bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrating articulatory constraints into models of second language phonological acquisition
Authors: COLANTONI LAURA , STEELE JEFFREY
Published: June 2008

Models such as Eckman's markedness differential hypothesis, Flege's speech learning model, and Brown's feature-based theory of perception seek to explain and predict the relative difficulty second language (L2) learners face when acquiring new or similar sounds. In this paper, we test their predictive adequacy as concerns native English speakers’ mastery of French /ʁ/ and Spanish /ɾ/. Based on an acoustic analysis of the learner data, we demonstrate that these three models do not account for the full range of variability nor for the developmental sequences attested, because they do not consider the degree of difficulty involved in the simultaneous mastery of multiple phonetic parameters across prosodic positions. Consequently, models of L2 phonological acquisition must not only integrate findings from markedness theory and speech perception but also incorporate phonetic constraints on production.
Mapping access to food in a deprived area: the development of price and availability indices
Authors: Donkin Angela JM , Dowler Elizabeth A , Stevenson Simon J , Turner Sheila A
Published: June 2008

Objective

To develop and map indices to illustrate variation in the cost and availability of healthy food.

Design

Two contiguous wards in London were selected by virtue of their high Carstairs deprivation scores. A 2-km area was defined around a randomly chosen central point. All retail outlets selling food within the area were visited and their location recorded. A list of foods, acceptable to the local ethnically diverse population, which met current dietary guidelines, was devised. Data on the availability and price of 71 food items were collected. Indices were developed using SPSS and mapped using Geographic Information System (GIS) software.

Results

Information on availability and prices were collected from 199 outlets. The mean price index shows how expensive a shop is relative to other shops in the area. The least cost index shows the relative expense of a shop using the cheapest ways of buying their range of foods. Shorthand indices were tested, using data on 19 of the 71 prices. Availability indices are also discussed, including a green availability index and a fresh green availability index. Illustrative maps of the shop locations and the mean price index and fresh green availability index are shown.

Conclusions

Data can be collected and indices developed which indicate geographic variation in shop ‘expensiveness’, and in the price and availability of healthy food. GIS software can be used to map these indices, to identify areas with high food prices or low availability.
n-3 fatty acids from fish and coronary artery disease: implications for public health
Authors: Schmidt Erik B , Skou Helle A , Christensen Jeppe H , Dyerberg Jørn
Published: June 2008

Objective

To review and discuss the effect of n-3 polyunsaturated fatty acids (PUFA) from fish in the prevention and, primarily, in the treatment of coronary artery disease (CAD).

Design

Overview of the literature.

Setting

Denmark.

Results

There is good evidence that fish consumption may reduce the risk of CAD.

Conclusions

Fish can be recommended to reduce the risk of CAD both in healthy subjects and in patients with a high risk of CAD or with documented CAD. The use of fish oil concentrates can not be recommended in general, but may be considered in patients after a myocardial infarction or in patients with hypertriglyceridaemia. An increased intake of n-3 polyunsaturated fatty acids from fish may have substantial implications for public health and health economy by decreasing the risk of coronary events and sudden cardiac death.
Food patterns defined by cluster analysis and their utility as dietary exposure variables: a report from the Malmö Diet and Cancer Study
Authors: Wirfält Elisabet , Mattisson Irene , Gullberg Bo , Berglund Göran
Published: June 2008

Objective

To explore the utility of cluster analysis in defining complex dietary exposures, separately with two types of variables.

Design

A modified diet history method, combining a 7-day menu book and a 168-item questionnaire, assessed dietary habits. A standardized questionnaire collected information on sociodemographics, lifestyle and health history. Anthropometric information was obtained through direct measurements. The dietary information was collapsed into 43 generic food groups, and converted into variables indicating the per cent contribution of specific food groups to total energy intake. Food patterns were identified by the QUICK CLUSTER procedure in SPSS, in two separate analytical steps using unstandardized and standardized (Z-scores) clustering variables.

Setting

The Malmö Diet and Cancer (MDC) Study, a prospective study in the third largest city of Sweden, with baseline examinations from March 1991 to October 1996.

Subjects

A random sample of 2206 men and 3151 women from the MDC cohort (n=28098).

Results

Both variable types produced conceptually well separated clusters, confirmed with discriminant analysis. ‘Healthy’ and ‘less healthy’ food patterns were also identified with both types of variables. However, nutrient intake differences across clusters were greater, and the distribution of the number of individuals more even, with the unstandardized variables. Logistic regression indicated higher risks of past food habit change, underreporting of energy and higher body mass index (BMI) for individuals falling into ‘healthy’ food pattern clusters.

Conclusions

The utility in discriminating dietary exposures appears greater for unstandardized food group variables. Future studies on diet and cancer need to recognize the confounding factors associated with ‘healthy’ food patterns.
The influence of recipe modification and nutritional information on restaurant food acceptance and macronutrient intakes
Authors: Stubenitsky K , Aaron JI , Catt SL , Mela DJ
Published: June 2008

Objective

To examine the influences of nutritional information and consumer characteristics on meal quality expectations, food selection and subsequent macronutrient intakes of consumers offered a reduced-fat option in a restaurant.

