bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors affecting energy and macronutrient requirements in elderly people
Authors: Ritz Patrck
Published: June 2008

Objectives:

(i) to describe energy and macronutrient requirements in healthy and diseased elderly patients from knowledge acquired about the age-related changes in energy balance (ii) to describe changes in body composition and the consequences of physical activity and exercise programs.

Results:

Aging in individuals considered healthy is associated with a reduction in muscle mass and strength (with consequences on autonomy), and an increase in fat mass mainly in the central area, the latter might increase the risk of cardiovascular disease. Body composition changes can be seen as a positive energy (fat) balance. The reduced fat-free mass is responsible for a low resting metabolic rate. Therefore, energy requirements are reduced all the more since physical activity is decreased. A simple means for calculating individuals' energy requirements from estimated resting metaboc rate and physical activity is not yet available in a validated form and is much required. Protein requirements are still debated.

Exercise programs can be implemented for increasing muscle mass and strength (resistance training) or for improving aerobic fitness and reducing fat mass (endurance exercise). It is not yet clear whether structured exercise programs or spontaneous physical activity have similar advantages. It is not known in which cases resistance, endurance, or a combination of both exercises should be recommended. The consequences of physical activity and exercise programs on energy and macronutrient requirements is not clear.

Diseased elderly persons are prone to malnutrition which impairs clinical and functional outcome. Malnutrition is the result of an energy intake inadequate to match energy requirements. Literature is very short of data on energy requirements in diseased elderly persons, who are under the complex influences of stress (increasing resting energy requirements), reduced body mass and physical activity (reducing energy requirements), plus potential effects of drugs. Almost nothing is known about macronutrient requirements.

Conclusions:

Further studies are required to enable calculations of energy and macronutrient requirements of individuals, especially diseased. More work has to be done to understand the energy imbalance in the elderly (healthy and diseased). Careful evaluations of physical activity and exercise programs are necessary.
Selenium, selenoproteins and human health: a review
Authors: Brown KM , Arthur JR
Published: June 2008

Selenium is of fundamental importance to human health. It is an essential component of several major metabolic pathways, including thyroid hormone metabolism, antioxidant defence systems, and immune function. The decline in blood selenium concentration in the UK and other European Union countries has therefore several potential public health implications, particularly in relation to the chronic disease prevalence of the Western world such as cancer and cardiovascular disease. Ten years have elapsed since recommended dietary intakes of selenium were introduced on the basis of blood glutathione peroxidase activity. Since then 30 new selenoproteins have been identified, of which 15 have been purified to allow characterisation of their biological function. The long term health implications in relation to declining selenium intakes have not yet been thoroughly examined, yet the implicit importance of selenium to human health is recognised universally.

Selenium is incorporated as selenocysteine at the active site of a wide range of selenoproteins. The four glutathione peroxidase enzymes (classical GP×1, gastrointestinal GP×2, plasma GP×3, phospholipid hydroperoxide GP×4)) which represent a major class of functionally important selenoproteins, were the first to be characterised.

Thioredoxin reductase (TR) is a recently identified seleno-cysteine containing enzyme which catalyzes the NADPH dependent reduction of thioredoxin and therefore plays a regulatory role in its metabolic activity.

Approximately 60% of Se in plasma is incorporated in selenoprotein P which contains 10 Se atoms per molecule as selenocysteine, and may serve as a transport protein for Se. However, selenoprotein-P is also expressed in many tissues which suggests that although it may facilitate whole body Se distribution, this may not be its sole function.

A second major class of selenoproteins are the iodothyronine deiodinase enzymes which catalyse the 5′5-mono-deiodination of the prohormone thyroxine (T4) to the active thyroid hormone 3,3′5-triiodothyronine (T3).

Sperm capsule selenoprotein is localised in the mid-peice portion of spermatozoa where it stabilises the integrity of the sperm flagella.

Se intake effects tissue concentrations of selenoprotein W which is reported to be necessary for muscle metabolism.

It is of great concern that the health implications of the decline in Se status in the UK over the past two decades have not been systematically investigated. It is well recognised that dietary selenium is important for a healthy immune response. There is also evidence that Se has a protective effect against some forms of cancer; that it may enhance male fertility; decrease cardiovascular disease mortality, and regulate the inflammatory mediators in asthma. The potential influence of Se on these chronic diseases within the European population are important considerations when assessing Se requirement.
Folates and prevention of disease
Authors: Molloy Anne M , Scott John M
Published: June 2008

Research in the past decade has established that low or inadequate folate status may contribute to congenital malformations and the development of chronic disease in later life. Using an evidence based approach, there are clear guidelines for recommending folic acid supplementation or fortification in certain disease conditions but further proof of its efficacy is required in other circumstances.

There is conclusive evidence that maternal periconceptional supplementation with folic acid prevents the majority of NTDs, probably by overcoming one or more genetically inherited metabolic blocks in folate dependent enzymes. Public health efforts to advise women to increase their folate intake have not been successful. As a result, the U.S. government passed legislation to have all flour fortified with folic acid. This intervention has had a dramatic effect on folate status in the U.S. To date, countries of the EU have not adopted mandatory fortification policies.

