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Objective:To compare the dietary habits of children living in northern villages and in the capital of Greenland, given the reported transition from traditional to westernised diet in adults over recent decades, and to explore the association between consumption of marine mammals and fish (MMF) and the children’s metabolic profile and vitamin D status.Design:Children answered an FFQ encompassing sixty-four individual food types pooled into six food categories. Their pubertal stage, body fat, fitness level, metabolic profile (non-HDL-cholesterol, glycated Hb, insulin, glucose, high-sensitivity C-reactive protein) as well as serum 25-hydroxyvitamin D (25(OH)D) concentration were evaluated.Setting:Siorapaluk and Qaanaaq (north of Greenland) and Nuuk (west).Participants:Children aged 6–18 years (n 177).Results:MMF were most frequently eaten by children from Siorapaluk (mean (sd): 73·4 (14·1) times/month), followed by children from Qaanaaq (37·0 (25·0) times/month), and least often eaten by children from Nuuk (23·7 (24·6) times/month; P < 0·001). Children from Qaanaaq consumed ‘junk food’ more frequently (P < 0·001) and fruits and vegetables less frequently (P < 0·01) than children from Nuuk. MMF consumption was positively associated with serum 25(OH)D concentration (P < 0·05), but the overall prevalence of vitamin D deficiency was high (18 %). No association was found between MMF consumption and metabolic parameters.Conclusions:The dietary transition and influence of western diets have spread to the north of Greenland and only the most remote place consumed a traditional diet highly based on MMF. We found no strong associations of MMF consumption with metabolic health, but a positive association with vitamin D status.

Objective:To explore adolescents’ perceptions, knowledge and behaviours regarding nutrition and physical activity in low-income districts of Abidjan, Côte d’Ivoire, taking into consideration their caregivers’ perspectives.Design:Two investigators conducted six focus group discussions.Setting:The study was carried out in two low-income suburbs, Yopougon and Port-Bouët, in Abidjan, Côte d’Ivoire.Participants:Adolescents and their caregivers were recruited into the study via local head teachers and heads of settlement.Results:Overall, seventy-two participants, including forty-six adolescents and twenty-six caregivers, took part. Participants demonstrated good nutrition knowledge, relating nutritional health to a balanced diet and hygiene. Sustained physical activity was reported. However, adopting good practices was challenging due to participant’s economic circumstances. Their environment was a barrier to improving health due to dirtiness and violence, with a lack of space limiting the possibility to practice sport. Adolescents and their caregivers differed in their response to these constraints. Many caregivers felt powerless and suggested that a political response was the solution. Alternatively, adolescents were more likely to suggest new creative solutions such as youth-friendly centres within their community.Conclusions:Participants were aware that their nutritional habits were not in line with what they had learnt to be good nutritional practices due to socio-economic constraints. Physical activity was part of adolescent life, but opportunities to exercise were restricted by their environment. Strategies for improving adolescent health in these settings need to be developed in collaboration with adolescents in a manner that accommodates their opinions and solutions.

Objective:To identify school community readiness to adopt a school-based adolescent nutrition intervention.Design:Cross-sectional study: mixed-methods design. The community readiness model was used to guide instrument development and qualitative analysis. Quantitative data are presented using descriptive statistics. Each statement was rated on a seven-point Likert scale, thereby producing scores between 1 (strongly disagree) and 7 (strongly agree).Setting:Ten of the twenty current public secondary schools in Bogor, Indonesia.Participants:Ninety teachers and ten school principals.Results:Eating behaviour problem awareness was present among all participants; awareness of efforts to improve eating habits was also present, but these efforts were perceived as having low efficacy; support from the City Education Authority and Health Authority was present, but the support type did not match the perceived needs; nutrition education had not been implemented across the entire school community due to competing priorities; existing nutrition policies did not provide concrete scenarios and clear guidelines for nutrition-friendly schools; the availability and accessibility of healthy foods at schools were considered to be key factors in improved adolescent nutrition; positive attitudes existed among respondents towards the implementation of various nutrition programmes, and the median and mode were seven in all types of school-based intervention.Conclusions:The school community readiness level regarding school-based adolescent nutrition interventions is currently in the action phase, implying that community leaders have begun organising efforts to address issues in adolescent nutrition and are aware of their consequences. Future support should be directed towards improving existing efforts and offering concrete ideas and clear policy guidelines for implementation.

ObjectivePhiladelphia passed a 1·5-cent-per-ounce sweetened beverage tax (SBT). Revenue will fund 10 000 quality pre-kindergarten slots for poor children. It is imperative to understand how revenue from SBT can be used to fund programmes to address education and other social determinants of health. The objective of the present study was to simulate quality pre-kindergarten attendance, educational achievement and sugar-sweetened beverage (SSB) consumption among Philadelphia children and adolescents under six intervention scenarios: (i) no intervention; (ii) 10 000 additional quality pre-kindergarten slots; (iii) a 1·5-cent-per-ounce SBT; (iv) expanded pre-kindergarten and 1·5-cent-per-ounce SBT; (v) a 3-cent-per-ounce SBT; and (vi) expanded pre-kindergarten and 3-cent-per-ounce SBT.DesignWe used an agent-based model to estimate pre-kindergarten enrolment, educational achievement and SSB consumption under the six policy scenarios. We identified key parameters in the model from the published literature and secondary analyses of the Panel Study of Income Dynamics – Child Development Supplement.SettingPhiladelphia, Pennsylvania, USA.SubjectsPhiladelphia children and adolescents aged 4–18 years.ResultsA 1·5-cents-per-ounce tax would reduce SSB consumption by 1·3 drinks/week among Philadelphia children and adolescents relative to no intervention, with larger effects among children below the poverty level. Quality pre-kindergarten expansion magnifies the effect of the SBT by 8 %, but has the largest effect on moderate-income children just above the poverty level. The SBT and quality pre-kindergarten programme each reduce SSB consumption, but primarily benefit different children and adolescents.ConclusionsPairing an excise tax with a complementary programme to improve a social determinant of health represents a progressive strategy to combat obesity, a disease regressive in its social patterning.

ObjectiveTo examine demographic and behavioural correlates of high consumption of soft drinks (non-alcoholic sugar-sweetened carbonated drinks excluding energy drinks) among Australian adolescents and to explore the associations between high consumption and soft drink perceptions and accessibility.DesignCross-sectional self-completion survey and height and weight measurements.SettingAustralian secondary schools.SubjectsStudents aged 12–17 years participating in the 2012–13 National Secondary Students’ Diet and Activity (NaSSDA) survey (n 7835).ResultsOverall, 14 % of students reported consuming four or more cups (≥1 litres) of soft drinks each week (‘high soft drink consumers’). Demographic factors associated with high soft drink consumption were being male and having at least $AU 40 in weekly spending money. Behavioural factors associated with high soft drink consumption were low fruit intake, consuming energy drinks on a weekly basis, eating fast foods at least once weekly, eating snack foods ≥14 times/week, watching television for >2 h/d and sleeping for ConclusionsHigh soft drink consumption clusters with other unhealthy lifestyle behaviours among Australian secondary-school students. Interventions focused on reducing the availability of soft drinks (e.g. increased taxes, restricting their sale in schools) as well as improved education on their harms are needed to lower adolescents’ soft drink intake.