Design

A target, full-fat (FF) main restaurant meal option was developed in a version substantially reduced in fat and energy (RF). Restaurant patrons were randomly placed into one of four treatment groups varying in provision of menu information about the target dish, and the actual version of that dish served (if ordered). A full-fat blind (FFB) control group was given no nutritional information in the menu and was served the FF version. The other three groups were all served the modified RF version: (i) reduced-fat blind (RFB), who were given no nutritional information; (ii) reduced-fat informed (RFI), who were given nutritional information; and (iii) reduced-fat informed with details (RFID), who were given the same nutritional information plus recipe modification details. Subjects rated their expected and actual liking, the pleasantness of taste, texture and appearance of the dish, how well the dish matched their expectations, and the likelihood of purchase again. Additional measures included the other dish selections, sociodemographic and attitudinal information.

Setting

A silver service (training) restaurant.

Subjects

Members of the public (n= 279) consuming meals in the restaurant.

Results

The presence of nutritional information on the menu did not significantly increase subsequent intakes of energy and fat from the rest of the meal, and did not significantly influence sensory expectations or post-meal acceptance measures (which also did not differ between the FF and RF versions). Consumer characteristics relating to fat reduction attitudes and behaviours were significantly related to the selection of different dishes.

Conclusions

Provision of RF alternatives in a restaurant can have significant positive dietary benefits. Menu nutritional information did not affect measures of meal acceptance. Further studies should identify which types of information formats might be most effective in enhancing the selection of ‘healthy’ options.
Food intake patterns and gallbladder disease in Mexican Americans
Authors: Tseng Marilyn , DeVellis Robert F , Maurer Kurt R , Khare Meena , Kohlmeier Lenore , Everhart James E , Sandler Robert S
Published: June 2008

Objective

Results of previous studies on diet and gallbladder disease (GBD), defined as having gallstones or having had surgery for gallstones, have been inconsistent. This research examined patterns of food intake in Mexican Americans and their associations with GBD.

Design

Cross-sectional.

Subjects

The study population included 4641 Mexican Americans aged 20–74 years who participated in the 1988–94 third National Health and Nutrition Examination Survey (NHANES III). GBD was diagnosed by ultrasound. Food intake patterns were identified by principal components analysis based on food frequency questionnaire responses. Component scores representing the level of intake of each pattern were categorized into quartiles, and prevalence odds ratios (POR) were estimated relative to the lowest quartile along with 95% confidence intervals (CI).

Results

There were four distinct patterns in women (vegetable, high calorie, traditional, fruit) and three in men (vegetable, high calorie, traditional). After age adjustment, none were associated with GBD in women. However, men in the third (POR = 0.42, 95%CI 0.21–0.85) and fourth (POR = 0.53, 95%CI 0.28–1.01) quartiles of the traditional intake pattern were half as likely to have GBD as those in the lowest quartile.

Conclusions

These findings add to a growing literature suggesting dietary intake patterns can provide potentially useful and relevant information on diet–disease associations. Nevertheless, methods to do so require further development and validation.
The epidemiology of iodine deficiency disorders (IDD) in Yemen
Authors: Zein AZ , Al-Haithamy S , Obadi Q , Noureddin S
Published: June 2008

Objective

This first nationwide survey was undertaken to estimate the prevalence rates and severity of iodine deficiency disorders (IDD) and the proportion of households consuming iodized salt.

Design

The country was stratified into two ecological zones and 30 clusters (primary schools) from each zone, including the required numbers of pupils, were selected randomly. A subsample of pupils provided urine and salt samples for the determination of urinary iodine excretion (UIE) and presence of iodate, respectively.

Setting

Yemen.

Subjects

There were a total of 2984 pupils aged 6–12 years of whom 2003 were boys and 981 girls. The majority (1800) pupils were from the lowland/coastal areas (zone II) and the rest (1184) from the mountainous regions (zone I).

Results

The total goitre rates (TGR) in the whole country, zones II and I were 16.8%, 31.1% and 7.4%, respectively. The TGR in zone I for males was 32.8% and 27.3% for females, while in zone II the corresponding rates were 8.1% and 5.9%, respectively, and the differences were not statistically significant. Only three cases of visible goitres were encountered. The median UIE levels in zones I, II and the whole country were 13.6, 18.9 and 17.3 μg dl−1, respectively. Based on UIE cut-off points recommended by WHO, IDD was severe in 4.7% of pupils in zone I and 2.6% in zone II. Mild and moderate IDD were found in 18.5% and 8.7% of the pupils respectively. Nearly 70% of the surveyed pupils had UIE values of > 10 μg dl−1 (no deficiency). Girls had relatively better iodine nutrition as suggested by higher levels of median UIE. In addition, across all age groups median UIE values were above 10 μg dl−1. Over half of the households consumed iodized salt.

