Dietary intake and development of a quantitative food-frequency questionnaire for the Barbados National Cancer Study

OBJECTIVE: To develop a quantitative food-frequency questionnaire (QFFQ) for the Barbados National Cancer Study (BNCS) that will permit examination of associations of diet with breast and prostate cancer. DESIGN: Population intake data from the year 2000 Barbados Food Consumption and Anthropometric Surveys (BFCAS 2000) were used to derive a list of foods consumed by the population. A 192-item draft QFFQ was developed from this list. SETTING: Barbados, West Indies provides an ideal environment to understand cancer risk in African-origin populations, with high relevance to African-Americans. The BNCS is a population-based case-control study examining risk factors for breast and prostate cancer in such populations. SUBJECTS: A total of 1600 persons, 18 years and older, completed a 24-hour recall in the BFCAS 2000. Fifty of 63 randomly selected residents (79% response rate) gave additional updated information on foods consumed. RESULTS: The 50 participants provided a one-time 24-hour recall and completed the draft QFFQ. The final instrument contains 148 items: breads, cakes, cereals = 17; rice, pastas, noodles = 8; dairy = 10; meat, fish, poultry = 42; fruit = 16; vegetables = 26; soft drinks = 14; alcoholic beverages = 5; others = 10. Additional questions include supplement use and food preparation methods such as grilling. CONCLUSION: The final instrument is concise, complete and the most up-to-date for assessing the food and nutrient intake of African-origin Barbadians and the associations with breast and prostate cancer.     

Fruit and vegetable intakes in a sample of pre-school children participating in the 'Five for All' project in Bradford

BACKGROUND: Longitudinal research has shown that eating fruit and vegetables during childhood has a positive impact on long-term health outcome from heart disease and asthma. However, recommendations for fruit and vegetable intakes in pre-school children are not as explicit as those for adults and few data exist on actual intakes of fruit and vegetables in this particular age group. AIMS: To describe fruit and vegetable intakes in the daily diets of a sample of pre-school children in Bradford, West Yorkshire, and to compare the findings with existing national UK data. SUBJECTS: Pre-school children aged 3 and 4 years (n = 207). All subjects attended nurseries in the Airedale and Bradford South and West regions at the time of the study.Design: Dietary data were collected using the pre-validated CADET (Child and Diet Evaluation Tool) diary. All children were also seen individually in order to assess their awareness and preference for a range of fruit and vegetables. RESULTS: Intakes of fruit and vegetables in this sample of pre-school children were below recommended levels. Only 16% of children in this sample were successfully eating fruit and vegetables on five occasions a day and conversely 14% ate no fruit and vegetables at all. Vegetable intakes were far lower than fruit intakes with 39% of the sample consuming no vegetables. There were statistically significant differences in median fruit and vegetable intakes between children with different demographic and lifestyle variables, such as which nursery they attended and what the highest educational qualification in the household was. Children's awareness of and preferences for different fruit and vegetables significantly affected their median intakes of fruit and vegetables. CONCLUSION: Fruit and vegetable intakes in this sample of pre-school children were far lower than the recommended levels of 5 portions a day. A greater diversity of intakes should be encouraged and these data suggest that this may be attained by increasing children's awareness by exposing them to a wider range of fruit and vegetables.     

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.     

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.     

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.     

