To study how individual and regional characteristics might explain regional variations in breast-feeding rates in maternity units and to identify outlier regions with very low or high breast-feeding rates.

Individual characteristics (mother and infant) were collected during hospital stay. All newborns fed entirely or partly on breast milk were considered breast-fed. Regional characteristics were extracted from census data. Statistical analysis included multi-level models and estimation of empirical Bayes residuals to identify outlier regions.

All births in all administrative regions in France in 2003.

A national representative sample of 13 186 live births.

Breast-feeding rates in maternity units varied from 43 % to 80 % across regions. Differences in the distribution of individual characteristics accounted for 55 % of these variations. We identified two groups of regions with the lowest and highest breast-feeding rates, after adjusting for individual-level characteristics. In addition to maternal occupation and nationality, the social characteristics of regions, particularly the population’s educational level and the percentage of non-French residents, were significantly associated with breast-feeding rates.

Social characteristics at both the individual and regional levels influence breast-feeding rates in maternity units. Promotion policies should be directed at specific regions, groups within the community and categories of mothers to reduce the gaps and increase the overall breast-feeding rate.

To compare macronutrient intakes of Swedish children and adolescents to population goals; to identify the major sources of energy, fat, saturated fat and sucrose; and to simulate the effect adherence to current food-based dietary guidelines (FBDG) would have on saturated fat and sucrose intakes.

Cross-sectional study. From 24 h recall data, food groups contributing most to energy, fat, saturated fat and sucrose were identified. Based on the prevailing consumption of foods mentioned in the FBDG, we simulated five scenarios: changes in milk and yoghurt; cheese; energy-dense, nutrient-dilute foods; soft drinks; and burger and sausage consumption.

Stockholm and Örebro (Sweden) in 1998–1999.

Children (n 551, 9·6 years) and adolescents (n 569, 15·5 years) participating in the European Youth Heart Study.

Intakes of saturated fat and sucrose exceeded population goals in all age and gender subgroups. Compliance to the goal for saturated fat was lower in children, particularly boys. Compliance to the sucrose goal was lower among adolescents. The major sources of energy, fat, saturated fat and sucrose in the diet reflect not only the traditional Swedish diet but also the influence of energy-dense, nutrient-dilute foods. The simulations suggest that a combination of FBDG is required to bring both saturated fat and sucrose intakes in line with recommendations.

Widespread adherence to a combination of FBDG could theoretically bring mean intakes in line with population goals. The effect on overall nutrient intakes as well as consumer acceptance of such changes needs to be considered.

To assess the relationship(s) between overall and within-food group diversity and several indices of dietary quality, such as dietary adequacy, moderation and balance, in Belgian adults. Dietary quality indices were derived from the food-based dietary guidelines (FBDG).

Information on food intake was collected with two 24 h recalls.

Average overall and within-food group diversity scores and dietary adequacy, moderation and balance scores were calculated.

A representative sample (n 3245) of the Belgian population at the age of 15 years and older was randomly selected from the National Register using a multistage stratified procedure.

For both men and women, total dietary diversity score increased with age and smokers had a significantly lower overall diversity score than non- or former smokers. A positive association was found between overall dietary diversity and both dietary adequacy and balance. For most food groups, especially bread and cereals, vegetables, dairy products and spreadable fats, within-food group dietary diversity was positively associated with the fulfilment of the specific recommendation for the intake of that food group. An inverse association was found between dietary diversity within the meat and the energy-dense, nutrient-poor food groups and dietary balance. Diversity within the dairy and spreadable fat group was responsible for the strongest increase in overall dietary adequacy and balance.

Overall dietary diversity is a useful indicator of dietary quality in Belgium. For some food groups, within-food group dietary diversity is a useful indicator of compliance with the specific FBDG for intake of that food group.

To evaluate plasma homocysteine (Hcy) levels and prevalence rates of hyperhomocysteinaemia (HHCY) in elderly Chinese individuals.

A cross-sectional study.

The study was conducted in 2006 in two counties from the north and the south of China.