The amino acid homocysteine is an essential intermediate in folate metabolism. Substantial evidence indicates that elevated plasma homocysteine is an independent risk factor for heart disease and stroke. Plasma homocysteine levels can be reduced by folic acid supplements. A food fortification policy would probably be an effective population strategy to reduce plasma homocysteine. However, many experts believe that this would be premature without first showing that such reduction would cause a decrease in the prevalence of cardiovascular disease.

The contribution of folate to cancer risk is not well defined although there is reasonable evidence to implicate low folate status in the specific case of colorectal cancer. In particular, long-term folic acid supplementation may reduce risk of colorectal cancer substantially.

Various mental disorders including Alzheimer's Disease have been associated with low folate status or elevated plasma homocysteine. While it is hard to determine if this is cause or effect, there is little doubt that if it were true then low dose folic acid intervention would be highly effective.
Dietary soy isoflavone intake in older Japanese American women
Authors: Rice Madeline Murguia , LaCroix Andrea Z , Lampe Johanna W , van Belle Gerald , Kestin Mark , Sumitani Megumi , Graves Amy Borenstein , Larson Eric B
Published: June 2008

Objective:

In a sample of older Japanese American women, we aimed to: (1) describe the most commonly consumed soy foods, (2) estimate dietary soy isoflavone intake, (3) describe characteristics associated with dietary soy isoflavone intake, and (4) compare our estimates with previously published estimates in other Japanese samples.

Design:

A 14-item soy food-frequency questionnaire was administered to older Japanese American women and responses were converted to quantitative estimates of soy isoflavones (genistein plus daidzein). Multiple regression was used to examine characteristics associated with dietary soy isoflavone intake, including self-reported lifestyle and cultural factors and dietary intake of various foods ascertained from a semi-quantitative food-frequency questionnaire. To compare our estimates with other samples, a review of the literature was conducted.

Setting/subjects:

Data are from 274 women aged 65+ years, recruited from a longitudinal cohort study of Japanese Americans in King County, Washington State.

Results:

The soy foods most commonly consumed were tofu (soybean curd), miso (fermented soybean paste) and aburaage (fried thin soybean curd). The mean intake of dietary soy isoflavones was 10.2 (standard deviation (SD), 12.4) mg day−1, approximately a quarter to a half that of previously published estimates in Japanese samples. Dietary soy isoflavone intake was positively associated with speaking Japanese, the consumption of traditional Japanese dishes (kamaboko, manju and mochi), low-fat/non-fat milk and yellow/red vegetables, vitamin E supplement use, and walking several blocks each day. Dietary soy isoflavone intake was negatively associated with the consumption of butter.

Conclusions:

The estimated dietary soy isoflavone intake in Japanese American women living in King County, Washington State was about a quarter to a half that of women living in Japan. Dietary soy isoflavone intake was associated with speaking Japanese and healthy lifestyle and dietary habits.
Food availability and consumption at national, household and individual levels: implications for food-based dietary guidelines development
Authors: Serra-Majem Lluís
Published: June 2008

The three levels of dietary data national, household and individual, are analysed and compared, and their use and misuse in FBDG development and monitoring are discussed. Food Balance Sheets (FBS) estimate the national availability of foods, and are an appropriate tool to evaluate food policies; they tend to overestimate food consumption, particularly for those foods with higher waste. Household Budget Surveys (HBS) estimate the household availability of foods, and are useful to evaluate dietary family interventions. Individual Dietary Surveys (IDS) evaluate individual food and nutrient intake and provide a unique estimation of nutritional status and are the best tool for planning FBDG; however, they are expensive and may be biased towards underreporting.

The understanding of the relationship between the different levels of food information is very important when formulating, evaluating and monitoring a nutrition policy in a country or region.
Correlation analyses as a step to identify foods that are sources of inter-individual variability in nutrients; their use for the development of food based dietary guidelines
Authors: Leclercq Catherine , Arcella Davide
Published: June 2008

Food Based Dietary Guidelines (FBDG), in order to be attainable, should take into account the cultural context of the population for which they are developed. They need to focus on foods that actually determine the intake of nutrients for which desirable changes have been identified. Inter-individual variability of nutrient intakes – a measure of the heterogeneity of intakes – is determined by the variability in the consumption of its food sources among the population. The foods that determine a high proportion of inter-individual variability in nutrient intake can be identified on the basis of data banks that describe food and nutrient intakes in the population. The experience accumulated to design Food Frequency Questionnaire through selection of key foods suggests that high quantitative contributors to a specific nutrient may not be important determinants of its intake. On the other hand, the Pearson correlation between the intake of each food source and the total nutrient intake allows quantification of the percentage of variability explained by each item and takes into account the possibility of correlations between different food sources. Once a key food is identified, several strategies are available to modify its intake in the population: through changes in the percentage of consumers/in the mean portion size/in the frequency of intake. The anticipated level of change can be predicted according to the strategy adopted.
Reproducibility and validity of a quantitative food-frequency questionnaire among Jamaicans of African origin
Authors: Jackson M , Walker S , Cade J , Forrester T , Cruickshank JK , Wilks R
Published: June 2008

Background:

An interviewer-administered quantitative food-frequency questionnaire (FFQ) was developed to determine the energy and nutrient intakes of adult Jamaicans of African origin as part of a study of the epidemiology of diabetes and hypertension.

