Concordance of nutritional research priorities with the related burden of disease is essential to develop cost-effective interventions to address the nutritional problems of populations. The present study aimed to evaluate whether nutrition research priorities are in agreement with the population’s nutritional problems in Latin America.

The epidemiological profile was contrasted with the research priorities and research produced by academic institutions for each country. Qualitative analysis of research production by type of contribution to problem solving was also conducted.

Nine Latin American countries.

Obesity (high body mass index (BMI)) and micronutrient deficiencies (anaemia) emerged as key problems, followed by stunting, breast-feeding/lactation and low birth weight. Wasting in children and women (low BMI) was uncommon. Concordance of ranked research priorities with the epidemiological profile of the country was generally good for nutrition-related chronic diseases, micronutrients and low birth weight, but not for undernutrition, stunting and breast-feeding. Studies on the efficacy and effectiveness of interventions were uncommon.

The present research agenda insufficiently supports the goal of public health nutrition, which is to ensure the implementation of cost-effective nutrition programmes and policies. A more rational approach to define research priorities is needed.

Information is needed on dietary adequacy of Arctic indigenous populations in Canada. Extensive work has been completed on composition of Arctic food and food use, and dietary reference intakes are available.

To complete the first comprehensive dietary adequacy assessment of three populations of adult Arctic indigenous people.

Dietary assessment interviews were conducted with randomly selected indigenous adults during two seasons in 44 representative communities of Yukon First Nations (n = 797), Dene/Métis, (n = 1007) and Inuit (n = 1525).

Twenty-four-hour recalls were used to derive adjusted distributions of usual nutrient intakes in four age/gender groups for assessment of dietary adequacy for carbohydrate, dietary fibre, protein, n–3 fatty acids, n–6 fatty acids, calcium, copper, iron, magnesium, manganese, phosphorus, selenium, zinc, vitamin A, riboflavin, folate, vitamin B6, vitamin C, vitamin D and vitamin E.

Nutrients with high prevalence of adequacy for most age/gender groups in all three cultures were protein, carbohydrate, n–3 fatty acids, iron, copper, zinc, manganese, selenium, riboflavin and vitamin B6; some individuals exceeded the upper intake level for iron, zinc, selenium, vitamin A and vitamin D. Estimated average requirement nutrients of concern for adequacy were magnesium, folate, vitamin A, vitamin C and vitamin E; however, a few age/gender groups were exceptions. Prevalence of inadequacy for AI nutrients which may be undesirably high were fibre, n–6 fatty acids and calcium. Vitamin D was more adequate in Inuit women and men than for Yukon First Nations or Dene/Métis.

Unique patterns of dietary adequacy exist among Arctic indigenous peoples. Local wildlife food sources and market food sources should be maximised for their nutrient contributions to Arctic diets.

To identify and describe characteristics of the bias of reported energy intake of participants in the Gothenburg Osteoporosis and Obesity Determinants (GOOD) study.

A validated diet history with a detailed questionnaire and an interview was used. Body fat was analysed by dual-energy X-ray absorptiometry. The ratio of energy intake (EI) to BMR was used to define under-reporters (EI:BMR < 1·30), acceptable reporters (EI:BMR ≥ 1.30 to <2.64) and over-reporters (EI:BMR ≥ 2.64).

Sahlgrenska University Hospital, Gothenburg, Sweden.

A total of 695 males (18–20 years).

Sixty-eight per cent were classed as acceptable reporters, 22 % as over-reporters and 10 % as under-reporters. The under-reporters had higher BMI and body fat percentage than acceptable reporters (P < 0·001), while over-reporters had lower BMI and body fat percentage (P < 0·001). Over-reporters had more frequent use of protein supplements than acceptable reporters and higher physical activity. Over-reporters had a more regular and under-reporters a less regular meal pattern compared with acceptable reporters.

Important knowledge of dietary reporting bias in a previously sparsely studied population has been provided. Over-reporting of energy intake was more common than under-reporting in the present population of young men and characteristics of under- and over-reporters were identified. The GOOD study was initiated with the central aim to determine environmental and genetic factors involved in the regulation of bone and fat mass, and the nutrient data of the acceptable reporters can be used for further investigation of the health effects of energy and nutrient intake.