A total of 810 individuals aged 65–74 years were recruited. Demographic characteristics and lifestyle factors were assessed through questionnaire interviews and physical examination. Hcy and folate levels were measured in blood samples. The distribution of Hcy level was analysed according to Hcy-related factors.

Northerners had higher Hcy levels (18·42 μmol/l) than southerners (10·20 μmol/l). Plasma Hcy was higher in men than in women and greater in smokers than in non-smokers. The prevalence rate of HHCY was 51·6 % in the north and 10·1 % in the south (P < 0·001). Hcy and plasma folate showed an inverse correlation (Spearman’s r = −0·44, P < 0·001; partial r = −0·229, P < 0·001). Region, gender, alcohol consumption and plasma folate were associated with HHCY among these elderly populations.

The results demonstrated that plasma Hcy levels and the prevalence rates of HHCY in Chinese elderly are considerably higher than those found in other countries, and substantial regional variations occur within China. The predominant determining factors of HHCY were region, gender, alcohol consumption and plasma folate. The elevated Hcy levels among elderly Chinese populations need to be decreased urgently.

To study the impact of migration on food consumption among Indian factory workers and their siblings and spouses.

A cross-sectional study was conducted to assess diet using an interviewer-administered semi-quantitative FFQ from which intake of 184 commonly consumed food items was obtained.

Participants recruited from factory sites in Bangalore, Lucknow, Nagpur and Hyderabad.

The sample comprised 7049 participants (41·6 % female), and included urban, migrant and rural groups.

Thirteen food items were eaten by the greatest proportion of individuals on a daily basis. These were all indigenous foods. The proportion of people consuming tandoori roti, dal with vegetables, potato and ghee on a daily basis was highest in the urban sample, intermediate in the migrant group and lowest in the rural group (P ≤ 0·01). The proportion of individuals consuming Western food on a weekly basis followed a similar trend.

The diet of this sample is predominantly indigenous in nature, irrespective of migration status, with the prevalence of daily Western food consumption being minimal.

To establish BMI percentile curves that describe the contemporary BMI distribution among Chinese children, and to compare their BMI percentile curves with those in two recently developed international references: the WHO and the US Centers for Disease Control and Prevention (US CDC) growth references.

A cross-sectional national survey.

Thirty provinces, municipalities and autonomous regions in China.

Nationally representative sample of 232 140 school students aged 7–18 years.

BMI percentile curves were established using the LMS method, and were compared with the percentiles of the WHO and the US CDC references. BMI distributions and growth patterns in Chinese children were dramatically different from those in the two international reference populations. Compared with the international reference populations, younger Chinese boys (7–12 years of age) had higher values of the percentiles above the median and lower values of the percentiles below the median, suggesting that they had larger proportions of extreme BMI values in both directions. Chinese girls and older Chinese boys (15–18 years of age) had substantially lower BMI percentiles than their counterparts in the reference populations, particularly those high percentiles among older age groups.

The present study described the unique patterns of BMI curves at the national level, and these curves are useful as a reference for comparing different regions and for monitoring changes over time in Chinese children. Higher proportions of children with extreme values in both directions indicate that China is currently facing both an increasing level of obesity and a high level of undernutrition, simultaneously.

To evaluate the relationship between energy available from sugar-sweetened beverages (SSB) and total energy availability.

Ecological study using food availability data from 1976 to 2007 from the database of the Canadian Socio-Economic Information Management System. The average available total daily energy per capita (kJ (kcal)/d per capita) and percentage of energy from SSB (%E/d per capita) were calculated. A regression analysis was performed with average available total daily energy per capita (kJ (kcal)/d per capita) as the outcome and percentage of energy from SSB as the independent variable (%E/d per capita).

Canada 1976–2007.

None.

Between 1976 and 2007, total available energy increased on average by 669 kJ (160 kcal)/d per capita, and energy from SSB by 155 kJ (37 kcal)/d per capita. Total available energy increased by 434 kJ (104 kcal)/d per capita for a one unit increase in average percentage of energy from SSB.

Total available energy increased as the contribution of energy available from SSB increased. This increase was larger than that explained by energy availability from SSB alone. Reducing energy from soft drinks may contribute to larger reductions in total energy available for consumption.

