Influence of gender and socio-economic status on dietary patterns and nutrient intakes in 18-year-old Australians

Causal relationship of cereal intake and type with cardiovascular disease: a Mendelian randomization study

Background

Observational studies have suggested that cereal consumption is associated with a reduced risk of cardiovascular disease (CVD). However, the potential causal relationship is not clear. We aimed to investigate the association of cereal intake and cereal type with CVD risk.

Methods

Two-step Mendelian randomization (MR) analysis was performed to confirm the causal association of cereal intake and cereal type with the risk of several common CVDs. Furthermore, two-step MR analysis was used to explore the mediating effect of cardiovascular metabolic factors, and multivariable MR analysis was used to assess the impact of socioeconomic status, such as education and income, on the causal association.

Results

The MR analysis indicated that genetically predicted cereal intake is associated with reduced risk of large artery stroke (LAS) (odd ratio (OR): 0.421; 95% confidence interval (CI) [0.193, 0.918]; p = 0.030), and muesli as the primary cereal intake is associated with reduced risk of coronary heart disease (CHD) (OR: 0.100; 95% CI [0.023, 0.437]; p = 0.002), myocardial infarction (MI) (OR: 0.101; 95% CI [0.020, 0.509]; p = 0.005), heart failure (OR: 0.210; 95% CI [0.064, 0.684]; p = 0.010), ischemic stroke (IS) (OR: 0.130; 95% CI [0.029, 0.591]; p = 0.008), LAS (OR: 0.017; 95% CI [0.0004, 0.737]; p = 0.034), and small-vessel stroke (OR: 0.021; 95% CI [0.001, 0.708]; p = 0.005). In contrast, genetically predicted biscuits as the primary cereal intake increased the risk of CHD (OR: 6.557; 95% CI [1.197, 36.031]; p = 0.031), and other cereals, such as cornflakes, as the primary cereal intake increased the risk of CHD (OR: 3.803; 95% CI [1.194, 12.111]; p = 0.024), MI (OR: 4.240; 95% CI [1.185, 15.174]; p = 0.026), stroke (OR: 3.154; 95% CI [1.070, 9.298]; p = 0.037), and IS (OR: 3.736; 95% CI [1.185, 11.782]; p = 0.024). Multivariable MR analysis underscored the significant role of education and income in the causal association, and two-step MR analysis indicated that body mass index, lipids, and blood glucose exerted important mediating effects in the causal association.

Conclusion

The findings of our study underscore the causal beneficial influence of muesli as the primary cereal intake on CVDs. A reasonable consumption of muesli may provide primary prevention of CVDs.

Individual, social-environmental and physical-environmental correlates of diet quality in young adults aged 18-30 years

Many young adults eat a poor-quality diet. However, understanding of the social-ecological correlates of diet quality in young adults is limited. The aim of the present study was to examine the correlates of diet quality in a cohort of young Australian adults. Data from the cross-sectional Measuring EAting in everyday Life Study were used. Young adults (n = 625; 18-30 years; 73% female) were included if they provided dietary data over three or four non-consecutive days using 'FoodNow', a real-time food diary smartphone application. Diet quality was estimated using the 2013 Dietary Guidelines Index (DGI). Thirty correlates from three levels of the social-ecological framework were collected using an online questionnaire: individual (e.g., self-efficacy), social-environmental (e.g., social support) and physical-environmental (e.g., living situation). Linear regression analyses were used to examine associations between correlates and DGI. Six individual-level correlates were associated with DGI: perceived time scarcity (b = -0.664, CI: 1.160, -0.168), food insecurity (b = -0.962, CI: 1.746, -0.178), self-efficacy (b = 0.230, CI: 0.137, 0.323), being born in Australia (b = -3.165, CI: 5.521, -0.808), being employed in non-trade roles (b = -4.578, CI: 8.903, -0.252) and preparing a meals with vegetables daily (b = 4.576, CI: 1.652, 7.500). No social-environmental or physical-environmental correlates were associated with DGI. Overall, this study showed that young adults had a higher diet quality if they had higher self-efficacy, perceived themselves to be less time scarce and less food insecure, were born in Australia, were employed in non-trade roles and prepared a meal with vegetables daily. Healthy eating policies and interventions in young adults may benefit from targeting individual-level correlates.

Texture and mouthfeel perceptions of a model beverage system containing soluble and insoluble oat bran fibres

Dietary fibre fortified products have increased in popularity as health-conscious consumers seek convenient ways to increase fibre intake. Fibres from wholegrains are particularly desirable inclusions in food products because of their proven physiological health-benefits. When fortifying beverages with fibre, however, the insoluble dietary fibre components present in wholegrains often contribute to unpleasant gritty sensations making the products unpalatable. Consequently, designing wholegrain-fortified beverages with sufficient fibre-content to make health related fibre claims is a major challenge in the food manufacturing industry. This work aims to take a systematic approach in identifying the texture/mouthfeel related sensory impact and interaction between two commercial oat fibre ingredients (Oatwell28XF® and Milled Oats) when added to a model beverage system. Eighteen samples were prepared containing either or both the ingredients, at varying levels, and were assessed by a trained panel using conventional sensory descriptive techniques. The results indicate that the two different oat bran fibres produced distinct mouthfeel perceptions which could be attributed to the varying soluble and insoluble fibre content of the samples. Insoluble dietary fibre concentrations above 2% (w/w) resulted in particle-related sensory properties chalkiness, dryness and particle perception, which dominated the overall mouthfeel and textural sensory perception of the samples. Samples with predominantly soluble β-glucan, resulted in perceptions of smoothness, sliminess and stickiness residue, while thickness, mouthcoating and cloying sensations were driven by total fibre concentration, irrespective of fibre solubility. This work provides a solid foundation for food manufacturers aiming to rationally design and develop nutritionally superior fibre-fortified beverages and is relevant to fibre content concentrations required for labelling/nutrition claims for consumer products in many developed nations.

Development of food lists as a first step to develop a food frequency questionnaire for toddlers in a multi-ethnic population

AIM

Toddlerhood is an important stage of growth, thus understanding the food intake of children in this age group is important. In Singapore, there is currently no simple tool, such as Food Frequency Questionnaire (FFQ), to collect dietary information from this ethnically diverse age group. Generating an appropriate food list is a crucial step in the development of a FFQ and this step is not clearly documented in the literature. The purpose of this study is to generate food lists and portion sizes for toddlers from three major ethnic groups in Singapore and document the processes involved in this first stage.

METHODS

A total of 30 mothers (equal number of Malays, Indians and Chinese) of 11-24-month-old children completed three-day food records and participated in the focus group discussion. The reported food items were then categorised into food groups.

RESULTS

The food lists varied by ethnic groups with the longest list obtained from Chinese toddlers. There were also other foods that were then classified as common foods for all ethnicities. Commonly used utensils among the three ethnic groups were small-sized bowls, plates, cups and spoons. For portion sizes, these utensils were typically half-filled for the toddlers.

CONCLUSIONS

As all Singaporeans have access to the same foods, the ethnic-specific food lists generated in this study could be combined into one list. Together with portion sizes, this information can be used for developing a semi-quantitative FFQ.

The addition of peanuts to habitual diets is associated with lower consumption of savory non-core snacks by men and sweet non-core snacks by women

Snacking is associated with intakes of non-core foods which may predispose to obesity. Peanuts have potential satiety benefits and may assist with weight management; we hypothesized that peanut consumption would reduce intake of non-core snack foods due to compensation. We investigated the effects of adding peanuts to a habitual diet on snacking habits and energy intake. Sixty-one healthy participants (65±7years, body mass index 31±4kg/m²) consumed their habitual diet with or without peanuts (56g/d for 32 women, 84g/d for 29 men) for 12weeks each in a randomized crossover design. Food diaries were analyzed at baseline and after each 12-week period for meal and snack content and timing. Total energy intake was higher (17% for men [P<.001], 9% for women [P<.001]) during the peanut phase. Body weight was 0.5±0.2kg (P=.010) greater during the peanut phase. Snacking occasions increased during the peanut phase (53% for men [P=.001], 14% for women [P=.01]). Servings of other snack foods did not change during the peanut phase (P=.6) compared with control. However, sex-specific analysis revealed that men and women consumed less savory (P<.001) and sweet (P=.01) non-core snacks, respectively, during the peanut phase. Despite increased energy intake and snacking frequency, peanuts may improve the diet through sex-specific reductions of non-core foods; for optimal energy balance, peanuts should be substituted rather than added to the diet.

