bluuebunny/crossref_metadata_2025 huggingface dataset:
Diarrhoea and child feeding practices in Saudi Arabia
Authors: Bani Ibrahim Ahmed , Saeed Abdallah Abdul Wahid , Othman Abdul Aziz Mohammed Al
Published: February 2003

Objective:

The aim of the study was to estimate the prevalence of diarrhoea in children less than two years old and study the relationship between diarrhoeal episodes and action taken for these episodes by their mothers.

Design:

The prevalence of diarrhoeal episodes among children and its associations with sociodemographic information and anthropometric measurements of the subjects was examined. Predictive factors for morbidity-associated diarrhoeal disease and actions taken for this were explored.

Setting:

Primary health care centres (PHCCs) in Riyadh, Kingdom of Saudi Arabia.

Subjects:

Children less than two years of age.

Results:

Nearly a quarter of the children contracted diarrhoea during the two weeks preceding the data collection point, giving about six episodes of diarrhoea per child per year. Diarrhoea was more common in children over 6 months of age, in children who had no vaccination or follow-up cards, and in those who were taken care of by friends and neighbours if their mothers were working outside the home. The mothers of the affected children were young, married before 25 years of age with 2–6 years of formal schooling. During diarrhoeal episodes, about 25% of mothers stopped or decreased breast-feeding, 11.3% reduced the volume of fluids given to their children, and 22.7% of children were fed less solid/semi-solid foods. Mothers used oral rehydration salt in more than 40% of diarrhoeal episodes and unprescribed antibiotics were used in 17% of cases. The mothers who were not taking appropriate action included young mothers with low education level and those working outside the home.

Conclusion:

Diarrhoea is common in children less than two years old in Riyadh City, and intervention based in PHCCs needs to be undertaken to correct the faulty practices of mothers during diarrhoeal episodes in their children. Health education messages should emphasise feeding during diarrhoeal episodes.
Increased intake of fruit and vegetables: estimation of impact in terms of life expectancy and healthcare costs†
Authors: Gundgaard Jens , Nielsen Jørgen Nørskov , Olsen Jens , Sørensen Jan
Published: February 2003

Objectives:

There is strong evidence that a high consumption of fruit and vegetables reduces the risk of developing many cancers. This study examined the economic consequences for the healthcare sector if people followed the recommendations and increased their intake of fruit and vegetables.

Design:

A life table was used to describe a base case population with respect to life expectancy, cancer incidence and healthcare costs. Relative risks of cancer for a high versus a low intake of fruit and vegetables were obtained from the literature and were used to simulate populations with a higher intake of fruit and vegetables. The empirical data consist of a 20% sample of the Danish population that was followed from 1993 to 1997. Civil registration numbers were used to link various computerised registers, in order to describe each individual in the sample in terms of morbidity, mortality and healthcare costs.

Results:

The average daily intake of fruit and vegetables was assumed to be approximately 250g for the general Danish population. Simulated intakes of 400g and 500g increased the life expectancy by 0.8 and 1.3 years, respectively. In addition, it was estimated that 19% and 32% of the cancer incidence could be prevented. The aggregate healthcare costs remained stable, as the resources saved due to a lower cancer incidence were offset by healthcare costs imposed by the fact that healthy people live longer and require more healthcare. However, the variations across age groups and health sectors were substantial.

Discussion:

The study adopted a healthcare sector perspective. Only costs from hospitalisation and primary care were included in the calculations. The costs of changing people's dietary habits, i.e. education, information and promotion as well as other costs that would be relevant from a societal perspective, have not been taken into account. Furthermore, the transition from one level of intake to another is not the focus of the analysis, although it might take decades to observe the full effect of the dietary changes.

Conclusion:

Empirical evidence suggests that a considerable fraction of all cancer incidences can be prevented by a higher intake of fruit and vegetables. That may result in improved public health (gain in life years) at no additional cost to the healthcare sector.
Effect of a fruit and vegetable subscription in Danish schools
Authors: Eriksen Karen , Haraldsdóttir Jóhanna , Pederson Robert , Flyger Hanne Vig
Published: February 2003

Objective:

To measure the effect of a school fruit and vegetable subscription on children's intake of fruit and vegetables after 5 weeks of intervention.

Setting:

Seven primary schools in Denmark.

Design and methods: Intervention schools (n = 4) were offered a fruit and vegetable subscription comprising one piece per day. Control schools (n = 3) situated in another municipality were not offered the subscription. Intake of fruit and vegetables was measured at baseline and 5 weeks after the start of the subscription. Two methods were used for dietary assessment: a pre-coded 24-hour recall form including total food intake and a food-frequency questionnaire (FFQ) including only fruit and vegetables.

Subjects:

Children aged 6–10 years (n = 804 from intervention schools and n = 689 from control schools). Response rate in the dietary assessment was 31%.

