Research is limited on whether mistrust of tap water discourages plain water intake and leads to a greater intake of sugar-sweetened beverages (SSB). The objective of the present study was to examine demographic differences in perceptions of tap water safety and determine if these perceptions are associated with intake of SSB and plain water.

The study examined perceptions of tap water safety and their cross-sectional association with intake of SSB and plain water. Racial/ethnic differences in the associations of tap water perceptions with SSB and plain water intake were also examined.

Nationally weighted data from the 2010 HealthStyles Survey (n 4184).

US adults aged ≥18 years.

Overall, 13·0 % of participants disagreed that their local tap water was safe to drink and 26·4 % of participants agreed that bottled water was safer than tap water. Both mistrust of tap water safety and favouring bottled water differed by region, age, race/ethnicity, income and education. The associations of tap water mistrust with intake of SSB and plain water were modified by race/ethnicity (P < 0·05). Non-white racial/ethnic groups who disagreed that their local tap water was safe to drink were more likely to report low intake of plain water. The odds of consuming ≥1 SSB/d among Hispanics who mistrusted their local tap water was twice that of Hispanics who did not (OR = 2·0; 95 % CI 1·2, 3·3).

Public health efforts to promote healthy beverages should recognize the potential impact of tap water perceptions on water and SSB intake among minority populations.

To assess the folate status of US women in a study of a folate-fortified oral contraceptive (OC) using the Short Folate Food Frequency Questionnaire and plasma and red blood cell (RBC) folate samples.

Sub-analysis from a multi-centre, randomised, double-blind, controlled contraceptive trial with assessments at baseline and 6 months. We calculated dietary folate equivalents (DFE) consumed and the proportion of participants meeting folate adequacy benchmarks.

Eight centres in the USA.

Healthy women aged 18–40 years requesting contraception with no contraindications for OC use.

Overall, 385 participants were randomised to either a novel folate-fortified OC or a marketed OC. The 262 (68 %) participants compliant with the protocol were included in the analysis set. Baseline daily DFE consumption was 529·8 (sd 342·1) μg and similar in both groups. At follow-up, the fortified OC group had higher intake than the conventional OC group (1225·9 (sd 346·2) μg compared with 500·6 (sd 361·2) μg). Mean plasma folate level increased from 44·5 (sd 17·2) to 55·8 (sd 21·1) nmol/l. Mean RBC folate level increased from 996·7 (sd 369·8) to 1311·9 (sd 436·0) nmol/l. The proportion meeting selected folate adequacy benchmarks increased in the fortified OC group (P < 0·001).

Lack of adequate folate intake in reproductive-aged women from dietary sources or supplements alone suggests the need for novel approaches. Use of folate-fortified OC ensures adequate folate levels and meeting of folate benchmarks.

To explore barriers and solutions to addressing physical inactivity and prolonged sitting in the adult population of Oman.

Qualitative study involving semi-structured interviews that took place from October 2011 to January 2012. Participants were recruited through purposive sampling. Data collection and analysis was an iterative process; later interviews explored emerging themes. Interviews were audio-recorded and transcribed and continued until data saturation; this occurred by the tenth interviewee. Thematic content analysis was carried out, guided by an ecological model of health behaviour.

Muscat, Oman.

Ten mid-level public health managers.

Barriers for physical inactivity were grouped around four themes: (i) intrapersonal (lack of motivation, awareness and time); (ii) social (norms restricting women's participation in outdoor activity, low value of physical activity); (iii) environment (lack of places to be active, weather); and (iv) policy (ineffective health communication, limited resources). Solutions focused on culturally sensitive interventions at the environment (building sidewalks and exercise facilities) and policy levels (strengthening existing interventions and coordinating actions with relevant sectors). Participants’ responses regarding sitting time were similar to, but much more limited than those related to physical inactivity, except for community participation and voluntarism, which were given greater emphasis as possible solutions to reduce sitting time.

Given the increasing prevalence of chronic disease in Oman and the Arabian Gulf, urgent action is required to implement gender-relevant public health policies and programmes to address physical inactivity, a key modifiable risk factor. Additionally, research on the determinants of physical inactivity and prolonged sitting time is required to guide policy makers.

To explore whether the effects on dietary behaviours of a computer-tailored intervention aimed to prevent excessive weight gain among adolescents, FATaintPHAT, were moderated by sociodemographic, cognitive and home environmental factors.