Comparison of Clostridium difficile Ribotypes Circulating in Australian Hospitals and Communities

Clostridium difficile infection (CDI) is becoming less exclusively a health care-associated CDI (HA-CDI). The incidence of community-associated CDI (CA-CDI) has increased over the past few decades. It has been postulated that asymptomatic toxigenic C. difficile (TCD)-colonized patients may play a role in the transfer of C. difficile between the hospital setting and the community. Thus, to investigate the relatedness of C. difficile across the hospital and community settings, we compared the characteristics of symptomatic and asymptomatic host patients and the pathogens from these patients in these two settings over a 3-year period. Two studies were simultaneously conducted; the first study enrolled symptomatic CDI patients from two tertiary care hospitals and the community in two Australian states, while the second study enrolled asymptomatic TCD-colonized patients from the same tertiary care hospitals. A total of 324 patients (96 with HA-CDI, 152 with CA-CDI, and 76 colonized with TCD) were enrolled. The predominant C. difficile ribotypes isolated in the hospital setting corresponded with those isolated in the community, as it was found that for 79% of the C. difficile isolates from hospitals, an isolate with a matching ribotype was isolated in the community, suggesting that transmission between these two settings is occurring. The toxigenic C. difficile strains causing symptomatic infection were similar to those causing asymptomatic infection, and patients exposed to antimicrobials prior to admission were more likely to develop a symptomatic infection (odds ratio, 2.94; 95% confidence interval, 1.20 to 7.14). Our findings suggest that the development of CDI symptoms in a setting without establishment of hospital epidemics with binary toxin-producing C. difficile strains may be driven mainly by host susceptibility and exposure to antimicrobials, rather than by C. difficile strain characteristics.

[Fruit and vegetable consumption by children and adolescents in Germany: Results of KiGGS wave 1]

BACKGROUND

A high fruit and vegetable intake contributes to a healthy diet, which is very important for the development of children and adolescents.

OBJECTIVES

With data from the first follow-up survey of the Child and Adolescent Health Surveys (KiGGS wave 1) the fruit and vegetable intake and its association with determinants are analyzed.

METHODS

Via telephone interviews the average numbers of portions of fruits and vegetables consumed by 9,950 girls and boys aged 3-17 years were assessed. In addition, the proportion of persons achieving five portions of fruits and vegetables per day was calculated. The number of portions was analyzed in association with social status, parent's educational level, media consumption, and other determinants via multiple linear regression models.

RESULTS

Only 12.2 % of girls and 9.4 % of boys consume the recommended five portions of fruits and vegetables per day. 38.6 % of girls and 33.5 % of boys consume at least three portions per day. On average, girls consume 2.7 and boys 2.4 portions of fruits and vegetables per day. Younger participants consume significantly more portions of fruits than older participants. The percentage of persons consuming five or at least three portions per day increases significantly with higher socioeconomic status, higher parent's educational level, and lower media consumption. Furthermore, children who conduct sport outside of school, those who are physically active every day, and boys living in central Germany consume significantly more portions of fruit and vegetables.

CONCLUSION

Most children and adolescents do not consume enough fruits and particularly vegetables. The consumption differs considerably according to socio-demographic background and lifestyle factors, which should be considered in promotional campaigns.

Impact of Breakfast Skipping and Breakfast Choice on the Nutrient Intake and Body Mass Index of Australian Children

Recent data on breakfast consumption among Australian children are limited. This study examined the impact of breakfast skipping and breakfast type (cereal or non-cereal) on nutrient intakes, likelihood of meeting nutrient targets and anthropometric measures. A secondary analysis of two 24-h recall data from the 2007 Australian National Children’s Nutrition and Physical Activity Survey was conducted (2–16 years; n = 4487) to identify (a) breakfast skippers and (b) breakfast consumers, with breakfast consumers further sub-divided into (i) non-cereal and (ii) cereal consumers. Only 4% skipped breakfast and 59% of skippers were 14–16 years. Breakfast consumers had significantly higher intakes of calcium and folate, and significantly lower intakes of total fat than breakfast skippers. Cereal consumers were more likely to meet targets and consume significantly higher fibre, calcium, iron, had significantly higher intakes of folate, total sugars and carbohydrate, and significantly lower intakes of total fat and sodium than non-cereal consumers. The prevalence of overweight was lower among breakfast consumers compared to skippers, and among cereal consumers compared to-cereal consumers (p < 0.001), while no significant differences were observed for mean body mass index (BMI), BMI z-score, waist circumference and physical activity level across the categories. Breakfast and particularly breakfast cereal consumption contributes important nutrients to children’s diets.

Variation in the effects of family background and birth region on adult obesity: results of a prospective cohort study of a Great Depression-era American cohort

Background

Studies have identified prenatal and early childhood conditions as important contributors to weight status in later life. To date, however, few studies have considered how weight status in adulthood is shaped by regional variation in early-life conditions, rather than the characteristics of the individual or their family. Furthermore, gender and life course differences in the salience of early life conditions to weight status remain unclear. This study investigates whether the effect of family background and birth region on adult obesity status varies by gender and over the life course.

Methods

We used data from a population-based cohort of 6,453 adults from the Health and Retirement Study, 1992–2008. Early life conditions were measured retrospectively at and after the baseline. Obesity was calculated from self-reported height and weight. Logistic models were used to estimate the net effects of family background and birth region on adulthood obesity risk after adjusting for socioeconomic factors and health behaviors measured in adulthood. Four economic and demographic data sets were used to further test the birthplace effect.

Results

At ages 50–61, mother’s education and birth region were associated with women’s obesity risk, but not men’s. Each year’s increase in mother’s education significantly reduces the odds of being obese by 6 % (OR = 0.94; 95 % CI: 0.92, 0.97) among women, and this pattern persisted at ages 66–77. Women born in the Mountain region were least likely to be obese in late-middle age and late-life. Measures of per capita income and infant mortality rate in the birth region were also associated with the odds of obesity among women.

Conclusions

Women’s obesity status in adulthood is influenced by early childhood conditions, including regional conditions, while adulthood health risk factors may be more important for men’s obesity risk. Biological and social mechanisms may account for the gender difference.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1870-7) contains supplementary material, which is available to authorized users.

Socio-economic status and ethnicity are independently associated with dietary patterns: the HELIUS-Dietary Patterns study

Background

Differences in dietary patterns between ethnic groups have often been observed. These differences may partially be a reflection of differences in socio-economic status (SES) or may be the result of differences in the direction and strength of the association between SES and diet.

Objective

We aimed to examine ethnic differences in dietary patterns and the role of socio-economic indicators on dietary patterns within a multi-ethnic population.

Design

Cross-sectional multi-ethnic population-based study.

Setting

Amsterdam, the Netherlands.

Subjects

Principal component analysis was used to identify dietary patterns among Dutch (n=1,254), South Asian Surinamese (n=425), and African Surinamese (n=784) participants. Levels of education and occupation were used to indicate SES. Linear regression analysis was used to examine the association between ethnicity and dietary pattern scores first and then between socio-economic indicators and dietary patterns within and between ethnic groups.

