bluuebunny/crossref_metadata_2025 huggingface dataset:
Vitamin status in different groups of the Spanish population: a meta-analysis of national studies performed between 1990 and 1999
Authors: Ortega RM , Mena MC , Faci M , Santana JF , Serra-Majem L
Published: February 2003

Objective:

Studies performed on the nutritional status of the Spanish population have been very heterogeneous with respect to methodology, sample size, geographical location, socio-economic level and health status of the subjects involved. In order to gain an overall view of the state of knowledge in this area, a meta-analysis was performed on the results of all such studies undertaken in Spain between 1990 and 1999.

Results:

The dietetic data reviewed showed mean intakes similar to those recommended. The results obtained for the biochemical parameters analysed were within normal limits. However, results for some vitamins were very close to the lower established limits for the reference intervals (recommended intakes or blood levels), meaning that a variable percentage of subjects show values lower than those recommended. The percentage of subjects with intakes below those recommended for niacin, vitamin B12 and C was small. The percentage of inadequate intakes of thiamine and riboflavin was small as well. However, for all other vitamins, especially D and E, the number of people with intakes below recommended was rather high, particularly so in some studies. At blood level, deficiencies of vitamins B12, A and E were infrequent. However, for all other vitamins, prevalence of deficiency varied within a wide range. With respect to vitamins D, B1, B2 and B6, over 50% of the population showed inadequate levels.

Conclusions:

The methodologies used in the studies included in this review were very varied and the knowledge gained is still incomplete. Despite the average Spanish diet often being regarded as satisfactory, this review and other studies show the situation can be improved.
Fortified foods. Criteria for vitamin supplementation in Spain
Authors: Serra-Majem Lluís , Ortega Rosa , Aranceta Javier , Entrala Alfredo , Gil Angel
Published: February 2003

Objective:

To review and analyse criteria for vitamin supplementation and fortification in Spain.

Design:

Systematic review of scientific literature and simulation analysis of food fortification.

Methods:

A simulation analysis using a fortified beverage was performed in a random sample of 2855 children aged 2 to 24 years in Spain.

Results:

High-risk groups for vitamin supplementation and fortification in Spain are highlighted, and target vitamins considered have been: folic acid, vitamin A, vitamin E, vitamin D and vitamin B12 (particularly in the elderly). A beverage fortified with vitamins C, A, B1 and B6 may contribute to improving the intake of all of these vitamins with the exception of vitamin A, since the Recommended Nutrient Intake is already covered with current consumption.

Conclusions:

A detailed knowledge of nutritional status helps to ensure the rationale and follow up of nutrient supplementation and fortification.
Early nutrition and risk of disease in the adult
Authors: Caballero Benjamin
Published: February 2003

The differentiation of key metabolic systems that occurs during intrauterine life is greatly influenced by environmental nutritional conditions, which in turn are related to maternal nutritional status. In postnatal life, childhood exposure to slow-acting environmental factors, primarily through the diet, will begin to condition adult susceptibility to diseases. Examples of these dietary factors are intake of saturated fat, sodium, calcium, etc. For example, bone calcium accumulation during childhood and adolescence will be a major determinant of risk of osteoporosis later in life. Similarly, a high intake of saturated fat during childhood may promote the process of atherosclerosis in persons with genetic susceptibility, thus accelerating the clinical manifestations of coronary heart disease in adult life.

These findings, although still not completely clarified, constitute a significant opportunity for preventive intervention. While preventive intervention in adult life may reduce risk, this is usually difficult and results are often limited. One example would be obesity. In contrast, interventions early in life, aimed at reducing these early risk factors, could potentially result in major reductions in the incidence of several diseases of adults.
School health services and community nutrition: a historical perspective
Authors: Rezola Juan Gondra , Santolaya Javier , Orduna Javier , Dehesa Francisco
Published: February 2003

The Bilbao School Health Service was created at the beginning of the century with the aim of preventing transmittable diseases among children as well as improving nutrition. At that time such services were established in many other countries. Since then, according to evolving societal changes and emerging needs, the Service has reoriented its scope and structure towards the Health Promotion scheme.

Current tasks include health screening examinations and hygiene surveillance as well as preventive and health education programmes.
School meals in Catalonia: surveillance and quality control
Authors: Roset M Asunción , Gonzalvo Blanca
Published: February 2003

The Education Council of the Catalonian government drew up a programme to improve the quality control of school canteens in Catalonia. The objectives of this programme were to contribute to developing healthier eating habits in school children through school canteens and to improve school canteen services considering other aspects such as service, operation, management, end-users, frontline staff and supervisors of menu planning.

This paper deals with two programme components aiming at introducing Nutrition in the school syllabus and school menu assessment. Various departments, organisations and associations were involved in programme development and implementation.

