Iodine deficiency still remains a major public health concern worldwide despite global progress in its elimination. The aims of the present study were to evaluate dietary iodine status in the mother and one adult member of each family and the association between mothers’ knowledge, attitude and behaviour and the dietary iodine status of adult family members in Tehran.

In this cross-sectional study, 24 h urinary iodine and Na concentrations and the iodine content of household salt were measured. Mothers’ knowledge, attitude and behaviour were assessed using a questionnaire administered in face-to-face interviews.

Health-care centres from four distinct areas of Tehran.

Mother–adult family member pairs aged ≥19 years (n 290), enrolled through randomized cluster sampling.

In mothers and adult family members, median 24 h urinary iodine concentration was 73 (interquartile range (IQR) 36–141) µg/l and 70 (IQR 34–131) µg/l, dietary iodine intake was 143 (IQR 28–249) µg/d and 130 (IQR 26–250) µg/d and dietary salt intake was 8·0 (IQR 5·9–10·2) g/d and 7·5 (IQR 5·3–10·0) g/d, respectively. Significant correlations were observed between mothers’ attitude and behaviour and the 24 h urinary iodine concentration, dietary iodine intake and iodine content of salt of adult family members. In multiple analysis, lower quartiles of salt iodine content and salt intake and inappropriate behaviour scores in mothers increased the risk of urinary iodine concentration <100 µg/l in adult family members.

The present study showed that mothers’ behaviour, but not knowledge and attitude, was among major contributors to the suboptimal dietary iodine status observed in adult family members.

To receive stakeholders’ feedback on the new structure of the Nutritional Disorders section of the International Classification of Diseases, 11th Revision (ICD-11).

A twenty-five-item survey questionnaire on the ICD-11 Nutritional Disorders section was developed and sent out via email. The international online survey investigated participants’ current use of the ICD and their opinion of the new structure being proposed for ICD-11. The LimeSurvey® software was used to conduct the survey. Summary statistical analyses were performed using the survey tool.

Worldwide.

Individuals subscribed to the mailing list of the WHO Department of Nutrition for Health and Development.

Seventy-two participants currently using the ICD, mainly nutritionists, public health professionals and medical doctors, completed the questionnaire (response rate 16 %). Most participants (n 69) reported the proposed new structure will be a useful improvement over ICD-10 and 78 % (n 56) considered that all nutritional disorders encountered in their work were represented. Overall, participants expressed satisfaction with the comprehensiveness, clarity and life cycle approach. Areas identified for improvement before ICD-11 is finalized included adding some missing disorders, more clarity on the transition to new terminology, links to other classifications and actions to address the disorders.

The Nutritional Disorders section being proposed for ICD-11 offers significant improvements compared with ICD-10. The new taxonomy and inclusion of currently missing entities is expected to enhance the classification and health-care professionals’ accurate coding of the full range of nutritional disorders throughout the life cycle.

To examine changes in the age-specific prevalence of overweight and obesity in Japanese children between 2000 and 2005 and compare Japanese centile curves with international ones.

A large, Japanese, representative cross-sectional growth study.

Japan.

Japanese children aged 5–17 years, including 669 986 subjects in 2000, 670 143 in 2001, 668 760 in 2002, 670 785 in 2003, 669 120 in 2004 and 668 234 in 2005.

BMI (weight/height2).

The prevalence of overweight and obesity in children aged 5–17 years decreased from 2000 to 2005 in both males and females, according to the definitions of the Centers for Disease Control and Prevention and the International Obesity Taskforce. For each year, the centile curves were drawn so that at age 17 years they passed through respectively 24·46 kg/m2 and 24·70 kg/m2 for males, and 29·41 kg/m2 and 29·69 kg/m2 for females, which are the BMI values at age 17 years from the international reference curves.

The study results indicate that centile curves can change according to the time of observation, thus suggesting that international reference curves therefore need to be regularly revised while including more data from a larger range of countries.

We investigated the association of dietary Mg intake with insulin resistance and markers of endothelial function among Iranian women.

A cross-sectional study.

