This study aimed to dynamically model and quantify expected health effects of four scenarios: (i) a reference scenario with an unchanged fruit and vegetable intake, (ii) the removal of value-added tax (VAT) on fruits and vegetables, (iii) the implementation of a 20 % subsidy on fruits and vegetables and (iv) a guideline scenario with a population-wide fruit and vegetable intake of five portions per day.

Baseline fruit and vegetable intake data was derived from the GEDA 2012 study. We used price elasticities for Germany to calculate the change in fruit and vegetable consumption under the zero VAT and the 20 % subsidy scenario. All scenarios were modelled over a 10-year projection period using DYNAMO-HIA.

Germany.

A projected real-life population.

Cumulated over the 10-year projection period, an estimated 4450 incident ischaemic heart disease (IHD) cases, 7010 stroke cases and 13 960 deaths would be prevented under the zero VAT scenario. Under the 20 % subsidy scenario, 17 990 incident IHD cases, 27 390 stroke cases and 54 880 deaths would be averted. Although this corresponds to only a fraction of the incidents that would occur under the reference scenario, the averted cases translate to 2 % (for the zero VAT scenario) and 9 % (for the 20 % subsidy scenario) of IHD, stroke and death cases that would be prevented if the whole population consumed the recommended five portions of fruits and vegetables per day.

Fiscal policies on fruits and vegetables provide a non-negligible step towards the removal of the health burden induced by low fruit and vegetable intake.

The face and construct validity of the Iranian version of the Yale Food Addiction Scale (YFAS) was evaluated, and the convergent validity and test–retest reliability of both Iranian and original versions of YFAS for obese women were assessed.

The internal consistency of the YFAS was analysed. Exploratory factor analysis for dichotomous data was performed by varimax rotation, polychoric correlation coefficients and confirmatory factor analysis (CFA). Convergent validity was established by evaluating the correlation between the original and the Iranian versions of YFAS and the Binge Eating Scale (BES). The intraclass correlation coefficient (ICC) was measured between test–retest results.

A weight management clinic in Tehran.

450 obese women.

The single-factor structure indicated that the factor loadings for all the items were > 0·5, except for three items (explained proportion variance = 51 %). Based on CFA, the single factor had a better fit to the data after excluding three items. The Kuder–Richardson-20 coefficient was 0·86 for the total twenty-two items. The symptom count and diagnostic version of both the Iranian (ICC = 0·92 and 0·87, respectively) and original YFAS (ICC = 0·92 and 0·86, respectively) were stable over 2 weeks. Both the symptom count and the diagnostic version of these two scales had significant correlations with the measures of BES (P < 0·001).

The initial reliability and validity of the Iranian version of the YFAS among obese women are supported. Further studies should be conducted on men and normal/overweight samples.

Rates of premature mortality have been higher in Scotland than in England since the 1970s. Given the known association of diet with chronic disease, the study objective was to identify and synthesise evidence on current and historical differences in food and nutrient intakes in Scotland and England.

A rapid review of the peer-reviewed and grey literature was carried out. After an initial scoping search, Medline, CINAHL, Embase and Web of Science were searched. Relevant grey literature was also included. Inclusion criteria were: any date; measures of dietary intake; representative populations; cross-sectional or observational cohort studies; and English-language publications. Study quality was assessed using the Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. A narrative synthesis of extracted information was conducted.

Fifty publications and reports were included in the review. Results indicated that children and adults in Scotland had lower intakes of vegetables and vitamins compared with those living in England. Higher intakes of salt in Scotland were also identified. Data were limited by small Scottish samples, difficulty in finding England-level data, lack of statistical testing and adjustment for key confounders.

Further investigation of adequately powered and analysed surveys is required to examine more fully dietary differences between Scotland and England. This would provide greater insight into potential causes of excess mortality in Scotland compared with England and suitable policy recommendations to address these inequalities.

Both physical activity (PA) and diet are important contributors to health and well-being; however, there is limited information on the association of these behaviours and whether observed associations differ by weight. The present study aimed to evaluate whether nutrient intake is associated with PA and if this association varies by weight in young adults.

Cross-sectional study to analyse the association between PA and nutrient intake.

Participants were stratified as normal weight (18·5 kg/m2 <BMI <25·0 kg/m2) and overweight/obese (BMI≥25·0 kg/m2). PA level (PAL) was calculated (PAL=total daily energy expenditure/RMR) and used to stratify groups (PAL<1·6, 1·6≤PAL<1·9, PAL≥1·9).

