The effect of the labelled serving size on consumption: A systematic review.

Guidance for food consumption and portion control plays an important role in the global management of overweight and obesity. Carefully conceptualised serving size labelling can contribute to this guidance. However, little is known about the relationship between the information that is provided regarding serving sizes on food packages and levels of actual food consumption. The aim of this systematic review was to investigate how serving size information on food packages influences food consumption. We conducted a systematic review of the evidence published between 1980 and March 2018. Two reviewers screened titles and abstracts for relevance and assessed relevant articles for eligibility in full-text. Five studies were considered eligible for the systematic review. In three of the included studies, changes in serving size labelling resulted in positive health implications for consumers, whereby less discretionary foods were consumed, if serving sizes were smaller or if serving size information was provided alongside contextual information referring to the entire package. One study did not find significant differences between the conditions they tested and one study suggested a potentially negative impact, if the serving size was reduced. The influence of labelled serving size on consumption of non-discretionary foods remains unclear, which is partially due to the absence of studies specifically focusing on non-discretionary food groups. Studies that investigate the impact of serving size labels within the home environment and across a broad demographic cross-section are required.

Perceptions of food intake and weight status among parents of picky eating infants and toddlers in China: A cross-sectional study.

BACKGROUND: Previous studies have suggested that children that are picky eaters may have a different and less varied diet than non-picky children, but the literature on picky eating in Chinese children is limited. OBJECTIVES: To assess the prevalence of picky eating in 6-35 month-old Chinese children, and to explore how parents' perceptions of picky eating relate to children's intake and body composition. METHODS: 1414 6-35 month-old infants and toddlers from 8 Chinese cities were included in this study. Questionnaires were used to collect information on family demographic factors, child picky eating behaviors, food group rejection, and parents' perception of child weight status. Dietary intake data was collected via 24-h recall. Children's length/height and weight were measured. RESULTS: The reported prevalence of picky eating was higher in 24-35 month-olds (36% of children) compared to 6-11 month-olds (12%). There were no consistent significant differences in dietary intakes of nutrients between picky and non-picky eaters. Picky eating children whose parents indicated that they avoided eggs had lower intake of this food group compared to non-picky eaters, whereas those reported to avoid grains or meat had higher intakes of those food groups. Weight status was underestimated by parents of both picky and non-picky children. CONCLUSIONS: Picky eating seems to occur at similar prevalence rates in China as has been reported in other countries. Parents' perceptions of food refusal do not reflect actual intakes, nor do nutrient intakes of picky eaters show additional gaps compared to non-picky eating children. In healthy children with typical growth patterns, picky eating seems to be a normal phase of development experienced by some children, without substantial consequences on their nutrient or food group intakes.

Picky eating: Associations with child eating characteristics and food intake.

Food rejection behaviors such as picky eating are of concern for many parents and attempts to increase healthy food intake can cause distress at mealtimes. An important limitation in most of the picky eating studies is that they cover few characteristics of picky eating behaviors and use limited measures of food intake. The objective of this study was to explore the associations between picky eating, child eating characteristics, and food intake among toddlers 12-47.9 months old (n = 2371) using data from the 2008 Feeding Infants and Toddlers Study (FITS). Logistic regression was used to examine associations between demographic and feeding characteristics and picky eater status. Differences in food group intake between picky and non-picky eaters were analyzed. Picky eaters were more likely to be neophobic, texture resistant, and to eat only favorite foods, In addition, the parents of picky eaters tend to offer new food a greater number of times than those of non-picky eaters before deciding that the child does not like it. Picky eaters showed significant lower intakes of eggs, burritos/tacos/enchiladas/nachos and sandwiches than non-picky eaters. Picky eaters consumed fewer vegetables from the "other vegetables" category and less raw vegetables than non-picky eaters. Neophobia, eating only favorite foods and difficulties with texture are all important characteristics of picky eaters which need to be integrated in studies measuring picky eating behaviors. Food intake of picky eaters differs only slightly from non-picky eaters. Because picky eating is a major parental concern, feeding strategies and advice related to the relevant characteristics of picky eating behavior need to be developed and assessed for their effectiveness.

