Home availability of ultraprocessed foods in families who prepare meals at home / Disponibilidade de alimentos ultraprocessados nos domicílios de famílias que preparam refeições em casa

ABSTRACT Objective This study characterized the degree of processing of the food items available at home and the routine of shopping for food in families with children and/or teenagers and whose meals are usually prepared at home. Methods Mixed methods (interview, questionnaires, and food inventory). Interview's transcripts were submitted to thematic analysis and the foods identified in the inventory were classified according to the degree of processing and analyzed for their availability and access in the home food environment. Results Results revealed the high availability of ultra-processed foods; that the supermarket was the main source of food acquisition; and that purchasing food is part of an organized routine where time and control of expenses are the most valued aspects. Conclusion Actions which focus on planning and executing the acquisition of unprocessed and minimally processed foods are needed to promote greater availability and increased intake of such foods, so that the composition of homemade meals may be in line with what is recommended by the national dietary guidelines.

RESUMO Objetivo O presente estudo caracterizou o grau de processamento dos alimentos disponíveis e a rotina de compra de alimentos de famílias com crianças e/ou adolescentes e que costumam preparar refeições em casa. Métodos Métodos mistos (entrevista, questionário e inventário de alimentos). As transcrições das entrevistas foram submetidas à análise temática e os alimentos identificados no inventário foram classificados segundo o grau de processamento e analisados quanto à disponibilidade e acessibilidade no ambiente alimentar domiciliar. Resultados Os resultados revelaram que a disponibilidade de alimentos ultraprocessados foi alta; que o supermercado foi o principal local de aquisição de alimentos e que a compra de alimentos faz parte de uma rotina previamente organizada em que o tempo e o controle de gastos são os aspectos mais valorizados. Conclusão Ações focadas no planejamento e execução da compra de alimentos in natura e minimamente processados são necessárias para promover maior disponibilidade domiciliar e, consequentemente, o consumo de alimentos in natura e minimamente processados, aproximando as refeições realizadas em casa do que é preconizado pelo Guia Alimentar para a População Brasileira.

Nutrition Label Use Is Related to Chronic Conditions among Mexicans: Data from the Mexican National Health and Nutrition Survey 2016.

BACKGROUND: Non-communicable diseases, such as obesity, diabetes, and hypertension, can be prevented and treated through a balanced nutrient-rich diet. Nutrition labels have been recognized as crucial to preventing obesity and non-communicable diseases through a healthier diet. OBJECTIVE: Our aim was to examine the association between nutrition label use and chronic conditions (overweight, obesity, previously diagnosed diabetes, and hypertension) among an adult Mexican population. DESIGN: This was a cross-sectional study that used data from the Mexican National Health and Nutrition Survey of 2016 (ENSANUT MC 2016). PARTICIPANTS/SETTING: The participants were 5,013 adults aged 20 to 70 years old. Older adults (>70 years), illiterate participants, pregnant women, and participants with implausible blood pressure data were excluded from the sample. The survey was conducted from May to August 2016 in the participants' households. MAIN OUTCOME MEASURES: We measured chronic conditions (overweight, obesity, previously diagnosed diabetes, and hypertension). STATISTICAL ANALYSES PERFORMED: Pearson χ2 test was used to examine the associations among the use of nutrition labels and sociodemographic characteristics and chronic conditions. Multiple logistic regression was used to determine the association between nutrition label use and chronic conditions adjusting for the effect of confounding variables like sex, age, body mass index, education level, marital status, ethnicity, residence area, region, and socioeconomic status. RESULTS: From the total sample, 40.9% (95% CI 38.4% to 43.8%) reported using nutrition labeling. Respondents with overweight or obesity were less likely to use nutrition labels (odds ratio 0.74; P<0.05). Participants who self-reported diabetes had significantly lower odds of nutrition label use than participants who did not report to have diabetes (odds ratio 0.66; P<0.05). Participants having 3 chronic conditions had lower odds of nutrition label use (odds ratio 0.34; P<0.01) relative to having zero chronic conditions. CONCLUSIONS: This study suggests an association between nutrition label use and chronic conditions (obesity and diabetes). These findings demonstrate that people with obesity, diabetes, and a combination of chronic conditions were less likely to use nutrition labels than people without these conditions.