Methods:

Reproducibility of the questionnaire was investigated in 123 participants aged 25–74 years. The relative validity of the FFQ was assessed against twelve 24-hour recalls administered over 12 months in 73 of the participants. In addition, energy intakes (EI) were compared with estimated basal metabolic rates (BMR).

Results:

Reproducibility correlation coefficients (Pearson and intraclass) varied between 0.42 for retinol and 0.71 for carbohydrate, with most values falling between 0.50 and 0.60. When compared with repeated 24-hour recalls, the FFQ estimated slightly higher energy (mean 6%) and macronutrient intakes (mean 2–14%), and was within 5% when expressed as a percentage of energy intake. Micronutrients were higher by 1.19 (calcium) to 1.61 times (vitamin C). Unadjusted correlations between the FFQ and the reference method ranged from 0.20 for beta-carotene to 0.86 for alcohol. Cross-classification of nutrients into quartiles showed that 46–48% of participants in the lowest and highest quartiles were jointly classified by both methods. Misclassifications were low for most nutrients with one or two persons misclassified at the extreme quartiles. EI/BMR ratios suggested light to moderate activity levels appropriate for an urban population in a developing country.

Conclusions:

The FFQ showed reasonable reproducibility and validity and is suitable for estimating the habitual intakes of energy and macronutrients, but was poor for some micronutrients (retinol and beta-carotene).
The development of food consumption in the Czech Republic after 1989
Authors: Dofkova M , Kopriva V , Resova D , Rehurkova I , Ruprich J
Published: June 2008

Objective:

To define the average food consumption per capita in the Czech population and to investigate food consumption development during the years of economic transition.

Design:

Three studies based on the household budget survey (HBS) were conducted in the 1990s. The primary data originated from so-called diaries of reporting households loaned out from the Czech Statistical Office (CSO). The arranging of representative samples has been done and is guaranteed by the CSO. Complementary inquiry was conducted to supplement the HBS data. The average consumption of basic food groups is presented.

Setting:

All regions of the Czech Republic.

Subjects:

The primary data came from the years 1991, 1994 and 1997. The basic sample representing the Czech population included 420 households and was arranged with regard to the region, size and socio-economic type of households.

Results:

The changes in food consumption during the 1990s were reflected, above all, in meat, milk and dairy products, added fats, fruit and beverages. The consumption of poultry meat, fish, fresh fruit and vegetables has increased. The proportion of added fats has changed in favour of vegetable fats. On the other hand, a negative feature may be the permanent reduction in milk consumption.

Conclusion:

Most of the changes in eating patterns that appeared in the Czech population after 1989 can be interpreted as positive ones.
Long-term evaluation of a micronutrient-fortified biscuit used for addressing micronutrient deficiencies in primary school children
Authors: van Stuijvenberg ME , Dhansay MA , Smuts CM , Lombard CJ , Jogessar VB , Benadé AJS
Published: June 2008

Objective:

To evaluate the long-term effect on micronutrient status of a β-carotene-, iron- and iodine-fortified biscuit given to primary school children as school feeding.

Design:

Children receiving the fortified biscuit were followed in a longitudinal study for 2.5 years (n=108); in addition, cross-sectional data from three subsequent surveys conducted in the same school are reported.

Setting:

A rural community in KwaZulu-Natal, South Africa.

Subjects:

Children aged 6–11 years attending the primary school where the biscuit was distributed.

Results:

There was a significant improvement in serum retinol, serum ferritin, haemoglobin, transferrin saturation and urinary iodine during the first 12 months of the biscuit intervention. However, when the school reopened after the summer holidays, all variables, except urinary iodine, returned to pre-intervention levels. Serum retinol increased again during the next 9 months, but was significantly lower in a subsequent cross-sectional survey carried out directly after the summer holidays; this pattern was repeated in two further cross-sectional surveys. Haemoglobin gradually deteriorated at each subsequent assessment, as did serum ferritin (apart from a slight increase at the 42-month assessment at the end of the school year).

Conclusions:

This study has shown that fortification of a biscuit with β-carotene at a level of 50% of the Recommended Dietary Allowance (RDA) was enough to maintain serum retinol concentrations from day to day, but not enough to sustain levels during the long school holiday break. Other long-term solutions, such as local food production programmes combined with nutrition education, should also be examined. The choice of the iron compound used as fortificant in the biscuit needs further investigation.
Epidemiology of helminth infections: implications for parasite control programmes, a South African perspective
Authors: Jinabhai CC , Taylor M , Coutsoudis A , Coovadia HM , Tomkins AM , Sullivan KR
Published: June 2008

Objectives:

To determine the epidemiology of helminthic infections and the efficacy of parasite treatment among rural South African primary school children in the province of KwaZulu-Natal. To assess the South African government's parasite control policy.

