Selecting a healthy diet score: lessons from a study of diet and health in early old age (the Boyd Orr cohort)

OBJECTIVES: To describe the selection and modification of an appropriate diet score to assess diet quality in early old age. DESIGN AND SETTING: Cross-sectional analyses of the Boyd Orr cohort - a long-term follow-up of men and women whose families took part in a survey of diet and health in pre-war Britain. Dietary data were obtained from a 113-item food-frequency questionnaire. A nine-item Healthy Diet Indicator (HDI) developed by Huijbregts and colleagues was identified from the literature and modified because some dietary variables were unavailable and to accord more closely with recommendations of the UK Committee on Medical Aspects of Food Policy. SUBJECTS: In total, 1475 traced, surviving cohort members aged 60 years and over. RESULTS: Modification resulted in a 12-item Healthy Diet Score (HDS). We found that about half the variation in the HDS was explained by variation in the HDI (r=0.71). There was, however, little misclassification of subjects (<10%) into extreme thirds of the distribution by the HDS compared with the HDI. Items of the score most strongly correlated with overall score were saturated fat (r=-0.57), red meat (r=-0.46), dietary fibre (r=0.58), fruit and vegetables (r=0.54) and percentage energy from carbohydrates (r=0.51). Modifying existing items had greater impact on agreement between HDI and HDS than the addition of new items. CONCLUSIONS: The selection and modification of diet scores is more complicated than often assumed. Furthermore, modest changes to an existing score can produce a score that is different from the original, and although it was not possible to test this issue, it may no longer predict subsequent health experience.     

Does the diet of the Balearic population, a Mediterranean-type diet, ensure compliance with nutritional objectives for the Spanish population?

OBJECTIVES: To assess the dietary habits of Balearic Islands' consumers who are successful in meeting current nutritional recommendations, to find clues for the development of future food-based dietary guidelines (FBDG) that would be relevant to this population. DESIGN: Cross-sectional nutritional survey carried out in the Balearic Islands between 1999 and 2000. SUBJECTS AND METHODS: Dietary habits were assessed by means of 24-hour recall (two non-consecutive days: warm and cold season) and a food-frequency questionnaire in a random sample (n=1200, aged 16-65 years) living in private households. Differences in percentage of compliers with the intermediate nutritional objectives for the Spanish population and differences in food consumption patterns between genders and between high (above the upper quartile of intake) and low (below the lower quartile of intake) consumers of fat, saturated fatty acids (SFA), fibre, and fruit and vegetables were analysed. RESULTS: Gender differences were observed in nutrient and energy intakes, as well as in attainment of the recommendations. Less than 25% of the population reached the intermediate nutritional recommendations for iodine, fruit, carbohydrates, SFA, fibre and vegetables. Low fat/SFA and high fruit and vegetables/fibre consumers kept a diet in line with the traditional Balearic diet and prevailing dietary pyramids, which ensured better compliance with the nutritional goals. CONCLUSIONS: The intermediate nutritional objectives for the Spanish population could be achieved through maintenance of the traditional Balearic diet, a Mediterranean-type diet in the Balearic population. Therefore, this dietary model could be used to develop FBDG relevant to this population.     

Mediterranean diet and cancer

OBJECTIVE: To analyse the role of various aspects of the Mediterranean diet in several common epithelial cancers, including digestive and selected non-digestive tract neoplasms. DESIGN: Systematic analysis of data from a series of case-control studies. SETTING: Northern Italy, between 1983 and 1998. SUBJECTS: Over 12,000 cases of 20 cancer sites and 10,000 controls. RESULTS: For most epithelial cancers, the risk decreased with increasing vegetable and fruit consumption, with relative risk (RR) between 0.3 and 0.7 for the highest versus the lowest tertile. For digestive tract cancers, population-attributable risks for low intake of vegetables and fruit ranged between 15 and 40%. A protective effect was observed also for breast, female genital tract, urinary tract and a few other epithelial neoplasms. A number of antioxidants and other micronutrients showed an inverse relationship with cancer risk, but the main components responsible for the favourable effect of a diet rich in vegetables and fruit remain undefined. Fish tended to be another favourable diet indicator. In contrast, subjects reporting frequent red meat intake showed RRs above unity for several common neoplasms. Intake of whole-grain foods was related to a reduced risk of several types of cancer, particularly of the upper digestive tract. This may be due to a favourable role of fibre, but the issue is still open to discussion. In contrast, refined grain intake and, consequently, glycaemic load and glycaemic index were associated with increased risk of different types of cancer including, among others, breast and colorectal. CONCLUSIONS: A low-risk diet for cancer in the Mediterranean would imply increasing the consumption of fruit and vegetables, as well as avoiding increasing the intakes of meat and refined carbohydrates. Further, olive oil and other unsaturated fats, which are also typical aspects of the Mediterranean diet, should be preferred to saturated ones.     