Behavior and Food Consumption Pattern of the French Polynesian Population in the 1960s -1970s.

BACKGROUND: Reconstruction of radiation doses to the thyroid for a case-control study of thyroid cancer in French Polynesians exposed to radioactive fallout from atmospheric nuclear weapons tests during childhood and adolescence faced a major limitation on very little availability of information on lifestyle of French Polynesians in the 1960s-1970s. METHOD: We use the focus group discussion and key informant interview methodology to collect historical, for the 1960s-1970s, data on behavior and food consumption for French Polynesia population exposed to radioactive fallout from nuclear weapons tests conducted between 1966 and 1974. RESULTS: We obtained archipelago-specific data on food consumptions by children of different ages and by pregnant and lactating women during pregnancy and breastfeeding and behaviour, including time spent outdoors and type and construction materials of residences. CONCLUSIONS: This article presents the first detailed information on several key aspects of daily life on French Polynesian archipelagoes during the 1960s-1970s impacting radiation exposure. Important behavior and food consumptions data obtained in this study are being used to improve the radiation dose estimates and to update the risk analysis reported earlier by correcting biases from previous assumptions and by providing better estimates of the parameter values important to radiation dose assessment.

Perceptions, experiences and barriers to lifestyle modifications in first-generation Middle Eastern immigrants to Sweden: a qualitative study.

OBJECTIVE: The prevalence of type 2 diabetes (T2D) among Iraqi immigrants to Sweden is high and partly related to sedentary physical activity and calorie dense food. The aim of the present study was to explore perceptions, experiences and barriers concerning lifestyle modifications (LSM) in Iraqi immigrants to Sweden at risk for T2D. DESIGN: A qualitative thematic analysis was conducted on data collected from gender-specific focus group interviews which took place during a culturally adapted randomised controlled intervention study addressing motivation to lifestyle change, self-empowerment, behavioural modifications and sociocultural barriers to LSM. Seven focus groups were held, with an interval of 1-4 weeks between January and May of 2015; each session lasted approximately 1.5 hours. SETTING: The city of Malmö, Sweden. PARTICIPANTS: Out of 27 women and 23 men assigned to the intervention group, 19 women and 14 men who attended at least one focus group session were included in the study. RESULTS: Participants expressed awareness of the content of healthy lifestyle practices. They also expressed numerous social and cultural barriers to LSM connected to irregular meals, overeating, food and drinking preferences and family expectations. Overeating was described as a consequence of social and cultural norms and expectations and of poor mental well-being. Facilitators for reaching successful LSM were connected to family involvement and support. CONCLUSION: Our study reports that facilitators for LSM are connected to presence of family support. Preventive actions addressing family involvement may benefit Middle Eastern immigrants at high risk for T2D to consider healthier lifestyles practices. Identification of sociocultural barriers and facilitators for LSM are crucial for successful health promotion in minority populations at risk for T2D. TRIAL REGISTRATION: Trial registration number: NCT01420198 for the MEDIM-study; Pre-results.

Questionnaire study of the dietary habits of breast cancer survivors and their relationship to quality of life (KROG 14-09).

