To apply the Theory of Planned Behaviour to examine the relationship between the constructs of background factors and beliefs towards using policy, systems and environmental (PSE) strategies and reported use of PSE strategies to prevent obesity by a group of professional nutrition educators.

Cross-sectional study using self-reported survey.

Cooperative Extension in New York, USA.

Nutrition educators (n 58); survey response rate 100 %.

Nutrition educators’ reported use of PSE strategies to prevent obesity were positively associated with background factors of their community networking and number of staff they managed, their belief of other people’s expectations of them to make PSE changes and the belief that their communities were ready to use PSE strategies; and negatively associated with their belief that individual-level factors contributed to obesity. The relationships among these variables were complicated and their use of PSE strategies occurred only when they utilized their professional networks at a moderately high level (above mean of 5·3 on a scale of 1–7), given that their community was also ready to use PSE strategies.

Nutrition educators’ use of PSE strategies depends on several internal and external factors. Community networking needs to be emphasized as one of the most significant factors contributing to nutrition educators’ work in this area. Organizational and community support should be in place in order to facilitate nutrition educators’ effective use of PSE strategies.

To determine the prevalence of vitamin D supplement use in Canadian adults and associations with demographic and socio-economic variables.

Data from the Healthy Aging module of the Canadian Community Health Survey were used to investigate the prevalence of vitamin D supplement use in Canadians aged 45 years and over. The prevalence of supplement use stratified by various behavioural and demographic characteristics was calculated and adjusted models were used to find associations with those factors.

The ten provinces of Canada.

Canadians aged 45 years and over who participated in the Healthy Aging module of the Canadian Community Health Survey from 2008–2009.

The highest observed prevalence for women was 48·0 % in the 65–69 years age group and the highest prevalence for men was 25·3 % in the 70–74 years age group. Women had higher odds of vitamin D supplement use than men in all age groups. Not using supplements was more common in smokers, those who did not engage in leisure-time physical activities and who were either overweight or obese. Vitamin D supplement use increased with household income and level of education, and decreased with self-perceived health. Supplement use was higher in those with chronic conditions.

The inverse association with self-perceived health could be partly explained by age, chronic conditions and increased use of health-care services. Associations with higher income and education suggest a strong socio-economic influence and that individuals may not have the expendable income to purchase vitamin D supplements or knowledge of their health benefits.

To investigate seasonal variations of vitamin D status at different latitudes and if these changes are accompanied by corresponding variations in certain health parameters in children living in a broad latitudinal range in Iran.

Longitudinal study.

In total, 530 apparently healthy children aged 5–18 years were randomly selected from six regions of Iran with a latitudinal gradient from 29°N to 37·5°N. All anthropometric and biochemical assessments were performed twice during a year (summer, winter). High BMI (Z-score >1), low HDL cholesterol (<40 mg/dl, males; <50 mg/dl, females) and high TAG (>150 mg/dl) were considered cardiometabolic risk factors.

Serum 25-hydroxyvitamin D (25(OH)D) showed between-season variation, with significantly higher concentrations (mean (sd)) in summer v. winter (43 (29) v. 27 (18) nmol/l; P<0·001). Change of circulating 25(OH)D between summer and winter was negatively correlated with change of BMI (r=−0·16; P<0·001), TAG (r=−0·09; P=0·04) and total cholesterol (r=−0·10; P=0·02) and directly correlated with change of height-for-age Z-score (r=0·09; P=0·04). Multiple stepwise linear regression analysis (β; 95 % CI) showed that winter serum 25(OH)D (−0·3; −0·4, −0·2; P<0·001), gender (boys v. girls: 9·7; 5·2, 14·1; P<0·001) and latitude (>33°N v. <33°N: 4·5; 0·09, 9·0; P=0·04) were predictors of change of serum 25(OH)D between two seasons.

Summertime improvement of vitamin D status was accompanied by certain improved cardiometabolic risk factors, notably serum TAG, total cholesterol and BMI, in children.

Due to the growing interest in the role of dietary patterns (DPs) on chronic diseases, we assessed the association between a posteriori identified DPs in the Seguimiento Universidad de Navarra (SUN) Project – a prospective cohort study in a Mediterranean country – and breast cancer (BC) risk.