Usual dietary intakes were assessed using a validated FFQ. Dietary Mg intake was calculated by summing up the amount of Mg in all foods. A fasting blood sample was taken to measure serum concentrations of glycemic indices (fasting plasma glucose and insulin) and endothelial function markers (E-selectin, soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1). Insulin resistance and sensitivity were estimated using the Homeostasis Model Assessment-Insulin Resistance (HOMA-IR), Homeostasis Model Assessment β-cell function (HOMA-β) and quantitative insulin sensitivity check index (QUICKI).

Iranian female nurses (n 345) selected by a multistage cluster random sampling method.

The Mg intake across energy-adjusted quartiles was 205 (se 7), 221·4 (se 8), 254·3 (se 7) and 355·2 (se 9) mg/d, respectively. After adjustments for potential confounders, QUICKI level was significantly different across quartiles of Mg intake (Q1: 0·34 (se 0·02), Q2: 0·36 (se 0·01), Q3: 0·40 (se 0·01), and Q4: 0·39 (se 0·02), P = 0·02); however, this association disappeared after considering markers of endothelial function, indicating that this relation might be mediated through endothelial dysfunction. After controlling for all potential confounders, Mg intake was inversely, but not significantly, associated with serum concentrations of sICAM (Q1: 239 (se 17), Q2: 214 (se 12), Q3: 196 (se 12), and Q4: 195 (se 17), P = 0·29). There was no other significant association between dietary Mg intake and other indicators of glucose homoeostasis or endothelial markers.

Higher dietary Mg intake was associated with better insulin sensitivity in Iranian females. This linkage was mediated through reduced endothelial dysfunction.

We aimed to identify factors (child diet, physical activity; maternal BMI) associated with body composition of Ghanaian pre-school children.

Longitudinal analysis of the International Lipid-Based Nutrient Supplements (iLiNS)-DYAD-Ghana randomized trial, which enrolled 1320 pregnant women at ≤20 weeks’ gestation and followed them and their infants until 6 and 18 months postpartum, respectively. At follow-up, child age 4–6 years, we collected data on body composition (by 2H dilution), physical activity and diet, extracted dietary patterns using factor analysis, and examined the association of children’s percentage body fat with maternal and child factors by regression analysis.

Eastern Region, Ghana.

Children 4–6 years of age.

The analysis included 889 children with percentage body fat and dietary data at follow-up. We identified two major dietary patterns, a snacking and a cooked foods pattern. Percentage body fat was positively associated (standardized β (se)) with maternal BMI at follow-up (0·10 (0·03); P = 0·003) and negatively associated with physical activity (−0·15 (0·05); P = 0·003, unadjusted for child gender), but not associated with the snacking (0·06 (0·03); P = 0·103) or cooked foods (−0·05 (0·07); P = 0·474) pattern. Boys were more active than girls (1470 v. 1314 mean vector magnitude counts/min; P < 0·0001) and had lower percentage body fat (13·8 v. 16·9 %; P < 0·0001).

In this population, maternal overweight and child physical activity, especially among girls, may be key factors for addressing child overweight/obesity. We did not demonstrate a relationship between the dietary patterns and body fatness, which may be related to limitations of the dietary data available.

To study the association of fish and fish-liver oil consumption across the lifespan with CHD later in life among Icelandic women, with special emphasis on the effects of consumption in adolescence.

Prevalence association study. Logistic regression was used to estimate odds ratios and 95 % confidence intervals of CHD according to fish or fish-liver oil exposure. Models were adjusted for age, education, concurrent diet and other known risk factors.

The study was nested within the AGES-Reykjavik Study, conducted in Reykjavik, Iceland.

Participants were 3326 women aged 66–96 years, with available information on CHD status at entry to the study and information on fish and fish-liver oil consumption during midlife and adolescence. Dietary habits were assessed retrospectively using a validated FFQ.

CHD was identified in 234 (7·9 %) women. Compared with women with no intake of fish-liver oil in adolescence or midlife, women who consumed fish-liver oil at least three times weekly in adolescence or in midlife had a decreased risk of CHD (OR=0·62; 95 % CI 0·45, 0·85 and OR=0·68; 95 % CI 0·50, 0·94, respectively). No associations were observed between fish intake (>2 portions/week v. ≤2 portions/week) in adolescence or midlife and CHD in this population with high fish intake.

