To determine vitamin A intake of children aged 2–5 years in a rural South African community one year after the implementation of a home-based food production programme targeting β-carotene-rich fruits and vegetables.

Dietary intake of children aged 2–5 years was determined during a cross-sectional survey before and one year after the implementation of a home-based food production programme.

A low socio-economic rural African community, approximately 60 km north-west of the coastal city of Durban in kwaZulu-Natal, South Africa.

Children aged 2–5 years (n=100); 50 children from households with home-gardens producing β-carotene fruits and vegetables (project gardens), and 50 children from households without project gardens.

As compared with baseline data, there was a significant increase in vitamin A intake in children from households with project gardens as well as in children from households without project gardens. However, children from households with project gardens had a significantly higher vitamin A intake than children from households without project gardens. The increased vitamin A intake in those children from households without project gardens can be attributed to the availability of butternuts in the local shop (as a result of the project), and because the mothers negotiated with project garden mothers to obtain these fruits and vegetables for their children.

A home-based food production programme targeting β-carotene-rich fruits and vegetables can lead to an increase in vitamin A intake.

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.

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.

Purworejo District, central Java, Indonesia.

Pregnant women (n = 490).

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.

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.

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.

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.

Consultations to WFP Ethiopia.

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.

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.

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

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

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

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

SMRs due to diabetes, hypertension and AMI have increased dramatically in parallel with the prevalence of obesity; therefore actions should be taken for the prevention of obesity. Reliable information about food consumption and physical activity is required to assess their specific roles in the aetiology of obesity.

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.

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.

One urban and one rural community in Jamaica.

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

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.

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.

To evaluate the provision of free school meals in Trinidad and Tobago in relation to children's social and nutritional status.

Design and methods: Cross-sectional survey of a nationally representative sample of 66 government schools, including children in the admissions classes (aged 4 to 7 years) and classes for ‘rising nines’ (aged 7–10 years). Data included questionnaire details of free school meals and children's social background, and measurements of children's heights, weights and skinfold thicknesses.

Of 6731 eligible children, data were analysed for 5688 (85%). There were 2386 (42%) children receiving free meals provided at school. At different schools the proportion of all children receiving free meals ranged from 20% to 100%, P < 0.001. Receipt of free meals was associated with larger family size (one child, 32% received free meals; ≥6 children, 63%), lower paternal educational attainment (primary, 52% free; university, 30%), father's employment (employed, 39% free meals; unemployed <12 months, 59%) as well as maternal education and employment and household amenities. After adjusting for age, sex and ethnic group, children who received free meals were shorter (mean difference in height standard deviation score (SDS) –0.12, 95% confidence interval (CI) –0.17 to –0.06), lighter (body mass index SDS –0.21, –0.28 to –0.14) and thinner (subscapular skinfold SDS –0.13, –0.18 to –0.09).

Free school meals were widely available, with some targeting of provision to children with less favourable social and nutritional status. Greater universality would reduce inequity, but more stringent targeting and reduction of school-level variation would increase efficiency.

In the fast growing city of Nairobi, women often combine the roles of mother and worker in trying to achieve better standards of living. The objective of this study was to document the effect of returning to work on breast-feeding by mothers in Kenya.

A cross-sectional survey.

Outpatient clinics of two major hospitals in Nairobi, one government hospital in an economically deprived area and one high-fee private hospital.

Four hundred and forty-four working mothers from low and higher socio-economic areas in Nairobi. All working mothers with infants aged 4 to 12 months attending during the survey period were invited to participate.

The prevalence of breast-feeding at the time of interview was found to be 94.1%. The lower socio-economic group exhibited a higher prevalence of breast-feeding (99%), 10% greater than the higher socio-economic group. The mean number of hours the mothers were away from home due to work was 46.2 hours each week. The majority (54.4%) of the mothers employed a ‘house-girl’ to care for their infant while they were at work, while 28.4% were able to take their infants to work. Most of the breast-feeding mothers (95%) breast-fed their infants at least three times a day and only 23 mothers reported not being able to breast-feed their infants during the day. The lower socio-economic group had a mean of 5.09 breast-feeding times per day while the higher socio-economic group had a mean of 3 times a day. In a logistic regression analysis the mode of work (fixed working hours vs. shift working hours) was associated with exclusive breast-feeding at one month (odds ratio (OR) = 0.45) and two months (OR = 0.39).

