To evaluate the impact on nutrition- and health-related practice of two methods of delivery of a nutrition and health intervention in Irish full-day-care pre-schools: training of pre-school managers only or training of managers and their staff.

A simple randomised study with pre-schools divided into two training groups: ‘manager trained’ and ‘manager and staff trained’. Direct observational data – food and fluid provision, physical activity, outdoor time, staff practices and availability of nutrition and health resources – were recorded during one full day spent in each pre-school both pre- and post-intervention, using a specifically developed and validated Pre-school Health Promotion Activity Scored Evaluation Form. Post-intervention, self-assessment data were also collected using the same evaluation tool.

Pre-schools, Midlands of Ireland.

A convenience sample of forty-two pre-schools registered with the Irish Health Service Executive.

From pre- to post-intervention, significant improvement (P < 0·05) in nutrition- and health-related practice was observed within both intervention delivery groups in all areas evaluated: environment, food service, meals and snacks. No additional effect attributable to staff training was observed. Scores assigned by direct independent observation were lower than pre-school self-assessment scores.

The implementation of a training intervention in pre-schools significantly improved practice with no significant benefit of additional staff training. Direct independent observation is required to quantify practice accurately.

To determine the presence of nutrition labels on pre-packaged food products, as well as to analyse the types of presentation.

This was a descriptive study. The following characteristics were analysed: (i) presence and placement of the nutrition declaration (either as front-of-pack (FOP) or back-of-pack (BOP)); (ii) content of the presented information; (iii) presence of nutrition and health claims; and (iv) legibility of the written information.

Three different types of retailers in Belgrade, Serbia.

A total of 2138 pre-packaged food products from ten categories.

A nutrition declaration was found on 65·9 % of all tested products. It was displayed on the back of the packaging of 62·7 % of products and on the front of the packaging of 19·1 % of products. BOP was the most commonly observed in breakfast cereals, soft drinks, milk and instant soups (in total over 90 %), and the least common in meat products (21·5 %). FOP was predominantly displayed on breakfast cereals (65·0 %) and the least frequently on milk products (2·4 %). The ‘Big 4’ (energy value, protein, carbohydrate and fat contents) and the ‘Big 4 with additional information’ figured on 40·9 % of products. The ‘Big 8’ (‘Big 4’ plus sugar, saturated fat, fibre and sodium contents) and the ‘Big 8 with additional information’ were present less frequently (20·5 %). Nutrition claims and health claims appeared on very few products (6·6 % and 6·3 %, respectively). The proportion of products with insufficient legibility was 31·5 %.

Nutrition labelling in Belgrade, Serbia is not satisfactory. Mandatory regulations may be the best way to improve the current situation.

While vegetables are often studied as one food group, global measures may mask variation in the types and forms of vegetables preferred by different individuals. To explore preferences for and perceptions of vegetables, we assessed main food preparers based on their preparation of eight specific vegetables and mushrooms.

An online self-report survey.

Ontario, Canada. Measures included perceived benefits and obstacles of vegetables, convenience orientation and variety seeking in meal preparation.

Of the 4517 randomly selected consumers who received the invitation, 1013 responded to the survey (22·4 % response). Data from the main food preparers were analysed (n 756).

Latent profile analysis indicated three segments of food preparers. More open to new recipes, the ‘crucifer lover’ segment (13 %) prepared and consumed substantially more Brussels sprouts, broccoli and asparagus than the other segments. Although similar to the ‘average consumer’ segment (54 %) in many ways, the ‘frozen vegetable user’ segment (33 %) used significantly more frozen vegetables than the other segments due to higher prioritization of time and convenience in meal preparation and stronger ‘healthy=not tasty’ perception. Perception of specific vegetables on taste, healthiness, ease of preparation and cost varied significantly across the three consumer segments. Crucifer lovers also differed with respect to shopping and cooking habits compared with the frozen vegetable users.

The substantial heterogeneity in the types of vegetables consumed and perceptions across the three consumer segments has implications for the development of new approaches to promoting these foods.