ObjectiveTo determine the prevalence and correlates of anaemia in male and female adolescents in Riyadh, Kingdom of Saudi Arabia.DesignA cross-sectional community-based study.SettingFive primary health-care centres in Riyadh.SubjectsWe invited 203 male and 292 female adolescents aged 13–18 years for interview, anthropometric measurements and complete blood count. Blood Hb was measured with a Coulter Cellular Analysis System using the light scattering method.ResultsUsing the WHO cut-off of Hbn34) of males and 34·2 % (n100) of females were suffering from anaemia. Mean Hb in males and females was 13·5 (sd1·4) and 12·3 (sd1·2) g/dl, respectively. Values for mean cell volume, mean cell Hb, mean corpuscular Hb concentration and red cell distribution width in male and female adolescents were 77·8 (sd6·2)v.76·4 (sd10·3) μm3, 26·1 (sd2·7)v.25·5 (sd2·6) pg, 32·7 (sd2·4)v.32·2 (sd2·6) g/dl and 13·9 (sd1·4)v.13·6 (sd1·3) %, respectively. Multivariate logistic regression revealed that a positive family history of Fe-deficiency anaemia (OR=4·7; 95 % CI 1·7, 12·2), infrequent intake (OR=3·7; 95 % CI 1·3, 10·0) and never intake of fresh juices (OR=3·5; 95 % CI 1·4, 9·5) and being 13–14 years of age (OR=3·1; 95 % CI 1·2, 9·3) were significantly associated with anaemia in male adolescents; whereas in females, family history of Fe-deficiency anaemia (OR=3·4; 95 % CI 1·5, 7·6), being overweight (OR=3·0; 95 % CI 1·4, 6·1), no intake of fresh juices (OR=2·6; 95 % CI 1·4, 5·1), living in an apartment (OR=2·0; 95 % CI 1·1, 3·8) and living in a small house (OR=2·5; 95 % CI 1·2, 5·3) were significantly associated with anaemia.ConclusionsAnaemia is more prevalent among Saudi female adolescents as compared with males. Important factors like positive family history of Fe-deficiency anaemia, overweight, lack of fresh juice intake and low socio-economic status are significantly associated with anaemia in adolescents.

ObjectiveMany developing countries are undergoing a nutrition transition with rising rates of overweight and obesity. This nutrition transition coincides with a rapid expansion of supermarkets. The objective of the present research is to study whether supermarkets directly contribute to overweight and other changes in nutritional status.DesignThis research builds on cross-sectional observational data. Household- and individual-level data were collected in Kenya using a quasi-experimental survey design. Instrumental variable regressions were employed to analyse the impact of supermarket purchase on nutritional status. Causal chain models were estimated to examine pathways through which supermarkets affect nutrition.SettingSmall towns in Central Province of Kenya with and without supermarkets.SubjectsA total of 615 adults and 216 children and adolescents.ResultsControlling for other factors, buying in a supermarket is associated with a significantly higher BMI (P=0·018) and a higher probability of overweight (P=0·057) among adults. This effect is not observed for children and adolescents. Instead, buying in a supermarket seems to reduce child undernutrition measured by height-for-age Z-score (P=0·017). Impacts of supermarkets depend on many factors including people’s initial nutritional status. For both adults and children, the nutrition effects occur through higher food energy consumption and changes in dietary composition.ConclusionsSupermarkets and their food sales strategies contribute to changing food consumption habits and nutritional outcomes. Yet the types of outcomes differ by age cohort and initial nutritional status. Simple conclusions on whether supermarkets are good or bad for nutrition and public health are not justified.

ObjectiveTo explore perceived factors that impede or facilitate healthful eating within the home environment among overweight/obese adolescents.DesignIn the present qualitative photovoice study, participants were instructed to take photographs of things that made it easier or harder to make healthful food choices at home. Digital photographs were reviewed and semi-structured interviews were conducted to promote discussion of the photographs. Data were analysed using constant comparative analysis.SettingVancouver, Canada, in 2012–2013.SubjectsTwenty-two overweight/obese adolescents who completed a family-based lifestyle modification intervention.ResultsThe mean age of participants was 14 (sd1·9) years, 77 % were female and their mean BMIZ-score was 2·4 (sd0·6). Adolescents talked about six aspects of the home environment that influenced their eating habits (in order of frequency): home cooking, availability and accessibility of foods/beverages, parenting practices, family modelling, celebrations and screen use/studying. In general, homes with availability of less healthful foods, where family members also liked to eat less healthful foods and where healthier foods were less abundant or inaccessible were described as barriers to healthful eating. Special occasions and time spent studying or in front of the screen were also conducive to less healthful food choices. Home cooked meals supported adolescents in making healthier food choices, while specific parenting strategies such as encouragement and restriction were helpful for some adolescents.ConclusionsAdolescents struggled to make healthful choices in their home environment, but highlighted parenting strategies that were supportive. Targeting the home food environment is important to enable healthier food choices among overweight/obese adolescents.

ObjectiveThe main objectives were to assess the adequacy of the micronutrient intakes of lactating women in a peri-urban area in Nepal and to describe the relationships between micronutrient intake adequacy, dietary diversity and sociodemographic variables.DesignA cross-sectional survey was performed during 2008–2009. We used 24 h dietary recall to assess dietary intake on three non-consecutive days and calculated the probability of adequacy (PA) of the usual intake of eleven micronutrients and the overall mean probability of adequacy (MPA). A mean dietary diversity score (MDDS) was calculated of eight food groups averaged over 3 d. Multiple linear regression was used to identify the determinants of the MPA.SettingBhaktapur municipality, Nepal.SubjectsLactating women (n 500), 17–44 years old, randomly selected.ResultsThe mean usual energy intake was 8464 (sd 1305) kJ/d (2023 (sd 312) kcal/d), while the percentage of energy from protein, fat and carbohydrates was 11 %, 13 % and 76 %, respectively. The mean usual micronutrient intakes were below the estimated average requirements for all micronutrients, with the exception of vitamin C and Zn. The MPA across eleven micronutrients was 0·19 (sd 0·16). The diet was found to be monotonous (MDDS was 3·9 (sd 1·0)) and rice contributed to about 60 % of the energy intake. The multiple regression analyses showed that MPA was positively associated with energy intake, dietary diversity, women’s educational level and socio-economic status, and was higher in the winter.ConclusionsThe low micronutrient intakes are probably explained by low dietary diversity and a low intake of micronutrient-rich foods.

ObjectiveTo investigate associations of self-perceived eating-related peer norms (called ‘subjective peer norms’) with adolescents’ healthy eating intentions and intake of healthy and unhealthy food.DesignCross-sectional data were collected in a large international survey.SettingTwo types of subjective peer norms were assessed: perceived peer encouragement of healthy eating and perceived peer discouragement of unhealthy eating. Outcome variables were healthy eating intentions, intake of healthy food (fruits and vegetables) and intake of unhealthy food (snacks and soft drinks).SubjectsOver 2500 European (pre-)adolescents aged between 10 and 17 years participated.ResultsSubjective peer norms were associated with all three outcome variables. While both perceived encouragement of healthy eating and perceived discouragement of unhealthy eating were related to intentions, only peer encouragement of healthy eating was related to intakes of both healthy and unhealthy food.ConclusionsSubjective peer norms play a role in adolescent eating behaviour and as such are an important target for health promotion. Addressing norms that encourage healthy eating may be more promising in changing behaviour than norms that discourage unhealthy eating.