Dietary intake and development of a quantitative food-frequency questionnaire for a lifestyle intervention to reduce the risk of chronic diseases in Canadian First Nations in north-western Ontario

OBJECTIVES: To characterise the diet of First Nations in north-western Ontario, highlight foods for a lifestyle intervention and develop a quantitative food-frequency questionnaire (QFFQ). DESIGN: Cross-sectional survey using single 24 h dietary recalls. SETTING: Eight remote and semi-remote First Nations reserves in north-western Ontario. SUBJECTS: 129 First Nations (Oji-Cree and Ojibway) men and women aged between 18 and 80 years. RESULTS: The greatest contributors to energy were breads, pasta dishes and chips (contributing over 20 % to total energy intake). 'Added fats' such as butter and margarine added to breads and vegetables made up the single largest source of total fat intake (8.4 %). The largest contributors to sugar were sugar itself, soda and other sweetened beverages (contributing over 45 % combined). The mean number of servings consumed of fruits, vegetables and dairy products were much lower than recommended. The mean daily meat intake was more than twice that recommended. A 119-item QFFQ was developed including seven bread items, five soups or stews, 24 meat- or fish-based dishes, eight rice or pasta dishes, nine fruits and 14 vegetables. Frequency of consumption was assessed by eight categories ranging from 'Never or less than one time in one month' to 'two or more times a day'. CONCLUSION:We were able to highlight foods for intervention to improve dietary intake based on the major sources of energy, fat and sugar and the low consumption of fruit and vegetable items. The QFFQ is being used to evaluate a diet and lifestyle intervention in First Nations in north-western Ontario.     

Secular and socio-economic trends in compliance with dietary targets in the north Glasgow MONICA population surveys 1986-1995: did social gradients widen?

OBJECTIVE: To compare trends in the consumption of key foods over 10 years in the most deprived and least deprived quarters in north Glasgow, Scotland as defined by the Carstairs deprivation index for their postcode of domicile. DESIGN: Four random, cross-sectional, age- and gender-stratified population surveys carried out in 1986, 1989, 1992 and 1995. After assigning a deprivation score, food-frequency questionnaires from 2883 men and 3127 women were examined for compliance with dietary targets, examining trends by gender and within the most and least deprived quarters of the population. SETTING: North Glasgow, Scotland. SUBJECTS: Over 600 men and 600 women (aged 25-64 years) in each of the four survey years who completed a lifestyle questionnaire including a food frequency section. RESULTS: Increasing trends in the reported consumption of fruit and vegetables and oil-rich fish were observed over the 10-year period. However, the trend to increased fruit and vegetable consumption in the most deprived groups was not significant, and in 1995 only 8% of men and 12% of women in this group claimed consumption of these foods 4 or more times a day. In general, a higher percentage of those in the least deprived group met the targets for the key foods. CONCLUSIONS: Trends to increasing consumption of fruit and vegetables and fish were in the right direction, but the targets for consumption of certain key foods were met by a minority of the population. The progress towards the target for fruit and vegetables showed widening social gradients with time.     

