We aimed to describe the difference in B-vitamin intake and in plasma B-vitamin and homocysteine concentrations before and after folic acid fortification, in relation to dietary patterns.

The Normative Aging Study (NAS) is a longitudinal study on ageing. Between 1961 and 1970, 2280 male volunteers aged 21–80 years (mean 42 years) were recruited. Dietary intake data have been collected since 1987 and assessment of plasma B vitamins and homocysteine was added in 1993.

Boston, Massachusetts, USA.

In the present study, 354 men who had completed at least one FFQ and one measurement of homocysteine, both before and after the fortification period, were included.

Three dietary patterns were identified by cluster analysis: (i) a prudent pattern, with relatively high intakes of fruit, vegetables, low-fat milk and breakfast cereals; (ii) an unhealthy pattern, with high intakes of baked products, sweets and added fats; and (iii) a low fruit and vegetable but relatively high alcohol intake pattern. Dietary intake and plasma concentrations of folate increased significantly (P < 0·05) among all dietary patterns after the fortification period. Homocysteine tended to decrease in supplement non-users and in subjects in the high alcohol, low fruit and vegetable dietary pattern (both P = 0·08).

After fortification with folic acid, folate intake and plasma folate concentration increased significantly in all dietary patterns. There was a trend towards greatest homocysteine lowering in the high alcohol, low fruit and vegetable group.

We evaluated the association of nutrient intake with Fe deficiency with regard to lifestyle factors and health condition in young Japanese women. Uniquely among developed countries, dietary habits render Japanese populations vulnerable to Fe deficiency, owing to their relatively low intake of Fe and high intake of Fe absorption inhibitors, such as green tea and soyabeans.

A cross-sectional study.

The subjects were 1019 female Japanese dietetic students aged 18–25 years. Dietary habits during the preceding month were assessed using a previously validated, self-administered, diet history questionnaire. Blood analysis was performed to assess body Fe status. Subjects were categorized with Fe deficiency when their serum ferritin levels were <12 ng/ml. Twenty-nine dietary variables, i.e. intakes of energy, sixteen nutrients including Fe and twelve food groups, were analysed using multivariate logistic regression models adjusted for possible confounders.

Of the subjects, 24·5 % were categorized with Fe deficiency. However, no dietary factors assessed were significantly associated with Fe deficiency. The risk of Fe deficiency was significantly lower in women with infrequent or no menstrual cycles than in those with regular cycles (OR = 0·58; 95 % CI 0·34, 1·00) and significantly higher in women with heavy menstrual flow than in women with average flow, albeit that these were self-reported (OR = 1·83; 95 % CI 1·35, 2·48).

These results suggest that dietary habits, including Fe intake, do not significantly correlate with Fe deficiency among young Japanese women.

To develop and evaluate a pictorial, web-based version of the NCI diet history questionnaire (Web-PDHQ).

The Web-PDHQ and paper version of the DHQ (Paper-DHQ) were administered 4 weeks apart with 218 participants randomised to order. Dietary data from the Web-PDHQ and Paper-DHQ were validated using a randomly selected 4 d food record recording period (including a weekend day) and two randomly selected 24 h dietary recalls during the 4 weeks intervening between these two diet history administrations.

Research office in Reston, VA, USA.

Computer-literate men and women recruited through newspaper advertisements.

Mean correlation of energy and the twenty-five examined nutrients between the Web-PDHQ and Paper-DHQ was 0·71 and 0·51, unadjusted and energy-adjusted by the residual method, respectively. Moderate mean correlations (unadjusted 0·41 and 0·38; energy-adjusted 0·41 and 0·34) were obtained between both the Web-PDHQ and Paper-DHQ with the 4 d food record on energy and nutrients, but the correlations between the Web-PDHQ and Paper-DHQ with the 24 h recalls were modest (unadjusted 0·31 and 0·29; energy-adjusted 0·37 and 0·26). A subset of participants (n 48) completing the Web-PDHQ at the initial visit performed a retest on the same questionnaire 1 week later to determine repeatability, and the unadjusted mean correlation was 0·82.