Vegetable variety: an effective strategy to increase vegetable choice in children.

OBJECTIVE: Most children do not meet the recommended intake of vegetables. Variety was identified as a potential factor to increase children's intake of these foods, as it was shown that variety was effective in improving meal composition in adults. Because younger children are suggested to be more responsive to internal satiation signals than to external food-related cues compared with adults, it is not clear whether variety is effective to improve meal composition in 7- to 10-year-old children. DESIGN: Experiment. SETTING: Children were assigned one of three different fake food buffets containing pasta, chicken, and either one vegetable (carrots or beans) or two vegetables (carrots and beans). The children were asked to serve themselves a meal that they would like to eat for lunch from the given selection. SUBJECTS: One hundred children (fifty-two boys; mean age 8·8 (sd 1·1) years). RESULTS: Children given the two-vegetable choice served themselves significantly more energy from vegetables (mean 64 (sd 51) kJ, 10·9 (sd 9·4) %) compared with children who were offered only either carrots (mean 37 (sd 25) kJ, 5·9 (sd 6·5) %) or beans (mean 38 (sd 34) kJ, 5·6 (sd 6·3) %). The total energy of the meal was not increased, indicating that children chose a more balanced lunch when offered more vegetables. CONCLUSIONS: School-aged children are responsive to food-related cues and variety is effective in increasing their vegetable choice. Serving an assortment of vegetables in school cafeterias might be a simple and effective strategy to improve children's nutrition.

Involving children in meal preparation. Effects on food intake.

The question of how to promote healthy eating habits in children is relevant because most children do not meet the recommended vegetable intake. Involving children in food preparation could be an opportunity to develop healthy eating behaviors and to increase vegetable consumption. The purpose of this study was to examine the effect of children's involvement in meal preparation on their food and vegetable intake. A between-subject experiment was conducted with 47 children aged 6 to 10 years. In condition 1 (n = 25), children prepared a lunch meal (pasta, breaded chicken, cauliflower, and salad) with the assistance of a parent. In condition 2 (n = 22), the meal was prepared by the parent alone. Independent samples t-tests were conducted to compare intake in the "child cooks" and "parent cooks" conditions. Children in the child cooks condition ate significantly more salad 41.7 g (76.1%), more chicken 21.8 g (27.0%), and more calories 84.6 kcal (24.4%) than children in the parent cooks condition. Between before cooking and directly after cooking the meal, children in the child cooks condition reported significantly increased feelings of valence (feeling positive) and dominance (feeling in control). This study confirms that involving children in meal preparation can increase vegetable intake. Because of the potential effect on energy intake, parents need to be made aware of appropriate portion sizes for their children. Taking this into account, encouraging parents to involve their children in the preparation of healthy and balanced meals could be a valuable intervention strategy to improve the diets and vegetable intake of children.

Development of a diet quality score and adherence to the Swiss dietary recommendations for vegans.