To evaluate the association between eating away from home and BMI and to examine whether dietary intake differs based on the consumption of away-from-home food (AFHF).

Data were obtained from the first Brazilian National Dietary Survey, using food records. The association between the percentage of energy provided by foods consumed away from home and BMI status was tested using logistic regression models. The mean percentages of energy provided by protein, fat, saturated fat and free sugars were calculated based on the consumption of foods away from home among AFHF consumers.

Urban areas of Brazil.

Adults (n 13 736) between 25 and 65 years old.

AFHF was not associated with BMI status. Individuals who consumed AFHF had higher intakes of free sugars away from home than at home and had higher intakes of energy-dense foods than AFHF non-consumers.

Although AFHF consumption was not related to overweight or obesity status, individuals who consumed foods away from home had higher intakes of energy-dense foods. Public health policies should be implemented to help people make healthier food choices away from home.

Few published community garden studies have focused on low socio-economic youth living in public housing or used a community-based participatory research approach in conjunction with youth-focused community garden programmes. The objective of the present study was to evaluate the feasibility (i.e. demand, acceptability, implementation and limited-effectiveness testing) of a 10-week experiential theory-based gardening and nutrition education programme targeting youth living in public housing.

In this mixed-methods feasibility study, demand and acceptability were measured using a combination of pre- and post-programme surveys and interviews. Implementation was measured via field notes and attendance. Limited-effectiveness was measured quantitatively using a pre–post design and repeated-measures ANOVA tests.

Two public housing sites in the Dan River Region of south central Virginia, USA.

Forty-three youth (primarily African American), twenty-five parents and two site leaders.

The positive demand and acceptability findings indicate the high potential of the programme to be used and be suitable for the youth, parents and site leaders. Field notes revealed numerous implementation facilitators and barriers. Youth weekly attendance averaged 4·6 of 10 sessions. Significant improvements (P<0·05) were found for some (e.g. fruit and vegetable asking self-efficacy, overall gardening knowledge, knowledge of MyPlate recommendations), but not all limited-effectiveness measures (e.g. willingness to try fruits and vegetables, fruit and vegetable eating self-efficacy).

This community-based participatory research study demonstrates numerous factors that supported and threatened the feasibility of a gardening and nutrition programme targeting youth in public housing. Lessons learned are being used to adapt and strengthen the programme for future efforts targeting fruit and vegetable behaviours.

To evaluate the associations of women’s autonomy and social support with infant and young child feeding practices (including consumption of highly processed snacks and sugar-sweetened beverages) and nutritional status in rural Nicaragua.

Cross-sectional study. Feeding practices and children’s nutritional status were evaluated according to the WHO guidelines complemented with information on highly processed snacks and sugar-sweetened beverages. Women’s autonomy was assessed by a seventeen-item questionnaire covering dimensions of financial independence, household-, child-, reproductive and health-related decision making and freedom of movement. Women’s social support was determined using the Duke-UNC Functional Social Support Questionnaire. The scores attained were categorized into tertiles.

Los Cuatro Santos area, rural Nicaragua.

A total of 1371 children 0–35 months of age.

Children of women with the lowest autonomy were more likely to be exclusively breast-fed and continue to be breast-fed, while children of women with middle level of autonomy had better complementary feeding practices. Children of women with the lowest social support were more likely to consume highly processed snacks and/or sugar-sweetened beverages but also be taller.

While lower levels of autonomy and social support were independently associated with some favourable feeding and nutrition outcomes, this may not indicate a causal relationship but rather that these factors reflect other matters of importance for child care.

To examine the prevalence of household food insecurity and compare dietary intake by food security status in a representative Korean population.

Cross-sectional. Food security status of households was classified using an eighteen-item food security questionnaire. The nutrition survey comprised questions on dietary habits, a 24 h dietary recall and a semi-quantitative FFQ.

The 2012 Korea National Health and Nutrition Examination Survey.

