To examine whether an intervention consisting of a WIC-based farmers’ market, nutrition education, recipe demonstrations and tastings, and handouts could be implemented as intended and the acceptability of the programme to recipients. The availability, variety and prices of fruits and vegetables (F&V) and the Farmers’ Market Nutrition Program voucher redemption rate at the site with market (relative to the rate among fourteen other WIC agency sites) also were examined.

Site-level data were used to evaluate programme implementation. Acceptability was assessed with participant data.

A large, New Jersey-based, urban WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) agency.

Fifty-four women who purchased F&V at the market.

Gaps in stakeholder communication and coordination, F&V selling out by midday and staffing levels affected implementation fidelity. On average, 12 (sd 3) F&V were available daily at the market (twenty-five unique F&V in total). For thirteen of nineteen items, prices were lower at the WIC-based market than area farmers’ markets. The voucher redemption rate at the site with the market (46 %) was higher than the rate among the fourteen other sites (39 %; P < 0·01). The mean rating of satisfaction with the programme was 6·9 (sd 0·6) on a 7-point scale. All participants reported intending to purchase F&V again at the market, owing to the convenient location, quality of the F&V and helpfulness of the staff. Improving F&V availability and variety were recommended.

The intervention is feasible with improved stakeholder communication and coordination, F&V availability and variety, and staffing.

This study evaluated the impact of the Addis Ababa School Feeding Program (SFP) on educational outcomes.

Single-group repeated measurement/longitudinal study design and multistage stratified sampling design were followed. Effect sizes estimates, repeated measures ANOVA, Chi-square, Generalised Additive Mixed Model and mixed effects negative binomial regression were used. Academic scores, attendance and dropout and height and weight of schoolchildren were collected.

School Feeding Programs in Addis Ababa, Ethiopia.

Schoolchildren in primary schools and school directors and teachers in fifteen randomly selected schools for Key Informant Interview (KII).

Anthropometric measurements of 4500 schoolchildren were taken from 50 schools. Academic scores of 3924 schoolchildren from 46 schools, class attendance records of 1584 schoolchildren from 18 schools and annual enrolment records of 50 schools were gathered. School meals achieved a minimum to large scale effects on educational outcomes with effect sizes (η 2) of academic scores (boys = 0·023, girls = 0·04), enrolment (girls = 0·001, boys = 0·05) and attendance (Cramer’s V = 0·2). The average scores of girls were significantly higher than that of boys (P < 0·0001). Height-for-age in all schoolchildren (P < 0·01) and BMI-for-age Z-scores in adolescent girls of 15–19 years (P < 0·0001) never had a significant positive relationship with average scores. Significant relation was observed between nutritional status and attendance (P = 0·021). KII showed that SFP created convenient teaching–learning environment and reduced hunger in schools, while boosting enrolment, attendance and academic performance among the schoolchildren.

The Addis Ababa SFP has positively contributed to educational outcomes. Strengthening the program would enhance nutritional outcomes and diminish educational inequalities.

To determine the association between livestock ownership and Hb concentration of women of child-bearing age (WCBA) and preschool-aged children in Sub-Saharan Africa (SSA).

A prospective analysis of publicly available cross-sectional data, using linear and logistic regressions controlling for potential confounders.

Twenty-eight countries in SSA.

162 305 WCBA and 118 607 children aged 6–59 months.

More than half of WCBA (62·5 %) and children (58 %) belonged to households that owned livestock. The average altitude-adjusted blood Hb concentration for WCBA and children was 12.23 and 10·24 g/dL, respectively. In adjusted models, higher number of livestock owned was associated with lower Hb concentration for children but not for WCBA. The magnitude of the association for children was small, with one additional unit of livestock owned reducing Hb concentration by 0·001 g/dL. Higher numbers of cattle, cows and bulls, sheep, and goats were associated with lower Hb concentration for both groups. The number of certain categories of livestock owned was associated with the consumption of relevant foods by children. There was no association between the consumption of animal-source foods and Hb concentration or between livestock ownership and diarrhoeal diseases or fever among children.

