To test a surveillance system on diet and physical activity based on data gathered at well-child visits.

Cross-sectional data collection on growth, diet, physical activity and sociodemographic variables.

Offices of 179 paediatricians in three Italian regions.

26 898 children for a total of 32 915 well-child visits at 1, 3, 5–6, 8–9, 12, 18, 24, 36 and 60–72 months of age.

The BMI Z-score was lower than the WHO standard at 1 and 3 months but higher from 8–9 months onwards. The rates of breast-feeding at 1, 3, 5–6, 8–9 and 12 months were 88 %, 75 %, 64 %, 52 % and 32 %, respectively, with 5 % and 3 % continuing up to 24 and 36 months. Exclusive breast-feeding was 64 %, 54 % and 20 % at 1, 3 and 5–6 months, respectively; 57 % at 5 months and 85 % at 6 months were given complementary foods. Only 8 % and 10 % of children were taking five portions of fruit and vegetables daily, while 47 % and 51 % were consuming sugar-sweetened beverages at 36 and 60–72 months, respectively. At 60–72 months, less than 10 % reported at least 1 h of moderate-to-vigorous physical activity on 5–7 d/week, and 32 % watched television or played videogames for more than 2 h/d, every day. The majority of paediatricians rated the surveillance system as reliable and feasible.

Surveillance for diet and physical activity in pre-school children, with data gathered during well-child visits, is feasible and potentially useful to plan and evaluate activities for the prevention of obesity.

To develop a dish composition database (DCD) and assess its ability to estimate dietary intake.

The DCD was developed based on 16 d dietary records (DR). We aggregated all reported dishes into 128 dish codes and calculated mean food group and nutrient contents for each code. These data were used to calculate dietary intake in a different population that completed a 4 d DR. The estimated values were compared with those estimated using the standard food composition database (FCD) of Japan.

Japan.

A total 252 adults aged 31–81 years for the 16 d DR (3941 d in total) and 392 adults aged 20–69 years for the 4 d DR (1568 d in total) participated.

There were significant differences in median intakes between the DCD and the FCD for eighteen and twenty (of twenty-six) food groups and for twenty-nine and twenty-two (of forty-three) nutrients (including energy) in men and women, respectively. For food group intakes, Spearman correlation coefficients between the DCD and FCD ranged from 0·19 (animal fats) to 0·90 (fruits and alcoholic beverages) in men (median: 0·61) and from 0·25 (oils) to 0·89 (noodles) in women (median: 0·58). For nutrient intakes, the corresponding values ranged from 0·25 (retinol) to 0·90 (alcohol) in men (median: 0·60) and from 0·15 (retinol) to 0·74 (alcohol) in women (median: 0·53).

Whereas it is difficult to accurately estimate absolute dietary intake values using the present DCD, it has acceptable ability to rank the intakes of many food groups and nutrients.

To examine secular trends and sociodemographic determinants of thinness, overweight and obesity among Malaysian children and adolescents from 2006 to 2015.

We used cross-sectional data from the National Health and Morbidity Surveys 2006, 2011 and 2015. Individuals were classified into pre- (6–9 years), early (10–13 years) and mid- (14–17 years) adolescence. BMI status was determined according to the International Obesity Task Force (IOTF) and WHO criteria, using measured height and weight. We analysed trends using log-binomial regression, by sex-age groups, stratified by sociodemographic factors (ethnicity, residential area, household size and household income), and accounting for the complex survey design. Associations between sociodemographic factors and prevalence of thinness and overweight (obesity included) in 2015 were assessed using log-Poisson regression.

Nationwide population-based surveys, Malaysia.

Eligible 6–17-year-olds from urban and rural residential areas (n 28 094).

