bluuebunny/crossref_metadata_2025 huggingface dataset:
The nutrition and health transition in Malaysia
Authors: Noor Mohd Ismail
Published: February 2003

The accelerated phase of industrialisation and urbanisation in recent decades has inevitably brought about changes in the lifestyle of Malaysians. Changes in dietary habits and sedentary lifestyles are known to be associated with changes in health and increased prevalence of chronic diseases in the population. The objective of this paper is to provide a better understanding of the link between demographic variables and food consumption patterns related to the nutrition transition in Malaysia. This review uses various reports and publications from several ministries and selected local studies. The statistics compiled over the last two decades have shown that as the population achieves affluence, intakes of calories, fats and sugars increase, which may account for the substantial increase in food importation bills over the same period. Similarly, the rapid growth of the fast food industry during the last decade has added another dimension to the change in food consumption patterns of Malaysians. With the exception of a study on adolescents, the prevalences of overweight and obesity in children and adults are not strictly comparable due to the difference in body mass index (BMI) cut-off points in children and the study protocol in adults, and hence should not be misinterpreted as trends. The recent recommendation to lower the BMI cut-off points for Asians would only increase the magnitude of the existing prevalence among adults. The need to promote healthy nutrition for the population must be pursued vigorously, as the escalation of nutrition-related chronic degenerative diseases – once an urban phenomenon – has now spread to the rural population at an alarming rate. This paper indicates that the problem is real and needs urgent attention because it may be just the tip of the iceberg.
The unique aspects of the nutrition transition in South Korea: the retention of healthful elements in their traditional diet
Authors: Lee Min-June , Popkin Barry M , Kim Soowon
Published: February 2003

Objective:

The purposes of this paper are to describe the unique aspects of the nutrition transition in South Korea, including trends in food consumption and obesity, patterns of morbidity and mortality; to focus on efforts to maintain the traditional diet in the midst of rapid economic growth and the introduction of Western culture; and to provide insights for other countries.

Design:

We analysed secondary dietary intake, anthropometric, morbidity and mortality datafrom published reports and articles.

Results:

In South Korea, the level and rate of increase in fat intake have remained very low, whereas vegetable intake has been high and fruit intake has increased greatly. South Kore also has a relatively low prevalence of obesity compared with other Asian countries. The traditional Korean diet is a low-fat and high-vegetable diet. Therefore, the government and nutrition specialists have been initiating numerous efforts to advertise and teach the public that the traditional diet is a healthy diet. They are also working on revival of the traditional dietusing an approach that is acceptable to contemporary Koreans.

Conclusions:

The nutrition transition in South Korea is unique. A range of government, nutrition specialists and some private organisation efforts has worked to retain healthful elements of the traditional diet in South Korea. The continued low level of total fat in the overalldiet and the high intake of fruits and vegetables bode well for South Korea.
Cardiovascular diseases in the developing countries: dimensions, determinants, dynamics and directions for public health action
Authors: Reddy K Srinath
Published: February 2003

The global burden of disease due to cardiovascular diseases (CVDs) is escalating, principally due to a sharp rise in the developing countries which are experiencing rapid health transition. Contributory causes include: demographic shifts with altered population age profiles; lifestyle changes due to recent urbanisation, delayed industrialisation and overpowering globalisation; probable effects of foetal undernutrition on adult susceptibility to vascular disease and possible gene–environment interactions influencing ethnic diversity. Altered diets and diminished physical activity are critical factors contributing to the acceleration of CVD epidemics, along with tobacco use. The pace of health transition, however, varies across developing regions with consequent variations in the relative burdens of the dominant CVDs. A comprehensive public health response must integrate policies and programmes that effectively impact on the multiple determinants of these diseases and provide protection over the life span through primordial, primary and secondary prevention. Populations as well as individuals at risk must be protected through initiatives that espouse and enable nutrition-based preventive strategies to protect and promote cardiovascular health. An empowered community, an enlightened policy and and energetic coalition of health professionals must ensure that development is not accompanied by distored nutrition and disordered health.
The emergence of cardiovascular disease during urbanisation of Africans
Authors: Vorster HH
Published: February 2003

Objective:

To review the available data on risk factors for cardiovascular disease (CVD), the influence of urbanisation of Africans on these risk factors, and to examine why stroke emerges as a higher risk than ischaemic heart disease (IHD) in the health transition of black South Africans.

Design:

A review of published data on mortality from and risk factors of CVD in South Africans.

Setting:

South Africa.

Subjects:

South African population groups and communities.

Methods:

The available data on the contribution of stroke and IHD to CVD mortality in South Africa are briefly reviewed, followed by a comparison of published data on the prevalence and/or levels of CVD risk factors in the different South African population groups. The impact of urbanisation of black South Africans on these risk factors is assessed by comparing rural and urban Africans who participated in the Transition and Health during Urbanisation of South Africans (THUSA) study.