Adults (n 407; age 27·6 (sd 3·8) years, 48 % male), with BMI between 20 and 35 kg/m2, having at least two 24 h diet recalls and at least 5 d (including two weekend days) of valid, objectively measured PA data were included in the analysis.

In normal-weight participants, higher PAL was associated with higher intakes of minerals (except Ca, Fe and Zn), B-vitamins and choline (P for trend <0·05). In the overweight/obese group, higher PAL was associated with higher intakes of fibre, K, Na and Cu (P for trend <0·05). These differences, however, were no longer significant after additionally controlling for total energy intake.

More active young adults have higher intakes of essential micronutrients. The benefits of PA may be predominantly due to a higher overall food intake while maintaining energy balance rather than a healthier diet.

To investigate the effect of different feeding patterns on the occurrence of diseases among infants.

Data on socio-economic status, feeding patterns before 6 months (exclusive breast-feeding (EBF); mixed feeding with breast milk and formula (MBF); exclusive formula-feeding (EFF)) and illness of infants were collected via face-to-face interviews. The proportions of infants who had ever been ill or hospitalized and their potential influence factors were investigated.

Eight large cities in China.

Infants (n 1654) aged 0–11·9 months were recruited from hospitals.

For infants aged 0–2·9 months, the percentage who had been ill was 19·2 %, 24·1 % and 26·3 % among the EBF, MBF and EFF groups, respectively. For those aged 3–5·9 and 6–11·9 months, the corresponding percentages were 41·6 %, 45·6 % and 51·0 %, and 67·0 %, 73·4 % and 67·7 %. Respiratory disease was the most common reported illness and cause of hospitalization. The risks of having (total) illness, diarrhoea and respiratory disease increased significantly with age, but not allergic disease. Compared with EBF, MBF and EFF infants had significantly higher risks of having illnesses except for allergic disease, and feeding patterns were not related to hospitalization. Low birth weight, middle family income and low level of mother’s education also increased the risk of illness.

A protective effect of EBF against total illness in urban Chinese infants was found. An increasing trend with age was observed among the percentages of infants who had been ill or had diarrhoea or respiratory disease, but not allergic disease.

We describe diet quality by demographic factors and weight status among Barbadian children and examine associations with excess energy intake (EI). A screening tool for the identification of children at risk of excess EI was developed.

In a cross-sectional survey, the Diet Quality Index–International (DQI-I) was used to assess dietary intakes from repeat 24h recalls among 362 children aged 9–10 years. Participants were selected by probability proportional to size. A model to identify excess energy intake from easily measured components of the DQI-I was developed.

Barbados.

Primary-school children in Barbados.

Over one-third of children were overweight/obese, and mean EI for boys (8644 (se 174·5) kJ/d (2066 (se 41·7) kcal/d)) and girls (8912 (se 169·9) kJ/d (2130 (se 40·6) kcal/d)) exceeded the RDA. Children consuming a variety of food groups, more vegetables and fruits, and lower percentage energy contribution from empty-calorie foods showed reduced likelihood of excess EI. Intake of more than 2400 mg Na/d and higher macronutrient and fatty acid ratios were positively related to the consumption of excess energy. A model using five DQI-I components (overall food group variety, variety for protein source, vegetables, fruits and empty calorie intake) had high sensitivity for identification of children at risk of excess EI.

Children’s diet quality, despite low intakes of fruit and vegetables, was within acceptable ranges as assessed by the DQI-I and RDA; however, portion size was large and EI high. A practical model for identification of children at risk of excess EI has been developed.

We wanted to identify factors related to dietary behavioural change among impoverished pregnant women in the face of nutrition education and counselling, describing what creates an enabling environment and barriers for dietary change.

We used qualitative data from a cluster-randomised maternal education trial and conducted a thematic analysis using a social ecological framework to describe the factors that influenced dietary adherence.

Mangochi district in rural Malawi.

We interviewed ten pregnant women and conducted four sets of focus group discussions with twenty-two significant family members (husbands and mothers-in-law) and twelve counsellors.

The participants’ experiences showed that the main barriers of adherence to the intervention were taste, affordability and poverty. The use of powders and one-pot dishes, inclusion of both women and significant family members and a harmonisation with local food practices enabled adherence to the intervention. We found it crucial to focus the dietary education and counselling intervention on locally available ingredients and food processing methods.

Use of contextualised food-based solutions to combat maternal malnutrition was observed to be relatively cheap and sustainable. However, there is need for more research on local foods used as nutrition supplements. We suggest that investments need to be directed not only to nutrition education and counselling but also to the enabling factors that enhance adherence. The original cluster-randomised controlled trial was registered with Clinical trials.gov ID: NCT03136393.