Associations of psychosocial factors with fruit and vegetable intake among African-Americans

OBJECTIVE: To examine associations of various psychosocial factors with fruit and vegetable intake in African-American adults. METHODS: A cross-sectional survey of a population-based sample of 658 African-Americans, aged 18-70 years, in North Carolina. Information was collected on diet-related psychosocial (predisposing, reinforcing and enabling) factors based on the PRECEDE (Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation) planning framework; demographic, lifestyle and behavioural characteristics, and fruit and vegetable intake. RESULTS: The mean participant age was 43.9 years (standard deviation 11.6), 57% were female and 76% were overweight/obese. Participants expressed healthy beliefs regarding many of, but not all, the psychosocial factors. For example, although half of the respondents believed it is important to eat a diet high in fruits/vegetables, only 26% knew that >or=5 daily servings are recommended. The strongest associations of the psychosocial factors with fruit/vegetable intake were for predisposing factors (e.g. belief in the importance of a high fruit/vegetable diet and knowledge of fruit/vegetable recommendations) and one reinforcing factor (social support), with differences between the healthiest and least healthy responses of 0.5-1.0 servings per day. There was evidence of effect modification by gender in associations between psychosocial factors and fruit/vegetable consumption (e.g. self-efficacy was only significant in women), with higher intakes and generally healthier responses to the psychosocial variables in women than men. CONCLUSIONS: Interventions to increase fruit/vegetable intake in African-Americans may be more effective if they focus primarily on predisposing factors, such as knowledge, self-efficacy and attitudes, but not to the exclusion of reinforcing and enabling factors. The psychosocial factors that are targeted may also need to be somewhat different for African-American men and women.     

Food variety and dietary diversity scores in children: are they good indicators of dietary adequacy?

OBJECTIVE: To assess whether a food variety score (FVS) and/or a dietary diversity score (DDS) are good indicators of nutrient adequacy of the diet of South African children. METHODS: Secondary data analyses were undertaken with nationally representative data of 1-8-year-old children (n = 2200) studied in the National Food Consumption Study in 1999. An average FVS (mean number of different food items consumed from all possible items eaten) and DDS (mean number of food groups out of nine possible groups) were calculated. A nutrient adequacy ratio (NAR) is the ratio of a subject's nutrient intake to the estimated average requirement calculated using the Food and Agriculture Organization/World Health Organization (2002) recommended nutrient intakes for children. The mean adequacy ratio (MAR) was calculated as the sum of NARs for all evaluated nutrients divided by the number of nutrients evaluated, expressed as a percentage. MAR was used as a composite indicator for micronutrient adequacy. Pearson correlation coefficients between FVS, DDS and MAR were calculated and also evaluated for sensitivity and specificity, with MAR taken as the ideal standard of adequate intake. The relationships between MAR and DDS and between anthropometric Z-scores and DDS were also evaluated. RESULTS: The children had a mean FVS of 5.5 (standard deviation (SD) 2.5) and a mean DDS of 3.6 (SD 1.4). The mean MAR (ideal = 100%) was 50%, and was lowest (45%) in the 7-8-year-old group. The items with the highest frequency of consumption were from the cereal, roots and tuber group (99.6%), followed by the 'other group' (87.6%) comprising items such as tea, sugar, jam and sweets. The dairy group was consumed by 55.8%, meat group by 54.1%, fats by 38.9%, other vegetables by 30.8%, vitamin-A-rich by 23.8%, other fruit by 22%, legumes and nuts by 19.7% and eggs by 13.3%. There was a high correlation between MAR and both FVS (r = 0.726; P < 0.0001) and DDS (r = 0.657; P < 0.0001), indicating that either FVS or DDS can be used as an indicator of the micronutrient adequacy of the diet. Furthermore, MAR, DDS and FVS showed significant correlations with height-for-age and weight-for-age Z-scores, indicating a strong relationship between dietary diversity and indicators of child growth. A DDS of 4 and an FVS of 6 were shown to be the best indicators of MAR less than 50%, since they provided the best sensitivity and specificity. CONCLUSION: Either FVS or DDS can be used as a simple and quick indicator of the micronutrient adequacy of the diet.     