Results and conclusions: The mortality rates from CVD confirmed that stroke is a major public health problem amongst black South Africans, possibly because of an increase in hypertension, obesity, smoking habit and hyperfibrinogenaemia during various stages of urbanisation. The available data further suggest that black South Africans may be protected against IHD because of favourable serum lipid profiles (low cholesterol and high ratios of high-density lipoprotein cholesterol) and low homocysteine values. However, increases in total fat and animal protein intake of affluent black South Africans, who can afford Western diets, are associated with increases in body mass indices of men and women and in total serum cholesterol. These exposures may increase IHD risk in the future.
Part III. Can we turn back the clock or modify the adverse dynamics? Programme and policy issues
Authors: Pekka Puska , Pirjo Pietinen , Ulla Uusitalo
Published: February 2003

A global health transition is currently underway. The burden of non-communicable diseases (NCDs) is increasing rapidly in the developing world, very much as a result of changes in lifestyles. In addition to changes in tobacco use and physical activity, major changes are taking place in diets, contributing greatly to the growing epidemic of NCD. Thus, a huge global public health challenge is how to influence the trends in diet and nutrition for effective global NCD prevention.

The health transition took place rapidly in Finland after World War II and mortality from cardiovascular disease (CVD) was exceptionally high. The North Karelia Project was launched in 1972 as a community-based, and later as a national, programme to influence diet and other lifestyles that are crucial in the prevention of CVD. The intervention had a strong theory base and it employed comprehensive strategies. Broad community organisation and the strong participation of people were the key elements. Evaluation has shown how the diet (particularly fat consumption) has changed and how these changes have led to a major reduction in population serum cholesterol and blood pressure levels. It has also shown how ischaemic heart disease mortality in a working-age population has declined by 73% in North Karelia and by 65% in the whole country from 1971 to 1995.

Although Finland is an industrialised country, North Karelia was rural, of rather low socio-economic level and with many social problems in the 1970s and 1980s. The project was based on low-cost intervention activities, where people's participation and community organisations played a key role. Comprehensive interventions in the community were eventually supported by national activities – from expert guidelines and media activities to industry collaboration and policy. Similar principles for nutrition intervention programmes could be used in developing countries, obviously tailored to the local conditions. This paper discusses the experiences of the North Karelia Project in the light of needs from the less-industrialised countries and makes some general recommendations.
What Brazil is doing to promote healthy diets and active lifestyles
Authors: Coitinho Denise , Monteiro Carlos A , Popkin Barry M
Published: February 2003

Objectives:

To present the way the Brazilian government is addressing the prevention of nutrition-related non-communicable diseases (NR-NCDs).

Results:

Innovative legislative and regulatory actions, mass communications and capacity building have been combined to create a comprehensive approach for addressing poor dietary and activity patterns in Brazil that are leading to obesity and NR-NCDs. Included are new nutrition-related initiatives in the labelling area, shifts in the types of food purchased for the school food programme, use of mass media to communicate components of the food guidelines, establishment of a smart shopping initiative, and training of teachers and health workers.

Conclusions:

The entire effort has taken several years to get underway. This paper describes the process and some of the initial changes seen.
What is China doing in policy-making to push back the negative aspects of the nutrition transition?
Authors: Zhai Fengying , Fu Dawei , Du Shufa , Ge Keyou , Chen Chunming , Popkin Barry M
Published: February 2003

Objective:

To review the nutrition policies and efforts related to nutrition transition in China.

Design and setting: This paper reviews the nutrition policy and activities of China to prevent and control diet-related non-communicable diseases (DR-NCDs). Data came from the Ministry of Health, the Ministry of Agriculture, the State Council and some cross-sectional surveys.

Results:

China is undergoing a remarkable, but undesirable, rapid transition towards a stage of the nutrition transition characterised by high rates of DR-NCDs in a very short time. Some public sector Chinese organisations have combined their efforts to create the initial stages of systematic attempts to reduce these problems. These efforts, which focus on both under- and overnutrition, include the new Dietary Guidelines for Chinese Residents and the Chinese Pagoda and The National Plan of Action for Nutrition in China, issued by the highest body of the government, the State Council. There are selected agricultural sector activities that are laudable and few other systematic efforts that are impacting behaviour yet. In the health sector, efforts related to reducing hypertension and diabetes are becoming more widespread, but there is limited work in the nutrition sector. This paper points to some unique strengths from past Chinese efforts and to an agenda for the next several decades.

Conclusions:

China is trying in its efforts to prevent and control the development of DR-NCDs but effects are limited. Systematic multi-sector co-operation is needed to effectively prevent and control DR-NCDs inside and outside the health sector.
Comparison of neonatal thyroid-stimulating hormone levels and indicators of iodine deficiency in school children
Authors: Copeland Daphne L , Sullivan Kevin M , Houston Robin , May Warwick , Mendoza Ivan , Salamatullah Quazi , Solomons Noel , Nordenberg Dale , Maberly Glen F
Published: February 2003

Objectives:

To compare thyroid-stimulating hormone (TSH) levels in neonatal cord blood between study sites in Bangladesh, Guatemala and the United States. Also, to compare neonatal TSH results with indicators of iodine deficiency in school children.