Impact of parental education and income inequality on children's food intake

OBJECTIVE: To analyse the association between socio-economic indicators and diet among 2-year-old children, by assessing the independent contribution of parental education and equivalent income to food intake. DESIGN: The analysis was based on data from a prospective birth cohort study. Information on diet was obtained using a semi-quantitative food-frequency questionnaire. Low and high intake of food was defined according to the lowest and the highest quintile of food consumption frequency, respectively. SETTING: Four German cities (Munich, Leipzig, Wesel, Bad Honnef), 1999-2001.Subjects Subjects were 2637 children at the age of 2 years, whose parents completed questionnaires gathering information on lifestyle factors, including parental socio-economic status, household consumption frequencies and children's diet. RESULTS: Both low parental education and low equivalent income were associated with a low intake of fresh fruit, cooked vegetables and olive oil, and a high intake of canned vegetables or fruit, margarine, mayonnaise and processed salad dressing in children. Children with a low intake of milk and cream, and a high intake of hardened vegetable fat, more likely had parents with lower education. Low butter intake was associated with low equivalent income only. CONCLUSIONS: These findings may be helpful for future intervention programmes with more targeted policies aiming at an improvement of children's diets.     

Increasing children's fruit and vegetable consumption: distribution or a multicomponent programme?

OBJECTIVE: To measure the effects of two school-based interventions on children's intake of fruit and vegetables (F&V). DESIGN AND METHODS: A total of six primary schools were randomly assigned to (1) a free F&V distribution programme, or (2) a multicomponent programme, consisting of a classroom curriculum and parental involvement. The two interventions were evaluated on their effects and compared with six control schools in a pre-test-post-test design. Two methods were used for dietary assessment: a pre-structured food recall and a food-frequency questionnaire including only F&V. SUBJECTS: A total of 939 parents of children aged 4-12 years filled out the questionnaire at both pre-test and post-test. The response rate was 54%. RESULTS: Multilevel analyses showed that both programmes were equally effective in increasing children's fruit consumption by 0.2 portions per day. The free F&V distribution increased vegetable intake among non-native children and the oldest age group, and the multicomponent programme among the oldest children and girls. The distribution also caused an increased 24 h fruit, juice and vegetable intake among the youngest and the oldest age groups, and the multicomponent programme among all children. CONCLUSION: The results of this study indicate that both interventions were shown to be effective for different subgroups regarding age, gender and ethnicity. When comparing both interventions, the distribution programme was shown to be more effective, especially in increasing vegetable consumption. An important next step will be to investigate which intervention has the greatest potential to be implemented in primary schools.     

Urine flavonoids and plasma carotenoids in the validation of fruit, vegetable and tea intake during pregnancy in the Norwegian Mother and Child Cohort Study (MoBa)

OBJECTIVE: To validate a new food-frequency questionnaire (FFQ) for measuring the intake of fruit, vegetables and tea reported by women participating in the Norwegian Mother and Child Cohort Study (MoBa). DESIGN: Intake of fruits, vegetables and tea estimated by the FFQ was compared with urinary flavonoid excretion, plasma carotenoid concentration and intake measured by a 4-day weighed food diary (FD). The triangular method was applied to calculate FFQ validity coefficients using two independent biomarkers. SETTING AND SUBJECTS: One hundred and nineteen women participating in MoBa. RESULTS: The FFQ estimate of fruit intake was significantly correlated with urine phloretin (r = 0.33), citrus fruit/juice with urine hesperetin (r = 0.44), cooked vegetables with plasma alpha-carotene (r = 0.37), and tea with urine kaempferol (r = 0.41) (P < 0.01 for all). On average, 60% of the participants fell into the same or adjacent quintiles when classified by FFQ and biomarkers. Significant correlations between the FFQ and FD were found for fruit (r = 0.39), vegetables (r = 0.34), juices (r = 0.50) and tea (r = 0.53). The FFQ validity coefficient was 0.65 for citrus fruit/juice and 0.59 for cooked vegetables as calculated by the triangular method. CONCLUSIONS: The validation study shows that the MoBa FFQ can be used to estimate fruit, juice, vegetable and tea intake in pregnant Norwegian women, and to rank individuals within the distribution.     

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.     

