BackgroundCross-country differences in dietary behaviours and obesity rates have been previously reported. Consumption of energy-dense snack foods and soft drinks are implicated as contributing to weight gain, however little is known about how the availability of these items within supermarkets varies internationally. This study assessed variations in the display of snack foods and soft drinks within a sample of supermarkets across eight countries.MethodsWithin-store audits were used to evaluate and compare the availability of potato chips (crisps), chocolate, confectionery and soft drinks. Displays measured included shelf length and the proportion of checkouts and end-of-aisle displays containing these products. Audits were conducted in a convenience sample of 170 supermarkets across eight developed nations (Australia, Canada, Denmark, Netherlands, New Zealand, Sweden, United Kingdom (UK), and United States of America (US)).ResultsThe mean total aisle length of snack foods (adjusted for store size) was greatest in supermarkets from the UK (56.4 m) and lowest in New Zealand (21.7 m). When assessed by individual item, the greatest aisle length devoted to chips, chocolate and confectionery was found in UK supermarkets while the greatest aisle length dedicated to soft drinks was in Australian supermarkets. Only stores from the Netherlands (41%) had less than 70% of checkouts featuring displays of snack foods or soft drinks.ConclusionWhilst between-country variations were observed, overall results indicate high levels of snack food and soft drinks displays within supermarkets across the eight countries. Exposure to snack foods is largely unavoidable within supermarkets, increasing the likelihood of purchases and particularly those made impulsively.

Background:We reported previously that lowering dietary protein intake in young healthy women to 0.7 g/kg depressed intestinal calcium absorption and was accompanied by elevations in parathyroid hormone (PTH). Moderate amounts of dietary protein (1.0 g/kg) did not appear to perturb calcium homeostasis. Objective: The purpose of this study was to evaluate the effect of graded intakes of dietary protein (0.7, 0.8, 0.9, and 1.0 g/kg) on calcium homeostasis. Design: The experiment consisted of 2 wk of a well-balanced diet containing moderate amounts of calcium, sodium, and protein followed by 4 d of an experimental diet containing 1 of 4 amounts of protein. Eight young healthy women received the 4 amounts of protein in random order. The average age of the subjects was 23.1 ± 2.3 y, their weight was 64 ± 3 kg, and their body mass index (in kg/m 2 ) was 24.3 ± 0.9. Results: Elevations in PTH developed by day 4 of the diets containing 0.7 and 0.8 g protein/kg but not during the diets containing 0.9 or 1.0 g protein/kg. By day 4 of the 0.7-and 0.8-g/kg diets, midmolecule PTH, calcitriol, and nephrogenous cyclic adenosine monophosphate were 1.5-3.5-fold higher than on day 0. Calcitropic hormones on day 4 of the diets containing 0.8 and 0.9 g protein/kg were within the normal range and 23-57% lower than values observed with the 0.7-and 0.8-g/kg diets (P < 0.005). Mean 24-h urinary calcium was 3.29 ± 0.35 mmol with the diet containing 0.7 g protein/kg and 3.54 ± 0.46 mmol with the diet containing 1.0 g protein/kg. Conclusions: Our data suggest that in young healthy women consuming a well-balanced diet, the current recommended dietary allowance for protein (0.8 g/kg) results in short-term perturbations in calcium homeostasis.Am J Clin Nutr 2000;72:168-73. KEY WORDSDietary protein, calcium metabolism, calcitropic hormones, vitamin D, parathyroid hormone, young healthy women, recommended dietary allowance INTRODUCTIONThe effect of dietary protein on calcium metabolism in humans was first documented nearly 80 y ago (1). There has been considerable investigative interest in the potential negative effects of a high-protein diet on mineral and skeletal homeostasis. For example, increasing dietary protein induces urinary calcium loss, negatively affects calcium balance (2), increases bone turnover (3), and may be associated with an increased risk of fracture (4). However, the effect of low-protein diets on calcium and bone homeostasis has received considerably less attention.We reported that in 16 young healthy women, 4 d of a lowprotein diet decreased urinary calcium excretion and was accompanied by elevations in calcitropic hormones; 1.5-3-fold increases were observed in concentrations of serum parathyroid hormone (PTH), 1,25(OH) 2 vitamin D (calcitriol), and urinary nephrogenous cyclic adenosine monophosphate (NcAMP; a bioindex of PTH action). The low-protein diet contained an average of 45 g protein (0.7 g/kg), including both animal and vegetable sources of protein; 20 mmol calcium; and 100 mmol sodium and was otherwi...