To develop an index that assesses the degree of adherence to existing diet–lifestyle recommendations for preschoolers (Preschoolers Diet–Lifestyle Index (PDL-Index)) and to investigate its association with obesity.

The PDL-Index was constructed using eleven components (i.e. questions regarding the frequency of consumption of selected foods/food groups, time spent on television watching and on moderate-to-vigorous physical activities).

Scores from 0 to 4 were assigned to all components of the index. The PDL-Index total score ranged from 0 to 44. Higher values of the PDL-Index indicate greater adherence to dietary and lifestyle recommendations for preschoolers or otherwise greater adherence to healthier dietary–lifestyle patterns.

As a validation procedure, a sample of 2287 preschoolers from Greece (GENESIS study) was used.

The participants following healthier diet–lifestyle patterns (third tertile of PDL-Index) were less likely to be obese or overweight/obese compared to those following unhealthy diet–lifestyle patterns (first tertile of PDL-Index). It was observed that a 1/44 unit increase in the score of the PDL-Index was associated with approximately 5 % and 3 % lower odds of being obese and overweight/obese, respectively. Statistically significant results were observed after adjusting for potential confounders.

The suggested PDL-Index could help public health policy makers in identifying vulnerable population subgroups and developing cost-effective, targeted intervention actions both in family and preschool settings. In addition, health-care professionals can use the PDL-Index to evaluate diet quality, lifestyle and risk for overweight/obesity at an individual level and counsel parents accordingly.

To provide an overview of the household dietary diversity score and the food consumption score, two indicators used for food security assessment and surveillance, and compare their performance in food security assessments in three countries.

Cross-sectional cluster sampling design using an interview-administered structured questionnaire on household food security, including household-level food group consumption measured over 1 d and 7 d.

Survey data are from Burkina Faso, Lao People’s Democratic Republic (Lao PDR) and northern Uganda.

Households in Burkina Faso (n 3640), Lao PDR (n 3913) and northern Uganda (n 1956).

Spearman’s correlation coefficients between the scores were 0·73 in Burkina Faso, 0·65 in Lao PDR and 0·53 in northern Uganda. Prevalence-adjusted kappa coefficients showed substantial strength of agreement in two countries. The proportion of agreement between the two scores ranged from 85 % in Lao PDR to 65 % in northern Uganda. Dietary profiles based on food group consumption using score tertiles were comparable. Rankings of the most food-insecure areas within a country corresponded well in northern Uganda and Burkina Faso but not in Lao PDR. Both indicators showed moderate correlations with other proxy measures of food security.

The comparative study highlights the similarities and differences between the food consumption and household dietary diversity scores. Similar classification of the most food-insecure areas within sub-national levels was obtained. The choice of indicator for food security assessment and surveillance will vary depending on user needs.

Pregnancy-related weight retention can contribute to obesity, and breast-feeding may facilitate postpartum weight loss. We investigated the effect of breast-feeding on postpartum weight retention.

A retrospective follow-up study of weight retention, compared in women who were fully breast-feeding, combining breast-feeding with formula-feeding (mixed feeding), or formula-feeding at 3 months (n 14 330) or 6 months (n 4922) postpartum, controlling for demographic and weight-related covariates using multiple linear regression.

The North Carolina Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Participants in the North Carolina WIC Programme who delivered a baby between 1996 and 2004.

In covariate-adjusted analyses, there was no association between breast-feeding and weight retention at 3 months postpartum. At 6 months postpartum, as compared to formula-feeders, mean weight retention was 0·84 kg lower in mixed feeders (95 % CI 0·39, 1·29; P = 0·0002) and 1·38 kg lower in full breast-feeders (95 % CI 0·89, 1·87; P ≤ 0·0001).

Breast-feeding was inversely associated with weight retention at 6 months postpartum in this large, racially diverse sample of low-income women. Further, full breast-feeding had a larger protective effect than did breast-feeding combined with formula-feeding.

To assess feeding practices of infants born to HIV-positive women in Dar es Salaam, Tanzania. These data then served as a proxy to evaluate the adequacy of current infant feeding counselling.

A cross-sectional survey of infant feeding behaviours.