The prevalence of thinness decreased from 2006 to 2015 (IOTF: boys from 22 % to 18 %, girls from 23 % to 19 %; WHO: boys from 9 % to 7 %, girls from 8 % to 6 %), while the prevalence of overweight increased (IOTF: boys from 20 % to 26 %, girls from 19 % to 24 %; WHO: boys from 25 % to 31 %, girls from 22 % to 27 %). These changes were statistically significant in most sex-age groups. Thinness and overweight co-existed in all sociodemographic subgroups, with variation in the prevalence estimates, but similar secular changes in most subgroups.

Malaysia is facing a double burden of malnutrition at population level with a secular increase in overweight and obesity and a gradual decrease in thinness among 6–17-year-olds from varying sociodemographic backgrounds.

To determine if the association between soda consumption and obesity is uniform among Asian-American population subgroups.

We conducted multivariate logistic regression analyses on odds of being obese among seven Asian subgroups and by place of birth using data from the 2009 California Health Interview Survey.

An omnibus population-based health survey.

Non-institutionalized adults, aged 18 years or over, residing in California (n 36 271).

Despite low levels of soda consumption in several Asian-American ethnic groups, soda consumption increased the odds of being obese among Chinese, Koreans and Other Asians but not for Whites. Obesity risk varied across Asian subgroups and by place of birth within these subgroups.

More public health efforts addressing soda consumption in Asian-American communities are needed as a strategy for not only preventing chronic diseases but also disparities, considering the varying levels of soda intake across subgroups. Results support the growing body of literature critiquing acculturation theory in immigrant health research by documenting inconsistent findings by place of birth. Future research should take into account the heterogeneity among Asian Americans to advance our understanding of health outcomes and disparities.

To examine the association between cereal consumption and cardiovascular risk factors including waist, height, total cholesterol, LDL cholesterol and HDL cholesterol in a sample of adolescent girls.

Longitudinal study.

The study was conducted from 1987 to 1997 and data were collected at three study sites (University of California at Berkeley, University of Cincinnati and Westat Inc., Rockville, MD, USA). Mixed models were used to estimate the association between the number of days of eating cereal and these four outcome variables.

Girls (n 2371) who participated in the 10-year National Heart, Lung, and Blood Growth and Health Study (NGHS) and completed a 3 d food diary in years 1–5 and 7, 8 and 10.

Adolescent girls who ate cereal more often had lower waist-to-height ratio (P < 0·005), lower total cholesterol (P < 0·05) and lower LDL cholesterol (P < 0·05), taking into account sociodemographic variables, physical activity levels and total energy intake.

Findings suggest that cereal consumption is associated with markers of cardiovascular risk and that childhood patterns of consumption may influence the development of risk factors later in adolescence.

To explore the relationship between subjective mood, folate status and homocysteine in healthy individuals.

Subjective mood assessments were completed twice daily over the course of one week using the Positive and Negative Affect Scale (PANAS). The PANAS is a validated scale which considers mood state on two distinct continua, one reflecting positive mood and the other negative mood, each requiring response to 10 adjectives on a Likert scale. A blood sample was taken on one occasion at the start of the week during which subjective mood was assessed and analysed for red-blood-cell (RBC) folate, serum folate and plasma homocysteine concentrations.

Male volunteers aged 19–47 years (n = 58) were recruited from local industries.

High concentrations of RBC folate were associated with less variability (lower standard deviation) in negative mood (P = 0.023). Subjective mood, however, was not related to serum folate or homocysteine.

This study appears to be the first to uncover an association between long-term folate status and subjective mood (employing the PANAS) in healthy males. More research is needed to further explore the relationship between nutritional status and mood.

The present study describes the consumption patterns of sweetened food and drink products in a Catholic Middle Eastern Canadian community and examines its associations with physical activity, sedentary behaviours and BMI.

A two-stage cross-sectional design was used. In Stage 1 (n 42), 24 h recalls enabled the identification of sweetened products. In Stage 2 (n 192), an FFQ was administered to measure the daily consumption of these products and to collect sociodemographic and behavioural data. Sweetened products were defined as processed culinary ingredients and ultra-processed products for which total sugar content exceeded 20 % of total energy.