Results:

At intervention schools 45% of the children enrolled in the subscription. After 5 weeks of intervention, both subscribers and non-subscribers had increased their intake of fruit by 0.4 (P = 0.019) and 0.3 (P = 0.008) pieces per school day, respectively, but no change was observed in vegetable intake. Total intake increased only for non-subscribers by 0.4 piece/school day (P = 0.008), mainly due to the consistent increase in fruit intake. No change in intake was measured at control schools. Only the 24-hour recall questionnaire was sensitive enough to pick up the changes of the subscription, whereas the FFQ was not.

Conclusion:

Five weeks with the subscription affected both subscribers and non-subscribers to increase intake of fruit. This may indicate that the subscription had an additional effect of stimulating parents of non-subscribers to supply their children with fruit. The results stress the importance of evaluating the effect of this type of programme, and the carefulness needed in designing the evaluation study.
Validation of the second version of a quantitative food-frequency questionnaire for use in Western Mali
Authors: Parr Christine L , Barikmo Ingrid , Torheim Liv E , Ouattara Fatimata , Kaloga Assitan , Oshaug Arne
Published: February 2003

Objective:

To assess the relative validity of the second version of a quantitative food-frequency questionnaire (QFFQ), designed to measure the habitual food and nutrient intake in one season in rural populations in Western Mali, West Africa.

Design:

The dietary intake during the previous week was assessed with the 164-item QFFQ administered by interview. This was compared with the intake from a 2-day weighed record (WR) with weighed recipes.

Setting:

The village of Ouassala in the Kayes region, Western Mali.

Subjects:

Thirty-four women and 36 men aged 15–45 years, from 29 households.

Results:

The QFFQ gave a lower intake of lunch and dinner and a higher intake of snacks than the WR. The discrepancies were larger for women than for men. The median proportion of subjects classified in the same quartile of intake was 29% for food groups and 36% for energy and nutrients. For classification into extreme opposite quartiles, the median proportion was 6% for food groups and 7% for energy and nutrients. Spearman's rank correlation for energy and nutrients ranged from 0.16 (% energy from protein) to 0.62 (retinol equivalents).

Conclusions:

The second version of the QFFQ tends to underestimate total food weight. The methods used for estimating food portion size should therefore be applied with caution. The changes made from the first version had little effect. The ability to rank subjects according to dietary intake is similar with both versions. The improved layout of the new QFFQ makes it a more user-friendly tool for comparing dietary intake between population groups and for measuring changes over time.
Urbanisation and cariogenic food habits among 4–24-month-old black South African children in rural and urban areas
Authors: MacKeown Jennifer M , Faber Mieke
Published: February 2003

Objective:

To determine if social class, education level and group environment (rural and urban) influence particular food habits commonly associated with dental caries incidence among 4–24-month-old black South African children.

Design, setting and subjects:

Information was collected by trained interviewers using a food-frequency questionnaire from mothers of children in two areas in South Africa: Ndunakazi, a rural area in KwaZulu/Natal (n = 105) and two urban areas in Gauteng – Soweto (low to middle socio-economic area) (n = 100) and the northern suburbs of Johannesburg and Sandton (middle to upper socio-economic area) (n = 101). Education level and occupation of the parents, which define social class, were also recorded. A linear logistic (Proc Catmod) analysis tested social class, education level and group environment as the independent variables and the food habits as the dependent variables.

Results:

Group environment was significantly associated with nine of the 18 food habits investigated. More urban than rural mothers added sugar to their child's comforter. More mothers in urban Soweto than in urban Johannesburg were still breast-feeding their infants at 24 months. More rural than urban mothers were giving ‘mutis’ (common and traditional medicines). Together with group environment, education level was significantly associated with giving of ‘mutis’ and the frequency of giving them. Social class was significantly associated with the frequency of breast-feeding and when the child was breast-fed. Mothers from the upper social class breast-fed less frequently than mothers from the lower class.

Conclusion:

The study showed a strong influence of rural/urban environment on specific cariogenic food habits among young black South African children, enabling the development and implementation of a nutrition strategy.
Size makes a difference
Authors: Matthiessen Jeppe , Fagt Sisse , Biltoft-Jensen Anja , Beck Anne Marie , Ovesen Lars
Published: February 2003

Objective:

To elucidate status and trends in portion size of foods rich in fat and/or added sugars during the past decades, and to bring portion size into perspective in its role in obesity and dietary guidelines in Denmark.

Data sources:

Information about portion sizes of low-fat and full-fat food items was obtained from a 4-day weighed food record (Study 1). Trends in portion sizes of commercial foods were examined by gathering information from major food manufacturers and fast food chains (Study 2). Data on intakes and sales of sugar-sweetened soft drinks and confectionery were obtained through nation-wide dietary surveys and official sales statistics (Study 3).