Effect of a pilot community intervention on fruit and vegetable intakes: use of FACET (Five-a-day Community Evaluation Tool)

BACKGROUND: In 2001 the UK Department of Health funded pilot community-based interventions to improve fruit and vegetable intakes in five economically deprived areas of England. The effectiveness of the programme and the use of a brief tool for evaluating community interventions are reported here. METHODS: Data on intakes of and beliefs about fruit and vegetables were collected by a short postal questionnaire (FACET--Five-a-day Community Evaluation Tool) simultaneously from 810 individuals living in the pilot communities and 270 individuals who were participating in an unrelated observational study (controls). Data were collected before and after a 12-month intervention period. Quantitative dietary data derived from 7-day food diaries available for control subjects were used to assess the ability of the FACET questionnaire to estimate fruit and vegetable intakes. RESULTS: Compared with controls, the intervention group significantly increased their knowledge of the 5-a-day optimum (P<0.01) and reported increased access to fruits and vegetables (P<0.001). Overall, the intervention had no demonstrable effect on total fruit and vegetable intakes as measured by FACET. However, smoking habit strongly predicted change in fruit and vegetable intakes (P<0.01) in the intervention group. Opposite trends were observed in the two groups, with 'smokers' and 'non-smokers' in the intervention and control groups respectively reducing their fruit and vegetable intakes. The FACET questionnaire agreed with food diary estimates of fruit and vegetable intakes in 56% of cases. CONCLUSIONS: Community-based interventions can produce important changes in knowledge of and access to fruit and vegetables. However, in this study change in fruit and vegetable intakes was strongly influenced by smoking habit. This bias needs to be considered in planning future intervention and evaluation programmes. The FACET questionnaire provides acceptable estimates of fruit and vegetable intakes which may be used for grading intake in large community-based projects.     

Body mass index, physical activity and dietary behaviours among adolescents in the Kingdom of Tonga

OBJECTIVES: To compare the prevalence of overweight and obesity among adolescents using international and ethnic-specific cut-off points and to examine patterns of physical activity and dietary behaviours. DESIGN: Cross-sectional analytical study. SETTING: Schools on Tongatapu, Vava'u and Hapa'ai islands in the Kingdom of Tonga. SUBJECTS: A total of 443 school students aged 11-16 years underwent anthropometric measures of height and weight and provided self-reported measures of physical activity and dietary behaviours.Results Mean body mass index (BMI) was higher among girls than boys (23.7 kg m(-2) vs. 21.8 kg m(-2) and tended to increase with age. A total of 36.0% of boys and 53.8% of girls were overweight or obese using the international cut-off points, whereas 25.0% of boys and 37.6% of girls were classified in this way using Polynesian-specific cut-off points. Tinned mutton or beef was the food that most participants (56.9%) reported eating once or more per day. Over half of the young people did not eat taro, fruit or vegetables at least once per day. Regular physical activity outside of school hours was reported by 20.7% of respondents, and 58.2% watched 1 h or more of television per day. Physical activity participation was the only behaviour independently associated with a lower risk of overweight or obesity.Conclusions Using Polynesian-specific cut-off points for overweight and obesity the prevalence of these conditions was still among the highest found in adolescents. The prevalence of physical inactivity and poor dietary habits indicate that risk factors for chronic disease are well established during adolescence in Tonga.     

The impact of a school-based nutrition education intervention on dietary intake and cognitive and attitudinal variables relating to fruits and vegetables

OBJECTIVE: To assess the impact of a school-based nutrition education intervention aimed at increasing the consumption of fruits and vegetables. DESIGN: The intervention programme increased the provision of fruits and vegetables in schools and provided a range of point-of-purchase marketing materials, newsletters for children and parents, and teacher information. Curriculum materials at age 6-7 and 10-11 years were also developed and utilised. Evaluation was undertaken with groups of younger (aged 6-7 years) and older (aged 10-11 years) children. Methods included 3-day dietary records with interview and cognitive and attitudinal measures at baseline, with follow-up at 9 months, in intervention and control schools. SETTING: The work was undertaken in primary schools in Dundee, Scotland. SUBJECTS: Subjects comprised 511 children in two intervention schools with a further 464 children from two schools acting as controls. RESULTS: Children (n=64) in the intervention schools had an average increase in fruit intake (133+/-1.9 to 183+/-17.0 g day(-1)) that was significantly (P<0.05) greater than the increase (100+/-11.7 to 107+/-14.2 g day(-1)) estimated in children (n=65) in control schools. No other changes in food or nutrient intake were detected. Increases in scores for variables relating to knowledge about fruits and vegetables and subjective norms were also greater in the intervention than in the control group, although taste preferences for fruits and vegetables were unchanged. CONCLUSIONS: It is concluded that a whole school approach to increasing intakes of fruits and vegetables has a modest but significant effect on cognitive and attitudinal variables and on fruit intake.     