These data indicate that the Web-PDHQ has comparable repeatability and validity to the Paper-DHQ but did not improve the relationship of the DHQ to other food intake measures (e.g. food records, 24 h recall).

There is growing interest in how the physical environment influences obesity. Few studies have considered how the food retail environment surrounding schools influences overweight in students.

To determine whether there is a relationship between food retailers surrounding schools and overweight among Canadian youth.

Cross-sectional study.

The number of food retailers was obtained within a 1 km and 5 km radius around 178 schools in Canada. Retailers included full-service restaurants, fast-food restaurants, sub/sandwich retailers, doughnut/coffee shops, convenience stores and grocery stores. An index of total food retailer exposure was also created. Multilevel analyses were used to control for individual- and area-level covariates.

None of the individual food retailers was associated with an increased likelihood of overweight. The total food retailer index was most strongly related to overweight, but in the opposite direction to that hypothesized. At 1 km, students attending schools with at least one food retailer had a lower relative odds of overweight (OR = 0·70, 95 % CI 0·61, 0·81). At 5 km, students attending schools with the highest exposure to the total food retailer index had a lower relative odds of overweight (OR = 0·56, 95 % CI 0·47, 0·68) compared with students attending schools with no exposure.

Exposure to various types of food retailers in school neighbourhoods was not associated with an increased likelihood of overweight in Canadian school-aged youth. The opportunity to make healthy choices from a variety of options and the unique Canadian context may explain the findings.

Transition from a low-fat vegetable-rich rural diet to a high-fat Westernised diet is considered a factor in the escalating occurrence of vascular-related diseases and type 2 diabetes in urban black South Africans. Consumption of morogo is a distinguishing feature of rural African diets.

To determine fatty acid profiles and folate contents of three widely consumed, wild-growing, African dark green leafy vegetables (morogo).

GC–MS was applied for analysis of fatty acid composition and a validated microbiological assay conducted to determine folic acid contents of wild-growing morogo sampled from deep rural villages in three different geographical regions of South Africa.

Measured fatty acids ranged from 1610·2 to 2941·6 mg/100 g dry mass, with PUFA concentrations 1·4 to 2·8 times those of SFA. Calculated from the relative percentages of linoleic acid (18:2n-6) and linolenic acid (18:3n-3), the ratio of 18:2n-6 to 18:3n-3 PUFA was 1·0:3·4 to 1·0:8·9. The only MUFA was palmitoleic acid (16:1), measured at 34·7 (sd 0·3) to 79·0 (sd 9·3) mg/100 g dry mass, and the predominant SFA was palmitic acid (16:0), measured at 420·6 (sd 83·3) to 662·0 (sd 21·2) mg/100 g dry mass. Folic acid concentration varied from 72 to 217 μg/100 g fresh sample.

Morogo is low-fat food item high in folate and with 18:3n-3 in excess of 18:2n-6, the proposed anti-inflammatory effects of which may lower risks of vascular-related chronic diseases and type 2 diabetes.

The possibility of mother-to-child transmission (MTCT) of HIV through breast-feeding has focused attention on how best to support optimal feeding practices especially in low-resource and high-HIV settings, which characterizes most of sub-Saharan Africa. To identify strategic opportunities to minimize late postnatal HIV transmission, we undertook a review of selected country experiences on HIV and infant feeding, with the aims of documenting progress over the last few years and determining the main challenges and constraints.

Field teams conducted national-level interviews with key informants and visited a total of thirty-six facilities in twenty-one sites across the three countries – eighteen facilities in Malawi, eleven in Kenya and seven in Zambia. During these visits interviews were undertaken with key informants such as the district and facility management teams, programme coordinators and health workers.

A rapid assessment of HIV and infant feeding counselling in Kenya, Malawi and Zambia, undertaken from February to May 2007.

Infant feeding counselling has, until now, been given low priority within programmes aimed at prevention of MTCT (PMTCT) of HIV. This is manifest in the lack of resources – human, financial and time – for infant feeding counselling, leading to widespread misunderstanding of the HIV transmission risks from breast-feeding. It has also resulted in lack of space and time for proper counselling, poor support and supervision, and very weak monitoring and evaluation of infant feeding. Finally, there are very few examples of linkages with community-based infant feeding interventions. However, all three countries have started to revise their feeding policies and strategies and there are signs of increased resources.