Results:

Study 1: Subjects ate and drank significantly more when they chose low-fat food and meal items (milk used as a drink, sauce and sliced cold meat), compared with their counterparts who chose food and meal items with a higher fat content. As a result, almost the same amounts of energy and fat were consumed both ways, with the exception of sliced cold meat (energy and fat) and milk (fat). Study 2: Portion sizes of commercial energy-dense foods and beverages, and fast food meals rich in fat and/or added sugars, seem to have increased over time, and in particular in the last 10 years. Study 3: The development in portion sizes of commercial foods has been paralleled by a sharp increase of more than 50% in the sales of sugar-sweetened soft drinks and confectionery like sweets, chocolate and ice creams since the 1970s.

Conclusions:

Larger portion sizes of foods low in fat and commercial energy-dense foods and beverages could be important factors in maintaining a high energy intake, causing over-consumption and enhancing the prevalence of obesity in the population. In light of this development, portion size ought to take central place in dietary guidelines and public campaigns.
Calibration of the dietary questionnaire for the Canadian Study of Diet, Lifestyle and Health cohort
Authors: Jain Meera G , Rohan Thomas E , Soskolne Colin L , Kreiger Nancy
Published: February 2003

Objective:

For proper interpretation of results from epidemiological studies that use food-frequency questionnaires (FFQs), it is necessary to know the relationship between reported intakes from the FFQ and true usual intake. In this paper, we report a calibration study conducted to investigate the performance of the FFQ used in a cohort study, the Canadian Study of Diet, Lifestyle and Health.

Methods:

Over a 1-year period, 151 men and 159 women completed a full set of questionnaires including a self-administered baseline FFQ, three 24-hour diet recalls administered by telephone, and a second FFQ self-administered subsequently. The association between the nutrient estimates derived from the FFQs and the diet recalls was evaluated by calculating deattenuated Pearson's correlation coefficients.

Results:

The FFQs estimated mean daily nutrient intakes higher than the diet recalls. When the log-transformed and energy-adjusted nutrient intakes from the average of three 24-hour recalls were compared against the baseline FFQ, the following deattenuated correlations were obtained in men and women, respectively: total energy 0.44 and 0.32, total fat 0.64 and 0.68, saturated fat 0.68 and 0.70, dietary fibre 0.65 and 0.44, vitamin E 0.32 and 0.37, vitamin C 0.40 and 0.37, β-carotene 0.34 and 0.29, alcohol 0.74 and 0.67, caffeine 0.81 and 0.76, with a median correlation of 0.49 and 0.53. Correlations between the second FFQ and diet recalls were similar. The correlations between the two FFQs as a test of reliability had a median value 0.64 for men and 0.63 for women for selected nutrients.

Conclusions:

The study suggests that the FFQ method gives acceptable levels of nutrients or food component estimates, as assessed by this calibration study against diet recalls, when limited to energy-adjusted and deattenuated values.
Complex correlation structure in consumption rates of major food groups: implications for the assessment of radiation exposure
Authors: Breuninger Melanie I , Schachtel Gabriel A , Lührmann Petra M , Hartmann Bernd , Neuhäuser-Berthold Monika
Published: February 2003

Objective:

An extensive dataset on individual food consumption was analysed in order to study all pairwise correlations between the consumption rates of 11 major food groups. Additionally, the project aimed to examine and quantify the accuracy of a recently proposed estimator of total food consumption to be used for the estimation of radiation exposure by food. Such an inquiry seems justified, because the proposed estimator implicitly presumes an essentially positive correlation structure in food consumption rates.

Design:

Statistical analysis using representative data gathered in Germany in a nation-wide food consumption survey.

Setting:

Germany.

Subjects:

Individuals aged between 4 and 94 years namely 10901 males and 12308 females.

Results:

The consumption rates of 11 major food categories showed several significantly positive, but also a number of significantly negative, correlations. Negative associations between cereal and potato products persisted consistently over all age groups, independent of sex. Other significantly negative correlations were limited to certain age groups. Reflecting these negative correlations, a subsequent analysis of relative ranks of consumption revealed that no person in the sample had the highest consumption rates in all food groups simultaneously. Based on representative samples, overestimations of 34 to 53% were obtained if – as recently suggested in the context of radiation exposure prediction – the 95th percentiles of total food consumption were determined as sums of the corresponding percentiles of the food groups.

Conclusions:

The complex correlation structure of food group consumption rates, as identified in this study, bears important implications for various health-related issues. Ignoring them could lead to overly conservative estimations of radiation exposure due to food ingestion or to confounding effects in epidemiological studies on nutritional risk factors of diseases. The results also indicate that a distinction into different dietary patterns might be useful in characterising different consumption habits.
Insights on food and nutrition in the Federated States of Micronesia: a review of the literature
Authors: Englberger Lois , Marks Geoffrey C , Fitzgerald Maureen H
Published: February 2003

Background:

Nutrition-related disorders, including vitamin A deficiency (VAD) and chronic diseases, are serious problems in the Federated States of Micronesia (FSM). Many suggest that these disorders are new problems related to dietary and lifestyle changes. In the past four decades, imported foods, such as white rice, flour, sugar, refined foods and fatty meats, have increasingly replaced local foods in the diet.