Conclusions

Since the introduction of universal salt iodization in 1996 both the prevalence and severity of IDD in Yemen were reduced markedly and Yemen can now be classified as a country with a mild IDD problem. However, the low level of households consuming iodized salt may hamper the goal of IDD elimination.
Nutritional status of preschool children in informal settlement areas near Bloemfontein, South Africa
Authors: Dannhauser A , Bester CJ , Joubert G , Badenhorst PN , Slabber M , Badenhorst AM , Du Toit E , Barnard HC , Botha P , Nogabe L
Published: June 2008

Objective

To determine the nutritional status and household resources of preschool children.

Design

A cross-sectional survey.

Setting

Two informal settlement areas, Joe Slovo (JS) and JB Mafora (JBM) in Mangaung, near Bloemfontein, South Africa.

Subjects

Preschool children (<72 months) of a randomly selected sample of households in JS (experimental) (n = 162) and JBM (control) (n = 186) were included. Standard methods were used to obtain household and care-giver particulars, weight and height measurements, blood and stool samples, and 24-hour dietary recalls.

Results

Breast-feeding and dietary intake in the two areas were nearly similar; breast-feeding was continued for 12 months and longer. Although the children's total protein intake was sufficient, their energy intake was low. A low median intake of micronutrients prevailed, including iron, zinc, calcium, niacin, riboflavin, thiamine and vitamins C, B6, A and D. The prevalence of being underweight (JS = 19.8%; JBM = 18.8%), stunted (JS = 29%; JBM = 21.5%) and wasted (JS = 6.5%; JBM = 3.7%) were fairly similar in both areas, as well as the prevalence of marginal vitamin A deficiency, anaemia, iron deficiency and parasite infestations. No significant associations could be found between household and nutritional status indicators, probably due to the small number of well-nourished children and the generally poor household situation of the participants.

Conclusions

The generally poor nutritional status and environmental conditions emphasize the urgency of intervention for these children.
Energy and macronutrient intake in relation to dental caries incidence in urban black South African preschool children in 1991 and 1995: the Birth-to-Ten study
Authors: MacKeown Jennifer M , Cleaton-Jones Peter E , Edwards Arthur W
Published: June 2008

Objective

To study energy and macronutrient intake in relation to dental caries incidence among urban black South African children at the ages of 1 and 5 years.

Design and subjects

Food frequency questionnaires and WHO caries diagnostic criteria were used. The study sample of 1639 urban black children with nutrition and dental information from the 1991 and/or 1995 Birth-to-Ten (BTT) Study interceptions comprised true longitudinal (n = 259) and cross-sectional (n = 1216 for 1991 and n = 164 for 1995) subjects. For the longitudinal group true dmfs (decayed, missing, filled surfaces) incidence and average intakes of energy and macronutrients between 1991 and 1995 were calculated.

Setting

South Africa.

Results

Median macronutrient intakes were not significantly different between the cross-sectional and longitudinal samples. Dental caries prevalences at age 1 were 1.2% and 1.5% for the cross-sectional and longitudinal samples, respectively. By age 5 these values were 60.4% and 62.2%, respectively. The median dmfs score at age 1 was 0. At 5 years this was 2 for all children and 5 for those with caries. Statistical analysis for trend at age 5 showed a significant increase in caries prevalence with increasing energy, carbohydrate and added sugar in the cross-sectional sample only. The only significant changes in dmfs scores were seen for energy and added sugar for the whole sample. The r values between log(dmfs incidence + 0.3) and the average nutrient log variables were low, and a general linear models analysis showed no statistically significant effects on log(dmfs incidence + 0.3) of any of the log nutrient variables.

Conclusions

For the relationship between macronutrient intake and caries (prevalence and incidence), a cross-sectional and true longitudinal study gave similar results.
Types of fat intake and body mass index in a Mediterranean country
Authors: González Carlos A , Pera Guillem , Quirós José R , Lasheras Cristina , Tormo María José , Rodriguez Mauricio , Navarro Carmen , Martinez Carmen , Dorronsoro Miren , Chirlaque María Dolores , Beguiristain José M , Barricarte Aurelio , Amiano Pilar , Agudo Antonio
Published: June 2008

Background

Although the fatty acid fractions provide similar metabolizable energy, the type of dietary fat consumed could be relevant to the development of obesity.

Objective

To investigate the relationship between body mass index (BMI), obesity and the consumption of different types of fat and olive oil in a Mediterranean country with high prevalence of obesity, and high intake of monounsaturated fatty acids (MUFA) and olive oil.

Subjects

The study was carried out in Spain among 23 289 women and 14 374 men, aged 29–69 years, who were participants of a large European prospective cohort.

Methods

Information on usual food intake was collected by interviewers by means of a dietary history questionnaire. The association between obesity (BMI ≥ 30 kg m2), dietary fat, other dietary patterns and other non-dietary factors were tested using multilinear regression analysis. The ratio of reported energy intake to energy requirement was used as an estimation of dietary underreporting.

