The objective was to evaluate maternal Mediterranean diet (MD) pattern adherence during pregnancy and its association with small for gestational age (SGA) and preterm birth. A secondary objective of the current study was to describe the sociodemographic, lifestyle and obstetric profile of the mothers studied as well as the most relevant paternal and newborn characteristics.

The current study is a two-phase retrospective population-based study of maternal dietary habits during pregnancy and their effect on newborn size and prematurity. The descriptive first phase examined maternal dietary habits during pregnancy along with the maternal sociodemographic, lifestyle and obstetric profile in a cross-sectional period study. In the second phase, newborn outcomes were evaluated in a nested case–control study. Adherence to MD during pregnancy was measured with the Spanish version of Kidmed index.

Obstetrics ward of the La Fe Hospital in Valencia.

All mother–child pairs admitted after delivery during a 12-month period starting from January 2018 were assessed for eligibility. A total of 1118 provided complete outcome data after signing informed consent.

14·5 % met the criteria of poor adherence (PA); 34·8 %, medium adherence (MA); and 50·7 %, optimal adherence (OA). Medium adherence to MD was associated in the adjusted scenarios with a higher risk of giving birth to a preterm newborn. No association was found between MD adherence and SGA.

Early intervention programmes geared towards pregnant women, where women were aided in reaching OA to MD, might reduce the risk of preterm newborn.

The effects of adverse childhood experiences (ACE) on children and adolescents’ health status such as obesity are understudied. The current study addressed the effect of ACE on obesity status during childhood utilising multiple waves of national panel data.

Longitudinal survey.

Data were drawn from three waves of the second cohort of the National Survey of Child and Adolescent Well-Being (NSCAW II). NSCAW II study sampled cases from Child Protective Services investigations that were closed between February 2008 and April 2009 nationwide. We measured ACE cumulatively and as separate events and stratified by gender.

Totally, 3170 youth births to 14 years of age at baseline.

A count measure of ACE is indeed associated with greater odds of obesity during childhood. Differential effects for different types of ACE were also found, most notably neglect. For girls, physical and psychological neglect increased odds of obesity.

Findings support evidence for the importance of using both a count measure of ACE as well as separating out single events by gender.

To investigate a 9-year trend of fresh fruit and vegetable availability and factors associated with the net availability change in two contrasting neighbourhoods.

Longitudinal design. Data were collected in 2003, 2009 and 2012 through in-store observations. Fresh fruit and vegetable availability was presented by weight-adjusted counts of stores having designated varieties per 10 000 population.

A low-income minority neighbourhood and an adjacent middle-income racially mixed neighbourhood in Albany, NY, USA. These neighbourhoods became sites of fresh produce interventions after baseline data were collected.

A total of 111, 128 and 146 eligible food stores in respective years.

Fresh fruit availability (two or more varieties) increased in both neighbourhoods. Inventory expansion of existing stores and the convenience store intervention contributed to the significant increase (P for trend=0·04) of fresh fruit availability in the minority neighbourhood. Although not statistically significant (P>0·05), the availability of two or more dark-coloured fresh vegetables also increased in the mixed neighbourhood, but declined slightly in the minority neighbourhood. The secular (non-intervention) fresh vegetable availability rate ratio by neighbourhood reached 3·0 in 2012 (P<0·01). The net decline of fresh vegetable availability in the minority neighbourhood was primarily attributed to inventory reduction of existing stores.

Longitudinal observations revealed narrowed neighbourhood disparities of fresh fruit availability and widened gaps of fresh vegetable availability. Inventory shifts of existing stores impacted the net availability change more profoundly than store opening or closing in the minority neighbourhood. Findings support increasing the programme capacity of the convenience store intervention to address the fresh vegetable disparity.

Consumers in the UK responded to the rapid increases in food prices between 2007 and 2009 partly by reducing the amount of food energy bought. Household food and drink waste has also decreased since 2007. The present study explored the combined effects of reductions in food purchases and waste on estimated food energy intakes and dietary energy density.

The amount of food energy purchased per adult equivalent was calculated from Kantar Worldpanel household food and drink purchase data for 2007 and 2012. Food energy intakes were estimated by adjusting purchase data for food and drink waste, using waste factors specific to the two years and scaled for household size.

