To estimate the burden of excess weight in Brazilian adolescents.

Systematic review with meta-analysis.

We searched the literature in four databases (MEDLINE/PubMed, EMBASE, SciELO and LILACS). Studies were included if they had cross-sectional or cohort design and enrolled Brazilian adolescents. Studies based on self-reported measures were excluded. Random effect models were used to calculate prevalence estimates and their 95 % CI.

Brazilian adolescents (10 to 19 years old).

One hundred and fifty-one studies were included. Trend analyses showed a significant increase in the prevalence of excess weight in the last decades: 8·2 % (95 % CI 7·7, 8·7) until year 2000, 18·9 (95 % CI 14·7, 23·2) from 2000 to 2009, and 25·1 % (95 % CI 23·4, 26·8) in 2010 and after. A similar temporal pattern was observed in the prevalence of overweight and obesity separately. In sensitivity analyses, lower prevalence of excess weight was found in older adolescents and those defined using International Obesity Task Force cut-off points. The Southeast and South regions had the highest prevalence of excess weight, overweight and obesity. No significant difference in prevalence by sex was found, except for studies before the year 2000.

The prevalence of overweight and obesity in Brazilian adolescents is high and continues to rise. Public policies on an individual level and targeting modifications in the obesogenic environment are necessary.

Dietary transition, obesity and risky use of alcohol and tobacco are challenges to public health among indigenous peoples. The aim of the article was to explore the role of social position in dietary patterns and expenditures on food and other commodities.

Countrywide population health survey.

Greenland.

2436 Inuit aged 15+ years.

Less than half of the expenditures on commodities (43 %) were used to buy nutritious food, and the remaining to buy non-nutritious food (21 %), alcoholic beverages (18 %) and tobacco (18 %). Participants were classified according to five dietary patterns. The cost of a balanced diet and an unhealthy diet was similar, but the cost per 1000 kJ was higher and the energy consumption was lower for the balanced diet. Participants with low social position chose the unhealthy pattern more often than those with high social position (40 % v. 24 %; P < 0·0001), whereas those with high social position more often chose the balanced alternative. Participants with low social position spent less money on the total food basket than those with high social position but more on non-nutritious food, alcohol and tobacco.

Cost seems to be less important than other mechanisms in the shaping of social dietary patterns and the use of alcohol and tobacco among the Inuit in Greenland. Rather than increasing the price of non-nutritious food or subsidising nutritious food, socially targeted interventions and public health promotion regarding food choice and prevention of excessive alcohol use and smoking are needed to change the purchase patterns.

To clarify nutrient supplementation usage and primary source of information among pregnant women in China.

This cross-sectional study used information on nutrient supplementation and primary source of information collected via face-to-face interviews. Data on the usage of folic acid, Ca/vitamin D, Fe, vitamins, DHA and other dietary supplements were collected. Primary source of information was categorised as family/relatives, friends/co-workers, the Internet, books/magazines, television/radio, doctors, other people and oneself.

Maternal and Child Health Hospital in Chengdu, China.

One thousand eighty-one Chinese pregnant women aged ≥20 years with singleton pregnancies.

In all three trimesters of pregnancy, usage was highest and most stable for folic acid (81·7 %), followed by vitamins (vitamin A, B-group vitamins, vitamin C and multivitamins; 75·0 %), whereas Ca/vitamin D (51·4 %) and Fe (18·1 %) usage was low, potentially indicating a deficiency risk. All supplementation usage percentages increased with pregnancy duration (P < 0·05). Notably, approximately 10 % of the pregnant women in our study did not use any nutrient supplementation, and this was especially common in early pregnancy. More than 50 % of the women reported getting information on nutrient supplementation from family members, and about 30 % reported getting this information from doctors.

Among pregnant women in China, awareness about nutrient supplementation increases as the pregnancy progresses, but some types of nutrient supplementation (such as Ca/vitamin D and Fe) remain at low levels. It is necessary to pay more attention to the health education of pregnant women in China, and the influence of family members should be emphasised.

Dietary patterns have been pointed out as useful diet quality indicators, but evidence about their relationship to metabolic phenotypes is still scarce. Thus, the present study aimed to verify the relationship between dietary patterns and metabolic phenotypes in Brazilian adults.

Cross-sectional study. A food consumption frequency questionnaire assessed food consumption profiles. Metabolic phenotypes were defined based on the criteria of the National Health and Nutrition Examination Survey: overweight or normal weight and metabolically healthy (MHOW and MHNW) or unhealthy (MUOW and MUNW). Dietary patterns were established through exploratory factor analysis and principal component analysis. The associations were tested using multinomial logistic regression.

Viçosa, Minas Gerais, Brazil.

Individuals (n 896) aged 20–59 years of both sexes, selected using probabilistic sampling.