Methods:

The study recruited 268 school children, aged 8 to 10, and randomly allocated them into treatment and placebo groups (treatment consisted of a single dose of albendazole (400 mg) and praziquantel (40 mg/kg)). Anthropometric measurements and the prevalence and intensity of helminth infections were taken at baseline (prior to treatment) and 16 weeks post treatment. Two weeks after treatment prevalence and intensity were again measured for an approximate 50% sub-sample of the children to investigate efficacy of treatment. An analysis of the South African government's policies concerning parasite control is assessed in the light of these epidemiological findings.

Results:

Low levels of both stunting and wasting were observed throughout the study (approximately 10% and 1%, respectively), but did not vary significantly across either treatment group or time period (P>0.50). At baseline the observed prevalences for the three main helminths found in this study among the treated children were Ascaris lumbricoides 29.5%, Trichuris trichiura 51.9% and Schistosoma haematobium 22.3%. These prevalences declined significantly to 4.7% (P<0.0005), 38.0% (P<0.03) and 3.3% (P<0.0002), respectively, 16 weeks post treatment. The majority of infections observed at baseline were of light intensity, namely A. lumbricoides (50%), T. trichiura (80%) and S. haematobium (100%), and following treatment these levels were reduced significantly (P<0.0001, P<0.05 and P<0.005, respectively). The levels of both prevalence and intensity in the untreated group remained constant. The cure rates over the first two weeks of the study were found to be 94.4% for A. lumbricoides, 40% for T. trichiura and 72.2% for S. haematobium.

Conclusion:

The benefits of targeted, school-based treatment in reducing the prevalence and intensity of infection supports the South African government's focus of using school-based interventions as part of an integrated parasite control programme. These strategies and programmes are consistent with recommendations of the World Health Organization (WHO) and The United Nations Children's Fund (UNICEF).
Television advertising and children: lessons from policy development
Authors: Caraher Martin , Landon Jane , Dalmeny Kath
Published: June 2008

Aim

To conduct a policy review of the regulations related to food advertising on television aimed at children.

Design

The study consisted of documentary analysis of relevant legislation and policy documents related to children's advertising from both industry and non-governmental organisations at a global level and in 20 countries. This was supported with semi-structured telephone interviews with individuals from 11 countries.

Results

The initial findings resulted in a listing of regulatory impacts from which we developed a taxonomy of regulatory schemes. There was a tension between the development of legislation to cover this area and the use of voluntary agreements and codes. This tension represents a food industry/civic society split. The food and advertising industries are still engaged in a process of denying the impact of advertising on food choice and children as well as commissioning their own research. Outright bans are unusual, with most countries addressing the situation through voluntary agreements and self-regulation. We found a deep division over the way forward and the role and place of legislation. Policy-makers expressed concerns that national legislation was increasingly less relevant in dealing with broadcast media transmitted from outside national boundaries and therefore not subject to the receiving countries' laws but to the laws of the country from which they were transmitted.

Conclusions

The options for the regulation of advertising targeted at children range from (1) a complete ban on advertising as in the case of Sweden, through (2) partial restrictions on advertising by type of food, target group or limits on the amount of advertisements or times shown, to (3) continuation of self-regulation by the advertising and food industries. There is a global dimension to regulation that needs to be built in, as national frontiers are no barriers to broadcast media and public health nutrition needs to ensure that its concerns are heard and addressed.
Validity and reproducibility of two semi-quantitative alcohol frequency questionnaires for the Colombian population
Authors: Herrán Oscar F , Ardila María F
Published: June 2008

Objective

To determine the relative validity and reproducibility of two alcohol intake frequency questionnaires (AFQ-A; AFQ-B), designed to classify subjects according to their alcohol intake level, in Bucaramanga, Colombia.

Method

One hundred and nine randomly selected subjects, aged between 20 and 60 years, completed three 30-day semi-quantitative alcohol intake records (30-DR). The AFQs were applied three months after the last 30-DR. AFQ-A contained 53 items; AFQ-B contained five items, with the alcoholic drinks for AFQ-B selected by Max_r. The correlation and agreement between alcohol intake assessed with the AFQs and the 30-DR were obtained using Pearson's correlation coefficient (r), Lin's concordance correlation coefficient (pC), Spearman's rank correlation coefficient(rS), Bland and Altman's limits of agreement (LOA) and Cohen's weighted kappa statistic (Kw).

Results

The reproducibility of the 30-DR was poor; rS ranged from 0.33 to 0.41. The reproducibility of the AFQs was higher, with rS between 0.50 and 0.73. The agreement(Kw) of the 30-DR and the AFQs was 0.40. The lower and upper LOA were between 56.4% and 11.0%. The AFQs and 30-DR were well correlated. Assessment of relative validity between the two methods yielded r values for alcohol between 0.52 Alcohol consumption and 0.60, which reduced to 0.20–0.29 after energy adjustment.