Three Catholic Middle Eastern churches located in Montreal, Canada.

Normoglycaemic men and women (18–60 years old).

Twenty-six sweetened products represented an average consumption of 75·4 g total sugars/d or 15·1 % of daily energy intake (n 190, 56 % women). Soft drinks, juices, sweetened coffee, chocolate, cookies, cakes and muffins were the main sources of consumption and mostly consumed between meals. Age (exp (β) = 0·99; P < 0·01), physical activity (exp (β) = 1·08; P < 0·01) and recreational computer use (exp (β) = 1·17; P < 0·01) were independently associated with sweetened product consumption. The association between sweetened product consumption and physical activity was U-shaped. BMI was not significantly associated with sweetened product consumption but all participants regardless of BMI were above the WHO recommendation for free sugars.

Being physically active and spending less time using a computer may favour a reduced consumption of sweetened products. Very active individuals may, however, overconsume such products.

The primary aim was to examine the association of socio-economic factors and diet with overweight (including obesity) among school-aged children in Haiti. The secondary aim was to describe food availability and the physical activity built environment in participating schools.

This cross-sectional study examined baseline data from the intervention Mamba study assessing the effectiveness of a fortified peanut butter paste in school-aged children. Logistic regression modelling was used to test hypothesized factors in association with overweight status.

Six primary schools in Cap-Haitien, the second largest city in Haiti.

Children (n 968) aged 3–13 years, in good health and enrolled in a participating school for the 2012/13 school year.

Child age (adjusted OR (AOR); 95 % CI=0·25; 0·12, 0·56), child age squared (1·08; 1·03, 1·13), always purchasing food at school (3·52; 1·12, 11·08), mother’s BMI (1·10; 1·04, 1·16) and household ownership of a bicycle (0·28; 0·11, 0·71) were significantly associated with overweight (likelihood ratio=36, P<0·0001). Consumption of fish was significantly lower in overweight children in the binary analysis (P=0·033) and improved the fit of the model. Schools had limited time and space for physical activity and foods sold by vendors were predominantly high in sugar or fat.

To our knowledge the present study is the first to examine the covariates of childhood overweight or describe school food availability and physical activity built environments in Haiti. Further research is necessary to identify intervention targets and feasible, cost-effective approaches for prevention of obesity in Haiti children.

Game bird consumption is an important part of the diet of Indigenous populations in Canada and, as part of country food consumption, is associated with improved nutritional status. The objective of this project was to document the consumption of game birds for Dene First Nations in the Northwest Territories (NWT), Canada.

Participants were invited to complete a FFQ using an iPad to document the types of country foods consumed, as well as consumption frequency and preparation methods, including thirteen types of game birds.

The project was implemented in nine communities in the Dehcho and Sahtú regions of the NWT, Canada.

A total of 237 children and adult participants from Dene First Nations in the Mackenzie Valley region of the NWT took part in the current study.

FFQ findings indicated that game birds were frequently consumed in both Dehcho and Sahtú communities. Canada goose and mallard were found to be consumed by the largest number of participants. Five different species (including Canada goose and mallard) were found to be consumed by at least 25 % of participants over the last year. When consuming game birds, most participants reported consuming the meat as well as most, if not all, other parts of the bird.

Differences were observed since the last country food assessment in the 1990s in the same regions. These findings increase knowledge of the current Dene diet patterns and support the understanding of diet transition.

To document food acquisition experiences during Iraqi military occupation in Kuwait.

Retrospective cross-sectional study.

Urban areas in Kuwait during occupation.

Those living in Kuwait during the period of occupation, and aged between 15 to 50 years at the time of occupation, recruited by snowball sampling. A total of 390 completed questionnaires (response rate 78 %, 202 female and 188 male) were returned.