To examine the relationship between television (TV) viewing and body mass index (BMI) among adolescents in a region of mainland China.

Population-based cross-sectional study, conducted between September and November of 2004, on a sample of enrolled high-school students aged 12–18 years.

One hundred and sixty-eight classes randomly selected from both urban and rural areas and belonging to 15 senior and 41 junior high schools in Nanjing, China, with a regional population of 6·0 million.

In total 6848 students participated; 47·7 % from urban and 52·3 % from rural areas; 49·0 % male and 51·0 % female. The response rate among eligible participants was 89·3 %.

The proportion of overweight was 6·6 % according to the criteria of overweight recommended for Chinese adolescents. Boys than girls (8·9 % vs. 4·4 %) had higher odds of being overweight (odds ratio (OR) 2·12, 95 % confidence interval (CI) 1·74, 2·60), while the proportion of overweight was significantly lower among rural students than urban students (4·5 % vs. 8·9 %; OR 0·49, 95 % CI 0·40, 0·60). Those students who watched TV for more than 7 h/week had a 1·5 times greater odds of being overweight relative to their counterparts who watched TV for 7 h/week or less (adjusted OR 1·51, 95 % CI 1·24, 1·82). Furthermore, there was a positive linear relationship between TV viewing time and BMI, even after adjusting for age, gender, residence area, time spent in study, in sleeping and in physical activity, and monthly pocket money.

Viewing TV might increase the likelihood of being overweight for Chinese adolescents in China.

The present paper aims to review and report on the current and predicted future public health nutrition workforce in South Africa. Additionally, it examines ways in which the Department of Health (DOH) is striving to meet the increasing burden of nutrition-related diseases in South Africa.

The primary sources of data used for the review were reports from the Census office, South African health reviews, mortality and morbidity statistics, and documents from the Health Professions Council of South Africa.

There are fewer than 2000 registered dietitians in South Africa and fewer than 600 of them work in the public health sector. Furthermore, professional nurses – who are the backbone of the primary health-care system and deliver the rudiments of basic nutritional care – are not being trained in sufficient numbers to meet population growth; in 2004 there was only one nurse per 4000 persons. This situation is aggravated by the growing burden of conditions associated with both overnutrition and undernutrition, as well as the enormous demands of the HIV/AIDS epidemic. The DOH is striving to meet these increasing needs by means of the Integrated Nutrition Programme as well as a National Human Resources Plan which includes numerous strategies to improve the quantity and quality of health professionals’ training, including dietitians and nutritionists. This plan includes the objective of increasing the public health nutrition workforce to more than 250 newly trained dietitians and nutritionists per annum by 2010.

The effect of depression on dietary intake has not, to our knowledge, been examined in persons with HIV infection.

We conducted a longitudinal analysis of participants in the Nutrition for Healthy Living Study (NFHL). We measured changes in dietary macronutrient intake in participants who developed depression and, using multiple regression analysis, compared the changes with a control group of patients who did not become depressed.

Ninety patients developed depression during the observation period, and we compared these with 152 non-depressed controls. The two groups had similar age and body mass index (BMI) at baseline, but those who developed depression were more likely to be female, less educated and had lower incomes. After adjustment, compared with non-depressed participants, those who developed depression had significantly greater decreases in the following daily intakes: total energy (−341 kcal, P = 0.006), protein (−12.3 g, P = 0.02), total fat (−18.5 g, P = 0.008), carbohydrate (−36.8 g, P = 0.02), total fibre (−4.3 g, P = 0.001) and saturated fat (−6.7 g, P = 0.01). There were no significant differences in the daily intakes of simple sugars and long-chain n−3 fatty acids, or BMI.

Depression is associated with decreases in total daily energy intake and in six of the eight dietary components we measured. Clinicians should be aware that depression-associated nutritional deficiencies may complicate the care of persons with HIV.

To assess the ability of a food-frequency questionnaire (FFQ) to rank Australians according to their intake of total carbohydrate, sugar, starch, fibre, glycaemic index (GI) and glycaemic load (GL).

Cross-sectional sample from a population cohort.