Four clinics in greater Dar es Salaam in early 2008.

A total of 196 HIV-positive mothers of children aged 6–10 months recruited from HIV clinics.

Initiation of breast-feeding was reported by 95·4 % of survey participants. In the entire sample, 80·1 %, 34·2 % and 13·3 % of women reported exclusive breast-feeding (EBF) up to 2, 4 and 6 months, respectively. Median duration of EBF among women who ever breast-fed was 3 (interquartile range (IQR): 2·1, 4·0) months. Most non-breast-milk foods fed to infants were low in nutrient density. Complete cessation of breast-feeding occurred within 14 d of the introduction of non-breast-milk foods among 138 of the 187 children (73·8 %) who had ever received any breast milk. Of the 187 infants in the study who ever received breast milk, 19·4 % received neither human milk nor any replacement milks for 1 week or more (median duration of no milk was 14 (IQR: 7, 152) d).

Infant feeding practices among these HIV-positive mothers resulted in infants receiving far less breast milk and more mixed complementary feeds than recommended, thus placing them at greater risk of both malnutrition and HIV infection. An environment that better enables mothers to follow national guidelines is urgently needed. More intensive infant feeding counselling programmes would very likely increase rates of optimal infant feeding.

To estimate the dietary intake of total polycyclic aromatic hydrocarbons (PAH) and benzo(a)pyrene (BaP), and to characterise factors associated with higher intake during pregnancy. Recent studies suggest that prenatal exposure to PAH is associated with adverse reproductive outcomes. Other than tobacco smoke and occupational exposures, diet is the main source of human PAH exposure.

Prospective birth cohort study. Dietary exposure to total PAH and BaP was calculated combining food consumption data and estimated PAH concentrations in foods. One-way ANOVA was used to assess differences in intake among non-smokers, passive or active smokers. Linear regression was used to assess factors related to higher intake, and associations between dietary PAH and birth weight.

Sabadell, Spain, 2004–2006.

Women (n 657) recruited during the first trimester of pregnancy.

The mean dietary intake of BaP and total PAH was significantly higher among active (0·199 and 10·207 μg/d, respectively) and passive smokers (0·196 and 9·458 μg/d) than among non-smokers (0·181 and 8·757 μg/d; P value < 0·005). Maternal age, educational level and region of origin were also associated with higher BaP intake. In all women, major contributors to PAH intake were processed/cured meats, cereals/potatoes and shellfish. Elevated first trimester dietary BaP was associated with a significant reduction in birth weight (fourth v. first quartile: β = −142·73 g, P value < 0·05).

Active and passive smokers had higher dietary PAH exposure during pregnancy because of higher intake of processed meats and shellfish. As tobacco smoke is an additional route of PAH exposure, the added dietary burden in these women is of concern.

To describe fruit and vegetable (FV) feeding practices at 6 months, and to examine whether these practices predict children’s FV intake at 7 years of age.

A prospective, longitudinal design was adopted. The mothers completed self-reported questionnaires at 6 months and 7 years postpartum, containing questions about their child’s FV intake.

The study was carried out on a geographically representative population of infants born in Avon, UK, from 1991 to 1992, as part of the Avon Longitudinal Study of Parents and Children.

Information was collected from 7866 mothers of infants.

Hierarchical linear regressions were used to predict FV consumption at 7 years from the early feeding variables. Children who were given home-cooked fruit or vegetables more often at 6 months were more likely to be eating a higher proportion of FV at 7 years, than those who were given home-cooked FV less often. There was no positive difference found in consumption of FV at 7 years according to how often ready-prepared fruits or vegetables were given at 6 months. The age of introduction to home-cooked vegetables moderated the relationship between frequency of consumption at 6 months and 7 years.

The findings support the concept that exposure to FV is important in the early weaning period. The finding that consumption of ready-prepared FV was not positively associated with later FV consumption needs to be further investigated, with reference to theories of exposure, modelling and parental food choices. If vegetables are introduced later in weaning, they need to be fed frequently, to ensure adequate exposure.

To investigate associations between dietary intakes throughout childhood and age at menarche, a possible indicator of future risk of disease, in a contemporary cohort of British girls.