Results

‘Noodle/rice dishes and white meat’, ‘red meat, snacks, and sweets’ and ‘vegetables, fruit and nuts’ patterns were identified. Compared to the Dutch origin participants, Surinamese more closely adhered to the ‘noodle/rice dishes and white meat’ pattern which was characterized by foods consumed in a ‘traditional Surinamese diet’. Closer adherence to the other two patterns was observed among Dutch compared to Surinamese origin participants. Ethnic differences in dietary patterns persisted within strata of education and occupation. Surinamese showed greater adherence to a ‘traditional’ pattern independent of SES. Among Dutch participants, a clear socio-economic gradient in all dietary patterns was observed. Such a gradient was only present among Surinamese dietary oatterns to the ‘vegetables, fruit and nuts’ pattern.

Conclusions

We found a selective change in the adherence to dietary patterns among Surinamese origin participants, presumably a move towards more vegetables and fruits with higher SES but continued fidelity to the traditional diet.

Diet Quality of Young Adults Enrolling in TXT2BFiT, a Mobile Phone-Based Healthy Lifestyle Intervention

BACKGROUND

Young adulthood is associated with poor dietary habits and vulnerability to weight gain. Population studies have revealed that inadequate fruit and vegetable intake, excessive sugar-sweetened beverages, and frequent takeaway food consumption are dietary habits requiring intervention.

OBJECTIVE

The aim was to examine the dietary patterns and diet quality of overweight young adults on enrollment into a mobile phone-based healthy lifestyle (mHealth) intervention, TXT2BFiT.

METHODS

Baseline diets were analyzed using the online Dietary Questionnaire for Epidemiological Studies version 2. The Healthy Eating Index for Australians (HEIFA) based on the 2013 Dietary Guidelines, was used to rate individual diets according to intake of core foods and deleterious nutrients including sugar, sodium, saturated fat, and alcohol. Findings were compared with the 2011 Australian National Nutrition and Physical Activity Survey (NNPAS). Gender differences were assessed with t tests and chi-square tests. ANOVA models were used to determine linear trends of core and noncore food intake and nutrients across quartiles of HEIFA scores. Associations between HEIFA score, sugar-sweetened beverages, and takeaway food consumption were assessed using linear regression analysis.

RESULTS

Diets of 230 participants (females: n=141; males: n=89; body mass index: mean 27.2, SD 2.5 kg/m(2)) were analyzed. The mean diet quality score was 45.4 (SD 8.8, range 21.7-77.0) out of 100 points, with no significant difference between genders. Compared with the NNPAS data for adults aged 19-30 years, this cohort had a lower intake of some core foods and higher intake of alcohol and saturated fat. Better quality diets were associated with higher intakes of fruits, vegetables, and wholegrains (P<.001). Takeaway food (P=.01) and sugar-sweetened beverage consumption (P<.001) were negatively associated with diet quality.

CONCLUSIONS

Overweight young adults had poorer diets compared with the reference Australian population within the same age group. This study reinforces that gender-specific interventions are required, as is the current practice in TXT2BFiT, with a need to reduce sodium and alcohol intake in males and sugar intake in females. It also confirms the need to increase fruit and vegetable intake and reduce takeaway food consumption in this population, with additional focus on saturated fat and wholegrain intake.

Sex- and age-specific associations between income and incident major osteoporotic fractures in Canadian men and women: a population-based analysis

We investigated sex- and age-specific associations between income and fractures at the hip, humerus, spine, and forearm in adults aged ≥50 years. Compared to men with the highest income, men with the lowest income had an increased fracture risk at all skeletal sites. These associations were attenuated in women.

INTRODUCTION

Associations between income and hip fractures are contested, even less is known about other fracture sites. We investigated sex- and age-specific associations between income and major osteoporotic fractures (MOF) at the hip, humerus, spine, and forearm.

METHODS

Incident fractures were identified from administrative health data for adults aged ≥50 years in Manitoba, Canada, 2000-2007. Mean neighborhood (postal code area) annual household incomes were extracted from 2006 census files and categorized into quintiles. We calculated age-adjusted and age-specific sex-stratified fracture incidence across income quintiles. We estimated relative risks (RR) and 95% CI for income quintile 1 (Q1, lowest income) vs. income quintile 5 (Q5) and tested the linear trend across quintiles.

RESULTS

We identified 15,094 incident fractures (4736 hip, 3012 humerus, 1979 spine, and 5367 forearm) in 2718 men and 6786 women. For males, the RR of fracture for the lowest vs. highest income quintile was 1.63 (95% CI 1.42-1.87) and the negative trend was statistically significant (p < 0.0001); individual skeletal sites showed similar associations. For females, the RR of fracture for the lowest vs. highest income quintile was 1.14 (95% CI 1.01-1.28), with a statistically significant negative trend (p = 0.0291); however, the only skeletal site associated with income in women was the forearm (Q1 vs. Q5 RR 1.09, 95% CI 1.01-1.28).

CONCLUSIONS

Compared to men with the highest income, men with the lowest income had an increased fracture risk at all skeletal sites. These associations were attenuated in women. For men, these effect sizes seem large enough to warrant public health concern.

Fruit and vegetable intake and body mass index in a large sample of middle-aged Australian men and women

Dietary guidelines around the world recommend increased intakes of fruits and non-starchy vegetables for the prevention of chronic diseases and possibly obesity. This study aimed to describe the association between body mass index (BMI) and habitual fruit and vegetable consumption in a large sample of 246,995 Australian adults aged 45 + year who had been recruited for the “45 and Up” cohort study. Fruit and vegetable intake was assessed using validated short questions, while weight and height were self-reported. Multinomial logistic regression was used, by sex, to assess the association between fruit and vegetable intake and BMI. Compared to the referent normal weight category (BMI 18.5 to 24.9), the odds ratio (OR) of being in the highest vegetable intake quartile was 1.09 (95% confidence interval (CI) 1.04–1.14) for overweight women (BMI 25.0–29.9) and 1.18 (95% CI 1.12–1.24) for obese women. The association was in the opposite direction for fruit for overweight (OR 0.85; 95% CI 0.80–0.90) and obese women (OR 0.75; 95% CI 0.69–0.80). Obese and overweight women had higher odds of being in the highest intake quartile for combined fruit and vegetable intake, and were more likely to meet the “2 and 5” target or to have five or more serves of fruit and vegetables per day. In contrast, overweight men were less likely to be in high intake quartiles and less likely to meet recommended target of 5 per day, but there was no consistent relationship between obesity and fruit and vegetable intake. Underweight women and underweight men were less likely to be in the highest intake quartiles or to meet the recommended targets. These data suggest that improving adherence to dietary targets for fruit and vegetables may be a dietary strategy to overcome overweight among men, but that overweight and obese women are already adhering to these targets. The association between fruit and vegetable intake and underweight in adults suggests that improving fruit and vegetables intakes are important for the overall dietary patterns of people in this group.

FRAX provides robust fracture prediction regardless of socioeconomic status

We investigated the fracture risk assessment tool (FRAX) Canada calibration and discrimination according to income quintile in 51,327 Canadian women, with and without a competing mortality framework. Our data show that, under a competing mortality framework, FRAX provides robust fracture prediction and calibration regardless of socioeconomic status (SES).

INTRODUCTION

FRAX® predicts 10-year fracture risk. Social factors may independently affect fracture risk. We investigated FRAX calibration and discrimination according to SES.

METHODS

Women aged ≥50 years with baseline femoral neck bone mineral density (BMD) were identified from the Manitoba Bone Density Program, Canada (n = 51,327), 1996-2011. Mean household income, extracted from 2006 census files, was categorized into quintiles. Ten-year fracture probabilities were calculated using FRAX Canada. Incident non-traumatic fractures were studied in relation to income quintile in adjusted Cox proportional hazards models. We compared observed versus predicted fractures with and without a competing mortality framework.