BACKGROUND: Vegan diets have recently gained popularity in Switzerland as well as globally. The aim of the present study was to develop a diet quality score for vegans (DQS-V) based on the Swiss dietary recommendations for vegans. METHODS: The dataset included 52 healthy vegan adults. Dietary intake data were assessed by three-day weighed food records. Body weight and height were measured, and a venous blood sample for the analysis of vitamin and mineral status was collected. Spearman rank correlation coefficients were used due to not-normally distributed data. Dietary patterns were identified using principal component analysis (PCA). RESULTS: The DQS-V score (mean ± SD) was 48.9 ± 14.7. Most vegans adhered to the recommended portions of vegetables, vitamin C-rich vegetables, fruits, omega-3-rich nuts, fats and oils, and iodized salt. However, the intake of green leafy vegetables, vitamin C-rich fruits, wholegrains, legumes, nuts and seeds, selenium-rich nuts, zero caloric liquid, and calcium-fortified foods was suboptimal. The sample overconsumed sweet-, salty-, fried foods, and alcohol. The DQS-V had a significantly positive correlation with intakes of fibre, polyunsaturated fatty acids, potassium, zinc, and phosphorus intakes (p's < 0.05) but was negatively correlated with vitamin B12 and niacin intakes (p's < 0.05). Two dietary patterns were derived from PCA: 1) refined grains and sweets and 2) wholegrains and nuts. The correlation between the DQS-V and the first dietary pattern was negative (- 0.41, p = 0.004) and positive for the second dietary pattern (0.37, p = 0.01). The refined grains and sweets dietary pattern was inversely correlated with beta-carotene status (- 0.41, p = 0.004) and vitamin C status (r = - 0.51, p = 0.0002). CONCLUSION: The newly developed DQS-V provides a single score for estimating diet quality among vegan adults. Further validation studies examining the DQS-V in relation to an independent dietary assessment method and to biomarkers of nutritional intake and status are still needed before the general application of the DQS-V.

A New Model for Ranking Schools of Public Health: The Public Health Academic Ranking.

Objectives: As there is no ranking designed for schools of Public Health, the aim of this project was to create one. Methods: To design the Public Health Academic Ranking (PHAR), we used the InCites Benchmarking and Analytics™ software and the Web Of Science™ Core Collection database. We collected bibliometric data on 26 schools of Public Health from each continent, between August and September 2022. We included 11 research indicators/scores, covering four criteria (productivity, quality, accessibility for readers, international collaboration), for the period 2017-2021. For the Swiss School of Public Health (SSPH+), a network gathering faculties across different universities, a specific methodology was used, with member-specific research queries. Results: The five top schools of the PHAR were: London School of Hygiene and Tropical Medicine, Public Health Foundation of India, Harvard T.H. Chan School of Public Health, SSPH+, Johns Hopkins Bloomberg School of Public Health. Conclusion: The PHAR allows worldwide bibliometric ordering of schools of Public Health. As this is a pilot project, the results must be taken with caution. This article aims to critically discuss its methodology and future improvements.

Snack frequency: associations with healthy and unhealthy food choices.

OBJECTIVE: We examined associations between snack frequency, sociodemographic characteristics, BMI, dietary and eating behaviour. In order to identify whether various subgroups of high-frequency snack consumers exist, we investigated underlying food patterns and lifestyle factors. DESIGN: The data were based on the Swiss Food Panel Questionnaire of 2010, which included an FFQ, questions relating to sociodemographics and lifestyle factors. Data were examined using ANOVA, regression analysis and hierarchical cluster analysis. Gender differences were also investigated in the analysis of the data. SETTING: A sample of 6189 adults participating in the Swiss Food Panel filled in a questionnaire (response rate 30%). SUBJECTS: The sample consisted of both men and women, with a mean age of 54?4 (SD 13?5) years. RESULTS: There was no association between snack frequency and BMI. Consumption frequency of sweets and savouries as well as fruit intake increased with increasing snack frequency. Additionally, three different subgroups of high-frequency snack consumers could be revealed: healthy, moderate and unhealthy dietary-pattern groups. The latter included respondents who were less health-conscious and was characterized by high alcohol consumption frequency, daily breakfast skipping and watching television during the main meal. CONCLUSIONS: High snack frequency occurred in the context of healthy as well as unhealthy dietary behaviour and lifestyle patterns. Women made healthier dietary food choices and were more likely to consume fruits as snacks, while men chose unhealthy foods, such as sweets and savouries, more often.

Dietary restraint, ambivalence toward eating, and the valence and content of spontaneous associations with eating.