Background. We investigated differences in family social class associations between food outlet exposure and fruit and vegetable intake. Methods. We supplemented data from the 2006 Health Behavior in School Aged Children Study (n = 6, 096) with geocoded food outlet information surrounding schools (n = 80). We used multilevel logistic regression to examine associations between infrequent fruit and vegetable intake and supermarket and fast food outlet concentration, stratified by family social class. Results. Boys and older children were most likely to eat fruit and vegetables infrequently. High fast food outlet exposure was marginally significant for low fruit intake in low social class children only. Children from middle and low social class backgrounds attending schools with combined high fast food outlet/low supermarket exposure were most likely to report infrequent fruit intake (ORlow = 1.60; CI:  1.02–2.45; ORmid = 1.40; CI:  1.03–190). Children from low social class backgrounds were also likely to report infrequent vegetable intake, given low supermarket and high fast food outlet exposure (OR = 1.79; CI:  0.99–3.21). Conclusion. Our findings suggest social class modifies the relationship between intake and food outlet concentration. School interventions improving fruit and vegetable intake should consider neighborhood surroundings, targetting older children from low social class backgrounds.

Objective: We examined associations between fast-food intake and perceived and objective fast-food outlet exposure. Design: Information from the Health Behaviours in School-aged Children Study was linked to fast-food outlets in seventy-five school neighbourhoods. We used multivariate multilevel logistic regression analyses to examine associations between at least weekly fast-food intake and perceived and objective fast-food outlet measures. Subjects: Data represent 4642 adolescents (aged 11-15 years) in Denmark. Results: Boys reporting two or more fast-food outlets had 34 % higher odds consuming fast food at least weekly. We detected higher odds of at least weekly fast-food intake among 15-year-old 9th graders (OR all = 1·74; 95 % CI 1·40, 2·18; OR boys = 2·20; 95 % CI 1·66, 2·91; OR girls = 1·41; 95 % CI 1·03, 1·92), Danish speakers (OR all = 2·32; 95 % CI 1·68, 3·19; OR boys = 2·58; 95 % CI 1·69, 3·93; OR girls = 2·37; 95 % CI 1·46, 3·84) and those travelling 15 min or less to school (OR all = 1·21; 95 % CI 1·00, 1·46; OR girls = 1·44; 95 % CI 1·08, 1·93) compared with 11-year-old 5th graders, non-Danish speakers and those with longer travel times. Boys from middle-(OR = 1·28; 95 % CI 1·00, 1·65) and girls from low-income families (OR = 1·46; 95 % CI 1·05, 2·04) had higher odds of at least weekly fast-food intake compared with those from high-income backgrounds. Girls attending schools with canteens (OR = 1·47; 95 % CI 1·00, 2·15) had higher odds of at least weekly fastfood intake than girls at schools without canteens. Conclusions: The present study demonstrates that perceived food outlets may impact fast-food intake in boys while proximity impacts intake in girls. Public health planning could target food environments that emphasize a better understanding of how adolescents use local resources.

Background: Intermittent monitoring of fruit and vegetable intake at the population level is essential for the evaluation and planning of national dietary interventions. Yet, only a limited number of studies on time trends in fruit and vegetable intake among children and adolescents have been published internationally. In Denmark, national comprehensive campaigns to enhance fruit and vegetable consumption were initiated in 2001. This paper describes secular trends in fruit intake among Danish adolescents by six comparable school surveys from 1988 to 2006. The paper demonstrates and discusses the consequences of measurement changes introduced in long-term trend analyses.

