Concerns have been raised about the potential health impact of ultra-processed foods (UPF) in the diet. Our objective was to investigate the contribution of UPF in the diet in a large French population and its association with sociodemographic factors and dietary patterns.

Cross-sectional analysis of dietary data from 74 470 participants in the web-based NutriNet-Santé cohort. UPF were identified in repeated 24 h records and the proportion (in weight) of UPF in the total diet (UPFp) was computed for each participant. Associations of sociodemographic characteristics and UPFp in quartiles were assessed using multivariate multinomial logistic regression. Food group consumption and nutrient intakes across quartiles of UPFp were estimated using linear regression adjusted for sociodemographic factors and energy intake.

France.

UPF contributed 18·4 % of the foods consumed in weight and 35·9 % of total energy intake. Higher UPFp consumption was independently associated with male gender, younger age, lower education, smoking, and overweight and obesity (all P<0·0001). Participants in the highest UPFp quartile consumed lower amounts of fruit and vegetables (difference between quartile 4 and quartile 1 of UPFp, Δ=−180·3 g/d) and higher amounts of sweet products (Δ=68·5 g/d) and soft drinks (Δ=98·6 g/d; all P<0·0001). They had higher intakes of energy (Δ=610 kJ/d (145·7 kcal/d)) and added sugar (Δ=17·1 g/d), and lower intakes of fibre (Δ=−4·04 g/d), β-carotene (Δ=−1019·6 μg/d) and Ca (Δ=−87·8 mg/d; all P<0·0001).

UPF represent an important part of the diet in adults from the French general population and are associated with unbalanced nutritional intakes.

To determine whether socio-economic groups differ in their fruit and vegetable consumption, and the variety eaten, and whether socio-economic differences are similar for adolescents and adults. The study also examined whether socio-economic groups vary in their reported desire to increase the amount of fruit and vegetables consumed, and the perceived barriers to achieving this.

Design, setting and subjects: The 1995 Australian National Nutrition Survey collected fruit and vegetable intake data from adolescents aged 13–17 years (n = 654) and adults 18–64 years (n = 7695) using a 24-hour dietary recall. Gross annual household income was used to measure socio-economic position.

Approximately 44% of males and 34% of females did not consume fruit in the 24 hours preceding the survey, and 20% of males and 17% of females did not consume vegetables. Among adolescents and adults, fruit and vegetable consumption was positively related to income. The only exception was vegetable consumption among adolescent males, which did not vary by income Lower-income adults consumed a smaller variety of fruits and vegetables than their higher-income counterparts. Fruit and vegetable variety did not vary by income among adolescents. Lower-income adults expressed less desire to increase their fruit and vegetable consumption, and were more likely to report that price and storage were barriers to doing so. Socio-economic differences in consumption and variety were more apparent for adults than for adolescents.

In addition to increasing the consumption of fruits and vegetables among the general population, nutrition interventions, programmes and policy aiming to improve diet should target adolescents and adults from low socio-economic groups. Strategies should address price and storage barriers.

To assess the prevalence and identify possible predictors of food insecurity among college students at the University of Hawai’i at Mānoa.

Cross-sectional survey, including the US Department of Agriculture’s Household Food Security Survey Module, demographic and spending variables.

University of Hawai’i at Mānoa, Honolulu, Hawai’i (USA).

Four hundred and forty-one non-freshmen students from thirty-one randomly selected classes.

Twenty-one per cent of students surveyed were food-insecure, while 24 % were at risk of food insecurity. Students at higher risk of food insecurity included those who reported living on campus and those living off-campus with room mates. Those identifying themselves as Hawaiians and Pacific Islanders, Filipinos and mixed were also at increased risk of food insecurity.

Food insecurity is a significant problem among college students at the University of Hawai’i at Mānoa. Food availability and accessibility should be increased for these students through the establishment of on-campus food banks and student gardens. Future studies should assess the prevalence of food insecurity in other college campuses nationwide.

Non-pharmacological approaches to the treatment of depression and anxiety are of increasing importance, with emerging evidence supporting a role for lifestyle factors in the development of these disorders. Observational evidence supports a relationship between habitual diet quality and depression. Less is known about the causative effects of diet on mental health outcomes. Therefore a systematic review was undertaken of randomised controlled trials of dietary interventions that used depression and/or anxiety outcomes and sought to identify characteristics of programme success.

A systematic search of the Cochrane, MEDLINE, EMBASE, CINAHL, PubMed and PyscInfo databases was conducted for articles published between April 1971 and May 2014.