Initial analysis was based on information collected from formal administrative reports completed by a survey on 100 primary schools. From this preliminary analysis it was concluded that problem identification needs to be completed by an understanding of underlying reasons in order to design adequate solutions and guarantee implementation.
Breast-feeding in Spain
Authors: de la Torre MJ Lozano , Martín-Calama J , Hernandez-Aguilar MT
Published: February 2003

Human milk is the best way to nurture the human infant. By breast-feeding their babies, mothers provide them with the best opportunities to wholly develop their potential, while protecting the infants and themselves from a whole range of diseases in the near future and in the years to come.

Even though these benefits are widely known and there is ample scientific evidence on the topic, it seems from published data that Spanish women are not breast-feeding their babies as much and for as long as they should. Less than 90% start breast-feeding, at 1 month there is already an attrition of 30%, at 3 months more than half of the infants are taking artificial milk and by 6 months only 10% continue to breast-feed their infants.

Low birth weight, Caesarean section and low study level are among the more significant factors that negatively affect breast-feeding.

There is still work to do to improve this situation. Promotion of breast-feeding among the general population, mothers and health professionals is needed.
Breast-feeding in Europe – rationale and prevalence, challenges and possibilities for promotion
Authors: Yngve Agneta , Kylberg Elisabeth , Sjöström Michael
Published: February 2003

The status reports and other information collected showed that interpretation of the data on breast-feeding prevalence and duration collected at national or regional level within European countries is difficult, since this information is not collected in every country or it is gathered under different criteria. However, there seem to be vast differences in prevalence of breast-fed children and breast-feeding duration between European countries and possibly within countries. There is a need to establish monitoring systems enabling comparability of data between countries. Assessing determinants for breast-feeding is required as well. There are a number of important consensus documents supporting breast-feeding action. These documents are related to either one or more of the following categories: health benefits of breastfeeding; recommendations regarding breast-feeding duration and exclusiveness; providing guidance on breast-feeding promotion. Current recommendation is exclusive breast-feeding for 6 months.
Dietary guidelines for the breast-feeding woman
Authors: Cervera Pilar , Ngo Joy
Published: February 2003

Sociodemographic and economic changes in Spain have played a role in the choice of infant feeding as more and more women enter the workforce. Nevertheless, the prevalence of breast-fed-only infants at 6 weeks remains fairly high, at 65.5% in 1999, although there is a sharp decline by 3 and 6 months postpartum. Achieving adequate nutritional status for lactation principally begins during pregnancy, as this constitutes the biological stage for accumulating nutrient stores. The benefits of breast-feeding for the mother and infant are presented, along with nutrition and dietary guidelines for the nursing woman. Apart from dietary considerations, special attention should be paid to encouraging a positive attitude and environment for breast-feeding success.
Preventive nutritional supplementation throughout the reproductive life cycle
Authors: Fernández-Ballart Joan , Murphy Michelle M
Published: February 2003

Current interest in preventive nutritional supplementation strategies during the reproductive cycle in developed countries focuses mainly on iron and folic acid. Iron deficiency is the most common cause of anaemia. Inadequate iron nutrition is mainly a problem in developing countries but it also seems to affect a large proportion of pregnant women in the industrialised world. There is no chance for diet modification alone to meet iron requirements during pregnancy. However, dietary advice must be provided to increase iron intake and iron bioavailability. The best choice is prescribed supplementation adapted to the individual's needs.

Folic Acid supplementation during the periconceptional period reduces the occurrence and recurrence of neural tube defects (NTDs). According to the updated edition of American Dietary Reference Intakes, recommended dietary allowance for folate for women of childbearing age varies throughout the reproductive cycle from 400 μg day−1 of dietary folate equivalents (DFEs) for non-pregnant women, to 600 μg day−1 DFEs for pregnant women and 500 μg day−1 DFEs in lactating women. Increasing dietary folate, fortifying staple foods with folic acid or use of folic acid supplements can increase folate intake.
Dietary conjugated linoleic acid (CLA) intake assessment and possible biomarkers of CLA intake in young women
Authors: Fremann Dorothee , Linseisen Jakob , Wolfram Günther
Published: February 2003

Objective:

The habitual intake of the conjugated linoleic acid (CLA) isomer C18:2 c9t11 (rumenic acid, RA) was assessed and compared with plasma biomarkers.

Design:

The newly developed food-frequency questionnaire (FFQ) comprised 46 food items and was validated by means of a 7-day estimated record (7-d ER). Additionally, the dietary intake results of the FFQ, 7-d ER, the last day (1-d ER) and the last two days (2-d ER) before blood sampling of the 7-d ER were compared to the content of C18:2 c9t11 in plasma phospholipids (PL) and triglycerides (TG) as possible biomarkers.

Setting:

Metabolic unit of a university institute.

Subjects:

Fifty-seven students completed both dietary instruments. From all participants fasting blood samples were taken.

Results:

Mean daily intake of rumenic acid was 246 mg day−1and 323 mg day−1as measured by the FFQ and the 7-d-ER, respectively. The degree of correspondence between both assessment methods was acceptable; this is indicated by a total kappa value of κ = 0.31 (P< 0.01) and a Pearson correlation coefficient ofr= 0.46 (P< 0.01). Rumenic acid content in plasma triglycerides was twice as high as found in phospholipids. The correlation between the intake results gained with the 7-d ER and the plasma PL contents of C18:2 c9t11 was statistically significant; this was also true for the C18:2 c9t11 values in plasma TG compared with the intake results of one or two days before blood sampling.