Livestock ownership in SSA had a net negative association with the Hb concentration of children and no association with that of WCBA. The results highlight the need for research aimed at clarifying the mechanisms linking livestock ownership and nutritional status, and identifying entry points for leveraging livestock ownership to improve the health of women and children in SSA.

Zn deficiency may be widespread in Asian countries such as South Korea. However, dietary habits have changed in response to rapid economic growth and globalization. Zn nutrition in South Koreans has therefore been assessed during a period (1969–1998) of unprecedented economic growth.

Cross-sectional food consumption data from the Korean National Nutrition Survey Reports (KNNSR) of South Korea at four separate time points (1969, 1978, 1988 and 1998) were used to calculate Zn, Ca and phytate intakes using various food composition tables, databases and literature values. Nutrient values in local foods were cited from their analysed values.

Average Zn intake was 5·8, 4·8 and 5·3 mg/d for 1969, 1978 and 1988 respectively, increasing to 7·3 mg/d in 1998 (73 % of the Korean Dietary Reference Intake). The phytate:Zn molar ratio decreased from 21 to 8 during the study period. Dietary Zn depletion due to marked decreases in cereal consumption, particularly barley which has a low Zn bioavailability, was counterbalanced by marked increases in the consumption of meat and fish, which are also Zn-rich foods. Reduced phytate consumption coincident with increased Zn intake suggests that Zn bioavailability also improved, particularly by 1998.

Although total Zn intake was not greatly affected over the initial period of economic growth in South Korea (1969–1988), Zn contributions from different food sources changed markedly and both Zn intake and potential bioavailability were improved by 1998. The study may have implications for Zn nutrition in other Asian countries currently experiencing rapid economic growth.

To validate a diet history questionnaire (DHQ) using a weighed food record(WFR) as the standard method in the estimation of food consumption andnutrient intake in a group of adults.

WFR: all foods consumed by subjects during 7 consecutive days were weighedand recorded by nutrition students. Two DHQ interviews were carried out ondays 1 (first diet history questionnaire, DHQ1) and 28 (second diet historyquestionnaire, DHQ2).

Costa Rica.

Sixty adults: 30 men and 30 women; 30 living in urban and 30 in ruralareas.

In comparison to the WFR, the DHQ1 gave statistically significant higherestimates of the mean intake of 19 nutrients for men and of three nutrientsfor women. The uncorrected correlation coefficients for nutrient intakeaccording to both methods ranged from 0.40 to 0.83 for males and from 0.22to 0.62 for females. Percentage of subjects classified in the same quartilesof nutrient intake according to each method ranged from 33.3% to 63.3% formales and from 23.3% to 53.3% for females. Misclassification in extremequartiles ranged from 0% to 13.3% for both sexes. The mean food groupconsumption, according to the DHQ1, when compared with the WFR, gavestatistically significant differences for three of the 18 food groups formen and for two groups in the case of women. The two applications of the DHQgave similar results.

Validation of a DHQ using a WFR as the standard method gave results thatcompare favourably with those reported by other authors. This study foundimportant differences in the response of men and women to the DHQ: amongmen, the estimates of mean nutrient intake from DHQ1 were significantlygreater than those of the WFR, while in the case of women, the mean nutrientintake estimates from both methods were not significantly different. Therewas a higher degree of correlation between the DHQ1 and the WFR meannutrient intakes among men than among women. The DHQ showed goodreproducibility.

To investigate the iodine status of schoolchildren in the Principality of Liechtenstein.

A representative, cross-sectional principality-wide screening of iodine level in household salt and urinary iodine concentrations (UIC) in primary-school children. Data were compared with the WHO criteria and with 2009 iodine survey data from Switzerland, a neighbouring country that supplies most of the salt used in Liechtenstein.

Principality of Liechtenstein.

Schoolchildren (n 228) aged 6–12 years from five different primary schools representing 11·4 % of the children at this age.

