The waist-to-height ratio (WHtR) assesses abdominal adiposity and has been proposed to be of greater value in predicting obesity-related cardiovascular health risks in children than BMI. The present study aims to develop WHtR cut-offs for overweight and obesity based on the 85th and 95th percentiles for the percentage body fat (%BF) in a cohort of children and adolescents.

Waist circumference (WC), height, triceps and subscapular skinfolds were used to calculate WHtR and %BF. Correlations between WHtR and %BF and WHtR/mid-abdominal skinfold were made. Receiver-operating characteristic (ROC) curve analysis was used to select WHtR cut-offs to define overweight and obesity. Subjects were grouped by WHtR cut-offs, and mean values for anthropometry, blood lipids and blood pressure (BP) variables were compared.

Australian primary and secondary schools.

A total of 2773 male (M) and female (F) subjects of the 1985 Australian Health and Fitness Survey, aged 8–16 years.

Correlation coefficients between WHtR and %BF were M: r = 0·73, F: r = 0·60, P < 0·01 and WHtR/mid-abdominal skinfold were M: r = 0·78, F: r = 0·65, P < 0·01. WHtR of 0·46(M) and 0·45(F) best identified subjects with ≥85th percentile for %BF and 0·48(M) and 0·47(F) identified subjects with ≥95th percentile for %BF. When comparing the highest WHtR group to the lowest, both sexes had significantly higher means for weight, WC, %BF, TG (male subjects only), systolic BP (female subjects only) and lower means for HDL cholesterol (P < 0·05).

WHtR is useful in clinical and population health as it identifies children with higher %BF at greater risk of developing weight-related CVD at an earlier age.

We conducted a hospital-based, case–control study to examine the association between dietary patterns and the risk of oesophageal squamous cell carcinoma in Iran.

A total of forty-seven patients with oesophageal squamous cell carcinoma and ninety-six controls underwent face-to-face interviews. Factor analysis was used to detect dietary patterns. Multivariate logistic regression was used to estimate OR and 95 % CI.

We defined two major dietary patterns in this population: ‘healthy diet’ (high in vegetables, nuts, fruits, low-fat dairy and fish) and ‘western diet’ (high in solid oil, sugar, sweets, tea, eggs, pickles and processed meat). Both healthy and western pattern scores were divided into two categories (based on medians). Higher healthy pattern scores were significantly associated with decreased risk of oesophageal squamous cell carcinoma (high: second median v. low: first median, OR = 0·17, 95 % CI 0·19, 0·98). An increased risk of oesophageal squamous cell carcinoma was observed with the western pattern (high: second median v. low: first median, OR = 10·13, 95 % CI 8·45, 43·68).

The results of the present study suggested that diet might be associated with oesophageal carcinoma.

Pakistani women in Oslo have high risk of overweight and type 2 diabetes. The objective is to present the effect of an intervention study on Pakistani women’s intentions to change dietary behaviour and changes made in dietary intake.

The intervention group received culturally adapted lifestyle education, including diet and physical activity. The questionnaire, applied before and after the 7-month intervention, included FFQ and questions on intentions to change.

Oslo, Norway.

A total of 198 Pakistani women, aged 25–63 years, randomised into control and intervention groups.

There was a shift in distribution of intentions to change the intake of selected foods in the intervention group after the intervention, resulting in significant differences between the groups. The daily intake of vegetables, fruits and fruit juice had increased (P = 0·043), and the intake of red meats (P = 0·001), full fat milk/yoghurt (P = 0·027) and sugar-rich drinks (P ≤ 0·007) was reduced in the intervention group. The differences between intervention and control after the intervention were significant for sugar-rich drinks (P ≤ 0·022). More women in the intervention group used olive and rapeseed oil and fewer used ‘vegetable’ oil after than before intervention (P < 0·011). Differences between intervention and control were significant (P = 0·001) for rapeseed oil. Comparing those who attended at least 60 % of the group sessions with the control group resulted in minor changes in these estimates.

Culturally adapted education has the potential to change Norwegian–Pakistani women`s intentions to make their diet healthier, and also to induce some beneficial, however modest, self-reported changes in diet.

To characterize the relationship between serum carotenoids, retinol and anaemia among pre-school children.