Conclusions:

Regarding RA intake, the FFQ data revealed an acceptable degree of correspondence with the 7-d ER data but failed to show significant correlations to the potential biomarkers. However, with respect to the results of the 7-d ER, the RA content in plasma PL and TG are possible biomarkers of short-term and medium-term intake, respectively.
The cognitive contexts of beliefs about the healthiness of meat
Authors: Lea Emma , Worsley Anthony
Published: February 2003

Objective:

The overall aim of this study was to examine a variety of belief and demographic factors that are associated with the perception that meat is intrinsically unhealthy.

Design:

State-wide survey (written questionnaire) that included questions on meat and nutrition beliefs, perceived barriers and benefits of vegetarian diets, personal values, number of vegetarian friends and family members, and use and trust of health/nutrition/food information sources.

Setting:

South Australia.

Subjects:

Six hundred and one randomly selected South Australians and 106 non-randomly selected vegetarians and semi-vegetarians.

Results:

For all respondents considered as a group, the most important predictors of the belief that meat is intrinsically unhealthy were the perceived benefits of vegetarian diets (all positive predictors). These included: (1) the perceived links between vegetarianism, peace and increased contentment; (2) animal welfare and environmental benefits; and (3) health benefits. There were differences between different dietary groups however. For non-vegetarians, social concerns about vegetarianism (positive) were most important, followed by health and non-health benefits (positive) of vegetarianism. Red meat appreciation was the strongest (positive) predictor for vegetarians, with health benefits of vegetarianism (positive) and education (negative predictor) also important.

Conclusions:

The implications of the findings for health and other issues are discussed. Judgements about the healthiness of meat are likely to be related to moral and environmental beliefs and, for non-vegetarians, to social concerns about vegetarianism, in addition to health beliefs. These need to be considered if any attempts are made to influence meat consumption.
Food and nutrient intakes of a population sample of 3-year-old children in the South West of England in 1996
Authors: Emmett Pauline , Rogers Imogen , Symes Carol ,   ALSPAC Study Team
Published: February 2003

Objective:

To investigate food and nutrient intakes in 3-year-old children.

Subjects:

Eight hundred and sixty-three children resident in South West England (69% of those invited at this age), a randomly selected sub-sample of the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC).

Methods:

Diet was assessed using a 3-day descriptive food record. Food and nutrient intakes were compared with intakes at 18 months in the same children, with intakes in the British National Diet and Nutrition Survey (NDNS) of pre-school children, and with dietary reference values (DRVs).

Results:

Intakes of energy and most nutrients had increased between 18 and 43 months. The macronutrient content of the diet had also changed, the percentage of energy from starch rose from 21 to 23% and from non-milk extrinsic (NME) sugar from 12 to 16%, while the polyunsaturated to saturated fat ratio increased from 0.26 to 0.33. When compared with the NDNS, intakes of energy and all nutrients were higher with the exception of NME sugar. Energy intakes were below the estimated average requirements. Mean intakes of iron and vitamin D were below the Reference Nutrient Intake. Fewer children were eating beef at 43 months than at 18 months. Total daily meat consumption was lower than in the NDNS. The proportion of children consuming any vegetables dropped between 18 and 43 months, although fruit eating remained constant.

Conclusions:

The diets of 3-year-olds in this study were adequate in most nutrients. Our results suggest that energy requirements of pre-school children in the 1990s are less than the DRV. Nutrient and food intakes changed between 18 and 43 months. Children were eating less meat than their counterparts in the NDNS.
Mortality in British vegetarians
Authors: Appleby Paul N , Key Timothy J , Thorogood Margaret , Burr Michael L , Mann Jim
Published: February 2003

Objective:

To compare the mortality of British vegetarians and non-vegetarians.

Design:

Analysis of original data from two prospective studies each including a large proportion of vegetarians – the Oxford Vegetarian Study and the Health Food Shoppers Study. Standardised mortality ratios (SMRs) compared with the population of England and Wales were calculated from deaths before age 90 for vegetarians and non-vegetarians in each study. Death rate ratios (DRRs) for vegetarians compared with non-vegetarians within each study were calculated for each of 14 major causes of death.

Setting:

UK.

Subjects:

Twenty-one thousand men and women aged 16–89 years at recruitment, including more than 8000 vegetarians.

Results:

SMRs for all causes of death were significantly below the reference level of 100 in both studies: 52 (95% confidence interval (CI) 49–56) based on 1131 deaths in the Oxford Vegetarian Study and 59 (57–61) based on 2346 deaths in the Health Food Shoppers Study. For all causes of death, the DRR for vegetarians compared with non-vegetarians was close to one in both studies: 1.01 (95% CI 0.89–1.14) in the Oxford Vegetarian Study, 1.03 (0.95–1.13) in the Health Food Shoppers Study.