Two postcode areas west of Sydney, Australia.

From 1992 to 1994, a total of 2868 older Australians provided dietary data using a 145-item Willett-derived FFQ. A representative sub-sample of 78 subjects completed three 4-day weighed food records (WFRs). Pearson and Spearman correlations, Bland–Altman plots and weighted kappa values were calculated.

Compared with the WFR, the FFQ provided higher mean estimates of all nutrients except starch and GI. All Pearson and/or Spearman correlations were greater than 0.5, except for GL. For GI, sugar, starch and fibre, the regression lines from the Bland–Altman analysis indicated a non-significant linear trend (P = 0.07, P = 0.36, P = 0.28 and P = 0.10, respectively). For GL and total carbohydrate, however, there was a significant linear trend (P = 0.006 and P < 0.0001, respectively), indicating that as the GL and carbohydrate intake of individuals increased, so did the magnitude of the error between the FFQ and WFR. Weighted kappa values all indicated moderate to good agreement, with the exception of GL which was only fair. The proportions of subjects correctly classified within one quintile for all of the nutrients were over 50% and gross misclassification was low (<10%).

This FFQ was able to rank individuals according to their intakes of total carbohydrate, sugar, starch, fibre and GI, but not as well for GL.

Despite the increasing dependence on systematic reviews to summarise the literature and to issue public health recommendations, the formal assessment of the reliability of conclusions emerging from systematic reviews has received little attention. The main goal of the present study was to evaluate whether two independent centres, in two continents, draw similar conclusions regarding the association of food, nutrition and physical activity and endometrial cancer, when provided with the same general instructions and with similar resources.

The assessment of reproducibility concentrated on four main areas: (1) paper search and selection; (2) assignment of study design; (3) inclusion of ‘key’ papers; and (4) individual studies selected for meta-analysis and the summary risk estimate obtained.

In total 310 relevant papers were identified, 166 (54 %) were included by both centres. Of the remaining 144 papers, 72 (50 %) were retrieved in the searches of one centre and not the other (54 in centre A, 18 in centre B) and 72 were retrieved in both searches but regarded as relevant by only one of the centres (52 in centre A, 20 in centre B). Of papers included by both centres, 80 % were allocated the same study design. Agreement for inclusion of cohort-type and case–control studies was about 63 % compared with 50 % or less for ecological and case series studies. The agreement for inclusion of 138 ‘key’ papers was 87 %. Summary risk estimates from meta-analyses were similar.

Transparency of process and explicit detailed procedures are necessary parts of a systematic review and crucial for the reader to interpret its findings.

To explore consumer trust in food, especially people’s experiences that support or diminish trust in the food supply; consumer practices to strengthen trust in food; and views on how trust in the food supply could be increased.

Adelaide, South Australia.

In-depth qualitative research interviews and focus groups.

Women and men who are primary food providers in families (n = 24).

Media coverage of food scares and scandals and personal experience of food-borne illness challenged respondents’ trust in the food system. Poor retail food handling practices and questionable marketing ploys by food manufacturers also decreased trust. Buying ‘Made-in-Australia’ produce and following food safety procedures at home were important practices to strengthen food trust. Knowledge of procedures for local food inspection and for national food regulation to keep food safe was scanty. Having a strong regulatory environment governing food safety and quality was considered by respondents to be of prime importance for trust building.

The dimensions of trust found in this study are consistent with key theoretical aspects of trust. The need for trust in highly complex environments, in this case the food supply, was evident. Trust was found to be integral to food choice, and negative media reports, the sources of which themselves enjoy various levels of dependability, were found to easily damage trust relationships. The lack of visibility of authoritative monitoring and surveillance, misleading food advertising, and poor retail food handling practices were identified as areas that decreased consumer trust. Respondents also questioned the probity of food labelling, especially health claims and other mechanisms designed to guide food choice. The research highlights the role trust plays in food choice. It also emphasises the importance of a visible authoritative presence in the food system to strengthen trust and provide reassurance to consumers.

To test the hypothesis that maternal food fortification with omega-3 fatty acids and multiple micronutrients increases birth weight and gestation duration, as primary outcomes.