Three dietary patterns were identified: Unhealthy pattern (alcoholic beverages, oils and fats, condiments, soda and juice, sugars and sweets, snacks, and meat and derivatives), Traditional pattern (culinary preparations, beans, milk and dairy products, and coffee and tea) and Healthy pattern (vegetables and fruits, whole grains, chicken and fish, and skimmed milk). Unhealthy pattern was positively associated with the MHOW and MUOW phenotypes in the fourth quartile (OR = 1·84; 95 % CI 1·06, 3·22) and in the third (OR = 1·94; 95 % CI 1·11, 3·39) and fourth (OR = 2·56; 95 % CI 1·41, 4·64) quartiles of consumption, respectively. Healthy pattern was also associated with these phenotypes.

Both the pattern comprising energy-dense foods and the healthier pattern were associated with overweight phenotypes among Brazilian adults.

This study investigated whether the duration and type of screen time (ST) (TV viewing, recreational computer use, video gaming) is longitudinally associated with z-BMI and if these relationships are mediated by disordered eating (emotional, restrained).

At baseline, participants were n 1197 (T1; 60 % female) adolescents (mean age = 13·51 years) who completed surveys over 2 years. ST was assessed by a self-reported measure created by the investigative team, while emotional and restrained eating was measured by the Dutch Eating Behaviour Questionnaire (DEB-Q). Height and weight were objectively measured to quantify z-BMI.

Thirty-one public and two private schools from the region of Ottawa, Canada.

Students in grades 7–12.

Parallel multiple mediation analyses revealed that more time spent watching TV at baseline is associated with higher z-BMI at T3 (total effect; B = 0·19, se = 0·07, P = 0·01, 95 % CI 0·05, 0·34), but no relationships were observed for total ST exposure or other types of ST and z-BMI. Disordered eating did not mediate the positive association between baseline TV viewing and z-BMI at T3.

TV viewing was longitudinally associated with higher z-BMI in a community-based sample of adolescents, but disordered eating behaviours did not mediate this relationship. However, other non-pathological eating behaviours may mediate the association between ST and obesity and warrant further investigation. Finding suggests that targeting reduction in youth’s TV viewing may be an effective component in the prevention of childhood obesity.

To determine undernutrition prevalence in 0–59-month-old children and its determinants during the period 2000–2015 in sub-Saharan Africa.

Ecological study of time series prevalence of undernutrition in sub-Saharan Africa assessed from 2000 to 2015.

Underweight and stunting prevalence from the World Bank database (2000–2015) were analysed. Mixed models were used to estimate prevalence of underweight and stunting. Country-specific undernutrition prevalence variation was estimated and region comparisons were performed. A meta-regression model considering health and socio-economic characteristics at country level was used to explore and estimate the contribution of different undernutrition determinants.

Countries of sub-Saharan Africa.

During 2000–2015, underweight prevalence in sub-Saharan Africa was heterogeneous, ranging between 7 and 40 %. On the other hand, stunting prevalence ranged between 20 and 60 %. In general, higher rates of underweight and stunting were estimated in Niger (40 %) and Burundi (58 %), respectively; while lowest rates of underweight and stunting were estimated in Swaziland (7 %) and Gabon (21 %). About 1 % undernutrition prevalence reduction per year was estimated across sub-Saharan Africa, which was not statistically significant for all countries. Health and socio-economic determinants were identified as main determinants of underweight and stunting prevalence variability in sub-Saharan Africa.

Undernutrition represents a major public health threat in sub-Saharan Africa and its prevalence reduction during the period 2000–2015 was inconsistent. Improving water accessibility and number of medical doctors along with reducing HIV prevalence and poverty could significantly reduce undernutrition prevalence in sub-Saharan Africa

To identify the social contextual factors, specifically the presence of information that supports v. undermines clinical recommendations, associated with infant feeding behaviours among mothers in low-income areas.

Cross-sectional survey evaluating social support networks and social relationships involved in providing care to the infant along with feeding beliefs and practices.

Out-patient paediatric and government-funded (Women, Infants, and Children) clinics in an urban, low-income area of the south-eastern USA.

Eighty-one low-income mothers of infants between 0 and 12 months old.

Most mothers reported receiving both supportive and undermining advice. The presence of breast-feeding advice that supports clinical recommendations was associated with two infant feeding practices that are considered beneficial to infant health: ever breast-feeding (OR=6·7; 95 % CI 1·2, 38·1) and not adding cereal in the infant’s bottle (OR=15·9; 95 % CI 1·1, 227·4). Advice that undermines clinical recommendations to breast-feed and advice about solid foods were not associated with these behaviours.

