To develop meal plans using grain-based foods demonstrating how to incorporate wholegrain foods into a balanced diet for weight maintenance for different cuisines. The present study examines the ability of meal plans with ≥4 grain-based servings daily to meet nutrient recommendations using lacto-ovo vegetarian and rice-based cuisines.

Eighteen plans from each cuisine for three age brackets for both genders were developed. Plans aimed for ≥4 servings of grain-based foods daily, with separate plans for all wholegrain, all refined-grain and half wholegrain–half refined-grain foods. Meal plans followed an isoenergetic approach and were designed to meet specific Australian nutrient reference values and serving sizes.

All plans met the Recommended Dietary Intake or Adequate Intake for targeted nutrients except for Fe in the rice-based meal plan for females aged ≥19 years (17 mg). In the plans for 14–18 year and ≥19 year age groups, four servings of grain-based foods could be accommodated. In the plans for 9–13 years, increasing the number of grain-based food servings to four reduced micronutrients levels delivered by the total diet. Specific food choices were made to ensure nutrient targets were met across each category for wholegrain and refined-grain plans. The major difference in nutrients between wholegrain and refined-grain foods was found in the vegetarian cuisine, where the meal plans containing whole grains produced on average 30 % higher fibre (38–53 g) levels than those with refined grains (27–40 g).

With careful food selection, meal plans with ≥4 servings of grain-based foods daily can meet nutrient reference values for lacto-ovo vegetarian and rice-based cuisines.

To produce study-specific portion sizes for 11-year-old children in a population-based birth cohort and to compare these study-specific portion sizes with previously published children's portion sizes, to assess their relevance today.

Two multiple-pass 24 h dietary recalls were taken. The Food Standard Agency's photographic food atlas was used to quantify intakes. Study-specific food portion sizes were calculated for each food group. Portion sizes were calculated for all children and separately for boys and girls. The nutrient intake from the 24 h dietary recalls was analysed using study-specific and published portion sizes for individual participants. Agreement was assessed using Pearson's correlation, intra-class correlation coefficients and the Bland–Altman method.

Birth cohort study, UK.

Children (mean age 11·3 years, n 264) and parents/guardians.

A total of 124 food portion sizes were calculated. Differences in portion weights between boys and girls were seen only for seven food items. There was a significant positive relationship (P < 0·001) between intakes of each nutrient as determined by the two sets of portion sizes. Correlation coefficients ranged from 0·77 (protein) to 0·98 (β-carotene). The intra-class correlation coefficients showed good agreement between nutrient intakes determined by the study-specific and published portion sizes (P < 0·001).

Nutrient intakes calculated using portion sizes from our population were similar to those calculated from portion size data collected in a national survey, despite being collected over a decade later. The present study adds to the small amount of evidence regarding portion sizes in UK children and shows agreement with previously published paediatric portion sizes.

There are abundant data on secular trends in BMI; however, information on the change in subcutaneous fat is limited. The present study examined the trends in the prevalence of elevated skinfold thickness among children and adolescents over the past 19 years (1995–2014) in Shandong Province, China.

Data for the study were obtained from two cross-sectional surveys of schoolchildren carried out in 1995 and 2014. Triceps and subscapular skinfold thicknesses (SFT) of all participants were measured. The sum of triceps and subscapular SFT (SSFT) was applied. Children and adolescents with SSFT above or equal to the national age- and sex-specific 85th percentile were defined as ‘high SFT’.

Shandong Province, China.

A total of 16 917 students aged 7–18 years were included.

For both boys and girls, an increasing trend in ‘high SFT’ was observed between 1995 and 2014. The overall prevalence of ‘high SFT’ increased from 10·31 % for boys and 13·40 % for girls in 1995 to 33·94 % for boys and 29·30 % for girls in 2014 (P<0·01).

There are more children and adolescents with very high levels of SFT. These trends describe very unfavourable changes in the body composition and should give cause for concern.

The eButton takes frontal images at 4s intervals throughout the day. A three-dimensional manually administered wire mesh procedure has been developed to quantify portion sizes from the two-dimensional images. The present paper reports a test of the inter-rater reliability and validity of use of the wire mesh procedure.

Seventeen foods of diverse shapes and sizes served on plates, bowls and cups were selected to rigorously test the portion assessment procedure. A dietitian not involved in inter-rater reliability assessment used standard cups to independently measure the quantities of foods to generate the ‘true’ value for a total of seventy-five ‘served’ and seventy-five smaller ‘left’ images with diverse portion sizes.

The images appeared on the computer to which the digital wire meshes were applied.