We evaluated the dietary habits of breast cancer survivors and investigated the relationship with quality of life (QoL), with 1,156 survivors recruited from 17 institutions. We used the Questionnaire Survey of Dietary Habits of Korean Adults (Q-DH-KOR) comprising 25 questions. The following indices were derived as follows: (1) quality of healthy dietary habits (Q-HD)-eight questions on number of meals, regularity, quantity, duration, skipping breakfast, dinner with companion(s), overeating and late-night snacks; (2) habits of nutritional balance (H-NB)-questions on consuming five food categories (grains, fruits, proteins, vegetables and dairy products); and (3) habits of unhealthy foods (H-UF)-questions on consuming three food categories (fatty, instant and fast foods). The times and regularity of meals, frequency of skipping breakfast, dinner with companion(s) and overeating were better in groups with high symptomatic and functional QoL. Symptomatic QoL positively affected Q-HD and H-NB (p < 0.001 and p = 0.024 respectively) and negatively affected H-UF (p = 0.02). Breast cancer survivors more frequently ate from the fruit, protein and vegetable categories than did the control group, with lower H-UF and higher Q-HD values (p < 0.001 and p < 0.001 respectively). Our findings supported the relationship between QoL and dietary habit and showed healthier dietary habits of breast cancer survivors than controls.

"If I Can Afford Steak, Why Worry About Buying Beans": African American Men's Perceptions of Their Food Environment.

Due to the high level of food-related chronic diseases for African American men, the purpose of this qualitative study was to induce ( n = 83) urban American men's perspective of their food environment considering different ethnic subgroups, built environment, and the temporal context using a phenomenological method and snowball sampling. Focus group interviews were audio-recorded, transcribed, and entered into ATLAS.ti to aid in establishing themes. African American men perceived that fast-food chains are their food choices and that they do not have any other healthy alternatives near their residential community. Their perspective of their current environment was primarily influenced by their formative years, the availability of current food environments, marketing and advertising of food on television, and the cost of eating healthy as compared to the cost of eating what is convenient to their residence. A central theme of the findings of this study is that the availability and accessibility of restaurants and food options are harmful to health over time. The finding suggests that future interventions should consider and incorporate how people develop and understand their current food practices and environment through the lens of time, not just their adult context.

Polycyclic aromatic hydrocarbons in traditionally smoked meat products from the Baltic states.

A total of 77 traditionally smoked meat samples produced in Latvia, Lithuania, and Estonia were tested for the occurrence of four EU regulated polycyclic aromatic hydrocarbons (PAHs). Levels of PAHs exceeding the EU maximum levels for benzo[a]pyrene and for the sum of four PAHs (PAH4) were detected in 46% and 48% of the samples originating from Latvia. The detected BaP levels in smoked meats ranged from 0.05 to 166 µg kg-1, while the PAH4 content ranged from 0.42 to 628 µg kg-1. The mean dietary exposure to PAHs was estimated at the levels of 5.4 ng BaP/kg bw/day and 36 ng PAH4/kg bw/day. The margin of exposure (MOE) approach was utilised to assess the risks to Latvian consumers due to PAHs and the obtained MOEs were in a range of 7205-24,434, thus indicating a potential concern for consumer health for specific population groups.

Immigrant women's food choices in pregnancy: perspectives from women of Chinese origin in Canada.

OBJECTIVE: Following migration, pregnant immigrant women may encounter social, cultural, and economic challenges that negatively affect their food choices and subsequent health outcomes. Culturally appropriate health care is crucial during the perinatal period to ensure the health of immigrant mothers and their children. This project aims to explore and understand how the health beliefs and practices of Chinese immigrant women affect their food choices during the perinatal period. DESIGN: This qualitative study used the methodology of focused ethnography. Women participated in one semi-structured interview, followed by a second photo-assisted, semi-structured interview which incorporated photographs taken by the women themselves. RESULTS: The food choices and health behaviors of immigrant women were influenced by their general health beliefs, cultural knowledge concerning particular types of foods, traditional Chinese medical beliefs, social advice and information, and socio-economic factors. CONCLUSION: The provision of culturally appropriate health care is crucial during the perinatal period, as it is not only a vulnerable life stage for women and their children but also a sensitive period of interaction with the Canadian health-care system. Understanding these intersecting factors can help to ensure culturally appropriate care and optimized health outcomes for Chinese immigrant women during the perinatal period.

Meat intake, cooking methods and doneness and risk of colorectal tumours in the Spanish multicase-control study (MCC-Spain).