To obtain a set of reference values for the intake of different types of dietary fibre in a healthy UK population.

This descriptive cross-sectional study used the UK Biobank data to estimate the dietary patterns of healthy individuals. Data on fibre content in different foods were used to calculate the reference values which were then calibrated using real-world data on total fibre intake.

UK Biobank is a prospective cohort study of over 500 000 individuals from across the United Kingdom with the participants aged between 40 and 69 years.

UK Biobank contains information on over 500 000 participants. This study was performed using the data on 19 990 individuals (6941 men, 13 049 women) who passed stringent quality control and filtering procedures and had reported above-zero intake of the analysed foods.

A set of reference values for the intake of six different types of soluble and insoluble fibres (cellulose, hemicelluloses, pectin and lignin), including the corresponding totals, was developed and calibrated using real-world data.

To our knowledge, this is the first study to establish specific reference values for the intake of different types of dietary fibre. It is well known that effects exerted by different types of fibre both directly and through modulation of microbiota are numerous. Conceivably, a deficit or excess intake of specific types of dietary fibre may detrimentally affect human health. Filling this knowledge gap opens new avenues for research in discussion in studies of nutrition and microbiota and offers valuable tools for practitioners worldwide.

To compare the performance of the commonly used 24 h recall (24hR) with the more distinct duplicate portion (DP) as reference method for validation of fatty acid intake estimated with an FFQ.

Intakes of SFA, MUFA, n-3 fatty acids and linoleic acid (LA) were estimated by chemical analysis of two DP and by on average five 24hR and two FFQ. Plasma n-3 fatty acids and LA were used to objectively compare ranking of individuals based on DP and 24hR. Multivariate measurement error models were used to estimate validity coefficients and attenuation factors for the FFQ with the DP and 24hR as reference methods.

Wageningen, the Netherlands.

Ninety-two men and 106 women (aged 20–70 years).

Validity coefficients for the fatty acid estimates by the FFQ tended to be lower when using the DP as reference method compared with the 24hR. Attenuation factors for the FFQ tended to be slightly higher based on the DP than those based on the 24hR as reference method. Furthermore, when using plasma fatty acids as reference, the DP showed comparable to slightly better ranking of participants according to their intake of n-3 fatty acids (0·33) and n-3:LA (0·34) than the 24hR (0·22 and 0·24, respectively).

The 24hR gives only slightly different results compared with the distinctive but less feasible DP, therefore use of the 24hR seems appropriate as the reference method for FFQ validation of fatty acid intake.

To investigate the ability of each metabolic syndrome (MetS) criterion, defined by the International Diabetes Federation, to predict insulin resistance (IR).

A cross-sectional study. IR was defined as homeostasis model assessment of IR (HOMA-IR) ≥3·04. The MetS criteria considered were TAG ≥ 1·69 mmol/l, HDL cholesterol (HDL-C) <1·29 mmol/l, blood pressure (BP) ≥130/85 mmHg and fasting glucose (FG) ≥5·6 mmol/l.

Busan, South Korea.

Ninety-six apparently healthy Korean women (mean age 42 (sd 10·6) years) with abdominal obesity (waist circumference (WC) ≥80 cm) were studied.

Of the ninety-six obese women, 11 % were insulin-resistant and 33 % fulfilled the criteria for IDF-defined MetS. Glucose and TAG were more likely to predict IR than BP and HDL-C when assessed using receiver-operating characteristic curves, multiple regression and multiple logistic regression analyses. Of the variation in HOMA-IR, TAG, FG, WC and age explained 42 %. High FG was independently associated with the presence of IR (OR = 8·6, 95 % CI 1·8, 41·8) even after adjusting for other components of MetS. The positive predictive value and positive likelihood ratio to detect IR were the highest for the FG criterion (33 % and 3·9, respectively), followed by TAG (28 %, 3·0), BP (19 %, 1·8) and HDL-C criteria (18 %, 1·7). The IDF definition of MetS exhibited a positive predictive value of 29 % and a positive likelihood ratio of 3·1.

Of the MetS criteria, high FG and high TAG seem to be more suitable for identifying obese women with IR than high BP and low HDL-C.

To describe trends across the intake distribution of total, manufactured and homemade sugar-sweetened beverages (SSB) from 1999 to 2012, focusing on high SSB consumers and on changes by socio-economic status (SES) subgroup.