In order to sustain this momentum it will be necessary to continue the advocacy with the HIV community and stress the importance of child survival – not just minimization of HIV transmission – and hence the need for integrating MTCT prevention.

To perform an evaluation of selected phytochemicals intake and breast cancer (BC) risk in Mexican women.

We conducted hospital-based case–control study.

Mexico City between 1994 and 1996.

A total of 141 histologically confirmed BC cases were age-matched (±3 years) to an equal number of hospital controls. The reproductive history of each woman was obtained by direct interview. The dietary consumption of flavonols, flavones, flavan-3-ols, cinnamic acid, lariciresinol, pinoresinol, secoisolariciresinol, matairesinol and coumestrol was obtained by means of a validated FFQ.

Among postmenopausal women, high dietary intake of flavonols and flavones was associated with a significant reduction of BC risk (high v. low tertile: OR = 0·21, 95 % CI 0·07, 0·60, P for trend = 0·004 and OR = 0·29, 95 % CI 0·10, 0·82, P for trend = 0·025, respectively); consumption of lignans (lariciresinol and pinoresinol) showed a similar effect, but only among premenopausal women (high v. low tertile: OR = 0·32, 95 % CI 0·10, 0·99, P for trend = 0·051 and OR = 0·19, 95 % CI 0·06, 0·62, P for trend = 0·006, respectively).

Our results support a protective role of specific dietary phytochemicals in BC risk by menopausal status, independent of other reproductive factors.

The present study explores the spatial distribution and in-store availability of fresh fruits and vegetables from a socio-environmental perspective in terms of the type of food store, level of deprivation and the setting (urban/rural) where the food outlets are located.

Seven types of fresh fruit and vegetable stores (FVS) were identified then visited in six districts (urban setting) and seven communities (rural setting). The quantity and diversity of fresh fruits and vegetables (F&V) were also assessed.

Québec City, Canada.

The FVS spatial distribution showed differences between the two settings, with accessibility to supermarkets being more limited in rural settings. The quantity and diversity of fresh F&V in-store availability were associated with the type of FVS, but not with setting or its level of deprivation. Greengrocers and supermarkets offered a greater quantity and diversity of fresh F&V than the other FVS.

The results suggest that inequalities in physical access to fresh F&V across the region could have an impact on public health planning considering that supermarkets, which are one of the excellent sources of F&V, are less prevalent in rural settings.

Using a nationally representative sample, to identify groups among British children aged 1½; – 4½; years who report similar patterns of diet.

Nationally representative dietary survey, using 4 d weighed dietary records, of girls and boys aged 1½; – 4½; years living in private households in Great Britain in 1992–1993. Cluster analysis was used to aggregate individuals into diet groups.

Great Britain.

Eight hundred and forty-eight boys and 827 girls.

Three clusters were identified for girls and three for boys. Among boys the most prevalent cluster was ‘Healthy Diet’ (52·3 %), the second was ‘Convenience Diet’ (38·3 %) and the third was ‘Traditional Diet’ (9·3 %). Among girls, the most prevalent dietary cluster was ‘Healthy Diet’ (58·7 %), followed by a ‘Convenience Diet’ (36·6 %) and ‘Traditional Diet’ (4·3 %). There were important differences in nutrient profile, sociodemographic and behavioural characteristics between clusters.

Cluster analysis identified three groups among both girls and boys which differed not only in terms of reported dietary intake, but also with respect to nutrient intake, social and behavioural characteristics. The groups identified could provide a useful basis for the development, monitoring and targeting of public health nutrition policy for pre-school children in the UK. Further research is needed on the consequences for chronic disease in the future for these children.

To identify the socio-environmental, personal and behavioural factors that are longitudinally predictive of changes in adolescents’ fast-food intake.

Population-based longitudinal cohort study.