Fish-liver oil consumption, from early life, may reduce the risk of CHD in older women. Lifelong nutrition may be of importance in the prevention of CHD in older women.

To examine Australian adolescents’ knowledge and beliefs regarding potential health consequences of soda and diet soda consumption and nutritional aspects of soda and explore associations with consumption.

A survey utilising a nationally representative sample (stratified two-stage probability design) assessed knowledge of nutritional contents and health consequences of soda, and beliefs regarding health risks of diet soda, and soda and diet drink consumption.

Australia.

9102 Australian school students (12–17 years) surveyed in 2018.

Adolescents had lower nutritional knowledge (sugar content (22·2 %), exercise equivalent (33·9 %), calories/kJ (3·1 %)) than general knowledge of health risks (87·4 %) and some health effects (71·7–75·6 % for tooth decay, weight gain and diabetes), with lower knowledge of heart disease (56·0 %) and cancer (19·3 %). Beliefs regarding health effects of diet soda were similar, albeit not as high. In general, female sex, older age and less disadvantage were associated with reporting health effects of soda and diet soda, and nutritional knowledge of soda (P < 0·001). Those reporting tooth decay, weight gain, heart disease and diabetes as health effects of soda and diet soda were lower consumers of soda and diet drinks (P < 0·001), as were those with higher nutritional knowledge (sugar content and exercise equivalent; P < 0·001).

This study highlights possible knowledge gaps regarding the health effects of soda and nutritional knowledge for public health intervention. When implementing such interventions, it is important to monitor the extent to which adolescents may consider diet drinks as an alternative beverage given varied beliefs about health consequences and evolving evidence.

To compare the microbiological profile, clinical course and outcome of acute diarrhoea in children aged <5 years having severe acute malnutrition (SAM) with those of children having normal nutritional status.

Cross-sectional comparative study.

Tertiary-care hospital catering mainly to the urban poor of East Delhi, India.

Children aged <5 years (n 140; seventy with SAM (cases) and seventy with normal anthropometry (controls)) with acute diarrhoea (duration < 14 d). Stool samples were collected for conventional culture, microscopy, acid-fast staining, rotavirus and Cryptosporidium antigen detection, and subtyping of diarrhoeagenic Escherichia coli (DEC). We followed-up these children for persistent diarrhoea and subsequent diarrhoeal episode in the next 3 months.

Rotavirus was detected in six (9 %) cases and in fifteen (21 %) controls (P = 0·03; OR = 0·34; 95 % CI 0·12, 0·94). DEC was isolated significantly more in cases compared with controls (93 v. 64 %; P < 0·001; OR = 7·25; 95 % CI 2·57, 20·4). Cryptosporidium was detected in seven (10 %) cases and five (7 %) controls. Total duration of diarrhoea and percentage change in weight after resolution of diarrhoea were comparable between cases and controls. At 3-month follow-up, number of subsequent episodes of diarrhoea and persistent diarrhoea were comparable between the two groups.

Rotavirus was found significantly less frequently, whereas DEC was detected more frequently in children with SAM in comparison to non-malnourished children. To further reduce diarrhoea-related mortality, preventive and therapeutic interventions need to be designed against organisms causing diarrhoea in children with SAM.

In light of the increasing prevalence of juvenile obesity seen around the world, obesogenic environments in general and the food environment in particular are receiving increasing attention in current public health research. Restaurants play a significant role in the food environment. The present study aimed to quantitatively describe and qualitatively evaluate the range of children’s meals available in full-service restaurants in Germany.

Five hundred restaurants were identified using a systematic quota sampling technique. The individual meals were evaluated using quality standards stipulated by the German Nutrition Society (DGE).

Nationwide sample of menus from full-service restaurants.

Meals (n 1877) from 500 menus were analysed.

Menus included 3·76 (sd 1·31) meals for children. About 70 % of the meals were limited to six typical dishes of low nutritional quality. In total, 54 % of meals included French fries or another form of fried potatoes. Of all meals, 23 % did not fulfil any of the eleven quality criteria set by the DGE and 38 % satisfied only one criterion. The majority of dishes on offer featured high energy density while simultaneously having low nutrient density. Healthy dishes were not highlighted visually in any menu.