Design:

Consecutive births and, in school children, cross-sectional surveys.

Setting:

Savar, Bangladesh; San Pedro Sacatepequez, Guatemala; and Atlanta, United States.

Subjects:

In each study site, cord blood was spotted on to filter paper and TSH levels determined using a sensitive monoclonal assay. In the USA, heel stick blood specimens from newborns spotted on to filter paper were also obtained as well as exposure to iodine-containing antiseptics during the birthing process. Urine specimens were collected from mothers of newborns and tested for iodine concentration. School children in the same areas were surveyed for thyroid size by palpation and ultrasonography, and urine specimens collected for iodine concentration.

Results:

Between 141 and 243 cord blood specimens were collected from each study site. The prevalence of elevated cord blood TSH levels (>5 mU l−1) was high in all study sites, from 58% to 84%. All sites would be categorised as having ‘severe’ iodine deficiency based on WHO/UNICEF/ICCIDD criteria. Iodine-containing antiseptics were used during 98% of the births in the USA but not in Bangladesh or Guatemala. The neonatal TSH classification indicated more severe iodine deficiency levels than classifications based on urinary iodine and goitre in school children.

Conclusions:

In the USA, elevated TSH levels may be partially attributed to use of beta-iodine-containing antiseptics prior to birth. We recommend the cautious interpretation of TSH results in newborns for the assessment of iodine deficiency disorders when iodine-containing antiseptics are used during the birthing process.
Infant feeding indicators for use in emergencies: an analysis of current recommendations and practice
Authors: McGrath Marie , Seal Andrew , Taylor Anna
Published: February 2003

Objective:

To assess the applicability and use of infant nutrition and health indicators during emergencies.

Design:

Indicators recommended by international health and nutrition organisations for assessing infant feeding practice were compiled and analysed to evaluate their consistency and applicability for use in surveys of emergency-affected populations. These indicators included measures of breast-feeding status, use of artificial feeding, anthropometric status and morbidity. Health and nutrition surveys performed on the resident or refugee population of Kosovo during the years 1996–1999 were then reviewed and the use of infant feeding and morbidity indicators were compared.

Results:

A number of recommended indicators exist for assessing infant and child feeding practice which have been generated by different international organisations. A comparison of these indicators revealed a number of inconsistencies, both in target population and measurement method. Their use during the Kosovo crisis was likewise inconsistent and prevented conclusions being drawn about the effectiveness of the international response in protecting infant health and nutrition.

Conclusions:

Standard indicators need to be agreed and promoted for use during surveys of emergency-affected populations. Failure to do so will lead to a continued inability to monitor the health and nutrition of infants at a population level during international relief operations.
Motivations for fruit and vegetable consumption in the UK Women's Cohort Study
Authors: Pollard Jennie , Greenwood Darren , Kirk Sara , Cade Janet
Published: February 2003

Abstract:Background: Despite recommendations to increase fruit and vegetable consumption within the UK population, intakes are still too low. In order to stimulate dietary behaviour change the determinants of food choice need to be explored.

Objectives:

To investigate how the priorities of high consumers of fruit and vegetables differ from those of low consumers, with respect to food choice motivations, and to identify what value high and low consumers place on different aspects of food choice behaviour.

Design:

A 4-day food diary and a questionnaire, including The Food Choice Questionnaire (FCQ) and a measure of Stage of Change (SOC) for fruit and vegetable consumption, were administered to subjects. Motivation scores from the FCQ were compared with fruit and vegetable intake and SOC data.

Subjects:

Nine hundred and ninety-eight females, aged 35–69 years, participating in the UK Women's Cohort Study.

Results:

In a multiple linear regression model, including age, education level and all FCQ motivations, the strongest motivations specifically affecting fruit and vegetable intake were health and natural content. It was found that, for a one point increase (measured on a scale of 0–4) in health and natural content scores, fruit and vegetable consumption increased by 1.11 portions (95% confidence interval (CI) 0.5–1.7) and 0.84 portions (95% CI 0.4–1.3), respectively (P>0.01). The SOC evaluation showed significant associations with portions of fruit and vegetables consumed (P>0.01). Women whose SOC was classed as maintenance phase were found to score higher on health, natural content, weight control and ethical concern factors (P>0.01). These women also scored lower on convenience questions (P>0.01).

Conclusion:

In this particular group of women the most important motivating factors for food choice, within the high fruit and vegetable consumers, were health and natural content of the food.
Food security and nutrition – the Ethiopian case for action
Authors: Kaluski Dorit Nitzan , Ophir Einat , Amede Tilahun
Published: February 2003

Objective:

To assess the 1999–2000 food security situation and the food relief programmes in Ethiopia, and evaluate the need for a national food and nutrition policy.