Of the 1274 articles identified, seventeen met eligibility criteria and were included. All reported depression outcomes and ten reported anxiety or total mood disturbance. Compared with a control condition, almost half (47 %) of the studies observed significant effects on depression scores in favour of the treatment group. The remaining studies reported a null effect. Effective dietary interventions were based on a single delivery mode, employed a dietitian and were less likely to recommend reducing red meat intake, select leaner meat products or follow a low-cholesterol diet.

Although there was a high level of heterogeneity, we found some evidence for dietary interventions improving depression outcomes. However, as only one trial specifically investigated the impact of a dietary intervention in individuals with clinical depression, appropriately powered trials that examine the effects of dietary improvement on mental health outcomes in those with clinical disorders are required.

We describe the methods used to develop and score a 17-item ‘screener’ designed to estimate intake of fruit and vegetables, percentage energy from fat and fibre. The ability of this screener and a food-frequency questionnaire (FFQ) to measure these exposures is evaluated.

Using US national food consumption data, stepwise multiple regression was used to identify the foods to be included on the instrument; multiple regression analysis was used to develop scoring algorithms. The performance of the screener was evaluated in three different studies. Estimates of intakes measured by the screener and the FFQ were compared with true usual intake based on a measurement error model.

US adult population.

For development of instrument, n = 9323 adults. For testing of instrument, adult men and women in three studies completing multiple 24-hour dietary recalls, FFQ and screeners, n = 484, 462 and 416, respectively.

Median recalled intakes for examined exposures were generally estimated closely by the screener. In the various validation studies, the correlations between screener estimates and estimated true intake were 0.5–0.8. In general, the performances of the screener and the full FFQ were similar; estimates of attenuation were lower for screeners than for full FFQs.

When coupled with appropriate reference data, the screener approach described may yield useful estimates of intake, for both surveillance and epidemiological purposes.

Diet has a significant impact on health, and ensuring that the population eats a healthy diet remains a public health challenge. Research is needed in order to improve the palatability of a healthy diet and make it attractive to the consumer. It has also been suggested that dietary recommendations should be tailored to regional conditions. The OPUS (Optimal well-being, development and health for Danish children through a healthy New Nordic Diet) project investigates whether it is possible to develop a healthy New Nordic Diet (NND) that is palatable, environmentally friendly and based on foods originating from the Nordic region. The present paper describes the overall guidelines for the NND, developed and investigated in the multidisciplinary, 5-year OPUS research project. All guidelines are described in relation to the key principles: health, gastronomic potential and Nordic identity, and sustainability.

The NND is described by the overall guidelines: (i) more calories from plant foods and fewer from meat; (ii) more foods from the sea and lakes; and (iii) more foods from the wild countryside. These overall guidelines result in a set of proposed dietary components which will be presented in a subsequent paper.

Both the guidelines and the diet are composed taking the potential health-promoting properties and Nordic identity of the NND into account, as well as concern for environmental issues and gastronomic potential.

To describe and compare the consumption of the main groups and sub-groups of vegetables and fruits (V&F) in men and women from the centres participating in the European Prospective Investigation into Cancer and Nutrition (EPIC).

Cross-sectional analysis. Dietary intake was assessed by means of a 24-hour dietary recall using computerised interview software and standardised procedures. Crude and adjusted means were computed for the main groups and sub-groups of V&F by centre, separately for men and women. Adjusted means by season, day of the week and age were estimated using weights and covariance analysis.

Twenty-seven centres in 10 European countries participating in the EPIC project.

In total, 35 955 subjects (13 031 men and 22 924 women), aged 35–74 years, randomly selected from each EPIC cohort.

The centres from southern countries had the highest consumption of V&F, while the lowest intake was seen in The Netherlands and Scandinavia for both genders. These differences were more evident for fruits, particularly citrus. However, slightly different patterns arose for some sub-groups of vegetables, such as root vegetables and cabbage. Adjustment for body mass index, physical activity, smoking habits and education did not substantially modify the mean intakes of vegetables and fruits.

Total vegetable and fruit intake follows a south–north gradient in both genders, whereas for several sub-groups of vegetables a different geographic distribution exists. Differences in mean intake of V&F by centre were not explained by lifestyle factors associated with V&F intake.

To investigate how consumption of ultra-processed foods has changed in Sweden in relation to obesity.

