associated with taking FA for at least 12 weeks preconceptionally. Among women who only took FA postconceptionally, almost two-thirds commenced it after day 28 of their pregnancy when the neural tube had already closed.

As the timing of FA was suboptimal both before and after conception, we recommend that current national FA guidelines need to be reviewed.

To assess the contribution of liver to the vitamin A intake of 24–59-month-old children from an impoverished South African community where liver is frequently consumed and vitamin A deficiency previously shown to be absent.

Cross-sectional.

Northern Cape Province, South Africa.

Children aged 24–59 months (n 150). Vitamin A intake from liver was assessed using a single 24 h recall and a quantified liver frequency questionnaire. In addition, information on vitamin A intake via the national fortification programme was obtained from the 24 h recall and information on vitamin A supplementation from the Road-to-Health Chart. Height, weight and socio-economic data were also collected.

Stunting, underweight and wasting were prevalent in 36·9 %, 25·5 % and 12·1 % of children. Mean daily vitamin A intake from liver was 537 and 325 μg retinol equivalents measured by the 24 h recall and liver frequency questionnaire, respectively. Liver was consumed in 92·7 % of households and by 84·7 % of children; liver intake was inversely related to socio-economic status (P < 0·05). The food fortification programme contributed 80 μg retinol equivalents and the vitamin A supplementation programme 122 μg retinol equivalents to daily vitamin A intake.

The study showed that liver alone provided more than 100 % of the Estimated Average Requirement of the pre-school children in this impoverished community. The results also challenge the notion generally held by international health bodies that vitamin A deficiency, poor anthropometric status and poverty go together, and reinforces the fact that South Africa is a culturally diverse society for which targeted interventions are required.

To estimate the proportion of products meeting Indian government labelling regulations and to examine the Na levels in packaged foods sold in India.

Nutritional composition data were collected from the labels of all packaged food products sold at Indian supermarkets in between 2012 and 2014. Proportions of products compliant with the Food Safety Standards Authority of India (FSSAI) regulations and labelled with Na content, and mean Na levels were calculated. Comparisons were made against 2010 data from Hyderabad and against the UK Department of Health (DoH) 2017 Na targets.

Eleven large chain retail stores in Delhi and Hyderabad, India.

Packaged food products (n 5686) categorised into fourteen food groups, thirty-three food categories and ninety sub-categories.

More packaged food products (43 v. 34 %; P<0·001) were compliant with FSSAI regulations but less (32 v. 38 %; P<0·001) reported Na values compared with 2010. Food groups with the highest Na content were sauces and spreads (2217 mg/100 g) and convenience foods (1344 mg/100 g). Mean Na content in 2014 was higher in four food groups compared with 2010 and lower in none (P<0·05). Only 27 % of foods in sub-categories for which there are UK DoH benchmarks had Na levels below the targets.

Compliance with nutrient labelling in India is improving but remains low. Many packaged food products have high levels of Na and there is no evidence that Indian packaged foods are becoming less salty.

Although studies have examined the association between adverse childhood experiences (ACE) and health and mental health outcomes, few studies have investigated the association between ACE and household food insecurity among children aged 0–5 years in the USA. The objective of this study is to investigate the association between ACE and household food insecurity among children aged 0–5 years.

The data used in this study came from the 2016–2017 National Survey of Children’s Health. Data were analysed using multinomial logistic regression with household food insecurity as the outcome variable.

United States.

An analytic sample of 17 543 children aged 0–5 years (51·4% boys).

Of the 17 543 respondents, 83·7% experienced no childhood adversity. About one in twenty (4·8%) children experienced moderate-to-severe food insecurity. Controlling for other factors, children with one adverse childhood experience had 1·43 times the risk of mild food insecurity (95 % CI 1·25, 1·63) and 2·33 times the risk of moderate-to-severe food insecurity (95 % CI 1·84, 2·95). The risk of mild food insecurity among children with two or more ACE was 1·5 times higher (95 % CI 1·24, 1·81) and that of moderate-to-severe food insecurity was 3·96 times higher (95 % CI 3·01, 5·20), when compared with children with no childhood adversity.

Given the critical period of development during the first few years of life, preventing ACE and food insecurity and early intervention in cases of adversity exposure is crucial to mitigate their negative impact on child development.