A total of 3007 households completed the food security questionnaire. Family members within each household aged ≥1 year (n 7118) participated in the nutrition survey.

Results from the 2012 survey indicated that 88·7 % of Korean households showed food security. The remaining 11·3 % (9·3 % for food insecurity without hunger and 2·0 % for food insecurity with hunger) were in food-insecure households. The prevalence of household food insecurity was 13·2 % in households with children and 10·3 % in households without children. Mean daily intakes of energy, fat and carbohydrates were not significantly different between food-secure and food-insecure adults. In contrast, mean daily intakes of protein, crude fibre, vitamins and minerals as well as weekly consumption frequencies of vegetables, seaweeds, fruits, fruit juice, nuts, and milk and milk products were significantly lower in food-insecure adults compared with food-secure adults.

The study demonstrated that food insecurity is associated with reduced intakes of healthy foods and nutrients essential for health and growth in a representative Korean population.

To analyse the Na content and labelling of processed and ultra-processed food products marketed in Brazil.

Cross-sectional study.

A large supermarket in Florianopolis, southern Brazil.

Ingredient lists and Na information on nutrition labels of all processed and ultra-processed pre-prepared meals and prepared ingredients, used in lunch or dinner, available for sale in the supermarket.

The study analysed 1416 products, distributed into seven groups and forty-one subgroups. Five products did not have Na information. Most products (58·8 %; 95 % CI 55·4, 62·2 %) had high Na content (>600 mg/100 g). In 78·0 % of the subgroups, variation in Na content was at least twofold between similar products with high and low Na levels, reaching 634-fold difference in the ‘garnishes and others’ subgroup. More than half of the products (52·0 %; 95 % CI 48·2, 55·6 %) had at least one Na-containing food additive. There was no relationship between the appearance of salt on the ingredients list (first to third position on the list) and a product’s Na content (high, medium or low; P=0·08).

Most food products had high Na content, with great variation between similar products, which presents new evidence for reformulation opportunities. There were inconsistencies in Na labelling, such as lack of nutritional information and incomplete ingredient descriptions. The position of salt on the ingredients list did not facilitate the identification of high-Na foods. We therefore recommend a reduction in Na in these products and a review of Brazilian legislation.

To determine the association of gestational weight gain (GWG) or pre-pregnancy BMI with postpartum weight retention (PPWR).

Meta-analysis.

PubMed, Cochrane Controlled Trials Register, EMBASE, Science Citation Index Expanded, Current Contents Connects and Biosis Previews were used to search articles.

Publications that described the influence of pre-pregnancy BMI or GWG on PPWR.

Seventeen studies that satisfied the eligibility criteria were included in the analyses. Women with inadequate and excessive GWG had significantly lower mean PPWR of −2·14 kg (95 % CI –2·43, –1·85 kg) and higher PPWR of 3·21 kg (95 % CI 2·79, 3·62 kg), respectively, than women with adequate GWG. When postpartum time spans were stratified into 1–3 months, 3–6 months, 6–12 months, 12–36 months and ≥15 years, the association between inadequate GWG and PPWR faded over time and became insignificant (−1·42 kg; 95 % CI −3·08, 0·24 kg) after ≥15 years. However, PPWR in women with excess GWG exhibited a U-shaped trend; that is, a decline during the early postpartum time span (year 1) and then an increase in the following period. Meta-analysis of qualitative studies showed a significant relationship between excessive GWG and higher PPWR risk (OR=2·08; 95 % CI 1·60, 2·70). Moreover, meta-analysis of pre-pregnancy BMI on PPWR indicated that mean PPWR decreased with increasing BMI group.

These findings suggest that GWG, rather than pre-pregnancy BMI, determines the shorter- or longer-term PPWR.

Whole-grain intake among children is well below recommendations. The purpose of the present study was to test the acceptability and liking of pizza made with whole-grain crust compared with refined-grain crust among children in restaurant and school settings.