Parent outcome expectancies for purchasing fruit and vegetables: a validation

OBJECTIVE: To validate four scales -- outcome expectancies for purchasing fruit and for purchasing vegetables, and comparative outcome expectancies for purchasing fresh fruit and for purchasing fresh vegetables versus other forms of fruit and vegetables (F&V). DESIGN: Survey instruments were administered twice, separated by 6 weeks. SETTING: Recruited in front of supermarkets and grocery stores; interviews conducted by telephone. SUBJECTS: One hundred and sixty-one food shoppers with children (18 years or younger). RESULTS: Single dimension scales were specified for fruit and for vegetable purchasing outcome expectancies, and for comparative (fresh vs. other) fruit and vegetable purchasing outcome expectancies. Item Response Theory parameter estimates revealed easily interpreted patterns in the sequence of items by difficulty of response. Fruit and vegetable purchasing and fresh fruit comparative purchasing outcome expectancy scales were significantly correlated with home F&V availability, after controlling for social desirability of response. Comparative fresh vegetable outcome expectancy scale was significantly bivariately correlated with home vegetable availability, but not after controlling for social desirability. CONCLUSION: These scales are available to help better understand family F&V purchasing decisions.     

A school salad bar increases frequency of fruit and vegetable consumption among children living in low-income households

OBJECTIVE: To measure change in fruit and vegetable (F&V) consumption among elementary-school children after the introduction of a salad bar programme as a lunch menu option in the US Department of Agriculture's (USDA) reimbursable lunch programme in Los Angeles Unified School District (LAUSD). DESIGN: A cross-sectional sample of children was interviewed before and after a salad bar intervention (1998 and 2000, respectively) utilising a 24-hour food recall questionnaire. Frequencies of F&V consumption were calculated. SETTING: The evaluation took place in three LAUSD elementary schools participating in the salad bar programme and the USDA reimbursable lunch programme. SUBJECTS: Three hundred and thirty-seven children in 2nd-5th grade (7-11 years old). RESULTS: After the salad bar was introduced, there was a significant increase in frequency (2.97 to 4.09, P < 0.001) of F&V consumed among the children studied. The increase in frequency of F&V consumed was almost all due to an increase during lunch (84%). Mean energy, cholesterol, saturated fat and total fat intakes were significantly lower in the children after the salad bar was introduced in the schools compared with the intakes in the children before the salad bar was introduced.Conclusion: A salad bar as a lunch menu option in the USDA reimbursable lunch programme can significantly increase the frequency of F&V consumption by elementary-school children living in low-income households.     

Identifying 'unhealthy' food advertising on television: a case study applying the UK Nutrient Profile model

OBJECTIVES: To evaluate the feasibility of the UK Nutrient Profile (NP) model for identifying 'unhealthy' food advertisements using a case study of New Zealand television advertisements. DESIGN: Four weeks of weekday television from 15.30 hours to 18.30 hours was videotaped from a state-owned (free-to-air) television channel popular with children. Food advertisements were identified and their nutritional information collected in accordance with the requirements of the NP model. Nutrient information was obtained from a variety of sources including food labels, company websites and a national nutritional database. RESULTS: From the 60 h sample of weekday afternoon television, there were 1893 advertisements, of which 483 were for food products or retailers. After applying the NP model, 66 % of these were classified as advertising high-fat, high-salt and high-sugar (HFSS) foods; 28 % were classified as advertising non-HFSS foods; and the remaining 2 % were unclassifiable. More than half (53 %) of the HFSS food advertisements were for 'mixed meal' items promoted by major fast-food franchises. The advertising of non-HFSS food was sparse, covering a narrow range of food groups, with no advertisements for fresh fruit or vegetables. CONCLUSIONS: Despite the NP model having some design limitations in classifying real-world televised food advertisements, it was easily applied to this sample and could clearly identify HFSS products. Policy makers who do not wish to completely restrict food advertising to children outright should consider using this NP model for regulating food advertising.     