Participants from Minnesota schools completed in-class assessments in 1999 (Time 1) while in middle school and mailed surveys in 2004 (Time 2) while in high school.

A racially, ethnically and socio-economically diverse sample of adolescents (n 806).

Availability of unhealthy food at home, being born in the USA and preferring the taste of unhealthy foods were predictive of higher fast-food intake after 5 years among both males and females. Among females, personal and behavioural factors, including concern about weight and use of healthy weight-control techniques, were protective against increased fast-food intake. Among males, socio-environmental factors, including maternal and friends’ concern for eating healthy food and maternal encouragement to eat healthy food, were predictive of lower fast-food intake. Sports team participation was a strong risk factor for increased fast-food intake among males.

Our findings suggest that addressing socio-environmental factors such as acculturation and home food availability may help reduce fast-food intake among adolescents. Additionally, gender-specific intervention strategies, including working with boys’ sports teams, family members and the peer group, and for girls, emphasizing the importance of healthy weight-maintenance strategies and the addition of flavourful and healthy food options to their diet, may help reduce fast-food intake.

The purpose of the present paper was to assess dietary energy reporting as a function of sex and weight status among Ontario and Alberta adolescents, using the ratio of energy intake (EI) to estimated BMR (BMRest).

Data were collected using the FBQ, a validated web-based dietary assessment tool (including a 24 h dietary recall, FFQ, and food and physical activity behavioural questions). BMI was calculated from self-reported height and weight and participants were classified as normal weight, overweight or obese. BMR was calculated using the WHO equations (based on weight). Reporting status was identified using the ratio EI:BMRest.

Data were collected in public, Catholic and private schools in Ontario and Alberta, Canada.

A total of 1917 (n 876 male and n 1041 female) students (n 934 grade 9 and n 984 grade 10) participated.

The mean EI:BMRest ratio across all participants was 1·4 (sd 0·6), providing evidence of under-reporting for the total sample. Females under-reported more than males (t = 6·27, P < 0·001), and under-reporting increased with increasing weight status for both males (F = 33·21, P < 0·001) and females (F = 14·28, P < 0·001). After removing those who reported eating less to lose weight, the EI:BMRest was 1·56 (sd 0·6) for males and 1·4 (sd 0·6) for females.

The present study highlights methodological challenges associated with self-reported dietary data. Systematic differences in under-reporting of dietary intake by gender and weight status were observed using a web-based survey, similar to observations made using paper-based 24 h recalls and dietitian interviews.

To make the best use of limited resources for supporting health-related research to reduce child mortality, it is necessary to apply a suitable method to rank competing research options. The Child Health and Nutrition Research Initiative (CHNRI) developed a new methodology for setting health research priorities. To broaden experience with this priority-setting technique, we applied the method to rank possible research priorities concerning the control of Zn deficiency. Although Zn deficiency is not generally recognized as a direct cause of child mortality, recent research indicates that it predisposes children to an increased incidence and severity of several of the major direct causes of morbidity and mortality.

Leading experts in the field of Zn research in child health were identified and invited to participate in a technical working group (TWG) to establish research priorities. The individuals were chosen to represent a wide range of expertise in Zn nutrition. The seven TWG members submitted a total of ninety research options, which were then consolidated into a final list of thirty-one research options categorized by the type of resulting intervention.

The identified priorities were dominated by research investment options targeting Zn supplementation, and were followed by research on Zn fortification, general aspects of Zn nutrition, dietary modification and other new interventions.

In general, research options that aim to improve the efficiency of an already existing intervention strategy received higher priority scores. Challenges identified during the implementation of the methodology and suggestions to modify the priority-setting procedures are discussed.

The objective of the present work was to quantify mothers’ misclassification of pre-school children’s weight status and to determine factors associated with the maternal misperception.

A representative sample of 2287 children aged 2–5 years was examined (GENESIS study). Mothers’ perceptions of their child’s weight status and the children’s and mothers’ anthropometric and other characteristics (sociodemographic and lifestyle) were recorded.