Conclusions:

British vegetarians have low mortality compared with the general population. Their death rates are similar to those of comparable non-vegetarians, suggesting that much of this benefit may be attributed to non-dietary lifestyle factors such as a low prevalence of smoking and a generally high socio-economic status, or to aspects of the diet other than the avoidance of meat and fish.
Nutritional advice to increase soluble fibre intake does not change plasma folate or homocysteine in men with angina: a randomised controlled trial
Authors: Ashfield-Watt Pauline AL , Clark Zoë E , Breay Pat , Zotos Paul C , Cale Sara B , Burr Michael L , McDowell Ian FW
Published: February 2003

Objective:

To study the effect of advice to increase dietary soluble fibre, including fruit and vegetables, on plasma folate and homocysteine in men with angina.

Design:

Data were collected on a subset of subjects from the Diet and Angina Randomised Trial (DART II). In a randomised (2 × 2) factorial design, subjects received advice on either, neither or both interventions to: (1) increase soluble fibre intake to 8.0 g day−1(fruit, vegetables and oats); (2) increase oily fish intake to 2 portions week−1. Those who received soluble fibre advice were compared with those who did not. Subjects were genotyped for C677T variant 5,10-methylenetetrahydrofolate reductase (MTHFR).

Setting/subjects:

Seven hundred and fifty-three male angina patients were recruited from general practice.

Results:

Plasma homocysteine concentrations were at the upper end of the normal range (median 11.5, 25% 9.4, 75% 14.0 μmol l−1). Baseline intake of fruit and vegetables was positively correlated with plasma folate (rs= 0.29,P< 0.01). Smokers had lower intakes of fruit and vegetables, lower plasma folate and higher homocysteine (allP< 0.01). Homozygotes for variant MTHFR had higher homocysteine concentrations at low plasma folate (P< 0.01). Reported intakes of fruit and vegetables and estimated dietary folate increased in the intervention group (ca.+75 g day−1,P< 0.01 andca.+20 g day−1,P< 0.05, respectively). However, neither plasma folate (baseline/follow-up 4.5 vs. 4.4 μg l−1,P= 0.40) nor homocysteine (baseline/follow-up 11.7 vs. 11.7 μmol l−1,P= 0.31) changed.

Conclusions:

Plasma homocysteine, a cardiovascular risk factor, is influenced by MTHFR genotype, plasma folate and smoking status. Dietary advice successfully led to changes in fruit and vegetable intake, but not to changes in plasma folate or homocysteine, possibly because the fruits and vegetables that were chosen were not those richest in folate.
Defining nutritional status of women in developing countries
Authors: Nestel Penelope , Rutstein Shea
Published: February 2003

Objective:

To define a de facto reference body mass index (BMI) for women in developing countries and compare its performance with the Quetelet BMI.

Design:

A logarithmic equation for elite wt/ht references was developed using the weight (wt) and height (ht) of 10 524 non-pregnant elite mothers. Functional outcomes were compared using both BMIs.

Setting:

Forty-six national surveys from 36 developing countries.

Subjects:

Mothers 15–49 years old.

Results:

The de facto reference standard deviation showed 2.2% of elite women were undernourished and 6.3% overnourished; lower and upper limits for ‘ideal’ wt/ht were 73% and 137%, respectively. Compared with the age-based and medium frame standards of the First and Second National Health and Nutrition Examination Surveys (NHANES I & II), the de facto reference defined fewer women as undernourished (5.3% vs. 10.5% and 14.4%, respectively), but more as overnourished (20.4% vs. 13.7% and 15.9%, respectively). In the de facto reference, BMI=wt/ht1.6. Using the age-based and medium-frame-based Quetelet BMI (wt/ht2), 28.5% and 31.7% had a low and 13.0% and 14.7% a high BMI, respectively. For the de facto reference, 18.4% of the elite mothers had a low BMI and 19.3% a high BMI. Applying the de facto reference to all women showed that the distribution of BMI was similar irrespective of the reference used. Functional outcomes were similar for both BMIs.

Conclusions:

The NHANES I & II growth curves define more women as overnourished than the de facto curve, but the opposite for defining the undernourished. Functional outcomes were similar for both BMIs, suggesting there is no great advantage to using a de facto BMI based on national-level data from these 46 national surveys.
Longitudinal changes in nutrient intakes in the Melbourne Chinese Cohort Study
Authors: Zhang Hua , Hsu-Hage Bridget H-H , Wahlqvist Mark L
Published: February 2003

Objective:

To assess longitudinal changes in the consumption of nutrients and the impact of socio-economic factors on diet transition in the Melbourne Chinese Health Study (MCHS) cohort.

Design:

Longitudinal study including two phases: baseline (1989/90) and follow-up (1995/97).

Settings:

Melbourne metropolitan areas in Victoria, Australia.

Study subjects and method:

Two hundred and sixty-two Chinese men and women aged 25 years and over, recruited at baseline, who had completed the both baseline and follow-up food-frequency questionnaires.