In a random sample of the German-speaking population of Switzerland (N=1388, 730 women), the technique of spontaneous associations was used to examine the relationship between valence (positive, negative) and content of participants' spontaneous associations with the term "eating" and dietary restraint, ambivalence toward eating, and health consciousness. Regression analysis revealed ambivalence to be the most important and food health consciousness the second most important predictor of restrained eating. Correspondence analysis of the content of the spontaneous associations revealed high-restrained eaters to have fewer associations with eating than unrestrained eaters. High-restrained eaters most often had negative associations with diet and positive associations with health. Unrestrained eaters mentioned a variety of positive associations, such as community, comfort and well-being, preparation of food, aesthetics, and various specific foods (e.g., starchy side dishes, and sweets). Results support the notion that the conflict between weight control and eating enjoyment is rather pronounced in high-restrained eaters, resulting in ambivalence toward eating, and the inhibition of associations with palatable foods. This was less pronounced, but still present, in medium-restrained eaters. In contrast, unrestrained eaters seemed to have a balanced and conflict-free relationship with eating. However, restrained eating also seemed to be driven by health considerations.

Usability and Overall Perception of a Health Bot for Nutrition-Related Questions for Patients Receiving Bariatric Care: Mixed Methods Study.

BACKGROUND: Currently, over 4000 bariatric procedures are performed annually in Switzerland. To improve outcomes, patients need to have good knowledge regarding postoperative nutrition. To potentially provide them with knowledge between dietetic consultations, a health bot (HB) was created. The HB can answer bariatric nutrition questions in writing based on artificial intelligence. OBJECTIVE: This study aims to evaluate the usability and perception of the HB among patients receiving bariatric care. METHODS: Patients before or after bariatric surgery tested the HB. A mixed methods approach was used, which consisted of a questionnaire and qualitative interviews before and after testing the HB. The dimensions usability of, usefulness of, satisfaction with, and ease of use of the HB, among others, were measured. Data were analyzed using R Studio (R Studio Inc) and Excel (Microsoft Corp). The interviews were transcribed and a summary inductive content analysis was performed. RESULTS: A total of 12 patients (female: n=8, 67%; male: n=4, 33%) were included. The results showed excellent usability with a mean usability score of 87 (SD 12.5; range 57.5-100) out of 100. Other dimensions of acceptability included usefulness (mean 5.28, SD 2.02 out of 7), satisfaction (mean 5.75, SD 1.68 out of 7), and learnability (mean 6.26, SD 1.5 out of 7). The concept of the HB and availability of reliable nutrition information were perceived as desirable (mean 5.5, SD 1.64 out of 7). Weaknesses were identified in the response accuracy, limited knowledge, and design of the HB. CONCLUSIONS: The HB's ease of use and usability were evaluated to be positive; response accuracy, topic selection, and design should be optimized in a next step. The perceptions of nutrition professionals and the impact on patient care and the nutrition knowledge of participants need to be examined in further studies.

Home-based cooking intervention with a smartphone app to improve eating behaviors in children aged 7-9 years: a feasibility study.

Objective: To develop and evaluate the feasibility of a mobile application in Swiss households and assess its impact on dietary behavior and food acceptability between children who cooked with limited parental support (intervention group) with children who were not involved in cooking (control group). Methods: A ten-week randomized controlled trial was conducted online in 2020. Parents were given access to a mobile-app with ten recipes. Each recipe emphasized one of two generally disliked foods (Brussels sprouts or whole-meal pasta). Parents photographed and weighed the food components from the child's plate and reported whether their child liked the meal and target food. The main outcome measures were target food intake and acceptability analyzed through descriptive analysis for pre-post changes. Results: Of 24 parents who completed the baseline questionnaires, 18 parents and their children (median age: 8 years) completed the evaluation phase. Mean child baseline Brussel sprouts and whole-meal pasta intakes were 19.0 ± 24.2 g and 86.0 ± 69.7 g per meal, respectively. No meaningful differences in intake were found post-intervention or between groups. More children reported a neutral or positive liking towards the whole-meal pasta in the intervention group compared to those in the control group. No change was found for liking of Brussel sprouts. Conclusions for practice: The intervention was found to be feasible however more studies on larger samples are needed to validate feasibility. Integrating digital interventions in the home and promoting meal preparation may improve child reported acceptance of some healthy foods. Using such technology may save time for parents and engage families in consuming healthier meals.