Design:

A systematic search of data sources from the Ethiopian Disaster Prevention and Preparedness Commission (DPPC), the Ethiopian Central Statistical Authority, the World Food Programme (WFP) and United Nations Children's Fund (UNICEF), the bibliographic database Medline and direct contacts with associations, institutions and people concerned with food security in Ethiopia.

Setting:

Consultations to WFP Ethiopia.

Results:

Food availability was severely restricted due to recurrent disasters such as drought, flood, war and a lack of diversity of food items. Food accessibility was limited due to a weak subsistence-agriculture-based economy, depletion of assets, absence of income diversity and a lack of alternative coping mechanisms. Food intake adequacy was rarely achieved due to food shortages, improper diet and poor sanitary conditions. There was a lack of early warning data to monitor food security indicators. Food aid programmes did not meet the requirements for food quantities and composition, and faced major obstacles in logistics and targeting of the vulnerable population.

Conclusions:

Improvements in food security and the eradication of famine will require investment in sustainable projects. There is an immediate need for better planning and targeting of food aid and a national food security monitoring system. A national food and nutrition policy is recommended, focusing both on relief efforts and on underlying factors contributing to the famine.
Tea consumption and the reduced risk of colon cancer – results from a national prospective cohort study
Authors: Su L Joseph , Arab Lenore
Published: February 2003

Objective:

This study examines the relationship between tea consumption and colon cancer risk in the US population.

Design:

Data from the NHANES I Epidemiologic Follow-up study (NHEFS) were used to examine the hypothesis. Cox proportional hazard models were used to examine the hypothesis of a protective effect of frequent tea consumption on colon cancer occurrence.

Setting:

Due to differences in the precision of the exposure data, we analysed two cohort periods based on the NHEFS. Cohort I was based on the survey conducted at the NHEFS baseline and Cohort II began at the first follow-up.

Subjects:

After excluding non-incidence cases and cases lost to follow-ups, there were 2359 tea users and 6498 non-tea users at baseline and 7656 tea users and 4514 non-tea users at the first follow-up.

Results:

After adjusting for confounders, the relative risks of colon cancer are 0.57 (95% confidence interval (CI) 0.42, 0.78) and 0.59 (95% CI = 0.35, 1.00) for subjects who consumed ≤1.5 cups and ≥1.5 cups per day, respectively, compared with non-tea users in Cohort II. Although more women consumed tea and the mean intake was higher, the preventive effect of tea consumption on colon cancer was found predominantly in men. The relative risks of colon cancer are 0.41 (95% CI = 0.25, 0.66) for men who consumed ≤1.5 cups day-1 and 0.30 (95% CI = 0.09, 0.98) for >1.5 cups day-1 of tea consumption (P-value for trend <0.01). No significant results were found in Cohort I.

Conclusions:

This study suggests an inverse association between colon cancer risk and habitual tea consumption.
Validation and calibration of food-frequency questionnaire measurements in the Northern Sweden Health and Disease cohort
Authors: Johansson Ingegerd , Hallmans Göran , Wikman Åsa , Biessy Carine , Riboli Elio , Kaaks Rudolf
Published: February 2003

Objectives:

To evaluate the reproducibility of, and to compare and calibrate, diet measures by the Northern Sweden 84-item food-frequency questionnaire (FFQ) with measures from 24-hour diet recalls (24-HDR).

Design:

Randomly selected respondents (n=246) from the EPIC (diet-cancer) and MONICA (diet-cardiovascular disease) study cohort in Northern Sweden were invited to answer the FFQ twice over a one-year interval (FFQ1 and FFQ2), and to complete ten 24-hour recalls (reference method) in the months between. Plasma β-carotene concentrations were determined from a subset of 47 participants.

Setting:

Vasterbotten and Norrbotten, Northern Sweden.

Participants:

Ninety-six men and 99 women, who completed the study.

Results:

The reproducibility of the FFQ was high in terms of both mean energy and nutrient intakes and relative ranking of participants by intake levels (median Pearson correlation of 0.68). Moderately higher food intake frequencies were recorded by FFQ1 compared with 24-hour recalls for dairy products, bread/cereals, vegetables, fruits and potato/rice/pasta, whereas meat, fish, sweet snacks and alcoholic beverage intakes were lower. The median Spearman coefficient of correlation between FFQ1 and the average of ten 24-HDR measurements was 0.50. Daily energy and nutrient intakes were similar for FFQ1 and 24-HDR measurements, except for fibre, vitamin C, β-carotene and retinol (FFQ1<24-HDR) and sucrose and cholesterol (FFQ1>4-HDR). Pearson coefficients of correlation between FFQ1 and 24-HDR corrected for attenuation due to residual day-to-day variation in the 24-HDR measurements ranged from 0.36 to 0.79 (median 0.54). Adjustment for energy had only very moderate effects on the correlation estimates. Calibration coefficients estimated by linear regression of the 24-HDR on the FFQ1 measurements varied between 0.30 and 0.59 for all nutrients except alcohol, which had calibration coefficients close to 1.0. These low calibration coefficients indicate that relative risk estimates corresponding to an absolute difference in dietary intake levels measured by the FFQ will generally be biased towards 1.0. Plasma β-carotene levels had a Pearson coefficient of correlation of 0.47 with the 24-HDR measurements, and of 0.23 with FFQ1 measurements.