A two-group cluster randomized trial. Potential moderation of the outcome measures (consumption of sugar-sweetened beverages, snacks, fruits and vegetables) was studied by gender, education level, ethnicity, awareness of risk behaviour, intention and home availability.

Twenty schools in the Netherlands.

Students (n 883) aged 12–13 years.

Of the twenty-four interactions tested, only three were significant. The intervention effect on sugar-sweetened beverages was moderated by level of education (P = 0·009); intervention effects were found only among academic preparatory students. The intervention effects on fruit and vegetable intake were moderated by awareness of fruit intake (P < 0·001) and home availability of vegetables (P = 0·007); an effect on fruit intake was found only among students who were aware of their low fruit intake at baseline and an effect on vegetable consumption was found only among students who reported that vegetables were always available at their home.

The effects of the intervention generally did not differ between sociodemographic subgroups. The moderation by home availability illustrates that the environment may influence the effects of educational interventions.

To examine (i) the association of percentage of total energy intake from protein (protein intake %) with bone mineral density (BMD, g/cm2) and bone loss at the femoral neck, trochanter and lumbar spine (L2–L4) and (ii) Ca as an effect modifier.

The Framingham Offspring Study.

Men (n 1280) and women (n 1639) completed an FFQ in 1992–1995 or 1995–1998 and underwent baseline BMD measurement by dual-energy X-ray absorptiometry in 1996–2000. Men (n 495) and women (n 680) had follow-up BMD measured in 2002–2005.

Cohort study using multivariable regression to examine the association of protein intake % with each BMD, adjusting for covariates. Statistical interaction between protein intake % and Ca (total, dietary, supplemental) intake was examined.

The mean age at baseline was 61 (sd 9) years. In the cross-sectional analyses, protein intake % was positively associated with all BMD sites (P range: 0·02–0·04) in women but not in men. Significant interactions were observed with total Ca intake (<800 mg/d v. ≥800 mg/d) in women at all bone sites (P range: 0·002–0·02). Upon stratification, protein intake % was positively associated with all BMD sites (P range: 0·04–0·10) in women with low Ca intakes but not in those with high Ca intakes. In the longitudinal analyses, in men, higher protein intake % was associated with more bone loss at the trochanter (P = 0·01) while no associations were seen in women, regardless of Ca intake.

This suggests that greater protein intake benefits women especially those with lower Ca intakes. However, protein effects are not significant for short-term changes in bone density. Contrastingly, in men, higher protein intakes lead to greater bone loss at the trochanter. Longer follow-up is required to examine the impact of protein on bone loss.

To outline a framework and a process for assessing the needs for capacity development to achieve nutrition objectives, particularly those targeting maternal and child undernutrition.

Commentary and conceptual framework.

Low- and middle-income countries.

A global movement to invest in a package of essential nutrition interventions to reduce maternal and child undernutrition in low- and middle-income countries is building momentum. Capacity to act in nutrition is known to be minimal in most low- and middle-income countries, and there is a need for conceptual clarity about capacity development as a strategic construct and the processes required to realise the ability to achieve population nutrition and health objectives. The framework for nutrition capacity development proposed recognises capacity to be determined by a range of factors across at least four levels, including system, organisational, workforce and community levels. This framework provides a scaffolding to guide systematic assessment of capacity development needs which serves to inform strategic planning for capacity development.

Capacity development is a critical prerequisite for achieving nutrition and health objectives, but is currently constrained by ambiguous and superficial conceptualisations of what capacity development involves and how it can be realised. The current paper provides a framework to assist this conceptualisation, encourage debate and ongoing refinement, and progress capacity development efforts.

Dietary sodium reduction is an important public health intervention that would reduce blood pressure and chronic disease. An understanding of how New Zealand consumers’ food purchasing behaviour is influenced by perceptions of dietary sodium will inform future sodium-reduction strategies.

The present qualitative study used in-depth interviews of adult consumers to explore consumer knowledge, understanding of food labels and food purchasing behaviour with respect to dietary sodium.

New Zealand.

A convenience sample of sixteen adult grocery shoppers.

A thematic analysis of the transcripts showed New Zealand consumers lacked the background knowledge necessary to understand and regulate their own salt intake and were unable to interpret existing food labels with respect to dietary salt.

The findings add further weight to calls for food labels that do not require background knowledge or numerical skills and highlight the need for population-based public health interventions. Education of New Zealand consumers on the health benefits of sodium reduction and how this may be achieved would complement this approach.

The present study was conducted to investigate reasons for the high prevalence of anaemia among adolescent schoolgirls and to elucidate the role of vitamin A in contributing to Fe-deficiency anaemia (IDA).