Results:

Women increased their daily intakes of energy (+549 kJ), protein (+7.8 g), fat (+7.3 g) and dietary fibre (+5.6 g) whereas men decreased their daily consumption of carbohydrate (-38.5 g) over an average period of 8 years. Energy contributions from protein and fat rose while that from carbohydrate dropped for all cohort subjects. Increased intakes of riboflavin, β-carotene and iron were observed in men, while an increased consumption of thiamine, riboflavin, niacin and minerals (except sodium) was observed in women. Socio-economic factors such as education, family income levels and occupational categories appeared to have a far more powerful influence on changes in individual daily nutrient intakes than age or length of stay in Australia. Changes in nutrient intake in women were less affected by sociodemographic variables.

Conclusion:

The observed changes in nutrient intakes indicated a progressive approach towards the Australian Recommended Dietary Intakes within this Chinese cohort population.
Food security in the Baltic Republics
Authors: Pomerleau Joceline , McKee Martin , Robertson Aileen , Vaask Sirje , Pudule Iveta , Grinberga Daiga , Abaravicius Algis , Bartkeviciute Roma
Published: February 2003

Objectives:

Food insecurity has become an important issue in many countries of the former Soviet Union following the transition to a market economy. This study examined three aspects of food security in the Baltic Republics: reasons for choosing foods; level of dependence on home-grown or raised foods; and use of home-grown vegetables.

Design:

Cross-sectional surveys.

Setting:

Data from surveys conducted in Estonia, Latvia and Lithuania in the summer of 1997 were used to describe the three aspects of food security and their socio-economic correlates (using descriptive statistics and logistic regression).

Subjects:

Representative samples of adults were selected in each country (Estonia, n = 2018; Latvia, n = 2308; Lithuania, n = 2153).

Results:

Cost was the most commonly reported reason for choosing foods, particularly in Lithuania (67%) and Latvia (60%) (Estonia 41%), and especially among people with lower income levels. In each country, large proportions of respondents depended partially or entirely on home-grown or raised foods (Latvia 47%, Lithuania 42%, Estonia 32%) or used home-grown vegetables frequently (Lithuania 66%, Latvia 53%, Estonia 29%); this was particularly the case in rural areas.

Conclusions:

The issue of food security needs to be examined further in the Baltic Republics and other transitional economies as increased access to safe, healthy foods for all could help improve dietary intake and reduce the high mortality from non-communicable diseases. Access to affordable, high-quality fresh foods by different social groups should be monitored and the potential contribution of home-grown and raised foods to reduce food poverty should be explored further1.
Dietary intake of 9–10-year-old and 11–12-year-old children in Liverpool
Authors: Hackett AF , Gibbon M , Sratton G , Hamill L
Published: February 2003

Objective:

To describe the eating habits of children in Liverpool and compare two age groups that bridge the transition from primary to secondary school.

Design:

Two cross-sectional studies carried out one year apart using a food intake questionnaire that records whether or not each child claims to have eaten specific marker foods on the previous day.

Setting:

Primary and secondary schools in Liverpool.

Subjects:

Six hundred and forty-nine children aged 11 or 12 years and 3556 children aged 9 or 10 years.

Results:

Fewer older children ate breakfast (68–82%), especially the girls, and not eating breakfast was associated with eating on the way to school in the younger children. More of the older girls ate nothing at breakfast or on the way to school. Overall, the less desirable foods were reported to have been eaten by more children, of both ages, than the more desirable foods. Fruit, however, was mentioned by most children (69–77%) but the next 10 foods mentioned by most children were all less desirable ones. Only 31% of primary and 21% of secondary children ate both fruit and vegetables but 23% of primary and 26% of secondary children ate neither fruit nor vegetables. Overall, more of the girls of both age groups claimed to have eaten foods that would normally be encouraged.

Conclusions:

Food choice changes appreciably between primary and secondary school and, in some key respects, for the worse. In particular, far more children of both age groups need to be eating fruit and vegetables every day.
Stakeholder interactions and the development of functional foods
Authors: McConnon Aine , Cade Janet , Pearman Alan
Published: February 2003

Objective:

This paper investigates the roles of the individual stakeholders involved in the development of functional foods and the implications of their actions for public perception of this new food concept.

Results:

At a time when consumer awareness of the link between diet and health is strong, a new food concept incorporating of a wide spectrum of foods has captured the imagination of the food industry and consumers alike. Functional foods provide a new category of foods that appear to be offering the public the opportunity to achieve a healthy lifestyle with minimal effort. Public perception may determine whether this new food concept is to become the next successful breakthrough in nutritional science or just another marketing gimmick devised by food manufacturers. The paper also addresses issues that arise directly as a result of the emergence of functional foods, such as appropriate legislation in connection to health claims in order to ensure consumer protection and also the lack of clarity in relation to definitions of what constitutes a functional food.