ObjectiveThe study aimed to examine nutrition label use and dietary behaviours among ethnically diverse middle- and high-school students, in Texas, USA.DesignThe School Physical Activity and Nutrition (SPAN) survey is a cross-sectional statewide study using a self-administered questionnaire to assess nutrition and physical activity behaviours. Height and weight measurements were used to determine BMI. Multivariable logistic regression was used to determine associations between nutrition label use and dietary behaviours, with gender, grade, ethnicity, BMI, parent education, socio-economic status and nutrition knowledge as covariates.SettingParticipants from 283 schools, weighted to represent Texas youth.SubjectsSPAN 2009–2011 included 6716 8th and 11th graders (3465 girls and 3251 boys). The study population consisted of 39·83 % White/Other, 14·61 % African-American and 45·56 % Hispanic adolescents; with a mean age of 14·9 years, and 61·95 % at a healthy weight, 15·71 % having overweight and 22·34 % having obesity.ResultsAdolescents who did not use nutrition labels had 1·69 times greater odds of consuming ≥1 sugary beverages/d (PPPConclusionsNutrition label use is associated with healthier dietary behaviours in adolescents. Intervention strategies for youth should include efforts to teach adolescents to use labels to make healthy food choices.

ObjectiveTo investigate dietary sources of Ca and vitamin D (VitD) intakes, and the associated sociodemographic and lifestyle factors, among European adolescents.DesignLinear regression mixed models were used to examine sex-specific associations of Ca and VitD intakes with parental education, family affluence (FAS), physical activity and television (TV) watching while controlling for age, Tanner stage, energy intake and diet quality.SettingThe Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA)Cross-Sectional Study.SubjectsAdolescents aged 12·5–17·5 years (n 1804).ResultsMilk and cheese were the main sources of Ca (23 and 19 % contribution to overall Ca intake, respectively). Fish products were the main VitD source (30 % contribution to overall VitD intake). Ca intake was positively associated with maternal education (β=56·41; 95 % CI 1·98, 110·82) and negatively associated with TV viewing in boys (β=–0·43; 95 % CI −0·79, −0·07); however, the significance of these associations disappeared when adjusting for diet quality. In girls, Ca intake was positively associated with mother’s (β=73·08; 95 % CI 34·41, 111·74) and father’s education (β=43·29; 95 % CI 5·44, 81·14) and FAS (β=37·45; 95 % CI 2·25, 72·65). This association between Ca intake and mother’s education remained significant after further adjustment for diet quality (β=41·66; 95 % CI 0·94, 82·38). Girls with high-educated mothers had higher Ca intake.ConclusionsLow-educated families with poor diet quality may be targeted when strategizing health promotion programmes to enhance dietary Ca.

Aim: The aim of the present study was to determine the impact of food advertising in primary and secondary schools on the food purchasing habits of children. Methods: All forty-four primary and secondary schools in Rzeszow, Poland were included in the investigation; 15 000 children attend primary and secondary schools in the region. Schools were visited by members of the research team, who filled in a questionnaire regarding the type of food products displayed or advertised in the school shop window and recorded the presence of direct corporate advertising in the proximity of the school shop. Shop owners were asked to fill in a form describing food purchases by students within the week preceding the visit. The school principal (or one of teachers) completed a form describing the school's policy regarding food advertising and the sponsorship of school activities by food companies. Results: Recommended foods like milk, yoghurts and fruit were offered by only 40·9% of shops. There was a correlation between foods offered in the shop and foods purchased by students. In schools, 40·9 % (95% CI 25-8, 56-0 %) of shop windows displayed or advertised 'healthy' foods while 9·1% (95 % CI 0·0, 17·9%) of shops displayed advertisements of food companies. The difference between display of 'healthy' food in shop windows and display of food on company advertisements was significant (likelihood ratio Χ 2 test, P< 0·04). Type of school (primary v. secondary) was not significant factor in advertising or purchasing pattern. Conclusions: Educational programmes should be introduced in schools with the aim of improving the understanding of nutritional principles among pupils, teachers and parents.

ObjectiveThe present study examines whether rural-to-urban migrant youth consume a greater diversity of high-sugar beverages and fried snacks (HSBFS) compared with their peers who remain in rural areas. It also tests whether the association between migration and HSBFS diversity is moderated by migrant youth’s social engagement with their peers.DesignParticipants were recruited in August and September 2011 following the completion of primary school (6th grade) and shortly before many rural youth migrate to urban areas. Participants were re-interviewed six months later. HSBFS diversity was assessed at follow-up; analyses control for baseline and follow-up characteristics.SettingBaseline interviews occurred in rural Southeast Haiti. Follow-up interviews of migrants occurred at urban destinations in Haiti.SubjectsThe sample includes 215 youth (mean age 15·9 years; 43·3 % female; 21·9 % rural-to-urban migrants) who were interviewed at baseline and follow-up.ResultsRural-to-urban migrant youth consumed a greater diversity of HSBFS products at follow-up than their rural counterparts (b=0·70,P≤0·05). Moreover, we found that this relationship varied by level of peer social engagement. Youth who migrated and had a high degree of peer social engagement consumed 2·2 additional types of HSBFS products daily than their counterparts who remained in rural areas and had low peer social engagement.ConclusionsHigher HSBFS diversity among migrant youth is consistent with the patterns proposed by the nutrition transition. Interactions with peers may have an important influence as migrant youth adopt new dietary preferences. Emerging dietary patterns among youth migrants have important implications for health trajectories and the development of degenerative diseases.

ObjectiveTo examine the quantitative relationship between sugar intake and the progressive development of dental caries.DesignA critical in-depth review of international studies was conducted. Methods included reassessing relevant studies from the most recent systematic review on the relationship between levels of sugars and dental caries. Reanalysis of dose–response relationships between dietary sugars and caries incidence in teeth with different levels of caries susceptibility in children was done using data from Japanese studies conducted by Takeuchi and co-workers.SettingGlobal, with emphasis on marked differences in both national sugar intake and fluoride use and preferably where one factor such as sugar intake changed progressively without changes in other factors over a decade or more.SubjectsChildren aged 6 years or more and adults.ResultsCaries occurred in both resistant and susceptible teeth of children when sugar intakes were only 2–3 % of energy intake, provided that the teeth had been exposed to sugars for >3 years. Despite increased enamel resistance after tooth eruption, there was a progressive linear increase in caries throughout life, explaining the higher rates of caries in adults than in children. Fluoride affects progression of caries development but there still is a pandemic prevalence of caries in populations worldwide.ConclusionsPrevious analyses based on children have misled public health analyses on sugars. The recommendation that sugar intakes should be ≤10 % of energy intake is no longer acceptable. The much greater adult burden of dental caries highlights the need for very low sugar intakes throughout life, e.g. 2–3 % of energy intake, whether or not fluoride intake is optimum.

ObjectiveTo describe the Nutrition Improvement Programme for Rural Compulsory Education Students (NIPRCES) in China and to share the experiences of developing and implementing nationwide school meal programmes with other countries.DesignThe article is based on a literature review of technical documents and reports of NIPRCES and relevant national legislation, technical reports and studies on school nutrition, minutes of meetings and national conferences, and official documents of the National Office of Student Nutrition and the Chinese Center for Disease Control and Prevention.SettingPeople’s Republic of China.SubjectsPublished papers, national policies, legislation and unpublished official documents.ResultsA total of 23 million rural compulsory education students were covered by NIPRCES. In the development and implementation process of NIPRCES, fifteen ministries and national committees were involved and an efficient collaborative mechanism was established. All NIPRCES-covered schools were required to serve meals on a daily basis. By the end of June 2012, the proportions of students choosing ‘school feeding’, ‘food package’ and ‘family feeding’ modes were respectively 64·0 %, 32·0 % and 4·0 %. The central government subsidized school meals annually by more than $US 2·5 billion and invested $US 4·8 billion on school kitchens to support this programme.ConclusionsThe NIPRCES is a significant movement of governmental nutritional intervention in China. Food safety, financial security, decentralization and other potential concerns should be considered and lessons can be learned from other countries. Further relevant research and a nationwide monitoring and evaluation programme are needed.