Results

The association between fatty acid fractions intake (saturated fatty acids (SFA) in women, and MUFA and polyunsaturated fatty acids (PUFA) in both sexes) and BMI was very weak, accounting for less than 1% of variance. All dietary and non-dietary variables accounted for 21% of variance in the measurement of BMI in women and only 6.7% of variance in men. Estimated underreporting of energy intake was 17.5% in obese women and 5.5% in obese men.

Conclusions

The association between consumption of specific types of dietary fat, olive oil and obesity in Spain is not very important. However, because of the cross-sectional design and some level of underreporting of energy intake observed in overweight subjects and overreporting in underweight subjects, systematic bias cannot be completely discarded.
The impact of consuming iron from non-food sources on iron status in developing countries
Authors: Harvey Philip WJ , Dexter Patricia B , Darnton-Hill Ian
Published: June 2008

Objective

To determine the impact of contaminant iron and geophagy on iron intake and status of persons living in developing countries.

Design

Literature for review was identified by searching Medline and Agricola, from appropriate other texts and from three reports from the Opportunities for Micronutrient Interventions (OMNI) Project of USAID.

Setting

The dietary intake of iron by people living in developing countries is generally high but iron deficiency remains prevalent. This apparent paradox is because the iron being consumed is predominantly in the non-haem form, which is poorly absorbed. Some of this non-haem iron is from contamination of food with iron from soil, dust and water; iron leaching into food during storage and cooking; contamination during food processing such as milling; and the practice of geophagy.

Results

Although the contribution of contaminant iron to overall iron intake is well documented, its absorption and thus its impact on iron status is not. To be available for absorption, contaminant iron must join the common non-haem pool, i.e. be exchangeable. The absorption of exchangeable contaminant iron is subject to the same interactions with other constituents in the diet as the non-haem iron that is intrinsic to food. The limited available evidence suggests wide variation in exchangeability. In situations where a significant fraction of the contaminating iron joins the pool, the impact on iron status could be substantial. Without a simple method for predicting exchangeability, the impact of contaminant iron on iron status in any particular situation is uncertain.

Conclusions

Interventions known to increase the absorption of iron intrinsic to foods will also increase absorption of any contaminant iron that has joined the common pool. Any positive effect of geophagy resulting from an increased intake of iron is highly unlikely, due to inhibiting constituents contained in soils and clays. The efficacy of approaches designed to increase the intake of contaminant iron remains encouraging but uncertain. An approach using multiple interventions will continue to be essential to reduce iron deficiency anaemia.
Anaemia in Bangladesh: a review of prevalence and aetiology
Authors: Ahmed Faruk
Published: June 2008

Objective

This paper provides a comprehensive review of the changes in the prevalence and the extent of anaemia among different population groups in Bangladesh up to the present time. The report also focuses on various factors in the aetiology of anaemia in the country.

Design and setting

All the available data have been examined in detail, including data from national nutrition surveys, as well as small studies in different population groups.

Results

Over the past three decades a number of studies including four national nutrition surveys (1962/64; 1975/76; 1981/82 and 1995/96) have been carried out to investigate the prevalence of anaemia among different population groups in Bangladesh, and have demonstrated a significant public health problem. Since the 1975/76 survey the average national prevalence of anaemia has not fallen; in 1995/96, 74% were anaemic (64% in urban areas and 77% in rural areas). However, age-specific comparisons suggest that the rates have fallen in most groups except adult men: in preschool children in rural areas it has decreased by about 30%, but the current level (53%) still falls within internationally agreed high risk levels. Among the rural population, the prevalence of anaemia is 43% in adolescent girls, 45% in non-pregnant women and 49% in pregnant women. The rates in the urban population are slightly lower compared with rural areas, but are high enough to pose a considerable problem. It appears that severe anaemia in the Bangladeshi population is less frequent, possibly present among only 2–3% of the population. The data on the aetiology of anaemia reveal that iron deficiency may be a substantial cause of anaemia in the Bangladeshi population. Other dietary factors in addition to parasitic infestations may also precipitate the high prevalence of anaemia.

Conclusions

While the overall prevalence of anaemia among the Bangladeshi population is still very high, the rates of severe anaemia are almost non-existent. A large proportion of anaemia can be attributed to iron deficiency. There is a need for a comprehensive strategy for the prevention and control of anaemia in Bangladesh.
Risk factors for poor iron status in British toddlers: further analysis of data from the National Diet and Nutrition Survey of children aged 1.5–4.5 years
Authors: Thane CW , Walmsley CM , Bates CJ , Prentice A , Cole TJ
Published: June 2008

Objective

To examine risk factors for poor iron status in British toddlers.

Design

National Diet and Nutrition Survey (NDNS) of children aged 1.5–4.5 years.

Setting

Mainland Britain, 1992/93.

Subjects

Of the 1859 children whose parents or guardians were interviewed, a weighed dietary intake was provided for 1675, and a blood sample obtained from 1003.