Conclusions:

The Northern Sweden FFQ measurements have good reproducibility and an estimated level of validity similar to that of FFQ measurements in other prospective cohort studies. The results from this study will form the basis for the correction of attenuation and regression dilution biases in relative risk estimates, in future studies relating FFQ measurements to disease outcomes.
Underreporting of energy intake is less common among pregnant women in Indonesia
Authors: Winkvist Anna , Persson Viveka , Hartini T Ninuk S
Published: February 2003

Objectives:

To evaluate the ratio of reported energy intake to basal metabolic rate (EI/BMR) among pregnant Indonesian women, as well as identifying risk factors for being an underreporter.

Design:

Longitudinal study of dietary intake, using six repeated 24-hour diet recalls each trimester. Basal metabolic rate was estimated from body weight and physical activity from occupation. The lower 95% confidence interval for plausible EI/BMR was calculated and the proportion of underreporters estimated. Risk factors for being an underreporter were assessed in multivariate logistic regression analyses.

Setting:

Purworejo District, central Java, Indonesia.

Subjects:

Pregnant women (n = 490).

Results:

For the three trimesters, EI/BMR ratio was 1.33±0.48, 1.53±0.43 and 1.52±0.40 (mean±standard deviation), respectively. The proportion of underreporters was 29.7%, 16.2% and 17.6%. Characteristics significantly associated with underreporting in at least one trimester included high body mass index and low education.

Conclusions:

Levels of underreporting were low among the pregnant Indonesian women during the second and third trimesters. The low EI/BMR ratio during the first trimester likely reflects a true low intake due to nausea, rather than underreporting. Risk factors for being an underreporter included those known from developed countries, i.e. obesity and low education.
Development, validation and utilisation of food-frequency questionnaires – a review
Authors: Cade Janet , Thompson Rachel , Burley Victoria , Warm Daniel
Published: February 2003

Objective:

The purpose of this review is to provide guidance on the development, validation and use of food-frequency questionnaires (FFQs) for different study designs. It does not include any recommendations about the most appropriate method for dietary assessment (e.g. food-frequency questionnaire versus weighed record).

Methods:

A comprehensive search of electronic databases was carried out for publications from 1980 to 1999. Findings from the review were then commented upon and added to by a group of international experts.

Results:

Recommendations have been developed to aid in the design, validation and use of FFQs. Specific details of each of these areas are discussed in the text.

Conclusions:

FFQs are being used in a variety of ways and different study designs. There is no gold standard for directly assessing the validity of FFQs. Nevertheless, the outcome of this review should help those wishing to develop or adapt an FFQ to validate it for its intended use.
The relationship between frequency of carbohydrates intake and dental caries: a cross-sectional study in Italian teenagers
Authors: Arcella Davide , Ottolenghi Livia , Polimeni Antonella , Leclercq Catherine
Published: February 2003

Objective:

To propose an approach for investigation of the relationship between the frequency of carbohydrates intake and dental caries in real-life conditions.

Design:

The frequency of separate eating events (with the exclusion of lunch and dinner) and their sugars and starch content were assessed on the basis of diaries collected for seven consecutive days. The total number of decayed, missing and filled teeth (DMFT) was assessed through clinical examination. The interrelation between DMFT and frequency of eating events was analysed through Pearson correlation coefficient and stepwise forward linear regression analysis.

Setting:

Italy.

Subjects:

One hundred and ninety-three students (males and females, mean age 16 years) of a secondary school.

Results:

Individual DMFT varied between 0 (24% of subjects) and 12, with a mean of 3. Once lunch and dinner were excluded, the mean number of separate eating events was 2.9. A statistically significant relationship was found between DMFT and eating frequency thus defined. Correlations were calculated considering only eating events containing a proportion of sugars or starch higher than different cut-off levels. In a stepwise multiple regression model for DMFT, the frequency of ‘high sugars and high starch events’ accounted for 8% of the DMFT variance. Overall frequency of separate eating events defined according to their content of both sugars and starch accounted for 18% of the DMFT variance. A stronger correlation was found among males only.

Conclusions:

The precise characterisation of eating events in terms of their sugars and starch content allows us to explain a consistent percentage of the variability in DMFT.
Prevalence of household food poverty in South Africa: results from a large, nationally representative survey
Authors: Rose Donald , Charlton Karen E
Published: February 2003

Objectives:

Household food insecurity is a major determinant of undernutrition, yet there is little information on its prevalence in the South African population. This paper assesses household food insecurity in South Africa using a quantitative and objective measure, known as food poverty, and provides prevalence estimates by geographic area and socio-economic condition.