Conclusions

These AFQs may be useful to rank subjects according to their alcohol Max_r intake. The AFQ-B is easy and quick to apply, and is also highly cost-effective.
Community-based assessment of infant feeding practices within a programme for prevention of mother-to-child HIV transmission in rural Zimbabwe
Authors: Orne-Gliemann J , Mukotekwa T , Miller A , Perez F , Glenshaw M , Nesara P , Dabis F
Published: June 2008

Objective

To describe the infant feeding practices and attitudes of women who used prevention of mother-to-child transmission of HIV (PMTCT) services in rural Zimbabwe.

Design

A cross-sectional study including structured interviews and focus group discussions was conducted between June 2003 and February 2004.

Setting

The study took place in Murambinda Mission Hospital (Buhera District, Manicaland Province), the first site offering PMTCT services in rural Zimbabwe.

Subjects

The interviews targeted HIV-infected and HIV-negative women who received prenatal HIV counselling and testing and minimal infant feeding counselling, and who delivered between 15 August 2001 and 15 February 2003. The focus groups were conducted among young and elderly men and women.

Results

Overall, 71 HIV-infected and 93 HIV-negative mothers were interviewed in clinics or at home. Most infants (97%) had ever been breast-fed. HIV-negative mothers introduced fluids/foods other than breast milk significantly sooner than HIV-infected mothers (median 4.0 vs. 6.0 months, P = 0.005). Infants born to HIV-negative mothers were weaned significantly later than HIV-exposed infants (median 19.0 vs. 6.0 months, P = 10−5). More than 90% of mothers reported that breast-feeding their infant was a personal decision, a third of whom also mentioned having taken into account health workers' messages.

Conclusion

The HIV-infected mothers interviewed were gradually implementing infant feeding practices recommended in the context of HIV. Increased infant feeding support capacity in resource-limited rural populations is required, i.e. training of counselling staff, decentralised follow-up and weaning support.
Leisure-time and occupational physical activity in relation to cardiovascular risk factors and eating habits in French adults
Authors: Oppert J-M , Thomas F , Charles M-A , Benetos A , Basdevant A , Simon C
Published: June 2008

Objective

To investigate the relationships of two main physical activity domains (during leisure and at work) with cardiovascular risk factors and eating habits.

Design

Cross-sectional study.

Setting

Preventive medicine centre.

Subjects

In 5478 adults (32% women, aged 20–80 years) who consecutively underwent a standardised health examination, leisure-time physical activity (LTPA; i.e. non-sport leisure and sport activities), occupational physical activity (OPA) and eating habits were assessed by self-administered questionnaires. We analysed sex-specific relationships of LTPA and OPA (in quartiles) with (1) various cardiovascular risk factors and (2) eating habits using analysis of variance and logistic regression, respectively.

Results

In both genders, with and without adjustment for education in addition to age, LTPA was associated negatively with body mass index, body fat, waist circumference, resting heart rate, diastolic blood pressure and triglycerides, and positively associated with high-density lipoprotein cholesterol (all P ≤ 0.005). OPA adjusted for age only was positively associated with most cardiovascular risk factors but these associations were not significant after further adjustment on education (except for waist circumference in women). Age- and education-adjusted LTPA was associated with increased frequency of consumption of fruits (odds ratio (OR) = 2.05, 95% confidence interval (CI) 1.68–2.52 in men; OR = 1.90, 95% CI 1.41–2.05 in women) and vegetables (OR = 1.81, 95% CI 1.48–2.21 in men; OR = 2.22, 95% CI 1.66–2.97 in women).

Conclusions

The data emphasise the favourable associations of LTPA, a modifiable behaviour, with various cardiovascular risk factors and healthy eating habits. The results also suggest that the relationships of OPA with cardiovascular risk factors depend, at least in part, on socio-economic status as reflected by educational level.
Food insecurity, weight control practices and body mass index in adolescents
Authors: Gulliford Martin C , Nunes Cheryl , Rocke Brian
Published: June 2008

Objective

We investigated whether experienced food insecurity was associated with weight control behaviour of adolescents.

Design

A national survey of 16-year-old students with the six-item food security scale, questions concerning intentions of trying to change weight, physical activity patterns, and measurement of height and weight.

Setting

Representative sample of 29 schools in Trinidad, West Indies.

Subjects

Data analysed for 1903 subjects including 1484 who were food-secure and 419 who were food-insecure.

Results

In the whole sample, food security status did not vary by body mass index (BMI) category. ‘Trying to gain weight’ and ‘spending most free time in activities involving little physical effort’ were each associated with lower BMI. ‘Trying to gain weight’ was more frequent in food-insecure subjects (135, 32%) than in food-secure subjects (369, 25%, P=0.012). After adjustment for BMI, age, sex, ethnicity and socio-economic variables, the adjusted odds ratio (OR) of ‘trying to gain weight’ for food-insecure subjects was 1.39 (95% confidence interval (CI) 1.07–1.82, P = 0.014). Food-insecure subjects (197, 47%) were more likely than food-secure subjects (575, 39%) to report that most of their free time was spent doing things that involved little physical effort (P = 0.003). This association was not explained by adjustment for BMI, age, sex and ethnicity (OR = 1.41, 95% CI 1.13–1.76, P = 0.002) or additional socio-economic variables (OR = 1.27, 95% CI 1.02–1.57, P = 0.033).