DPs were ascertained through a principal component analysis based on 31 predefined food groups. BC cases were initially identified through self-report or, if deceased, from death certificates or by notification by the next kin. Women reporting BC were asked to provide a copy of their medical report and diagnoses for confirmation purposes. We fitted Cox regression models to assess the association between adherence to the identified DPs and BC risk.

Spanish university graduates.

We included 10 713 young and middle-aged – mainly premenopausal – women.

After a median follow-up of 10·3 years, we identified 100 confirmed and 168 probable incident BC cases. We described two major DPs: ‘Western dietary pattern’ (WDP) and ‘Mediterranean dietary pattern’ (MDP). A higher adherence to a WDP was associated with an increased risk of overall BC (multivariable-adjusted HR for confirmed BC Q4 v. Q1 1·70; 95 % CI 0·93, 3·12; P for trend = 0·045). Contrarily, adherence to a MDP was inversely associated with premenopausal BC (multivariable-adjusted HR Q4 v. Q1 0·33; 95 % CI 0·12, 0·91). No significant associations were observed for postmenopausal BC.

Whereas a higher adherence to the WDP may increase the risk of BC, a higher adherence to the MDP may decrease the risk of premenopausal BC.

To estimate the changes in the prevalence of underweight among girls and boys living in Kraków that occurred between 1983 and 2010.

The study was based on two cross-sectional surveys conducted in 1983 and 2010. The prevalence of underweight was estimated based on the International Obesity Task Force (IOTF) and Centers for Disease Control and Prevention (CDC) cut-off points.

The study was conducted in Kraków, Poland.

Children aged 3–18 years (n 5245).

Between 1983 and 2010 the prevalence of underweight decreased in both sexes. Using the IOTF criteria, the prevalence of underweight decreased from 10·5 to 10·3 % in girls and from 8·9 to 7·5 % in boys, but it was still higher in girls than in boys. According to the CDC criteria, this prevalence decreased from 5·1 to 4·4 % and from 5·9 to 4·6 %, respectively, and was slightly lower in girls. According to the IOTF criteria, underweight prevalence increased slightly during childhood in both sexes while according to the CDC criteria it decreased in boys and did not change in girls. Among juveniles and adolescents, it decreased regardless of the method used.

The frequency of underweight in the population of children and adolescents from Kraków changed slightly in 1983 and 2010 despite economic and social changes. Depending on the cut-off points used, not only the magnitude but also the direction of changes between series could be different. In order to aid global monitoring, the prevalence of underweight as well as overweight should always be evaluated by several methods.

To characterize the association of longitudinal changes in maternal anthropometric measures with neonatal anthropometry and to assess to what extent late-gestational changes in maternal anthropometry are associated with neonatal body composition.

In a prospective cohort of pregnant women, maternal anthropometry was measured at six study visits across pregnancy and after birth, neonates were measured and fat and lean mass calculated. We estimated maternal anthropometric trajectories and separately assessed rate of change in the second (15–28 weeks) and third trimester (28–39 weeks) in relation to neonatal anthropometry. We investigated the extent to which tertiles of third-trimester maternal anthropometry change were associated with neonatal outcomes.

Women were recruited from twelve US sites (2009–2013).

Non-obese women with singleton pregnancies (n 2334).

A higher rate of increase in gestational weight gain was associated with larger-birth-weight infants with greater lean and fat mass. In contrast, higher rates of increase in maternal anthropometry measures were not associated with infant birth weight but were associated with decreased neonatal lean mass. In the third trimester, women in the tertile of lowest change in triceps skinfold (−0·57 to −0·06 mm per week) had neonates with 35·8 g more lean mass than neonates of mothers in the middle tertile of rate of change (−0·05 to 0·06 mm per week).

The rate of change in third-trimester maternal anthropometry measures may be related to neonatal lean and fat mass yet have a negligible impact on infant birth weight, indicating that neonatal anthropometry may provide additional information over birth weight alone.

This study aimed to assess whether maternal age at first marriage is associated with nutritional and developmental penalties in Roma children.