Results

Mean haemoglobin (Hb) and ferritin levels were significantly lower in younger (1.5–2.5 years) than in older (3.5–4.5 years) children, with boys having significantly lower ferritin levels than girls. Poor iron status (Hb>110 g l−1, ferritin >10 μg l−1, or low values for both indices) was associated with lower socioeconomic and employment status. Iron status was directly associated with meat and fruit consumption and inversely with that of milk and milk products, after adjustment for age and gender. The latter association remained significant after further adjustment for sociodemographic variables, energy intake and body weight. Children consuming <400 g day−1of milk and cream were less likely to consume foods in other groups, with those also consuming little meat, fish, fruit and nuts at greatest risk of poor iron status. Few associations were observed between poor iron status and individual nutrient intakes, and iron status was not associated with either iron intake or with consumption of a vegetarian diet.

Conclusions

Overdependence on milk, where it displaces iron-rich or iron-enhancing foods, may put toddlers at increased risk of poor iron status. However, this becomes non-significant when moderate-to-high amounts of foods known to enhance iron status (e.g. meat and/or fruit) are also consumed. Milk consumption in this age group should ideally be part of a mixed and balanced diet including all food groups, and particularly lean meat (or other iron-rich or fortified foods) and fruit. This is particularly relevant for households of lower socioeconomic and employment status.
Herbal medicine: from the past to the future
Authors: Tyler Varro E
Published: June 2008

A brief discussion of the history of the use of herbal medicines from prehistoric times to the mid-twentieth century precedes an explanation of why usage of such remedies in the United States declined in the 1940s but returned to popularity in the 1980s. The provisions of the Dietary Supplement Health and Education Act of 1994 are presented together with its perceived influence, both positive and negative, on the health of the American people. Possible futures of herbal medicines are considered. The negative viewpoint that they will ultimately be rejected is refuted, and the more optimistic prediction that herbs are ultimately destined to become a part of mainstream medicine is defended. Stumbling blocks to such acceptance are evaluated and methods of overcoming them suggested. The urgent need for the development of a sensible regulatory environment encouraging the approval of botanicals as drugs is emphasized. After predicting a bright future for rational phytomedicines, the author opines that many of them will eventually play significant roles in medicinal practice.
Epidemiologic challenges in the study of the efficacy and safety of medicinal herbs
Authors: Arab Lenore
Published: June 2008

Although clinical trials are needed to prove the efficacy of medicinal herbs and pharmacological studies are essential to the long-term goal of identifying the active ingredients in plants, these will not be forthcoming rapidly enough to meet the acute public health needs for knowledge on efficacy and safety since these substances are currently being widely consumed at various dosages. Resulting from the ongoing ‘natural experiment’ well-conducted observational epidemiology can bridge the gap and determine whether, as consumed its use is of benefit or detrimental, for whom and when in the course of disease prevention or minimization of disease severity. The classic study designs (cohort and case-control) and the more recent development of case-only studies can be put to service for these purposes. The challenges are in dose assessment, understanding mechanisms of effect, determining the relevant time period of exposure for a given disease or symptom, controlling for confounding factors such as disease status, and the special challenges presented by irregular use of medicinal herbs and concurrent use of multiple products and multiple sources.
Efficacy and safety of St. John's wort for the treatment of major depression
Authors: Nangia Monica , Syed Waqar , Doraiswamy P Murali
Published: June 2008

Objective

Extracts of St. John's wort have been widely used in the treatment of depression. Our aim was to review information related to the efficacy and safety of St. John's wort as an antidepressant.

Data sources

Primary and review articles were identified by a search of Medline (1960 to February 2000) and through secondary sources.

Study selection

All the articles identified from the data sources were evaluated and all relevant information was included in this review. The pharmacokinetics, mechanism of action, efficacy, side effects and drug interactions of St. John's wort have been examined in various studies.

Conclusion

St. John's wort is a promising investigational antidepressant, but the data are not yet sufficient to accept hypericum as a first line antidepressant preparation for treatment of depression. Besides the need for dose standardization and adequate trial lengths, there is a need for studies in severely depressed patients and long-term studies to assess the risk of relapse and recurrence.
The efficacy and safety of comfrey
Authors: Stickel Felix , Seitz Helmut K
Published: June 2008

Herbal medication has gathered increasing recognition in recent years with regard to both treatment options and health hazards. Pyrrolizidine alkaloids have been associated with substantial toxicity after their ingestion as tea and in the setting of contaminated cereals have led to endemic outbreaks in Jamaica, India and Afghanistan. In Western Europe, comfrey has been applied for inflammatory disorders such as arthritis, thrombophlebitis and gout and as a treatment for diarrhoea. Only recently was the use of comfrey leaves recognized as a substantial health hazard with hepatic toxicity in humans and carcinogenic potential in rodents. These effects are most likely due to various hepatotoxic pyrrolizidine alkaloids such as lasiocarpine and symphytine, and their related N-oxides. The mechanisms by which toxicity and mutagenicity are conveyed are still not fully understood, but seem to be mediated through a toxic mechanism related to the biotransformation of alkaloids by hepatic microsomal enzymes. This produces highly reactive pyrroles which act as powerful alkylating agents. The main liver injury caused by comfrey (Symphytum officinale) is veno-occlusive disease, a non-thrombotic obliteration of small hepatic veins leading to cirrhosis and eventually liver failure. Patients may present with either acute or chronic clinical signs with portal hypertension, hepatomegaly and abdominal pain as the main features.