Plate waste data were collected via observation from child restaurant patrons consuming pizza made with either whole-grain or refined-grain crust. Waste was estimated by trained observers over eight months (August 2012–March 2013). Percentage waste was calculated and compared by crust type. A taste test was conducted with school children who tasted pizza made with whole-grain crust alongside pizza made with refined-grain crust and rated their liking of each product. Liking ratings were compared by crust type.

Five Green Mill restaurant (a Midwest US chain) locations and one elementary school in the Minneapolis/St. Paul metropolitan area, Minnesota, USA.

Child restaurant patrons (n 394) and school children (n 120, grades 3–5).

Children consumed as much of the pizza made with whole-grain crust (42·1 %) as the pizza made with refined-grain crust (44·6 %; P=0·55), based on an average serving size of 350–400 g. Liking ratings for both types of pizza were high (>4·5 of 5) and did not differ by crust type (P=0·47).

These positive consumption and liking outcomes indicate that whole-grain pizza crust is well accepted among children in a restaurant setting. The impact on whole-grain intake could be substantial if large, national restaurant chains served pizza made with whole-grain crust.

The present study aimed to (i) evaluate the reproducibility and validity of a designed FFQ, (ii) apply the FFQ for estimating the dietary intakes of four flavonols and two flavones in female adolescents and (iii) explain their major dietary sources.

The reproducibility between the first and second FFQ administrations (1 year interval) was estimated using the intra-class correlation coefficient. The validity of the first FFQ relative to the average of four three-day 24 h dietary recalls (24-HR) from four seasons was assessed using the Spearman correlation coefficient. Using a flavonoid content database, the individual flavonol and flavone intakes were calculated and the major food sources were estimated.

Middle school in Suihua area of Heilongjiang Province, northern China.

Female adolescents (n 887) aged 12–18 years.

Better reproducibility and validity were obtained in the present study. The flavonol and flavone intakes were 16·29 and 4·31 mg/d, respectively. Quercetin and kaempferol were the major contributors (26·8 % and 23·7 %, respectively) to the total intake of flavonols and flavones. The main food sources of flavonols and flavones were apples (14·1 %), followed by potatoes (7·5 %), lettuce (7·3 %) and oranges (7·3 %).

The dietary flavonol and flavone intakes among female adolescents in northern China were similar to those reported in several countries, but significant differences were observed in the food sources ascribed to the geographical location and dietary characteristics.

To understand stakeholders’ perspectives on food waste in a universal free School Breakfast Program implementing a Breakfast in the Classroom model.

Semi-structured focus groups and interviews were conducted with school district stakeholders. Inductive methods were used to code resulting transcripts, from which themes were identified. The analysis provides a thematic analysis of stakeholders’ perspectives on food waste in the School Breakfast Program.

Ten elementary schools in a large urban school district implementing a universal free Breakfast in the Classroom model of the US national School Breakfast Program.

Elementary-school students (n 85), parents (n 86), teachers (n 44), cafeteria managers (n 10) and school principals (n 10).

Stakeholders perceived food waste as a problem and expressed concern regarding the amount of food wasted. Explanations reported for food waste included food-related (palatability and accessibility), child-related (taste preferences and satiation) and programme-related (duration, food service policies, and coordination) factors. Milk and fruit were perceived as foods particularly susceptible to waste. Several food waste mitigation strategies were identified by participants: saving food for later, actively encouraging children’s consumption, assisting children with foods during mealtime, increasing staff support, serving smaller portion sizes, and composting and donating uneaten food.

Stakeholders recognized food waste as a problem, reported myriad contributing factors, and have considered and employed multiple and diverse mitigation strategies. Changes to the menu and/or implementation logistics, as well as efforts to use leftover food productively, may be possible strategies of reducing waste and improving the School Breakfast Program’s economic, environmental and nutritional impact.

The present study was performed to describe the operational implications of using mid-upper arm circumference (MUAC) as a single admission criterion for treatment of severe acute malnutrition in South Sudan.