ObjectiveTo assess differences in adherence to the Mediterranean diet (MD) between consumers and non-consumers of functional foods among the Balearic Islands’ adolescent population.DesignCross-sectional nutritional survey carried out (2007–2008) in the Balearic Islands, a Mediterranean region. Dietary assessment was based on a semi-quantitative FFQ and two non-consecutive 24 h recalls. Anthropometric measurements and questions related to socio-economic status, physical activity and adherence to the MD were assessed.SettingData obtained from a representative sample of all inhabitants living in the Balearic Islands aged 12–17 years.SubjectsA random sample (n 1961) of the adolescent population was interviewed.ResultsThe mean adherence to the MD among consumers of functional foods was 56·42 (sd 6·05) % and 55·76 (sd 5·41) % among non-consumers. Consumption of fruit juice, fibre-rich bread/cookies, cereal bars, fish and soya milk was higher among adolescents with high MD adherence, and consumption of modified milk, probiotics, breakfast cereals and infusions was higher among adolescents with low MD adherence. Daily intakes of functional dietary components from plant foods (dietary fibre, vitamins C and E, carotene, folic acid) were higher among adolescents with high MD adherence.ConclusionsThe Balearic Islands’ adolescent population had moderate adherence to the MD; higher adherence was observed among consumers of functional foods. Average daily intakes of functional foods and functional dietary components were higher among adolescents with high adherence to the MD. Gender, age and low parental education were risk factors for low adherence to the MD, mainly among non-consumers of functional foods.

Since the 1970s, childhood obesity prevalence has increased in developed countries worldwide(1). Estimates suggest that up to 60 % of obese adolescents become obese adults(2) and that dietary patterns established during childhood and adolescence often persist into adulthood(3). Accordingly, there has been an increased focus on diet and dietary behaviours in children and adolescents. Consumption of sugar-sweetened beverages(4–8), increased portion sizes(9,10) and eating more meals away from home(5,11) have all been positively associated with excess weight gain in childhood. Further, nationally representative US trend data from children aged 2 to 18 years show that average eating frequency has increased from three to five daily eating occasions between 1970 and the 2000s(12) and average total daily energy intake has increased by 770 kJ (184 kcal) over the same time frame(13). These findings, among others, have led researchers to explore what role eating frequency plays in dietary intake and weight status in childhood. The observed increase in eating frequency is largely attributable to snacking, given that the average American child eats three snacks per day(14). Snacking contributes nearly one-third of total energy consumed, the majority of which comes from desserts and sugar-sweetened beverages(14). Further, compared with breakfast, lunch and dinner meals, snacks have a significantly higher energy density(15). Despite these findings, the cross-sectional literature on the relationship between eating frequency and snacking generally suggests an inverse relationship with weight status(16,17). Given the inconsistencies in the literature, no consensus exists with regard to the impact of eating frequency on relative weight in children(18,19). A 2013 review of this relationship cited inconsistent definitions for snacking occasions, methodological limitations in cross-sectional studies and a shortage of prospective studies, and concluded that the evidence base is lacking(17). In the absence of clear guidance to parents, schools and clinicians as to an ideal eating frequency to help reduce childhood obesity risk, the objective of the present study was to explore the relationships of eating frequency, meal frequency and snack frequency with total energy intake and diet quality in an effort to clarify the possible role of eating frequency in excess weight gain in children. Further, given that younger children appear to have a better ability to self-regulate intake(20), and that adolescents typically have greater autonomy over their eating habits, have greater spending power and consume more meals outside the home(21), a secondary objective was to examine whether these associations differ between elementary school-age (9–11-year-olds) and adolescent participants (12–15-year-olds). We hypothesized that eating frequency would be positively associated with total energy intake and inversely associated with diet quality in this racially diverse, low-income sample of school-age children.

ObjectiveTo evaluate the relative validity and reliability of the SEARCH FFQ that was modified from the Block Kids Questionnaire.DesignStudy participants completed the eighty-five-item FFQ twice plus three 24 h dietary recalls within one month. We estimated correlations between frequencies obtained from participants with the true usual intake for food groups and nutrients, using a two-part model for episodically consumed foods and measurement error adjustment.SettingThe multi-centre SEARCH for Diabetes in Youth Nutrition Ancillary Study.SubjectsA subgroup of 172 participants aged 10–24 years with type 1 diabetes.ResultsThe mean correlations, adjusted for measurement error, of food groups and nutrients between the FFQ and true usual intake were 0·41 and 0·38, respectively, with 57 % of food groups and 70 % of nutrients exhibiting correlations >0·35. Correlations were high for low-fat dairy (0·80), sugar-sweetened beverages (0·54), cholesterol (0·59) and saturated fat (0·51), while correlations were poor for high-fibre bread and cereal (0·16) and folate (0·11). Reliability of FFQ intake based on two FFQ administrations was also reasonable, with 54 % of Pearson correlation coefficients ≥0·5. Reliability was high for low-fat dairy (0·7), vegetables (0·6), carbohydrates, fibre, folate and vitamin C (all 0·5), but less than desirable for low-fat poultry and high-fibre bread, cereal, rice and pasta (0·2–0·3).ConclusionsWhile there is some room for improvement, our findings suggest that the SEARCH FFQ performs quite well for the assessment of many nutrients and food groups in a sample of youth with type 1 diabetes.

ObjectiveTo investigate meal pattern longitudinally and explore whether meal skipping was associated with overweight among Norwegian children and adolescents.DesignLongitudinal study. Children's meal frequencies were reported by their parents using a retrospective FFQ. Weight and height were measured by public health nurses. Descriptive data comparing 4th and 7th grade were analysed by paired-sample t tests for continuous variables and χ2 tests for categorical variables. Odds ratio estimates, including confidence intervals, with BMI category (normal/overweight) as the dependent variable, were determined through logistic regression analyses.SettingPrimary schools, Telemark County, Norway.SubjectsA cohort of 428 Norwegian boys and girls; 4th graders in 2007, 7th graders in 2010.ResultsThe number of children eating four main meals per day (regular meal frequency) decreased from 4th grade (47 %) to 7th grade (38 %; P = 0·001). Those who ate regular meals in 4th grade but not in 7th grade had higher odds (OR = 3·1; 95 % CI 1·1, 9·0) of being overweight in 7th grade after adjusting for gender, maternal education and physical activity, but the odds ratio was not statistically significant after adjusting for overweight in 4th grade (OR = 2·8; 95 % CI 0·7, 11·6).ConclusionsThe present study showed significant increases in overall meal skipping among children between 4th and 7th grade. The results indicate an association between overweight and meal skipping, but additional prospective and longitudinal analyses and intervention trials are warranted to confirm this relationship.