Nationwide ecological analysis of changes in processed foods along with corresponding changes in obesity. Trends in per capita food consumption during 1960–2010 were investigated using data from the Swedish Board of Agriculture. Food items were classified as group 1 (unprocessed/minimally processed), group 2 (processed culinary ingredients) or group 3 (3·1, processed food products; and 3·2, ultra-processed products). Obesity prevalence data were pooled from the peer-reviewed literature, Statistics Sweden and the WHO Global Health Observatory.

Nationwide analysis in Sweden, 1960–2010.

Swedish nationals aged 18 years and older.

During the study period consumption of group 1 foods (minimal processing) decreased by 2 %, while consumption of group 2 foods (processed ingredients) decreased by 34 %. Consumption of group 3·1 foods (processed food products) increased by 116 % and group 3·2 foods (ultra-processed products) increased by 142 %. Among ultra-processed products, there were particularly large increases in soda (315 %; 22 v. 92 litres/capita per annum) and snack foods such as crisps and candies (367 %; 7 v. 34 kg/capita per annum). In parallel to these changes in ultra-processed products, rates of adult obesity increased from 5 % in 1980 to over 11 % in 2010.

The consumption of ultra-processed products (i.e. foods with low nutritional value but high energy density) has increased dramatically in Sweden since 1960, which mirrors the increased prevalence of obesity. Future research should clarify the potential causal role of ultra-processed products in weight gain and obesity.

The aim of the National Food Consumption Survey (NFCS) in South Africa was to determine the nutrient intakes and anthropometric status of children (1–9 years old), as well as factors that influence their dietary intake.

This was a cross-sectional survey of a nationally representative sample of all children aged 1–9 years in South Africa. A nationally representative sample with provincial representation was selected using 1996 Census information.

Of the 3120 children who were originally sampled data were obtained from 2894, a response rate of 93%.

The sociodemographic status of each household was assessed by a questionnaire. Dietary intake was assessed by means of a 24-hour recall and a food-frequency questionnaire from the caregivers of the children. Food purchasing practices were determined by means of a food procurement questionnaire. Hunger was assessed by a modified hunger scale questionnaire. Nutritional status was determined by means of anthropometric measurements: height, weight, head circumference and arm circumference.

At the national level, stunting (height-for-age below minus two standard deviations (< -2SD) from the reference median) was by far the most common nutritional disorder, affecting nearly one in five children. The children least affected (17%) were those living in urban areas. Even with regard to the latter, however, children living in informal urban areas were more severely affected (20%) compared with those living in formal urban areas (16%). A similar pattern emerged for the prevalence of underweight (weight-for-age < -2SD), with one in 10 children being affected at the national level. Furthermore, one in 10 (13%) and one in four (26%) children aged 1–3 years had an energy intake less than half and less than two-thirds of their daily energy needs, respectively. For South African children as a whole, the intakes of energy, calcium, iron, zinc, selenium, vitamins A, D, C and E, riboflavin, niacin, vitamin B6 and folic acid were below two-thirds of the Recommended Dietary Allowances. At the national level, data from the 24-hour recalls indicated that the most commonly consumed food items were maize, sugar, tea, whole milk and brown bread. For South African children overall, one in two households (52%) experienced hunger, one in four (23%) were at risk of hunger and only one in four households (25%) appeared food-secure.

The NFCS indicated that a large majority of households were food-insecure and that energy deficit and micronutrient deficiencies were common, resulting in a high prevalence of stunting. These results were used as motivation for the introduction of mandatory fortification in South Africa.

The purpose of the present study was to test the construct validity, internal consistency and convergent validity of the Household Food Insecurity Access Scale (HFIAS) in measuring household food insecurity in rural Tanzania, and to determine socio-economic characteristics associated with household food insecurity.

Key informant interviews and a cross-sectional survey were conducted in February and March 2008.

Rural Iringa, Tanzania.

Key informant interviews were conducted with twenty-one purposively selected male and female village leaders. For the household surveys, a sample of 237 households with mothers (caregivers) and at least one child between 1 and 5 years of age were included.

Approximately 20·7 % of the households were categorized as food-secure, 8·4 % as mildly food-insecure, 22·8 % as moderately food-secure and 48·1 % as severely food-insecure. Two main factors emerged from the rotated principal component factor analysis: (i) insufficient food quality; and (ii) insufficient food intake. Both factors explained 69 % of the total variance. The full food insecurity scale and the two subscales had good internal consistency (Cronbach’s α = 0·83–0·90). Food security, as measured by HFIAS, was positively associated with maternal education, husband’s education, household wealth status, being of an agricultural rather than pastoral tribe and animal-source food consumption; it was negatively associated with maternal age and household size.