The median UIC was 96 (range: 10–446) μg/l; 11 %, 56 % and 1 % of children had a UIC <50, <100 and >300 μg/l, respectively. In all, 79 % of households were using adequately iodised salt (≥15 ppm). The median UIC was 20 % lower than that in children at comparable age in Switzerland (120 μg/l; P < 0·05).

According to the WHO criteria, schoolchildren in Liechtenstein are mildly iodine deficient and household iodised salt coverage is inadequate. Public health measures to increase iodine intakes in the Principality should be considered.

To evaluate the association between nutritional quality of breakfast and cardiometabolic risk factors.

Cross-sectional study, 2015 Health Survey of São Paulo (2015 ISA-Capital) with Focus on Nutrition Study (2015 ISA-Nutrition).

Population-based study, with a representative sample of adults and elderlies living in São Paulo, Brazil.

The sample included 606 adults (aged 20–59 years) and 537 elderlies (aged ≥60 years) from the 2015 Health Survey of São Paulo. Dietary intake was assessed by at least one 24-h recall. Breakfast quality was evaluated using the proposed Brazilian Breakfast Quality Index (BQI), ranging scores from 0 to 10. BQI associations with sociodemographic, lifestyle, dietetic and cardiometabolic variables were estimated using survey-weighted multiple logistic regression models.

Being ≥60 years of age, self-identifying as White or Asian, having a per capita family income with ≥1 minimum wage, being sufficiently active at leisure time and non-smoker were associated with better scores of BQI. A higher BQI score was inversely associated with elevated blood pressure (OR 0·81, 95 % CI 0·70, 0·94), fasting glucose (OR 0·85, 95 % CI 0·73, 0·98), HOMA-IR (OR 0·86, 95 % CI 0·74, 0·98), total cholesterol (OR 0·87, 95 % CI 0·76, 0·99), LDL-C (OR 0·85, 95 % CI 0·74, 0·97), metabolic syndrome (OR 0·82, 95 % CI 0·72, 0·93) and being overweight (OR 0·87, 95 % CI 0·76, 0·99).

Breakfast quality of Brazilian adults needs improvement with disparities across some sociodemographic factors. BQI was associated with lower odds of cardiometabolic risk factors, suggesting a beneficial effect in this population and emphasising the role of breakfast in reducing the risk of CVD.

To explore the influences of migration to a Western country on obesity and related risk factors by comparing measures of body composition and energy balance-related behaviours between Turkish adolescents in Turkey (TR-TR) and adolescents from Turkish immigrant ethnicity in the Netherlands (TR-NL).

Cross-sectional survey or baseline intervention data from six Dutch school-based studies and one Turkish study.

Primary and secondary schools.

A total of 915 (49 % girls; mean age 13·1 (sd 0·8) years) TR-TR adolescents and 433 (51 % girls; mean age 11·7 (sd 1·3) years) TR-NL adolescents were included. Outcome measures were self-reported sugar-containing beverage consumption, fruit and vegetable intake, screen time, physical activity, measured body height and weight, BMI, waist and hip circumferences, and skinfold thicknesses.

Our data showed that more TR-NL adolescents were overweight (31 % v. 26 %) and obese (9 % v. 6 %) and had significantly higher mean BMI (21·1 v. 20·0 kg/m2), waist circumference (72·2 v. 71·3 cm) and suprailiac skinfold thickness (19·8 v. 13·1 mm) than TR-TR adolescents. TR-NL adolescents reported significantly higher sugar-containing beverage consumption (1173 v. 115 ml/d), less fruit and vegetable intake (295 v. 647 g/d), less screen time (253 v. 467 min/d) and higher physical activity levels (61 v. 27 min/d) than TR-TR adolescents.

Immigrant adolescents in the Netherlands were more often overweight and had a less favourable dietary pattern than their peers in Turkey, while their physical activity and screen time patterns were more favourable. These results suggest that adolescents from Turkish immigrant ethnicity in the Netherlands have adopted lifestyles towards the host culture.