ObjectiveTo analyse whether poor breakfast habits in adolescence predict the metabolic syndrome and its components in adulthood. Previous studies suggest that regular breakfast consumption improves metabolic parameters.DesignProspective. Breakfast habits and other lifestyle variables at age 16 years were assessed from questionnaires. Poor breakfast habits were defined as skipping breakfast or only drinking or eating something sweet. At age 43 years, the effective sample consisted of 889 participants defined as having the metabolic syndrome or not, using the International Diabetes Federation criteria. Logistic regression was used to calculate odds ratios and confidence intervals.SettingThe Northern Swedish Cohort, a longitudinal population-based cohort with 27-year follow-up.SubjectsAdolescents (age 16 years).ResultsPrevalence of the metabolic syndrome at age 43 years was 27·0 %. Of the participants, 9·9 % were classified with poor breakfast habits at age 16 years. Adjusted odds for the metabolic syndrome at age 43 years was OR = 1·68 (95 % CI 1·01, 2·78) for those with poor breakfast habits at age 16 years compared with breakfast eaters. Looking at the metabolic syndrome components, poor breakfast habits at age 16 years were associated with central obesity (OR = 1·71; 95 % CI 1·00, 2·92) and high fasting glucose (OR = 1·75; 95 % CI 1·01, 3·02) at age 43 years, even after multivariate adjustments.ConclusionsPoor breakfast habits in adolescence predicted the metabolic syndrome in adulthood. Of the metabolic syndrome components, poor breakfast habits in adolescence predicted central obesity and high fasting glucose in adulthood. Further research is needed to fully understand the relationship between early breakfast habits and adult metabolic syndrome.

ObjectiveThe objective of the present study was to determine the knowledge and practices among Trinidad and Tobago school-attending adolescents towards energy drinks (ED), alcohol combined with energy drinks (AwED), weight-altering supplements (WAS) and vitamin/mineral supplements (VMS) and their experience of adverse effects associated with such use.DesignA cross-sectional, proportionate, stratified sampling strategy was adopted using a self-administered, de novo questionnaire.SettingSecondary schools throughout Trinidad and Tobago.SubjectsStudents aged 15–19 years.ResultsFive hundred and sixty-one students participated, an 84 % response rate; 43·0 % were male, 40·5 % East Indian and 34·1 % mixed race. VMS, ED, WAS and anabolic steroids were used by 52·4 %, 44·0 %, 8·9 % and 1·4 % of students, respectively, with 51·6 % of ED users using AwED. Predictors of use of AwED were males and students who played sport for their school (OR = 1·9; 95 % CI 1·2, 3·2 and OR = 2·6; 95 % CI 1·4, 4·7, respectively). Predictors of ED use were males and attendees of government secondary schools (OR = 1·7; 95 % CI 1·1, 2·4 and OR = 1·7; 95 % CI 1·2, 2·4, respectively). Side-effects, mainly palpitations, headaches and sleep disturbances, were reported in 20·7 % of dietary supplement users.ConclusionsMany adolescent students in Trinidad and Tobago use dietary supplements, including ED and AwED, and about one-fifth of users experience side-effects. Identification of students at risk for ED, AwED and WAS use and education of students about the dangers of using dietary supplements need to be instituted to prevent potential adverse events.

ObjectiveThe development of type 1 diabetes (T1D) is potentially influenced by nutrition. The aim of our study was to assess food and nutrient intakes of children at increased risk of T1D.DesignDietary intake of the last 4 weeks was assessed using a diet history interview. The daily nutrient and food intakes were compared with the German Dietary Reference Intakes, the Optimized Mixed Diet recommendations and those of a representative sample of children from the EsKiMo study.SettingChildren included in the analysis participated in the prospective TEENDIAB study.SubjectsFirst-degree relatives of people with T1D (n 268), aged 8–12 years.ResultsThe TEENDIAB children consumed 52·0 % of their total energy from carbohydrates, 32·6 % from fat and 14·3 % from protein. Compared with the reference values, their intake was lowest for folate at 61·3 % of the reference, for iodine at 58·1 % and for vitamin D at 8·9 %, and exceeded the reference for vitamin K about 5-fold, for Na about 3·5-fold and for protein about 1·5-fold. Their nutrient intakes were similar to those of a control cohort without increased T1D risk. The consumption of non-desirable food groups (meat products, sweets/snacks) was above the recommendations and the consumption of desirable food groups (fruits, vegetables, carbohydrate-rich foods) was below the recommendations.ConclusionsThe TEENDIAB children had intakes considerably below the recommendations for vitamin D, iodine, folate and plant-based foods, and intakes above for vitamin K, Na, protein, meat products and sweets/snacks. They showed similar dietary patterns to non-risk children.

ObjectiveThe 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).DesignAmong 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.SettingMyanmar.SubjectsAdolescent schoolgirls (n 391).ResultsOne-third of the anaemia (30·4 %) was IDA. Prevalence of low vitamin A status (serum retinol ConclusionsFe 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.

ObjectiveTo develop a child- and adolescent-appropriate physical activity frequency questionnaire (PAFQ) in Tunisia, North Africa.DesignA PAFQ was developed from a physical activity (PA) inventory that comprised major activity components (at home, preparing meals, school time, transport, non-sport leisure, sports, prayer and sleeping time). Then, type and duration of each activity undertaken during the past week were estimated. Total energy expenditure (TEE) estimated by the PAFQ was compared with data derived from two criterion methods: heart-rate monitoring (HRM) and a 24 h PA recall (24h-R), both collected during a 3 d period including one weekday and two weekend days.SettingTwo elementary schools and two high schools of the most developed and urbanized area, Greater Tunis.SubjectsOne hundred and forty-two volunteer children and adolescents aged 10–19 years.ResultsThe PAFQ strongly was correlated with both HRM (r= 0·70; 95 % CI 0·62, 0·76) and 24h-R (r= 0·81; 95 % CI 0·77, 0·84). It featured acceptable agreement with both criterion measures, slightly underestimating TEE compared with 24h-R (−2·8 %, mean of individual differences −272·7 kJ/d; 95 % CI −490·6, −57·4 kJ/d) and moderately overestimating it compared with HRM (+11·3 %, mean of individual differences +1106·2 kJ/d; 95 % CI 845·8, 1366·6 kJ/d). Reliability ranged from moderate to good (weighted kappa coefficients from 0·47 to 0·78 and intra-class correlation coefficients between 0·79 and 0·86 for energy expenditure by PA categories), indicating strong agreement between the two assessments.ConclusionsThis PAFQ could be useful in the description and surveillance of PA patterns or for the evaluation of population-based interventions directed at promoting PA in Tunisian children and adolescents.

ObjectiveTo describe the prevalence of ‘graded thinness’ in children aged 11, 13 and 15 years in eleven developed countries and to identify trends in the prevalence of ‘thinness’ (BMI < 17 kg/m2 at age 18 years) by age and gender.DesignCross-sectional study using data collected through self-reported questionnaires.SettingData were taken from the 1997/1998, 2001/2002 and 2005/2006 surveys of the Health Behaviours in School-aged Children (HBSC) Study.SubjectsChildren and adolescents from ten European countries and the USA (n 158 000).ResultsPrevalence of grades 1, 2 and 3 of thinness was higher among 11-year-old students compared with the 13- and 15-year-olds in all countries. A higher prevalence of thinness was observed in girls than in boys. Since 1998 the prevalence of thinness decreased steadily in Czech boys and girls, while it increased for French girls. In the total European sample of females, thinness decreased from 1998 to 2006 (χ2 for trend, P < 0·01). Age-adjusted logistic regression analysis showed that Czech boys and girls, and Flemish and American girls were less likely to be thin in 2006 than in 1998; while a noteworthy increment, even if borderline significant, was observed for French girls with a 41 % increase in the likelihood to be thin.ConclusionsOur findings suggest that thinness is an important overlooked phenomenon with wide variation in prevalence and trends across developed countries. It deserves further longitudinal studies in a multinational context that could increase the understanding of the factors associated with thinness and contribute to developing preventive and nutritional programmes targeted at controlling obesity and chronic diseases, while monitoring thinness.