Two dietitians and three engineers independently estimated portion size of the larger (‘served’) and smaller (‘left’) images for the same foods.

The engineers had higher reliability and validity than the dietitians. The dietitians had lower reliabilities and validities for the smaller more irregular images, but the engineers did not, suggesting training could overcome this limitation. The lower reliabilities and validities for foods served in bowls, compared with plates, suggest difficulties with the curved nature of the bowls.

The wire mesh procedure is an important step forward in quantifying portion size, which has been subject to substantial self-report error. Improved training procedures are needed to overcome the identified problems.

To investigate the frequency of psychiatric disorders in subjects wishing to lose weight categorized according to BMI.

Cross-sectional study.

An academic outpatient clinical nutrition service in Italy.

A total of 207 subjects (thirty-nine men and 168 women; mean age: 38·7 (sd 14·1) years) consecutively attending the study centre for the first time between January 2003 and December 2006.

In the entire study group, eighty-three (40 %) subjects had a psychiatric disorder according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision. Eating disorders were the most prevalent psychiatric condition (thirty-six subjects, 17·4 %), followed by mood and anxiety disorders (9·7 % and 8·7 %, respectively). The frequency of psychiatric disorders among different BMI categories was as follows: 75·0 % in underweight, 50·0 % in normal weight, 33·3 % in overweight and 33·3 % in obese subjects.

Psychiatric disorders may be frequently found in subjects wishing to lose weight. Our results highlight the importance of psychiatric assessment especially in underweight and normal-weight subjects.

To study associations between reported sugar intake and salivary bacteria (mutans streptococci, MS and lactobacilli, LB), and sugar intake in relation to body mass index (BMI), in women and adolescents.

Cross-sectional study. Habitual dietary intake was reported in a questionnaire and whole saliva samples were collected and cultivated.

Stockholm, Sweden.

Four hundred and fourteen mothers and their 16-year-old children (57% girls).

Reported total sugar intake was significantly associated with LB in mothers (P = 0.001), but not in daughters and sons (P = 0.03 for mother–son interaction). When excluding lactose, the associations with LB and MS were significant in daughters (P = 0.032 and 0.005, respectively). High BMI and sugar intake from milk were independently associated with MS counts in mothers in a multiple regression model (R2 = 0.053). In daughters, sugar from beverages, candies/chocolates and fruits were all independently associated with MS counts (R2 = 0.074), whereas in sons, only mothers’ MS counts were associated (R2 = 0.084). High BMI, low intake from cooked meals and high intake of candies/chocolates were all independently associated with LB in mothers (R2 = 0.076), while, except for candies/chocolates in daughters, no significant associations were found in children. BMI was significantly associated with bacteria counts in both mothers and children, whereas reported sugar intake was not.

The associations between reported sugar intake and bacteria were generally weak. In mothers and daughters, some significant associations were found, but not in sons. Bacteria counts, but not reported sugar intake, were positively associated with BMI.

The present study aimed to examine the combined effects of disease management and food insecurity on physical and mental health in a representative Korean population.

A cross-sectional study.

Data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2012–2015.

Adults aged ≥30 years (n 17 934) who participated in the KNHANES.

Among health-care factors, unmet health-care needs and mental health counselling were different by food insecurity status, with a higher prevalence in adults with food insecurity. The prevalence of underweight was higher in men with food insecurity (5·9 %), whereas the prevalence of obesity was higher in women with food insecurity (37·4 %), than that in men and women with food security. Food insecurity was associated with a high risk of all mental health outcomes. For the combined effects of disease management and food insecurity, unmet health-care needs was related to increased risk of obesity for food-insecure men (Pinteraction = 0·029) and lack of participation in nutrition education or counselling was related to increased risk of obesity for food-insecure women (Pinteraction = 0·010). In addition, higher unmet health-care needs in adults with food insecurity was related to higher risk of mental health outcomes.

Unmet health-care needs may exacerbate obesity for food-insecure men and mental health problems for both food-insecure men and women. In addition, lack of participation in nutrition education or counselling may exacerbate the obesity for food-insecure women.

Breast-feeding in the first 6 months of life is critical for ensuring both child health and well-being. Despite efforts to improve breast-feeding practices, recent studies have reported that Myanmar continues to have low rates of exclusive breast-feeding.

A community-based breast-feeding promotion programme using trained community members was implemented for 1 year in hard-to-reach townships of Myanmar. The present study assessed the breast-feeding practices using a cross-sectional survey of 610 mothers of children under 2 years old: specifically, breast-feeding within 24 h, exclusive breast-feeding up to 6 months and breast-feeding duration.