Therapeutic approaches include avoiding intake and, if hepatic failure is imminent, liver transplantation. In view of the known serious hazards and the ban on distributing comfrey in Germany and Canada, it is difficult to understand why comfrey is still freely available in the United States.
Assessing the prevalence of nutrient inadequacy
Authors: Carriquiry Alicia L
Published: June 2008

Objective:

To describe an approach for assessing the prevalence of nutrient inadequacy in a group, using daily intake data and the new Estimated Average Requirement (EAR).

Design:

Observing the proportion of individuals in a group whose usual intake of a nutrient is below their requirement for the nutrient is not possible in general. We argue that this proportion can be well approximated in many cases by counting, instead, the number of individuals in the group whose intakes are below the EAR for the nutrient.

Setting:

This is a methodological paper, and thus emphasis is not on analysing specific data sets. For illustration of one of the statistical methods presented herein, we have used the 1989–91 Continuing Survey on Food Intakes by Individuals.

Results:

We show that the EAR and a reliable estimate of the usual intake distribution in the group of interest can be used to assess the proportion of individuals in the group whose usual intakes are not meeting their requirements. This approach, while simple, does not perform well in every case. For example, it cannot be used on energy, since intakes and requirements for energy are highly correlated. Similarly, iron in menstruating women presents some difficulties, due to the fact that the distribution of iron requirements in this group is known to be skewed.

Conclusions:

The apparently intractable problem of assessing the proportion of individuals in a group whose usual intakes of a nutrient are not meeting their requirements can be solved by comparing usual intakes to the EAR for the nutrient, as long as some conditions are met. These are: (1) intakes and requirements for the nutrient must be independent, (2) the distribution of requirements must be approximately symmetric around its mean, the EAR, and (3) the variance of the distribution of requirements should be smaller than the variance of the usual intake distribution.
Dietary intake of Indians living in the metropolitan area of Durban
Authors: Wolmarans P , Seedat YK , Mayet FGH , Joubert G , Wentzel E
Published: June 2008

Objective:

To report on energy and nutrient intakes, as a risk factor for coronary heart disease in Indian South Africans.

Design:

Cross-sectional dietary study as part of a coronary heart disease survey.

Setting:

Metropolitan area of Durban, South Africa.

Subjects:

Free-living Indian men (n = 406) and women (n = 370) 15–69 years of age.

Methodology:

Dietary data were collected by three interviewers using a 24-h dietary recall and expressed as median intakes of macronutrients.

Results:

Results reported a low energy intake and the percentage of energy derived from total fat varied between 32.3 and 34.9% in men and between 33.1 and 36.1% in women. The energy intake to basal metabolic rate (EI: BMR) ratios were low for all age groups suggesting potential under-reporting. Intake of polyunsaturated fatty acids was high, more than 10% of energy, with a median polyunsaturated to saturated fatty acid ratio (P: S ratio) that varied between 1.38 and 1.96 for the various age and sex groups. Dietary cholesterol varied between 66 and 117 mg per 4.2 MJ in men and between 76 and 109 mg per 4.2 MJ in women. Dietary fibre intakes were low and varied between 8.0 and 11.0 g per 4.2 MJ in men and between 7.6 and 9.6 g per 4.2 MJ in women.

Conclusions:

The dietary P:S ratios were high and the effect of such a high P:S ratio on the oxidation of low density lipoprotein in this population, with a high prevalence of coronary heart disease (CHD), should be investigated as a possible risk factor for CHD.
Methods used to conduct the pan-European Union survey on consumer attitudes to physical activity, body weight and health
Authors: Kearney JM , Kearney MJ , McElhone S , Gibney MJ
Published: June 2008

Objective

The purpose of conducting this survey was to identify data on consumer attitudes towards and beliefs about physical activity, body weight and health among the 15 countries of the EU.

Design

A cross-sectional study to get a picture of the attitudes to physical activity, body weight and health in the EU. For this, it was considered important that samples be nationally representative so that inferences drawn from the data could be applied to the population in each country as well as to the EU population as a whole. Using a non-probability sampling method employing quota controls (and the national weight) we obtained large sample sizes from each country which were nationally representative in terms of the variables age, sex and regional distribution. To ensure samples were truly nationally representative a national weight was used when analysing the data using the same characteristics as those used to define quotas. When examining pooled estimates for the total EU sample a population weight was applied.

Results

In total, 15 239 subjects aged 15 years and upwards in the EU completed the survey. This article gives details on the methods used in carrying out the survey from design of the questionnaire to sample selection, questionnaire administration and analysis of the data. The methods and their limitations are discussed.
Nutritional status and dietary practices of 4–24-month-old children from a rural South African community
Authors: Faber Mieke , Benadé AJS
Published: June 2008

Objectives

To assess the nutritional status and dietary practices of 4–24-month-old children (under-twos) in a rural South African community.