Almost 38 % of mothers underestimated their child’s weight status. The frequency of underestimation was much higher among ‘at risk of being overweight’ and ‘overweight’ children (88·3 % and 54·5 %, respectively) compared with ‘underweight/normal-weight’ children (18·0 %, P < 0·001). Multiple logistic regression modelling revealed that the likelihood of mothers’ underestimation of their child’s weight status was significantly higher in boys, in children engaging in physical activity for less than 3 h/week and in children whose mothers had low education status, compared with their counterparts. Moreover, the higher the BMI-for-age Z-score, the greater the odds that the mother would underestimate her child’s weight status.

The current study demonstrated that more than one-third of mothers misclassify their children’s weight status as being lower than the actual. Given that mother’s weight perception might be an important determinant of child’s body weight development, clinicians and health professionals should help mothers correctly classify their children’s weight status, which could potentially help in the early prevention of overweight and obesity.

In the majority of exercise intervention studies, the aggregate reported weight loss is often small. The efficacy of exercise as a weight loss tool remains in question. The aim of the present study was to investigate the variability in appetite and body weight when participants engaged in a supervised and monitored exercise programme.

Fifty-eight obese men and women (BMI = 31·8 ± 4·5 kg/m2) were prescribed exercise to expend approximately 2092 kJ (500 kcal) per session, five times a week at an intensity of 70 % maximum heart rate for 12 weeks under supervised conditions in the research unit. Body weight and composition, total daily energy intake and various health markers were measured at weeks 0, 4, 8 and 12.

Mean reduction in body weight (3·2 ± 1·98 kg) was significant (P < 0·001); however, there was large individual variability (−14·7 to +2·7 kg). This large variability could be largely attributed to the differences in energy intake over the 12-week intervention. Those participants who failed to lose meaningful weight increased their food intake and reduced intake of fruits and vegetables.

These data have demonstrated that even when exercise energy expenditure is high, a healthy diet is still required for weight loss to occur in many people.

To determine the prevalence of anaemia, identify the predictors of anaemia, compare the prevalence of anaemia among children living in American Samoa to those found in children living in the USA, and compare the growth patterns obtained from this study to Centers for Disease Control and Prevention (CDC) data and data obtained earlier in American Samoan children.

Cross-sectional.

American Samoa, a Pacific Island.

In all, 208 children aged 5–10 years.

Anaemia (Hb < 11·5 g/dl) prevalence was 17·3 %. There was a significant difference in mean Hb levels in children within American Samoa as compared to National Health and Nutrition Examination Survey III data (P < 0·05). In children with BMI Z-score (BMIZ) (P < 0·05) and weight-for-age Z-score (WAZ) (P < 0·05) >2·0, females had a significantly higher prevalence of anaemia than males. Females with a WAZ > 2·0 had a significantly higher prevalence of anaemia than females with a WAZ ≤ 2·0 (P < 0·03). Risk factors for anaemia were mother having less than a high school education (P = 0·02), no car (P < 0·01) and no phone (P = 0·02). The BMIZ (P < 0·000), height-for-age Z-score (P < 0·000) and WAZ (P < 0·000) were significantly different from the distribution of CDC reference data and that found in children previously assessed in American Samoa.

Anaemia is high among children aged 5–10 years living in American Samoa. Growth pattern Z-scores reveal that American Samoan children are, on average, taller, heavier and more overweight. Further examination into the causes of anaemia and overweight is warranted.

While corner store-based nutrition interventions have emerged as a potential strategy to increase healthy food availability in low-income communities, few evaluation studies exist. We present the results of a trial in Baltimore City to increase the availability and sales of healthier food options in local stores.

Quasi-experimental study.

Corner stores owned by Korean-Americans and supermarkets located in East and West Baltimore.

Seven corner stores and two supermarkets in East Baltimore received a 10-month intervention and six corner stores and two supermarkets in West Baltimore served as comparison.

During and post-intervention, stocking of healthy foods and weekly reported sales of some promoted foods increased significantly in intervention stores compared with comparison stores. Also, intervention storeowners showed significantly higher self-efficacy for stocking some healthy foods in comparison to West Baltimore storeowners.