Roma nationally representative population-based study. Proxies for child nutritional outcomes included children’s individual-level height-for-age Z (HAZ) and weight-for-age Z (WAZ) scores, HAZ and WAZ scores below two standard deviations from the median of WHO’s reference population (children aged 0–59 months) and Early Child Development (ECD) (children aged 36–59 months). Multiple and logistic regressions were used to estimate the association between maternal age at marriage and the outcomes and other socio-demographic determinants as possible confounders.

Aggregated data from UNICEF’s fifth and sixth Multiple Indicator Cluster Surveys for Serbian Roma settlements.

Children (n 2652) aged 0–59 months born to ever-married women aged 15–48 years.

In total, 64 % of women married before age 18, 19 % of children were stunted, 9 % wasted and ECD score was low. Maternal age at first marriage was not associated with either nutritional status or early development of Roma children. Weight at birth (children aged 0–24 years) emerged as the main predictor of children’s nutritional status. Boys were more likely to be shorter, more stunted and wasted than girls. Child’s age, maternal parity and unimproved toilet facility negatively impacted nutritional status, while maternal literacy mitigated against poor nutritional and developmental outcomes.

Roma children up to 5 years of age bear no negative consequences of maternal early marriage. The underlying determinants of children’s well-being include improved sanitation, child characteristics, maternal literacy and reproductive behavior and parental investment.

To estimate the proportion of products meeting Fiji government labelling regulations, assess compliance with national Na reformulation targets and examine the Na and total sugar levels in packaged foods sold in selected major supermarkets.

We selected five major supermarkets in 2018 and collected the product information and nutritional content from the labels of all packaged foods sold. We organised 4278 foods into fourteen major food categories and thirty-six sub-categories and recorded the proportion of products labelled in accordance with the Fiji labelling regulations. We looked at the levels of Na and total sugar in each food category and assessed how many products complied with the Fiji reformulation targets set for Na. We also listed the companies responsible for each product.

Suva, Fiji.

Fourteen percentage of packaged foods in fourteen major categories met Fiji national labelling regulations. Na was labelled on 95·4 % products, and total sugar labelled on 92·4 %. The convenience foods category had the highest Na levels (1699 mg/100 g), while confectionery had the highest content of total sugar (52·6 g/100 g). Forty percentage of eligible products did not meet the proposed voluntary Na reformulation targets.

Our findings indicate significant room for improvement in nutrient labelling, as well as a need for further enforcement of reformulation targets and monitoring of changes in food composition. Through enacting these measures and establishing additional regulations such as mandatory front-of-pack labelling, government and food industry can drive consumers towards healthier food choices and improve the nutritional quality of packaged foods in Fiji.

To assess the more prevalent beliefs about body weight and the factors involved in weight changes in the Spanish adult population.

A national survey was carried out according to an established protocol on Spanish subjects selected by a multistage procedure following a random route model, which was quota-controlled for several sociodemographic variables. This study was undertaken by the Spanish arm of a pan-European survey and was performed with a validated questionnaire. It contained questions to evaluate some aspects concerning the relationship between obesity, physical activity and health. We also estimated the proportion of self-reported overweight and obesity.

Spain.

The sample included 1000 subjects aged 15 years or older.

Eleven per cent of the sample were obese (body mass index, BMI > 30 kg m-2) and an additional 32% were overweight (BMI > 25 and < 30 kg m-2). Obesity prevalence was higher among older individuals, those with lower education and socioeconomic levels, and among housewives and retired or unemployed people. Most Spanish people believed that fat intake (51%) and the amount of food consumption (44%) were the major factors involved in weight gain, while physical activity was less mentioned (12%). The method most frequently used to lose weight was diet (9%). Individuals from central and southern regions payed more attention to genetics (20–27%) and physical activity (12–20%) as determinants of weight gain than people living in the north or northwest regions (15–17% and 8–9%, respectively). Normal weight people participated more often in some physical activity during their leisure time.

The Spanish population is not familiar with factors influencing weight gain. Health promotion strategies should emphasize the role of physical activity, especially among older individuals, retired or unemployed subjects, those from lower educational or socioeconomic levels and among people living in the north or northwest of Spain.

The aim of the study was to determine the main factors (sociodemographic, anthropometric, lifestyle and health status) associated with high Na excretion in a representative population of Chile.