The Nutritional Content of Meal Images in Free-Living Conditions-Automatic Assessment with goFOODTM.

A healthy diet can help to prevent or manage many important conditions and diseases, particularly obesity, malnutrition, and diabetes. Recent advancements in artificial intelligence and smartphone technologies have enabled applications to conduct automatic nutritional assessment from meal images, providing a convenient, efficient, and accurate method for continuous diet evaluation. We now extend the goFOODTM automatic system to perform food segmentation, recognition, volume, as well as calorie and macro-nutrient estimation from single images that are captured by a smartphone. In order to assess our system's performance, we conducted a feasibility study with 50 participants from Switzerland. We recorded their meals for one day and then dietitians carried out a 24 h recall. We retrospectively analysed the collected images to assess the nutritional content of the meals. By comparing our results with the dietitians' estimations, we demonstrated that the newly introduced system has comparable energy and macronutrient estimation performance with the previous method; however, it only requires a single image instead of two. The system can be applied in a real-life scenarios, and it can be easily used to assess dietary intake. This system could help individuals gain a better understanding of their dietary consumption. Additionally, it could serve as a valuable resource for dietitians, and could contribute to nutritional research.

Development and Evaluation of a Diet Quality Index for Preschool-Aged Children in an Asian population: The Growing Up in Singapore Towards Healthy Outcomes cohort.

BACKGROUND: Diet quality indexes are useful tools to measure diet quality because they compare dietary intakes against recommendations. A dietary quality index for Asian preschool-aged children is lacking. OBJECTIVE: The aims of this study were to develop and evaluate a dietary quality index for preschool-aged children (ie, the DQI-5) based on Singapore dietary recommendations and to examine diet quality in a cohort of 5-year-old children. An additional aim was to assess associations between sociodemographic characteristics and DQI-5 scores. DESIGN: A secondary analysis was conducted using dietary intake of children from the Growing Up in Singapore Towards healthy Outcomes mother-offspring cohort assessed in 2015-2016 using a validated food frequency questionnaire. The sociodemographic data were assessed at recruitment between June 2009 and September 2010. The DQI-5 was evaluated using a construct validity approach, whereby nutrition parameters associated with diet quality were studied. PARTICIPANTS AND SETTING: Participants were 767 Singaporean children aged 5 years of Chinese, Malay, or Indian ethnicity. MAIN OUTCOME MEASURES: The main outcome measures were the DQI-5 scores and the sociodemographic characteristics associated with diet quality. STATISTICAL ANALYSES PERFORMED: Kruskal-Wallis tests were used to evaluate differences in adherence to dietary recommendations across DQI-5 tertiles. Linear multiple regression analysis was performed to identify sociodemographic characteristics that were associated with diet quality in the children. RESULTS: The DQI-5 consists of 12 food and nutrient components, with a minimum score of zero and a maximum score of 110 points. The higher scores indicate a healthier diet, the mean ± SD DQI-5 score for the children was 61.6 ± 13.2. DQI-5 components with low scores included whole grains, vegetables, and fatty acid ratio, whereas total rice and alternatives and milk and dairy products components were overconsumed by 18% and 24.4% of children, respectively. Children with higher scores were more likely to meet dietary recommendations and had higher intake of nutrients such as dietary fiber, iron, vitamin A, and beta carotene. Children whose mothers were of Malay ethnicity and whose mothers had low income, an education below university, and shared primary caregiver responsibilities were more likely to have lower DQI-5 scores. CONCLUSIONS: The DQI-5 scores revealed diets to be low for several components and excessive for a few. The DQI-5 developed for preschool-aged children in Singapore had adequate construct validity.

Overcoming picky eating. Eating enjoyment as a central aspect of children's eating behaviors.