Non-blinded, randomised controlled study.

Pregnant women received powdered milk during their health check-ups at 19 antenatal clinics and delivered at two maternity hospitals in Santiago, Chile.

Pregnant women were assigned to receive regular powdered milk (n = 477) or a milk product fortified with multiple micronutrients and omega-3 fatty acids (n = 495).

Intention-to-treat analysis showed that mean birth weight was higher in the intervention group than in controls (65.4 g difference, 95% confidence interval (CI) 5–126 g; P = 0.03) and the incidence of very preterm birth (<34 weeks) was lower (0.4% vs. 2.1%; P = 0.03). On-treatment analysis showed a mean birth weight difference of 118 g (95% CI 47–190 g; P = 0.001) and a relative fall in both the proportion of birth weight ≤3000 g (P = 0.015) and the incidence of pre-eclampsia (P = 0.015). Compliance with the experimental product was apparent from a haematological study of red-blood-cell folate at the end of pregnancy, which was performed in a sub-sample. In both types of analyses, positive differences were also present for mean gestation duration, birth length and head circumference. Nevertheless, the relatively small sample sizes allowed a statistical power of >0.80 just for mean birth weight and birth length in the on-treatment analysis; birth length in that analysis had a difference of 0.57 cm (95% CI 0.19–0.96 cm; P = 0.003).

The new intervention resulted in increased mean birth weight. Associations with gestation duration and most secondary outcomes need a larger sample size for confirmation.

To examine the association between household socio-economic status (SES) at birth and poor infant growth such as small for gestational age (SGA) and stunting across two different socio-cultural settings: South Africa and the Philippines.

Data were from two longitudinal birth cohorts, the Birth to Twenty (Bt20) study in South Africa and the Cebu Longitudinal Health and Nutrition Survey (CLHNS) in the Philippines.

Bt20 infants (n 2293 total; reduced to 758 (SGA), 450 (stunting 1 year) and 401 (stunting 2 years)) and CLHNS infants (n 2513 total; reduced to 2161 (SGA), 1820 (stunting 1 year) and 1710 (stunting 2 years)).

CLHNS infants were significantly more likely to be born SGA (20·9 v. 11·7 %) and be stunted at 1 year (32·6 v. 8·7 %) and 2 years (48·9 v. 21·1 %) compared with Bt20 infants. Logistic regression analyses showed that SES (index) was a significant predictor of stunting at 1 and 2 years of age in the CLHNS cohort. SES (index or individual variables) was not a significant predictor of SGA in either cohort, or of stunting in the Bt20 cohort. Maternal education, ownership of a television and toilet facilities were all independent predictors of stunting in the CLHNS cohort.

The social and economic milieu within the Philippines appears to place CLHNS infants at greater risk of being born SGA and being stunted compared with Bt20 infants. The present research highlights the importance of investigating the individual SES variables that predict infantile growth faltering, to identify the key areas for context-specific policy development and intervention.

The objective of the present study was to assess the construct validity, criterion-related validity and internal consistency of the Radimer/Cornell food insecurity measure for use in rural Tanzania.

A cross-sectional community-based survey was conducted from March to May 2005. Key adaptations to the nine-item Radimer/Cornell items included translation to Swahili, replacing the term ‘balanced diet’ with ‘full meal’ and constructing the items as questions rather than statements. Factor analysis and Cronbach’s alpha were used to assess validity and reliability, respectively.

Rural Kilimanjaro, Tanzania.

Analysis was restricted to data from 530 women aged 15–44 years who had children under 5 years old.

Principal component factor analysis revealed a two-factor solution: (1) altered eating pattern at household level and (2) altered eating pattern at child level. The two factors accounted for 66·2 % of the total variance. The subscales developed had good reliability. Internal consistency of the scales was 0·853 and 0·784 for food insecurity at household level and food insecurity at child level, respectively. Only 14·0 % of the women reported to be food-secure and 86·0 % reported some kind of food insecurity. The Radimer/Cornell food insecurity measure showed significant associations with selected sociodemographic factors in the expected directions. There was also an association with the NHANES III (Third National Health and Nutrition Examination Survey) and CCHIP (Community Childhood Hunger Identification Project) indicators.