During the occupation, food became increasingly difficult to acquire. Two food systems emerged: (i) an underground Kuwaiti network linked to foods recovered from local food cooperatives and (ii) a black market supplied by food imported through Iraq or stolen locally. Food shortages led to reductions in meal size and frequency. Some respondents (47·7 %) reported not having sufficient income to purchase food and 22·1 % had to sell capital items to purchase food. There was a significant increase (P<0·01) in home production, with 23·1 % of people growing vegetables and 39·0 % raising animals to supplement food needs. Reduction in food wastage also emerged as a significant self-reported behaviour change. Respondents reported deterioration in the quality and availability of fish, milk, and fruit in particular. Despite a decrease in opportunities for physical activity, most respondents reported that they lost weight during the occupation.

Although the Kuwaiti population fell by about 90 % and domestic food production increased during the 7-month occupation, the local population continued to rely heavily on imported food to meet population needs. The high prevalence of self-reported weight loss indicates the inadequacies of this food supply. High apparent food security in systems which significantly exceed the ecological carrying capacity of the local environment and rely on mass food importation remains vulnerable.

Federal law requires calorie information on chain restaurant menus. We sought to assess the prevalence of calorie disclosures on online menus and determine if the menus are controlled by restaurants subject to US labelling requirements.

Cross-sectional

Restaurant websites and mobile apps for restaurant located in New York City, Los Angeles, Chicago, and Houston

US chain restaurants (top seventy-five by number of outlets) and third-party platforms (TPP): Grubhub, Uber Eats, DoorDash

There was at least one calorie disclosure (for at least one food or beverage, in at least one location) on sixty-eight of seventy-two (94 %) menus on restaurant websites or apps, thirty-two of fifty-five (58 %) menus on DoorDash, six of forty-nine (12 %) menus on Grubhub and thirty of fifty-nine (51 %) menus on Uber Eats. There was consistent calorie labelling (all foods and beverages, all locations) on forty-three of seventy-two (60 %) menus on restaurant websites or apps, fifteen of fifty-five (27 %) menus on DoorDash, three of forty-nine (6 %) menus on Grubhub and eleven of fifty-nine (19 %) menus on Uber Eats. Only four restaurant chains consistently labelled calories for all items, in all locations, on all platforms where their menus were found. All three TPP provided restaurants the ability to enter and modify menu items, making the menus subject to US labelling requirements. Only Uber Eats provided guidance to restaurants on entering calorie information.

As consumers increasingly rely on TPP for restaurant ordering, menus on these platforms should include calories in order to promote transparency and nutrition.

To simulate the impact that Na reductions in food categories that are the largest contributors to dietary Na intake would have on population Na intake from packaged foods among US adults and children.

24 h Dietary recall data were used. For each store-bought packaged food product reported by participants, we generated sales-weighted Na content at the median and 25th percentile using Nutrition Facts Panel data from 193 195 products purchased by US households. The impact that Na reductions would have on population Na intake, overall and by sociodemographic subgroup, was examined.

US households.

Children aged 2–18 years (n 2948) and adults aged >18 years (n 4878), 2011–2012 National Health and Nutrition Examination Survey.

Na intake from packaged foods was 1258 (se 21) mg for adults and 1215 (se 35) mg for children. Top-ten packaged food group sources contributed 67 % of Na intake. For adults and children, there was a decrease of 8·7 % (109 mg) and 8·0 % (97 mg), respectively, in Na intake if the top-ten sources reduced Na from the median to the 25th percentile. Although absolute reduction in intake varied between sociodemographic subgroups, significant differences were not observed.

The study demonstrated that if Na reduction shifted the top-ten packaged food group sources of dietary Na intake from the median to 25th percentile, population Na intake would be reduced by 9 % in US adults and children. These findings will help inform the US government’s Na reduction targets, as well as policy makers’ understanding of differences in intake of critical sub-populations in the USA.

In view of the fact that height differences between socio-economic groups are apparent early in childhood, it is of interest to examine whether skeletal growth is reflective of the social class gradient in CVD risk. The present study examined blood pressure levels, adiposity and growth of adolescent boys from high and low social classes.