Using Cox models for breast-feeding duration before 24 months, the hazard of breast-feeding cessation was lower in programme v. non-programme townships (hazard ratio (HR)=0·55; 95 % CI 0·32, 0·95). Mothers who worked as shop owners or ran a family business had lower hazard of breast-feeding cessation (HR=0·13, P<0·05) v. those who worked as supervisors, managers, self-employed and businesswomen. The hazard of breast-feeding cessation was higher in women in higher wealth quintiles v. those in the lowest quintile (lower quintile, HR=3·49, P<0·1; higher quintile, HR=3·50, P<0·1; highest quintile, HR=3·47, P<0·1).

The intervention did not affect exclusive breast-feeding practices or breast-feeding within the first 24 h. Potential reasons include existing high levels of early initiation of breast-feeding due to ongoing government-led maternal and child health activities, and social and traditional practices related to complementary feeding. Community-based breast-feeding programmes should continue to promote exclusive breast-feeding and develop strategies to support working mothers.

To examine associations of changes in dietary intake with education in young black and white men and women.

The Coronary Artery Risk Development in Young Adults (CARDIA) study, a multi-centre population-based prospective study. Dietary intake data at baseline and year 7 were obtained from an extensive nutritionist-administered diet history questionnaire with 700 items developed for CARDIA.

Participants were recruited in 1985–1986 from four sites: Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California.

Participants were from a general community sample of 703 black men (BM), 1006 black women (BW), 963 white men (WM) and 1054 white women (WW) who were aged 18–30 years at baseline. Analyses here include data for baseline (1985–1986) and year 7 (1992–1993).

Most changes in dietary intake were observed among those with high education (≥ 12 years) at both examinations. There was a significant decrease in intake of energy from saturated fat and cholesterol and a significant increase in energy from starch for each race-gender group (P < 0.001). Regardless of education, taste was considered an important influence on food choice.

The inverse relationship of education with changes in saturated fat and cholesterol intakes suggests that national public health campaigns may have a greater impact among those with more education.

Accurate and easy to use methods for dietary Na intake estimation in population level are lacking. We aimed at (i) estimating the mean Na intake in the group level using a variety of dietary methods (DM) and urinary methods (UM) and correlating them with 24-h urine collection (24UCol) and (ii) improving the accuracy of the existing DM.

The most common DM (three 24-h dietary recalls (24DR) and FFQ) and UM (24UCol and spot urine collection using common equations) were applied. To improve the existing: (i) 24DR, discretionary Na was quantified using salt-related questions or adding extra 15 % in total Na intake and (ii) FFQ, food items rich in Na and salt-related questions were added in the standard questionnaire (NaFFQ).

National and Kapodistrian University of Athens, Greece.

Totally, 122 high cardiovascular risk subjects (56·0 ± 12·6 years; 55·7 % males).

Mean 24 h Na excretion (24UNa) was 2810 ± 1304 mg/d. Spot urine methods overestimated the 24UNa (bias range: −1781 to −492 mg) and were moderately correlated to 24UCol (r = 0·469–0·596, P ≤ 0·01). DM underestimated the 24UNa (bias range: 877 to 1212 mg) and were weakly correlated with 24UCol. The improved DM underestimated the 24UNa (bias range: 877 to 923 mg). The NaFFQ presented the smallest bias (−290 ± 1336 mg) and the strongest correlation with 24UCol (r = 0·497, P ≤ 0·01), but wide limits of agreement in Bland–Altman plots (−2909 mg; 2329 mg), like all the other methods did.

The existing methods exhibit poor accuracy. Further improvement of the newly developed NaFFQ could be promising for more accurate estimation of mean dietary Na intake in epidemiological studies. Additional validation studies are needed.

To report on vitamin D status, measured as plasma 25-hydroxyvitamin D concentration (25(OH)D), the prevalence of vitamin D insufficiency and deficiency, and to explore associations between vitamin D status and background characteristics.

Data were collected in a National Dietary Survey, Riksmaten adolescents 2016–2017. The participants completed dietary assessments and questionnaires on the web and wore accelerometers. (25(OH)D) was measured with a MS method.

Representative survey conducted in schools throughout Sweden.

Participants attended school years 5 (Y5, mean age 12. 5 years), 8 (Y8, mean age 14. 5 years) and 11 (Y11, mean age 18 years), and included 1100 participants.