Scotland.

Households in Scotland (n 2657 in 2007; n 2841 in 2012).

The amount of food energy purchased decreased between 2007 and 2012, from 8·6 to 8·2 MJ/adult equivalent per d (P<0·001). After accounting for the decrease in food waste, estimated food energy intake was not significantly different (7·3 and 7·2 MJ/adult equivalent per d for 2007 and 2012, respectively; P=0·186). Energy density of foods purchased increased slightly from 700 to 706 kJ/100 g (P=0·010).

While consumers in Scotland reduced the amount of food energy that they purchased between 2007 and 2012, this was balanced by reductions in household food and drink waste over the same time, resulting in no significant change in net estimated energy intake of foods brought into the home.

The present paper aimed to identify the stakeholders, as well as their arguments and recommendations, in the debate on the application of a food processing-based classification system to the new Brazilian Food Guide.

Qualitative approach; an analysis was made of documents resulting from the consultation conducted for the development of the new Brazilian Food Guide, which uses the NOVA classification for its dietary recommendations. A thematic matrix was constructed and the resulting themes represented the main points for discussion raised during the consultation.

Brazil.

Actors from academia, government and associations/unions/professional bodies/organizations related to the area of nutrition and food security; non-profit institutions linked to consumer interests and civil society organizations; organizations, associations and food unions linked to the food industry; and individuals.

Four themes were identified: (i) conflicting paradigms; (ii) different perceptions about the role and need of individuals; (iii) we want more from the new food guide; and (iv) a sustainable guide.

There was extensive participation from different sectors of society. The debate generated by the consultation revealed two main conflicting opinions: a view aligned with the interests of the food industry and a view of healthy eating which serves the interests of the population. The first group was against the adoption of a food processing-based classification system in a public policy such as the new Brazilian Food Guide. The second group, although mostly agreeing with the new food guide, argued that it failed to address some important issues related to the food and nutrition agenda in Brazil.

To validate an FFQ to assess antioxidant intake in overweight postmenopausal women.

A seventy-four-item antioxidant 1-month FFQ was developed based on major antioxidant sources in the American diet. Forty overweight postmenopausal women participated in a 9-month observational study and completed four sets of FFQ and 7 d food record (7dFR) every 3 months. Twelve-hour fasting blood was collected for plasma antioxidant measurement at the first visit.

Connecticut, USA.

Forty overweight postmenopausal women.

Spearman correlation coefficients of 1-month antioxidant intake estimated from the first set of FFQ and 7dFR ranged from 0·34 to 0·87, except for γ-tocopherol. The proportion of participants categorized into the extremely opposite tertiles averaged 7 %. Significant correlations were observed for diet–plasma vitamin C, α-tocopherol and carotenoids (P < 0·05). No time effect was observed on the dietary antioxidant intakes estimated from four 7dFR and four FFQ. Dietary antioxidants estimated from averaged four 7dFR showed moderate to high correlation with those estimated from averaged four FFQ and from each FFQ collected every 3 months. Bland–Altman plots did not show any systematic bias. Averaged misclassifications were below 10 % between these two instruments.

These findings attested a reasonable validity and a good acceptance of this 1-month FFQ in assessing both short-term and long-term diverse antioxidant intakes in these overweight postmenopausal women. The use of this FFQ in associating antioxidant intake with disease risk needs further investigation.

To identify ingredients from products and by-products derived from GM crops in packaged food products and to analyse the presence of these ingredients in the foods most commonly consumed by the Brazilian population.

Cross-sectional study.

A search of the scientific literature to identify the use of products and by-products derived from GM crops in foods in Brazil and a study of food labels in a supermarket belonging to one of the ten largest supermarket chains in Brazil.

To identify the ingredients present in packaged food products and their nomenclatures, the labels of all packaged food products available for sale in a supermarket were analysed. Subsequently, the presence of potential GM ingredients in the foods most commonly consumed by the Brazilian population was analysed.

A total of twenty-eight GM crops’ by-products with applications in the food industry (from soyabeans, corn, cotton and a yeast) were identified. Such by-products are presented as food ingredients or additives on food labels with 101 distinct nomenclatures. Most of the variety (63·8 %) and the quantity (64·5 %) of the foods most commonly consumed by Brazilians may contain a least one GM ingredient.