We performed a retrospective analysis of routine programme data of children with severe acute malnutrition aged 6–59 months admitted to a therapeutic feeding programme using weight-for-height Z-score (WHZ) and/or MUAC. To understand the implications of using MUAC as a single admission criterion, we compared patient characteristics and treatment outcomes for children admitted with MUAC<115 mm (irrespective of WHZ) v. children admitted with WHZ<−3 and MUAC≥115 mm.

Of 2205 children included for analysis, 719 (32·6 %) were admitted to the programme with MUAC<115 mm and 1486 (67·4 %) with WHZ<−3 and MUAC≥115 mm. Children who would have been admitted using a single MUAC<115 mm criterion were more severely malnourished and more likely to be female and younger. Compared with children admitted with WHZ<−3 and MUAC≥115 mm, children who would have been admitted using MUAC<115 mm were less likely to recover (54 % v. 69 %) and had higher risk of death (4 % v. 1 %), but responded to treatment with greater weight and MUAC gains. MUAC<115 mm would have failed to identify 33 % of deaths, while 98 % were identified by WHZ<−3 alone and 100 % by MUAC<130 mm.

The study shows that MUAC<115 mm identified more severely malnourished children with a higher risk of mortality but failed to identify a third of the children who died. Admission criteria for therapeutic feeding should be adapted to the programmatic context with consideration for both operational and public health implications.

We conducted a cluster-randomized controlled trial to assess the efficacy of a cereal made from caterpillars, a micronutrient-rich, locally available alternative animal-source food, on reducing stunting and anaemia in infants in the Democratic Republic of Congo.

Six-month-old infants were cluster randomized to receive either caterpillar cereal daily until 18 months of age or the usual diet. At 18 months of age, anthropometric measurements and biological samples were collected.

The rural Equateur Province in the Democratic Republic of Congo.

One hundred and seventy-five infants followed from 6 to 18 months of age.

Stunting was common at 6 months (35 %) and the prevalence increased until 18 months (69 %). There was no difference in stunting prevalence at 18 months between the intervention and control groups (67 % v. 71 %, P=0·69). Infants in the cereal group had higher Hb concentration than infants in the control group (10·7 v. 10·1 g/dl, P=0·03) and fewer were anaemic (26 v. 50 %, P=0·006), although there was no difference in estimates of body Fe stores (6·7 v. 7·2 mg/kg body weight, P=0·44).

Supplementation of complementary foods with caterpillar cereal did not reduce the prevalence of stunting at 18 months of age. However, infants who consumed caterpillar cereal had higher Hb concentration and fewer were anaemic, suggesting that caterpillar cereal might have some beneficial effect. The high prevalence of stunting at 6 months and the lack of response to this micronutrient-rich supplement suggest that factors other than dietary deficiencies also contribute to stunting.

School garden programmes have become popular action-oriented learning environments in many countries, often driven by converging priorities of environmental sustainability and healthful diets. Many of these programmes have assessed the impact on dietary intake, specifically fruit and vegetable intake, and related dietary behaviours, such as knowledge, preference, motivation, intention and self-efficacy to eat and prepare fruit and vegetables. The objective of the present study was twofold: (i) to review published garden-based programmes conducted in schools targeting dietary intake and/or determinants of dietary behaviour in children; and (ii) to identify similar strategies and components employed by these garden-based programmes.

The review included thirteen studies that have examined the impact of garden-based programmes conducted in school, either during school hours or in after-school settings, on dietary behaviours in children (kindergarten through 8th grade students).

Three of the reviewed studies did not have a comparison or control group and simply evaluated within-group changes after a garden intervention. None of the reviewed studies were randomized, but were assigned based on school’s interest and timing of new school gardens being built. Out of the eleven programmes that examined dietary intake, six found that the programme resulted in increased vegetable intake, whereas four showed no effect. Seven of the eight studies that measured preference found that the programmes resulted in increased preference for vegetables. Gardening programmes also resulted in improved attitudes towards, willingness to taste, identification of and self-efficacy to prepare/cook fruit and vegetables. Similar strategies/components employed by the majority of the programmes included: ‘hands on’ curriculum, incorporation of a cooking component, providing the instructors, parental and stakeholder support, food provision and using the garden as the focal point for media promotion.