The 2010 Dietary Guidelines for Americans call for an increase in consumption of vegetables due to their high nutrient profile, protective association with certain chronic diseases and relatively low energy content(1). Although they do not advocate for one specific eating pattern, these dietary guidelines do emphasize the importance of nutrient-dense foods in the diet and recommend increased intake of nutrient-dense foods, particularly vegetables, with little added solid fats or sugars(1). In addition, the guidelines continue to recognize that some forms of vegetables are more healthful than others, such as dark-green or orange vegetables, and give specific recommendations for intake(1); however, the guidelines do not give specific recommendations for how much vegetable consumption should be in whole forms, or forms where a vegetable is eaten primarily by itself, whether raw or cooked, without other added ingredients or foods, or as part of other dishes where vegetables may not be the main ingredient. In dietary research, vegetables are often treated as a broad classification that may or may not include vegetables from mixed dishes, such as pizza, or those that include a relatively high proportion of white or fried potatoes that US children and adolescents are known to consume but generally are of lower nutritional value(1). Distinguishing between vegetables eaten in their whole forms and those contained within mixed dishes is important due to the potential differences in added fats and sugars, as well as nutrient profile, associated with these categorizations. These distinctions remain under-explored in the literature, particularly among children. Vegetables may often be eaten as part of mixed food dishes (e.g. tomato sauce on pizza), particularly by children who may resist eating vegetables in their whole forms due to issues regarding preference and undeveloped taste(2). Although mixed dishes may be a way to incorporate more vegetables into children’s diets, they also may provide more unfavourable aspects of dietary intake, such as greater intake of energy, fat or added sugar, especially when compared with vegetables in their whole forms. Some national nutritional data sets and databases in the USA commonly used to estimate food intake, such as the US Department of Agriculture’s (USDA) My Pyramid Equivalent Database (MPED), capture servings of vegetables eaten as part of mixed dishes; while others, such as the National Health and Nutrition Examination Survey (NHANES) individual food files, do not. Therefore, measurement and quantification of overall vegetable intake may differ according to the database used. This could lead to variable estimates of population vegetable intake depending on the amount vegetables eaten as part of mixed dishes contribute to overall vegetable intake. However, there has been little recent description of vegetables eaten as mixed dishes υ. whole forms in the diets of children and adolescents and how this may impact overall intake, an issue recently highlighted in a review by Roark and Niederhauser(3). The objectives of the present analysis are twofold. First, we aim to describe vegetable intake among children and adolescents in more specific detail according to type of vegetable and source of vegetable (i.e. whole form or mixed dish) and second to examine how the use of different dietary databases and coding schemes affects population estimates of vegetable intake among children and adolescents. We also examine potential differences in forms of vegetable consumption by demographic characteristics.

ObjectiveThe study aimed to test the reliability of a nutrition questionnaire and to assess potential associations between nutrition knowledge, food consumption and lifestyle behaviours, controlling for sociodemographic factors.DesignCross-sectional survey.SettingComprehensive school in the municipality of Butera, a rural area of Sicily, South Italy.SubjectsThe survey was conducted between March and May 2010 on 445 students (4–16 years).ResultsAll constructs of the questionnaire had statistically significant Cronbach's α and Pearson's correlation coefficients, showing good internal consistency and temporal stability. After controlling for covariates, nutrition knowledge was positively associated with pasta/rice, fish, vegetable and fruit intakes, and negatively with sweets, snacks, fried foods and sugary drinks consumption. Moreover, students whose parents were in the highest educational and occupational categories reported eating significantly more fruits and vegetables and less meat, sweets, snacks, fried foods and sugary drinks. Students with higher nutrition knowledge scores were less likely to have two or more snacks daily and to spend more than 3 h in sedentary activities daily (OR = 0·89, 95 % CI 0·83, 0·97 and OR = 0·92, 95 % CI 0·86, 0·99, respectively). High parental education was associated with less frequent snacking and more frequent weekly physical activity, compared with lower categories, whereas high parental occupational category was associated with daily breakfast.ConclusionsImproving nutrition knowledge in children and young adolescents may translate into educating them in good dietary habits. Moreover, nutrition intervention programmes should also involve parents to improve dietary quality and nutritional habits of the entire family.

ObjectiveTo describe breakfast habits at food group level in European adolescents and to investigate the associations between these habits and sociodemographic factors.DesignCross-sectional study.SettingSecondary schools from nine European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Breakfast habits were assessed twice using a computer-based 24 h dietary recall. Adolescents who consumed breakfast on at least one recall day were classified as ‘breakfast consumers’ and adolescents who did not have anything for breakfast on either of the two recall days were considered ‘breakfast skippers’. A ‘breakfast quality index’ to describe breakfast quality was created based on the consumption or non-consumption of cereals/cereal products, dairy products and fruits/vegetables. The sociodemographic factors studied were sex, age, region of Europe, maternal and paternal education, family structure and family affluence.SubjectsAdolescents (n 2672, 53 % girls) aged 12–17 years.ResultsThe majority of the adolescents reported a breakfast that scored poorly on the breakfast quality index. Older adolescents, adolescents from the southern part of Europe and adolescents from families with low socio-economic status were more likely to consume a low-quality breakfast.ConclusionsThe study highlights the need to promote the consumption of a high-quality breakfast among adolescents, particularly in older adolescents, adolescents from southern Europe and adolescents from families with low socio-economic status, in order to improve public health.

ObjectivesTo examine whether involvement in food preparation tracks over time, between adolescence (15–18 years), emerging adulthood (19–23 years) and the mid-to-late twenties (24–28 years), as well as 10-year longitudinal associations between home food preparation, dietary quality and meal patterning.DesignPopulation-based, longitudinal cohort study.SettingParticipants were originally sampled from Minnesota public secondary schools (USA).SubjectsParticipants enrolled in Project EAT (Eating Among Teens and Young Adults)-I, EAT-II and EAT-III (n 1321).ResultsMost participants in their mid-to-late twenties reported an enjoyment of cooking (73 % of males, 80 % of females); however, few prepared meals including vegetables most days of the week (24 % of males, 41 % of females). Participants in their mid-to-late twenties who enjoyed cooking were more likely to have engaged in food preparation as adolescents and emerging adults (P < 0·01); those who frequently prepared meals including vegetables were more likely to have engaged in food preparation as emerging adults (P < 0·001), but not as adolescents. Emerging adult food preparation predicted better dietary quality five years later in the mid-to-late twenties, including higher intakes of fruit, vegetables and dark green/orange vegetables, and less sugar-sweetened beverage and fast-food consumption. Associations between adolescent food preparation and later dietary quality yielded few significant results.ConclusionsFood preparation behaviours appeared to track over time and engagement in food preparation during emerging adulthood, but not adolescence, was associated with healthier dietary intake during the mid-to-late twenties. Intervention studies are needed to understand whether promoting healthy food preparation results in improvements in eating patterns during the transition to adulthood.