The presence of at least one potential GM ingredient was observed in more than half of the variety of foods most commonly consumed by the Brazilian population. Such ingredients were identified with distinct nomenclatures and incomplete descriptions, which may make it difficult to identify potential GM foods and confuse consumers when making food choices.

To determine vitamin A (retinol) and fat concentrations in breast milk during early lactation.

Healthy lactating women (n 88) aged between 18 and 35 years were randomly selected for the study from urban, semi-urban, rural and estate (plantation) sectors of Galle District. Their anthropometry was recorded; breast milk samples were collected from the right breast one hour after the last feed. Breast milk retinol was determined by HPLC and fat content by the crematocrit method.

Subjects were in the 2nd to 9th month of lactation. Retinol concentrations of the breast milk samples ranged from 0·10 to 2·46 μmol/l, with a mean of 0·50 μmol/l, and correlated positively with parity (Pearson correlation coefficient, r = 0·307; P = 0·01) and negatively with period of lactation (r = −0·209; P = 0·05). The fat content of breast milk ranged between 5·09 and 56·46 g/l with a mean of 26·95 g/l. A significant difference in either breast milk fat or retinol content and mean birth weight of the babies was not seen between the groups. The ratio of retinol to fat in breast milk was positively correlated with weight (r = 0·274; P = 0·01) and height (r = 0·328; P < 0·001) of the mothers.

In this primary investigation on breast milk quality the fat content was found to be marginal; the majority of lactating mothers (92·0 %) were not providing the minimum daily requirement (1·05 μmol/l) of retinol to their babies.

California Assembly Bill 1535 awarded $US 15 million to California public schools to promote, develop and sustain instructional school gardens through the California Instructional School Garden Program (CISGP). The present study was designed to assess the effectiveness of the CISGP at assisting schools in implementing, maintaining and sustaining an academic school garden programme, determine how schools utilized the funding they received and assess the impact of the California state budget crisis on the CISGP.

A mid-term evaluation was used to assess the degree to which schools achieved their instructional garden-related goals.

California.

Only schools that applied for the CIGSP grant as part of a school district and also provided a contact email and had a unique contact person were included in the study (n 3103, 80·6 %).

In general, many schools reported not achieving their predicted goals with regard to the CISGP grant. Only 39·4 % of schools reported accomplishing all of their garden-related goals. Over one-third (37·8 %) of schools reported that their school gardens were negatively affected by the California budget deficit.

The difference between predicted and actual utilization of the CISGP grants may be due to a combination of the effects of budget shortfall and insufficiency of the grant award amount.

To develop and evaluate a Nutrition Transition-FFQ (NT-FFQ) to measure nutrition transition among adolescents in South India.

We developed an interviewer-administered NT-FFQ comprising a 125-item semi-quantitative FFQ and a twenty-seven-item eating behaviour survey. The reproducibility and validity of the NT-FFQ were assessed using Spearman correlations, intra-class correlation coefficients (ICC), and levels of agreement using Bland–Altman and cross-classification over 2 months (NT-FFQ1 and NT-FFQ2). Validity of foods was evaluated against three 24-h dietary recalls (24-HR). Face validity of eating behaviours was evaluated through semi-structured cognitive interviews. The reproducibility of eating behaviours was assessed using weighted kappa (κw) and cross-classification analyses.

Vijayapura, India.

A representative sample of 198 adolescents aged 14–18 years.

Reproducibility of NT-FFQ: Spearman correlations ranged from 0·33 (pulses) to 0·80 (red meat) and ICC from 0·05 (fruits) to 1·00 (tea). On average, concordance (agreement) was 60 % and discordance was 7 % for food groups. For eating behaviours, κw ranged from 0·24 (eating snacks while watching television) to 0·67 (eating lunch at home) with a mean of 0·40. Validity of NT-FFQ: Spearman correlations ranged from 0·11 (fried traditional foods) to 0·70 (tea) and ICC ranged from 0·02 (healthy global foods) to 1·00 (grains). The concordance and discordance were 48 % and 8 %, respectively. Bland–Altman plots showed acceptable agreement between NT-FFQ2 and 24-HR. The eating behaviours had acceptable face validity.