Some of the garden programmes resulted in increased vegetable intake, which has positive implications for both environment sustainability and health-related outcomes. Further, the majority resulted in some improvement in behaviour determinants more generally. However, more research is warranted to understand how to achieve long-term improvements in dietary behaviours and how to sustain the garden-based programmes in schools.

To assess the reproducibility and validity among adults in the Southern Cone of Latin America (Argentina, Chile and Uruguay) of a self-administered FFQ to be used in the CESCAS I Study, an ongoing observational prospective cohort study to detect and follow up CVD and their risk factors, as well as in other epidemiological studies.

Relative validity of the FFQ was evaluated by comparing nutrient and selected food group intakes with those from three 24 h recalls (24HR) administered over 6 months. The FFQ was administered at baseline (FFQ1) and again after 3 months (FFQ2).

Primary-care centres in Argentina, Chile and Uruguay.

Adults (n 147) aged 21–74 years.

Reproducibility (FFQ1 v. FFQ2): the intra-class correlation coefficients for nutrients ranged from 0·52 (potassium) to 0·74 (fat). Validity (FFQ1 v. the average of three 24HR): the Pearson correlations for energy-adjusted nutrients ranged from 0·39 (thiamin and cholesterol) to 0·59 (carbohydrate). Joint classification: overall, 66 % of participants in the lowest 24HR quintile were in the lowest one or two FFQ1 quintiles, and 62 % of those in the highest 24HR quintile were in the highest one or two FFQ1 quintiles. On average, only 4 % were misclassified into extreme quintiles.

The FFQ version for the Southern Cone seems to present moderate to acceptable relative validity and reliability for its use in the CESCAS I Study to measure dietary exposure.

The 2H dilution technique is the reference method to estimate total body water for body composition assessment. The aims of the present study were to establish the total body water technique at the Kuwait Institute for Scientific Research and assess body composition of Kuwaiti children.

The isotope ratio mass spectrometer was calibrated with defined international reference water standards. A non-random sampling approach was used to recruit a convenience sample of Kuwaiti children. A dose of 2H2O, 1–3 g, was consumed after an overnight fast and 2H enrichment in baseline and post-dose urine samples was measured. Total body water was calculated and used to estimate fat-free mass. Fat mass was estimated as body weight minus fat-free mass.

The total body water study was implemented in primary schools.

Seventy-five boys and eighty-three girls (7–9 years).

Measurements of the isotope ratio mass spectrometer were confirmed to be accurate and precise. Children were classified as normal weight, overweight or obese according to the WHO based on BMI-for-age Z-scores. Normal-weight and overweight girls had significantly higher percentage body fat (median (range): 32·4 % (24·7–39·3 %) and 38·3 % (29·3–44·2 %), respectively) compared with boys (median (range): 26·5 % (14·2–37·1 %) and 34·6 % (29·9–40·2 %), respectively). No gender difference was found in obese children (median 46·5 % v. 45·6 %).

The establishment of a state-of-the-art stable isotope laboratory for assessment of body composition provides an opportunity to explore a wide range of applications to better understand the relationship between body size, body composition and risk of developing non-communicable diseases in Kuwait.

The objective was to investigate parents’ motives for selecting foods for their children and the associations between these motives and children’s food preferences.

Cross-sectional survey. A modified version of the Food Choice Questionnaire was used to assess parents’ food choice motives. Parents also reported children’s liking/disliking of 176 food and beverage items on 5-point Likert scales. Patterns of food choice motives were examined with exploratory principal component analysis. Associations between motives and children’s food preferences were assessed with linear regression while one-way and two-way ANOVA were used to test for sociodemographic differences.