Monetary costs of dietary energy reported by young Japanese women: association with food and nutrient intake and body mass index

OBJECTIVE: Little is known about the relationship of monetary diet costs to dietary intake and obesity, particularly in non-Western populations. This study examined monetary cost of dietary energy in relation to diet quality and body mass index (BMI) among young Japanese women. DESIGN: Dietary intake was assessed by a validated, self-administered, diet history questionnaire. Diet costs were estimated using retail food prices. Monetary cost of dietary energy (Japanese yen 1000 kcal-1) was then calculated. BMI was computed from self-reported body weight and height. SUBJECTS: A total of 3931 female Japanese dietetic students aged 18-20 years. RESULTS: Monetary cost of dietary energy was positively associated with intakes of fruits, vegetables, fish and shellfish, and pulses; however, higher monetary cost of dietary energy was also associated with higher consumption of fat and oil, meat and energy-containing beverages, and lower consumption of cereals (rice, bread and noodles) (all P for trend <0.01). At the nutrient level, monetary cost of dietary energy was positively associated with intakes of dietary fibre and key vitamins and minerals, but also associated positively with intakes of fat, saturated fatty acids, cholesterol and sodium, and negatively with carbohydrate intake (all P for trend <0.0001). After adjustment for possible confounders, monetary cost of dietary energy was quite weakly but significantly negatively associated with BMI (P for trend = 0.0197). CONCLUSIONS: Increasing monetary cost of dietary energy was associated with both favourable and unfavourable dietary intake patterns and a quite small decrease in BMI in young Japanese women.     

Changes in carotenoid intake from fruit and vegetables in the Spanish population over the period 1964-2004

OBJECTIVE: To assess changes in carotenoid intake based on the variations in the consumption of fresh fruit and vegetables in the Spanish population over the period 1964-2004. DESIGN: Consumption data of fresh fruit and vegetables from Family Budget Surveys carried out in 1964, 1980, 1990 and 2004. Consumption data (g per person per day) accounted for >90% of fruit and vegetable consumption at each time point. Quality controlled high-performance liquid chromatography analysis of the carotenoid composition of Spanish fruit and vegetable was used. SUBJECTS: Randomly selected, private households throughout Spain (20,800 households in 1964, 30,311 households in 1980, 21,155 households in 1990 and 6000 households in 2004). Twelve vegetables and 16 fruits representing 89-96% of the total consumption of fresh fruit and vegetables were used. RESULTS: Individual consumption of fruit and vegetables has changed over this period, altering the total and individual intake of carotenoids. Total carotenoid intake increased from 2.5 mg per person per day in 1964 to 4.1 mg per person per day in 1990, with a decrease to 3.3 mg per person per day in 2004. These increments are due to an increase in lycopene, alpha- and beta-carotene, while a decrease in lutein and zeaxanthin is observed during the last decade. A continuous and consistent decrease in the relative contribution of lutein in the diet is observed over the period studied. CONCLUSION: Although the consumption of fruit and vegetables is still consistent with a Mediterranean-type pattern, modifications in the consumption of individual fruits and vegetables have provoked changes in total and specific carotenoid intake with potential relevance in human health.     