Design:

Secondary data analysis combining two sources: Statistics South Africa's household-based 1995 Income and Expenditure Survey; and the University of Port Elizabeth's Household Subsistence Level series, a nationally-conducted, market-based survey.

Setting:

South Africa.

Subjects:

A nationally representative sample of the entire country – stratified by race, province, and urban and non-urban areas – consisting of 28 704 households.

Results:

A household is defined to be in food poverty when monthly food spending is less than the cost of a nutritionally adequate very low-cost diet. The prevalence of food poverty in South Africa in 1995 was 43%. Food poverty rates were highest among households headed by Africans, followed by coloureds, Indians and whites. Higher food poverty rates were found with decreasing income, increasing household size, and among households in rural areas or those headed by females.

Conclusions:

The widespread nature of household food insecurity in South Africa is documented here. Prevalence rates by geographic and socio-economic breakdown provide the means for targeting of nutritional interventions and for monitoring progress in this field. The corroboration of these findings with both internal validation measures and external sources suggests that food poverty is a useful, objective measure of household food insecurity.
Assessment of breast-feeding promotion in hospitals and follow-up survey of mother–infant pairs in Germany: the SuSe Study
Authors: Kersting Mathilde , Dulon Madeleine
Published: February 2003

Objective:

To assess breast-feeding promotion in maternity hospitals and breast-feeding prevalences during the first year of life in mother–infant pairs in Germany.

Design:

Cross-sectional assessment of breast-feeding practices in a random sample of German maternity hospitals by use of a postal questionnaire. Follow-up of mother–infant pairs recruited in the participating hospitals to assess breast-feeding prevalences and infant feeding practices by use of a telephone interview 14 days after birth and food-frequency questionnaires mailed at the end of the 2nd, 4th, 6th, 9th and 12th month of life. Use of indicators for breast-feeding proposed by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF).

Setting:

Nation-wide survey.

Subjects:

One hundred and seventy-seven maternity hospitals, 1717 mother–infant pairs.

Results:

There were wide variations in breast-feeding promotion in hospitals as evaluated by the practice of the '10 Steps to Successful Breastfeeding' given by WHO and UNICEF for certification as a ‘Babyfriendly Hospital’. Some steps (3, 4, 8) were practised in about 90% of the hospitals, others (steps 7, 9) in only 10%. Prevalences for exclusive (total) breast-feeding as defined by WHO were: 73% (86%) at discharge, 60% (85%) at 14 days, 42% (70%) at 2 months, 33% (59%) at 4 months, 10% (48%) at 6 months, <1% (26%) at 9 months and 0 (13%) at 12 months.

Conclusions:

By use of indicators proposed by WHO and UNICEF, a differentiated insight into the breast-feeding situation in Germany has become possible. Moderate levels of breast-feeding promotion in hospitals resulted in almost satisfactory early breast-feeding prevalences but were not effective for long-term breast-feeding success in most mothers.
Validity of self-reported height and weight in 4808 EPIC–Oxford participants
Authors: Spencer Elizabeth A , Appleby Paul N , Davey Gwyneth K , Key Timothy J
Published: February 2003

Objective:

To assess the validity of self-reported height and weight by comparison with measured height and weight in a sample of middle-aged men and women, and to determine the extent of misclassification of body mass index (BMI) arising from differences between self-reported and measured values.

Design:

Analysis of self-reported and measured height and weight data from participants in the Oxford cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC–Oxford).

Subjects:

Four thousand eight hundred and eight British men and women aged 35–76 years.

Results:

Spearman rank correlations between self-reported and measured height, weight and BMI were high (r<0.9,P>0.0001 ). Height was overestimated by a mean of 1.23 (95% confidence interval (CI) 1.11–1.34) cm in men and 0.60 (0.51–0.70) cm in women; the extent of overestimation was greater in older men and women, shorter men and heavier women. Weight was underestimated by a mean of 1.85 (1.72–1.99) kg in men and 1.40 (1.31–1.49) kg in women; the extent of underestimation was greater in heavier men and women, but did not vary with age or height. Using standard categories of BMI, 22.4% of men and 18.0% of women were classified incorrectly based on self-reported height and weight. After correcting the self-reported values using predictive equations derived from a 10% sample of subjects, misclassification decreased to 15.2% in men and 13.8% in women.

Conclusions:

Self-reported height and weight data are valid for identifying relationships in epidemiological studies. In analyses where anthropometric factors are the primary variables of interest, measurements in a representative sample of the study population can be used to improve the accuracy of estimates of height, weight and BMI.
A comparison of five questionnaires to assess alcohol consumption in a Mediterranean population
Authors: Serra-Majem L , Santana-Armas JF , Ribas L , Salmona E , Ramon JM , Colom J , Salleras L
Published: February 2003

Objective:

To evaluate the reliability of alcohol consumption measured by five different dietary methods in the Catalan Nutrition Survey (1992–1993).

Design:

The different questionnaires used were: (1) two 7-day food records, (2) five items addressing alcoholic beverages in a 76-item food-frequency questionnaire, (3) a 1-week recall of 13 alcoholic beverages, (4) a 13-item alcoholic beverages frequency questionnaire and (5) two 24-hour recalls.