sObjectiveLittle is known about the prevalence of nutritional supplement use in European adolescents. We conducted the present study to analyse the prevalence of nutritional supplement use and factors associated with this use among Slovenian adolescents.DesignThe nutritional supplementation practices of 818 adolescents were studied using an anonymous questionnaire. Information was sought on the type of supplements used, frequency of use and sources of information.SettingThe region of north-west Slovenia.SubjectsSchoolchildren from twenty primary schools and twelve secondary schools.ResultsSome 19·3% of all adolescents reported using at least one nutritional supplement and the prevalence of use was significantly higher in adolescents who were members of sports clubs. Multivitamins were the most common nutritional supplement. Older adolescents were significantly more likely to be supplementing with iron, protein and minerals. Less than 16 % of supplement users in our study sought information from health-care professionals. Nearly 62 % obtained information from parents and coaches, and many adolescents appear to decide on nutritional supplementation themselves, without advice. Older adolescents were significantly more likely to combine supplements than younger adolescents.ConclusionsOne-fifth of Slovenian adolescents use nutritional supplements. There are clear differences in supplement use between younger (age 12 years) and older (age 17 years) adolescents. Multiple use of supplements, coupled with self-managed supplementation in older adolescents, is concerning. Hence, there is an urgent need to provide accurate information regarding nutritional supplements, which will help adolescents, their parents and coaches to make informed choices about their use.

ObjectiveLittle is known of the beverage intake patterns of Canadian children or of characteristics within these patterns. The objective was to determine beverage intake patterns among Canadian children and compare intakes of fourteen types of beverages, along with intakes of vitamin C and Ca, and sociodemographic factors across clusters.DesignDietary information was collected using one 24 h recall. Sociodemographic data were collected by interview. Cluster analysis was used to determine beverage intake patterns. Pearson's χ2 and 95 % CI were used to test differences across clusters.SettingData from the Canadian Community Health Survey Cycle 2·2.SubjectsChildren aged 2–18 years with plausible energy intake and complete sociodemographic data (n 10 038) were grouped into the following categories: 2–5-year-old boys and girls, 6–11-year-old girls, 6–11-year-old boys, 12–18-year-old girls and 12–18-year-old boys.ResultsFive beverage clusters emerged for children aged 2–5 years, six clusters for children aged 6–11 years (both sexes) and four clusters for those aged 12–18 years (both sexes). Sweetened beverage clusters appeared in all age–sex groups. Intakes of sweetened beverages ranged from 553 to 1059 g/d and contributed between 2 % and 18 % of total energy intake. Girls 6–11 years of age in the ‘soft drink’ cluster had lower Ca intake compared with other clusters in that age–sex group. Age and ethnicity differed across clusters for most age–sex groups. Differences for household food security status and income were found; however, no pattern emerged.ConclusionsPatterns in beverage intake among Canadian children include beverages that are predominantly sugar sweetened. Public health nutrition professionals can use knowledge about beverage patterns among children, as well as the characteristics of these groups, in the development of nutritional programmes and policies.

ObjectiveThe aim of the present study was to investigate the relationship between area-level socio-economic status and healthy and less healthy eating behaviours among adolescents and to determine whether the relationship between area-level socio-economic status and dietary behaviours was related to the relevant attitudes and environments.DesignData were collected as part of Youth’07, a nationally representative survey of the health and well-being of New Zealand youth.SettingNew Zealand secondary schools, 2007.SubjectsA total of 9107 secondary-school students in New Zealand.ResultsStudents from more deprived areas perceived more supportive school environments and cared as much about healthy eating as students in more affluent areas. However, these students were significantly more likely to report consuming fast food, soft drinks and chocolates.ConclusionsAddressing area-level socio-economic disparities in healthy eating requires addressing the availability, affordability and marketing of unhealthy snack foods, particularly in economically deprived areas.

ObjectiveTo examine neighbourhood food environments, adolescent nutrition and weight status.DesignCross-sectional, observational study.SettingMinneapolis/St. Paul metropolitan region, Minnesota, USA.SubjectsA total of 349 adolescents were recruited to the study. Participants completed 24 h dietary recalls and had their weight and height measured. They also reported demographic information and other diet-related behaviours. Geographic Information Systems were used to examine the availability and proximity of food outlets, particularly those captured within the 800, 1600 and/or 3000 m network buffers around participants’ homes and schools.ResultsAdjusting for gender, age and socio-economic status, adolescents’ sugar-sweetened beverage intake was associated with residential proximity to restaurants (including fast food), convenience stores, grocery stores and other retail facilities within the 800 and/or 1600 m residential buffers (P≤ 0·01). BMIZ-score and percentage body fat were positively associated with the presence of a convenience store within a 1600 m buffer. Other individual-level factors, such as energy, fruit and vegetable intake, as well as convenience store and fast food purchasing, were not significantly associated with features of the residential neighbourhood food environment in adjusted models. In addition, school neighbourhood environments yielded few associations with adolescent outcomes.ConclusionsMany factors are likely to have an important role in influencing adolescent dietary intake and weight status. Interventions aimed at increasing neighbourhood access to healthy foods, as well as other approaches, are needed.

ObjectiveThe 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.DesignFocus 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.ResultsFindings 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.ConclusionsFindings 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.

Objective To explore mean food group intakes associated with central obesity anthropometry among children and adolescents enrolled in the Third National Health and Nutrition Examination Survey (NHANES III). Design Cross-sectional study. Setting Representative sampling of the US population (1998-2002). Subjects Subjects were 3761 children (5-11 years) and 1803 adolescents (12-16 years) with single 24 h dietary recalls and anthropometric measures of central body fat (waist circumference and sum of subscapular and suprailiac skinfold thicknesses). Results Results were controlled for confounding by age, height, race/ethnicity, Tanner stage, television viewing and parental education. In younger children, there was no relationship between central adiposity and mean intakes of dairy, fruit, vegetables or grains, while a positive association with meat intake was found among boys. In adolescent boys and girls, central body fat measures were inversely associated with mean dairy and grain intakes. Adolescent boys in the highest quartile of central adiposity consumed less fruit and fewer vegetables; those in the lowest central adiposity quartile consumed less meat. Finally, adolescents who met the criteria for central obesity (waist circumference >or=85th percentile for age and sex) reported consuming significantly less total dairy (as well as milk and cheese separately), total grains (whole and refined) and total fruit and vegetables. There was no association with meat consumption. To test the stability of these findings, the final analysis was replicated in 2541 same-aged adolescents from NHANES 1999-2002; the results were very similar. Conclusions These cross-sectional analyses suggest that intakes of dairy, grains and total fruits and vegetables are inversely associated with central obesity among adolescents.

ObjectiveThe Mediterranean diet is considered one of the healthiest dietary models. Recent changes in the actual Mediterranean diet include a reduction in energy intake and a higher consumption of foods with low nutrient density (e.g. soft drinks, candy, sweets, etc.). In Spain, in association with cultural and lifestyle changes, there has been a reduction in the intake of antioxidants and vitamins, an increase in the proportion of SFA and a decrease in the consumption of fibre, among other changes. Children and adolescents may be the age groups with the most deteriorated Mediterranean diet. The current paper presents the results of applying the Mediterranean Diet Quality Index for children and adolescents (KIDMED) to a large sample of Spanish schoolchildren.DesignData from questionnaires were used to calculate the KIDMED index.SettingGranada, Southern Spain.SubjectsSchoolchildren (n3190) aged 8–16 years.ResultsAmong the 8–10-year-olds, the KIDMED index classification was ‘good’ in 48·6% of the population, ‘average’ in 49·5% and ‘poor’ in 1·6%. Among the 10–16-year-olds, the KIDMED index classification was good in 46·9% of the population, average in 51·1% and poor in 2·0%.ConclusionsThe nutritional behaviour of the present population of schoolchildren is similar to that found in the earlier KIDMED study.