A cross-sectional study was conducted in two groups: anaemic and non-anaemic. Serum levels of retinol, α-carotene, β-carotene, β-cryptoxanthin, lycopene, lutein and zeaxanthin were measured in the study subjects.

Six rural communes of Dinh Hoa, a rural and mountainous district in Thai Nguyen Province, in the northern mountainous region of Vietnam.

A total of 682 pre-school children, aged 12–72 months, were recruited.

Geometric mean serum concentrations of carotenoids (μmol/l) were 0·056 for α-carotene, 0·161 for β-carotene, 0·145 for β-cryptoxanthin, 0·078 for lycopene, 0·388 for lutein and 0·075 for zeaxanthin. The mean levels of Hb and serum retinol were 108·8 g/l and 1·02 μmol/l, respectively. The prevalence of anaemia and vitamin A deficiency was 53·7 % and 7·8 %, respectively. After adjusting for sex and stunting, serum retinol concentrations (μmol/l; OR = 2·06, 95 % CI 1·10, 3·86, P = 0·024) and total provitamin A carotenoids (μmol/l; OR = 1·52, 95 % CI 1·01, 2·28, P = 0·046) were independently associated with anaemia, but non-provitamin A carotenoids (μmol/l; OR = 0·93, 95 % CI 0·63, 1·37, P = 0·710) were not associated with anaemia.

Among pre-school children in the northern mountainous region of Vietnam, the prevalences of vitamin A deficiency and anaemia are high, and serum retinol and provitamin A carotenoids are independently associated with anaemia. Further studies are needed to determine if increased consumption of provitamin A carotenoids will reduce anaemia among pre-school children.

To investigate associations between dietary intakes throughout childhood and age at menarche, a possible indicator of future risk of disease, in a contemporary cohort of British girls.

Diet was assessed by FFQ at 3 and 7 years of age, and by a 3 d unweighed food diary at 10 years. Age at menarche was categorised as before or after 12 years 8 months, a point close to the median age in this cohort.

Bristol, South-West England.

Girls (n 3298) participating in the Avon Longitudinal Study of Parents and Children.

Higher energy intakes at 10 years were positively associated with the early occurrence of menarche, but this association was removed on adjusting for body size. Total and animal protein intakes at 3 and 7 years were positively associated with age at menarche ≤12 years 8 months (adjusted OR for a 1 sd increase in protein at 7 years: 1·14 (95 % CI 1·04, 1·26)). Higher PUFA intakes at 3 and 7 years were also positively associated with early occurrence of menarche. Meat intake at 3 and 7 years was strongly positively associated with reaching menarche by 12 years 8 months (OR for menarche in the highest v. lowest category of meat consumption at 7 years: 1·75 (95 % CI 1·25, 2·44)).

These data suggest that higher intakes of protein and meat in early to mid-childhood may lead to earlier menarche. This may have implications for the lifetime risk of breast cancer and osteoporosis.

To examine the use of nutrition and health claims on packaged foods commonly eaten in Ireland.

An assessment of the labels of packaged food products that are commonly eaten in Ireland to determine the level of use of nutrition and health claims. Where present, the exact text of the claims as observed was recorded for seventeen different food categories and the claims categorised in accordance with EU Regulation 1924/2006 on nutrition and health claims made on foods.

Four retailers in Dublin, Ireland.

Of the foods surveyed, 47·3 % carried a nutrition claim and 17·8 % carried a health claim. Frozen fruit & vegetables and Breakfast cereals were the food categories with the highest proportion of nutrition claims. The most widespread nutrition claim was that referring to ‘fat’ and, within this group, the most commonly used text was ‘low fat’. The largest category of health claims observed in the present survey was general health claims. Claims referring to the digestive system were the most common followed by claims that a product will ‘lower/reduce/regulate your cholesterol’. Yoghurt & yoghurt drinks was the food category with the highest proportion of health claims, of which improving or boosting the digestive system was the most common.

The use of nutrition and health claims on the Irish market is widespread. EU Regulation 1924/2006 requires monitoring of the market for these types of claims. The current study could provide baseline data for the food industry and regulators to monitor the development of this market in the future.