The HFIAS measurement instrument shows validity and reliability in measuring household food insecurity among poor households in rural Tanzania.

We evaluated the performance of the food-frequency questionnaire (FFQ) administered to participants in the US NIH–AARP (National Institutes of Health–American Association of Retired Persons) Diet and Health Study, a cohort of 566 404 persons living in the USA and aged 50–71 years at baseline in 1995.

The 124-item FFQ was evaluated within a measurement error model using two non-consecutive 24-hour dietary recalls (24HRs) as the reference.

Participants were from six states (California, Florida, Pennsylvania, New Jersey, North Carolina and Louisiana) and two metropolitan areas (Atlanta, Georgia and Detroit, Michigan).

A subgroup of the cohort consisting of 2053 individuals.

For the 26 nutrient constituents examined, estimated correlations with true intake (not energy-adjusted) ranged from 0.22 to 0.67, and attenuation factors ranged from 0.15 to 0.49. When adjusted for reported energy intake, performance improved; estimated correlations with true intake ranged from 0.36 to 0.76, and attenuation factors ranged from 0.24 to 0.68. These results compare favourably with those from other large prospective studies. However, previous biomarker-based studies suggest that, due to correlation of errors in FFQs and self-report reference instruments such as the 24HR, the correlations and attenuation factors observed in most calibration studies, including ours, tend to overestimate FFQ performance.

The performance of the FFQ in the NIH–AARP Diet and Health Study, in conjunction with the study’s large sample size and wide range of dietary intake, is likely to allow detection of moderate (≥1.8) relative risks between many energy-adjusted nutrients and common cancers.

The purpose of the present study was to use a meta-analytic approach to examine the convergent validity of the International Physical Activity Questionnaire (IPAQ).

Systematic review by meta-analysis.

The relevant studies were surveyed from five electronic databases. Primary outcomes of interest were the product-moment correlation coefficients between IPAQ and other instruments. Five separate meta-analyses were performed for each physical activity (PA) category of IPAQ: walking, moderate PA (MPA), total moderate PA (TMPA), vigorous PA (VPA) and total PA (TPA). The corrected mean effect size (ESρ) unaffected by statistical artefacts (i.e. sampling error and reliability) was calculated for each PA category. Selected moderator variables were length of IPAQ (i.e. short and long form), reference period (i.e. last 7 d and usual week), mode of administration (i.e. interviewer and self-reported), language (i.e. English and translated) and instruments (i.e. accelerometer, pedometer and subjective measure).

A total of 152 ESρ across five PA categories were retrieved from twenty-one studies.

The results showed small- to medium-sized ESρ (0·27–0·49). The highest value was observed in VPA while the lowest value was found in MPA. The ESρ were differentiated by some of the moderator variables across PA categories.

The study shows the overall convergent validity of IPAQ within each PA category. Some differences in degree of convergent validity across PA categories and moderator variables imply that different research conditions should be taken into account prior to deciding on use of the appropriate type of IPAQ.

Amidst a hunger–obesity paradox, the purpose of the present study was to examine the grocery shopping behaviour and food stamp usage of low-income women with children to identify factors influencing their food choices on a limited budget.

Focus groups, which included questions based on Social Cognitive Theory constructs, examined food choice in the context of personal, behavioural and environmental factors. A quantitative grocery shopping activity required participants to prioritize food purchases from a 177-item list on a budget of $US 50 for a one-week period, an amount chosen based on the average household food stamp allotment in 2005.

Ninety-two low-income women, with at least one child aged 9–13 years in their household, residing in the Twin Cities, Minnesota, USA.

Participants' mean age was 37 years, and 76% were overweight or obese (BMI≥25·0kg/m2). Key findings suggest that their food choices and grocery shopping behaviour were shaped by not only individual and family preferences, but also their economic and environmental situation. Transportation and store accessibility were major determinants of shopping frequency, and they used various strategies to make their food dollars stretch (e.g. shopping based on prices, in-store specials). Generally, meat was the most important food group for purchase and consumption, according to both the qualitative and quantitative data.

Efforts to improve food budgeting skills, increase nutrition knowledge, and develop meal preparation strategies involving less meat and more fruits and vegetables, could be valuable in helping low-income families nutritionally make the best use of their food dollars.

To examine associations of the frequency of eating at fast-food restaurants with demographic, behavioural and psychosocial factors and dietary intake in African American adults.