Aim:

A literature review was conducted to understand underlying issues related to dietary change and obtain insights for nutrition research and interventions.

Method:

Published and unpublished papers from different disciplines were reviewed and collated for information on food and nutrition in FSM. Topics covered were historical background, local foods, infant and child feeding, dietary assessment, and nutritional status. Particular focus was on information and data relating to VAD, the primary topic that led to the review of the literature.

Conclusions:

FSM, a tropical country of abundant agricultural resources, has suffered a great loss in production and consumption of local foods. Inconsistent external and internal government policies and food aid programmes have contributed to the problem. Further research on the nutrient content of local foods and factors affecting production, acquisition and consumption is needed, as well as a broad, well-planned, intersectoral intervention aimed at dietary improvement for all age groups in the population.
Achievement of dietary fatty acid intakes in long-term controlled intervention studies: approach and methodology
Authors: Nydahl MC , Smith RD , Kelly CNM , Fielding BA , Williams CM
Published: February 2003

Objectives:

To describe the calculations and approaches used to design experimental diets of differing saturated fatty acid (SFA) and monounsaturated fatty acid (MUFA) compositions for use in a long-term dietary intervention study, and to evaluate the degree to which the dietary targets were met.

Design, setting and subjects:

Fifty-one students living in a university hall of residence consumed a reference (SFA) diet for 8 weeks followed by either a moderate MUFA (MM) diet or a high MUFA (HM) diet for 16 weeks. The three diets were designed to differ only in their proportions of SFA and MUFA, while keeping total fat, polyunsaturated fatty acids (PUFA),trans-fatty acids, and the ratio of palmitic to stearic acid, andn– 6 ton– 3 PUFA, unchanged.

Results:

Using habitual diet records and a standardised database for food fatty acid compositions, a sequential process of theoretical fat substitutions enabled suitable fat sources for use in the three diets to be identified, and experimental margarines for baking, spreading and the manufacture of snack foods to be designed. The dietary intervention was largely successful in achieving the fatty acid targets of the three diets, although unintended differences between the original target and the analysed fatty acid composition of the experimental margarines resulted in a lower than anticipated MUFA intake on the HM diet, and a lower ratio of palmitic to stearic acid compared with the reference or MM diet.

Conclusions:

This study has revealed important theoretical considerations that should be taken into account when designing diets of specific fatty acid composition, as well as practical issues of implementation.
Urinary iodine excretion in pregnant women residing in areas with adequate iodine intake
Authors: Azizi F , Aminorroya A , Hedayati M , Rezvanian H , Amini M , Mirmiran P
Published: February 2003

Objective:

Pregnancy is accompanied by profound alterations in thyroid economy and relative iodine deficiency. The aim of this study was to evaluate urinary iodine excretion of pregnant women in cities with adequate and more than adequate iodine intake.

Methods:

A cross-sectional study was performed on schoolchildren and pregnant women in four cities in the Islamic Republic of Iran. Urinary iodine excretion was measured for 438 schoolchildren and 403 pregnant women. In addition, in Isfahan City, thyroid volume was measured by sonography for 30 pregnant women in each trimester of pregnancy and for 90 non-pregnant women who also had urinary iodine measurement.

Results:

Median urinary iodine of schoolchildren was 31.2, 25.0, 20.2 and 19.3 μg/dl in Rasht, Isfahan, Ilam and Tehran, respectively. Corresponding values for pregnant women were 33.8, 21.2, 19.0 and 18.6μg/dl. The percentage of pregnant women with urinary iodine below 20μg/dl was 16, 45, 55 and 54, and below 10μg/dl was 1, 7, 7 and 13, in Rasht, Isfahan, Ilam and Tehran, respectively. In Isfahan, urinary iodine was significantly decreased in the third trimester of pregnancy, compared with controls. Mean thyroid volume was 7.8±3.1 ml and 7.8±2.8 ml in pregnant and non-pregnant women, respectively.

Conclusion:

Recommended values for dietary iodine through universal salt iodisation may not be adequate for pregnant women, and the specific problem of iodine and pregnancy should be considered further in the light of the latest recommendations.
Department of Health Research Initiative on Nutrition Phase 2: overview of findings and recommendations
Authors: Hughes Joyce M
Published: February 2003

Objective:

The purpose of this overview is to synthesise and summarise the findings and recommendations of all 14 projects funded between 1997 and 2002 under Phase 2 of the Department of Health's Policy Research Programme Nutrition Initiative. This is aimed at end users, including policy makers, practitioners, researchers and research funding bodies.

Design:

The main findings and recommendations for policy and practice, as well as for future research, contained in the peer-reviewed final report of each project are summarised under headings identified as being useful for policy groups and practitioners: Maintenance of a healthy weight; Functional outcomes related to different markers of iron status; Nutritional aspects of bone health in humans; and Dietary interventions.