PURPOSE: Although there is convincing evidence that red and processed meat intake increases the risk of colorectal cancer (CRC), the potential role of meat cooking practices has not been established yet and could partly explain the current heterogeneity of results among studies. Therefore, we aimed to investigate the association between meat consumption and cooking practices and the risk of CRC in a population-based case-control study. METHODS: A total of 1671 CRC cases and 3095 controls recruited in Spain between September 2008 and December 2013 completing a food frequency questionnaire with a meat-specific module were included in the analyses. Odds ratios (OR) and confidence intervals (CI) were estimated by logistic regression models adjusted for known confounders. RESULTS: Total meat intake was associated with increased risk of CRC (OR T3-T1 1.41; 95% CI 1.19-1.67; p trend < 0.001), and similar associations were found for white, red and processed/cured/organ meat. Rare-cooked meat preference was associated with low risk of CRC in red meat (ORrare vs. medium 0.66; 95% CI 0.51-0.85) and total meat (ORrare vs. medium 0.56; 95% CI 0.37-0.86) consumers, these associations being stronger in women than in men. Griddle-grilled/barbecued meat was associated with an increased CRC risk (total meat: OR 1.45; 95% CI 1.13-1.87). Stewing (OR 1.25; 95% CI 1.04-1.51) and oven-baking (OR 1.18; 95% CI 1.00-1.40) were associated with increased CRC risk of white, but not red, meat. CONCLUSIONS: Our study supports an association of white, red, processed/cured/organ and total meat intake with an increased risk of CRC. Moreover, our study showed that cooking practices can modulate such risk.

Barriers and Strategies for Healthy Food Choices among American Indian Tribal College Students: A Qualitative Analysis.

BACKGROUND: American Indian and Alaskan Native individuals experience disproportionate levels of chronic health conditions such as type 2 diabetes and overweight and obesity that are influenced by dietary patterns and food choices. Understanding factors that influence healthy food choices among tribal college students can enrich education and programs that target dietary intake. OBJECTIVE: To build an understanding of factors that influence healthy food choices among tribal college students at increased risk for college attrition. DESIGN: A nonexperimental cohort design was used for qualitative descriptive analysis. PARTICIPANTS/SETTING: Participants (N=20) were purposively sampled, newly enrolled, academically underprepared tribal college students enrolled in a culturally relevant life skills course at an upper Midwest tribal college between September 2013 and May 2015. Participant demographic characteristics included various tribal affiliations, ages, and number of dependents. MAIN OUTCOME MEASURES: Participant responses to qualitative research questions about dietary intake, food choices, self-efficacy for healthy food choices, psychosocial determinants, and barriers to healthy food choices during telephone interviews were used as measures. ANALYSIS: Qualitative analysis included prestudy identification of researcher bias/assumptions, audiorecording and transcription, initial analysis (coding), secondary analysis (sorting and identifying meaning), and verification (comparative pattern analysis). RESULTS: Qualitative analysis revealed a variety of themes and subthemes about healthy food choices. Main themes related to barriers included taste, food gathering and preparation, and difficulty clarifying healthy food choices. Main themes related to strategies included taste, cultural traditions and practices, and personal motivation factors. CONCLUSIONS: Qualitative analysis identified barrier and strategy themes that may assist nutrition and dietetics practitioners working with tribal/indigenous communities, tribal college educators and health specialists, and tribal community health workers who target health and dietary intake of American Indian and Alaskan Native students.

Effect of a price discount and consumer education strategy on food and beverage purchases in remote Indigenous Australia: a stepped-wedge randomised controlled trial.