Knowledge of dietary and behaviour-related determinants of non-communicable disease in urban Senegalese women

OBJECTIVE: To assess knowledge of dietary and behaviour-related determinants of non-communicable disease (NCD) of urban Senegalese women. DESIGN: A cross-sectional, population study using an interviewer-administered knowledge questionnaire, developed and validated for this study. The questionnaire consisted of 24 items with six scores measuring knowledge of: (1) diet- and behaviour-related causes of NCD; (2) diet quality-NCD relationship; (3) fruit and vegetable link with NCD; (4) health consequences of obesity; (5) causes of cardiovascular disease (CVD); and (6) causes of certain cancers. SUBJECTS: A random sample of 301 women aged 20-50 years. RESULTS: The knowledge scores developed suggest that the health consequences of obesity (mean score of 65.4%) were best understood followed by causes of CVD (mean score of 60.6%), because obesity, smoking, high blood cholesterol and dietary fat were well recognised as risk factors for CVD. Subjects scored least for their knowledge of the protective effect of fruit and vegetables (mean score of 19.9%). Knowledge of causes of certain cancers (mean score of 36.1%) was also low. Women who worked outside the home had better knowledge for two scores but otherwise no relationship was found between knowledge and literacy, formal education or body mass index. CONCLUSIONS: Findings suggest reasonable overall knowledge concerning diet and behaviour with NCD, especially given the relatively new context of the obesity epidemic in Senegal. However, there was poor knowledge of the benefit of eating fruit and vegetables and other preventable causes of certain cancers. Education targeting the benefits of vegetables and fruit may have the greatest impact on NCD prevention.     

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.     

Selection of food items for inclusion in a newly developed food-frequency questionnaire

OBJECTIVES: To highlight the differences between the food list required in a food-frequency questionnaire (FFQ) to rank people by their intake and the food items that contribute to absolute intake, and to discuss possible applications. METHODS: We conducted a nutritional survey among 1173 adults using an adapted 24-hour recall questionnaire. STATISTICAL ANALYSIS: To develop an FFQ, we analysed the 24-hour recall survey data by performing a stepwise multiple regression after grouping conceptually similar food items into 175 food groups. RESULTS: In total, 126 food groups were included in the developed FFQ in order to explain at least 80% of the variance in the consumption of each of 27 nutrients. The nutrients that were explained by a few food groups were vitamin A (one food group), alcohol (two), beta-carotene (two), vitamin E (three) and cholesterol (five). Nutrients that were explained by a large number of food groups were energy (37 food groups), potassium (31), magnesium (31), dietary fibre (30), phosphorus (31) and sodium (29). Using energy intake as an example, soft drinks were the best between-person energy classifiers, while providing only 2.4% of the total energy intake. Wine, seeds and nuts, which contributed highly to the variance, were minor energy contributors. In contrast, milk, sugar, fried chicken/turkey breast or whole chicken/turkey, which explained little of the variation in the population, were major energy contributors. CONCLUSIONS: Developing an FFQ on the basis of common foods may not explain the between-person variation required for ranking individual intake in diet-disease studies. Producing lists of "discriminating items" can be a useful application in developing mini-FFQs for selected nutrients.     

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.     

Correlates of fruit and vegetable intake among Norwegian schoolchildren: parental and self-reports

OBJECTIVES: To identify correlates of 6th and 7th graders' (age 10-12 years) fruit and vegetable intake, to investigate parent-child correlations of fruit and vegetable intake, and to compare parents' and children's reports of children's accessibility, skills and preferences with respect to fruit and vegetables. DESIGN: The results presented are based on the baseline survey of the 'Fruits and Vegetables Make the Marks Project', where 38 schools participated. SETTING: Fruit and vegetable intake was measured by food frequency questions. Theoretical factors, based on Social Cognitive Theory, potentially correlated to intake were measured, including behavioural skills, accessibility, modelling, intention, preferences, self-efficacy and awareness of 5-a-day recommendations. SUBJECTS: In total, 1950 (participation rate 85%) 6th and 7th graders and 1647 of their parents participated. RESULTS: Overall, 34% of the variance in the pupils' reported fruit and vegetable intake was explained by the measured factors. The strongest correlates to fruit and vegetable intake were preferences and accessibility. The correlation between the children's and their parents' fruit and vegetable intake was 0.23. The parents perceived their children's accessibility to be better than what was reported by the children (P<0.01), while the children reported their skills to be better than what was perceived by their parents (P<0.01). CONCLUSION: The results from this study clearly point to a need for nutrition interventions aimed at parents. An important next step will be to investigate whether the identified correlates predict future fruit and vegetable intake, and whether they mediate any changes in intake in an intervention study.     