Na excretion (g/d), a valid marker of Na intake, was determined by urine analysis and Tanaka’s formulas. Blood pressure was measured by trained staff and derived from the mean of three readings recorded after 15 min rest. The associations of Na excretion with blood pressure and the primary correlates of high Na excretion were determined using logistic regression.

Chileans aged ≥15 years.

Participants (n 2913) from the Chilean National Health Survey 2009–2010.

Individuals aged 25 years or over, those who were obese and those who had hypertension, diabetes or metabolic syndrome were more likely to have higher Na excretion. The odds for hypertension increased by 10·2 % per 0·4 g/d increment in Na excretion (OR=1·10; 95 % CI 1·06, 1·14; P < 0·0001). These findings were independent of major confounding factors.

Age, sex, adiposity, sitting behaviours and existing co-morbidities such as diabetes were associated with higher Na excretion levels in the Chilean population. These findings could help policy makers to implement public health strategies tailored towards individuals who are more likely to consume high levels of dietary salt.

With political support from the Danish Organic Action Plan 2020, organic public procurement in Denmark is expected to increase. In order to evaluate changes in organic food procurement in Danish public kitchens, reliable methods are needed. The present study aimed to compare organic food procurement measurements by two methods and to collect and discuss baseline organic food procurement measurements from public kitchens participating in the Danish Organic Action Plan 2020.

Comparison study measuring organic food procurement by applying two different methods, one based on the use of procurement invoices (the Organic Cuisine Label method) and the other on self-reported procurement (the Dogme method). Baseline organic food procurement status was based on organic food procurement measurements and background information from public kitchens.

Public kitchens participating in the six organic food conversion projects funded by the Danish Organic Action Plan 2020 during 2012 and 2013.

Twenty-six public kitchens (comparison study) and 345 public kitchens (baseline organic food procurement status).

A high significant correlation coefficient was found between the two organic food procurement measurement methods (r=0·83, P<0·001) with measurements relevant for the baseline status. Mean baseline organic food procurement was found to be 24 % when including measurements from both methods.

The results indicate that organic food procurement measurements by both methods were valid for the baseline status report of the Danish Organic Action Plan 2020. Baseline results in Danish public kitchens suggest there is room for more organic as well as sustainable public procurement in Denmark.

This study assessed the level of fathers’ involvement in childcare activities and its association with the diet quality of their children in Northern Ghana.

The study was carried out in the Northern, Upper East and Upper West regions of Ghana. The people in the study area mostly depend on agriculture as their main occupation.

A community-based comparative analytical cross-sectional study.

A sample of 422 rural mother–father pairs who had at least one child aged 6–36 months.

The overall level of fathers’ involvement in childcare and feeding activities was high among 63·5 % of the respondents in the 6 months prior to the study. The most common childcare activity men were involved in was providing money for the purchase of food for the child. Minimum acceptable diet was higher for children with a higher level of paternal involvement in childcare activities (adjusted OR = 3·33 (95 % CI: 1·41, 7·90)), compared to their counterparts whose father’s involvement was poor. Fathers who had a positive attitude to childcare and feeding were 2·9 more likely to get involved in childcare activities (adjusted OR = 2·90 (95 % CI: 1·87, 4·48)).

The findings confirm earlier studies that show that fathers’ involvement in childcare activities including feeding is positively associated with improved child feeding practices. The findings point to the need to have a policy shift in which both men and women are key actors in interventions designed to improve child nutritional status in rural settings of Northern Ghana.

To estimate the association between food insufficiency and mental health service utilisation in the USA during the COVID-19 pandemic.

Cross-sectional study. Multiple logistic regression models were used to estimate the associations between food insufficiency and mental health service utilisation.

US Census Household Pulse Survey data collected in October 2020.

Nationally representative sample of 68 611 US adults.

After adjusting for sociodemographic factors, experiencing food insufficiency was associated with higher odds of unmet mental health need (adjusted OR (AOR) 2·90; 95 % CI 2·46, 3·43), receiving mental health counselling or therapy (AOR 1·51; 95 % CI 1·24, 1·83) and psychotropic medication use (AOR 1·56; 95 % CI 1·35, 1·80). Anxiety and depression symptoms mediated most of the association between food insufficiency and unmet mental health need but not the associations between food insufficiency and either receiving mental health counselling/therapy or psychotropic medication use.