BACKGROUND: Evidence is mounting that price discounts can be effective in improving diet. This study examined the effectiveness of a 20% price discount on food and drink purchases with and without consumer education in remote Indigenous Australia. METHODS: A 20% discount on fruit, vegetables, water, and artificially sweetened soft drinks was applied for 24 weeks in 20 communities in remote Indigenous Australia where the community store was managed by the Arnhem Land Progress Aboriginal Corporation (ALPA) or Outback Stores (OBS) in a stepped-wedge randomised trial. Communities were randomly allocated to a fixed framework of five sets of four stratified by store association; ten stores (two in each set) were randomly assigned to receive consumer education. A store from each of the ALPA and OBS store groups (contained in separate opaque envelopes) was selected, and stores in turn continued to be consecutively allocated to the fixed store set framework, starting with the first store slot in the first store set, until all stores had been allocated. The effect of the discount on the weight of fruit and vegetables purchased (the primary endpoint) was assessed using weekly store sales data and mixed models per protocol. We did sensitivity analyses by repeating the analyses with the outliers included and repeating the analyses for the primary outcome measure removing each store one at a time. This trial was registered with Australian New Zealand Clinical Trials Registry, number ACTRN12613000694718. FINDINGS: Weekly store sales data on all food and drink products sold in 20 stores were collected from July 1, 2012, to Dec 28, 2014. Price discount alone was associated with a 12·7% (95% CI 4·1-22·1) increase in purchases in grams of fruit and vegetables combined (primary outcome), and a 19·8% (6·2-35·1) increase post discount (after vs before); an effect of 12 g and 18 g per capita per day. Sensitivity analyses did not modify the results for the primary outcome measure. INTERPRETATION: A 20% discount can only increase fruit and vegetable purchases to help protect against obesity and diet related disease to a certain extent. Large discounts might have a greater impact than small discounts. Creative merchandising approaches to consumer education could also be considered alongside fiscal interventions to achieve marked improvements in diet. FUNDING: Australian National Health and Medical Research Council.

Story Immersion May Be Effective in Promoting Diet and Physical Activity in Chinese Children.

OBJECTIVE: To evaluate the effect of playing a health video game embedded with story immersion, Escape from Diab (Diab), on children's diet and physical activity (PA) and to explore whether children immersed in Diab had greater positive outcomes. DESIGN: Two groups, nonrandomized; 3 outcome assessments: at baseline, immediately after the game (post 1), and 8-10 weeks after the game (post 2). PARTICIPANTS: A total of 179 Chinese children aged 8-12 years. INTERVENTION: The treatment group played Diab; the control group received no intervention. MAIN OUTCOME MEASURES: Motivation; self-efficacy; preference for fruit, vegetables, water, and PA; as well as PA behavior. ANALYSIS: Adjusted changes to post 1 and post 2 by ANCOVA controlling for demographic and baseline variables. RESULTS: Children who played Diab had increased intrinsic motivation for fruit and water, self-efficacy for PA, and self-reported PA scores at post 1 (all P < .05). Children with higher immersion scores (above the median) had increased intrinsic motivation for fruit and water, and autonomous and controlled motivation for PA at post 1 (all P < .05). However, these were not significant at post 2. CONCLUSIONS AND IMPLICATIONS: Diab provides a promising innovative medium for promoting Chinese children's psychological correlates of diet and PA and PA behavior. However, its maintenance of effectiveness needs to be enhanced and mechanisms of change need to be investigated more thoroughly.

Brazilian version of food cravings questionnaires: Psychometric properties and sex differences.

The Food Cravings Questionnaires, State (FCQ-State) and Trait (FCQ-Trait), are commonly used to assess food-craving behavior. This study aimed to develop and validate the Brazilian version of these questionnaires, and to explore potential gender differences in the trait version scores. Data were collected from (n = 611) undergraduate students. Confirmatory factor analysis was conducted to examine the questionnaires structure, and construct validity was assessed. The FCQ-State-Br and FCQ-Trait-Br presented good psychometric properties, adequate model fit, and internal consistency, in general and by gender. A conservation of original structure of the Food Cravings Questionnaires was verified in the Brazilian versions. A good performance in the evaluations concerning the discriminant and convergent validity seem to corroborate these structures. Overweight individuals showed an increase in food-craving behavior. In females, this increase occurred in the guilt dimension, whereas in males, the increase was in the lack of control dimension. In addition, female dieters presented higher scores on the guilt dimension compared with female non-dieters. FCQ-State-Br and FCQ-Trait-Br constitute valid instruments for measuring food-craving behavior in the Brazilian population. Moreover, these findings suggest that food cravings may be an important aspect to be considered in clinical management of overweight individuals, and may require a sex-specific approach.