Design

Cross-sectional survey.

Setting

A low socioeconomic rural African community (Ndunakazi), approximately 60 km north-west of Durban, KwaZulu-Natal, South Africa.

Subjects

Children (n= 115), 4–24 months old who attended growth monitoring posts in the area.

Results

Of these under-twos, 37.3% had low vitamin A status (serum retinol < 20 μg dl−1), 65.2% were anaemic, 43.2% had serum ferritin levels < 10 μgl−1(an indicator of low iron stores) and 15.3% were stunted. Breastfeeding was initiated by 99% of mothers. At the time of the survey, 80% of infants in the 4–12-month-old category and 56.9% of children in the 12–24-month-old category were being breastfed. Solid foods were introduced at 3.6 ± 0.8 months. Food intake reflected a high intake of carbohydrate-rich foods, and irregular intakes of fruit and vegetables, especially those rich in vitamin A. Foods of animal origin were not consumed regularly. Of these under-twos, 15.9% experienced an episode of diarrhoea during 2 weeks prior to the survey.

Conclusion

These under-twos had a poor vitamin A and iron status. Nutrition education, intervention programmes and feeding schemes should address micronutrient deficiencies, with the focus on the quality of the diet, rather than quantity.
Public health issues arising from microbiological and labelling quality of foods and supplements containing probiotic microorganisms
Authors: Hamilton-Miller JMT , Shah S , Winkler JT
Published: June 2008

Objective

To assess the accuracy and helpfulness of labelling on products containing probiotic bacteria.

Design and setting

52 such products – 44 from the UK (21 supplements, 15 fermented functional foods, eight ‘health-care’ products) and eight from continental Europe – have been tested for microbiological content, and results compared to the information available on their labels. Products were stored in the dark at 4°C and analysed before their expiry or sell-by date. Careful note was taken of wording on labels, package inserts, packaging, promotional literature and catalogue descriptions, as applicable. Products were cultured on appropriate bacteriological media, and organisms grown were counted and identified.

Results

Bioyoghurts gave no indication of numbers, and only five accurately described their bacterial content; results of culture were usually satisfactory. ‘Health-care’ products (mostly intended for the bowel) usually indicated the presence of bacteria, but the numerical content was hard to ascertain, and cultural results fell short of label claims. Supplements were sometimes incorrectly labelled in bacteriological terms, and often contained markedly reduced numbers and/or had extraneous strains and/or strains specified on the label were missing. Products from continental Europe (that were sold for specific medical indications) seemed of a higher microbiological standard. The potential pathogen Enterococcus faecium was found in nine products. The most successful of the new functional foods in Britain now contain probiotics, and probiotic preparations are prominent among the expanding range of nutritional supplements presently available to consumers.

Conclusions

Our findings have public health implications, and suggest that improvements are needed in labelling and quality assurance procedures for products containing probiotic organisms. The presence of the potential pathogen Enterococcus faecium (intentionally or as a contaminant) in some products calls for a review of the value of this species as a probiotic.
Risk factors for iron deficiency anaemia in preschool children in northern Ethiopia
Authors: Adish AA , Esrey SA , Gyorkos TW , Johns T
Published: June 2008

Objective

To determine risk factors for anaemia in preschool children.

Design

A cross-sectional study.

Setting

Tigray province, northern Ethiopia.

Subjects

2080 of 2373 children aged 6–60 months provided blood to assess anaemia.

Results

Anaemia was highly prevalent (42%) and constituted an important nutritional problem in the region. In a sub-sample of 230 anaemic children, 56% had a low red blood cell (RBC) count, and 43% had a serum ferritin of less than 12 μg l−1indicating that the anaemia was largely due to iron deficiency. Unlike other regions in developing countries, hookworm (0.4%) and malaria (0.0%) were rare and contributed little to the anaemia. Even though their diet lacked variety, the amount of iron consumed through cereal-based staple foods was adequate. However, the iron in these foods was not readily available and their diets were probably high in iron absorption inhibitors and low in enhancers. Dietary factors associated with anaemia included frequent consumption of inhibitors, such as fenugreek and coffee, and poor health in the child such as diarrhoea and stunting.

Conclusions

Underlying causes of anaemia were lack of safe water and inadequate human waste management, maternal illiteracy and mother being ill, and having no food reserves. The root cause of these factors was poverty. The optimal control strategy for iron deficiency anaemia should have a holistic approach which includes the alleviation of poverty, the empowerment of women and the provision of a safe environment.
Evaluation of a simplified vitamin supplement inventory developed for the Women's Health Initiative
Authors: Patterson Ruth E , Levy Lisa , Tinker Lesley Fels , Kristal Alan R
Published: June 2008

Objective

To evaluate the accuracy of a simplified inventory procedure for assessing nutrient intake from vitamin and mineral supplements.