The range of dishes on offer for children in German restaurants is severely lacking in variety and in need of improvement from a nutritional point of view. Considering the growing importance of restaurants as food environments, there is a need to improve the presentation of menus and the meals offered.

People with lactose intolerance have to limit their consumption of lactose-containing dairy products which are a main source of Ca. In particular, for low-income people it is of interest which alternative diet form rich in Ca leads to the lowest additional costs. This study aims to calculate the additional costs of lactose-reduced diets and to show which of different options represent the most cost-effective alternative within a lactose-reduced diet.

Using linear programming, food baskets with different lactose contents were calculated and were compared to a basic model, reflecting a normal diet without a limitation of lactose. By comparing the costs and the composition of the food baskets, recommendations for a lactose-reduced diet were derived.

Germany.

A consumer panel dataset representative for Germany is used for the calculations. Information on prices and nutrients is derived from the 9429 adult households without children, and information on consumed food quantities from the 3046 single households.

The minimum additional food costs depend on the severity of lactose intolerance and range from 0·2 % to 6·1 % per month. It was found that the greatest adjustments due to lactose reduction could be observed within the dairy product group. In this group, with a rising lactose limit, normal milk was increasingly replaced by lactose-free milk.

It was shown that a lactose-reduced diet is generally associated with higher food costs. When suffering from lactose intolerance, switching to lactose-free milk seems to be the most cost-effective way to cover nutrient requirements.

The aim of this study was to explore and analyse the actions implemented by civil society to contribute to food security in the context of the COVID-19 outbreak in Uruguay, a high-income country in South America.

An exploratory systematic approach was used to identify the contributions of civil society to food security through reports in news websites and Facebook posts. Data were analysed based on content analysis following a deductive–inductive approach.

Uruguay, Latin America.

A total of 1220 civil society organisations were identified, which developed two main actions to increase access to food among the Uruguayan population: food baskets and ‘community pots’ (also known as ‘common pots’). Most of the initiatives targeted citizens under socioeconomic vulnerability in the face of COVID-19, without specifying any specific requirement or population segment. Actions were mainly led by spontaneously organised community groups, and, to a lesser extent, by consolidated organisations. Interactions between organisations were identified. The foods provided by the organisations were mostly aligned with national dietary guidelines. Social media posts evidenced that the main challenge faced by organisations was related to the lack of funds or supplies.

Results from this work suggest that the lack of funds or supplies poses challenges to the medium- and long-term contributions of civil society to food security and stresses the need for comprehensive governmental measures to guarantee food security amongst Uruguayan citizens.

To assess and compare the (macro-)nutritional composition of red meat (RM) and poultry meat (PM) products with the emerging category of meat substitutes.

We use information on nutritional values per 100 g to estimate the differences in the nutritional composition between RM, PM, vegan meat substitute (VMS) and non-vegan meat substitute (NVMS) and derive six unique meat product clusters to enhance the comparability.

Meat markets from five major European countries: France, Germany, UK, Italy and Spain.

Product innovation data for 19 941 products from Mintel’s Global New Product Database from 2010 to 2020.

Most of the innovations in the sample are RM products (55 %), followed by poultry (30 %), VMS (11 %) and NVMS (5 %). RM products exhibit a significantly higher energy content in kcal/100 g as well as fat, saturated fat, protein and salt all in g/100 g than the meatless alternatives, while the latter contain significantly more carbohydrates and fibre than either poultry or RM. However, results differ to a certain degree when products are grouped into more homogeneous clusters like sausages, cold cuts and burgers. This indicates that general conclusions regarding the health effects of substituting meat with plant-based alternatives should only be drawn in relation to comparable products.

Meat substitutes, both vegan and non-vegan, are rated as ultra-processed foods. However, compared with RM products, they and also poultry products both can provide a diet that contains fewer nutrients-to-limit, like salt and saturated fats.

Little is known about the contribution of childhood socio-economic position (SEP) and social mobility to weight change. The present study evaluated the effect of family SEP during the pre-school years and social mobility on BMI between birth and adolescence.