Factors related to food involvement in the adult population / Fatores relacionados ao envolvimento com alimentação da população adulta

ABSTRACT Objective This study aimed to investigate aspects associated with food involvement and to ascertain whether individuals with higher food involvement consume larger amounts of fruits and vegetables. Methods This cross-sectional, analytical study was conducted with 301 adults (19-59 years old) from the Federal District, Brazil. Sample size calculation was based on numbers from the Brazilian Demographic Census and on consumption data for fruits and vegetables obtained from the Surveillance of Risk and Protective Factors for Chronic Diseases by Telephone Interviews survey. Data were collected in October of 2012. The questionnaire comprised 28 questions and included socio-demographic variables, reported fruit and vegetable consumption, and an adapted food involvement scale. Data were analyzed using Statistical Package for the Social Sciences software. Descriptive and comparative analyses were performed to determine population characteristics . Results Women and older individuals displayed a higher degree of food involvement than did men and younger individuals ( p <0.001). Among the factors included in food involvement, the highest influence was attributed to satisfaction in preparing food (cooking), pre-preparation of food, and pleasure in cooking for other people ( p <0.001). Conclusion The results presented here suggest that food involvement can be stimulated through innovative strategies of communication that go beyond the biological arguments and focus on the cultural expression of the elements of socialization, whose relationship with eating is well established.

RESUMO Objetivo Investigar os aspectos associados ao envolvimento com alimentação e verificar se os indivíduos que apresentam um maior envolvimento com alimentação consomem maiores quantidades de frutas e hortaliças. Métodos Estudo analítico transversal conduzido com 301 adultos (19-59 anos) do Distrito Federal. O cálculo amostral foi baseado no quantitativo fornecido pelo Censo Demográfico Brasileiro e em dados de consumo referido de frutas e hortaliças, de acordo com dados da pesquisa Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico. A coleta de dados ocorreu em outubro de 2012. O questionário, composto por 28 questões abrangeo as variáveis sócio-demográficas, consumo referido de frutas e hortaliças e uma escala de envolvimento com alimentação, adaptada. Os dados foram analisados utilizando o software Statistical Package for the Social Sciences. Análises descritivas e comparativas foram realizadas para verificar as características da população. Resultados Mulheres e indivíduos mais velhos apresentaram um grau de envolvimento com a alimentação maior que homens e pessoas mais jovens (p<0,001). Dentre os fatores que compõem o envolvimento com alimentação tiveram maior influência os relacionados à satisfação em preparar de alimentos (cozinhar), ao pré-preparo de alimentos e ao prazer de cozinhar para outras pessoas (p<0,001). Conclusão Os resultados apresentados sugerem que o envolvimento com alimentação pode ser estimulado por meio de estratégias de comunicação inovadoras, que ultrapassem o sentido biológico e se concentrem na expressão cultural sobre os elementos de socialização, reconhecidamente relacionados à alimentação.

Reproducibility of an in-laboratory test meal to assess ad libitum energy intake in adolescents with obesity.

AIM: The aim of the present work was to test the reproducibility of a personalized in-laboratory ad libitum buffet meal in assessing energy and macronutrient intake in obese adolescents. METHODS: Twelve 13.5 ± 1.5 years old obese adolescent girls were asked to complete three identical experimental sessions during which an ad libitum buffet meal was presented at lunch time. The buffet was personalized based on food preference questionnaires, presented usually consumed food items and excluded preferred foods. Total energy intake and the energy ingested derived from each macronutrient were assessed by investigators using the Bilnuts nutritional software. RESULTS: Mean body mass was 87.0 ± 13.7 kg and mean BMI was 32.2 ± 4.9 kg/m(2). Mean FM percentage was 39.1 ± 4.4% and FFM was 50.6 ± 7.7 kg. There was no significant difference between total energy intake, the percentage of intake related to fat, protein or Carbohydrates (CHO) between the three sessions. The Intraclass Correlations (ICC) observed for total energy intake was 0.99. ICC for Protein, Fat and CHO were 0.38; 0.96 and 0.81 respectively. The Bland & Altman visual analysis revealed an important agreement between meals. CONCLUSION: The proposed personalized in-laboratory ad libitum test meal produces is a reproducible methods to assess energy and macronutrients intake in obese adolescent girls.