RESULTS

During mean 6.2 ± 3.7 years of follow up, there were 6,392 deaths, 3,723 women with ≥1 major osteoporotic fracture (MOF), and 1,027 with hip fractures. Lower income was associated with higher risk for death, MOF, and hip fracture in adjusted models (all p < 0.005). More women in income quintile 1 (lowest) versus quintile 5 experienced death (19 vs. 8%), MOF (10 vs. 6%), or hip fracture (3.0 vs. 1.3 %) (all p ≤ 0.001). Adjustment for competing mortality mitigated the effect of SES on FRAX calibration, and good calibration was observed. FRAX provided good fracture discrimination for MOF and hip fracture within each income quintile (all p < 0.001). Area under the curve was slightly lower for income quintiles 1 versus 5 for FRAX with BMD to predict MOF (0.68, 95% CI 0.66-0.70 vs. 0.71, 95% CI 0.69-0.74) and hip fracture (0.79, 95% CI 0.76-0.81 vs. 0.87, 95% CI 0.84-0.89).

CONCLUSION

Increased fracture risk in individuals of lower income is offset by increased mortality. Under a competing mortality framework, FRAX provides robust fracture prediction and calibration regardless of SES.

Sizing the association between lifestyle behaviours and fatness in a large, heterogeneous sample of youth of multiple ethnicities from 4 countries

Background

The magnitude of the relationship between lifestyle risk factors for obesity and adiposity is not clear. The aim of this study was to clarify this in order to determine the level of importance of lifestyle factors in obesity aetiology.

Methods

A cross-sectional analysis was carried out on data on youth who were not trying to change weight (n = 5714), aged 12 to 22 years and from 8 ethnic groups living in New Zealand, Australia, Fiji and Tonga. Demographic and lifestyle data were measured by questionnaires. Fatness was measured by body mass index (BMI), BMI z-score and bioimpedance analysis, which was used to estimate percent body fat and total fat mass (TFM). Associations between lifestyle and body composition variables were examined using linear regression and forest plots.

Results

TV watching was positively related to fatness in a dose-dependent manner. Strong, dose-dependent associations were observed between fatness and soft drink consumption (positive relationship), breakfast consumption (inverse relationship) and after-school physical activity (inverse relationship). Breakfast consumption-fatness associations varied in size across ethnic groups. Lifestyle risk factors for obesity were associated with percentage differences in body composition variables that were greatest for TFM and smallest for BMI.

Conclusions

Lifestyle factors were most strongly related to TFM, which suggests that studies that use BMI alone to quantify fatness underestimate the full effect of lifestyle on adiposity. This study clarifies the size of lifestyle-fatness relationships observed in previous studies.

Maternal work hours in early to middle childhood link to later adolescent diet quality

Objective

Previous studies on maternal work hours and child diet quality have reported conflicting findings possibly due to differences in study design, lack of a comprehensive measure of diet quality and differing ages of the children under investigation. The present study aimed to prospectively examine the impact of parental work hours from age 1 year to age 14 years on adolescent diet quality.

Design

Multivariate linear regression models were used to examine independent associations between parents’ work hours at each follow-up and across 14 years and adolescent diet quality at age 14 years. A diet quality index was based on the international literature and Australian recommendations, consisting of six food groups and nine nutrients.

Setting

Perth, Western Australia.

Subjects

Children (n 1629) participating in the Western Australian Pregnancy Cohort (Raine) Study.

Results

Compared with children of mothers in full-time employment, children of mothers who were not employed in early childhood up to age 5 years had a higher average diet quality score at age 14 years, independent of maternal and family socio-economic status. Across 14 years the number of years the mother worked full time and increasing average weekly hours were associated with lower diet quality. Father's work hours had little association with adolescent diet quality.

Conclusions

Having a mother stay at home in early to middle childhood is associated with better diet quality in adolescence. Support may be beneficial for families where the mother returns to full-time employment before the child reaches 8 years of age.

Sociodemographic and lifestyle characteristics in relation to dietary patterns among young Brazilian adults

OBJECTIVE

To identify dietary patterns among young adults and the relationships with socio-economic, demographic and lifestyle characteristics.

DESIGN

Population-based, cross-sectional analysis of a cohort study. Food intake was assessed by a frequency questionnaire, and dietary patterns were identified using principal components analysis.

SETTING

Southern Brazil.

SUBJECTS

A total of 4202 men and women aged 23 years, who participated in the 1982 Pelotas Birth Cohort Study.

RESULTS

Five dietary patterns were identified: common Brazilian, processed food, vegetable/fruit, dairy/dessert and tubers/pasta. Subjects who had low own or maternal educational levels, low social position or who were always poor throughout life had high adherence to the common Brazilian dietary pattern. In contrast, the processed food pattern was more likely to be followed by those belonging to middle and high social position and who were never poor. Men and smokers showed high adherence to the processed food and common Brazilian dietary patterns. Vegetable/fruit pattern was more likely to be followed by women and subjects engaged in physical activity. Women also showed high adherence to the dairy/dessert pattern.

CONCLUSIONS

Our study among young Brazilian adults has identified distinct dietary patterns that are clearly influenced by socio-economic and lifestyle characteristics, which have important policy implications in a country with marked social and economic inequalities.

Maternal influences on fruit and vegetable consumption of schoolchildren: case study in Hong Kong

This study investigated whether the consumption of fruit and vegetable by Chinese primary students in Hong Kong is associated with their mother's (1) nutrition knowledge on fruit and vegetables; (2) attitude towards healthy eating; and (3) fruit and vegetable consumption. Fourth- and fifth-grade students from 10 primary schools located in different districts, along with their mothers, were invited to each fill-in a questionnaire related to their diet intake. Accomplished questionnaires were matched and analysed. There were 1779 mother-child pairs who were successfully matched. Chi-square analysis revealed that students' fruit consumption is associated with their mother's (1) knowledge on fruit and vegetables (P = 0.006); (2) attitude towards healthy eating (P = 0.010); and (3) fruit consumption (P < 0.001). Students' vegetable consumption exhibited the same association with their mother's (1) knowledge (P < 0.001), (2) attitude towards healthy eating (P = 0.005), and (3) vegetable consumption (P < 0.001). Logistic regression showed that knowledge, attitude and dietary practice of mothers were independent factors associated with the consumption of fruit and vegetables by students and are not influenced by the level of education and household income. The results highlight the important role of parents in promoting fruit and vegetable consumption to primary students. It reaffirmed the importance of parent nutrition education in the formulation of a comprehensive health promotion strategy to school-aged children.

Associations between childhood socioeconomic position and adulthood obesity

Childhood socioeconomic position (SEP) is inversely associated with cardiovascular disease and all-cause mortality. Obesity in adulthood may be a biologic mechanism. Objectives were to systematically review literature published between 1998 and 2008 that examined associations of childhood SEP with adulthood obesity. Five databases (Cochrane Library, MEDLINE, EMBASE, PsycINFO, Web of Science) were searched for studies from any country, in any language. Forty-eight publications based on 30 studies were identified. In age-adjusted analyses, inverse associations were found between childhood SEP and adulthood obesity in 70% (14 of 20) of studies in females and 27% (4 of 15) in males. In studies of females showing inverse associations between childhood SEP and adulthood obesity, typical effect sizes in age-adjusted analyses for the difference in body mass index between the highest and lowest SEP were 1.0-2.0 kg/m(2); for males, effect sizes were typically 0.2-0.5 kg/m(2). Analyses adjusted for age and adult SEP showed inverse associations in 47% (8 of 17) of studies in females and 14% (2 of 14) of studies in males. When other covariates were additionally adjusted for, inverse associations were found in 4 of 12 studies in females and 2 of 8 studies in males; effect sizes were typically reduced compared with analyses adjusted for age only. In summary, the findings suggest that childhood SEP is inversely related to adulthood obesity in females and not associated in males after adjustment for age. Adulthood SEP and other obesity risk factors may be the mechanisms responsible for the observed associations between childhood SEP and adulthood obesity.