Longitudinal. The SEP of each child’s family was classified according to an asset-based wealth index as low, medium or high. Four different categories of childhood–adolescence SEP groups were created in order to examine social mobility: low–medium/high, medium–medium, medium–high and high–high/medium. For each of these categories, BMI was tracked from birth to adolescence. Linear mixed-effects models were used to analyse the data.

Cuiabá–MT, Brazil.

A population-based cohort of children born between 1994 and 1999 was assessed between 1999 and 2000, and again between 2009 and 2011.

A total of 1716 adolescents were followed from childhood to adolescence (71·4 % of baseline). The prevalence of overweight/obesity was 20·4 % in childhood and 27·7 % in adolescence. A higher SEP in childhood was associated with a greater prevalence of overweight in adolescence. Expressive upward social mobility occurred, mainly in the lowest SEP group. There was a greater rate of change in BMI between birth and adolescence among children with a higher SEP in childhood and children who remained in the higher SEP from childhood to adolescence.

Individuals from a higher SEP in childhood and those who remained in the higher social classes showed greater rate of change in BMI. Thus, initial SEP was the major determinant of changes in BMI.

To determine the serum concentrations of aflatoxin B1 (AFB1), aflatoxin B2 (AFB2), aflatoxin G1 (AFG1) and aflatoxin G2 (AFG2) in the healthy adult population living in both the Black Sea and Mediterranean regions of Turkey and to investigate the regional, seasonal and gender variability in aflatoxins (AF) exposure in these regions.

Serum AFB1, AFB2, AFG1 and AFG2 concentrations were analysed by HPLC.

In total, four hundred and eighty-four serum samples were analysed.

Four hundred and eighty-four healthy adult volunteers living in rural areas of the Black Sea and Mediterranean regions of Turkey were studied.

The mean serum concentration of total AF in the Black Sea region was 1·33 ppb (min–max 0·15–3·38 ppb) and 0·90 ppb (min–max 0·18–2·48 ppb) for summer and winter, respectively. In the Mediterranean region, the mean serum concentration of total AF was determined as 0·55 ppb (range 0·04–1·72 ppb) for summer and 0·45 ppb (range 0·12–1·43 ppb) for winter. The total AF concentrations in serum samples were statistically higher in summer compared with winter for the two regions. The differences between the regions were statistically significant concerning all samples, with higher total AF concentrations in the Black Sea region.

The overall results suggest that the Turkish population living in these two regions is continuously exposed to AF, particularly in the summer, and that mycotoxin contamination in food should be monitored routinely for food safety and human health.

This review summarises the evidence for the effectiveness of primary care based interventions of diet and physical activity aimed at reducing blood pressure.

As blood pressure rises so does the risk of heart disease and stroke. There is a large literature on the effects on blood pressure of changing various aspects of diet either as single nutrient interventions, patterns of food consumption, or the addition of dietary supplements (potassium, magnesium, and fish oil). Controlled trials have been undertaken to assess the relative benefits of lifestyle changes in activity (walking etc) compared with more structured exercise programmes. There is sufficient evidence to suggest that changes in diet and activity under controlled conditions can reduce blood pressure and delay or reduce the need for drug treatment in subjects who are hypertensive. What is less clear is how to achieve these lifestyle changes in the primary care setting as part of routine clinical management.

There have been a number of systematic reviews undertaken to evaluate the evidence. The interventions were either delivered alone or in combination with other advice, either with or without aids, and by various practice nurse staff (GP, nurse, Dietitian); follow-up varied from 3 months to a year. Compliance with the advice was generally not measured. The variability in the quality of the studies and interventions made it difficult to draw conclusions: any effects seen tended to be small.

Equivocal results (non statistically significant reductions) should not be considered as proof of no effect without careful consideration of the effects of chance, bias and confounding, and without better measures of compliance. There is little debate that, under investigator control, blood pressure can be reduced by changes in diet and activity. Changes to a ‘healthy’ diet (low in total and saturated fat; energy intake balanced with expenditure to maintain or achieve optimal body weight; low in salt; high in fruits, vegetables, legumes; and whole grains) and increases in modest levels of physical activity (walking etc) would be expected to reduce blood pressure by between two and four mmHg. A shift in the population distribution of this order would be expected to have a substantial impact on population mortality patterns and could be achieved cost-effectively in primary care.