Findings of the study demonstrated that increases in the stocking and promotion of healthy foods can result in increased sales. Working in small corner stores may be a feasible means of improving the availability of healthy foods and their sales in a low-income urban community.

To evaluate the relative validity of an FFQ for assessing nutrient intakes in 12-month-old infants.

The FFQ was developed to assess the diets of infants born to women in the Southampton Women’s Survey (SWS), a population-based survey of young women and their offspring. The energy and nutrient intakes obtained from an interviewer-administered FFQ were compared with those obtained from 4d weighed diaries (WD).

A sub-sample of fifty infants (aged 1 year) from the SWS had their diets assessed by both methods. The FFQ recorded the frequencies and amounts of foods and drinks consumed by the infants over the previous 28 d; milk consumption was recorded separately. The WD recorded the weights of all foods and drinks consumed by the infants on 4 d following the FFQ completion.

The Spearman rank correlation coefficients for intakes of energy, macronutrients and eighteen micronutrients, determined by the two methods, ranged from r = 0·25 to 0·66. Bland–Altman statistics showed that mean differences between methods were in the range +5 % to +60 % except for vitamin D (+106 %). Differences in micronutrient intake were partly explained by changes in patterns of milk consumption between the two assessments.

Although there were differences in absolute energy and nutrient intakes between methods, there was reasonable agreement in the ranking of intakes. The FFQ is a useful tool for assessing energy and nutrient intakes of healthy infants aged around 12 months.

Increase in fibre intake during pregnancy may reduce weight gain, glucose intolerance, dyslipidaemia, pre-eclampsia and constipation. Few studies have evaluated adequacy of fibre intake during pregnancy.

To assess, through an FFQ, the dietary fibre intake of pregnant women receiving prenatal care from general public practices and compare it with current guidelines.

Cross-sectional analyses of a pregnancy cohort study (ECCAGE – Study of Food Intake and Eating Behaviour in Pregnancy) conducted in eighteen general practices in southern Brazil, from June 2006 to April 2007.

Five hundred and seventy-eight pregnant women with mean (sd) age of 24·9 (6·5) years and mean gestational age of 24·5 (5·8) weeks.

The mean energy intake was 11 615 kJ/d (2776 kcal/d). The mean total fibre intake (30·2 g/d) was slightly above the recommended value of 28g/d (P < 0·001), yet 50 % (95 % CI 46, 54) of the women failed to meet the recommendation. Whole-grain fibre constituted only 1 % of total fibre intake in the cereal group. In adjusted Poisson regression analyses, not meeting the recommendation for fibre intake was associated with alcohol intake (prevalence ratio 1·29; 95 % CI 1·11, 1·50) and absence of nutritional guidance (prevalence ratio 1·22; 95 % CI 1·05, 1·42) during pregnancy.

About half of the pregnant women failed to meet the recommended fibre intake, especially those not reporting nutritional guidance during pregnancy. For most women, whole-grain cereal intake was absent or trivial. Taken together, our data indicate the need, at least in this setting, for greater nutritional education in prenatal care.

To examine the relationship between obesity and the community and/or consumer food environment.

A comprehensive literature search of multiple databases was conducted and seven studies were identified for review. Studies were selected if they measured BMI and environmental variables related to food outlets. Environmental variables included the geographic arrangement of food stores or restaurants in communities and consumer conditions such as food price and availability within each outlet. The study designs, methods, limitations and results related to obesity and the food environment were reviewed, and implications for future research were synthesized.

The reviewed studies used cross-sectional designs to examine the community food environment defined as the number per capita, proximity or density of food outlets. Most studies indirectly identified food outlets through large databases. The studies varied substantially in sample populations, outcome variables, units of measurement and data analysis. Two studies did not find any significant association between obesity rates and community food environment variables. Five studies found significant results. Many of the studies were subject to limitations that may have mitigated the validity of the results.

Research examining obesity and the community or consumer food environment is at an early stage. The most pertinent gaps include primary data at the individual level, direct measures of the environment, studies examining the consumer environment and study designs involving a time sequence. Future research should directly measure multiple levels of the food environment and key confounders at the individual level.