Skipping breakfast is associated with dysmenorrhea in young women in Japan

To evaluate the effects of breakfast habits on the quality of life in young women in Japan, the relation between breakfast habits and menstrual and intestinal disorders was estimated by responses to a questionnaire. Subjects were recruited from young Japanese female students of Ashiya College ranging in age from 18 to 20 years. Breakfast habits were classified into three groups (group I, having breakfast every morning, n=289; group II, having breakfast one to six times per week, n=106; group III, having breakfast less than once a week, n=44). The intensity of dysmenorrhea was classified into three grades (score 1, free of pain or painful, but without need for analgesic; score 2, painful, requiring analgesic; score 3, painful, not relieved by analgesic). The grades of bowel movement were classified into three groups (score 1, no more than once a week; score 2, two to six times a week; score 3, every day). Group II and group III had significantly higher scores for dysmenorrhea compared with group I. Students in group III showed a tendency toward constipation. Since dysmenorrhea is a risk factor for psychological disorders as well as gynecological diseases, the present study suggests the importance of eating breakfast to the quality of life of young women.

Breakfast and the diets of Australian children and adolescents: an analysis of data from the 1995 National Nutrition Survey

The aim of this study was to describe the nutrients provided to Australian children and adolescents by the breakfast meal and compare the food and nutrient intakes and health of regular breakfast eaters (those who ate breakfast 5 days or more a week) and skippers (who are breakfast rarely or never). The Australian Bureau of Statistics was commissioned to undertake additional analysis of data collected in the 1995 Australian National Nutrition Survey. The survey included 24-h recalls, physical measurements and a food-habits questionnaire collected during the period February 1995-March 1996, with a nationally representative sample of 3,007 Australians aged between 2 and 18 years. The median nutrient intakes at breakfast and the proportion of the daily total contributed by breakfast were calculated. Differences between regular breakfast eaters and breakfast skippers in terms of nutrient intake, body mass index and health status were compared using student t-tests. The findings show the typical breakfast consumed by young Australians was low in fat, high in carbohydrate and a good source of thiamin, riboflavin, niacin, calcium and magnesium. Those who did not eat breakfast cereal were much more likely to have inadequate nutrient intakes, especially of thiamin, riboflavin, calcium, magnesium and iron. There was no difference between the fat intake and the body mass index of regular breakfast eaters compared with breakfast skippers. Regular breakfast consumption is associated with better diets for children and adolescents.

Can social cognitive theory constructs explain socio-economic variations in adolescent eating behaviours? A mediation analysis

Adolescents of low socio-economic position (SEP) are less likely than those of higher SEP to consume diets in line with current dietary recommendations. The reasons for these SEP variations remain poorly understood. We investigated the mechanisms underlying socio-economic variations in adolescents' eating behaviours using a theoretically derived explanatory model. Data were obtained from a community-based sample of 2529 adolescents aged 12-15 years, from 37 secondary schools in Victoria, Australia. Adolescents completed a web-based survey assessing their eating behaviours, self-efficacy for healthy eating, perceived importance of nutrition and health, social modelling and support and the availability of foods in the home. Parents provided details of maternal education level, which was used as an indicator of SEP. All social cognitive constructs assessed mediated socio-economic variations in at least one indicator of adolescents' diet. Cognitive factors were the strongest mediator of socio-economic variations in fruit intakes, while for energy-dense snack foods and fast foods, availability of energy-dense snacks at home tended to be strong mediators. Social cognitive theory provides a useful framework for understanding socio-economic variations in adolescent's diet and might guide public health programmes and policies focusing on improving adolescent nutrition among those experiencing socio-economic disadvantage.

Food experiences and eating patterns of visually impaired and blind people

PURPOSE

The number of visually impaired and blind Canadians will rise dramatically as our population ages, and yet little is known about the impact of blindness on the experience of food and eating. In this qualitative study, the food experiences and eating patterns of visually impaired and blind people were examined. Influencing factors were also explored.

METHODS

In 2000, nine blind or severely visually impaired subjects were recruited through blindness-related organizations in British Columbia. Participants completed individual semi-structured, in-depth interviews. These were transcribed verbatim, coded, and analyzed to explicate participants' experiences.

RESULTS

Participants experienced blindness-related obstacles when shopping for food, preparing food, and eating in restaurants. Inaccessible materials and environments left participants with a diet lacking in variety and limited access to physical activity. Seven participants were overweight or obese, a finding that may be related to limited physical activity and higher-than-average restaurant use.

CONCLUSIONS

This is the first study in which the experience of food and eating is described from the perspective of visually impaired Canadians. Nutrition and blindness professionals must work together to reduce the food-related obstacles faced by visually impaired and blind people. Professionals must address both individual skill development and social and structural inequities.

Benefits of Breakfast for Children and Adolescents: Update and Recommendations for Practitioners

A number of studies report health benefits for children and adolescents who consume breakfast. Breakfast skipping is fairly common in children and adolescents and increases as children age. Breakfast can enhance children's diets by positively contributing to daily nutrient intake, augmenting intake of key nutrients such as fiber and calcium, and provides an opportunity to help meet the recommendations of the Dietary Guidelines for Americans. Breakfast also is associated with more healthful food choices. Cross-sectional studies support that eating breakfast more often may help children and adolescents maintain a healthful weight. However, the results from longitudinal studies are inconclusive and suggest that more research is needed to clarify this relationship, including understanding the mediating effects of initial weight status, dieting behavior, and physical activity levels. Breakfast consumption may provide some benefit toward cognitive function and academic achievement, but more research is needed. Breakfast is one facet of a healthy lifestyle that may help contribute to the short- and long-term health and well-being of children and adolescents. Health practitioners can promote healthy breakfast consumption in children and adolescents by addressing barriers to eating breakfast and focusing on individuals who may be more likely to skip breakfast on a regular basis.

Socio-demographic influences on trends of fish consumption during later adult life in the Whitehall II study

Our aim was to investigate how socio-demographic factors influence trends and age-related trajectories of fish consumption. We examined consumption of total, fried and recommended fish (white and oily fish, and shellfish) in the Whitehall II study over 11 years in participants aged 39–59 years at phase 3. The cohort included 8358 British civil servants who completed a FFQ at phase 3 (1991–3), phase 5 (1997–9, n 5430) and phase 7 (2002–4, n 5692). Occupational grade, ethnicity, marital and retirement status were collected at each phase. To analyse changes in age-related trends of fish intake over time according to socio-demographic characteristics, we applied a random mixed-effect model. Over the follow-up a significant increase in consumption of ‘recommended’ (mean: 1·85 to 2·22 portions/week) and total fish (mean: 2·32 to 2·65 portions/week) and a decreasing trend in fried-fish intake (mean: 0·47 to 0·43 portions/week) was observed. Recommended, fried and total fish consumption differed by occupational status, ethnicity, marital status and sex. The trend of age-related fish intake diverged significantly by ethnicity. In South Asian participants (n 432), slope of recommended-fish consumption was significantly higher compared with white participants (0·077 v. 0·025 portions/week per year). For black participants (n 275) slope of fried-fish intake was significantly higher compared with white participants (0·0052 v. − 0·0025 portions/week per year). In terms of public health, our descriptive and analytical work allows detailed understanding of the impact of socio-demographic factors on fish intake and its age-related trends. Such information is valuable for food policies that seek to promote health equity.

Food consumption patterns in the Waterloo Region, Ontario, Canada: a cross-sectional telephone survey

BACKGROUND

The demographics and lifestyles of Canadians are changing, thereby influencing food choices and food preparation in the home. Although different dietary practices are associated with increased risk of foodborne illness, our ability to evaluate food consumption trends and assess risks associated with foodborne illness is limited by lack of data on current eating habits and consumer food safety practices. The objective of this study was to describe, for the first time, the food consumption patterns in a Canadian-based population from a food safety perspective, in order to establish baseline data on actual food intake of individuals.

METHOD

A cross-sectional telephone survey of 2,332 randomly selected residents of Waterloo Region, Ontario, Canada (C-EnterNet pilot site) was conducted between November 2005 and March 2006. Food intake was assessed using a 7-day dietary recall method.