Among 1269 schoolgirls who were previously screened for anaemia (Hb < 120 g/l), 391 anaemic girls were further assessed for Fe, vitamin A and subclinical inflammation status. Fe and vitamin A indicators were corrected for inflammation and were compared in the Fe-deficient and non-deficient groups as well as between those with and without inflammation. Logistic regression was done to determine whether vitamin A status and subclinical inflammation were risk factors for Fe deficiency. The differences in Fe status among tertiles of vitamin A concentrations were assessed using ANOVA.

Myanmar.

Adolescent schoolgirls (n 391).

One-third of the anaemia (30·4 %) was IDA. Prevalence of low vitamin A status (serum retinol <1·05 μmol/l) was 31·5 %. Fe and vitamin A status were significantly different between the IDA and non-IDA groups and also based on their inflammation status. Logistic regression showed that low vitamin A status was a significant predictor for being Fe deficient (OR = 1·81; 95 % CI 1·03, 3·19 and OR = 2·31; 1·31, 4·07 in the middle (1·056–1·298 μmol/l) and low (≤1·056 μmol/l) vitamin A tertiles, respectively). ANOVA showed that better Fe status was associated with a higher concentration of serum retinol but only in IDA.

Fe deficiency was not the main cause of anaemia in the present population. The role of vitamin A as well as other micronutrients should be taken into account in addressing the problem of anaemia.

Vitamin D insufficiency is known to be related to cardiometabolic disorders; however, the associations among serum 25-hydroxyvitamin D (25(OH)D) concentration and metabolic syndrome and cardiometabolic risk factors in children and adolescents have not yet been clearly delineated. For this reason, we investigated the relationship among serum 25(OH)D concentration and metabolic syndrome and cardiometabolic risk factors among Korean adolescents.

We performed a cross-sectional analysis and used hierarchical multivariate logistic regression analysis models to adjust for confounding variables.

We used the data gathered during the 2008–2009 Korea National Health and Nutrition Examination Survey (KNHANES).

Our subjects included 1504 Korean adolescents aged 12–18 years who participated in the KNHANES.

Vitamin D insufficiency, defined as 25(OH)D concentration <50 nmol/l, was found in 75·3 % of Korean adolescents and was associated with an increased risk of the prevalence of metabolic syndrome. Waist circumference and BMI were the most closely correlated cardiometabolic components of metabolic syndrome according to serum 25(OH)D status, but no significant relationship was found between serum 25(OH)D concentration and insulin resistance or for the risks for high blood pressure, hyperglycaemia, reduced HDL-cholesterol or hypertriacylglycerolaemia, with or without adjustment for confounding variables.

Low serum 25(OH)D concentration appears to be associated with several cardiometabolic risk factors and an increased risk of the prevalence of metabolic syndrome in Korean adolescents.

The aim of the present study was to evaluate the effects of a 1-year family-based healthy lifestyle intervention implemented through day-care centres on toddlers’ BMI Z-scores and reported activity- and dietary-related behaviours.

Pilot cluster-randomized controlled trial.

Seventy child-care centres in three different intervention communities and three paired-matched control communities in Flanders, Belgium.

A sample of 203 Belgian toddlers aged 9–24 months was included in the study. Objectively assessed weight and height were used to calculate BMI Z-scores. A parental-report questionnaire was used to assess children's lifestyle behaviours.

Positive intervention effects were found on BMI Z-score. No intervention effects were found for activity- and dietary-related behaviours targeted by the intervention. In both intervention and control groups, daily consumption of water, soft drinks, sweets and savoury snacks increased while daily consumption of fruit and vegetables decreased over 1 year. Daily physical activity remained stable but screen-time behaviour increased in both groups over time.

The study showed that a family-based healthy lifestyle intervention implemented through day-care centres can lead to healthier weight outcomes in toddlers. In both groups, an unhealthier lifestyle pattern was observed over 1 year which underlines the importance of the early childhood period as the focus of future behavioural interventions.

To assess understanding of the Department of Health weaning guidelines and weaning influences in a self-selected sample of black and minority ethnic (BME) parents, residing in London.

A face-to-face, questionnaire-facilitated survey among Black African, Black Caribbean and South Asian parents.

An opportunistic sample of parents was recruited from Sure Start centres, churches and play groups across key London boroughs.

Three hundred and forty-nine interviews were included; 107 Black African, fifty-four Black Caribbean, 120 South Asian and sixty-four of Black mixed-race ethnicity.