Objective: We examined the quality of food outlet addresses provided by secondary sources and determined whether they could be physically located in the field. Design: Addresses of food outlets in fourteen school districts in the northern part of Copenhagen were obtained from multiple business locators. We geocoded 202 addresses using a geographic information system and cross-referenced the sources against each other using a validation grid. Physical presence was determined via street survey. We applied gamma statistics and calculated positive predictive value, sensitivity and percentage agreement to assess the overall correspondence between our test of physical presence and each source of secondary information. Setting: The study took place within city boundaries of Copenhagen, Denmark. Subjects: Food outlets within fourteen school districts within Copenhagen. Results: Positive predictive value between field results and secondary sources indicated good to excellent correspondence (range: 0?81-0?98), comparable with other studies. Gamma coefficients indicated low to high positive correspondence (range: 0?23-0?98). Conclusions: Despite moderately high correspondence between secondary sources of address information and field observation, the findings illustrate that the use of combined sources is recommended.

Objective: To investigate whether exposure to fast-food outlets and supermarkets is socio-economically patterned in the city of Copenhagen. Design: The study was based on a cross-sectional multivariate approach to examine the association between the number of fast-food outlets and supermarkets and neighbourhood-level socio-economic indicators. Food business addresses were obtained from commercial and public business locators and geocoded using a geographic information system for all neighbourhoods in the city of Copenhagen (n 400). The regression of counts of fast-food outlets and supermarkets v. indicators of socio-economic status (percentage of recent immigrants, percentage without a high-school diploma, percentage of the population under 35 years of age and average household income in Euros) was performed using negative binomial analysis. Setting: Copenhagen, Denmark. Subjects: The unit of analysis was neighbourhood (n 400). Results: In the fully adjusted models, income was not a significant predictor for supermarket exposure. However, neighbourhoods with low and mid-low income were associated with significantly fewer fast-food outlets. Using backwise deletion from the fully adjusted models, low income remained significantly associated with fast-food outlet exposure (rate ratio 5 0?66-0?80) in the final model. Conclusions: In the city of Copenhagen, there was no evidence of spatial patterning of supermarkets by income. However, we detected a trend in the exposure to fast-food outlets, such that neighbourhoods in the lowest income quartile had fewer fast-food outlets than higher-income neighbourhoods. These findings have similarities with studies conducted in the UK, but not in the USA. The results suggest there may be socio-economic factors other than income associated with food exposure in Europe.

Background:To investigate socioeconomic patterning of physical activity resources in Copenhagen.Methods:We used multivariate logistic regression analysis to examine the association between physical activity-supportive resources [public open space (POS), cycling and walking paths, sports facilities, and intersection density] and neighborhood sociodemographic indicators (low education, recent immigrants, children under 15 yr, and household income).Results:Neighborhoods with high proportions of residents with low education were most likely to have POS (OR = 2.63; CI: 2.10–3.29), paths (OR = 3.60; CI: 2.84–4.56) and sports facilities (OR = 5.96; CI: 4.31–8.24). Mid-to-low income areas were less likely to contain POS (OR = 67; CI: 0.49–0.90), paths (OR = 0.36; CI: 0.26–0.50), and sports facilities (OR = 0.48; CI: 0.30–0.77). Areas with children were less likely to have connected streets (OR = 0.51; CI: 0.31–0.83) but more likely to have POS (OR = 1.40; CI: 1.15–1.70) and paths (OR = 1.52; CI: 1.25–1.85).Conclusions:Residents living in areas with high proportions of low education or young children are likely to have high exposure to physical activity resources. Exposure to physical activity resources in Copenhagen may not explain the inequalities in physical activity behavior. Further examination of exposure to built environment resources is warranted.