RESULTS

Certain food items were consumed more than others among the same food groups, and consumption of many food items varied by gender and age. Specific foods considered high-risk for the transmission of certain enteric pathogens were significantly more likely to be consumed by males (i.e. unpasteurized juice, bean sprouts, and undercooked meat) and elderly individuals (i.e. undercooked eggs). The majority of households prepared and consumed most meals at home, allocating an average of 44 minutes to prepare a meal.

CONCLUSION

Baseline data on actual food intake is useful to public health professionals and food safety risk assessors for developing communication messages to consumers and in foodborne outbreak investigations.

Breakfast skipping and body mass index among adolescents in Greece: whether an association exists depends on how breakfast skipping is defined

Many studies have found an association between breakfast skipping and either body mass index (BMI; calculated as kg/m(2)) or overweight/obesity among adolescents, but several studies have found no association. This cross-sectional study investigated the hypothesis that this discrepancy is partly due to three differences in methodology. First, some studies have examined BMI, but other studies have examined overweight/obesity. Second, some studies have controlled for potential confounders, but other studies have not. Third, different studies have used different definitions of breakfast skipping. This study examined both the relationship between breakfast skipping and BMI and the relationship between breakfast skipping and overweight/obesity, compared unadjusted results with results adjusted for potential confounders, and compared results for 24 definitions of breakfast skipping. The sample consisted of 811 students at high schools in Piraeus, Greece, who completed a questionnaire and had their height and weight measured. The results supported this hypothesis. First, fewer breakfast-skipping variables were associated with BMI than with overweight/obesity. Second, fewer associations were found when controlling than when not controlling for potential confounders. Third, fewer associations were found for variables corresponding to some definitions of breakfast skipping than for variables corresponding to other definitions.

Potential renal acid load in the diet of children and adolescents: impact of food groups, age and time trends

Objective

The impact of acid–base balance on health is widely accepted. Here, we describe the potential renal acid load (PRAL) in the diet of healthy German children and adolescents.

Design

The Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study is an ongoing longitudinal (open cohort) study (start 1985) collecting detailed data on diet, growth, development and metabolism in infants, children and adolescents.

Setting

Research Institute of Child Nutrition, Dortmund.

Subjects

Seven hundred and twenty children and adolescents (351 boys and 369 girls), aged 3–18 years, provided 4187 yearly collected 3-day dietary records between 1995 and 2005.

Results

Mean daily PRAL was positive in all age/sex groups (6–21 mEq day−1), and significantly higher in boys than in girls after the age of 8 years, even when calculated as mEq MJ−1. Fruits, vegetables and potatoes had a negative impact on PRAL; cheese, dairy products, cereals/bread and meat/fish/eggs had a positive impact. In a mixed linear model, PRAL, expressed as mEq day−1 and mEq MJ−1, remained stable during the study period, since time trends of PRAL-relevant food groups countervail each other. PRAL intake (mEq MJ−1) was significantly positively associated (P < 0.0001) with fat intake (% of energy intake, %E), but negatively with carbohydrate intake (%E; P < 0.0001).

Conclusions

The analysis of dietary habits in our sample of German children and adolescents showed a moderate excess of acidity. Especially older boys should be encouraged to eat more potatoes and vegetables as good sources of dietary alkalinity. The PRAL concept is compatible with current concepts for a healthy diet.

An index of diet and eating patterns is a valid measure of diet quality in an Australian population

Diet indices represent an integrated approach to assessing eating patterns and behaviors. The aim of this study was to develop a comprehensive food-based dietary index to reflect adherence to healthy eating recommendations, evaluate the construct validity of the index using nutrient intakes, and evaluate this index in relation to sociodemographic factors, health behaviors, risk factors, and self-assessed health status. Data were analyzed from adult participants of the Australian National Nutrition Survey who completed a 108-item FFQ and a food habits questionnaire (n = 8220). The dietary guideline index (DGI) consisted of 15 items reflecting the dietary guidelines, including dietary indicators of vegetables and legumes, fruit, total cereals, meat and alternatives, total dairy, beverages, sodium, saturated fat, alcoholic beverages, and added sugars. Diet quality was incorporated using indicators relating to whole-grain cereals, lean meat, reduced/low fat dairy, and dietary variety. We investigated associations between the DGI score, sociodemographic factors, health behaviors, chronic disease risk factors, and nutrient intakes. We found associations between the DGI scores and sex, age, income, area-level socioeconomic disadvantage, smoking, physical activity, waist:hip ratio, systolic blood pressure (males only), and self-assessed health status (females only) (all P < 0.05). Higher DGI scores were associated with lower intakes of energy, total fat, and saturated fat and higher intakes of fiber, beta-carotene, vitamin C, folate, calcium, and iron (P < 0.05). This food-based dietary index is able to discriminate across a variety of sociodemographic factors, health behaviors, and self-assessed health and reflects intakes of key nutrients.

Convenience food in the diet of children and adolescents: consumption and composition

Despite an increasing trend towards the use of convenience food, there is to date little debate on it in the nutritional sciences. In the present study, we present and evaluate data on consumption frequencies and composition of savoury convenience food in German families using data from the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study. The DONALD Study is an ongoing, longitudinal (open cohort) study (started 1985), collecting detailed data on diet, development, and metabolism in infants, children and adolescents. Dietary intake was measured by yearly repeated 3 d weighed dietary records (n 1558) in 554 subjects (278 boys; 276 girls), 3-18 years old, between 2003 and 2006. A total of 1345 (86%) 3 d dietary records mentioned consumption of at least one convenience food. Convenience food consumption (percentage of total food intake, g/d) increased with age from approximately 3% in the 3-8 year olds to 7% in 14-18-year-old boys and 5% in 14-18-year-old girls (P < 0.0001) but remained constant during the study period. Convenience foods contributed more to total fat (g/d) (P < 0.001) and less to total carbohydrate (P < 0.0001) than to total energy (kJ/d) intake. The 700 convenience-food products recorded by our sample had on average fourteen ingredients; 4% were flavourings and 16% were food additives. In conclusion, convenience foods were widely consumed by our sample of German children and adolescents and their consumption increased with age. The composition of convenience food was characterised by a high fat content and a high number of flavourings and food additives.

The relationship between education and food consumption in the 1995 Australian National Nutrition Survey

Objective:

To assess the relationship between education and the intake of a variety of individual foods, as well as groups of foods, for Australian men and women in different age groups.

Design:

Cross-sectional national survey of free-living men and women.

Subjects:

A sample of 2501 men and 2739 women aged 18 years and over who completed the National Nutrition Survey (NNS) 1995.

Methods:

Information about the frequency of consumption of 88 food items was obtained using a food-frequency questionnaire in a nation-wide nutrition survey. Irregular and regular consumers of foods were identified according to whether they consumed individual foods less than or more than once per month. The relationship between single foods and an index of education (no post-school qualifications, vocational, university) was analysed via contingency table chi-square statistics for men and women. Food group variety scores were derived by assigning individual foods to conventional food group taxonomies, and then summing the dichotomised intake scores for individual foods within each food group. Two-way analyses of variance (education by age groups) were performed on food variety scores for men and women, separately.

Results:

While university-educated men and women consumed many individual foods more regularly than less-educated people, they were less likely to be regular consumers of several meat products. The relationship between education and food consumption was less apparent when individual food scores were aggregated into food group scores. University-educated men and women exhibited higher scores on total food group variety than the other educational groups.

Conclusions:

Higher education is associated with the regular consumption of a wider variety of foods. Aggregation of individual food consumption indices into food variety scores may mask the apparent effects of educational background on food consumption.

Who eats four or more servings of fruit and vegetables per day? Multivariate classification tree analysis of data from the 1998 Survey of Lifestyle, Attitudes and Nutrition in the Republic of Ireland

Objective

To identify, using the novel application of multivariate classification trees, the socio-economic, sociodemographic and health-related lifestyle behaviour profile of adults who comply with the recommended 4 or more servings per day of fruit and vegetables.