In Western countries ‘return to work’ is often cited as the reason that breast-feeding is discontinued prematurely. In this study we have shown how mothers in Kenya are able to successfully continue breast-feeding after they have returned to work, often for very long hours.

To describe anthropometric characteristics of participants of the European Prospective Investigation into Cancer and Nutrition (EPIC).

A cross-sectional analysis of baseline data of a European prospective cohort study.

This analysis includes study populations from 25 centres in nine European countries. The British populations comprised both a population-based and a ‘health-conscious’ group. The analysis was restricted to 83 178 men and 163 851 women aged 50–64 years, this group being represented in all centres.

Anthropometric examinations were undertaken by trained observers using standardised methods and included measurements of weight, height, and waist and hip circumferences. In the ‘health-conscious’ group (UK), anthropometric measures were predicted from self-reports.

Except in the ‘health-conscious’ group (UK) and in the French centres, mean body mass index (BMI) exceeded 25.0 kg m-2. The prevalence of obesity (BMI≥30 kg m-2) varied from 8% to 40% in men, and from 5% to 53% in women, with high prevalences (>25%) in the centres from Spain, Greece, Ragusa and Naples (Italy) and the lowest prevalences (<10%) in the French centres and the ‘health-conscious’ group (UK). The prevalence of a large waist circumference or a high waist-to-hip ratio was high in centres from Spain, Greece, Ragusa and Naples (Italy) and among women from centres in Germany and Bilthoven (The Netherlands).

Anthropometric measures varied considerably within the EPIC population. These data provide a strong base for further investigation of anthropometric measures in relation to the risk of chronic diseases, especially cancer.

To test the effect of dietary nutrients on oral precancerous lesions in a reverse-smoking (i.e. smoking with the glowing end inside the mouth) population in South India.

Case–control. Cases with precancerous lesions were matched to an equal number of lesion-free controls matched on age (±5 years), sex and village. All subjects used tobacco in some form. Dietary data were obtained using an interviewer-administered food-frequency questionnaire, designed for use in this population. All interviews were conducted blinded to the disease status of the subject. Data were analysed using logistic regression.

Nineteen rural villages in Srikakulam District, Andhra Pradesh.

From a survey of 6007 tobacco users, 485 (79% women) were found to have precancerous, mostly palatal, lesions (cases), and 487 lesion-free subjects were selected as controls.

All eligible subjects consented to participate and nearly all (>99%) had complete data for analyses. Reverse smoking was the most common form of tobacco use among cases (81.9%) and controls (73.5%), and reverse smokers were 5.19 times more likely than chewers to have these lesions (95% confidence interval = 1.35, 19.9). After controlling for relevant covariates, including the type of tobacco use, protective linear effects were observed for zinc (70% reduction across the interquartile range, P<<0.002 ), calcium (34% reduction, P<0.002 ), fibre (30% reduction, P<0.009 ), riboflavin (22% reduction, P<0.03 ) and iron (17% reduction, P<0.05 ).

Several dietary nutrients appear to protect against oral precancerous lesions that are strongly associated with reverse smoking. The results of this study indicate scope for targeting dietary factors in preventing oral cancer, which should be coupled with aggressive anti-tobacco use efforts.

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.

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.

South Africa.

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

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.

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.

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.

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.

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

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

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.

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 recent meta-analysis showed that breast-feeding confers a 3.2 point increment in cognitive function through adolescence. Little is known, however, about possible longer-term effects of breast-feeding. We investigated the effect of breast-feeding on educational attainment, and on a range of cognitive skills in midlife, in the British 1946 birth cohort.