Subjects:

Ninety-three of the 120 adults (aged 20 to 70 years) initially recruited completed the questionnaires and provided a peripheral blood sample.

Results:

Mean daily alcohol intakes as assessed by the questionnaires were very similar. Beer was the alcoholic beverage most frequently consumed, followed by wine and liquor. Eighty-two per cent of the study population consumed less than 20 g of alcohol per day. No biochemical parameters were significantly correlated with alcohol intake estimated from the questionnaires.

Conclusions:

We found a satisfactory level of reproducibility and validity in the pattern of alcohol consumption across different levels and types of alcoholic beverage intake. We also found that the self-administered 13-item questionnaire and the 1-week recall were the best techniques to measure moderate or low alcohol consumption, suggesting that the two methods are the most suitable to assess overall alcohol intake in the general population.
Non-home prepared foods: contribution to energy and nutrient intake of consumers living in two low-income areas in Nairobi
Authors: van't Riet Hilda , den Hartog Adel P , van Staveren Wija A
Published: February 2003

Objective:

To determine the nutritional importance of non-home prepared foods for men, women and schoolchildren living in two low-income residential areas of Nairobi, and the sources of these non-home prepared foods.

Design, setting and subjects: A survey was conducted in Korogocho, a slum area, and Dandora, a low–middle-income residential area. Some 241 men, 254 women and 146 children aged 9 to 14 years were included in the study. Food intake was measured using three 24-hour recalls per individual, with special attention on the sources of all foods consumed.

Results:

The median proportion of daily energy intake of consumers provided by non-home prepared foods ranged from 13% for schoolchildren in Korogocho to 36% for men in Dandora. The median contribution to fat intake was higher than to energy, but the contributions to iron and vitamin A intakes were lower than to energy intake. Men consumed more non-home prepared foods on weekdays than at the weekend. Intakes of energy and most nutrients were below Kenyan Recommended Daily Intakes in all groups, but similar for consumers and non-consumers. In Korogocho, street foods were the main source of non-home prepared foods. In Dandora, both kiosks and street foods were major sources.

Conclusions:

Non-home prepared foods are an important source of energy and nutients for men, women and schoolchildren in Nairobi. In Korogocho, street foods, and in Dandora, both kiosks and street foods are the main sources of non-home prepared foods. The adequacy of energy and nutrient intakes does not differ between consumers and non-consumers of non-home prepared foods.
A review of the MAFF Optimal Nutrition Status research programme: folate, iron and copper
Authors: Buttriss J , Hughes J
Published: February 2003

Objective:

The objective was to conduct a critical appraisal of research conducted within one of the UK government's research programmes, Optimal Nutrition Status, and to place the findings of this work in the context of the international research effort, to assist policy makers and advisers. Nine nutrients are addressed within the programme; the findings for three of these are reported here: folate/folic acid, iron and copper.

Design:

To conduct the review, the researchers had access to all unpublished progress reports, submitted to officials, arising from the projects. The overall assessment criterion was whether the information generated by the research programme could be regarded as reliable experimental data of direct relevance to setting optimal dietary requirements for the particular micronutrients. However, findings were also assessed against specific scientific criteria concerning understanding of the bioavailability, interactions, development of functional markers and inter-individual variations in metabolism, for each of the nutrients scrutinised.

Results:

The results of the review indicated that many important questions are indeed being addressed by the UK government's research programme, and that the work is contributing to the overall research effort being conducted world-wide on this important subject.

Conclusions:

Many major questions still need to be addressed before it will be possible to identify optimal intakes for various sub-populations. These priorities are summarised in the paper.
Nutrition interventions by primary care staff: a survey of involvement, knowledge and attitude
Authors: Moore Helen , Adamson Ashley J
Published: February 2003

Objective:

To undertake a survey to investigate the quality and format of nutrition health promotion in UK primary care. Data from both primary care practitioners – i.e. level of nutritional knowledge and attitude towards nutrition interventions – and patients – i.e. the format and quality of dietary consultations – are presented.

Design:

A self-completion questionnaire was used to assess nutritional knowledge and attitude of primary care staff towards nutrition interventions. Data regarding the format and quality of the dietary consultation were collected from patients using a screening question and follow-up questionnaire.

Setting:

Twelve general practices in a city in north-east England.

Subjects:

One hundred and nine primary care staff, and 2400 consecutive patients recruited from the 12 practices.

Results:

Seventy-seven per cent of primary care staff completed the questionnaire. Sixty-five per cent of the knowledge questions were answered correctly by most practitioners. Questions containing complex nutritional terminology were answered poorly. Most practitioners believed primary care teams have an essential role in giving dietary advice. Thirteen per cent of patients reported that they had discussed diet. Of these, 40% were asked to make dietary changes; 20% discussed how they cooked or prepared food; and 33% were asked to make a follow-up appointment.