Design

Cross-sectional 1998 Survey of Lifestyle, Attitudes and Nutrition.

Setting

Community-dwelling adults aged 18 years and over on the Republic of Ireland electoral register.

Subjects

Six thousand five hundred and thirty-nine (response rate 62%) adults responded to a self-administered postal questionnaire, including a semi-quantitative food-frequency questionnaire.

Results

The most important determining factor of compliance with the fruit and vegetable dietary recommendations was gender. A complex constellation of sociodemographic and socio-economic factors emerged for males whereas the important predictors of 4 or more servings of fruit and vegetable consumption among females were strongly socio-economic in nature. A separate algorithm was run to investigate the importance of health-related lifestyle and other dietary factors on compliance with the fruit and vegetable recommendations. Following an initial split on compliance with dairy recommendations, a combination of non-dietary behaviours showed a consistent pattern of healthier options more likely to lead to compliance with fruit and vegetable recommendations. There did, however, appear to be a compensatory element between the variables, particularly around smoking, suggesting the non-existence of an exclusive lifestyle for health risk.

Conclusions

Material and structural influences matter very much for females in respect to compliance with fruit and vegetable recommendations. For males, while these factors are important they appear to be mediated through other more socially contextual-type factors. Recognition of the role that each of these factors plays in influencing dietary habits of men and women has implications for the manner in which dietary strategies and policies are developed and implemented.

Gender differences in the consumption of meat, fruit and vegetables are similar in Finland and the Baltic countries

BACKGROUND

Women's diets are healthier than men's. Finnish women eat more fruits and vegetables but less meat than men. Gender differences may be larger in the Baltic countries, which represent Eastern European transition societies than in Finland, a society characterized by the Scandinavian welfare ideology and a high degree of gender equality.

METHODS

The data are based on questionnaires to random samples of adults in Finland, Estonia, Latvia and Lithuania. The data provide a way of addressing gender differences at the turn of the century in the economically and culturally different countries. The purpose is to explore whether the consumption of foods classified as masculine or feminine-meat, fruits and vegetables-follow a similar gender pattern in Finland and the Baltic countries.

RESULTS

Men ate meat more often while women ate fruits and vegetables. A high educational level was associated with frequent consumption of fruits and vegetables. Educational differences in the consumption of meat were few and inconsistent. The consumption of fruits and vegetables was more common in urban areas except in Finland. Gender differences were similar in all countries throughout age and educational groups and in rural and urban areas.

CONCLUSION

The consistent association of gender and food and the similarity of gender patterning in population subgroups point to the stability of masculine versus feminine food habits. The similarity suggests that food habits contribute equally to the gender gap in health in the Baltic countries as they do in Finland.

Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part I: Quantitative studies

BACKGROUND

In order to more effectively promote fruit and vegetable intake among children and adolescents, insight into determinants of intake is necessary. We conducted a review of the literature for potential determinants of fruit and vegetable intake in children and adolescents.

METHODS

Papers were identified from Medline and PsycINFO by using all combinations of the search terms: "fruit(s) or vegetable(s)" and "children or adolescents". Quantitative research examining determinants of fruit and/or vegetable intake among children and adolescents aged 6-18 years were included. The selection and review process was conducted according to a four-step protocol resulting in information on country, population, design, methodology, theoretical basis, instrument used for measuring intake, statistical analysis, included independent variables, and effect sizes.

RESULTS

Ninety-eight papers were included. A large number of potential determinants have been studied among children and adolescents. However, for many presumed determinants convincing evidence is lacking, mostly because of paucity of studies. The determinants best supported by evidence are: age, gender, socio-economic position, preferences, parental intake, and home availability/accessibility. Girls and younger children tend to have a higher or more frequent intake than boys and older children. Socio-economic position, preferences, parental intake, and home availability/accessibility are all consistently positively associated with intake.

CONCLUSION

The determinants most consistently supported by evidence are gender, age, socio-economic position, preferences, parental intake and home availability/accessibility. There is a need for internationally comparative, longitudinal, theory-based and multi-level studies taking both personal and environmental factors into account. This paper is published as part of the special Pro Children series in the International Journal of Behavioral Nutrition and Physical Activity. Please see [http://www.ijbnpa.org/content/3/1/26] for the relevant editorial.

Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents

Breakfast has been labeled the most important meal of the day, but are there data to support this claim? We summarized the results of 47 studies examining the association of breakfast consumption with nutritional adequacy (nine studies), body weight (16 studies), and academic performance (22 studies) in children and adolescents. Breakfast skipping is highly prevalent in the United States and Europe (10% to 30%), depending on age group, population, and definition. Although the quality of breakfast was variable within and between studies, children who reported eating breakfast on a consistent basis tended to have superior nutritional profiles than their breakfast-skipping peers. Breakfast eaters generally consumed more daily calories yet were less likely to be overweight, although not all studies associated breakfast skipping with overweight. Evidence suggests that breakfast consumption may improve cognitive function related to memory, test grades, and school attendance. Breakfast as part of a healthful diet and lifestyle can positively impact children's health and well-being. Parents should be encouraged to provide breakfast for their children or explore the availability of a school breakfast program. We advocate consumption of a healthful breakfast on a daily basis consisting of a variety of foods, especially high-fiber and nutrient-rich whole grains, fruits, and dairy products.

Heritage retention and bean intake correlates to dietary fiber intakes in Hispanic mothers--Qué Sabrosa Vida

OBJECTIVE

To determine the correlation between fruit/vegetable and bean stage of change and heritage retention with fiber intake in Hispanic mothers.

DESIGN

Cross-sectional study design used baseline survey data from the Qué Sabrosa Vida nutrition intervention developed by the University of Texas School of Public Health, Human Nutrition Center (Houston, TX). Participants were recruited and data gathered from telephone surveys using random digit dial methodology ensuring proportional representation of demographic subgroups.

SUBJECTS

Hispanic mothers (N=293) responded to the baseline survey in El Paso, TX.

ANALYSES

Using SPSS version 11.0 (SPSS Inc, Chicago, IL), descriptive statistics, chi2 , correlations, and analyses of variance were used to determine the relationship of variables to fiber intake. Potential confounding variables included were grain stage of change, age, education level, and marital status.

RESULTS

Mean fiber intake for mothers was 21.9 g/day and mean age was 35.8 years. Chi2 of fruit/vegetable stage was P =.784. Chi 2 of bean stage, heritage retention score, age, and education to fiber intake were significant, P =.008, P =.004, P =.005, and P =.001, respectively. Bean stage, heritage retention score, age, and education level were significantly correlated. One-way analysis of variance of bean stage, heritage retention score, age, and education level by fiber intake were significant, P =.006, P =.001, P =.004, and P =.002, respectively.

CONCLUSIONS

Older Hispanic mothers in the action/maintenance bean stage with strong heritage retention score had greater fiber intakes than younger mothers in pre-action bean stage with weak heritage retention score. As education level increased fiber intake decreased. Encouragement of bean consumption and heritage retention may increase fiber intake in this Hispanic mother population.

Educational and economic determinants of food intake in Portuguese adults: a cross-sectional survey

BACKGROUND

Understanding the influences of educational and economic variables on food consumption may be useful to explain food behaviour and nutrition policymaking. The aim of this study was to evaluate the importance of educational and economic factors in determining food pattern in Portuguese adults.

METHODS

A cross-sectional study in a representative sample of Portuguese adults (20977 women and 18663 men). Participants were distributed in four categories according to years of education (12) and income (815 euros). Logistic regression models were fitted to estimate the magnitude of the association between food groups and education/income, adjusting for confounders.

RESULTS

In both genders, the odds favouring milk, vegetable soup, vegetables, fruit, and fish consumption, increased significantly with education, for those having >12 years of education compared to those with 12 years of education compared to those with 815 euros compared to those with

CONCLUSIONS

The low and high income groups are or tend to be similar in regard to several food groups consumption, and access to education/information appears to be the key element to a better food pattern as indicated by higher frequency of milk, vegetable soup, vegetables, fruit, and fish consumption.

