A high inclusion rate and low drop out rate was achieved. This study will be the first to determine whether school meals based on the NND improve children's diet, health, growth, cognitive performance, and early disease risk markers.

Benign adrenocortical masses often contain lipid; metastases and pheochromocytomas do not. Standard and lipid-sensitive (chemical shift) magnetic resonance (MR) images of the adrenal glands in 31 patients with 45 adrenal masses were reviewed to determine if simple visual analysis of these images would increase diagnostic specificity. Lipid was considered present if signal intensity of the adrenal mass relative to other tissues decreased on chemical shift images relative to comparable standard images. Both myelolipomas and 26 of 27 benign cortical masses displayed a loss of signal intensity on at least one chemical shift image; all 12 metastases, the three hemorrhages, and a cyst did not. Opposed-phase images were slightly more sensitive than fat-suppressed images in depicting lipid within benign cortical masses. All masses had higher signal intensity than that of the liver on standard T2-weighted MR images. Chemical shift MR imaging can demonstrate lipid within benign adrenocortical masses and thus increase specificity, potentially obviating biopsy and aggressive follow-up.

It is safe to implement shared care and nursing consultations as alternatives to rheumatologist consultations for RA outpatients with low disease activity without deterioration in disease control. Nursing consultations can enhance patients' self-efficacy, confidence and satisfaction.

It is widely assumed that nutrition can improve school performance in children; however, evidence remains limited and inconclusive. In the present study, we investigated whether serving healthy school meals influenced concentration and school performance of 8-to 11-year-old Danish children. The OPUS (Optimal well-being, development and health for Danish children through a healthy New Nordic Diet) School Meal Study was a cluster-randomised, controlled, cross-over trial comparing a healthy school meal programme with the usual packed lunch from home (control) each for 3 months (NCT 01457794). The d2 test of attention, the Learning Rating Scale (LRS) and standard tests on reading and mathematics proficiency were administered at baseline and at the end of each study period. Intervention effects were evaluated using hierarchical mixed models. The school meal intervention did not influence concentration performance (CP; primary outcome, n 693) or processing speed; however, the decrease in error percentage was 0·18 points smaller (P,0·001) in the intervention period than in the control period (medians: baseline 2·03 %; intervention 1·46 %; control 1·37 %). In contrast, the intervention increased reading speed (0·7 sentence, P¼0·009) and the number of correct sentences (1·8 sentences, P,0·001), which corresponded to 11 and 25 %, respectively, of the effect of one school year. The percentage of correct sentences also improved (P, 0·001), indicating that the number correct improved relatively more than reading speed. There was no effect on overall math performance or outcomes from the LRS. In conclusion, school meals did not affect CP, but improved reading performance, which is a complex cognitive activity that involves inference, and increased errors related to impulsivity and inattention. These findings are worth examining in future trials.Key words: School meals: Nutrition: Cognition: School performance It is widely considered that a nutritionally balanced diet is beneficial for learning and school performance in children. The influence of diet is plausible, since a poor diet may result in deficiency of nutrients that could play a role in cognitive development (1) . In low-income countries where malnutrition is prevalent, school feeding programmes have consistently shown positive short-term effects on the achievement in academic tests (2) . The relatively high brain metabolism in children also means that children are more vulnerable to fasting compared with adults. In line with this, breakfast skipping has been shown to impair cognitive function and has also been associated with attention problems and lower school grades, especially in younger children (3) . Moreover, carbohydrate quality and glycaemic response of foods may influence shortterm cognitive performance (4) . The dietary composition has also been hypothesised to influence cognition and school performance through effects on neurological factors involved in learning and memory. Components of a 'Western diet', i.e. a diet high in salt, saturated fat and...

Sufficient summer/autumn vitamin D status appears important to mitigate winter nadirs at northern latitudes. We conducted a cross-sectional study to evaluate autumn vitamin D status and its determinants in 782 Danish 8-11-year-old children (55°N) using baseline data from the Optimal well-being, development and health for Danish children through a healthy New Nordic Diet (OPUS) School Meal Study, a large randomised controlled trial. Blood samples and demographic and behavioural data, including 7-d dietary recordings, objectively measured physical activity, and time spent outdoors during school hours, were collected during September-November. Mean serum 25-hydroxyvitamin D (25(OH)D) was 60·8 (SD 18·7) nmol/l. Serum 25(OH)D levels ≤50 nmol/l were found in 28·4 % of the children and 2·4 % had concentrations <25 nmol/l. Upon multivariate adjustment, increasing age (per year) (β −2·9; 95 % CI −5·1, −0·7 nmol/l), female sex (β −3·3; 95 % CI −5·9, −0·7 nmol/l), sampling in October (β −5·2; 95 % CI −10·1, −0·4 nmol/l) and November (β −13·3; 95 % CI −17·7, −9·1), and non-white ethnicity (β −5·7; 95 % CI −11·1, −0·3 nmol/l) were negatively associated with 25(OH)D (all P < 0·05). Likewise, immigrant/descendant background was negatively associated with 25(OH)D, particularly in females (β −16·3; 95 % CI −21·9, −10·7) (P < 0·001) (P interaction = 0·003). Moderate-to-vigorous physical activity (MVPA) (min/d) (β 0·06; 95 % CI 0·01, 0·12), outdoor walking during school hours (min/week) (β 0·4; 95 % CI 0·1, 0·6) and intake of vitamin D-containing supplements ≥3 d/week (β 8·7; 95 % CI 6·4, 11·0) were positively associated with 25(OH)D (all P < 0·05). The high proportion of children with vitamin D status below the recommended sufficiency level of 50 nmol/l raises concern as levels expectedly drop further during winter months. Frequent intake of vitamin D supplements was strongly associated with status. MVPA and outdoor activity during school hours should be investigated further in interventions to improve autumn vitamin D status in children at northern latitudes. Key words: Vitamin D: Children: Northern latitudes: DeterminantsDeterminants of vitamin D status are complex to evaluate but require attention as vitamin D deficiency has been found to occur commonly among, for example, healthy European children and adolescents (1) , and as vitamin D facilitates intestinal Ca absorption and optimal bone health (2,3) . Vitamin D plays a particularly crucial role during childhood growth stages, when accumulation of skeletal Ca increases vastly (4) . The vitamin D metabolite 25-hydroxyvitamin D (25(OH)D) has a half-life of 2-3 weeks, and currently serves as a suitable marker of vitamin D status (5) . Although different cut-off levels are advocated (6) , the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) has recently re-established the recommendation of a 25(OH)D concentration >50 nmol/l (20 ng/ml) to indicate sufficiency (1) . Severe vitamin D deficiency during childhood, established by ESPGHAN as ...