The present study examines the receptivity to and potential effects of menu labelling on food choices of low-income and minority individuals – a group often at disproportionate risk for preventable, lifestyle-related health conditions (e.g. obesity, diabetes and CVD).

We conducted a cross-sectional survey to examine the knowledge, attitudes and potential response to menu labelling in an urban public health clinic population.

United States.

A total of 639 clinic patients were recruited in the waiting rooms of six, large public health centres in Los Angeles County (2007–2008). These centres provide services to a largely uninsured or under-insured, low-income, Latino and African-American population.

Among those approached and who met eligibility criteria, 88 % completed the survey. Of the 639 respondents, 55 % were overweight or obese based on self-reported heights and weights; 74 % reported visiting a fast food restaurant at least once in the past year, including 22 % at least once a week; 93 % thought that calorie information was ‘important’; and 86 % thought that restaurants should be required to post calorie information on their menu boards. In multivariate analyses, respondents who were obese, female, Latino and supportive of calorie postings were more likely than others to report that they would choose food and beverages with lower calories as a result of menu labelling.

These findings suggest that clinic patients are receptive to this population-based strategy and that they would be inclined to change their food selections in response to menu labelling.

To evaluate the effectiveness of stainless steel (Fe alloy) cooking pots in reducing Fe-deficiency anaemia in food aid-dependent populations.

Repeated cross-sectional surveys. Between December 2001 and January 2003, three surveys among children aged 6–59 months and their mothers were conducted in 110 households randomly selected from each camp. The primary outcomes were changes in Hb concentration and Fe status.

Two long-term refugee camps in western Tanzania.

Children (6–59 months) and their mothers were surveyed at 0, 6 and 12 months post-intervention. Stainless steel pots were distributed to all households in Nduta camp (intervention); households in Mtendeli camp (control) continued to cook with aluminium or clay pots.

Among children, there was no change in Hb concentration at 1 year; however, Fe status was lower in the intervention camp than the control camp (serum transferrin receptor (sTfR) concentration: 6·8 v. 5·9 μg/ml; P < 0·001). There was no change in Hb concentration among non-pregnant mothers at 1 year. Subjects in the intervention camp had lower Fe status than those in the control camp (sTfR concentration: 5·8 v. 4·7 μg/ml; P = 0·003).

Distribution of stainless steel pots did not increase Hb concentration or improve Fe status in children or their mothers. The use of stainless steel prevents rusting but may not provide sufficient amounts of Fe and strong educational campaigns may be required to maximize use. The distribution of stainless steel pots in refugee contexts is not recommended as a strategy to control Fe deficiency.

To describe the ‘Smart Lunch Box’ intervention and provide details on feedback from the participants on the acceptability and usability of the intervention materials.

A cluster randomised controlled trial, randomised by school. English schools were stratified on percentage free-school-meals eligibility and attainment at Key Stage 2. A ‘Smart Lunch Box’ with supporting materials and activities on healthy eating was delivered to parents and children via schools in the intervention group. Feedback forms containing information on a total of fifteen intervention items were filled out by the parents and/or children participating in the intervention and were collected after each of the three phases of the intervention.

Eighty-nine primary schools in England, Scotland, Wales and Northern Ireland, randomly selected; forty-four schools in the intervention arm.

A total of 1294 children, aged 9–10 years, took part in the trial. Of the 604 children in the intervention arm, 343 provided feedback after at least one of the three phases.

A median of twelve items out of a total of fifteen were used by responders. The two intervention items most likely to be used were the individual food boxes and the cooler bags. Whether a participant liked an item significantly affected whether they used it for all items except the cooler bag, fruity face and individual food boxes.

Practical intervention items aimed at parents are likely to be used in the longer term and therefore may be appropriate for use in an intervention strategy to improve packed lunches.

To assess the short-term (15-d) and long-term (12-month) effects of a school-based health and nutrition education intervention on diet, nutrition intake and BMI.

The 12-week teacher-implemented intervention in combination with seminars organized for parents was aimed at improving children’s diet and nutrition knowledge. The intervention took place between September 2007 and January 2008. The participants were randomized to two study groups, the intervention group (IG) and control group (CG), and were examined prior to the intervention on a variety of health knowledge, dietary, behavioural and anthropometric indices. The same measurements were collected 15 d and 1 year after the intervention.