Efforts to facilitate optimal infant feeding practices may focus on increasing information supportive of clinical recommendations while concentrating less on reducing the presence of undermining information within mothers’ networks. Cultural norms around breast-feeding may be stronger than the cultural norms around the introduction of solid foods in mothers’ social environments; thus, additional efforts to increase information regarding introduction of solid foods earlier in mothers’ infant care career may be beneficial.

To estimate reporting bias of WebCAAFE, a web-based questionnaire for the assessment of food intake (recall of frequency of intake of thirty-two food items the day before) and physical activity in schoolchildren.

Cross-sectional study. Self-reported food intake on WebCAAFE was compared with direct observation of school meals in five public schools. Additional data included school grade, sex, BMI, socio-economic status and access to Internet at home. Poisson regression was used to calculate the reporting bias (WebCAAFE v. direct observation) and the sample size necessary to detect a statistically significant difference between WebCAAFE reports and at least 75 % compliance with the recommendations for a healthy diet.

Intentional sample of five elementary public schools in Florianopolis, Brazil.

Schoolchildren (n 629) from 2nd to 5th grades.

Moderate bias magnitude was found for most food groups of interest. Frequency of consumption was not related to the bias. Sample sizes necessary to detect the compliance with dietary recommendations varied between four and seventy-four individuals for the different groups investigated.

After adjusting for moderate bias, WebCAAFE may be used as a food questionnaire for evaluation of schoolchildren’s food compliance on a group level, even with a relatively small sample size.

To describe the process of establishing and implementing a social support infant feeding intervention.

This paper outlines the initial stages of a randomised controlled trial which assessed the effectiveness of a social support intervention on a range of infant feeding outcomes. Details are presented of the processes involved in recruiting, training and supporting a group of volunteers who provided support to the study sample.

Camden and Islington, London, UK.

Initial networking with local agencies and organisations provided invaluable information and contacts. Employing a dedicated volunteer co-ordinator is vitally important in the recruitment, training and support of volunteers. Providing child care and travel expenses is an essential incentive for volunteers with young children. Advertisements placed in local newspapers were the most successful means of recruiting volunteers. Appropriate training is needed to equip volunteers with the necessary knowledge and skills to provide effective support. Particular emphasis in the training focused upon developing the necessary interpersonal skills and self-confidence. The evaluation of the training programme demonstrated that it improved volunteers’ knowledge and reported confidence. The provision of ongoing support is also essential to maintain volunteers’ interest and enthusiasm. The retention of volunteers is, however, a key challenge.

The processes outlined in this paper have demonstrated the feasibility of successfully establishing, implementing and maintaining a community-based social support infant feeding programme. The experiences described provide useful insights into the practical issues that need to be addressed in setting up a social support intervention.

To analyse the association between macronutrient intake and body mass index (BMI).

A series of hospital-based case–control studies.

Selected teaching and general hospitals in several Italian regions.

A total of 6619 subjects from the comparison groups of the case–control studies were included in the analysis.

We obtained data from a validated 78-item food-frequency questionnaire submitted between 1991 and 2002. For various macronutrients, the partial regression coefficient (variation of BMI (kg m− 2) per 100 kcal increment of energy intake) was derived from multiple linear regression models, after allowance for age, study centre, education, smoking habits, number of eating episodes and mutual adjustment for macronutrients.

BMI was directly associated with protein intake among women only (β = 0.68) and with unsaturated fats in both genders (for monounsaturated fats β = 0.27 for men and 0.26 for women; for polyunsaturated fats β = 0.27 for men and 0.54 for women), and inversely related to carbohydrates (β = − 0.05 for men and − 0.21 for women) and number of eating episodes in both genders (β =  − 0.42 for men and − 0.61 for women) and to saturated fats among women only (β =  − 0.57).

These results confirm and provide convincing evidence that, after allowance for selected covariates including total energy intake, a protein-rich diet is not inversely related to BMI, and a carbohydrate-rich diet is not directly related to BMI.

Little is known about the relationship of dietary cost to health status. The present cross-sectional study examined the association between the monetary cost of dietary energy (Japanese yen/4184 kJ) and several metabolic risk factors.

Monetary cost of dietary energy was estimated based on dietary intake assessed by a self-administered diet history questionnaire and retail food prices. Body height and weight, from which BMI was derived, waist circumference and blood pressure were measured and fasting blood samples were collected for biochemical measurements.

A total of fifteen universities and colleges in Japan.

A total of 1136 female Japanese dietetic students aged 18–22 years.

After adjustment for potential confounding factors, monetary cost of dietary energy was significantly and negatively associated with BMI (P for trend = 0·0024). Monetary cost of dietary energy also showed a significant and negative association with waist circumference independently of potential confounding factors, including BMI (P for trend = 0·0003). No significant associations were observed for other metabolic risk factors examined (P for trend = 0·10–0·88).

The monetary cost of dietary energy was independently and negatively associated with both BMI and waist circumference, but not other metabolic risk factors, in a group of young Japanese women.