The NT-FFQ has good reproducibility and acceptable validity for food intake and eating behaviours. The NT-FFQ can quantify the nutrition transition among Indian adolescents.

Millions of children suffer from severe acute malnutrition (SAM) in low- and middle- income countries. Much is known about the effectiveness of community treatment programmes (CMAM) but little is known about post-discharge outcomes after successful treatment. The present study aimed to evaluate post-discharge outcomes of children cured of SAM.

Prospective, observational cohort study. Children with SAM who were discharged as cured were followed monthly for 6 months or until they experienced relapse to SAM. ‘Cure’ was defined as a child achieving a mid-upper arm circumference (MUAC) of ≥115 mm with ≥15 % weight gain after loss of oedema. Relapse was defined as a child with MUAC<115 mm and/or oedema at any monthly visit.

Save the Children CMAM programme in Swabi, Pakistan, from January 2012 to December 2014.

Children aged 6–59 months (n 117) discharged as cured from the CMAM programme were eligible for the study and followed for 6 months.

One hundred children (92·6 %) remained free of SAM, eight (7·4 %) relapsed to SAM, nine (8·3 %) were lost to follow-up and none died. Most relapses occurred within 3 months of discharge (mean time to relapse 73·4 (sd 36·2) d). At enrolment, 90 % had moderate acute malnutrition (MAM) and 10 % were not malnourished. By the end of 6 months, 35 % persisted with MAM and the remaining were not malnourished.

In rural Pakistan, fewer than 10 % of children cured of SAM relapsed. The first 3 months is the most vulnerable time.

To prioritise policy actions for government to improve the food environment and contribute to reduced obesity and related diseases.

Cross-sectional study applying the Food Environment Policy Index (Food EPI) in two stages. First, the evidence on all relevant policies was compiled, through an Internet search of government documents, and reviewed for accuracy and completeness by government officials. Second, independent experts were brought together to identify critical gaps and prioritise actions to fill those gaps, through a two-stage rating process.

England.

A total of seventy-three independent experts from forty-one organisations were involved in the exercise.

The top priority policy actions for government identified were: (i) control the advertising of unhealthy foods to children; (ii) implement the levy on sugary drinks; (iii) reduce the sugar, fat and salt content in processed foods (leading to an energy reduction); (iv) monitor school and nursery food standards; (v) prioritise health and the environment in the 25-year Food and Farming Plan; (vi) adopt a national food action plan; (vii) monitor the food environment; (viii) apply buying standards to all public institutions; (ix) strengthen planning laws to discourage less healthy food offers; and (x) evaluate food-related programmes and policies.

Applying the Food EPI resulted in agreement on the ten priority actions required to improve the food environment. The Food EPI has proved to be a useful tool in developing consensus for action to address the obesity epidemic among a broad group of experts in a complex legislative environment.

To examine the mediating effects of maternal perception of child weight (weight perception) and concern about overweight (weight concern) on the paths between child weight and maternal feeding practices.

Pudong District, Shanghai, China.

A convenience sample of 1164 mothers who were primary caregivers of preschool children.

Sixty per cent of the mothers perceived their overweight/obese children as normal weight or even underweight. The disagreement between actual child weight and maternal weight perception was statistically significant (Kappa = 0·212, P < 0·001). Structural equation modelling indicated that weight perception fully mediated the relationship between child BMI Z-scores and pressure to eat. Weight concern fully mediated the relationships between child BMI Z-scores and the other three feeding practices. The serial mediating effects of weight perception and concern were statistically significant for the paths between child BMI Z-score and monitoring (β = 0·035, P < 0·001), restriction (β = 0·022, P < 0·001), and food as a reward (β = –0·017, P < 0·05).

Child weight may influence maternal feeding practices through weight perception and concern. Thus, interventions are needed to increase the accuracy of weight perception, which may influence several maternal feeding practices and thereby contribute to child health.

To explore influences on adolescent diet and physical activity, from the perspectives of adolescents and their caregivers, in Jimma, Ethiopia.

Qualitative design, using focus group discussions (FGD).

A low-income setting in Jimma, Ethiopia.