Conclusion:

The paper concludes that functional foods can only reach their maximum potential if the food industry, government and health professionals work together to improve communication between themselves and consumers and also to educate consumers, thereby allowing them to make informed decisions about dietary choices.
Dieting patterns and related lifestyles of school-aged children in the Republic of Ireland
Authors: Gabhainn Saoirse Nic , Nolan Geraldine , Kelleher Cecily , Friel Sharon
Published: February 2003

Objective:

The aim of this study was to identify differences in food habits and lifestyle behaviours by dieting status among young people in Ireland.

Design:

Cross-sectional survey. Participants responded to a self-completion questionnaire designed by researchers on the World Health Organization's collaborative study – Health Behaviour in School Aged Children. Pupils were selected by school and classroom and the sample was stratified to be representative of the geographical distribution of school students in Ireland.

Setting:

Data were collected by teachers from school pupils in their classrooms.

Subjects:

Data were collected from 187 schools which included 8497 pupils (51% girls) aged 9–17 years.

Results:

While a minority of pupils (12% of girls, 4% of boys) reported that they were on a diet to lose weight, a substantial proportion (28% of girls, 18% of boys) said that they should be on a diet. Dieters reported consuming unhealthy foods less frequently than non-dieters, but did not report an increased consumption of fruit and vegetables. Rather, some categories of dieters reported higher levels of coffee and tobacco use and lower exercise levels than non-dieters.

Conclusions:

The results could indicate substitution of unhealthy foods by other unhealthy behaviours as opposed to an increased consumption of healthier foodstuffs, and suggest that both smoking and exercise need to be addressed alongside nutrition in youth health promotion.
Longitudinal study of energy and nutrient intakes for infants from low-income, urban families
Authors: Nolan Karen , Schell Lawrence M , Stark Alice D , Gómez Marta I
Published: February 2003

Objective:

To assess the energy and nutrient intakes of healthy infants from low-income families and to compare intakes with current recommendations.

Design:

We interviewed mother–infant pairs longitudinally when the infants were 3, 6, 9, 12, 18 and 24 months old. Food intake data were obtained by 24-hour dietary recalls. Selected nutrient intakes were calculated and compared with the Recommended Dietary Allowances (RDAs).

Subjects/setting:

Infants (n= 200) were the offspring of low-income, pregnant women recruited at the Albany County Department of Health, New York for the Albany Pregnancy and Infancy Lead Study, a prospective investigation of factors related to blood lead levels, including nutrition. Interviews were conducted during paediatric clinic visits.

Statistical analyses performed:

Means and standard deviations were used to describe energy and micronutrient intakes for age groups. The probability approach was utilised to examine the prevalence of inadequate intakes.

Results:

Mean energy and nutrient intakes generally met or exceeded the RDA. The exceptions were vitamin D and zinc for which observed means were below the RDA at several data points. Protein consumption was exceptionally high in this sample. The highest estimated prevalences of inadequate intakes were observed for iron, zinc and vitamin D at the older ages.

Conclusions:

This study identified several potential concerns about the diets of infants during the transition from infant food and formula to table foods. Low intakes of vitamin D, zinc and iron, especially at 12 and 18 months, were observed. High protein intakes were noted at all ages.
Use of dietary supplements in Denmark is associated with health and former smoking
Authors: Knudsen Vibeke K , Rasmussen Lone B , Haraldsdóttir Jóhanna , Ovesen Lars , Bülow Inge , Knudsen Nils , Jørgensen Torben , Laurberg Peter , Perrild Hans
Published: February 2003

Objectives:

To describe the use of dietary supplements in a group of Danish adults and to investigate the differences between users and non-users with respect to age, gender, health and lifestyle factors.

Design:

Cross-sectional study in two Danish cities.

Setting:

The Danish Investigation on Iodine Intake and Thyroid Diseases, 1997–1998.

Subjects:

Participants were 3707 women (selected age groups between 18 and 65 years) and 942 men (60–65 years). Participation rate was 50%. Supplement data were collected in a personal interview. Data on education, smoking, alcohol intake, physical activity, use of medication and self-perceived health were derived from a self-administered questionnaire. Multiple logistic regression was used for the statistical analysis.

Results:

Participants were asked about all kinds of supplements, ranging from products containing vitamins and minerals, to fish oils and products of herbal origin. On average 59% reported use of some kind of dietary supplement. Most common were combined multivitamin/mineral products (48%) followed by single vitamin C products (10%). Twelve per cent used three or more different supplements. Supplement use was strongly associated with age and gender, being highest among elderly women (78%). Ex-smokers were more likely to use supplements than subjects who had never smoked (odds ratio (OR) 1.36, 95% confidence interval (CI) 1.09–1.76). Supplement use was more likely among subjects who had many days of illness (OR = 1.37, 95% CI 1.12–1.66) and among users of medication (OR = 1.22, 95% CI 1.04–1.42). Subjects who perceived their health as poor were more likely to use supplements other than just a multivitamin/mineral tablet (OR = 2.2, 95% CI 1.31–3.77).