Self-reported data from a population-based cross-sectional survey of 658 African Americans, aged 20–70 years, in North Carolina. An 11-page questionnaire assessed eating at fast-food restaurants, demographic, behavioural and diet-related psychosocial factors, and dietary intake (fruit, vegetable, total fat and saturated fat intakes, and fat-related dietary behaviours).

The participants were aged 43.9±11.6 years (mean±standard deviation), 41% were male, 37% were college graduates and 75% were overweight or obese. Seventy-six per cent reported eating at fast-food restaurants during the previous 3 months: 4% usually, 22% often and 50% sometimes. Frequency of eating at fast-food restaurants was positively associated with total fat and saturated fat intakes and fat-related dietary behaviours (P < 0.0001) and inversely associated with vegetable intake (P < 0.05). For example, mean daily fat intake was 39.0 g for usually/often respondents and 28.3 g for those reporting rare/never eating at fast-food restaurants. Participants who reported usual/often eating at fast-food restaurants were younger, never married, obese, physically inactive and multivitamin non-users (all P < 0.01). Frequency of eating at fast-food restaurants was positively associated with fair/poor self-rated health, weak belief in a diet–cancer relationship, low self-efficacy for healthy eating, weight dissatisfaction, and perceived difficulties of preparing healthy meals and ordering healthy foods in restaurants (all P < 0.05). Frequency of eating at fast-food restaurants did not differ significantly by sex, education, smoking, ability to purchase healthy foods or knowledge of the Food Guide Pyramid.

Eating at fast-food restaurants is associated with higher fat and lower vegetable intakes in African Americans. Interventions to reduce fast-food consumption and obesity in African Americans should consider demographic and behavioural characteristics and address attitudes about diet–disease relationships and convenience barriers to healthy eating.

To compare the prevalence of self-reported hypertension and mean systolic and diastolic blood pressures in four diet groups (meat eaters, fish eaters, vegetarians and vegans) and to investigate dietary and other lifestyle factors that might account for any differences observed between the groups.

Analysis of cross-sectional data from participants in the Oxford cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC–Oxford).

United Kingdom.

Eleven thousand and four British men and women aged 20–78 years at blood pressure measurement.

The age-adjusted prevalence of self-reported hypertension was significantly different between the four diet groups, ranging from 15.0% in male meat eaters to 5.8% in male vegans, and from 12.1% in female meat eaters to 7.7% in female vegans, with fish eaters and vegetarians having similar and intermediate prevalences. Mean systolic and diastolic blood pressures were significantly different between the four diet groups, with meat eaters having the highest values and vegans the lowest values. The differences in age-adjusted mean blood pressure between meat eaters and vegans among participants with no self-reported hypertension were 4.2 and 2.6 mmHg systolic and 2.8 and 1.7 mmHg diastolic for men and women, respectively. Much of the variation was attributable to differences in body mass index between the diet groups.

Non-meat eaters, especially vegans, have a lower prevalence of hypertension and lower systolic and diastolic blood pressures than meat eaters, largely because of differences in body mass index.

To modify the self-administered, short version of the International Physical Activity Questionnaire (IPAQ) for adults to be used in the elderly (aged 65 years and above), and to validate this modified IPAQ for the elderly (IPAQ-E).

A direct validity study using accelerometer-measured physical activity (PA) as the criterion measure, and an indirect criterion validity study using high-sensitivity C-reactive protein (hs-CRP) as a biological marker of activity.

Organisations for retired persons in Sweden.

The direct validity study consisted of fifty-four participants and the indirect criterion validity study consisted of 359 participants. All participants were retired persons (66–91 years) living independently.

All self-reported activity domains (sitting, walking, moderate and vigorous) were positively correlated with the corresponding variable objectively assessed by an accelerometer (ρ = 0·277–0·471), but a systematic error was observed. The specificity of IPAQ-E to identify low-active participants was 85 %, and the sensitivity to identify the more active participants was 81 %. A main effect of IPAQ-E category (Low, Moderate or High) was observed for hs-CRP (P = 0·041).

We found this modified version of IPAQ, the IPAQ-E, to be well accepted by our sample of socially active elderly. It provided acceptable estimates of PA, well in line with other questionnaires, even though it had a systematic error. The IPAQ-E was able to identify an expected response of a biomarker (hs-CRP) to PA. We recommend the use of the IPAQ-E to classify participants aged 65 years and above into PA categories, to rank individuals or to identify individuals meeting certain PA criteria.