Fifty-two per cent of Black and 66 % of South Asian parents had accurate understanding of the guidelines. Inaccurate knowledge of the guidelines was associated with weaning before 17 weeks (P < 0·001); 36 % of Black Africans and 31 % of Black Caribbeans were weaned before 4 months compared with 16 % of South Asians. All BME groups were most influenced by weaning information from the previous generations of mothers in their families, which was associated with earlier weaning (21·5 (sd 6·5) v. 24·1 (sd 4·2) weeks; F(2,328) = 5·79, P = 0·003), and less so by professional infant feeding advice, which was associated with a later weaning age (23·7 (sd 5·1) v. 20·7 (sd 5·7) weeks; F(1,344) = 34·7, P < 0·001).

Lack of awareness of the Department of Health weaning guidelines is common among these BME populations, whose weaning behaviour is strongly influenced by informal advice. Further research is necessary to elucidate the influences on weaning in these populations and to facilitate the development of infant feeding support which is salient for BME groups in the UK.

The prevalence of Bitot's spots (BS) is often used to quantify vitamin A deficiency burden in India, both before and after mega-dose vitamin A supplementation (MVAS) programmes. However, the proportion of BS cured following this intervention is unclear in contemporary times. The current study evaluated the responsiveness of BS over 1 year to MVAS administered as per the national programme in rural India.

Prospective, community-based, 1-year follow-up of a cohort.

Rural Uttar Pradesh, India.

Two hundred and sixty-two children with BS, aged between 1 and 5 years, administered 60 mg (retinol equivalent) of vitamin A on diagnosis and after 1 month. Cure or resolution was defined if there was no discernible BS in either eye.

During 1 year, only three children were lost to follow-up. At 6 months of follow-up (MVAS at baseline and 1 month later), 51·1 (95% CI 45·3, 57·3) % were classified as cured. The corresponding figure at 1 year (additional MVAS at 6 months) was 59·9 (95% CI 54·1, 65·9) %. Among those cured at 6 months, about half and three-quarters had resolved at 2 and 3 months, respectively. Apart from male gender, there were no significant sociodemographic or clinical predictors of response.

Substantial non-response to MVAS at 6 months (49%) and 1 year (40%) of follow-up suggests that presently in the Indian subcontinent, BS is a relatively crude indicator of severe current vitamin A deficiency. For programmatic decisions and evaluation, the public health burden of vitamin A deficiency should not be assessed solely through BS.

To evaluate high-circulation US and Canadian newspaper coverage of the Institute of Medicine (IOM) report Dietary Reference Intakes for Calcium and Vitamin D and assess pre-report and post-report reporter-specific vitamin D-related coverage.

Two independent reviewers analysed the newspaper articles. The key report findings cited, proportion of sentences describing the IOM report and proportion of sentences describing critical viewpoints on the report were calculated. The content of articles written by reporters with a history of pre-report vitamin D-related articles was compared with that of articles written by reporters without such a history.

Factiva and LexisNexis searches of the top thirty US and three English-language Canadian print newspapers, by circulation.

Articles on the IOM report published from 30 November to 21 December 2010 and previous vitamin D-related articles written by the same reporters.

Only ten articles met inclusion/exclusion criteria. Articles inconsistently cited the key findings in the IOM report. Reporters with a history of pre-report articles highlighting the benefits of vitamin D dedicated a greater proportion of sentences to viewpoints critical of the IOM report (P < 0·01). There was no significant difference between pre-report publication history and proportion of sentences focused on the IOM report. A borderline-significant difference (P = 0·058) was observed between pre-report articles highlighting the benefits of vitamin D and the absence of reference to potential risks of vitamin D overconsumption.

Our findings suggest that newspaper articles did not consistently or comprehensively report the IOM recommendations and that pre-report publication history of reporters was related to post-report article content.

To establish a laboratory iodization quality assurance system to support small-scale salt production facilities in India and to assess the level of agreement for the internal quality assurance (IQA) and external quality assurance (EQA) protocols.

Operational research. The IQA and EQA programme was established in the year 2008. Agreement between field laboratories and the reference laboratory for estimation of iodine content of salt from 2008 to 2011 was assessed. Agreement was assessed using the χ2 test, kappa statistics and the Bland–Altman plot.

Small-scale salt producers in the states of Andhra Pradesh, Gujarat, Rajasthan, Tamil Nadu, Odisha and Karnataka; ‘field laboratories’ supporting the small-scale salt producers; and the ‘reference laboratory’ of the Regional Office (South Asia) of the International Council for the Control of Iodine Deficiency Disorders.