The present cross-sectional study aimed to determine population-attributable risk (PAR) estimates for factors associated with inappropriate complementary feeding practices in The Gambia.

The study examined the first and most recent Demographic and Health Survey of The Gambia (GDHS 2013). The four complementary feeding indicators recommended by the WHO were examined against a set of individual-, household- and community-level factors, using multilevel logistic analysis. PAR estimates were obtained for each factor associated with inappropriate complementary feeding practices in the final multivariate logistic regression model.

The Gambia.

Last-born children (n 2362) aged 6–23 months.

Inadequate meal frequency was attributed to 20 % (95 % CI 15·5 %, 24·2 %) of children belonging to the youngest age group (6–11 months) and 9 % (95 % CI 3·2 %, 12·5 %) of children whose mothers were aged less than 20 years at the time of their birth. Inadequate dietary diversity was attributed to 26 % (95 % CI 1·9 %, 37·8 %) of children who were born at home and 20 % (95 % CI 8·3, 29·5 %) of children whose mothers had no access to the radio. Inadequate introduction of solid, semi-solid or soft foods was attributed to 30 % (95 % CI 7·2 %, 38·9 %) of children from poor households.

Findings of the study suggest the need for community-based public health nutrition interventions to improve the nutritional status of Gambian children, which should focus on sociocultural and economic factors that negatively impact on complementary feeding practices early in infancy (6–11 months).

To evaluate the iodine nutritional status of children living on the island of Tanna, Republic of Vanuatu.

Cross-sectional study. Urine and household salt samples were collected for iodine measurement. Thyroid volumes were measured by ultrasound. A food consumption frequency survey was carried out, particularly in relation to salt, iodine-rich foods and foods that containing thiocyanate, a potentially goitrogenic substance. Urinary thiocyanate levels were also measured.

Island rural communities in Tanna, Vanuatu.

One hundred and fifty-three schoolchildren between 8 and 10 years of age from four locations on the island participated.

The median urinary iodine excretion (UIE) among the children was 49mg/l, indicating moderate iodine deficiency. This was corroborated by 27% of boys and 33% of girls having thyroid glands greater than the international standard for their age, and 36% of boys and 45% of girls having thyroid glands greater than the international standard for their body surface area based on ultrasonography. There was a highly statistically significant inverse correlation between thyroid volume and UIE for boys and girls (r = −0·444, P = 0·001 and r = −0·319, P = 0·005, respectively). There was no correlation between thiocyanate and UIE or thyroid volume. Only 34% of children reported to consume fish (tinned or fresh) on a weekly basis.

Against the common perception, the study has demonstrated that the children on the island of Tanna were in a state of moderate iodine deficiency. More data need to be collected from other Pacific Island countries in order to provide evidence for formulating public policy in prevention and control of iodine deficiency disorders in these nations.

Describing the consumption of ultra-processed foods (UPF) and their association with the nutritional profiles among users of a health promotion service in a Brazilian city.

Cross-sectional study.

Public health promotion service of Primary Health Care in Belo Horizonte, Minas Gerais, Brazil.

Totally, 3372 participants.

UPF were found to contribute to 27·7 % of the diet’s total energy. The highest consumption was associated with higher values for energy intake (1561·8 v. 1331·8 kcal/d; P < 0·01), energy density (1·7 v. 1·4 kcal/g; P < 0·01), total (32·5 v. 27·3 %; P < 0·01) and trans-fats (2·1 v. 1·2 %; P < 0·01) and Na (1001·6 v. 758·9 mg/1000 kcal; P < 0·01) and with lower values for proteins (14·9 v. 19·6 %; P < 0·01), mono-unsaturated fats (16·1 v. 20·1 %; P = 0·02), n-3 (0·9 v. 1·1 %; P < 0·01) and some vitamins and minerals when comparing individuals in the last quintile of energy contribution from UPF in relation to the first one. The prevalence rate of nutrient inadequacy aimed at preventing non-communicable diseases increased between 30 % and 100 % when compared with the values of the fifth to the first quintile of UPF consumption (P < 0·001). However, the participants had lower energy intake, energy density and Na and higher fibre consumption when compared to Brazilian population.

Participants showed a high consumption of UPF, but also positive diet characteristics when compared with the national data. The results suggest the importance of health promotion services to promote healthy food and the need to include approaches to reduce UPF consumption.