Results:

The overview draws together the key findings and recommendations for current and future policy and practice from the second phase of the research programme and identifies research gaps.

Conclusions:

The findings and recommendations of the Department of Health's Nutrition Research Initiative have contributed to the scientific evidence base for policy development, policy evaluation, and will inform practitioners as well as researchers and research funding bodies.
The Boyd Orr Lecture: Nutrition interventions in aging and age-associated disease
Authors: Meydani Mohsen
Published: February 2003

Aging is a complex biological process, which usually is accompanied by changes in socioeconomic status, which may have a great impact on the physical and nutritional status of the elderly. Decreased food intake and a sedentary lifestyle in the growing numbers of the elderly increase their risk for malnutrition, decline of bodily functions and developing chronic diseases. Oxidative stress is believed to be an important factor in aging and many age-associated degenerative diseases. Modulation of oxidative stress by energy restriction in animals has been shown to be one of the mechanisms for retarding the aging process. Dietary antioxidants are regarded as being important in modulating oxidative stress of aging and age-associated diseases. Supplementation of the elderly with vitamin E has been shown to enhance immune response, delay onset of Alzheimer's disease, and increase resistance to oxidative injury associated with exercise. Vitamin E, in comparison with other antioxidants, is also effective in reducing viral titres, but not the longevity of middle-aged mice. Our studies have indicated that polyphenols or vitamin E may assist in preventing cardiovascular disease, in part by decreasing expression by endothelial cells of proinflammatory cytokines, adhesion molecules, and monocyte adhesion. Most recently, we have found that some of these antioxidants may prevent tumour growth by inhibiting angiogenesis via suppression of interleukin 8 and modulation of the cell junction molecule, VE-cadherin. These findings provide further support for the consumption of fruit and vegetables, which contain several forms of phytochemicals with antioxidant activity, in order to reduce the risk of cardiovascular disease and cancer, the leading causes of morbidity and mortality among the elderly.
Nutritional epidemiology of cancer: accomplishments and prospects
Authors: Lagiou Pagona , Trichopoulou Antonia , Trichopoulos Dimitrios
Published: February 2003

Nutritional epidemiology of cancer has gone through several stages. Initially, the long latency of cancer, the difficulties in undertaking long-term cohort investigations or ascertaining remote diet in case-control studies, and the absence of convenient intermediate biomarkers of disease, such as cholesterol in cardiovascular diseases, discouraged studies on diet and cancer. Subsequently, however, epidemiological successes in the chemical, viral and occupational aetiology of cancer, and the increasing insight into the sources of variation of diet and dietary information, prompted investigators to undertake both case-control and cohort studies. The results have been mixed. On the one hand, vegetables and fruits have been shown to be inversely associated with several forms of cancer. On the other hand, the information concerning specific macro- or micronutrients in relation to particular forms of cancer has been very limited and mostly inconclusive. There are several reasons for the complexity of investigations of the nutritional epidemiology of cancer and these reasons are briefly considered. An overview of our current understanding of the nutritional causes of cancer is also presented. It is noted that, notwithstanding the substantial gaps in our scientific knowledge, preventive nutritional approaches can be envisaged and they are likely to be moderately succeessful.
Antioxidant strategies for Alzheimer's disease
Authors: Grundman Michael , Delaney Patrick
Published: February 2003

Oxidative damage is present within the brains of patients with Alzheimer's disease (AD), and is observed within every class of biomolecule, including nucleic acids, proteins, lipids and carbohydrates. Oxidative injury may develop secondary to excessive oxidative stress resulting from β-amyloid-induced free radicals, mitochondrial abnormalities, inadequate energy supply, inflammation or altered antioxidant defences. Treatment with antioxidants is a promising approach for slowing disease progression to the extent that oxidative damage may be responsible for the cognitive and functional decline observed in AD. Although not a uniformly consistent observation, a number of epidemiological studies have found a link between antioxidant intake and a reduced incidence of dementia, AD and cognitive decline in elderly populations. In AD clinical trials molecules with antioxidant properties such as vitamin E andGinkgo bilobaextract have shown modest benefit. A clinical trial with vitamin E is currently ongoing to determine if it can delay progression to AD in individuals with mild cognitive impairment. Combinations of antioxidants might be of even greater potential benefit for AD, especially if the agents worked in different cellular compartments or had complementary activity (e.g. vitamins E, C and ubiquinone). Naturally-occurring compounds with antioxidant capacity are available and widely marketed (e.g. vitamin C, ubiquinone, lipoic acid, β-carotene, creatine, melatonin, curcumin) and synthetic compounds are under development by industry. Nevertheless, the clinical value of these agents for AD prevention and treatment is ambiguous, and will remain so until properly designed human trials have been performed.
Changes in fat synthesis influenced by dietary macronutrient content
Authors: Parks Elizabeth J.
Published: February 2003