Picky eating is a relatively common problem during childhood, and parents lack clear strategies with which to decrease picky eating. This study examined whether increasing eating enjoyment and cooking enjoyment might give opportunities to decrease picky eating. Parents (n=305), mainly mothers with children between 6 and 12 years of age (53.8% boys; 46.2% girls), completed a questionnaire on pressure and restriction, eating enjoyment, and picky eating, and cooking enjoyment. Path analyses were performed to examine the mediating role of eating enjoyment. The final model provided a good fit to the data and explained 33% variance in picky eating. A strong inverse association between eating enjoyment and picky eating was found (ß=-.44). Significant direct effects were found between cooking enjoyment and picky eating (ß=-.16) and restriction and picky eating (ß=.18). Eating enjoyment partly mediated the association between cooking enjoyment and picky eating. Results showed pressure had only an indirect effect on picky eating through eating enjoyment. Eating enjoyment serves as an important and central factor in children's picky-eating behavior. High controlling practices might create a negative environment around food and healthy eating and so decrease eating enjoyment and increase picky eating.

Development of the Cook-EdTM Matrix to Guide Food and Cooking Skill Selection in Culinary Education Programs That Target Diet Quality and Health.

Culinary education programs are generally designed to improve participants' food and cooking skills, with or without consideration to influencing diet quality or health. No published methods exist to guide food and cooking skills' content priorities within culinary education programs that target improved diet quality and health. To address this gap, an international team of cooking and nutrition education experts developed the Cooking Education (Cook-EdTM) matrix. International food-based dietary guidelines were reviewed to determine common food groups. A six-section matrix was drafted including skill focus points for: (1) Kitchen safety, (2) Food safety, (3) General food skills, (4) Food group specific food skills, (5) General cooking skills, (6) Food group specific cooking skills. A modified e-Delphi method with three consultation rounds was used to reach consensus on the Cook-EdTM matrix structure, skill focus points included, and their order. The final Cook-EdTM matrix includes 117 skill focus points. The matrix guides program providers in selecting the most suitable skills to consider for their programs to improve dietary and health outcomes, while considering available resources, participant needs, and sustainable nutrition principles. Users can adapt the Cook-EdTM matrix to regional food-based dietary guidelines and food cultures.

Improvement of meal composition by vegetable variety.

OBJECTIVE: Our physical environment influences our daily food choices unconsciously. Strategic changes in the food environment might therefore be potential measures to influence consumers' food selection towards better nutrition, without affecting the consumers' freedom of choice. The present study aimed to examine whether increased vegetable variety enhances healthy food choices and improves meal composition. DESIGN: A randomised experiment. SETTING: Participants were instructed to serve themselves a lunch from a buffet of food replicas. Individuals were randomly assigned to one of three food combinations: condition A - cooked carrots, pasta and chicken; condition B - cooked green garden beans, pasta and chicken; condition AB - carrot sticks, green garden beans, pasta and chicken. Two one-vegetable conditions were compared with one two-vegetable condition. Data from Zurich, Switzerland, were analysed using one-way ANOVA. SUBJECTS: Ninety-eight students (fifty-three men; mean age 22·8 (sd 2·2) years, minimum = 19 years, maximum = 29 years). RESULTS: Participants who could choose from two vegetables derived significantly more energy (141 kJ) from vegetables compared with participants in the one-vegetable condition (104 and 84 kJ, respectively). Furthermore, in the two-vegetable condition, the relative energy of the meal derived from vegetables (10·9 %) increased significantly compared with the one-vegetable condition (8 % and 6·1 %, respectively). The total energy content of the meal (mean 1472 (sd 468) kJ) was not affected by the experimental manipulation. CONCLUSIONS: Having a choice of vegetables increases a person's tendency to choose vegetables and leads to the selection of a more balanced meal. Serving an assortment of vegetables as side dishes might be a simple and effective strategy to improve food selection.

Ready-meal consumption: associations with weight status and cooking skills.