To investigate dietary health understandings, healthy foods access perceptions and the main sources of nutritional knowledge of residents in three urban communities of varying socio-economic make-up.

An ethnographic approach to primary qualitative data collection, involving frequent visits to study areas over 4 months and in-depth interviews. Interviews were recorded, transcribed verbatim and analysed through an iterative approach.

Yogyakarta, Indonesia.

A purposive sample of 45 participants divided equally among the 3 communities. Participants were mostly female (93 %), aged between 27 and 75 years (mean 47·7) and largely identified as the person responsible for household food-related decisions (93 %).

Three overarching themes emerged: (i) dietary health understandings; (ii) healthy foods access perceptions and (iii) sources of nutritional knowledge. Participants employed multifaceted conceptualisation of dietary health. Most identified healthy foods with traditional plant-based foods, inexpensive and locally available from multiple sources. Thus, all participants perceived healthy foods as highly available in the local environment and most (80 %) as affordable. Reported affordability issues referred to specific foods (particularly animal source products) and were independent of income levels. Participants acquired nutritional knowledge from multiple sources, including many community-based initiatives. These were overall perceived as useful, but also as presenting some limitations.

The variety in dietary health understandings reported by study participants, and their high perceptions of healthy foods availability in the local environment reinforce the idea that individual- and food environment-level determinants of nutritional behaviours are highly contextual.

To systematically audit the extent of unhealthy sponsorship within junior community sporting clubs and ascertain whether differences exist across geographical areas and sport types.

Club sponsorship data were assessed to determine the extent of unhealthy food/beverage, alcohol and gambling sponsorship using a cross-sectional design. Differences across geographical areas were assessed using logistic regressions.

A stratified random sampling procedure was used to select thirty communities across the state of Victoria, Australia. Within each community, local clubs across the top eight participating junior sports were selected for audit.

Sponsorship data were collected from 191 club websites and Facebook pages in September–November 2019.

Unhealthy sponsorships represented 8·9 % of all identified sponsorship arrangements. A quarter of all clubs accepted alcohol (25·6 %) and unhealthy food sponsors (25·9 %), and one-fifth of all clubs accepted high-risk food (unhealthy brands with large market share) (18·1 %) and gambling sponsors (20·4 %). Acceptance of unhealthy sponsorship differed across sport types with football, netball, cricket and soccer clubs having the greatest numbers. Compared with metro areas, a significantly greater proportion of sporting clubs in regional areas were affiliated with unhealthy food (32·7 % v. 19·6 %) and high-risk food sponsors (26·9 % v. 9·8 %). A higher proportion of clubs in low socio-economic status (SES), compared with the high SES areas, were affiliated with alcohol (33·9 % v. 16·5 %) and gambling sponsors (27·4 % v. 12·6 %).

Victorian children participating in community junior sports are being exposed to marketing of unhealthy brands and products. Public health intervention is necessary to protect children from this exposure.

The present study aimed to translate the English version of the Nutritional Form For the Elderly into Simplified Chinese, as well as to test the reliability (homogeneity and stability) and validity (content and construct validity) of the Chinese version of the Nutritional Form For the Elderly (NUFFE-CHI).

The study adopted a cross-sectional design. The English version of the NUFFE was translated into Simplified Chinese and a questionnaire survey was conducted. The data were analysed with statistical methods to estimate the homogeneity, stability, content and construct validity.

Jinzhou City, China.

A total number of 701 community-dwelling older adults answered the questionnaire, including background variables and the NUFFE-CHI. A small group of the participants (n 50) completed the NUFFE-CHI twice for test–retest reliability.

Cronbach’s α was 0·65 and the split-half reliability was 0·67. Item-to-total correlation analyses showed that the scale has sufficient internal consistency. The test–retest reliability regarding the total scores of NUFFE-CHI was reflected in an intra-class correlation coefficient of 0·88. The intra-class correlation coefficients between the test and retest of the NUFFE-CHI items varied between 0·43 and 0·98. A content validity index of 0·83 explained good content validity. Construct validity was demonstrated in an exploratory factor analysis with a six-factor solution, explaining 57·65 % of the variance.

This first testing of the NUFFE-CHI indicates sufficient evidence for reliability, content and construct validity. Further testing studies regarding homogeneity, concurrent validity, sensitivity and specificity are required before the NUFFE-CHI can be used as a screening instrument in clinical settings and in research.