De novolipogenesis is the biological process by which C2precursors of acetyl-CoA are synthesized into fatty acids. In human subjects consuming diets higher in fat (>30 % energy), lipogenesis is down regulated and extremely low; typically < 10 % of the fatty acids secreted by the liver. This percentage will increase when dietary fat is reduced and replaced by carbohydrate, although the extent of carbohydrate-induced lipogenesis is dependent on the type of carbohydrate (monosaccharidev. polysaccharide) and the form in which the carbohydrate is fed (liquid meals, solid less-processed food). Clearly, massive overconsumption of carbohydrate can also increase lipogenesis. A second related phenomenon that occurs when dietary fat is reduced is hypertriacylglycerolaemia. This rise in blood triacylglycerol concentration could be due to increasedde novolipogenesis or to reduced clearance of lipid from the blood. The present paper will review the metabolic mechanisms leading to the elevations in blood triacylglycerol concentration that occur with dietary fat reduction. Studies considered will be those investigating fatty acid synthesis in subjects chronically fed low-fat high-carbohydrate diets and studies in which data were obtained in both the fasted and fed states. Also summarized will be data from subjects who had consumed diets of different carbohydrate types, as well as the most recent data from postprandial studies investigating factors that affect the magnitude of the rise in blood lipids following a meal. Given the changing availability of carbohydrate in the food supply, it will be important to understand how the balance of fat and carbohydrate in the diet influences lipogenesis, and the relative contribution of the process ofde novolipogenesis to the escalating incidence of obesity observed around the world.
Low-fat diets and energy balance: how does the evidence stand in 2002?
Authors: Astrup Arne , Buemann Benjamin , Flint Anne , Raben Anne
Published: February 2003

The role of high-fat diets in weight gain and obesity is assessed by evidence-based principles. Four meta-analyses of weight change occurring onad libitumlow-fat diets in intervention trials consistently demonstrate a highly significant weight loss of 3–4 kg in normal-weight and overweight subjects (P< 0·001). The analyses also find a dose-response relationship, i.e. the reduction in percentage energy as fat is positively associated with weight loss. Weight loss is also positively related to initial weight; a 10 % reduction in dietary fat is predicted to produce a 4–5 kg weight loss in an individual with a BMI of 30kg/m2. The non-fat macronutrient composition of the diet is also important. Whereas the glycaemic index of the carbohydrate may play a role for cardiovascular risk factors, there is so far no evidence that low-glycaemic index foods facilitate weight control. In contrast, intervention studies show that sugar in drinks is more likely to produce weight gain than solid sugar in foods. Although the evidence is weak, alcoholic beverages promote a positive energy balance, and wine may be more obesity-promoting than beer. Protein is more satiating and fhermogenic than carbohydrates, and one intervention study has shown that anad libitumlow-fat diet where carbohydrate was replaced by protein produced more weight loss after 6 months (8·1v. 5·9 kg). The evidence linking particular fatty acids to body fatness is weak. If anything, monounsaturated fat may be more fattening than polyunsaturated and saturated fats, and noad libitumdietary intervention study has shown that a normal-fat high-monounsaturated fatty acid diet is equivalent or superior to a low-fat diet in the prevention of weight gain and obesity. The evidence strongly supports the low-fat diet as the optimal choice for the prevention of weight gain and obesity, while the use of a normal-fat high-monounsaturated fatty acid diet is unsubstantiated.
Fortification strategies to meet micronutrient needs: sucesses and failures
Authors: Darnton-Hill Ian , Nalubola Ritu
Published: February 2003

Food fortification is likely to have played an important role in the current nutritional health and well-being of populations in industrialized countries. Starting in the early part of the 20th century, fortification was used to target specific health conditions: goitre with iodized salt; rickets with vitamin D-fortified milk; beriberi, pellagra and anaemia with B-vitamins and Fe-enriched cereals; more recently, in the USA, risk of pregnancy affected by neural-tube defects with folic acid-fortified cereals. A relative lack of appropriate centrally-processed food vehicles, less-developed commercial markets and relatively low consumer awareness and demand, means it has taken about another 50 years for fortification to be seen as a viable option for the less-developed countries. The present paper reviews selected fortification initiatives in developing countries to identify different factors that contributed to their successful implementation, as well as the challenges that continually threaten the future of the se programmes. Ultimately, the long-term sustainability of fortification programmes is ensured when consumers are willing and able to bear the additional cost of fortified foods. There has been an enormous increase in fortification programmes over the last couple of decades in developing countries. Considerable progress has been made in reducing vitamin A and I deficiencies, although less so with Fe, even as Zn and folic acid deficiencies are emerging as important public health problems. Food fortification based on sound principles and supported by clear policies and regulations can play an increasingly large role in this progress towards prevention and control of micronutrient malnutrition.
Meeting the challenges of micronutrient deficiencies in emergency-affected populations
Authors: Prinzo Z. Weise , de Benoist B.
Published: February 2003