In a cross-sectional study, skeletal growth (height and sitting height), adiposity (weight, BMI and body fat) and blood pressure levels of the adolescents were measured.

Pune, India.

Adolescent schoolboys (9–16 years) from high socio-economic (HSE; n 1146) and low socio-economic (LSE; n 932) class.

LSE boys were thin, short and undernourished (mean BMI: 15·5 kg/m2v. 19·3 kg/m2 in HSE boys, P = 0·00). Social gradient was revealed in differing health risks. The prevalence of high systolic blood pressure (HSBP) was high in HSE class (10·5 % v. 2·7 % in LSE class, P = 0·00) and was associated with adiposity, while the prevalence of high diastolic blood pressure (HDBP) was high in LSE class (9·8 % v. 7·0 % in HSE class, P = 0·00) and had only a weak association with adiposity. Despite this, lower ratio of leg length to height was associated with significantly higher respective health risks, i.e. for HDBP in LSE class (OR = 1·99, 95 % CI 1·14, 3·47) and for HSBP in HSE class (OR = 1·69, 95 % CI 1·02, 2·77).

As stunting in childhood is a major problem in India and Asia, the leg length to height indicator needs to be validated in different populations to understand CVD risks.

We examined associations of urine iodide excretion, proxy for iodine intake, with child development and growth.

This is a secondary analysis of a 1:1 cluster-randomised trial with a 6-month nutrition/stimulation/hygiene education intervention among mothers of children aged 6–8 months to improve child development and growth. Development was assessed using Bayley Scales of Infant and Toddler Development–III (BSID-III) and Ages and Stages Questionnaire (ASQ), whereas anthropometry was used to assess growth. Urine iodide concentration (UIC) and urine iodide/creatinine ratio (ICR) were measured.

The current study was conducted in southern Uganda.

We randomly selected 155 children from the 511 enrolled into the original trial and analysed data when they were aged 20–24 and 36 months.

Median UIC for both study groups at 20–24 and 36 months were similar (P > 0·05) and within the normal range of 100–199 µg/l (0·79–1·60 µmol/l), whereas the intervention group had significantly higher ICR at 20–24 months. The BSID-III cognitive score was positively associated (P = 0·028) with ICR at 20–24 months in the intervention group. The ASQ gross motor score was negatively associated (P = 0·020) with ICR at 20–24 months among the controls. ICR was not significantly associated with anthropometry in the two study groups at either time-point.

Following the intervention, a positive association was noted between ICR and child’s cognitive score at 20–24 months, whereas no positive association with ICR and growth was detected. Iodine sufficiency may be important for child’s cognitive development in this setting.

To disrupt cycles of health inequity, traceable to dietary inequities in the earliest stages of life, public health interventions should target improving nutritional wellbeing in preconception/pregnancy environments. This requires a deep engagement with pregnant/postpartum people (PPP) and their communities (including their health and social care providers, HSCP). We sought to understand the factors that influence diet during pregnancy from the perspectives of PPP and HSCP, and to outline intervention priorities.

We carried out thematic network analyses of transcripts from ten focus group discussions (FGD) and one stakeholder engagement meeting with PPP and HSCP in a Canadian city. Identified themes were developed into conceptual maps, highlighting local priorities for pregnancy nutrition and intervention development.

FGD and the stakeholder meeting were run in predominantly lower socioeconomic position (SEP) neighbourhoods in the sociodemographically diverse city of Hamilton, Canada.

All local, comprising twenty-two lower SEP PPP and forty-three HSCP.

Salient themes were resilience, resources, relationships and the embodied experience of pregnancy. Both PPP and HSCP underscored that socioeconomic-political forces operating at multiple levels largely determined the availability of individual and relational resources constraining diet during pregnancy. Intervention proposals focused on cultivating individual and community resilience to improve early-life nutritional environments. Participants called for better-integrated services, greater income supports and strengthened support programmes.

Hamilton stakeholders foregrounded social determinants of inequity as main factors influencing pregnancy diet. They further indicated a need to develop interventions that build resilience and redistribute resources at multiple levels, from the household to the state.