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Key Words Collapse

MESH Headings

• Adult
• Aged
• Cross-Sectional Studies
• Diet/economics
• Diet Surveys
• Educational Status
• Feeding Behavior/psychology
• Female
• Humans
• Income
• Logistic Models
• Male
• Middle Aged
• Portugal
• Socioeconomic Factors

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Grants Collapse

Affiliation(s)

Pedro A Moreira Faculty of Nutrition and Food Sciences, University of Porto, R. Roberto Frias, 4200-465 Porto, Portugal
Patricia D Padrão Faculty of Nutrition and Food Sciences, University of Porto, R. Roberto Frias, 4200-465 Porto, Portugal

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Current problems of food intake in young women in Japan: Their influence on female reproductive function

Accumulating evidence suggests that food customs are associated with quality of life in women of the reproductive age. In Japan, dietary limitation for cosmetic purposes, skipping food intake, intake of processed foods and the shift from Japanese to Westernized style food have increased among young women. These changes in food habits can cause inadequate intake of calories, micronutrients, unsaturated fat, phytestrogens and fiber as well as increasing environmental toxins. Furthermore, these food habits increase risk as a result of intake of food additives, anti-oxidants, processing agents and sweeteners, which have been demonstrated to be harmful to human health. These factors are speculated to not only influence the present lifestyle, but also to induce gynecologic disorders such as dysmenorrhea and irregular menstruation. The adverse effects of these dietary habits on pregnancy outcome and carcinogenesis of breast and ovarian cancers have also been demonstrated. In addition, latent development of organic diseases such as endometriosis, which are accompanied by dysmenorrhea, is a concern under the current nutritional environment in young women. Thus, it is an urgent issue to evaluate the present situation of eating habits in young Japanese women and estimate the influence of these habits on the quality of life including reproductive functions. (Reprod Med Biol 2004; 3: 107-114).

Demographic, familial and trait predictors of fruit and vegetable consumption by pre-school children

OBJECTIVE

To examine the contribution to fruit and vegetable eating in children of potential predictive variables within the domains of demographics, parental feeding practices and personality traits.

DESIGN

Cross-sectional survey.

SETTING

Questionnaires were distributed to parents through 22 London nursery schools.

SUBJECTS

Questionnaires were completed and returned by 564 parents or principal caregivers of 2-6-year-old children.

RESULTS

Significant predictors of children's fruit and vegetable intake emerged from all three domains examined. Demographic variables associated with child's vegetable consumption were mother's education and child's age and gender. Only ethnicity was significantly associated with fruit consumption. Parental consumption, breast-feeding and early introduction to fruit and vegetables were related to intake of both. Family meal times were associated with higher intake of vegetables, but not of fruit. Two characteristics of children themselves (food neophobia and enjoyment of food) were strongly related to the consumption of fruit and vegetables. Subsequent multivariate analyses revealed that parental intake and child food neophobia independently predicted intake of both foods. In the presence of these, fruit consumption was affected by breast-feeding and early introduction to fruit, whereas vegetable consumption was related only to child's gender and enjoyment of food.

CONCLUSIONS

These findings may be used to inform future interventions aimed at increasing children's consumption of fruit and vegetables. Parents should be made aware of the possible impact of their own behaviour on the eating habits of their children.

A randomized trial of interactive group sessions achieved greater improvements in nutrition and physical activity at a tiny increase in cost

OBJECTIVE

Weight gain may follow altered eating habits and decreased physical activity in couples beginning to live together. Mutual support and willingness to accept changes in lifestyle at this stage may facilitate positive responses to health promotion. We aimed to compare the effects of a diet and physical activity program in couples using a randomized controlled trial.

STUDY DESIGN AND SETTING

Couples were randomized to a control group or to one of two intervention groups in whom the program was either delivered mainly by mail or with a combination of mail-outs and interactive group sessions.

RESULTS

Diets, physical fitness, and blood cholesterol improved up to 12 months after beginning the 4-month program, mainly in the interactive group. In that group, at the end of the program, the estimated cost was 445.30 dollars (111.33 dollars/month) per participant per unit change in outcome variables, only 0.03 dollars per participant per month more than the group receiving the program mainly by mail. One year after beginning the program, costs per participant per month were 38.37 dollars in the interactive group and 38.22 dollars in the group receiving the program mainly by mail-out.

CONCLUSION

The changes observed in cardiovascular risk factors could translate to a substantial cost-savings relating to health.

An innovative program for changing health behaviours

Health-related behaviours affecting diet, weight control and physical activity are important for long-term cardiovascular health but behaviour change is difficult to initiate and even more difficult to maintain. We have developed a health promotion program, in which social support has a key role, to encourage a prudent diet, weight control and physical activity. Behaviour change is based on evaluating initial behaviour, weighing up costs and benefits, assessing barriers to change and goal-setting. We first evaluated the program in couples beginning to live together, a group chosen because of the risk of weight gain and decreased physical activity after marriage, readiness to change behaviour at that time in the life course and the opportunity to use partner's support in achieving behaviour change. In an initial short-term study with 39 couples, intake of fat and take-away foods decreased and consumption of fruit, vegetables and reduced fat foods increased. Physical activity increased and there was a 6% fall in blood cholesterol. Further evaluation in 137 couples included assessment after 12 months. A decrease in fat intake and increase in physical activity and fitness seen at the end of the program persisted 1 year later. Lower cholesterol and a trend to lower weight gain and lower blood pressure were also maintained after 12 months. We have modified the program aiming for weight loss, improved dietary habits and increased physical activity in overweight treated hypertensives, supported by their partners. Decreased intake of energy, total and saturated fat, and weight loss seen at the end of the 16 week program was significantly greater in the intervention group than with usual care. Blood pressure fell in the program group at the end of intervention and, in men, withdrawal of antihypertensive drugs was significantly associated with the intervention. Weight loss and a decrease in waist circumference were maintained in the program group up to 16 months after entering the study. This program has the potential for wider application in other at-risk groups.

Socioeconomic differences in dietary patterns among middle-aged men and women

The aim of the study is to (i) identify common dietary patterns, (ii) study socioeconomic differences in these dietary patterns, and (iii) assess whether they contribute to socioeconomic differences in biological risk factors. The data come from the Whitehall II study of London civil servants, who participated in the third phase (1991-1993) and were 39-63-years old (N=8004). Food frequency questionnaire and socioeconomic background information was from a questionnaire, and biological risk factors from a medical screening. Six dietary patterns were identified. In reference to high employment grade men, the odds ratios of low grade men consuming the 'unhealthy' or the 'very unhealthy' diet were 1.26 and 3.34, respectively, while the odds for the 'French' diet was 0.13. Among women the corresponding odds were 2.98, 6.19 and 0.25. Adjusting for spouse's socioeconomic status and to a lesser extent smoking and exercise as well as job control attenuate these grade differences somewhat. Among men and women adjusting for dietary patterns accounted for about 25-50 per cent of grade differences in HDL and serum triglyceride levels.

Consumers' health perceptions of three types of milk: a survey in Australia

A survey was conducted among 345 randomly selected shoppers in Melbourne, Australia, to identify their perceptions of the healthiness of whole milk, reduced fat milk and soy milk and to investigate demographic influences on health perceptions and types of milk consumption. The survey revealed major differences in shoppers' perceptions of the three types of milk along the themes of bone health, weight control, disease prevention, and, allergy and disease causation. Generally whole milk was perceived more negatively than soy or reduced fat milk. There were few demographic differences in the shoppers' perceptions of the three products. Reported consumption of reduced fat milk was more frequent among women and elderly people, and whole milk consumption was positively related to parenthood. The findings suggest that previous marketing and education campaigns have been effective but the widespread uncertainty and erroneous beliefs about milk products suggest that many consumers have not assimilated new findings about milk products. This represents a challenge for industry and public health practitioners.