We analysed data from one 24 h dietary recall from two nationally representative surveys. Quantile regression models at the 50th, 75th and 90th percentiles of energy intake distribution of SSB were used.

1999 Mexican National Nutrition Survey and 2012 Mexican National Health and Nutrition Survey.

School-aged children (5–11 years) and women (20–49 years) for trend analyses (n 7718). Population aged >1 year for 2012 (n 10 096).

Over the 1999–2012 period, there were significant increases in the proportion of total and manufactured SSB consumers (5·7 and 10·7 percentage points), along with an increase in per-consumer SSB energy intake, resulting in significant increases in per-capita total SSB energy intake (142, 247 and 397 kJ/d (34, 59 and 95 kcal/d) in school-aged children and 155, 331 and 456 kJ/d (37, 79 and 109 kcal/d) in women at the 50th, 75th and 90th percentile, respectively). Total and manufactured SSB intakes increased sharply among low-SES children but remained similar among high-SES children during this time span.

Large increases in SSB consumption were seen between 1999 and 2012 during this pre-tax SSB period, particularly for the highest consumers. Trends observed in school-aged children are a clear example of the nutrition transition experienced in Mexico. Policies to discourage high intake of manufactured SSB should continue, joined with strategies to encourage water and low-calorie beverage consumption.

To evaluate the effectiveness of a social marketing intervention in enhancing knowledge, attitudes and practice (KAP) related to consumption of vitamin A-fortified oil.

The intervention employed community events, distribution of educational materials and radio broadcasts. The intervention was assessed in a quasi-experimental non-equivalent control group study design by collecting information on KAP regarding vitamin A-fortified oil consumption before and after 9 months of a 13-month intervention.

Six districts in Manyara and Shinyanga regions in Tanzania were non-randomly selected as the intervention districts and two districts served as the control districts.

At baseline, 568 lactating mothers with children aged <5 years were randomly selected from the intervention and control districts. Of these, 494 mothers were followed up at endline.

After 9 months of intervention, knowledge of fortification and actual consumption of adequately fortified oil were significantly higher in the intervention districts compared with the control districts (P <0·05). Knowledge of the health benefits of vitamin A improved significantly from about 33 to 45 % in both the intervention and control districts. The major sources of information for women were health clinics and community health workers (CHW).

The study showed that a social marketing intervention is effective in improving KAP regarding fortified oil consumption at the household level. Clinics and CHW are channels that should be prioritized when communicating health messages, particularly those targeting women.

To investigate: (i) how lunch frequency of adolescents varies between schools and between classes within schools; (ii) the associations between frequency of lunch and individual sociodemographic factors and school characteristics; and (iii) if any observed associations between lunch frequency and school characteristics vary by gender and age groups.

Cross-sectional study in which students and school headmasters completed self-administered questionnaires. Associations were estimated by multilevel multivariate logistic regression.

The Danish arm of the Health Behaviour in School-Aged Children study 2010.

Students (n 4922) aged 11, 13 and 15 years attending a random sample of seventy-three schools.

The school-level and class-level variations in low lunch frequency were small (intraclass correlation coefficient <2·1 %). At the individual level, low lunch frequency was most common among students who were boys, 13- and 15-year-olds, from medium and low family social class, descendants of immigrants, living in a single-parent family and in a reconstructed family. School-level analyses suggested that having access to a canteen at school was associated with low lunch frequency (OR=1·47; 95% CI 1·14, 1·89). Likewise not having an adult present during lunch breaks was associated with low lunch frequency (OR=1·44; 95% CI 1·18, 1·75). Cross-level interactions suggested that these associations differed by age group.

Lunch frequency among Danish students appears to be largely influenced by sociodemographic factors. Additionally, the presence of an adult during lunch breaks promotes frequent lunch consumption while availability of a canteen may discourage frequent lunch consumption. These findings vary between older and younger students.

To study the total goitre rate (TGR), urinary iodine concentration (UIC) and salt iodine content among schoolchildren in a previously endemic area for severe iodine deficiency disorder (IDD).

Cross-sectional epidemiological study.

The study was carried out in the Gonda district (sub-Himalayan region) of North India.

Nine hundred and seventy-seven schoolchildren (6–12 years) were studied for parameters such as height, weight, UIC and salt iodine content. Thyroid volume (TV) was measured by ultrasonography to estimate TGR.