Conclusions

Adolescents who experience food insecurity are more likely to intend to gain weight but engage in less physical activity than food-secure subjects with the same BMI.
Efficacy and safety of food fortification with calcium among adults in Finland
Authors: Hirvonen Tero , Tapanainen Heli , Valsta Liisa , Hannila Marja-Leena , Aro Antti , Pietinen Pirjo
Published: June 2008

Objective

To examine the efficacy and safety of foods fortified with calcium in the adult population in Finland.

Design

A simulation study based on the FINDIET 2002 Survey, which estimated habitual food consumption, dietary supplement use and nutrient intakes using 48-hour recall and two 3-day food records, and an Internet survey of the consumption of fortified foods and dietary supplements.

Setting/participants

Participants of FINDIET 2002 were 25–64 years old from five areas (n= 2007). Participants of the Internet-based survey (n= 1537) were over 15 years of age from all over the country.

Results

If all potentially fortifiable foods were to be fortified with calcium, the proportion of participants with calcium intake below the recommended level (<800 mg day−1) would decrease from 20.3% to 3.0% in men and from 27.8% to 5.6% in women compared with the situation where no foods were fortified. At the same time, the proportion of participants with calcium intake above the tolerable upper intake level (UL, >2500 mg day−1) would increase from 0.6% to 12.7% in men and from 0.1% to 3.8% in women. However, in a probability-based model (11% of all fortifiable foods to be fortified with calcium) the proportion of participants with calcium intake below the recommended level would be 15.7% in men and 23.2% in women. The proportion with intake above the UL in this model would be 1.2% in men and 0.7% in women.

Conclusions

Food fortification would be a relatively effective and safe way to increase the calcium intake of the Finnish adult population.
Deaths and years of life lost due to suboptimal breast-feeding among children in the developing world: a global ecological risk assessment
Authors: Lauer Jeremy A , Betrán Ana Pilar , Barros Aluísio JD , de Onís Mercedes
Published: June 2008

Objective

We estimate attributable fractions, deaths and years of life lost among infants and children ≤2 years of age due to suboptimal breast-feeding in developing countries.

Design

We compare actual practices to a minimum exposure pattern consisting of exclusive breast-feeding for infants ≤6 months of age and continued breast-feeding for older infants and children ≤2 years of age. For infants, we consider deaths due to diarrhoeal disease and lower respiratory tract infections, and deaths due to all causes are considered in the second year of life. Outcome measures are attributable fractions, deaths, years of life lost and offsetting deaths potentially caused by mother-to-child transmission of HIV through breast-feeding.

Setting

Developing countries.

Subjects

Infants and children ≤2 years of age.

Results

Attributable fractions for deaths due to diarrhoeal disease and lower respiratory tract infections are 55% and 53%, respectively, for the first six months of infancy, 20% and 18% for the second six months, and are 20% for all-cause deaths in the second year of life. Globally, as many as 1.45 million lives (117 million years of life) are lost due to suboptimal breast-feeding in developing countries. Offsetting deaths caused by mother-to-child transmission of HIV through breast-feeding could be as high as 242 000 (18.8 million years of life lost) if relevant World Health Organization recommendations are not followed.

Conclusions

The size of the gap between current practice and recommendations is striking when one considers breast-feeding involves no out-of-pocket costs, that there exists universal consensus on best practices, and that implementing current international recommendations could potentially save 1.45 million children's lives each year.
Carotenoid content of pandanus fruit cultivars and other foods of the Republic of Kiribati
Authors: Englberger Lois , Aalbersberg William , Dolodolotawake Usaia , Schierle Joseph , Humphries Julia , Iuta Tinai , Marks Geoffrey C , Fitzgerald Maureen H , Rimon Betarim , Kaiririete Mamarau
Published: June 2008

Background

Kiribati, a remote atoll island country of the Pacific, has serious problems of vitamin A deficiency (VAD). Thus, it is important to identify locally grown acceptable foods that might be promoted to alleviate this problem. Pandanus fruit (Pandanus tectorius) is a well-liked indigenous Kiribati food with many cultivars that have orange/yellow flesh, indicative of carotenoid content. Few have been previously analysed.

Aim

This study was conducted to identify cultivars of pandanus and other foods that could be promoted to alleviate VAD in Kiribati.

Method

Ethnography was used to select foods and assess acceptability factors. Pandanus and other foods were analysed for β- and α-carotene, β-cryptoxanthin, lutein, zeaxanthin, lycopene and total carotenoids using high-performance liquid chromatography.

Results

Of the nine pandanus cultivars investigated there was a great range of provitamin A carotenoid levels (from 62 to 19 086 μg β-carotene/100 g), generally with higher levels in those more deeply coloured. Seven pandanus cultivars, one giant swamp taro (Cyrtosperma chamissonis) cultivar and native fig (Ficus tinctoria) had significant provitamin A carotenoid content, meeting all or half of estimated daily vitamin A requirements within normal consumption patterns. Analyses in different laboratories confirmed high carotenoid levels in pandanus but showed that there are still questions as to how high the levels might be, owing to variation arising from different handling/preparation/analytical techniques.