The primary purpose of the current study was to establish Turkish smoothed centile charts and Lambda, Mu, Sigma (LMS) tables for four-site skinfold thickness based on a population-based sample, and secondary purpose was to elaborate a reference for the percentage of body fat.

A cross-sectional and descriptive study was conducted between January and May 2017. Triceps, biceps and subscapular, suprailiac skinfold thicknesses were measured using Holtain skinfold caliper. Age- and gender-specific percentile values were determined with the LMS method, and body fat percentage was calculated using the Westrate and Deurenberg equation.

Afyonkarahisar province in Turkey.

The current study was conducted on 4565, 6–18-year-old students.

The triceps, biceps and subscapular skinfolds of the girls were higher than the boys. From the age of seven, the sum of four skinfold thicknesses of the girls was more than those of the boys. This difference became more evident after the age of 12. Although fat percentages of girls showed a fluctuating change, it decreased with the age in boys. Westrate and Deurenberg equation fat percentages of girls until adolescence were lower than boys, but increased after 12 years of age and exceeded that of boys.

The current study has provided sex- and age-specific reference values for skinfold thickness and has shown that obesity in girls is higher than in boys in schoolchildren in Afyonkarahisar. The current study has also shown that skinfold thickness measurements are a valuable tool for screening obesity in children.

To investigate the effects of providing free fruit and snack vegetables at a university on students’ fruit intake, snack vegetable intake and total vegetable intake.

Free fruit and raw snack vegetables (e.g. bite-sized tomatoes) were provided in a stand in the form of a miniature wooden house located in the central hall of the university’s main building, which students regularly pass through on their way to lectures and the cafeteria. Three interventions tested with a pre-test/post-test design were performed. In these three interventions, small changes to the appearance of the stand were made, such as placing potted plants around it. Demographic characteristics and fruit and vegetable intakes were assessed with questionnaires.

A Dutch university of applied science.

Intervention 1 included 124 students; Intervention 2 included ninety-two students; Intervention 3 included 237 students.

Longitudinal linear regression analyses showed that post-test snack vegetable intake was consistently higher compared with pre-test. In the three interventions, post-test snack vegetable intakes were between 11 and 14 g/d higher than at the pre-test, which is comparable to three bite-sized tomatoes. No differences in fruit intake or total vegetable intake were found. Subgroup analyses showed that, in all three interventions, students with the lowest pre-test fruit intake and total vegetable intake reported the largest increase in fruit intake and snack vegetable intake after the interventions.

Providing free fruit and vegetables to students at their university might be beneficial for those with low habitual intakes.

To examine food and beverage purchasing patterns across formal and informal outlets among Mexican households’ and explore differences by urbanicity and income.

Cross-sectional study of a nationally representative sample of households. We calculated the proportion of total food and beverage expenditure in each household by food outlet type overall and by urbanicity and income. We defined informal outlets as those which are not registered or regulated by tax and fiscal laws. Since some of the outlets within community food environments do not fall in clear categories, we defined a continuum from formal to informal outlets, adding mixed outlets as a category.

Mexico.

Mexican households (n 74 203) from the 2018 National Income and Expenditure Survey.

Of the total food and beverage purchases, outlets within the formal food sector (i.e. supermarkets and convenience stores) accounted for 15 % of the purchases, 13 % of purchases occurred in outlets within the informal food sector (i.e. street markets, street vendors and acquaintances) and 70 % in fiscally mixed outlets (i.e. small neighbourhood stores, specialty stores and public markets). Across levels of urbanicity and income, most food and beverage purchases occurred in mixed outlets. Also, purchases in informal and mixed outlets decreased as levels of urbanicity and income increased. In contrast to informal outlets, purchases in formal outlets were most likely from richer households and living in larger sized cities.

Understanding where Mexican households shop for food is relevant to create tailored interventions according to food outlet type, accounting for regulatory and governance structures.