Micronutrient deficiencies occur frequently in refugee and displaced populations. These deficiency diseases include, in addition to the most common Fe and vitamin A deficiencies, scurvy (vitamin C deficiency), pellagra (niacin and/or tryptophan deficiency) and beriberi (thiamin deficiency), which are not seen frequently in non-emergency-affected populations. The main causes of the outbreaks have been inadequate food rations given to populations dependent on food aid. There is no universal solution to the problem of micronutrient deficiencies, and not all interventions to prevent the deficiency diseases are feasible in every emergency setting. The preferred way of preventing these micronutrient deficiencies would be by securing dietary diversification through the provision of vegetables, fruit and pulses, which may not be a feasible strategy, especially in the initial phase of a relief operation. The one basic emergency strategy has been to include a fortified blended cereal in the ration of all food-aid-dependent populations (United Nations High Commissioner for Refugees/World Food Programme, 1997). In situations where the emergency-affected population has access to markets, recommendations have been to increase the general ration to encourage the sale and/or barter of a portion of the ration in exchange for locally-available fruit and vegetables (World Health Organization, 1999a, b, 2000). Promotion of home gardens as well as promotion of local trading are recommended longer-term options aiming at the self-sufficiency of emergency-affected households. The provision of fortified blended foods in the general ration has successfully prevented and controlled micronutrient deficiencies in various emergency settings. However, the strategy of relying only on fortified blended foods to prevent micronutrient deficiencies should be reviewed in the light of recurring evidence that provision of adequate supplies of these foods is often problematic. Donor policies on the bartering or exchange of food aid should also be clarified. Furthermore, the establishment of micronutrient surveillance systems, including standardized micronutrient deficiency diagnostic criteria, are vital for the control of micronutrient deficiency diseases.
Developmental issues in attitudes to food and diet
Authors: Hill Andrew J.
Published: February 2003

As a rule, children and most adults eat what they like and leave the rest. They like and consume foods high in fat and sugar. Parental behaviour shapes food acceptance, and early exposure to fruit and vegetables or to foods high in energy, sugar and fat is related to children's liking for, and consumption of, these foods. Some parents are imposing child-feeding practices that control what and how much children eat. However, over-control can be counter-productive, teaching children to dislike the very foods we want them to consume, and generally undermining self-regulation abilities. The external environment is also important, with concerns expressed about food advertising to children and girls dieting for an ideal thin body shape. Up to one-quarter of young adolescent girls report dieting to lose weight, their motivation driven by weight and shape dissatisfaction. For some, dieting and vegetarianism are intertwined and both legitimised as healthy eating. For others, striving for nutritional autonomy, the choice of less-healthy foods is not just because of their taste, but an act of parental defiance and peer solidarity. The determinants of what children choose to eat are complex, and the balance changes as children get older. A better understanding is crucial to informing how we might modify nutritional behaviour. Adults occupy a central position in this process, suggesting that children should be neither the only focus of nutritional interventions nor expected to solve the nutritional problems with which adults around them are continuing to fail.
Is there a potential therapeutic value of copper and zinc for osteoporosis?
Authors: Lowe Nicola M , Fraser William D , Jackson Malcolm J
Published: February 2003

Osteoporosis is almost universal in very old age, and is a major cause of morbidity and mortality in the elderly of both sexes. Bone is lost at a rate of 0·2–0·5 %/year in both men and women after the age of 40–45 years. The causes of age-related changes in bone mass are multifactorial and include genetic predisposition, nutritional factors, endocrine changes, habitual exercise levels and body weight. Bone loss is accelerated to 2–5 % year immediately before and for up to 10 years post-menopause (Heaney, 1986). In women hormone-replacement therapy is effective in reducing the rate of bone loss caused by this peri-menopausal decrease in hormone levels (Smith & Studd, 1993); however, in men and older women (>10 years post-menopause) nutrition plays a key role in the rate of bone loss. One factor contributing to bone loss in the elderly may be a subclinical Zn and/or Cu deficiency, due to a reduced dietary intake of micronutrients and reduced absorption (Thomson & Keelan, 1986). Zn and Cu are essential cofactors for enzymes involved in the synthesis of various bone matrix constituents. Paradoxically, Ca supplementation may accentuate the problem of reduced Zn and Cu levels by impairing the absorption of simultaneously-ingested Zn and the retention of Cu (Snedeker et al. 1982; Grekas et al. 1988). The present paper will review the current literature on the potential benefits of Cu and Zn supplementation in reducing bone loss, and present new information on the effect of Ca supplementation on Zn and Cu status in post-menopausal women with osteoporosis.
Food-based strategies to meet the challenges of micronutrient malnutrition in the developing world
Authors: Tontisirin Kraisid , Nantel Guy , Bhattacharjee Lalita
Published: February 2003