We examined the quality of food outlet addresses provided by secondary sources and determined whether they could be physically located in the field.

Addresses of food outlets in fourteen school districts in the northern part of Copenhagen were obtained from multiple business locators. We geocoded 202 addresses using a geographic information system and cross-referenced the sources against each other using a validation grid. Physical presence was determined via street survey. We applied gamma statistics and calculated positive predictive value, sensitivity and percentage agreement to assess the overall correspondence between our test of physical presence and each source of secondary information.

The study took place within city boundaries of Copenhagen, Denmark.

Food outlets within fourteen school districts within Copenhagen.

Positive predictive value between field results and secondary sources indicated good to excellent correspondence (range: 0·81–0·98), comparable with other studies. Gamma coefficients indicated low to high positive correspondence (range: 0·23–0·98).

Despite moderately high correspondence between secondary sources of address information and field observation, the findings illustrate that the use of combined sources is recommended.

To evaluate if the inclusion of nutritional warnings in food ordering websites can discourage consumers from purchasing foods with excessive content of nutrients associated with non-communicable diseases (NCD).

Participants were randomly assigned to one of the two experimental conditions: control (n 225) or nutritional warnings (n 222). Nutritional warnings corresponded to separate black octagonal signs containing the word ‘Excess’ followed by the corresponding nutrient: total fat, saturated fat, sugars and sodium. Participants were asked to purchase a lunch for themselves using a simulated food ordering website.

Online study in Uruguay.

Convenience sample of 447 Uruguayan participants, recruited using social media.

In the control condition, 76 % of the participants selected a dish or a beverage with excessive content of at least one nutrient in the simulated food ordering website. When nutritional warnings were included, this percentage significantly decreased to 62 % (P = 0·002). In addition, nutritional warnings caused a significant reduction in the percentage of participants who selected dishes with excessive content of total fat: 50 % v. 62 % (P = 0·012).

Results from the present work provide preliminary evidence that the inclusion of nutritional warnings in food ordering websites could discourage consumers from selecting dishes and beverages with excessive content of nutrients associated with NCD.

Dietary diversity, and in particular consumption of nutrient-rich foods including fruits, vegetables, nuts, beans and animal-source foods, is linked to greater nutrient adequacy. We developed a ‘dietary gap assessment’ to evaluate the degree to which a nation’s food supply could support healthy diets at the population level.

In the absence of global food-based dietary guidelines, we selected the Dietary Approaches to Stop Hypertension (DASH) diet as an example because there is evidence it prevents diet-related chronic disease and supports adequate micronutrient intakes. We used the DASH guidelines to shape a hypothetical ‘healthy’ diet for the test country of Cameroon. Food availability was estimated using FAO Food Balance Sheet data on country-level food supply. For each of the seven food groups in the ‘healthy’ diet, we calculated the difference between the estimated national supply (in kcal, edible portion only) and the target amounts.

In Cameroon, dairy and other animal-source foods were not adequately available to meet healthy diet recommendations: the deficit was −365 kcal (–1527 kJ)/capita per d for dairy products and −185 kcal (–774 kJ)/capita per d for meat, poultry, fish and eggs. Adequacy of fruits and vegetables depended on food group categorization. When tubers and plantains were categorized as vegetables and fruits, respectively, supply nearly met recommendations. Categorizing tubers and plantains as starchy staples resulted in pronounced supply shortfalls: −109 kcal (–457 kJ)/capita per d for fruits and −94 kcal (–393 kJ)/capita per d for vegetables.

The dietary gap assessment illustrates an approach for better understanding how food supply patterns need to change to achieve healthier dietary patterns.

There is a lack of qualitative research developing sugar-sweetened beverage (SSB) warning labels with their intended end users. We sought to identify promising SSB warning elements for improving label effectiveness and for future testing in policy and institutional settings.

Mixed methods design using ten focus groups, a design task and a survey. The design task was used to generate ideas for an icon that would dissuade SSB consumption. The survey and focus group guide assessed participant perceptions of SSB warning label mock-ups of text (loss frame, gain frame and loss frame with attribution), colour and icon options.

Three large public universities in California from February to March 2018.

Young adult SSB consumers (n 86) enrolled in one of three diverse California public universities.

Participants perceived the following elements as most effective for reducing SSB consumption: loss-frame text with attribution to a credible source, yellow and red colour for label background and an image or icon to accompany the text. Preferred images included sugar near or inside of an SSB, intuitive shapes like a triangle with exclamation mark or octagon and a visual indicator of SSB sugar content compared with recommended limits. Support was high for using SSB warning labels in university cafeterias and on bottles/cans.

Loss-frame text with a credible source, yellow or red label colour and icons could potentially enhance effectiveness of SSB warning labels and warrant further testing.