The overall TGR in the study population was 2·8 % (95 % CI 1·8, 3·8). No significant difference in TGR was observed between boys and girls (3·5 % v. 1·9 %, P = 0·2). There was a non-significant trend of increasing TGR with age (P = 0·05). Median UIC was 157·1 μg/l (interquartile range: 94·5–244·9). At the time of the study, 97 % of salt sample were iodised and nearly 86 % of salt samples had iodine content higher than or equal to 15 part per million. Overall, TGR was significantly lower (2·8 % v. 31·0 %, P < 0·001), and median UIC was significantly higher (157·1 v. 100·0 μg/l, P < 0·05) than that reported in the same area in 2009.

A marked improvement was seen in overall iodine nutrition in the Gonda district after three and a half decades of Universal Salt Iodisation (USI). To sustainably control IDD, USI and other programmes, such as health education, must be continuously implemented along with putting mechanisms to monitor the programme at regular intervals in place.

To evaluate the correlation among nutritional status, tooth wear and quality of life in Brazilian schoolchildren.

The study followed a cross-sectional design. Nutritional status was measured via anthropometry using BMI and tooth wear was measured using the Dental Wear Index; both these assessments were carried out by a trained recorder according to standard criteria. A modified version of the Child Oral Impacts on Daily Performances was used to assess quality of life.

City of Bauru, in Brazil.

A cluster sample of 396 schoolchildren (194 boys and 202 girls) aged 7–10 years.

The anthropometric assessment showed similar situations for both sexes regarding underweight (31·40 % in boys and 30·20 % in girls) and overweight/obesity (33·96 % in boys and 33·17 % in girls). The underweight children showed a greater severity of tooth wear in the primary teeth (OR=0·72; CI 0·36, 1·42), although in the permanent dentition the obese children had a greater severity of tooth wear (OR=1·42; 95 % CI 0·31, 6·55). The tooth wear was correlated with age for both dentitions.

Tooth wear in the primary and permanent dentition may be related to nutritional status. Tooth wear and obesity did not have a significant impact on the schoolchildren’s perception of quality of life.

Few studies have been conducted to investigate the influence of recombinant human erythropoietin (rhEPO) on the long-term prognosis of end-stage renal disease (ESRD).

A retrospective cohort study.

The largest regional hospital renowned for haemodialysis in northern Taiwan.

A total of 702 ESRD patients undergoing haemodialysis between 1993 and 2002 were evaluated.

The rate of overall use of rhEPO, vitamin D3 or Fe therapy was 62 %. The 10-year survival rate in patients with rhEPO supplementation was statistically more favourable than that in patients without rhEPO (hazard ratio (HR) = 0·38, 95 % CI 0·30, 0·47, P < 0·0001). Similar findings were noted for patients receiving vitamin D3 (HR = 0·36, 95 % CI 0·21, 0·64, P = 0.0004) and Fe (HR = 0·45, 95 % CI 0·33, 0·61, P < 0·0001). After adjusting for age, education and aetiology, the administration of rhEPO resulted in statistically significant improvements in long-term survival rate either with (HR = 0·30, 95 % CI 0·22, 0·42) or without (HR = 0·48, 95 % CI 0·38, 0·61) combined use of Fe or vitamin D3.

We demonstrated a reduction in long-term mortality related to supplementation therapy with rhEPO, vitamin D3 and Fe. The findings provide a justification for the administration of combined supplement therapy in patients undergoing haemodialysis.

To assess the factors associated with overweight and obesity among women of childbearing age in Brazil.

Cross-sectional study.

Using the National Health Survey (PNS) database, from the year 2013. The socio-economic and demographic factors analysed were age, race/skin colour, region, marital status, education level, employment and family income. Concerning health history, diagnoses of hypertension, diabetes mellitus, high cholesterol, heart attack, stroke, chronic kidney disease, menarche, parity and depression were evaluated. For lifestyle information, health status, alcoholic beverage consumption, smoking and physical activity were included. The outcomes were obesity and overweight. The association of excess weight with socio-economic and demographic factors, health history and lifestyle characteristics was investigated according to the appropriate theoretical–conceptual model for the topic.

The sample size was 17 109 women aged 18–49 years.

The prevalence of women with excess weight was 55·20 %, with 33·26 % being overweight and 21·94 % with obesity. The factors associated with excess weight were age, non-white skin colour, having a partner, family income of up to two minimum wages, menarche before the age of 12, multiparity, diabetes mellitus, depression, hypertension, high cholesterol, stroke and heart attack.

The results showed an association between excess weight and socio-demographic factors, both determinants of general and reproductive health history. Implementation of effective public health policies is necessary to prevent unfavourable outcomes related to the health of women of childbearing age with excess weight.