Three hundred small-scale salt producers in the states of Andhra Pradesh, Gujarat, Rajasthan, Tamil Nadu, Odisha and Karnataka and seventeen ‘field laboratories’.

A total of 6573 salt samples for IQA and 347 salt samples for EQA were exchanged between field and reference laboratories during 2008–2012. Out of the total salt sample exchanges, 527 were from Andhra Pradesh and Odisha, 2343 from Gujarat, 2016 from Rajasthan and 1677 from Tamil Nadu and Karnataka. The overall between-laboratory agreement was for 61·6 % for IQA and 64·8 % for EQA. The mean difference between iodine content estimation of field laboratories and the reference laboratory was 0·3 ppm (sd 8·2 ppm) for IQA and –0·3 ppm (sd 3·5 ppm) for EQA.

Our study successfully documents implementation of a laboratory iodization quality assurance protocol in laboratories supporting small-scale salt production facilities in India.

The current study aimed to evaluate the effect of fortified milk combined with a lifestyle and counselling programme on several CVD risk factors after a 3-month dietary intervention.

Hypercholesterolaemic adults were randomized to a group supplemented with low-fat milk that was enriched with phytosterols, α-linolenic and linoleic fatty acids, vitamins and antioxidants (enriched milk group, EMG: n 40), a placebo milk group (PMG: n 36) or a control group (CG: n 25). The EMG and PMG consumed respectively 500 ml of enriched milk or placebo milk daily and attended biweekly counselling sessions over a 3-month period.

Harokopio University, Athens, Greece.

A sample of 101 hypercholesterolemic adults aged 40–60 years.

Regarding lifestyle changes, total and saturated fat intakes decreased significantly in both intervention groups compared with the CG (P < 0·005). Furthermore, total steps were increased (P = 0·029) and BMI was decreased (P = 0·017) significantly in both intervention groups compared with the CG. Regarding biochemical indices, EPA content in erythrocyte membranes increased (P < 0·001) while serum C-reactive protein decreased (P = 0·003) significantly in both intervention groups compared with the CG. Finally, significant increases in plasma folic acid and vitamin B12 levels and a significant decrease in homocysteine levels were observed in the EMG compared with the PMG and CG (all P < 0·001). A favourable change in LDL cholesterol:HDL cholesterol was also observed in the EMG and tended to be significant compared with the PMG and CG (P = 0·066).

The present study showed that consumption of fortified milk accompanied with lifestyle counselling induces extra benefits in terms of LDL cholesterol:HDL cholesterol and serum homocysteine levels.

To examine the association between breakfast skipping and physical activity among US adolescents aged 12–19 years.

A cross-sectional study of nationally representative 2007–2008 National Health and Nutrition Examination Survey (NHANES) data.

Breakfast skipping was assessed by two 24 h dietary recalls. Physical activity was self-reported by participants and classified based on meeting national recommendations for physical activity for the appropriate age group. Multiple logistic regression analysis was used to model the association between breakfast skipping and physical activity while controlling for confounders.

A total of 936 adolescents aged 12–19 years in the USA.

After adjusting for family income, there was no association between breakfast skipping and meeting physical activity guidelines for age among adolescents aged 12–19 years (OR = 0·95, 95 % CI 0·56, 1·32).

Findings from the study differ from previous research findings on breakfast skipping and physical activity. Therefore, further research that uses large, nationally representative US samples and national recommended guidelines for physical activity is needed.

Food prepared and consumed away from home accounts for a significant proportion of dietary intake among Canadians. Currently, Canadians receive little or no nutrition information when eating in restaurant and fast-food outlets. The present study examined the impact of nutrition information on menus in hospital cafeterias on noticing and perceived influence of nutrition information and on food consumption.

Cross-sectional surveys.

Exit surveys (n 1003) were conducted in two hospital cafeterias. The ‘intervention’ site featured energy (calorie), sodium and fat content on digital menu boards, as well as a health logo for ‘healthier’ items. The intervention site had also revised its menu items to improve the nutrient profiles. The ‘control’ site provided limited nutrition information at the point of sale.

Cafeteria patrons recruited using the intercept technique.

Significantly more respondents at the intervention site reported noticing nutrition information (OR = 7·6, P < 0·001) and using nutrition information to select their food items (OR = 3·3, P < 0·001) compared with patrons at the control site, after adjusting for sociodemographic factors. Patrons at the intervention site consumed significantly less energy (−21 %, P < 0·001), sodium (−23 %, P < 0·001), saturated fat (−33 %, P < 0·001) and total fat (−37 %, P < 0·001) than patrons at the control site.