Conclusions:

Use of dietary supplements was related to age, gender and smoking, but also to poor self-perceived health status and absence from work. This indicates that a group of people use supplements as a form of self-medication.
Part I. What has happened in terms of some of the unique elements of shift in diet, activity, obesity, and other measures of morbidity and mortality within different regions of the world?
Authors: Monteiro Carlos A , Conde Wolney L , Popkin Barry M
Published: February 2003

Objective:

To describe time trends in under- and overnutrition in different regional and income strata of the child and adult population of Brazil.

Design:

Nation-wide surveys conducted in 1975, 1989 and 1996/7 in probabilistic samples of 1–4-year-old children and adults 20 years and over. Time trends refer to stunting, wasting and overweight prevalences among children and age-adjusted underweight and obesity prevalences among adults (95% confidence intervals included).

Subjects:

Individuals examined by each survey in each age group ranged from 1796 young children in 1996 to 78 031 adults in 1975.

Setting:

North-eastern and south-eastern regions of Brazil.

Results:

Undernutrition indicators declined intensively and continuously among children and adults in all region and income strata. Obesity remained low and relatively stable among children, but increased intensively and continuously in all regions and income strata among adult males. Obesity also increased intensively and continuously among adult women from the less economically developed region of Brazil (the north-eastern region) and among lower-income women from the more developed region (the south-eastern region). Higher-income women from the more developed region had a significant increase in obesity from 1975 to 1989, followed by a significant decline from 1989 to 1997.

Conclusions:

Undernutrition in young children is being controlled in Brazil without evidence of increasing obesity. However, obesity is rapidly replacing undernutrition in most gender, region and income strata of the adult population. Adult obesity is already more frequent than adult undernutrition in the more economically developed region, among all higher-income groups, and also among lower-income women living in the more developed region. These lower-income women are significantly more exposed than their higher-income counterparts to both undernutrition and obesity.
Epidemiological and nutritional transition in Mexico: rapid increase of non-communicable chronic diseases and obesity
Authors: Rivera Juan A , Barquera Simón , Campirano Fabricio , Campos Ismael , Safdie Margarita , Tovar Víctor
Published: February 2003

Objective:

The objective of this paper is to characterise the epidemiological and nutritional transition and their determinants in Mexico.

Design:

Age-adjusted standardised mortality rates (SMRs) due to acute myocardial infarction (AMI), diabetes mellitus and hypertension were calculated for 1980–1998. Changes in the prevalences of overweight and obesity in women and children and of dietary intake from 1988 to 1999 were also used in the analysis. Quantities of food groups purchased by adult equivalent (AE) and food expenditures away from home between 1984 and 1989 were used to assess trends. All information was analysed at the national and regional levels, and by urban and rural areas.

Results:

SMR for diabetes, AMI and hypertension increased dramatically parallel to obesity at the national and regional levels. Fat intake in women and the purchase of refined carbohydrates, including soda, also increased.

Discussion:

The results suggest that obesity is playing a role in the increased SMRs of diabetes, AMI and hypertension in Mexico. Total energy dietary intake and food purchase data could not explain the rise in the prevalence of obesity. The increases in fat intake and the purchase of refined carbohydrates may be risk factors for increased mortality. Information on physical activity was not available.

Conclusion:

SMRs due to diabetes, hypertension and AMI have increased dramatically in parallel with the prevalence of obesity; therefore actions should be taken for the prevention of obesity. Reliable information about food consumption and physical activity is required to assess their specific roles in the aetiology of obesity.
An accelerated nutrition transition in Iran
Authors: Ghassemi Hossein , Harrison Gail , Mohammad Kazem
Published: February 2003

Objective:

To describe the emergence of the nutrition transition, and associated morbidity shifts, in the Islamic Republic of Iran.

Design:

Review and analysis of secondary data relating to the socio-political and nutritional context, demographic trends, food utilisation and consumption patterns, obesity, and diet-related morbidity.

Results and conclusions:

The nutrition transition in Iran is occurring rapidly, secondary to the rapid change in fertility and mortality patterns and to urbanisation. The transition is occurring against the backdrop of lack of sustained economicgrowth. There is considerable imbalance in food consumption with low nutrient density characterising diets at all income levels, over-consumption evident among more than a third of households, and food insecurity among 20% of the population. Obesity is an emerging problem, particularly in urban areas and for women, and both diabetes and other risk factors for heart disease are becoming significant problems.
Where does the black population of South Africa stand on the nutrition transition?
Authors: Bourne Lesley T , Lambert Estelle V , Steyn Krisela
Published: February 2003

Objective:

To review data on selected risk factors related to the emergence of non communicable diseases (NCDs) in the black population of South Africa.

Methods:

Data from existing literature on South African blacks were reviewed with an emphasis placed on changes in diet and the emergence of obesity and related NCDs.

Design:

Review and analysis of secondary data over time relating to diet, physical activity and obesity and relevant to nutrition-related NCDs.

Settings:

Urban, peri-urban and rural areas of South Africa. National prevalence data are also included.

Subjects:

Black adults over the age of 15 years were examined.