All high schools in Vyronas, a densely populated district of Athens, Greece.

The sample consisted of 191 students aged 12–13 years.

Twelve months after the intervention, the programme was effective in reducing various indices in the IG compared with baseline findings (BMI: 23·3 (sd 2·8) v. 24·0 (sd 3·1) kg/m2, P < 0·001; daily energy intake: 8112·4 (sd 1412·4) v. 8503·3 (sd 1419·3) kJ/d, P < 0·001; total fat intake: 31·3 (sd 4·4) v. 35·4 (sd 4·7) % of daily energy, P < 0·001). Except for BMI, decreases in the aforementioned indices were also observed 15 d after the intervention. In addition, students of the IG reduced their weekly consumption of red meat and non-home-made meals and increased their frequency of fruit and breakfast cereal consumption.

The beneficial effects of this nutrition education intervention among adolescents may highlight the potential of such programmes in the prevention of obesity.

Inappropriate complementary feeding is one of the major causes of malnutrition in young children in developing countries. We developed an educational intervention, delivered by local health-care providers, aimed at improving complementary feeding practices and child nutrition.

Eight townships in Laishui, a rural area in China, were randomly assigned to the educational intervention or control group. A total of 599 healthy infants were enrolled at age 2–4 months and followed up until 1 year of age. In the intervention group, educational messages and enhanced home-prepared recipes were disseminated to caregivers through group trainings and home visits. Questionnaire surveys and anthropometric measurements were taken at baseline and ages 6, 9 and 12 months. Analysis was by intention to treat.

It was found that food diversity, meal frequency and hygiene practices were improved in the intervention group. Infants in the intervention group gained 0·22 kg more weight (95 % CI 0·003, 0·45 kg, P = 0·047) and gained 0·66 cm more length (95 % CI 0·03, 1·29 cm, P = 0·04) than did controls over the study period.

Findings from the study suggest that an educational intervention delivered through local health-care providers can lead to substantial behavioural changes of caregivers and improve infant growth.

Despite public health campaigns based on Fe and folic acid supplements, Fe-deficiency anaemia remains highly prevalent among women in India. We investigated leaf concentrate as an alternative to Fe and folic acid supplements for treating anaemia in adolescent girls.

Randomised controlled two-arm trial over 3 months: one group received daily Fe and folic acid (IFA; 60 mg Fe, 500 μg folic acid); the other daily leaf concentrate (LC; 5 mg Fe, 13 μg folic acid). Hb concentration, mean cell volume, serum Fe, serum ferritin and total Fe-binding capacity were measured pre- and post-intervention.

Jaipur, India.

One hundred and two adolescent girls aged 14–18 years.

Of the 102 girls randomized to the two arms of the trial, four (3·9 %) were severely anaemic (Hb < 7 g/dl), twenty-eight (27·5 %) were moderately anaemic (Hb ≥ 7 g/dl, <10 g/dl) and seventy (68·6 %) were mildly anaemic (Hb ≥ 10 g/dl, <12 g/dl). In the IFA group, eleven girls (20·4 %) withdrew due to side-effects, compared with one girl (2·1 %) in the LC group (P = 0·005). Total losses to follow-up were 14/54 in the IFA group and 2/48 in the LC group. At the end of the trial, none of the eighty-six remaining girls were severely anaemic, nine (10·5 %) were moderately anaemic and twenty-six (30·2 %) were mildly anaemic; fifty-one (59·3 %) had normal Hb levels (≥12 g/dl). After adjustment for baseline values, LC was as effective as IFA in improving serum Fe parameters and treating anaemia.

Leaf concentrate is an effective, and more palatable, alternative to Fe and folic acid supplements for treating anaemia in adolescent girls.

The purpose of the present analysis was to examine secular trends in school performance indicators in relationship to the implementation of a programme targeting the school food and physical activity environment.

Data on available school performance indicators were obtained; retrospective analyses were conducted to assess trends in indicators in association with programme implementation; each outcome was regressed v. year, beginning with the year prior to programme implementation.

The Healthy Kids, Smart Kids programme, a grass-roots effort to enhance the school food and physical activity environment in the Browns Mill Elementary School in Georgia.