Two Australian cities.

Parents (n 371) of 2–5-year-old children.

Health, nutrition and taste were key motivators for parents, whereas price, political concerns and advertising were among the motives considered least important. The more parents’ food choice for their children was driven by what their children wanted, the less children liked vegetables (β =−0·27, P<0·01), fruit (β=−0·19, P<0·01) and cereals (β=−0·28, P<0·01) and the higher the number of untried foods (r=0·17, P<0·01). The reverse was found for parents’ focus on natural/ethical motives (vegetables β=0·17, P<0·01; fruit β=0·17, P<0·01; cereals β=0·14, P=0·01). Health and nutrition motives bordered on statistical significance as predictors of children’s fruit and vegetable preferences.

Although parents appear well intentioned in their motives for selecting children’s foods, there are gaps to be addressed in the nature of such motives (e.g. selecting foods in line with the child’s desires) or the translation of health motives into healthy food choices.

Peer counselling (PC) programmes have been shown to improve breast-feeding outcomes in populations at risk for early discontinuation. Our objective was to describe associations between programme components (individual and combinations) and breast-feeding outcomes (duration and exclusivity) in a PC programme for low-income women.

Secondary analysis of programme data. Multivariable-adjusted Cox proportional hazards models were used to examine associations between type and quantity of peer contacts with breast-feeding outcomes. Types of contacts included in-person (hospital or home), phone or other (e.g. mail, text). Quantities of contacts were considered ‘optimal’ if they adhered to standard programme guidelines.

Programme data collected from 2005 to 2011 in Michigan’s Breastfeeding Initiative Peer Counseling Program.

Low-income (n 5886) women enrolled prenatally.

For each additional home, phone and other PC contact there was a significant reduction in the hazard of discontinuing any breast-feeding by 6 months (hazard ratio (HR)=0·90 (95 % CI 0·88, 0·92); HR=0·89 (95 % CI 0·87, 0·90); and HR=0·93 (95 % CI 0·90, 0·96), respectively) and exclusive breast-feeding by 3 months (HR=0·92 (95 % CI 0·89, 0·95); HR=0·90 (95 % CI 0·88, 0·91); and HR=0·93 (95 % CI 0·89, 0·97), respectively). Participants receiving greater than optimal in-person and less than optimal phone contacts had a reduced hazard of any and exclusive breast-feeding discontinuation compared with those who were considered to have optimum quantities of contacts (HR=0·17 (95 % CI 0·14, 0·20) and HR=0·28 (95 % CI 0·23, 0·35), respectively).

Specific components of a large PC programme appeared to have an appreciable impact on breast-feeding outcomes. In-person contacts were essential to improving breast-feeding outcomes, but defining optimal programme components is complex.

Fast foods are often energy dense and offered in large serving sizes. Observational data have linked the consumption of fast foods to an increased risk of obesity and related diseases.

We surveyed the reported energy, total fat and saturated fat contents, and serving sizes, of fast-food items from five major chains across ten countries, comparing product categories as well as specific food items available in most countries.

MRC Human Nutrition Research, Cambridge, UK.

Data for 2961 food and drink products were collected, with most from Canada (n 550) and fewest from the United Arab Emirates (n 106).

There was considerable variability in energy and fat contents of fast foods across countries, reflecting both the portfolio of products and serving size variability. Differences in total energy between countries were particularly noted for chicken dishes (649–1197 kJ/100 g) and sandwiches (552–1050 kJ/100g). When comparing the same product between countries variations were consistently observed in total energy and fat contents (g/100 g); for example, extreme variation in McDonald’s Chicken McNuggets with 12 g total fat/100 g in Germany compared with 21·1 g/100 g in New Zealand.

These cross-country variations highlight the possibility for further product reformulation in many countries to reduce nutrients of concern and improve the nutritional profiles of fast-food products around the world. Standardisation of serving sizes towards the lower end of the range would also help to reduce the risk of overconsumption.