Barriers to Eating Traditional Foods Vary by Age Group in Ecuador With Biodiversity Loss as a Key Issue.

OBJECTIVE: To document the perceptions of indigenous peoples for the sustainable management of natural resources against malnutrition. DESIGN: Initially 4 and then 12 interviews were conducted with 4 different age groups. SETTING: Eight rural villages in Guasaganda, central Ecuador, were studied in 2011-2012. PARTICIPANTS: A total of 75 people (22 children, 18 adolescents, 20 adults, and 15 elders). MAIN OUTCOME MEASURES: Benefits, severity, susceptibility, barriers, cues to action, and self-efficacy of eating traditional foods. ANALYSIS: Qualitative content analysis was completed using NVivo software. Initial analysis was inductive, followed by a content analysis directed by the Health Belief Model. Coding was completed independently by 2 researchers and kappa statistics (κ ≥ 0.65) were used to evaluate agreement. RESULTS: Healthy perceptions toward traditional foods existed and differed by age. Local young people ate traditional foods for their health benefits and good taste; adults cultivated traditional foods that had an economic benefit. Traditional knowledge used for consumption and cultivation of traditional foods was present but needs to be disseminated. CONCLUSIONS AND IMPLICATIONS: Nutrition education in schools is needed that supports traditional knowledge in younger groups and prevents dietary changes toward unhealthy eating. Increased production of traditional food is needed to address current economic realities.

Changes in Food Choices of Participants in the Special Diabetes Program for Indians-Diabetes Prevention Demonstration Project, 2006-2010.

INTRODUCTION: American Indians/Alaska Natives (AI/ANs) have a disproportionately high rate of type 2 diabetes. Changing food choices plays a key role in preventing diabetes. This study documented changes in the food choices of AI/ANs with diagnosed prediabetes who participated in a diabetes prevention program. METHODS: The Special Diabetes Program for Indians-Diabetes Prevention Demonstration Project implemented the evidence-based Diabetes Prevention Program (DPP) lifestyle intervention in 36 health care programs nationwide, engaging 80 AI/AN communities. At baseline, at 30 days post-curriculum, and at the first annual assessment, participants completed a sociodemographic survey and 27-item food frequency questionnaire and underwent a medical examination assessing fasting blood glucose (FBG), blood pressure, body mass index (BMI), low-density lipoprotein [LDL], high-density lipoprotein [HDL], and triglycerides. Multiple linear regressions were used to assess the relationship between temporal changes in food choice and other diabetes risk factors. RESULTS: From January 2006 to July 2010, baseline, post-curriculum, and first annual assessments were completed by 3,135 (100%), 2,046 (65%), and 1,480 (47%) participants, respectively. An increase in healthy food choices was associated initially with reduced bodyweight, BMI, FBG, and LDL and increased physical activity. At first annual assessment, the associations persisted between healthy food choices and bodyweight, BMI, and physical activity. CONCLUSION: AI/AN adults from various tribal and urban communities participating in this preventive intervention made sustained changes in food choices and had reductions in diabetes risk factors. The outcomes demonstrate the feasibility and effectiveness of translating the DPP lifestyle intervention to community-based settings.

Nutritional advice from George Orwell. Exploring the social mechanisms behind the overconsumption of unhealthy foods by people with low socio-economic status.