Data included publicly available school records from the years 1995 to 2006.

The number of nurse, counselling and disciplinary referrals per 100 students demonstrated a downward trend, while standardized test scores demonstrated an upward trend beginning in the year of programme implementation. School year was a significant predictor of all indicators.

Promoting nutrition and physical activity within the school environment may be a promising approach for enhancing both student health and educational outcomes.

To estimate associations between the length of residence and overweight among US immigrants by region of birth and age at arrival.

Cross-sectional data from the National Health Interview Survey 1997–2005 were pooled. Multivariate-adjusted prevalence and OR were computed to test associations of length of residence and overweight.

United States.

Immigrant adults aged 18–74 years.

The odds of being overweight were three times higher in migrants from Mexico, South America, Europe, Russia, Africa and the Middle East residing in the US for >15 years than their counterparts residing in the United States for <5 years. On the other hand, migrants from the Indian subcontinent and Southeast (SE) Asia had no association between the length of residence and overweight prevalence. Among both men and women, weight differences emerged as early as 5 years after arrival among those arriving at 18–24 years of age (OR 1·5–1·8). The odds of being overweight was higher among Hispanic men arriving before the age of 18 years than the European migrants (Mexico OR 1·7, 95 % CI 1·3, 2·2; South America OR 1·5, 95 % CI 1·0, 2·3), whereas the odds of being overweight among those from Africa and SE Asia was lower (OR 0·5, 95 % CI 0·3, 0·9 and OR 0·5, 95 % CI 0·4, 0·8, respectively). Among women who arrived at 25–44 years of age, the odds of being overweight among those from Africa and the Indian subcontinent was higher than the European migrants (OR 2·9, 95 % CI 1·7, 5·0 and OR 1·8, 95 % CI 1·8, 2·8, respectively).

We found associations between the length of residence and overweight to vary by region of birth and age at arrival, highlighting the importance of these characteristics in assessing overweight risk among the US immigrants.

Studies indicate that food and beverages typically marketed to children are products high in fat, sugar and salt. LazyTown is an entertainment brand with a focus on healthy lifestyle, aimed at making health education entertaining. The aim of the present study was to assess whether children perceive food to taste better with a LazyTown label on the wrapping compared with the original packaging.

Five pairs of identical food and beverage samples were introduced. We aimed to select healthy food and beverages from various food groups. Preference for the LazyTown food was coded as +1, no preference 0 and preference for the original food as −1. An average ‘preference score’ was calculated for each subject by adding up the answers.

Three pre-schools in the Greater Reykjavik area, Iceland.

Subjects were pre-school children aged 3·5 to 6 years (n 66).

Most children answered correctly that there was no difference in the taste between the two identical food samples. However, between 27 and 42 % (depending on the product) of children preferred the taste of LazyTown food and beverages despite the fact that the test food was identical. The mean preference score was 0·29 (sd 0·32, median 0·20, 95 % CI 0·21, 0·38).

Our findings add to past research by demonstrating children’s preferences for child-oriented wrappings rather than regular wrapping. It might be suggested that popular brands could be useful to promote healthy eating among young children along with other actions.

The purpose of the present paper is to provide an integrated overview of the research methodology and key findings from a decade of research on family meals as part of Project EAT (Eating Among Teens), a large, population-based study of adolescents.

Focus groups conducted with 141 middle-school and high-school adolescents suggested the importance of family meals in influencing adolescents’ food choices. These findings led to the inclusion of questions on family meals in the Project EAT-I survey, completed by 4746 middle-school and high-school students, and in the Project EAT-II longitudinal survey, completed by 2516 of the original participants five years later. A subset of 902 parents also participated in telephone interviews as part of Project EAT-I.

Findings indicate that many adolescents and parents view family meals in a positive light, but there is great diversity in the context and frequency of family meal patterns in the homes of adolescents. Findings further suggest that family meals may have benefits in terms of dietary intake, disordered eating behaviours, substance use and psychosocial health.

Findings from Project EAT, in conjunction with other research studies on family meals, suggest the importance of working with families to increase the frequency and improve the quality of family meals. Further research is needed in order to elucidate the pathways that underpin the relationships between family meals and health outcomes. Suggestions for a future research agenda based on what was learned from Project EAT are provided.