Diet was assessed by FFQ at 3 and 7 years of age, and by a 3 d unweighed food diary at 10 years. Age at menarche was categorised as before or after 12 years 8 months, a point close to the median age in this cohort.

Bristol, South-West England.

Girls (n 3298) participating in the Avon Longitudinal Study of Parents and Children.

Higher energy intakes at 10 years were positively associated with the early occurrence of menarche, but this association was removed on adjusting for body size. Total and animal protein intakes at 3 and 7 years were positively associated with age at menarche ≤12 years 8 months (adjusted OR for a 1 sd increase in protein at 7 years: 1·14 (95 % CI 1·04, 1·26)). Higher PUFA intakes at 3 and 7 years were also positively associated with early occurrence of menarche. Meat intake at 3 and 7 years was strongly positively associated with reaching menarche by 12 years 8 months (OR for menarche in the highest v. lowest category of meat consumption at 7 years: 1·75 (95 % CI 1·25, 2·44)).

These data suggest that higher intakes of protein and meat in early to mid-childhood may lead to earlier menarche. This may have implications for the lifetime risk of breast cancer and osteoporosis.

Studies indicate that food and beverages typically marketed to children are products high in fat, sugar and salt. LazyTown is an entertainment brand with a focus on healthy lifestyle, aimed at making health education entertaining. The aim of the present study was to assess whether children perceive food to taste better with a LazyTown label on the wrapping compared with the original packaging.

Five pairs of identical food and beverage samples were introduced. We aimed to select healthy food and beverages from various food groups. Preference for the LazyTown food was coded as +1, no preference 0 and preference for the original food as −1. An average ‘preference score’ was calculated for each subject by adding up the answers.

Three pre-schools in the Greater Reykjavik area, Iceland.

Subjects were pre-school children aged 3·5 to 6 years (n 66).

Most children answered correctly that there was no difference in the taste between the two identical food samples. However, between 27 and 42 % (depending on the product) of children preferred the taste of LazyTown food and beverages despite the fact that the test food was identical. The mean preference score was 0·29 (sd 0·32, median 0·20, 95 % CI 0·21, 0·38).

Our findings add to past research by demonstrating children’s preferences for child-oriented wrappings rather than regular wrapping. It might be suggested that popular brands could be useful to promote healthy eating among young children along with other actions.

To assess whether Swiss residents aged 15–24 years follow current nutritional guidelines and whether differences exist according to gender and weight status.

Cross-sectional national survey.

Switzerland.

The 1786 participants (48·4 % women) were divided into overweight, normal weight and underweight. We used traditional BMI cut-offs for people ≥18 years of age (underweight = BMI < 18·5 kg/m2, normal weight = BMI ≥ 18·5 kg/m2 and <25 kg/m2, overweight = BMI ≥ 25 kg/m2) and age- and gender-appropriate tables for people aged <18 years, with BMI calculated from self-reported weight and height. We performed bivariate analyses by gender, and then bivariate and multivariate analyses comparing overweight to normal weight people (excluding underweight, n 129, 71·6 % women) regarding adherence to recommendations for fruit, vegetables, meat, fish and dairy products; physical activity; attitude towards body weight; depression, smoking and alcohol consumption.

Overall, adherence to nutritional guidelines was low, particularly for vegetables and dairy products. Women had a higher adherence than men except for fish and dairy products. In the multivariate analyses, overweight women had a lower vegetable intake, were less satisfied with body weight and had more often been on a diet, whereas overweight men were less satisfied with body weight and wanted to lose weight more often than their normal weight peers. There were no significant differences for physical activity.

Overweight prevention programmes should target youth specifically by gender and promote an appropriate self-perception. Overweight women should be encouraged to eat more vegetables and men to be more sensitised on healthy food. Further research is needed to assess how to make nutritional guidelines more adaptable to young people’s daily life.

First, to describe the prevalence of both full and partial breast-feeding during the first 6 months; second, to study the associations between selected health service-related factors and cessation of full breast-feeding at three time intervals.

Retrospective questionnaires, 6 months after birth.