Design: Regression analyses were used to test the association between breast-feeding, likelihood of obtaining advanced educational qualifications by age 26 years, and three cognitive test scores at age 53 years: i.e. reading ability (NART), timed visual search and verbal memory. These associations were then adjusted for social confounding variables and for cognitive ability at age 15 years.

One thousand seven hundred and thirty-nine male and female participants in the MRC National Survey of Health and Development, also known as the British 1946 birth cohort, distributed throughout England, Wales and Scotland.

Breast-feeding was significantly and positively associated with educational attainment, an effect that was independent of early social background, but largely accounted for by cognitive ability at age 15 years. Breast-feeding was significantly and positively associated with the NART at 53 years, an effect that was independent of early social background, educational attainment and adult social class, but, again, largely accounted for by cognitive ability at 15 years. There was no independent effect of breast-feeding on timed visual search or verbal memory at 53 years.

The benefit of breast-feeding has long-term potential impact across the life course through its influence on childhood cognition and educational attainment.

The purpose of this study was to analyse the determinants and consequences of the nutrition transition in Chile and describe the related health promotion policies.

Design and setting: This is a descriptive, population-based study including data on demographic, diet, nutrition and biomedical related variables. Data came from the Food and Agriculture Organization (FAO), the National Institute of Statistics (INE), the Ministries of Planning, Health and Education surveillance systems, and national surveys.

As malnutrition decreased during the 1980s, obesity increased rapidly in all age groups. In adults, currently about 25% of women are obese (body mass index > 30 kgm−2); particularly those from low socio-economic levels. Among pre-schoolers, obesity is now 10% while in 6-year-old children it is 17.5% (weight/height greater than two standard deviations (>2SD) of the World Health Organization reference). Nutritional risk factors are prevalent, diet is changing to a ‘Western diet’ with an increasing fat consumption, and sedentarianism is constant in all groups. High blood pressure (>140/90) is greater than 10% in adults. Diabetes is increasing in urban areas, including in the indigenous population, and more than 40% of adults have a cholesterol level of more than 200mgml−1.

Promotion of healthy lifestyles is the main strategy to cope with this situation, particularly changing behaviour in food habits, physical activity and psychosocial factors. Changes in lifestyles will not only allow the prolonged life expectancy to be of better quality, but also will favour a decrease in the morbidity and mortality from chronic diseases, mainly cardiovascular diseases.

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

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

Forty-six national surveys from 36 developing countries.

Mothers 15–49 years old.

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

The NHANES I & II growth curves define more women as overnourished than the de facto curve, but the opposite for defining the undernourished. Functional outcomes were similar for both BMIs, suggesting there is no great advantage to using a de facto BMI based on national-level data from these 46 national surveys.

To compare various food-frequency questionnaires (FFQs) used in nutritional studies in China for various purposes.

In Study 1, a simplified FFQ with 17 questions on food was used in a large rural study. In Study 2, a questionnaire consisting of 84 questions on food consumption of 16 food categories was used in a study comparing dietary consumption data and various health indicators of elderly people in four geographical areas in China. In Study 3, a questionnaire with 149 items in 17 food categories is being validated by comparison with data obtained by repeated 24-hour recalls.

Study 1 was carried out in one southern site and a northern site in 1996 to 1997. Study 2 was conducted in four different geographical sites in 1998. The on-going study, Study 3, has been carried out in Jiangsu and Beijing since 1999.

Study 1 included 12 234 rural Chinese adults aged 40 years. There were 546 elderly people in Study 2. Study 3 is collecting data from 300 healthy adults.

The results of food consumption and nutrient intakes from Study 1 were comparable with those obtained from a previous household dietary survey, in which sensible correlations between diet and diseases were also found. In Study 2, the dietary data from the four geographical areas showed significant differences in food and nutrient intakes among the different areas. The validation of the new FFQ in Study 3 is still going on.

The FFQ is a useful method for the collection of individual food consumption information. The above FFQ forms could be used in studies with different purposes, especially in studying the relationship between diet, nutrition and chronic diseases.