ObjectiveDespite 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.DesignRandomised 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.SettingJaipur, India.SubjectsOne hundred and two adolescent girls aged 14–18 years.ResultsOf 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, 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.ConclusionsLeaf concentrate is an effective, and more palatable, alternative to Fe and folic acid supplements for treating anaemia in adolescent girls.

ObjectiveTo study whether service of a free school lunch has an impact on weight development and food intake among pupils at a lower secondary school, and to assess the association between self-perceived school behaviour and food intake.DesignA controlled intervention study involving service of a free healthy school lunch to 9th grade pupils took place over 4 months, from January to May 2007. Weight and height were measured before and after the intervention. The pupils also completed a short FFQ and a questionnaire concerning self-perceived school behaviour and the classroom environment before and after the intervention. A healthy food score was calculated using the FFQ data.SettingAll 9th graders at three different lower secondary schools in southern Norway were invited to participate. One school was randomly selected as the intervention school.SubjectsFifty-eight pupils (91 %) from the intervention school and ninety-two pupils (77 %) from the control schools participated.ResultsBMI did not increase among the girls at the intervention school, but increased significantly among the boys at the intervention school and among the control school groups. The healthy food score correlated positively with the trait ‘satisfied with schoolwork’ (P < 0·001). Fifteen per cent of the variance in food score could be explained by gender and the trait ‘satisfied with schoolwork’.ConclusionsServing of a healthy free school lunch to secondary-school pupils may result in restricted weight gain. Further studies are needed to clarify the impact of school meals on overweight and academic performance.

ObjectiveIn view of the fact that height differences between socio-economic groups are apparent early in childhood, it is of interest to examine whether skeletal growth is reflective of the social class gradient in CVD risk. The present study examined blood pressure levels, adiposity and growth of adolescent boys from high and low social classes.DesignIn a cross-sectional study, skeletal growth (height and sitting height), adiposity (weight, BMI and body fat) and blood pressure levels of the adolescents were measured.SettingPune, India.SubjectsAdolescent schoolboys (9–16 years) from high socio-economic (HSE; n 1146) and low socio-economic (LSE; n 932) class.ResultsLSE boys were thin, short and undernourished (mean BMI: 15·5 kg/m2v. 19·3 kg/m2 in HSE boys, P = 0·00). Social gradient was revealed in differing health risks. The prevalence of high systolic blood pressure (HSBP) was high in HSE class (10·5 % v. 2·7 % in LSE class, P = 0·00) and was associated with adiposity, while the prevalence of high diastolic blood pressure (HDBP) was high in LSE class (9·8 % v. 7·0 % in HSE class, P = 0·00) and had only a weak association with adiposity. Despite this, lower ratio of leg length to height was associated with significantly higher respective health risks, i.e. for HDBP in LSE class (OR = 1·99, 95 % CI 1·14, 3·47) and for HSBP in HSE class (OR = 1·69, 95 % CI 1·02, 2·77).ConclusionsAs stunting in childhood is a major problem in India and Asia, the leg length to height indicator needs to be validated in different populations to understand CVD risks.

ObjectiveThe present paper reports the prevalence of underweight, overweight and obesity by gender, ethnicity and grade, among participants in a 2002 national survey among South African school-going youth that included height and weight measurements.DesignA stratified two-stage sample was used. Nationally representative rates of underweight, overweight and obesity were calculated using weighted survey data and compared using χ2 analysis.SettingIn all, 9224 grade 8 to grade 11 students, present at school in selected classes within selected South African government-funded schools in all nine provinces, participated in this study. Most of the students were between 13 and 19 years of age.ResultsHigher rates of underweight were observed for males than females as well as for black and ‘coloured’ than white students. Within each gender group, black and ‘coloured’ students had significantly higher rates of underweight than their white counterparts. Higher percentages of females than males were overweight and obese, overall and among black students. Furthermore, white male students had significantly higher rates of overweight than their black and ‘coloured’ counterparts. Among females, black and white students had significantly higher rates than ‘coloured’ students. Students in higher grades showed significantly lower rates of underweight and higher rates of overweight.DiscussionThese data confirm that South Africa, a developing nation in socio-economic transition, is experiencing both undernutrition and overnutrition. However, these problems are disproportionately distributed by gender, socio-economics and ethnicity. Continued surveillance of nutritional status may be one important component of a national strategy to prevent and control malnutrition.

ObjectivesTo review associations between the family environment and young people’s fruit and vegetable consumption.DesignA systematic review. Published English-language (n60) papers were identified using electronic databases and manual searches of personal files and reference lists. Observational research reporting a measure of fruit/vegetable intake for children (aged 6–11 years) and/or adolescents (aged 12–18 years) and at least one potential family correlate of dietary intake was included.ResultsParental modelling and parental intake were consistently and positively associated with children’s fruit and fruit, juice and vegetable (FJV) consumption. There were also positive associations between home availability, family rules and parental encouragement and children’s fruit and vegetable consumption. Parental intake was positively associated with adolescents’ fruit and vegetable consumption. There were also positive associations between parental occupational status and adolescent fruit consumption and between parental education and adolescents’ FJV consumption.ConclusionsOur findings highlight the importance of targeting the family environment for the promotion of healthy eating behaviours among children and adolescents. Future interventions should encourage parents to be positive role models by targeting parental intake and to create a supportive home environment through increased encouragement and availability of fruits and vegetables and employing rules to govern eating behaviours. For adolescents, indicators of family circumstances (e.g. parental education) should be used to identify target groups for interventions aimed at promoting healthy eating.

ObjectivesTo examine knowledge of and adherence to the Mediterranean dietary pattern (MDP) among Greek adolescents, assess associations between MDP knowledge and adherence with BMI, and determine socio-cultural factors predicting MDP compliance.DesignCross-sectional.SettingGreek adolescents aged 15–17 years.SubjectsTwo hundred adolescents (103 females, ninety-seven males) from six schools on the Greek island of Chios. The sampling procedure was similar for all schools; schools were randomly selected from different geographic areas and all municipalities. BMI was calculated from measured height and weight; participants completed four questionnaires assessing parents’ socio-economic status and education, adolescents’ perceived and actual MDP knowledge, past-week dietary habits, and MDP adherence.ResultsParticipants’ BMI indicated 64·5 % were normal weight and 35·5 % were overweight/obese (mean BMI 23·7 (sd 3·8) kg/m2). Over half had very poor MDP knowledge (58·5 %) and adherence (59·5 %); both perceived (F = 3·35, P = 0·037) and actual MDP knowledge (F = 3·45, P = 0·034) were significantly different across MDP adherence. Perceived MDP knowledge was positively correlated with vegetable consumption (r = 0·185, P = 0·009); actual knowledge was negatively correlated with meat consumption (r = −0·191, P = 0·007). BMI was negatively correlated with family income (r = −0·202, P = 0·004), indicating higher BMI in less affluent households. Actual MDP knowledge was the only significant predictor of MDP adherence (standardized β = 0·162, P = 0·030) in a model accounting for 7·3 % of overall variance.ConclusionsGreek adolescents reported consuming a more Westernized diet detached from the traditional MDP. Actual MDP knowledge and family income were important factors affecting MDP adherence and BMI, respectively. Promoting the traditional MDP among Greek adolescents and their families appears warranted.