Our findings suggest that the adapted Radimer/Cornell measure may have some utility in assessing food insecurity in settings like rural Tanzania.

To unravel the concept of nutrition awareness, as it relates to risky personal nutrition-related behaviours, and to assess the sociodemographic and psychosocial correlates of nutrition awareness.

Data were collected in a cross-sectional study with the aid of a face-to-face interview-assisted questionnaire that was based on the Precaution Adoption Process Model and Stages of Change Model.

Dutch consumer homes.

Six hundred and three Dutch adults aged 18 to 80 years, selected from a panel.

Our model explains nutrition awareness well (explained variance 53.7%). Psychosocial correlates were involvement with nutrition, health awareness, association with healthy food, perceived relevance of eating less fat, association with necessity, perceived relevance of vitamins, and perceived attributes of independent organisations. Sociodemographic correlates were gender and age. The relationship between nutrition awareness and nutrition-related behaviours proved to be very complicated.

The value of our study is that it unravels the concept of nutrition awareness. Understanding the correlates of nutrition awareness can contribute to a more effective application of behavioural change models. Our results support increasing involvement with nutrition through personalising and tailoring to the motivational stage.

To describe (1) the prevalence of overweight and obesity and their association with physical activity; (2) the effect of different cut-off points for body mass index (BMI) on weight status categorisation; and (3) associations of weight status with perceptions of body size, health and diet quality.

A cross-sectional study.

Secondary schools in Barbados.

A cohort of 400 schoolchildren, 11–16 years old, selected to study physical education practices.

Prevalence of overweight (15% boys; 17% girls) and obesity (7% boys; 12% girls) was high. Maternal obesity, as defined by the International Obesity Task Force (IOTF) BMI cut-off points, predicted weight status such that reporting an obese mother increased the odds of being overweight by 5.25 (95% confidence interval: 2.44, 11.31). Physical activity was inversely associated with weight status; however levels were low. Recreational physical activity was not associated with weight status in either category. Overweight subjects tended to misclassify themselves as normal weight and those who misclassified perceived themselves to be of similar health status to normal-weight subjects. The National Center for Health Statistics and IOTF BMI cut-off points produced different estimates of overweight and obesity.

Our findings suggest that inadequate physical activity and ignorance related to food and appropriate body size are promoting high levels of adiposity with a strong contribution from maternal obesity, which may be explained by perinatal and other intergenerational effects acting on both sexes. Prevalence studies and local proxy tools for adiposity assessment are needed.

To evaluate whether consumption of breakfast cereals is associated with BMI in a sample of Greek adolescents.

A cross-sectional health and nutrition survey.

During 2004–5, 2008 schoolchildren aged 12–17 years were selected from twelve schools located in Vyronas region (Athens metropolitan area). Height and weight were measured and BMI was calculated. A semi-quantitative FFQ was applied and multiple logistic regression analysis was used.

Overall, 4·7 % of boys and 1·7 % of girls were obese, whereas 19·4 % of boys and 13·2 % of girls were overweight. Only 20·7 % of boys and 15·5 % of girls reported that they consume cereals as a first choice for breakfast. Consumption of breakfast cereals was associated with lower BMI in boys (P = 0·08) and girls (P = 0·019), irrespective of age and physical activity status. More prominent results were observed for daily cereal consumption or for more than two daily servings of cereals consumed for breakfast. Consumption of pre-sweetened breakfast cereals was associated with lower BMI compared with non-pre-sweetened or no intake of cereals, in both genders (P < 0·001). Consumption of breakfast cereals was associated with 33 % (95 % CI 14 %, 48 %) lower likelihood of overweight/obesity, irrespective of age, sex and physical activity status.

Consumption of breakfast cereals was associated with lower BMI levels and a lower likelihood of overweight/obesity in both genders; thus a solid basis for public health professionals could be built when issuing advice on weight management.

Women of lower educational attainment have less balanced and varied diets than women of higher educational attainment. The diets of women are vital to the long-term health of their offspring. The present study aimed to identify factors that influence the food choices of women with lower educational attainment and how women could be helped to improve those choices.