Sufficient maternal dietary intake of n-3 fatty acids (FA) supports offspring development. We aimed to construct simple criteria for dietary counselling to improve intake of n-3 FA.

Serum phospholipid FA from mothers and infants were analysed by GC one month after delivery. Dietary intake of foods during pregnancy and one month after delivery were recorded using 3 d food diaries and an index for healthy eating was calculated. Fish consumption was established by questionnaires. Dietary consumption of foods resulting in an increase in serum n-3 FA was defined.

A mother–child follow-up study in Southwest Finland.

Mothers (n 90) and 1-month-old infants (n 63).

After delivery, the mother’s consumption of fish at least three times per week resulted in an increase in total serum n-3 FA (mean difference (95 % CI): 1·7 (0·7, 2·8) % of total FA, P<0·001) and DHA (1·1 (0·5, 1·8) % of total FA, P<0·001) compared with non-consumers. Persistent fish intake once weekly throughout pregnancy increased total serum n-3 FA (P=0·001) and DHA (P<0·001). Overall, a healthy diet (middle and highest tertiles of healthy eating index score v. the lowest tertile) resulted in higher total serum n-3 FA (P=0·004) and DHA (P=0·008). Mother’s diet along with higher serum levels of n-3 FA were related to serum FA levels in 1-month-old infants.

An overall healthy diet and persistent consumption of fish at least once weekly throughout pregnancy or more frequent fish intake three times per week increases n-3 FA in serum phospholipids of both mothers and their infants.

To assess correlations between cruciferous vegetable intake and urinary isothiocyanate (ITC) level, in addition to glutathione S-transferase (GST) genotypes and other individual factors.

The study included cohort participants whose urinary ITC levels had been previously ascertained. Urinary ITC was assessed using HPLC. Usual dietary intake of cruciferous vegetables was assessed using a validated FFQ and total dietary ITC intake was calculated. Recent cruciferous vegetable intake was determined. GST genotypes were assessed using duplex real-time quantitative PCR assays. Spearman correlations were calculated between the covariates and urinary ITC levels and linear regression analyses were used to calculate the mean urinary ITC excretion according to GST genotype.

Urban city in China.

The study included 3589 women and 1015 men from the Shanghai Women’s and Men’s Health Studies.

Median urinary ITC level was 1·61 nmol/mg creatinine. Self-reported usual cruciferous vegetable intake was weakly correlated with urinary ITC level (rs=0·1149; P<0·0001), while self-reported recent intake was more strongly correlated with urinary ITC (rs=0·2591; P<0·0001). Overall, the GST genotypes were not associated with urinary ITC level, but significant differences according to genotype were observed among current smokers and participants who provided an afternoon urine sample. Other factors, including previous gastrectomy or gastritis, were also related to urinary ITC level.

The study suggests that urinary secretion of ITC may provide additional information on cruciferous vegetable intake and that GST genotypes are related to urinary ITC level only in some subgroups.

Consumption of trans-fatty acids (TFA) is a well-established risk factor for CVD morbidity and mortality. Our objective was to investigate TFA levels in Slovenian food supply.

Cross-sectional study.

Selected foods (n 282) were purchased in Slovenia (2016), and the TFA content was determined. The sample included pre-packed foods with/without declared partially hydrogenated vegetable oils (PHO), as well as non-pre-packed foods. A sales-weighting approach was used to ponder different market shares of the products.

While the majority of the investigated samples had low levels of TFA, up to 6·8 g of TFA per 100 g of food was observed in certain foods. Within pre-packed foods (n 207), the highest proportion of samples with high TFA levels was found among cookies with labelled PHO: 69 % (n 18) would exceed European Union regulatory TFA limit (2 g industrial TFA per 100 g of fats), which will be implemented in April 2021. Among the investigated non-pre-packed foods (n 75), only croissants contained notable TFA levels (mean 0·90 (sd 0·97); maximum 3·3 g/100 g), with about half of the samples exceeding 2 g TFA per 100 g of fats.