A multilevel study of socio-economic inequalities in food choice behaviour and dietary intake among the Dutch population: the GLOBE study

OBJECTIVE: To examine the influence of individual- and area-level socio-economic characteristics on food choice behaviour and dietary intake. SETTING: The city of Eindhoven in the south-east Netherlands. DESIGN: A total of 1339 men and women aged 25-79 years were sampled from 85 areas (mean number of participants per area = 18.4, range 2-49). Information on socio-economic position (SEP) and diet was collected by structured face-to-face interviews (response rate 80.9%). Individual-level SEP was measured by education and household income, and area-level deprivation was measured using a composite index that included residents' education, occupation and employment status. Diet was measured on the basis of (1) a grocery food index that captured compliance with dietary guidelines, (2) breakfast consumption and (3) intakes of fruit, total fat and saturated fat. Multilevel analyses were performed to examine the independent effects of individual- and area-level socio-economic characteristics on the dietary outcome variables. RESULTS: After adjusting for individual-level SEP, few trends or significant effects of area deprivation were found for the dietary outcomes. Significant associations were found between individual-level SEP and food choice, breakfast consumption and fruit intake, with participants from disadvantaged backgrounds being less likely to report food behaviours or nutrient intakes consistent with dietary recommendations. CONCLUSIONS: The findings suggest that an individual's socio-economic characteristics play a more important role in shaping diet than the socio-economic characteristics of the area in which they live. In this Dutch study, no independent influence of area-level socio-economic characteristics on diet was detected, which contrasts with findings from the USA, the UK and Finland.     

Associations between parental report of the home food environment and adolescent intakes of fruits, vegetables and dairy foods

OBJECTIVE: This study examines parental report of household food availability, parent dietary intake and associations with adolescent intakes of fruits, vegetables and dairy foods. DESIGN: Cross-sectional study. Adolescents completed the Project EAT survey and the Youth Adolescent Food Frequency Questionnaire at school. Parents of adolescents were interviewed by telephone about the home food environment, eating habits and weight-related behaviours. General linear modelling was used to compare dietary intakes of adolescents across different levels of household food availability and parental intakes. SUBJECTS/SETTING: The study sample included 902 adolescents and their parent or guardian. RESULTS: Many parents were not consuming the minimum number of daily recommended fruit (44.5%), vegetable (69.9%) or dairy (46.9%) servings. While most parents reported that fruits and vegetables were available at home (90.3%) and vegetables were usually served at dinner (87.0%), fewer parents reported milk was served at meals (66.6%). Soft drinks were usually available at home (56.8%). Among girls, household availability was positively associated with fruit and vegetable intake (ttrend=2.70, P<0.01) and soft drink availability was inversely associated with dairy intake (ttrend=2.08, P=0.04). Among boys, serving milk at meals was positively associated with dairy intake (ttrend=3.65, P<0.01). Parental intakes were positively associated with dairy intake for boys (ttrend=2.04, P=0.04), and with dairy (ttrend=2.43, P=0.01), vegetable (ttrend=3.72, P<0.01) and fruit (ttrend=3.17, P<0.01) intakes for girls. CONCLUSIONS/APPLICATIONS: Interventions designed to help adolescents improve consumption of fruits, vegetables and dairy foods may be enhanced by including a parental component aimed at increasing household availability and parents' intake of healthful food choices.     

Prevalence of obesity, food choices and socio-economic status: a cross-sectional study in the north-west of Iran

AIM: To document the epidemiological features and influencing factors of obesity in the north-west of Iran, to provide baseline information for setting up a regional population-based centre to control and prevent obesity-related disorders in the area. METHODS: In this cross-sectional study, a total of 300 subjects were selected/studied in Tabriz, one of the major cities in Iran. Data on basic characteristics, anthropometric measurements, dietary assessment and physical activity were collected. Obesity was defined as body mass index > or =30 kg m(-2) for both women and men. RESULTS: Total prevalence of obesity in the area was 22.4% (95% confidence interval (CI): 18.0-27.6). The prevalence of obesity was 24% (95% CI: 18.5-31.4) for women and 18% (95% CI: 12.5-25.6) for men. For both women and men obesity prevalence showed a positive association with age (P<0.001), while there was a negative correlation of obesity with education and income (P<0.001). Fruit consumption decreased the risk of obesity in both women and men (odds ratio (OR)=0.60, 95% CI: 0.49-0.71 vs. OR=0.62, 95% CI: 0.51-0.74, respectively). The same significant pattern was observed for the consumption of green vegetables (OR=0.71, 95% CI: 0.57-0.63 vs. OR=0.86, 95% CI: 0.77-0.98 for women and men, respectively), legumes (OR=0.70, 95% CI: 0.59-0.84 vs. OR=0.78, 95% CI: 0.66-0.91 for women and men, respectively) and dairy products (OR=0.73, 95% CI: 0.61-0.91 vs. OR=0.77, 95% CI: 0.63-0.93 for women and men, respectively). CONCLUSIONS: Our study showed that educational attainment, higher income and consumption of certain food groups (i.e. vegetables, fruits, legumes and dairy products) may decrease the risk of obesity. Our findings also indicate the crucial necessity of establishing a population-based centre for obesity in the area. The essential information is now achieved to propose to local health authorities to act accordingly. However, more population-based investigations on dietary choices are needed to develop effective preventive strategies to control overweight and obesity disorders in different regions.     