Despite a general consensus and recognition of the importance of the "social gradient" on nutritional standards and ultimately people's health, (Budrys, 2003; Marmot & Wilkinson, 1999; Marmot et al., 1991; Ross & Wu, 1995), the body of literature identifying and describing the actual underlying social mechanisms which could explain this association is small, fragmented and not contained within one single discipline of thought - the effects of this conundrum seem easier to describe than to explain. The aim of this article is therefore to explore and identify social mechanisms, which could help explain why people with low socio-economic status consume a disproportionate amount of unhealthy foods and therefore also observe poorer diets. It is therefore in many ways an exploration into the nature of (relative) poverty. The point of departure for this exploration and identification is historical descriptions (in the form of excerpts) from George Orwell's (1937) book "The Road to Wigan Pier" on the living conditions of the British working classes. These descriptions will be aligned with results from contemporary research into nutritional behaviour. Strong similarities are identified between George Orwell's historical descriptions of the working-class's unhealthy diet and the findings from contemporary research into nutritional behaviour of people with a low socio-economic status. Certain social mechanisms influencing nutritional choices are readily identifiable across disciplines, and even partly reproduced in different historical, social and spatial contexts, with stronger negative (nutritional) consequences for people with low socio-economic status. The disregard of social mechanisms, and therefore implicitly issues of class, could indicate a general "de-socialization" of nutritional advice also in its dispersal through various health-promotion initiatives and campaigns, which raises serious questions about the usefulness of much nutritional advice, already tentatively questioned by some nutritionist (Burr et al., 2007) as well as "food" sociologist (Smith & Holm, 2010).

Dietary habits in adolescent girls with polycystic ovarian syndrome.

The phenotype of polycystic ovarian syndrome (PCOS) is known to worsen with weight gain, increased ingestion of carbohydrates and a sedentary lifestyle. The purpose of this study was to assess the dietary habits in a group of adolescent girls with PCOS. Adolescents with PCOS were recruited and asked to complete a questionnaire on their eating habits and a recall dietary diary, from which their caloric and macronutrient intake was calculated. Results were compared with those from a group of normal controls. Thirty-five women with PCOS and 46 controls were included. Girls with PCOS were less likely to have cereals for breakfast (20.7 versus 66.7%) and as a result consumed less fibre than controls. They were more likely to eat an evening meal (97.1 versus 78.3%) and eat this over an hour later when compared to controls. Despite having comparable body mass indexes, girls with PCOS ate a daily surplus calorie average of 3% versus controls that had a negative calorie intake of 0.72% (p = 0.047). Ameliorating eating habits early in adolescence in girls with PCOS may improve future metabolic concerns related to a genetic predisposition and worsened by an unhealthy lifestyle.

Mediation of parental educational level on fruit and vegetable intake among schoolchildren in ten European countries.

OBJECTIVE: To examine which factors act as mediators between parental educational level and children's fruit and vegetable (F&V) intake in ten European countries. DESIGN: Cross-sectional data were collected in ten European countries participating in the PRO GREENS project (2009). Schoolchildren completed a validated FFQ about their daily F&V intake and filled in a questionnaire about availability of F&V at home, parental facilitation of F&V intake, knowledge of recommendations about F&V intake, self-efficacy to eat F&V and liking for F&V. Parental educational level was determined from a questionnaire given to parents. The associations were examined with multilevel mediation analyses. SETTING: Schools in Bulgaria, Finland, Germany, Greece, Iceland, the Netherlands, Norway, Portugal, Slovenia and Sweden. SUBJECTS: Eleven-year-old children (n 8159, response rate 72%) and their parents. RESULTS: In five of the ten countries, children with higher educated parents were more likely to report eating fruits daily. This association was mainly mediated by knowledge but self-efficacy, liking, availability and facilitation also acted as mediators in some countries. Parents' education was positively associated with their children's daily vegetable intake in seven countries, with knowledge and availability being the strongest mediators and self-efficacy and liking acting as mediators to some degree. CONCLUSIONS: Parental educational level correlated positively with children's daily F&V intake in most countries and the pattern of mediation varied among the participating countries. Future intervention studies that endeavour to decrease the educational-level differences in F&V intake should take into account country-specific features in the relevant determinants of F&V intake.