To compare, along with behavioural habits, the potential atherogenicity of diets in rural and urban areas in Costa Rica.

Subjects (n = 503) were randomly selected from the general population in Costa Rica. A validated food-frequency questionnaire that inquired about dietary intake in the previous year was administered once to each subject. Each subject provided plasma and an adipose tissue biopsy, which were used as biomarkers for carotenoid, tocopherol and/or fatty acid intakes. Each subject also answered another questionnaire on personal profile and household characteristics.

A dietitian visited all subjects and conducted the interviews at their homes.

Adult male and female free-living rural, suburban and urban Costa Ricans without a history of physical or mental disability.

Subjects in rural areas were significantly (P < 0.05) more active physically, earned less income and had a higher intake of dietary fibre than urban dwellers. Urban residents reported a significantly (P < 0.05) higher consumption of total fat, specifically unsaturated fat mostly from soyabean oil, and had higher plasma and adipose tissue tocopherol and lycopene concentrations. Interestingly, no differences in body mass index were observed.

These data show differences in cardiovascular disease (CVD) risk factors of rural and urban populations in Costa Rica. In rural areas, low socio-economic status and low intake of unsaturated fatty acids appear to be the prevalent CVD risk factors, while in urban areas they were low physical activity, high trans-fatty acids in the diet and adipose tissue, and low dietary fibre intake.

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

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

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

The study showed a strong influence of rural/urban environment on specific cariogenic food habits among young black South African children, enabling the development and implementation of a nutrition strategy.

To describe and analyse the changes in diet, physical activity and body composition of the Cuban population during the 1990s and the health implications of these changes.

Design and setting: Data on national food balance and physical activity are from government agencies and the Ministry of Public Health; nation-wide and local representative surveys were used to analyse body composition and leisure activities. Data on morbidity and mortality arefrom the Ministry of Public Health.

The collapse of the European socialist countries and the Soviet Union, as well as the reinforced United States' blockade, provoked a sudden shortage of fuel, raw materials, imported foods and essential supplies. Per capita energy availability decreased, physical activity increased, and the prevalence of obesity decreased. Nutrition deficiencies were observed in the early 1990s, while the trend of morbidity from non-communicable disease continued to increase. The nutrition transition characteristics following the economic recovery in 1995–1996 resembled those of the 1980s because of the increased food availability, decreased physical activity and increased obesity prevalence.

Programmes to deal with the complex situation generated a response in a remarkably short time. Undesirable changes in diet composition and the reduction of physical activity constitute a challenge in the current post-critical stage that must be prevented.

To compare the effects of disparities in economic development in urban and rural Eastern China on the nutritional status of adolescents.

A cross-sectional survey consisting of self-completion questionnaires, anthropometry and haemoglobin measurement.

Twelve middle schools in an urban and a rural area of Zhejiang Province: Hangzhou, the capital, and Chunan, a poor mountainous area.

Some 4835 young adolescents (predominant age range 13–16 years).

The mean body mass index (BMI) was significantly higher in urban Hangzhou (P=0.01) Overweight affected 3.6% overall; adjusted odds ratios (ORs) showed male sex (OR 2.1, 95% confidence interval (CI) 1.1–3.4) and urban residence (OR 9.1, 95% CI 3.7–22) to be the most important risk factors. The prevalence of underweight was 18%, with no significant urban–rural difference. Predictors of underweight were male sex (OR 1.5, 95% CI 1.1–2.0) and low household income (OR, 1.3, 95% CI 1.1–1.5). Mean haemoglobin was significantly lower in the rural area. Anaemia was more common in girls, 51% compared with 21% of the boys, but rural residence was not an independent risk factor. Rural students exercised more and had a less varied diet than their urban counterparts. Around one-third of the respondents consumed dietary supplements on a regular basis.

These results suggest that in urban areas of Eastern China a dual picture is emerging with the problems of excess (overweight and obesity) coexisting with underweight and anaemia. In rural areas the problems of relative nutritional deprivation predominate, but the long-term consequences of such marginal underweight and anaemia are not clear.