In 2016, some foods in Slovenian food supply still contained notable amounts of TFA. Foods with listed PHO as an ingredient were usually higher in TFA as compared with foods not labelled to contain PHO. Biscuits were identified as the most concerning category of pre-packed foods, while croissants contained highest levels of TFA within non-pre-packed foods.

To explore influences on the diet and physical activity of adolescents living in Mumbai slums, from the perspectives of adolescents and their caregivers.

Three investigators from Mumbai conducted six focus group discussions.

The study was conducted in suburban Mumbai slums.

Thirty-six adolescents (aged 10–12 and 15–17 years) and twenty-three caregivers were recruited through convenience sampling.

The findings highlighted the complex negotiations between adolescent and caregivers surrounding adolescent junk food consumption and physical activity opportunities. Caregivers learned recipes to prepare popular junk foods to encourage adolescents to eat more home-cooked, and less ‘outside’, food, yet adolescents still preferred to eat outside. To adolescents, the social aspect of eating junk food with friends was an important and enjoyable experience. Caregivers felt that they had no control over adolescents’ food choices, whereas adolescents felt their diets were dictated by their parents. Adolescents wanted to be physically active but were encouraged to focus on their academic studies instead. Gender was also a key driver of physical activity, with girls given less priority to use outside spaces due to cultural and religious factors, and parental fears for their safety.

These findings show that adolescents and caregivers have different agendas regarding adolescent diet. Adolescent girls have less opportunity for healthy exercise, and are more sedentary, than boys. Adolescents and caregivers need to be involved in designing effective interventions such as making space available for girls to be active, and smartphone games to encourage healthy eating or physical activity.

To conduct a needs assessment of all aspects of food provision in a residential home and to evaluate a subsequent nutrition intervention.

An intervention study using a before and after design. A participatory approach was adopted and quantitative and qualitative methods used throughout. The intervention involved a revised menu, kitchen equipment, and establishing wholesale shopping and food donations.

A residential home for senior citizens in Guyana.

Meals at the home were nutritionally inadequate and deeply unpopular with the residents. Intakes of fruits and vegetables were low and the home was heavily reliant on donated soya mince and rice. Meals were served within an eight-hour period to accommodate the staff's hours of work. Cutbacks in the food budget indicated that the financial state of the home explained some of the problems. The intervention was unable to address all problems identified, but led to substantial improvements in the nutritional adequacy of the food provided following the inclusion in the menu of a number of nutrient-dense foods such as chicken liver. The new menu was acceptable to the cooks and largely popular with the residents, although some problems persisted.

The results show that improvements in the nutrient profile of the diet could be achieved with a flexible, community-based, participatory approach that addressed all elements of a home's food provision system. The changes also proved largely popular with the residents, thus potentially contributing to their quality of life.

To test the impact of training for educators on the health of children enrolled in public and philanthropic day-care nurseries.

A randomised, institutional, non-blind clinical trial was conducted. An educational intervention was performed in four day-care centres and the control group consisted of four other day-care centres. Interviews with the mothers, collection of blood from the children by digital puncture and anthropometry were performed. The chosen indicator for the improvement of health was anaemia (Hb <11 g/dl). An unconditional logistic regression model was set for the risk factors for anaemia, considering associations with P ≤ 0·05 as statistically significant.

Eight day-care centres in the city of Sao Paulo, Brazil.

Two hundred and fifty-two children from day-care nurseries.

The children from the day-care centres that were not subject to intervention presented a 2·11 times greater risk (95% CI 1·04, 4·30; P = 0·40) of having anaemia at the end of the study independent of the control variables (sex, age, time in the day-care centre, anaemia at the beginning of the study, maternal age, use of oral iron supplements, number of siblings, per capita family income, use of antibiotics and the necessity of avoidable hospitalisations) used in the construction of the final logistical model.

The assessed educational intervention promoted significant changes in the health status of the children, reinforcing the importance of training for professionals who care for young children in day-care centres in developing countries in order to promote child health.