School-based internet-tailored fruit and vegetable education combined with brief counselling increases children's awareness of intake levels

OBJECTIVE: Children's fruit/vegetable intake is still below recommended levels. This study applied Internet-tailored advice for schoolchildren and Internet-supported brief dietary counselling (with child and parent) within preventive health care to promote fruit/vegetable intake. SETTING/SUBJECTS: The study involved 30 seventh-grade classes (16 in the intervention group and 14 in the control group) with a total of 675 children aged 9-12 years, of whom 495 were allowed to participate. DESIGN: A cluster-randomised baseline-post-test experimental design was applied. During school hours, all children completed Internet-administered questionnaires on fruit/vegetable intake and related determinants. Children in the intervention group received immediate online individually tailored nutrition feedback. For each child in the intervention group, a nurse received information concerning the assessment of fruit/vegetable intake via the Internet to support a 5 min counselling protocol to promote fruit/vegetable intake. Children completed a similar post-test questionnaire 3 months after the first assessment. Intention-to-treat analyses were conducted using multilevel regression analyses. RESULTS: A total of 486 children (98% of 495) participated (263 in the intervention group, 223 in the control group); 240 child-parent couples in the intervention group attended the counselling. Awareness of inadequate fruit intake (odds ratio (OR) = 3.0; 95% confidence interval (CI) = 1.8-5.3) and knowledge of recommended vegetable intake levels (OR = 2.7; 95% CI = 1.8-4.1) were significantly more likely at post-test in the intervention group than in the control group. No significant effects were found on intake or other determinants. CONCLUSIONS: A compact, integrated two-component intervention can induce positive changes in knowledge and awareness of intake levels of fruit/vegetables among schoolchildren. To induce changes in intake levels, more comprehensive interventions may be needed.     

Pregravid body mass index is negatively associated with diet quality during pregnancy

OBJECTIVE: To investigate the association between pregravid weight status and diet quality. DESIGN: Institute of Medicine body mass index (BMI) cut-off points of 26.0-29.0 kg m- 2 for overweight and >29 kg m- 2 for obese were used to categorise women's weight status. Dietary information was obtained by self-report at 26-28 weeks' gestation using a modified Block food-frequency questionnaire. The Diet Quality Index for Pregnancy (DQI-P) included: servings of grains, vegetables and fruits, folate, iron and calcium intake, percentage calories from fat, and meal pattern score. Multinomial logistic regression models were used to estimate the association between weight status and tertiles of DQI-P controlling for potential individual confounders. SETTING: A clinical-based population recruited through four prenatal clinics in central North Carolina. SUBJECTS: A total of 2394 women from the Pregnancy, Infection and Nutrition study were included in this analysis. RESULTS: Evidence of a dose-response relationship was found between BMI and inadequate servings of grains and vegetables, and iron and folate intake. Pregravid obesity was associated with 76% increased odds of falling into the lowest diet quality tertile compared with underweight women after controlling for potential confounders. CONCLUSION: A modest association was found between pregravid weight status and diet quality. If corroborated, these findings suggest that overweight pregnant women should be targeted for nutrition counselling interventions aimed to improve diet quality.     