Conclusions

These carotenoid-rich acceptable foods should be promoted for alleviating VAD in Kiribati and possibly other Pacific contexts where these foods are important. Further research in the Pacific is needed to identify additional indigenous foods with potential health benefits.
The process of establishing, implementing and maintaining a social support infant feeding programme
Authors: Watt RG , McGlone P , Russell JJ , Tull KI , Dowler E
Published: June 2008

Objective

To describe the process of establishing and implementing a social support infant feeding intervention.

Design

This paper outlines the initial stages of a randomised controlled trial which assessed the effectiveness of a social support intervention on a range of infant feeding outcomes. Details are presented of the processes involved in recruiting, training and supporting a group of volunteers who provided support to the study sample.

Setting

Camden and Islington, London, UK.

Results

Initial networking with local agencies and organisations provided invaluable information and contacts. Employing a dedicated volunteer co-ordinator is vitally important in the recruitment, training and support of volunteers. Providing child care and travel expenses is an essential incentive for volunteers with young children. Advertisements placed in local newspapers were the most successful means of recruiting volunteers. Appropriate training is needed to equip volunteers with the necessary knowledge and skills to provide effective support. Particular emphasis in the training focused upon developing the necessary interpersonal skills and self-confidence. The evaluation of the training programme demonstrated that it improved volunteers’ knowledge and reported confidence. The provision of ongoing support is also essential to maintain volunteers’ interest and enthusiasm. The retention of volunteers is, however, a key challenge.

Conclusions

The processes outlined in this paper have demonstrated the feasibility of successfully establishing, implementing and maintaining a community-based social support infant feeding programme. The experiences described provide useful insights into the practical issues that need to be addressed in setting up a social support intervention.
Food insecurity, malnutrition and mortality in Maewo and Ambae islands, Vanuatu
Authors: Renzaho Andre MN
Published: June 2008

Context

This paper reports on findings from the ex-post evaluation of the Maewo Capacity Building project in Maewo Island, Vanuatu, which was funded by World Vision Australia.

Objectives

To examine the extent to which the infrastructure and systems left behind by the project contributed to the improvement of household food security and health and nutritional outcomes in Maewo Island, using Ambae Island as a comparator.

Setting

Two-stage cluster survey conducted from 6 to 20 July 2004, which included anthropometric measures and 4.5-year retrospective mortality data collection.

Participants

A total of 406 households in Maewo comprising 1623 people and 411 households in Ambae comprising 1799 people.

Main outcome measures

Household food insecurity, crude mortality rate (CMR), under-five mortality rate (U5MR) and malnutrition prevalence among children.

Results

The prevalence of food insecurity without hunger was estimated at 15.3% (95% confidence interval (CI): 12.1, 19.2%) in Maewo versus 38.2% (95% CI: 33.6, 43.0%) in Ambae, while food insecurity with hunger in children did not vary by location. After controlling for the child's age and gender, children in Maewo had higher weight-for-age and height-for-age Z-scores than children of the same age in Ambae. The CMR was lower in Maewo (CMR=0.47/10 000 per day, 95% CI: 0.39, 0.55) than in Ambae (CMR=0.59/10 000 per day, 95% CI: 0.51, 0.67) but no difference existed in U5MR. The major causes of death were similar in both locations, with frequently reported causes being malaria, acute respiratory infection and diarrhoeal disease.

Conclusions

Project initiatives in Maewo Island have reduced the risks of mortality and malnutrition. Using a cross-sectional 'external control group' design, this paper demonstrates that it is possible to draw conclusions about project effectiveness where baseline data are incomplete or absent. Shifting from donor-driven evaluations to impact evaluations has greater learning value for the organisation, and greater value when reporting back to the beneficiaries about project impact and transformational development in their community. Public health nutritionists working in the field are well versed in the collection and interpretation of anthropometric data for evaluation of nutritional interventions such as emergency feeding programmes. These same skills can be used to conduct impact evaluations, even some time after project completion, and elucidate lessons to be learned and shared. These skills can also be applied more widely to projects which impact on the longer-term nutritional status of communities and their food security.
Mothers' views on feeding infants around the time of weaning
Authors: Walker Ruth B , Conn Jennifer A , Davies Michael J , Moore Vivienne M
Published: June 2008

Objective

To describe women's views about aspects of infants' diets around the time of weaning, making comparisons with national guidelines.

Design

A survey of women with a 9-month-old child.

Setting

Adelaide, South Australia.

Subjects

Five hundred and five women who joined a longitudinal study during pregnancy.

Results

Sources of information varied, with written material most commonly used (37%). Cows' milk was considered suitable as the main drink for weaned infants by 14% of women. There were divergent views about the suitability of eggs, with many women concerned about allergy. The majority of women (84%) viewed fruit juice as suitable although many qualified their response, often by stating that fruit juice should be diluted. Almost all women considered the amount of sugar mattered, primarily because of tooth decay, and that salt mattered although the reason was often uncertain. It was widely believed (77%) that additives in food could cause health problems, in particular hyperactivity and allergies, and half of the women reported avoiding specific foods because of concerns about allergies. Many women thought that giving their child food that was high in fat would encourage a liking for ‘junk’ food or lead to fatness in adulthood.