To study the implementation of a school-based healthy eating (HE) model one year after scale-up in British Columbia (BC). Specifically, to examine implementation of Action Schools! BC (AS! BC) and its influence on implementation of classroom HE activities, and to explore factors associated with implementation.

Diffusion of Innovations, Social Cognitive and Organizational Change theories guided our approach. We used a mixed-methods research design including focus group interviews (seven schools, sixty-two implementers) and a cross-sectional multistage survey to principals (n 36, 92 % response rate) and teachers of grades 4 to 7 (n 168, 70 % response rate). Self-reported implementation of classroom HE activities and reported use of specific AS! BC HE activities were primary implementation measures. Thematic analysis of focus group data and multilevel mixed-effect logistic regression analyses of survey data were conducted.

Elementary schools across BC, Canada.

Thirty-nine school districts, thirty-six principals, 168 grade 4 to 7 teachers.

Forty-two per cent of teachers in registered schools were implementing AS! BC HE in their classrooms. Users were 6·25 times more likely to have delivered a HE lesson in the past week. Implementation facilitators were school champions, technical support and access to resources; barriers were lack of time, loss of leadership or momentum. Implementation predictors were teacher training, self-efficacy, experience with the physical activity component of AS! BC, supportive school climate and parental post-secondary education.

Our findings reinforce that continued teacher training and support are important public health investments that contribute to successful implementation of school-based HE models after scale-up.

To compare the nutritional quality of children’s combination meals offered at large US chain restaurants characterised by three versions – default (advertised), minimum (lower-energy) and maximum (higher-energy).

We identified default children’s meals (n 92) from online restaurant menus, then constructed minimum and maximum versions using realistic additions, substitutions and/or portion size changes for existing menu items. Nutrition data were obtained from the MenuStat database. Bootstrapped linear models assessed nutrition differences between meal versions and the extent to which meal components (main dish, side dish, beverage) drove differences across versions. For each version, we examined the proportion of meals meeting the Guidelines for Responsible Food Marketing to Children.

Twenty-six fast-food and fast-casual restaurants, in 2017.

None.

Nutrient values differed significantly across meal versions for energy content (default 2443 kJ (584 kcal), minimum 1674 kJ (400 kcal), maximum 3314 kJ (792 kcal)), total fat (23, 17, 33 g), saturated fat (8, 6, 11 g), Na (1046, 915, 1287 mg) and sugar (35, 14, 51 g). The substitution of lower-energy beverages resulted in the greatest reduction in energy content (default to minimum, −418 kJ (−100 kcal)) and sugar (−20 g); choosing lower-energy side dishes resulted in the greatest reduction in total fat (default to minimum, −4 g), saturated fat (−1·1 g) and Na (−69 mg). Only 3 % of meals met guidelines for all nutrients.

Realistic modifications to children’s combination meals using existing menu options can significantly alter a meal’s nutrient composition. Promoting lower-energy items as the default option, especially for beverages and side dishes, has a potential to reduce fat, saturated fat and/or sugar in children’s meals.

The first aim was to evaluate BMI cross-sectionally over a period of 14 years (1992 to 2005) in 43 343 army men and the second was to compare BMI using the paired data of 1497 army men. The data were analysed as a function of the military ranking system, used as an indicator for socio-economic position.

Multiple cross-sectional and longitudinal design.

A significant increase of BMI between age categories was detected over the 14-year period; BMI remained stable in each age category. In the paired cohort, median BMI increased during the same period from 23·9 (interquartile range 3·3) kg/m2 to 24·7 (interquartile range 3·5) kg/m2 (P < 0·0001). This age-dependent evolution was present in all military rankings. From age 40 years or more, BMI indicated a significant increase in the prevalence of overweight and obesity.

For the total cohort, BMI remained stable in each age category. For the paired cohort, BMI increased over time. The military leadership should emphasize prevention in order to reduce the health-care costs and disease burden in this cohort. This emphasis on prevention should target those aged less than 40 years.