A nutritional programme, including nutrition information on menus and improved nutrition profile of food offerings, was associated with substantial reductions in energy, sodium and fat consumption. The results are consistent with a positive impact of menu labelling.

The aim was to explore how the behaviour of consumers changed while they selected food in a supermarket environment after they were reminded about weight management. This investigation was carried out from the perspective of selection criteria, reading of package labels, nutritional quality of the products selected and time taken to select a product.

The subjects, who were actively watching their weight, participated in two consecutive tasks in a supermarket. They were given a shopping list of eleven food categories and asked to think aloud while selecting from each category a product they usually buy and a product they would use for weight management. The data (n 792 selections) were collected through interviews and a verbal analysis protocol combined with wireless audio-visual observation.

Thirty-six consumers were recruited from a sample of 367 supermarket customers.

Kuopio, Finland.

The subjects’ behaviour changed radically after they were reminded about weight management. In the first selection, taste and familiarity were the main food selection criteria while in the latter selection the energy/fat content predominated. Consequently, the nutritional quality of products improved greatly because subjects read package labels twice as much in the latter selection. The time taken to select a product increased significantly, on average, from 23 (sd 10) to 60 (sd 51) s/product (P = 0·000).

Only by reminding consumers about weight management was there a significant impact on their food selection behaviour. Marketing communication should be developed which quickly and easily promotes consumers’ awareness of healthy food in supermarkets.

To investigate the knowledge, attitudes and behaviour of Greek adults towards salt as well as their differences with respect to gender, age and level of education.

Cross-sectional, observational survey.

Voluntary participation to a telephone interview, using a seventeen-item questionnaire.

Greek adults aged over 25 years (n 3609), nationally representative according to age, gender and geographical distribution of the Greek population, were interviewed.

More women of all age groups compared with men reported adding salt during cooking (P < 0·001), while less reported adding salt on the plate (P < 0·001). Also, more women believed that salt added during cooking was the main source of salt in the diet (P < 0·001). Participants aged 25–34, 35–44 and 45–54 years old had better knowledge of the harmful effects of salt on health compared with the 55+ years age group (P = 0·002, P = 0·001, P < 0·001, respectively); respondents in the aforementioned age groups also knew that children should consume less salt than adults compared with 55+ years age group (P = 0·004, P < 0·001, P < 0·001, respectively). Respondents with secondary and higher educational status were more likely to avoid consumption of processed foods (P < 0·001) and to check the nutrition information on food packaging as compared with respondents having basic education status (P < 0·001).

Awareness needs to be raised regarding salt recommendations for adults and children, sources of sodium in the diet and adding less salt during cooking, as well as reading food labels. Future campaigns for salt reduction should consider gender, age and level of education differences regarding knowledge, attitudes and behaviour towards salt.

To quantify short- and long-term associations between dietary patterns defined a priori and bone mineral density (BMD) during adolescence.

Dietary patterns were defined at 13 years old using a Mediterranean diet (MD) quality index, the Dietary Approaches to Stop Hypertension (DASH) diet index and the Oslo Health Study (OHS) dietary index. Linear regression coefficients were used to estimate associations between dietary patterns and forearm BMD at 13 and 17 years, measured by dual-energy X-ray absorptiometry.

Public and private schools of Porto, Portugal.

The EPITeen cohort comprising 1180 adolescents born in 1990, recruited at schools during the 2003/2004 school year and re-evaluated in 2007/2008.

In girls, at 13 years, mean BMD (g/cm2) in the first and third tertiles was 0·369 and 0·368 for the MD pattern, 0·368 and 0·369 for the DASH diet, and 0·370 and 0·363 for the OHS index. In boys, mean BMD (g/cm2) in the first and third tertiles was 0·338 and 0·347 for the MD pattern, 0·342 and 0·346 for the DASH diet, and 0·344 and 0·342 for the OHS index. None of these differences were significant. Mean BMD at 17 years and prospective variation were also not significantly different between tertiles of adherence to each score. However, a trend of increased BMD at 13 years with greater adherence to the MD pattern was observed in boys (adjusted coefficient = 0·248; 95 % CI 0·052, 0·444).

The selected dietary patterns may not capture truly important dietary differences in determining BMD or diet may not be, beyond nutrient adequacy, a limiting determinant of BMD.