OBJECTIVE: The ready-meal market has grown considerably in recent years. At the same time, a degradation of traditional cooking skills has been observed. Ready meals are often rich in energy, fat and sugar and lack vegetables; however, studies investigating associations between ready-meal consumption, overweight and cooking skills are lacking. The present study examines whether demographic factors, overweight, beliefs about the nutritional value and taste of ready meals and cooking skills are associated with ready-meal consumption. DESIGN: Cross-sectional survey. SETTING: Ready-meal consumption, weight status, cooking skills, beliefs about the taste and nutritional value of ready meals and demographic variables were assessed with self-administered questionnaires. Data were analysed with one-way ANOVA and multiple regression analysis. SUBJECTS: A total of 1017 adults from the German-speaking part of Switzerland. RESULTS: Men reported being more positive about ready meals and having fewer cooking skills compared with women. Overweight adults (BMI > 25 kg/m2) were more positive about nutrients and vitamins in ready meals compared with normal-weight adults. Ready-meal consumption was associated with cooking skills (ß = -0·192), age (ß =- 0·228), overweight (ß = 0·129), nutritional value (ß = -0·131), taste (ß = -0·126), working status (ß = 0·096) and gender (ß = 0·084). CONCLUSIONS: Cooking skills were identified as a strong predictor of ready-meal consumption. The importance of cooking skills as a barrier to healthy eating should be explored, as it is plausible that cooking skills will further decrease in the future. Next, the study provided evidence for an association between ready-meal consumption and overweight. Further research should examine the importance of ready meals for the overweight epidemic.

Vitamin and mineral supplement users. Do they have healthy or unhealthy dietary behaviours?

It is unknown whether people use vitamin and mineral supplements (VMS) to compensate for unhealthy diets, or people whom already have a healthy diet use VMS. Therefore, this study aimed to examine correlates of VMS use and whether VMS users can be categorised into specific clusters based on dietary lifestyle variables. The data used came from the Swiss Food Panel questionnaire for 2010. The sample consisted of 6189 respondents, mean age was 54 years and 47.6% were males. Data was analysed with logistic regression analysis and hierarchical cluster analysis. The results revealed that for VMS use, gender, age, education, chronic illness, health consciousness, benefits of fortification, convenience food and sugar-sweetened beverage consumption were of importance. Cluster analysis revealed three clusters (1) healthy diet, (2) unhealthy diet and (3) modest diet. Compared to non-users a higher percentage of VMS users was categorised in the healthy cluster and a lower percentage in the unhealthy cluster. More VMS-users were categorised as having an unhealthy diet (31.4%) than having a healthy diet (20.6%). The results suggest that both hypotheses-VMS are used by people with unhealthy diets and by people who least need them-hold true meaning.

Determinants of physical activity and sedentary behaviour in young people: a review and quality synthesis of prospective studies.

OBJECTIVE: The aim of this systematic review was to summarise and update the existing literature on determinants of physical activity and sedentary behaviour in young people, considering the methodological quality of the studies. METHODS: Prospective studies were identified from searches in PubMed and PsycINFO, from April 2004 through November 2010. The authors included studies investigating the association between determinants of overall physical (in)activity and/or sedentary behaviour in healthy children or adolescents. When a determinant was investigated for its association with physical (in)activity and sedentary behaviour assessed between ages of 4-12, or mean age ≤12, it was classified as 'child determinant'. When a determinant was investigated for its association with physical activity and sedentary behaviour assessed between ages of 13-18 or mean age >12, it was classified as 'adolescent determinant'. Included articles were scored on their methodological quality and a best-evidence synthesis was applied to summarise the results. RESULTS: The authors identified 30 papers, of which seven were of high methodological quality. Intention was found as a determinant of children's physical activity. Determinants of adolescents' physical activity were age (ie, older children were more active), ethnicity (ie, being of African--American descent determined being less physically active) and planning. The authors found insufficient evidence for determinants of sedentary behaviour. CONCLUSION: Studies on determinants of physical activity and sedentary behaviour were in general of poor methodological quality. To develop long-term effective interventions that increase physical activity and decrease time spent in sedentary behaviours in young people, we need more high quality prospective evidence on the determinants of these behaviours.