Design

Participants brought their supplements to a clinic. An interviewer conducted the supplement inventory procedure, which consisted of recording data on the type of multiple vitamin and single supplements used. For the multiple vitamins, the interviewer recorded the exact dose for a subset of nutrients (vitamin C, calcium, selenium). For other nutrients, we imputed the dose in multiple vitamins. The dose of all single supplements was recorded. Labels of the supplements were photocopied and we transcribed the exact nutrient label data for the criterion measure. Spearman correlation coefficients were used to assess precision of nutrient intakes from the simplified inventory compared to the criterion measure.

Setting/subjects

Data are from 104 adult vitamin supplement users in Washington state.

Results

Correlation coefficients between nutrient intake estimated from the simplified inventory compared to the criterion measure were high (0.8–1.0) for those nutrients (vitamin C, calcium, selenium) for which the interviewer recorded the exact dose contained in multiple vitamins. However, for nutrients for which imputations were made regarding dose in multiple vitamins, correlation coefficients ranged from good (0.8 for vitamin E) to poor (0.3 for iron).

Conclusions

The simplified inventory is rapid (4–5 min) and practical for large-scale studies. The precision of nutrient estimates using this procedure was variable, although excellent for the subset of nutrients for which the dose was recorded exactly. This study illustrates many of the challenges of collecting high quality supplement data.
Association between low levels of 1,25-dihydroxyvitamin D and breast cancer risk
Authors: Janowsky Esther C , Lester Gayle E , Weinberg Clarice R , Millikan Robert C , Schildkraut Joellen M , Garrett Peter A , Hulka Barbara S
Published: June 2008

Objective

To determine if blood levels of 25-hydroxyvitamin D (25-D) or its active metabolite, 1,25-dihydroxyvitamin D (1,25-D), are lower in women at the time of first diagnosis of breast cancer than in comparable women without breast cancer.

Design

This was a clinic-based case–control study with controls frequency-matched to cases on race, age, clinic and month of blood drawing.

Setting

University-based breast referral clinics.

Subjects

One hundred and fifty-six women with histologically documented adenocarcinoma of the breast and 184 breast clinic controls.

Results

There were significant mean differences in 1,25-D levels (pmol ml−1) between breast cancer cases and controls; white cases had lower 1,25-D levels than white controls (mean difference ± SE: −11.08 ± 0.76), and black cases had higher 1,25-D levels than black controls (mean difference ± SE: 4.54 ± 2.14), although the number of black women in the study was small. After adjustment for age, assay batch, month of blood draw, clinic and sample storage time, the odds ratio (95% confidence interval, CI) for lowest relative to highest quartile was 5.2 (95% CI 2.1, 12.8) for white cases and controls. The association in white women was stronger in women above the median age of 54 than in younger women, 4.7 (95% CI 2.1, 10.2) vs. 1.5 (95% CI 0.7, 3.0). There were no case–control differences in 25-D levels in either group.

Conclusions

These data are consistent with a protective effect of 1,25-D for breast cancer in white women.
Relative validity of a food frequency questionnaire among tin miners in China: 1992/93 and 1995/96 diet validation studies
Authors: Forman MR , Zhang J , Nebeling L , Yao S-X , Slesinski MJ , Qiao Y-L , Ross S , Keith S , Maher M , Giffin C , Barrett M , Taylor PR , Graubard BI
Published: June 2008

Objective

Diet validation research was conducted to compare the respondents' reporting of dietary intake in a food frequency questionnaire (FFQ) with intake reported in food recalls. Because the population received annual salary increments that could modify food intake, diet validation studies (DVSs) were conducted during two time intervals.

Design

A 99-item FFQ was administered by an interviewer twice in a 1-year interval, and responses to each FFQ item were compared with 28 days of interviewer-administered food recalls that were collected in four 1-week intervals during each season of 1992/93. The second validation study in 1995/96 had a similar design to the earlier one.

Setting

A prospective cohort study of lung cancer among tin miners in China was initiated in 1992, with dietary and other risk factors updated annually.

Subjects

Among a cohort of high risk tin miners for lung cancer, two different samples (n = 141 in 1992/93, and n = 113 in 1995/96) for each diet validation study were randomly selected from four mine units, that were representative of all worker units.

Results

Miners reported a significantly higher average frequency of intake of foods in the food recalls than the FFQ, with few exceptions. Deattenuated Pearson correlation coefficients of the frequency of food intake between the FFQ and food recalls were in the range of –0.40 to 0.72 in both studies, with higher positive correlations for beverages and cereal staples than for animal protein sources, vegetables, fruits and legumes. The percentage of individuals with exact agreement in the extreme quartiles of intake in the food recalls and FFQ ranged from 0 to 100% in both studies.

Conclusions

Among Chinese miners, the range in correlations between the food recalls and the FFQ were due to: (i) market availability of foods during the food recall weeks compared to their annual reported intake in the FFQ; (ii) cultural perception of time; and (iii) differences in how the intake of mixed dishes and their multi-ingredient foods were reported in the recalls vs. the FFQ. The range in the percentage of agreement in the same quartiles and the changes in food intake over time may have implications for the analysis of the diet-disease relationship in this cohort.