Clinicians should regularly screen patients for food insufficiency, especially in the wake of the COVID-19 pandemic. Expanding access to supplemental food programmes may help to mitigate the need for higher mental health service utilisation during the COVID-19 pandemic.

To examine the association between red/processed meat consumption and glycaemic conditions (i.e. prediabetes (preDM) and diabetes mellitus (DM)) among middle-aged residents in rural Khánh Hòa, Vietnam.

In this cross-sectional study, a multinomial logistic regression model was used to examine the association between daily consumption of red/processed meat (0–99 g, 100–199 g or ≥ 200 g) and preDM/DM with adjustments for socio-demographic, lifestyle-related and health-related variables.

Khánh Hòa Province, Vietnam

The study used data collected through a baseline survey conducted during a prospective cohort study on CVD among 3000 residents, aged 40–60 years, living in rural communes in Khánh Hòa Province.

The multinomial regression model revealed that the relative-risk ratios for DM were 1·00 (reference), 1·11 (95 % CI = 0·75, 1·62) and 1·80 (95 % CI = 1·40, 2·32) from the lowest to the highest red/processed meat consumption categories (Ptrend = 0·006). The corresponding values for preDM were 1·00 (reference), 1·25 (95 % CI = 1·01, 1·54) and 1·67 (95 % CI = 1·20, 2·33) (Ptrend = 0·004). We did not find any evidence of statistical significance in relation to poultry consumption.

Increased red/processed meat consumption, but not poultry consumption, was positively associated with the prevalence of preDM/DM in rural communes in Khánh Hòa Province, Vietnam. Dietary recommendations involving a reduction in red/processed meat consumption should be considered in low- and middle-income countries.

Epidemiological investigations evaluating the association of dietary Ca intake with metabolic syndrome (MetS) risk have yielded controversial results. Therefore, a meta-analysis was conducted to quantitatively summarize the association between dietary Ca intake and the risk of MetS.

PubMed, Embase and Web of Science were searched for relevant articles published up to October 2018. The pooled OR and 95 % CI were calculated with a random-effects model.

Meta-analysis.

Nine cross-sectional studies.

A total of nine articles with fifteen studies for dietary Ca intake were finally included in the meta-analysis. The combined OR with 95 % CI of MetS for the highest v. lowest category of dietary Ca intake was 0·80 (95 % CI 0·70, 0·91). For dose–response analysis, a non-linear relationship was found between dietary intake of Ca and risk of MetS (Pnon-linearity<0·001). The threshold for dietary Ca intake was 280 mg/d (OR=0·87; 95 % CI 0·82, 0·93), reducing the risk of MetS by 13 %.

The present meta-analysis suggests that dietary Ca intake might reduce the risk of MetS, which needs to be further confirmed by larger prospective cohort studies.

High salt intake is one of the leading diet-related risk factors for several non-communicable diseases. We aimed to estimate the prevalence of high salt intake in Iran.

A modelling study by the small area estimation method, based on a nationwide cross-sectional survey, Iran STEPwise approach to risk factor Surveillance (STEPS) 2016. The modelling estimated the prevalence of high salt intake, defined as a daily salt intake ≥ 5 g in all districts of Iran based on data from available districts. The modelling results were provided in different geographical and socio-economic scales to make the comparison possible across the country.

429 districts of all provinces of Iran, 2016.

18 635 salt intake measurements from individuals 25 years old and above who participated in the Iran STEPS 2016 survey.

All districts in Iran had a high prevalence of high salt intake. The estimated prevalence of high salt intake among females of all districts ranged between 72·68 % (95 % UI 58·48, 84·81) and 95·04 % (95 % UI 87·10, 100). Estimated prevalence for males ranged between 88·44 % (95 % UI 80·29, 96·15) and 98·64 % (95 % UI 94·97, 100). In all categorisations, males had a significantly higher prevalence of high salt intake. Among females, the population with the lower economic status had a higher salt consumption than the participants with higher economic status by investigating the concentration index.