The present study investigated Guarani village interviewees’ diet changes over time, their perceptions about the changes and the effects of these changes on their health.

The study employed qualitative methods with a sample of Guarani Indians selected by snowball sampling. Ethnographic methods and techniques included field diaries, informal and unstructured interviews and participant observation.

The Tenondé Porã Guarani village is located in the district of Parelheiros, São Paulo, Brazil. Interviews were conducted from July 2008 to December 2009.

Fifteen Guarani Indians, males and females in age categories ranging from youths to elders, took part in the study.

The interviewees reported changes in how food was obtained, the occurrence of food substitutions and food species abandonment, recipe changes and the introduction of new foods. Some ritual use of plants was maintained. Disease frequency was found to increase because of this change and a lack of obedience to Nhanderu (the Guarani God). A lack of space for daily traditional activities (e.g. farming, hunting) was found to result in sedentary lifestyles.

The village location was a key factor in the Guarani diet change, although some rituals related to available plants were preserved.

To assess the potential contribution of foods fortified with folic acid (FA) to target population intakes when included as part of a healthy breakfast.

Breakfast models aligned with the Spanish Dietary Guidelines were studied using the recommended, average and 95th percentile of serving sizes consumed by women of childbearing age. Food composition data were obtained from a database including FA analytical data from sixty-eight products and the Spanish food composition tables. Different scenarios were assessed with the inclusion of one, two or three FA-fortified products and with two different fortification levels: ≤33 µg/serving (L1) and ≥70 µg/serving (L4). FA contents provided by the different models for each scenario were compared with the Recommended Nutrient Intake (RNI) for folate and the Upper Level (UL) of intake for FA.

Madrid Region, Spain.

Women aged 16–49 years were considered.

Overall, simulation of ten breakfast models and three scenarios of product inclusion accounted for 20–25 % of total daily energy recommendations for women. Unfortified breakfast models provided on average 4–23 % of the folate RNI. Inclusion of one L4 FA-fortified food contributed 20–60 % of the RNI. Fortified yoghurt and milk had the highest FA contents per serving. Scenarios with two or three fortified products delivered 40–80 % of the RNI. None of the evaluated models exceeded the FA UL.

At existing levels of FA fortification, inclusion of fortified products as part of a regular breakfast meal could positively impact the nutritional quality of women’s diet without involving a risk of excessive FA exposure.

To examine associations between serum antioxidant levels and mortality (all-cause, cancer and CVD) among US adults.

We examined the risk of death from all-cause and cause-specific mortality associated with serum antioxidant (vitamin E and carotenoids) and vitamin A levels using Cox regression models to estimate hazards ratios (HR) and 95 % CI.

The National Health and Nutrition Examination Survey (NHANES) 1999–2002 was followed up through 31 December 2015.

The NHANES 1999–2002 cohort included 8758 participants aged ≥ 20 years. Serum carotenoid levels were only assessed for the 1999–2000 cycle. Therefore, sample size for each assessed antioxidant ranged from 4633 to 8758.

Serum vitamin E level was positively associated with all-cause mortality (HR = 1·22, 95 % CI 1·04, 1·43, highest v. lowest quartile). No other antioxidants were associated with mortality in overall analysis. In race/ethnicity-specific analyses, high vitamin E and α-tocopherol levels were associated with increased risk of all-cause mortality among non-Hispanic Whites. Among non-Hispanic Blacks, serum α-tocopherol level was associated with decreased risk of cancer mortality (HR = 0·30, 95 % CI 0·12, 0·75, third v. first quartile) and total carotenoid levels with reduced risk of CVD mortality (HR = 0·26; 95 % CI 0·07, 0·97, second v. lowest quartile). Hispanics with high β-carotene levels had reduced risk of CVD mortality.

Serum antioxidant levels may be related to mortality; these associations may differ by race/ethnicity and appeared to be non-linear for all-cause and cause-specific mortality. Further studies are needed to confirm our results.