Fruit and vegetable consumption and self-reported functional health in men and women in the European Prospective Investigation into Cancer-Norfolk (EPIC-Norfolk): a population-based cross-sectional study

OBJECTIVES: To investigate the association between fruit and vegetable consumption and self-reported physical and mental functional health measured by an anglicised short-form 36-item questionnaire (UK SF-36). DESIGN: Population-based cross-sectional study. SETTING: General community in Norfolk, UK. SUBJECTS: A total of 16,792 men and women aged 40-79 years recruited from general practice population registers as part of the European Prospective Investigation into Cancer (EPIC)-Norfolk study, who completed food-frequency questionnaires in 1993-1997 and Health and Life Experiences Questionnaires 18 months later, were enrolled in the study. RESULTS: Mean SF-36 physical component summary scores increased significantly with increasing total fruit and vegetable consumption in both men and women (P < 0.0001 for trend). Men and women in the top quartile of consumption compared with the bottom quartile had a significantly higher likelihood of reporting good physical health (defined as a score > or = 55); odds ratio (OR) 1.30, 95% confidence interval (CI) 1.11-1.53 for men and OR 1.28, 95% CI 1.11-1.48 for women, after controlling for age, body mass index, smoking, education, social class, prevalent illness and total energy intake. Exclusion of current smokers and people with prevalent illness did not alter the associations. CONCLUSION: Higher fruit and vegetable consumption is associated with better self-reported physical functional health within a general population. Increasing daily intake by two portions of fruit and vegetables was associated with an 11% higher likelihood of good functional health. Since the current average consumption of fruit and vegetables in the UK is about three portions, the recommended 'five a day' strategy may have additional benefit for functional as well as other health outcomes in the population.     

Lignan content of selected foods from Japan

Lignans constitute a group of phytochemicals widely distributed in the human diet. Once ingested, most dietary lignans are metabolized by the gut microflora to enterolactone and enterodiol, also known as enterolignans. Together with isoflavones and coumestrol, enterolignans have been traditionally classified as phytoestrogens, plant-derived compounds that exhibit estrogen-like activity. In addition to a higher intake of vegetables, many studies have suggested that the presence of phytoestrogens in the Japanese diet is one of the factors that might explain the reduced incidence of certain chronic diseases in Japanese populations compared with Western countries. Being a vegetable-based diet, exposure to dietary lignans should be high, but to assess this exposure, a lignan food database is required. Stable isotope-dilution gas chromatography coupled with mass spectrometry was used to quantify six plant lignans in 86 food items commonly consumed in Japan. These data will complement the previous databases and most importantly expand the knowledge of occurrence of lignans in food to Eastern diets.     

Increasing fruit and vegetable consumption: success of the Western Australian Go for 2&5 campaign

OBJECTIVE: The Western Australian Health Department's Go for 2&5 campaign aimed to increase adults' awareness of the need to eat more fruit and vegetables and encourage increased consumption of one serving over five years. DESIGN: The multi-strategy fruit and vegetable social marketing campaign, conducted from 2002 to 2005, included mass media advertising (television, radio, press and point-of-sale), public relations events, publications, a website (www.gofor2and5.com), and school and community activities. Campaign development and the evaluation framework were designed using health promotion theory, and assessed values, beliefs, knowledge and behaviour. Two independent telephone surveys evaluated the campaign: the Campaign Tracking Survey interviewed 5032 adults monitoring fruit and vegetable attitudes, beliefs and consumption prior to, during and 12 months after the campaign; and the Health & Wellbeing Surveillance System surveyed 17,993 adults between 2001 and 2006, continuously monitoring consumption. SETTING: Population public health intervention-social marketing campaign in Western Australia, population of 2,010,113 in 2005. SUBJECTS: Adults in the Perth metropolitan area. RESULTS: The campaign reached the target audience, increasing awareness of the recommended servings of fruit and vegetables. There was a population net increase of 0.8 in the mean number of servings of fruit and vegetables per day over three years (0.2 for fruit (1.6 in 2002 to 1.8 in 2005) and 0.6 for vegetables (2.6 in 2002 to 3.2 in 2005), significant at P < 0.05). CONCLUSION: Sustained, well-executed social marketing is effective in improving nutrition knowledge, attitudes and consumption behaviour. The Go for 2&5 campaign provides guidance to future nutrition promotion through social marketing.