Findings of this study highlight the high salt intake as a prominent risk factor in all Iran regions, despite some variations in different scales. More suitable population-wide policies are warranted to handle this public health issue in Iran.

We aimed to study the correlation between neck circumference (NC) and anthropometric adiposity indicators, and to determine cut-off points of NC for both sexes to identify elevated central adiposity in schoolchildren in western Mexico.

Cross-sectional study.

Rural settings in western México.

Children from a convenience sample of six schools in Acatlán, Jalisco, Mexico (n 1802).

NC showed a strong positive correlation with all anthropometric adiposity indicators in both sexes, which were notably higher in boys regardless of age. Noteworthy, waist circumference displayed the highest significant correlation when analysed by both age and sex. As age increased, NC cut-off points to identify elevated central adiposity ranged from 25·7 to 30·1 cm for girls and from 27·5 to 31·7 cm for boys.

NC could be used as a simple, inexpensive and non-invasive indicator for central obesity assessment in Mexican schoolchildren.

The current study assessed intake of iron-and-folic-acid (IFA) tablet/syrup (grouped into none, < 100 d of IFA consumption or < 100 IFA and ≥ 100 d of IFA consumption or ≥ 100 IFA) among prospective mothers and its association with various stages of low-birth weight (ELBW, extremely low-birth weight; VLBW, very low-birth weight and LBW, low-birth weight) and neonatal mortality (death during day 0–1, 2–6, 7–27 and 0–27) in India.

The cross-sectional, nationally representative, 2015–2016 National Family Health Survey (NFHS-4) data were used. Weighted descriptive analysis and multiple binary logistic regression modelling were used.

NFHS-4 covered 640 districts from thirty-seven states and union territories of India.

A total of 120 374 and 143 675 index children aged 0–59 months were included to analyse LBW and neonatal mortality, respectively.

Overall, 30·7 % mothers consumed ≥ 100 IFA in 2015–2016, and this estimate ranged from 0·0 % in Zunheboto district of Nagaland state to 89·5 % in Mahe district of Puducherry of India. Multiple regression analysis revealed that children of mothers who consumed ≥ 100 IFA had lower odds of ELBW, VLBW, LBW and neonatal mortality during day 0–1, as compared with mothers who did not buy/receive any IFA. Consumption of IFA (< 100 IFA and ≥ 100 IFA) had a protective association with neonatal death during day 7–27 and 0–27. Consumption of IFA was not associated with neonatal death during day 2–6.

While ≥ 100 IFA consumption during pregnancy was found to be associated with preventing select types of LBW and neonatal mortality, a large variation in coverage of ≥ 100 IFA consumption across 640 districts is concerning.

A recent meta-analysis suggested that the association between vitamin D and risk of hypertension was markedly stronger in women aged <55 years in observational data, while the association became null in women aged ≥55 years. We therefore hypothesized that this difference in associations might potentially be caused by the change in oestrogen around menopause. Our objective was to investigate associations between vitamin D status and hypertension risk and to evaluate those associations as they may differ according to menopausal status.

A cross-sectional population survey conducted by the US Centers for Disease Control and Prevention, National Center for Health Statistics.

The National Health and Nutrition Examination Surveys (NHANES) 2007–2010 formed the setting for the present study.

We analysed data from 2098 premenopausal women and 2298 postmenopausal women.

After adjustment for sociodemographic, behavioural and dietary factors, higher concentrations both of serum total 25-hydroxyvitamin D (25(OH)D) and serum 25-hydroxycholecalciferol (25(OH)D3) revealed significant dose-dependent trends with lower risk of hypertension (Ptrend = 0·005 and 0·014, respectively) in premenopausal women. In those women, 25(OH)D ≥ 50 nmol/l (sufficient; in contrast to deficient, vitamin D < 30 nmol/l) appeared to have a protective effect against hypertension (OR = 0·64, 95 % CI 0·39, 1·02 for total 25(OH)D and OR = 0·60, 95 % CI 0·36, 1·00 for 25(OH)D3). Neither association with hypertension was observed in postmenopausal women.

Serum 25(OH)D concentrations were associated with lower risk of hypertension in premenopausal women, but not in postmenopausal women.