The purpose of the present paper is to review the evidence in favour of food-based strategies to meet the challenges of micronutrient malnutrition in the developing world. Increasing dietary diversification is the most important factor in providing a wide range of micronutrients, and to achieve this objective in a development context requires an adequate supply, access and consumption of a variety of foods. Diets in developing countries generally lack many nutrients, including energy (inadequate amounts of food), so that strategies need to also emphasize an increase in total food intake, in addition to a greater variety. Agricultural and food policies tend to be oriented to primary agricultural productions, but they could also be formulated to promote and support home gardens and small livestock production for the explicit purpose of increasing the household consumption of micronutrient-rich foods. The adoption of ‘desirable’ dietary patterns for nutrition improvement, e.g. appropriately formulated to meet micronutrient needs, could be used in the formulation of agricultural policies and programmes. This process could be achieved through support for integrated farming systems oriented to assuring household food security, but also based on a variety of foods that will meet total dietary (including micronutrient) needs. Thus, availability of energy-rich staples, animal and/or fish as major sources of protein, and vitamin-, mineral- and phytonutrient-rich fruit and vegetables could constitute the types of production envisaged. The cultivation of edible indigenous plants as additional sources of micronutrients could also be added. The low bioavailability of some key micronutrients from foods, such as Fe, are substantially enhanced with the right food combinations and with appropriate food processing and preparation techniques. Simple appropriate technology for the preservation of micronutrientrich foods would need further development and promotion for their year-round availability. Linking community development policies to national programmes for the alleviation of hunger and malnutrition, with an emphasis on increasing the variety of foods consumed, is probably the best strategy for improving micronutrient malnutrition sustainably.
The production of food: from quantity to quality
Authors: McInemey John
Published: February 2003

The present paper presents a non-technical overview of contemporary developments in food supply, as seen from the standpoint of economic adjustment. The historical concerns over availability and price of food have now passed in the UK, and agriculture is no longer dominantly driven by the supply-side forces of new farming technology and the stimulus of support policies. As a now demand-driven sector of the economy, it is the developing diversity of consumer food preferences that will increasingly determine the adjustment path of agricultural production. Those demands seek distinctive elements of food value, many of which are entirely created and delivered by industries beyond the farm gate. However, many of the quality characteristics of food that consumers increasingly seek are associated explicitly with what takes place on farms and how crop and livestock husbandry is conducted. In responding to these demand preferences many farmers will shift from being merely raw material producers to becoming genuine producers of food, or capturing more of the final value of the products consumed. As a result a dual structure within farming will develop, with a ‘quality agriculture’ becoming increasingly differentiated from a ‘commodity agriculture’ as two distinct strategies for farm business survival.
Dietary fat: assessing the evidence in support of a moderate-fat diet; the benchmark based on lipoprotein metabolism
Authors: Kris-Etherton P. M. , Binkoski A. E. , Zhao G. , Coval S. M. , Clemmer K. F. , Hecker H. D. , Jacques H. , Etherton T. D.
Published: February 2003

There is a growing database that has evaluated the effects of varying amounts of total fat on risk factors for cardiovascular disease, diabetes and overweight and obesity. The evidence clearly suggests that extremes in dietary fat should be avoided, and instead a diet moderate in total fat (25–35 % energy) is preferable for the majority of individuals. Moreover, we now appreciate the importance of individualizing dietary fat recommendations within this range of total fat. With respect to cardiovascular disease, a diet higher in total fat (30–35 % energy) affects the lipid and lipoprotein risk profile more favourably than a lower-fat diet; this is also the case for individuals with diabetes, with the added benefit of better glycaemic control. Dietary fibre (≧25g/d) attenuates and even prevents the potentially adverse lipid and lipoprotein effects of a lower-fat diet. With respect to weight control, a moderate-fat diet can be as, or even more, effective than a lower-fat diet, because of advantages with long-term adherence and potentially favourable effects on lipids and lipoproteins. Thus, there is now a convincing scientific basis to advocate a diet moderate in total fat for the majority of individuals. Implicit to this position is that unsaturated fat has numerous beneficial health effects. However, because fat is energy dense, moderation in fat intake is essential for weight control. Consequently, a simple message to convey is to avoid diets that are very low and very high in fat. Moreover, within the range of a moderate-fat diet it is still important to individualize the total fat prescription. Nonetheless, the guiding principle is that moderation in total fat is the defining benchmark for a contemporary diet that reduces risk of chronic disease.
Effects of micronutrient supplements on u.v.-induced skin damage
Authors: Jackson M. J. , McArdle F. , Storey A. , Jones S. A. , McArdle A. , Rhodes L. E.
Published: February 2003

Development of an orally-administered systemic agent that could reduce the effects of u.v. exposure on skin could potentially have a major effect on the incidence of skin cancers and photo-ageing. A number of micronutrients have been suggested to have metabolic properties that could induce this protection, and our data indicate that n–3 polyunsaturated fatty acids are particularly effective in this role. The mechanisms of action of n–3 polyunsaturated fatty acids appear to depend on their anti-inflammatory properties, acting to reduce the u.v.-induced release of cytokines and other mediators from a variety of skin cell types.