To evaluate the impact of nutrition education in kindergartens and to promote healthy dietary habits in children.

Prospective cohort study. Four kindergartens with 1252 children were randomized to the intervention group and three with 850 children to the control group. The personal nutritional knowledge, attitudes and dietary behaviours of the parents were also investigated. Each month, children and parents in the intervention group participated in nutrition education activities. The main outcome measures were anthropometrics and diet-related behaviours of the children and the nutritional knowledge and attitudes of the parents at baseline, 6 months (mid-term) and 1 year (post-test). Baseline demographic and socio-economic characteristics were also collected.

Seven kindergartens from Hefei, the capital city of Anhui Province, eastern China.

Two thousand one hundred and two 4- to 6-year-old pre-schoolers from seven kindergartens participated.

The prevalence of children’s unhealthy diet-related behaviours decreased significantly and good lifestyle behaviours increased in the group receiving nutrition education compared with controls. Parental eating habits and attitudes to planning their children’s diets also changed appreciably in the intervention group compared with the control group (P < 0·05). However, there were no statistically significant differences in children’s height, weight, height-for-age Z-score or weight-for-age Z-score between the two groups.

Kindergarten-based nutrition education improves pre-schoolers’ lifestyle behaviours and brings about beneficial changes in parents’ attitudes to planning their children’s diets and their own personal eating habits.

To systematically analyse determinants of overweight prevalence and incidence in children and adolescents, as a basis of treatment and prevention.

Cross-sectional and longitudinal data of the Kiel Obesity Prevention Study (KOPS).

Schools in Kiel, Germany.

Cross-sectional data from 6249 students aged 5–16 years and 4-year longitudinal data from 1087 children aged 5–11 years. Weight status of students was assessed and familial factors (weight status of parents and siblings, smoking habits), social factors (socio-economic status, nationality, single parenting), birth weight as well as lifestyle variables (physical activity, media time, nutrition) were considered as independent variables in multivariate logistic regression analyses to predict the likelihood of the student being overweight.

The cross-sectional data revealed the prevalence of overweight as 18·3 % in boys and 19·2 % in girls. In both sexes determinants of overweight prevalence were overweight and obese parents, overweight siblings, parental smoking, single parenthood and non-German nationality. High birth weight and low physical activity additionally increased the risk in boys. High media time and low parental education were significant determinants in girls. Effect of media time was mediated by maternal weight status in boys as well as by socio-economic status and age in girls. From the longitudinal data, the 4-year cumulative incidence of overweight was 10·0 % in boys and 8·2 % in girls. Parental obesity, parental smoking and low physical activity were determinants of overweight incidence in boys, whereas paternal obesity increased the risk in girls.

Treatment and prevention should address family and social determinants with a focus on physical activity and media use.

In the context of the nutrition transition and associated changes in the food retail sector, to examine the socio-economic characteristics and motivations of shoppers using different retail formats (large supermarkets (LSM), medium-sized supermarkets (MSM) or traditional outlets) in Tunisia.

Cross-sectional survey (2006). Socio-economic status, type of food retailer and motivations data were collected during house visits. Associations between socio-economic factors and type of retailer were assessed by multinomial regression; correspondence analysis was used to analyse declared motivations.

Peri-urban area around Tunis, Tunisia, North Africa.

Clustered random sample of 724 households.

One-third of the households used LSM, two-thirds used either type of supermarket, but less than 5 % used supermarkets only. Those who shopped for food at supermarkets were of higher socio-economic status; those who used LSM were much wealthier, more often had a steady income or owned a credit card, while MSM users were more urban and had a higher level of education. Most households still frequently used traditional outlets, mostly their neighbourhood grocer. Reasons given for shopping at the different retailers were most markedly leisure for LSM, while for the neighbourhood grocer the reasons were fidelity, proximity and availability of credit (the latter even more for lower-income customers).

The results pertain to the transition in food shopping practices in a south Mediterranean country; they should be considered in the context of growing inequalities in health linked to the nutritional transition, as they differentiate use and motivations for the choice of supermarkets v. traditional food retailers according to socio-economic status.