Results:

Shifts in dietary intake, to a less prudent pattern, are occurring with apparent increasing momentum, particularly among blacks, who constitute three-quarters of the population. Data have shown that among urban blacks, fat intakes have increased from 16.4% to 26.2% of total energy (a relative increase of 59.7%), while carbohydrate intakes have decreased from 69.3% to 61.7% of total energy (a relative decrease of 10.9%) in the past 50 years. Shifts towards the Western diet are apparent among rural African dwellers as well. The South African Demographic and Health Survey conducted in 1998 revealed that 31.8% of African women (over the age of 15 years) were obese (body mass index (BMI) ≥ 30 kgm−2) and that a further 26.7% were overweight (BMI ≥ 25 to <30 kgm−2). The obesity prevalence among men of the same age was 6.0%, with 19.4% being overweight. The national prevalence of hypertension in blacks was 24.4%, using the cut-off point of 140/90 mmHg. There are limited data on the population's physical activity patterns. However, the effects of the HIV/AIDS epidemic will become increasingly important.

Conclusions:

The increasing emergence of NCDs in black South Africans, compounded by the HIV/AIDS pandemic, presents a complex picture for health workers and policy makers. Increasing emphasis needs to be placed on healthy lifestyles.
A Tanzanian perspective on the nutrition transition and its implications for health
Authors: Maletnlema TN
Published: February 2003

Objective:

The purpose of this paper is to describe social and economic changes related to shifts in diet and activity and to present prevalences for chronic diseases associated with the nutrition transition.

Design:

Observations about social changes are descriptive, based on published reports and personal observations. Prevalence and trends data are based on a Ministry of Health published report and, for infants and toddlers, on primary data.

Setting:

Disease prevalences for diabetes mellitus and hypertension are taken from four sites, representing underdeveloped, semi-developed and well-developed rural communities and Dar es Salaam, the largest city in Tanzania. The prevalences of underweight and overweight for infants and toddlers are taken from a small periurban clinic in Tanzania.

Subjects:

Adults over 15 years of age are included in the prevalence data for chronic disease. The urban sample is stratified by occupation and ethnicity. The data for infants and toddlers include newborns to those aged 23 months.

Results:

An increase in the prevalence of diabetes and hypertension was observed. Simultaneously, there have been rapid changes in diet and physical activity related to urbanisation and modernisation. The highest prevalences for diabetes and hypertension were among high-ranking executives.

Conclusion:

The increase in chronic disease could be related to the rise in the number of high-ranking executives. Simultaneously, per capita income has gone down, and malnutrition prevalence has risen. Programmes are being developed to simultaneously monitor trends in overweight while preventing protein-energy malnutrition and micronutrient deficiency.
A new stage of the nutrition transition in China
Authors: Du Shufa , Lu Bing , Zhai Fengying , Popkin Barry M
Published: February 2003

Objective:

To fully explore the long-term shifts in the nutrition transition and the full implications of these changes in the Chinese diet.

Design:

A descriptive, population-based study.

Setting:

Data come from nationally representative surveys: the China Health and Nutrition Survey (1989–1997), the China National Nutrition Survey (1982 and 1992), the annual household consumption surveys of the State Statistical Bureau, and the Annual Death Report of China.

Results:

During the first part of the major economic transformation in China (before 1985), cereal intake increased but decreased thereafter. There was also a long-term reduction of vegetable consumption that has now stabilised. Intake of animal foods increased slowly before 1979 and more quickly after the economic reforms occurred. While the total energy intake of residents has decreased, as has energy expenditure, large changes in the composition of energy have occurred. The overall proportion of energy from fat increased quickly, reaching an overall average of 27.3% and 32.8% for urban residents in 1997. Over a third of all Chinese adults and 60.1% of those in urban areas consumed over 30% of their energy from fat in 1997. Large shifts towards increased inactivity at work and leisure occurred. These changes are linked with rapid increases of overweight, obesity and diet-related non-communicable diseases (DRNCDs) as well as total mortality for urban residents.

Conclusions:

The long-term trend is a shift towards a high-fat, high-energy-density and low-fibre diet. The Chinese have entered a new stage of the nutrition transition.
Nutrition transition in India
Authors: Shetty Prakash S
Published: February 2003

Objective:

The primary objective of this review is to examine the demographic and nutrition transition in India in relation to its contribution to the emerging epidemic of chronic non-communicable diseases in this country.

Setting:

India, the country as a whole and its different states with a population exceeding 1 billion in 2001.

Subjects:

The review examines demographic changes in the population with consequent effects on the population pyramid, the rapidity and rates of urbanisation with striking variations in chronic disease patterns and the trends in obesity between rural and urban communities, attempting to relate their prevalence with the diet and lifestyle changes accompanying them.

Design:

The review is based largely on representative large-scale surveys in the country and other reliable documented data on population characteristics. It also includes a review of the published literature.

Results:

The results indicate that the demographic changes, rates of urbanisation and changes in dietary patterns are contributing to the changing trends in chronic disease in India.

Conclusions:

There is clear evidence of a demographic, epidemiological and nutrition transition in India that is fuelling the epidemic of chronic diseases and obesity, particularly in the urban areas.