Conclusions

There is considerable diversity in the views women express about aspects of infant feeding that have been the subject of guidelines. Further health promotion efforts are needed to achieve greater consistency with recommendations and to address other concerns women have. This will entail greater engagement with parents and shared development of responses.
Exclusive and any breast-feeding rates of Pacific infants in Auckland: data from the Pacific Islands Families First Two Years of Life study
Authors: Schluter Philip J , Carter Sarnia , Percival Teuila
Published: June 2008

Objectives

To present current breast-feeding rates for Pacific infants resident in New Zealand. Reasons for the introduction of complementary liquid foods were also explored.

Design

A longitudinal study using hospital discharge summary records and maternal home interviews undertaken at 6 weeks, 12 and 24 months postpartum. Turnbull's non-parametric survival analysis was used to model exclusive breast-feeding rates.

Setting

Auckland, New Zealand.

Results

The cohort comprised 1376 infants at 6 weeks, 1223 infants at 12 months and 1142 infants at 24 months. Exclusive breast-feeding rates at hospital discharge, 6 weeks, 3 and 6 months postpartum were 84% (95% confidence interval (CI): 80–88%), 49% (95% CI: 43–55%), 37% (95% CI: 32–42%) and 9% (95% CI: 7–11%), respectively. Significant ethnic difference existed, with Samoan mothers having higher exclusive breast-feeding rates than Tongan mothers (P = 0.002). The percentage of infants receiving any breast milk at hospital discharge, 6 weeks, 12 and 24 months was 96% (95% CI: 94–97%), 95% (95% CI: 94–96%), 31% (95% CI: 28–34%) and 15% (95% CI: 13–17%), respectively. Again ethnic differences emerged. Common reasons cited for discontinuation of exclusive breast-feeding included uncertainty of breast milk supply (56%), problems with breasts (30%) and difficulties breast-feeding in work or educational environments (26%). However, 691 (50%) mothers sought no advice about their breast-feeding concerns within the first six weeks of life.

Conclusions

Exclusive breast-feeding rates for Pacific infants are ethnically heterogeneous, have declined since the 1990s and fall short of the World Health Organization recommendations. The principal reasons cited for exclusive breast-feeding discontinuation echo those reported over a decade ago.
Evaluation of health, nutrition and food security programmes in a complex emergency: the case of Congo as an example of a chronic post-conflict situation
Authors: Rossi Laura , Hoerz Thomas , Thouvenot Veronique , Pastore Gianni , Michael Markus
Published: June 2008

Objective

To describe the case of Congo as an example of the assessment and appropriateness of donor operational and sectoral strategies in a complex emergency.

Design and setting

The paper reports the findings of an external evaluation of operations financed by the European Commission Humanitarian Office in the Democratic Republic of Congo (DRC).

Results

The Congolese health system is suffering from severe deterioration. What is functioning in the public health context is donor-dependent with high costs and limited coverage. Despite a relatively favourable agro-climatic situation, food shortage and famine severely affect the nutritional status of large population groups. In this context, humanitarian programmes have generally improved access to health care and the nutritional status of beneficiaries. The reduction of malnutrition in project areas is often demonstrated even though the context did not permit consolidation of these results. Malnutrition continues to claim a massive cost of lives owing to the effect of widespread food insecurity that follows a circular cause-and-effect pattern of very low food production and extreme poverty.

Conclusions

The current context in DRC does not correspond yet to ‘post-crisis’: neither at population level with regard to indicators of poverty, malnutrition, disease and death, nor at institutional level, with regard to state support to institutions. In these situations, the international community is often called upon to replace the state as service provider. Integrated humanitarian actions should be the future of relief projects in DRC. Health, nutrition and food security components should be considered a standard public health intervention strategy representing the most sensible approach to address the needs of the affected population.
Responding to the crisis in sub-Saharan Africa: the role of nutrition
Authors: Chopra Mickey , Darnton-Hill Ian
Published: June 2008

In the chapter dealing with education and health, the report of the influential Commission for Africa prioritises basic health systems, HIV/AIDS, malaria and tuberculosis. In contrast, nutrition is given less than half a page and is reduced to parasite control and micronutrient support. Such neglect of nutrition is hard to understand in the context of increasing hunger and malnutrition across the continent. Sub-Saharan Africa is the only region in the world where the proportion of underweight children has stagnated and the absolute numbers have actually increased in the last decade. It has been pointed out that if current trends continue sub-Saharan Africa will achieve the Millennium Development Goal for child mortality around 2115 – one century after the target date. Quite clearly those concerned with nutrition need to more powerfully advocate the role of nutrition in lifting Africa out of the spiral of poverty. The present paper argues that to achieve this requires an understanding not just of the critical role of nutrition for health and development (both individual and national), but also of how recent global changes are interacting with changes in food production and supply, other determinants of maternal and child health, and the role and capacity of the state to tackle malnutrition in Africa. It concludes by suggesting some responses that nutritionists could now be making.