Five FGD with adolescents aged 10–12 years and 15–17 years (n 41) and three FGD with parents (n 22) were conducted.

Adolescents displayed a holistic understanding of health comprising physical, social and psychological well-being. Social and cultural factors were perceived to be the main drivers of adolescent diet and physical activity. All participants indicated that caregivers dictated adolescents’ diet, as families shared food from the same plate. Meals were primarily determined by caregivers, whose choices were driven by food affordability and accessibility. Older adolescents, particularly boys, had opportunities to make independent food choices outside of the home which were driven by taste and appearance, rather than nutritional value. Many felt that adolescent physical activity was heavily influenced by gender. Girls’ activities included domestic work and family responsibilities, whereas boys had more free time to participate in outdoor games. Girls’ safety was reported to be a concern to caregivers, who were fearful of permitting their daughters to share overcrowded outdoor spaces with strangers.

Adolescents and caregivers spoke a range of social, economic and cultural influences on adolescent diet and physical activity. Adolescents, parents and the wider community need to be involved in the development and delivery of effective interventions that will take into consideration these social, economic and cultural factors.

To investigate maintenance of changes in food intake and motivation for healthy eating at follow-up 2 data collection after a lifestyle intervention among Pakistani immigrant women.

A culturally adapted lifestyle intervention, aiming at reducing the risk of type 2 diabetes mellitus. Data collection including FFQ and questions on intentions to change dietary behaviour was completed at baseline, right after the 7 ± 1 month intervention (follow-up 1) and 2–3 years after baseline (follow-up 2).

Oslo, Norway.

Pakistani women (n 198), aged 25–60 years, randomized into control and intervention groups.

From follow-up 1 to follow-up 2 there was a shift from action to maintenance stages for intention to reduce fat intake (P < 0·001), change type of fat (P = 0·001), increase vegetable intake (P < 0·001) and reduce sugar intake (P = 0·003) in the intervention group. The reduction in intakes of soft drinks with sugar, fruit drinks with sugar and red meats, and the increase in intakes of vegetables and fish from baseline to follow-up 1 were maintained (significant change from baseline) at follow-up 2 in the intervention group. The intake of vegetables was higher (P = 0·019) and the intake of fruit drinks with sugar lower (P = 0·023) in the intervention group compared with the control group at follow-up 2.

The culturally adapted intervention had the potential of affecting intentions to change food behaviour among Pakistani immigrant women long after completion of the intervention and also of leading to long-term maintenance of beneficial changes in diet.

To evaluate the cost and cost-effectiveness of a farm-to-Special Supplemental Nutrition Programme for Women, Infants and Children (WIC) intervention to promote vegetable intake and the redemption of WIC vouchers for produce purchases at farmers’ markets.

An economic analysis was undertaken using data from a pilot of the intervention. Vegetable intake was assessed with a reflection spectroscopy device (the Veggie Meter® [VM]) and via self-report. Voucher redemption was reported by WIC. Total and per participant intervention costs and cost-effectiveness ratios (expressed as cost per intervention effect) were estimated in 2019 US dollars over a 6-month period from the perspective of the agency implementing the intervention.

A large, urban WIC agency.

Participants were 297 WIC-enrolled adults.

Post-intervention, VM scores, self-reported vegetable intake and voucher redemption were higher in the intervention as compared with the control study group. Over the 6-month period, intervention costs were $31 092 ($194 unit cost per participant). Relative to the control group, the intervention cost $8·10 per increased VM score per participant, $3·85 per increased cup/d of vegetables consumed per participant and $3·29 per increased percentage point in voucher redemption per participant.

Intervention costs and cost-effectiveness ratios compared favourably with those reported for other interventions targeting vegetable intake in low-income groups, suggesting that the programme may be cost effective in promoting vegetable purchases and consumption. As there is no benchmark against which to compare cost-effectiveness ratios expressed as cost per unit of effectiveness, conclusions regarding whether this is the case must await further research.

A comprehensive nutrition policy containing a broad package of cross-sector and synergistic policy actions is required to attenuate the systemic drivers of poor nutrition. The current study aims to critically analyse trends in the scope of federal nutrition policy actions in Australia between 2007 and 2018 by: (1) describing the changes in nutrition policy actions, benchmarked against an international best-practice policy framework and (2) investigating how and why the scope of these policy actions have changed over time by examining the decision-making processes that led to the establishment of Australia’s Healthy Food Partnership (the Partnership).