Conclusion:

Encouraging signs included good levels of nutritional knowledge and belief amongst staff that they should be involved in nutrition interventions. Patients reported that they understood and felt able to achieve the dietary changes suggested. Less encouraging were little evidence of discussion about the practical aspects of food and fairly low rates of follow-up being arranged.
A randomised trial in Mali of the effectiveness of weekly iron supplements given by teachers on the haemoglobin concentrations of schoolchildren
Authors: Hall Andrew , Roschnik Natalie , Ouattara Fatimata , Touré Idrissa , Maiga Fadima , Sacko Moussa , Moestue Helen , Bendech Mohamed Ag
Published: February 2003

Objective:

To assess the effect on the haemoglobin concentrations of schoolchildren of weekly iron tablets administered by teachers.

Design:

Sixty schools were randomly assigned to two groups: in 30 schools children were given weekly for 10 weeks a tablet providing 65 mg of iron and 0.25 mg of folic acid; in the other 30 schools no iron tablets were given. All children were dewormed and given vitamin A before the study began. The haemoglobin concentration of up to 20 randomly selected children in each school was estimated before and 2 weeks after the end of treatment.

Setting:

Rural community schools in Kolondieba district of Mali.

Subjects:

Some 1113 schoolchildren aged 6–19 years with a mean of 11.4 years.

Results:

The haemoglobin concentration of treated children rose on average by 1.8 g l-1 (P < 0.001) and the prevalence of anaemia fell by 8.2% (P < 0.001); in untreated children the haemoglobin concentration fell by an average of -2.7 g l-1 (P < 0.001) and the prevalence of anaemia rose by 9.4% (P < 0.001). The fall in haemoglobin concentration among untreated girls of -4.0 g l-1 was greater than in untreated boys (-0.3 g l-1, P < 0.001).

Conclusions:

Weekly iron tablets given by teachers prevented a general fall in the haemoglobin concentrations of untreated children, and led to a small but statistically significant rise among treated children (P < 0.001). Young children benefited more than children aged ≥12 years, and girls benefited more than boys.
Reference values for serum levels of vitamin B12and folic acid in a population-based sample of adults between 35 and 80 years of age
Authors: Wahlin Åke , Bäckman Lars , Hultdin Johan , Adolfsson Rolf , Nilsson Lars-Göran
Published: February 2003

Objectives:

To examine folic acid and vitamin B12status in a group of 1000 persons sampled from the community of Umeå, Sweden, and aged 35, 40, 45, 50, 55, 60, 65, 70, 75 or 80 years. Reference data for folate and age-stratified reference data for vitamin B12are presented, together with an examination of potential confounders.

Measurements:

All subjects participated in extensive health examinations and interviews, and laboratory blood testing was performed.

Results:

A series of exclusion criteria were applied, and data from 961 subjects were analysed. Vitamin B12levels were found to decrease with increasing age, whereas folate levels remained constant across the age span studied. None of the vitamins was found to vary with sex, education, smoking or alcohol consumption, body mass index, prescription-free vitamin supplements, level of haemoglobin, or mean cell volume of erythrocytes. Further, none of these factors was associated with the age-related decrease of vitamin B12level.

Conclusions:

The offered reference ranges should be used only in order to rule out deficiency. For B12levels, the age of the subject should be considered such that, for elderly people in particular, values above the medians should be considered as indicative of normal vitamin status.
Complementary foods in Jamaica: viscosity, energy density and feeding practices
Authors: Gardner Julie Meeks , Walker Susan P , Gavin Karlene A , Ashworth Ann
Published: February 2003

Objectives:

To develop and validate a field method for measuring the viscosity of small quantities of weaning porridges, to measure the viscosity and energy density of porridges fed in urban and rural environments, and to relate the findings to ingredients used and feeding practices.

Design:

A new method for determining the viscosity of homogeneous, semi-solid weaning foods was developed. The viscosity and energy density of porridges fed to young children were measured, ingredients obtained by recall, and caregiver feeding behaviours observed.

Setting:

One urban and one rural community in Jamaica.

Subjects:

A purposive random sample of 70 children aged 3 to 14 months.

Results:

Most children (80%) were fed porridges with medium viscosity (1700–2900 mPa s) or thicker. The mean energy density was 3.18±0.92 kJ g−1. Energy density was only moderately related to viscosity, being higher only in porridges >4000 mPa s (analysis of variance (ANOVA), P<0.05). Energy density was correlated (P<0.05) with the amounts of sugar (r=0.28) and milk powder (r=0.24) used. Viscosity and energy density were lower in porridges fed by bottle than in those fed by spoon. Anthropometric status (weight-for-length and weight-for-age) was positively correlated with energy density of the porridge but not to the encouragement or persistence of the caregiver.

Conclusions:

Porridges of adequate energy density were prepared by caregivers in Jamaica without raising viscosity to levels that might constrain intakes. Improvements in porridge preparation and more varied weaning diets may have contributed to the decline in undernutrition in Jamaica.