Overall, there was no difference in plasma 25(OH)D between girls and boys. Vitamin D insufficiency differed between the three school years. The prevalence of insufficiency in Y5 was 32 (boys) and 48 (girls) percent, while in Y11 62 (boys) and 43 (girls) percent. The prevalence of deficiency in Y11 was 16 and 15 % in boys and girls, respectively. Being born outside of Sweden was associated with a 10-fold increased risk of being vitamin D deficient. Deficiency was also associated with longer time spent in sedentary intensity, a lower consumption of fortified dairy products and fats and oils.

Vitamin D deficiency was most common in the oldest age group and being born outside of Sweden increased the risk of being deficient. The present study will form a baseline for future follow-up studies of the implementation of a new mandatory vitamin D fortification policy in 2018.

To investigate the effects of providing a daily healthy school snack on children’s nutritional, social and educational outcomes and explore stakeholders’ perceptions of an emergency school feeding programme (SFP).

Convergence triangulation mixed-methods study design. Associations were examined between receiving the school feeding intervention and children’s outcomes using multivariable regression models. Quantitative data were complemented with interviews and focus group discussions with parents and staff.

In vulnerable communities in Lebanon, the World Food Programme has implemented an emergency SFP targeting Lebanese (attending morning sessions) and Syrian refugee children (attending afternoon sessions) in public schools.

Children from ten intervention schools (morning n 403; afternoon n 379) and ten matched control schools (morning n 399; afternoon n 401), as well as twenty-nine parents and twenty-two school staff members.

Diet diversity was higher in intervention schools as compared with control with a significantly higher consumption of dairy products, nuts and fruit in both sessions. Child-reported food insecurity experience was lower in children attending the afternoon session of intervention v. control schools. The SFP intervention was associated with higher school engagement and sense of school community in the morning session only. While the SFP was significantly associated with higher attendance for children in afternoon sessions only, it was significantly associated with school retention of children in both sessions.

A daily healthy snack potentially acts as an incentive to improve children’s nutritional outcomes, school engagement, sense of belonging, equality between students and improvement in children’s attendance and retention in public schools.

To: (i) understand the nutrition attitudes, self-efficacy, knowledge and practices of school food-service personnel (SFP) in Nebraska and (ii) identify potential barriers that schools face in offering healthy school meals that meet the US Department of Agriculture (USDA) nutrition standards.

Convergent parallel mixed-methods study.

Kindergarten–12th grade schools in Nebraska, USA.

SFP (260 survey participants; fifteen focus group participants) working at schools that participate in the USDA National School Lunch Program.

Mixed-methods themes identified include: (i) ‘Mixed attitudes towards healthy meals’, which captured a variety of conflicting positive and negative attitudes depending on the situation; (ii) ‘Positive practices to promote healthy meals’, which captured offering, serving and promotion practices; (iii) ‘Mixed nutrition-related knowledge’, which captured the variations in knowledge depending on the nutrition concept; and (iv) ‘Complex barriers’, which captured challenges with time, support and communication.

The study produced relevant findings to address the barriers identified by SFP. Implementing multicomponent interventions and providing training to SFP may help reduce some of the identified barriers of SFP.

Social and economic changes associated with new roads can bring about rapid nutritional transitions. To study this process, we: (1) describe trends in adult overweight and obesity (OW/OB) among rural Afro-Ecuadorians over time and across a gradient of community remoteness from the nearest commercial centre; (2) examine the relationship between male and female adult OW/OB and factors associated with market integration such as changing livelihoods and (3) examine the co-occurrence of adult OW/OB and under-five stunting and anaemia.

Adult anthropometry was collected through serial case–control studies repeated over a decade across twenty-eight communities. At the same time, anthropometry and Hb were measured for all children under 5 years of age in every community.

Northern coastal Ecuador.

Adults (n 1665) and children under 5 years of age (n 2618).

From 2003 and 2013, OW/OB increased from 25·1 % to 44·8 % among men and 59·9 % to 70·2 % among women. The inverse relationship between remoteness and OW/OB in men was attenuated when adjusting for urban employment, suggesting that livelihoods mediated the remoteness–OW/OB relationship. No such relationship was observed among women. Communities with a higher prevalence of male OW/OB also had a greater prevalence of stunting, but not anaemia, in children under 5 years of age.

The association between male OW/OB and child stunting at the community level, but not the household level, suggests that changing food environments, rather than household- or individual-level factors, drove these trends. A closer examination of changing socio-economic structures and food environments in communities undergoing rapid development could help mitigate future public health burdens.

To propose cut-off points for the TAG–glucose (TyG) index in Brazilian children and evaluate the link to cardiometabolic risk.