Comparison between household budget survey and 24-hour recall data in a nationally representative sample of Polish households

OBJECTIVE: Household budget survey (HBS) data are used regularly for nutritional epidemiological purposes. The validity of HBS data, however, is not well established. The aim of this project was to compare HBS and individual nutrition survey (INS) data in a nationally representative sample of Polish households. DESIGN: Estimates of food consumption and nutrient intake were compared between household food acquisition data collected over 1 month and a single 24-hour recall collected from every household member in a nationally representative sample of Polish households surveyed between September and November 2000. To facilitate the comparison, INS food consumption data excluded food eaten away from home and were modified using a computer program to estimate food 'as purchased' (including disaggregation of recipe data) and to allow for wastage. SETTING: Poland. SUBJECTS: Participants were 3716 individuals in 1215 households (representing co-operation rates of 86.2% and 89.2%, respectively). RESULTS: Good agreement was shown between median estimates of foods such as potatoes, vegetables (including processed), meat, meat products and poultry, and animal fats (excluding butter), but agreement was poor for bread and rolls, fruit, vegetable fats and oils, eggs and six other food groups. Estimates of energy and nutrient intake were within +/-10% with the exceptions of polyunsaturated fats, potassium and vitamin C. CONCLUSIONS: Possible reasons for differences in findings between the two surveys include survey bias (e.g. social approval bias leading to overreporting of fruit), seasonal variations (e.g. high potato purchases between September and November) and aspects of the methodology (e.g. HBS data were based on records collected over 1 month, whereas 24-hour recall data were based on recalls collected from all household respondents on only 1 day and averaged for each household type). HBSs provide useful data for epidemiological research, but findings need to be interpreted in the light of other data regarding consumption, and numerous factors that may affect consumption need to be taken into account.     

Reproducibility of a short semi-quantitative food group questionnaire and its performance in estimating nutrient intake compared with a 7-day diet diary in the Million Women Study

OBJECTIVES: To assess the short- and long-term reproducibility of a short food group questionnaire, and to compare its performance for estimating nutrient intakes in comparison with a 7-day diet diary. DESIGN: Participants for the reproducibility study completed the food group questionnaire at two time points, up to 2 years apart. Participants for the performance study completed both the food group questionnaire and a 7-day diet diary a few months apart. Reproducibility was assessed by kappa statistics and percentage change between the two questionnaires; performance was assessed by kappa statistics, rank correlations and percentages of participants classified into the same and opposite thirds of intake. SETTING: A random sample of participants in the Million Women Study, a population-based prospective study in the UK. SUBJECTS: In total, 12 221 women aged 50-64 years. RESULTS: In the reproducibility study, 75% of the food group items showed at least moderate agreement for all four time-point comparisons. Items showing fair agreement or worse tended to be those where few respondents reported eating them more than once a week, those consumed in small amounts and those relating to types of fat consumed. Compared with the diet diary, the food group questionnaire showed consistently reasonable performance for the nutrients carbohydrate, saturated fat, cholesterol, total sugars, alcohol, fibre, calcium, riboflavin, folate and vitamin C. CONCLUSIONS: The short food group questionnaire used in this study has been shown to be reproducible over time and to perform reasonably well for the assessment of a number of dietary nutrients.     

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.