Qualitative case study involving documentary analysis and key-informant interviews. Australian federal government documents (n 10) were analysed against the NOURISHING framework. Key informants (n 6) were interviewed and asked about the Partnership’s decision-making and establishment processes.

Australia.

Executive Committee (the Partnership’s governing body) and working group members.

From 2007 to 2018, the scope of Australian national nutrition policy has fluctuated from evidence-informed recommendations for a comprehensive policy to the mostly discrete policy actions of the Partnership. Themes of ‘pragmatism and compromise’, ‘actor relationships and lobbying’ and ‘political context’ were critical drivers for establishing the Partnership.

The narrowing of Australian nutrition policy reflects a response to political expediency and compromise. This political dynamic highlights a dilemma facing nutrition policy advocates: should (and if so, how) a balance be sought between the aspirational but possibly unrealistic goals, and the limited but likely deliverable outcomes during policy-making processes? These findings have relevance for developing a future comprehensive national nutrition policy.

To compare serum lipids and their changes during a family-based health education in children aged 6–17 years with or without the ɛ4 allele of the gene encoding apolipoprotein E (apoE).

An intervention study.

A family-based prevention of risk factors of coronary heart disease in Eastern Finland. The programme consisted of two counselling meetings at children's schools and three at children's homes.

Four hundred and thirty-nine children with a family history of cardiovascular diseases (CVD) participated in a family-based health education. The children were divided into two groups according to apoE genotype. The risk group consisted of 143 children having apoE ɛ4 allele (genotype ɛ3/4 or ɛ4/4) and the non-risk group of 296 children without apoE ɛ4 allele (ɛ2/3 or ɛ3/3). The final sample of the follow-up study included 354 (81%) children (114 and 240, respectively).

Baseline differences were found in low-density lipoprotein cholesterol (LDL-C) (P = 0.007) and LDL-C/high-density lipoprotein cholesterol (HDL-C) ratio (P = 0.030) among boys and in total cholesterol (TC)/HDL-C (P = 0.008) and LDL-C/HDL-C ratios (P = 0.006) among girls. Differences between groups in changes during the follow-up were observed only for TC/HDL-C ratio (P-value adjusted for age = 0.049) among boys.

At baseline, children with apoE ɛ4 allele had on average a more unfavourable lipid profile than those without apoE ɛ4 allele. However, the effect of about 33 months' family-based health education on plasma lipids did not depend on apoE genotype in children with a family history of CVD.

Folic acid food fortification has successfully reduced neural tube defect-affected pregnancies across Canada. The effect of this uncontrolled public health intervention on folate intake among Canadian children is, however, unknown. Our objectives were to determine folic acid intake from food fortification and whether fortification promoted adequate folate intakes, and to describe folic acid-fortified food usage among Ontario preschoolers.

Cross-sectional data were used from the NutriSTEP™ validation project with preschoolers recruited using convenience sampling. Mean daily total folate and folic acid intakes were estimated from 3 d food records, which included multivitamin supplement use. Comparisons were made to Dietary Reference Intakes, accounting for and excluding fortificant folic acid, to determine the prevalence of inadequate and excessive intakes.

Canada.

Two hundred and fifty-four preschoolers (aged 3–5 years).

All participants (130 girls, 124 boys) ate folic acid-fortified foods and 30 % (n 76) used folic acid-containing supplements. Mean (se) fortificant folic acid intake was 83 (2) μg/d, which contributed 30 % and 50 % to total folate intake for supplement users and non-users, respectively. The prevalence of total folate intakes below the Estimated Average Requirement was <1 %; however, excluding fortificant folic acid, the prevalence was 32 %, 54 % and 47 % for 3-, 4- and 5-year-olds, respectively. The overall prevalence of folic acid (fortificant and supplemental) intakes above the Tolerable Upper Intake Level was 2 % (7 % among supplement users).

Folic acid food fortification promotes dietary folate adequacy and did not appear to result in excessive folic acid intake unless folic acid-containing supplements were consumed.