A cross-sectional study with children from a municipality in Minas Gerais, Brazil. Anthropometric (weight, height, waist circumference and waist:height ratio), biochemical (lipid and glucose profile) and blood pressure (BP) tests were performed. Using the receiver operating characteristic curve, cut-off points for the TyG index were proposed according to sex using homoeostasis model of assessment – insulin resistance (IR) as the reference method.

Viçosa, MG, Brazil.

Children aged 4–9 years (n 515).

The TyG index cut-off points to identify the risk of IR were 7·9 and 8·1 for boys and girls, respectively. We observed that 48·7 % of the children had an increased TyG index. The increased TyG index was associated with overweight, total body and central fat, increased BP and altered lipid profile. Children with an increased TyG index had a higher accumulation of cardiometabolic risk factors.

According to the cut-off points proposed by the current study, children at risk of IR estimated by the TyG index presented a higher cardiometabolic risk, including isolated risk factors, as to the higher accumulation of these.

To assess the relationship between market concentration and diversity, as indicators of market structure, and the healthiness of food and beverage sales across Europe.

Market share (MS) data per country were used to calculate market concentration, assessed by the four-firm concentration ratio and market diversity, and by the number of companies with ≥1 % MS and the number of companies uniquely present in one European country. The healthiness of food sales was assessed by applying the NOVA classification (level of processing). Simple and multiple linear regressions were performed to assess the relationship between market concentration, diversity and the healthiness of food and beverage sales.

The European single market.

The twenty-seven European single market member states for which Euromonitor sales data were available at the most fine-grained Euromonitor packaged food and non-alcoholic beverage product subcategory level.

Increased market concentration with a country and a product category fixed effect significantly predicted increased sales of ultra-processed packaged food products. There was insufficient data variability in the level of processing of non-alcoholic beverage product categories to formulate conclusions for non-alcoholic beverages. Increased market diversity in turn significantly predicted reduced country-level sales of ultra-processed products.

The results indicated a relationship between market structure and the healthiness of packed food products sold on the European market. However, more research with detailed nutritional data is warranted to document and quantify this interaction.

Examine the key elements that characterise social media advertisements targeted at adolescents by asking adolescents which features of Instagram ads promoting ultra-processed products make them designed to appeal to adolescents.

Instagram ads promoting ultra-processed products and brands were selected from a database in which ads had been classified regarding whether they were primarily targeted at adolescents from an adult perspective. Adolescents completed a sorting task in small groups and were requested to reach a consensus through discussions and sticky notes regarding whether sixty ads were designed to appeal to them. The sorting task was analysed using content analysis based on inductive coding.

One private secondary school and two after-school clubs.

Convenience sample of 105 Uruguayan adolescents aged 11–17 years.

Ten categories were identified regarding the reasons for sorting ads as (not) designed to appeal to adolescents: product type, graphic design, explicit references to age groups, language, activities or themes, memes, celebrities, characters, promotions and novelty. Product type emerged as a key element, with adolescents perceiving ads as designed to appeal to them simply because they promoted specific products.

This research contributes to the validation of criteria defined in previous studies and can be used for the development of tools to monitor the prevalence and power of adolescent-targeted digital marketing. However, the importance attributed to type of product suggests that regulations should not exclusively focus on exposure to digital marketing specifically targeted at adolescents but also on exposure to marketing in general.

Evaluating an intervention’s theoretical basis can inform design modifications to produce more effective interventions. Hence the present study’s purpose was to determine if effects from a multicomponent lifestyle intervention were mediated by changes in the psychosocial constructs decisional balance, self-efficacy and social support.

Delta Body and Soul III, conducted from August 2011 to May 2012, was a 6-month, church-based, lifestyle intervention designed to improve diet quality and increase physical activity. Primary outcomes, diet quality and aerobic and strength/flexibility physical activity, as well as psychosocial constructs, were assessed via self-report, interviewer-administered surveys at baseline and post intervention. Mediation analyses were conducted using ordinary least squares (continuous outcomes) and maximum likelihood logistic (dichotomous outcomes) regression path analysis.

Churches (five intervention and three control) were recruited from four counties in the Lower Mississippi Delta region of the USA.

Rural, Southern, primarily African-American adults (n 321).

Based upon results from the multiple mediation models, there was no evidence that treatment (intervention v. control) indirectly influenced changes in diet quality or physical activity through its effects on decisional balance, self-efficacy and social support. However, there was evidence for direct effects of social support for exercise on physical activity and of self-efficacy for sugar-sweetened beverages on diet quality.

Results do not support the hypothesis that the psychosocial constructs decisional balance, self-efficacy and social support were the theoretical mechanisms by which the Delta Body and Soul III intervention influenced changes in diet quality and physical activity.