The Norwegian Mother and Child Cohort Study (MoBa).

In total, 29 621 women.

While 96·6 %, 94·0 %, 90·8 %, 86·9 %, 83·8 % and 80·0 % of the infants were breast-fed at 1, 2, 3, 4, 5 and 6 months, respectively, the corresponding proportions for full breast-feeding were 84·6 %, 79·1 %, 70·9 %, 44·0 %, 16·7 % and 2·1 %. An increased risk of cessation of full breast-feeding during the first month was associated with supplementation during the first week of life with water (relative risk (RR) 1·77; 95 % CI 1·52, 2·06), sugar water (RR 1·73; 95 % CI 1·49, 2·00) or formula (RR 5·99; 95 % CI 5·58, 6·42). An increased risk was also associated with Caesarean delivery (RR 1·08; 95 % CI 1·00, 1·16) and breast-feeding problems (RR 1·56; 95 % CI 1·45, 1·67). Between months 1 and 3, the risk of cessation of full breast-feeding remained elevated in the case of supplementation during the first week of life with water (RR 1·29; 95 % CI 1·14, 1·45), sugar water (RR 1·48; 95 % CI 1·34, 1·64) or formula (RR 1·18; 95 % CI 1·07, 1·29). The same applied to Caesarean delivery (RR 1·15; 95 % CI 1·06, 1·25).

Supplementation during the first week, breast-feeding problems and Caesarean delivery are associated with early cessation of full breast-feeding. The results support a cautious approach to supplementation during the first week of life.

To identify factors associated with exclusive breast-feeding and breast-feeding during the first year of life among Norwegian infants.

Data on breast-feeding practices were collected by a semi-quantitative FFQ.

In 2006–2007 about 3000 infants were invited to participate in a population-based prospective cohort study in Norway.

A total of 1490 mothers/infants participated at both 6 and 12 months of age.

Exclusive breast-feeding at 4 months was associated with parental education, parity and geographical region, while exclusive breast-feeding at 5·5 months was associated only with maternal age. At both ages, a negative association with exclusive breast-feeding was observed for maternal smoking. Breast-feeding at 6 months was associated with parental education, maternal age and marital status. Breast-feeding at 12 months was associated with maternal education, maternal age and number of children. At both ages, negative associations with breast-feeding were observed for maternal smoking and descending birth weight. At 12 months, a negative association was also observed for having day care by other than the parents.

Even though Norway has an extensive and positive breast-feeding tradition and a maternal leave system that supports the possibility to breast-feed, factors like maternal education, maternal age and maternal smoking are strongly associated with duration of exclusive breast-feeding and breast-feeding. Research to better understand the reasons for inequalities in breast-feeding is needed to facilitate the development of more effective breast-feeding promotion strategies. This again may improve compliance with recommendations and reduce inequalities in infant feeding practices.

To examine changes in breast-feeding and impacts on child health during the Bosnian conflict.

Four linked representative cross-sectional household surveys, 1994 to 1997.

The countries of former Yugoslavia largely missed the international wave of enthusiasm for breast-feeding of the 1980s and early 1990s. The concern is that breast-feeding deteriorates during humanitarian emergencies, when children need it most.

The four surveys visited a random sample of clusters from population registers in the Federation of Bosnia and Herzegovina (BiH) and the Republica Srpska (RS). Interviewers asked about breast-feeding and other factors related to child health, and measured mid upper-arm circumference in 1123 infants aged 1–12 months.

One-fifth of infants were not breast-fed at all (220/1087). Muslim and displaced children were less likely to breast-feed; 59 % of Muslim displaced children never breast-fed. Among infants in sites visited by all four surveys, there was no change in the proportion ever breast-fed and a significant increase in duration of breast-feeding and exclusive breast-feeding between 1994 and 1997. Children were breast-fed for shorter durations in male absent households, in frontline communities, the RS, and households that did not receive remittances from abroad. Non-breast-fed children and those who breast-fed for less than 4 months were more likely to be malnourished, as were those with complementary foods added either before or after their sixth month of life.

If relief agencies had promoted and supported breast-feeding, this might have avoided some of the increased malnutrition that occurred during the conflict.