We conducted eight focus group discussions with women of lower educational attainment to identify these factors. We contrasted the results of these discussions with those from three focus group discussions with women of higher educational attainment.

Southampton, UK.

Forty-two white Caucasian women of lower educational attainment and fourteen of higher educational attainment aged 18 to 44 years.

The dominant theme in discussions with women of lower educational attainment was their sense that they lacked control over food choices for themselves and their families. Partners and children exerted a high degree of control over which foods were bought and prepared. Women’s perceptions of the cost of healthy food, the need to avoid waste, being trapped at home surrounded by opportunities to snack, and having limited skill and experience with food, all contributed to their sense they lacked control over their own and their family’s food choices.

An intervention to improve the food choices of women with lower educational attainment needs to increase their sense of control over their diet and the foods they buy. This might include increasing their skills in food preparation.

To investigate the effect of television food advertising on children’s food intake, specifically whether childhood obesity is related to a greater susceptibility to food promotion.

The study was a within-subject, counterbalanced design. The children were tested on two occasions separated by two weeks. One condition involved the children viewing food advertisements followed by a cartoon, in the other condition the children viewed non-food adverts followed by the same cartoon. Following the cartoon, their food intake and choice was assessed in a standard paradigm.

The study was conducted in Liverpool, UK.

Fifty-nine children (32 male, 27 female) aged 9–11 years were recruited from a UK school to participate in the study. Thirty-three children were normal-weight (NW), 15 overweight (OW) and 11 obese (OB).

Exposure to food adverts produced substantial and significant increases in energy intake in all children (P < 0·001). The increase in intake was largest in the obese children (P = 0·04). All children increased their consumption of high-fat and/or sweet energy-dense snacks in response to the adverts (P < 0·001). In the food advert condition, total intake and the intake of these specific snack items correlated with the children’s modified age- and gender-specific body mass index score.

These data suggest that obese and overweight children are indeed more responsive to food promotion, which specifically stimulates the intake of energy-dense snacks.

To study dietary diversity and its relationship with socio-economic and nutritional characteristics of women in an urban Sahelian context.

A qualitative dietary recall was performed over a 24-h period. Dietary diversity scores (DDS = number of food groups consumed) were calculated from a list of nine food groups (DDS-9) or from a list of 22 food groups (DDS-22) which detailed both micronutrient- and energy-dense foods more extensively. Body mass index (BMI), mid upper-arm circumference and body fat percentage were used to assess the nutritional status of the women.

Five hundred and fifty-seven women randomly selected in two districts of Ouagadougou, the capital of Burkina Faso.

The mean DDS-9 and DDS-22 were 4.9 ± 1.0 and 6.5 ± 1.8 food groups, respectively. In the high tertile of DDS-22, more women consumed fatty and sweetened foods, fresh fish, non-fatty meat and vitamin-A-rich fruits and vegetables. The DDS-9 was not associated with the women’s socio-economic characteristics whereas the DDS-22 was higher when the women were younger, richer and had received at least a minimum education. Mean BMI of the women was 24.2 ± 4.9 kg m–2 and 37% of them were overweight or obese (BMI ≥ 25 kg m–2). Neither the DDS-9 nor the DDS-22 was associated with the women’s anthropometric status, even though there was a trend towards fewer overweight women in the lowest tertile of DDS-22.

In this urban area, the qualitative measurement of dietary diversity is not sufficient to identify women at risk of under- or overweight.

To explore the quality (accuracy, balance, practical context) of tabloid articles reporting on nutrition research, and public attitudes towards it.

A qualitative multi-method study consisting of a systematic analysis of tabloid articles and a series of focus groups with members of the public.

Tabloid newspapers (nationwide). Focus groups were conducted at a UK university.

All UK tabloid newspapers were collated for a full calendar month. Members of the local Women’s Institute and non-teaching staff within the University College Chester were recruited as focus group participants.

Twenty-nine tabloid articles were included. A standardised TAT (Tabloid Analysis Tool) was used a total of thirty-nine times (once for each research study cited). Twenty-six failed to accurately report research results, thirty-six failed to mention significant research limitations, and only five quoted a third-party expert source. Two focus groups, each with eight participants, were conducted. Attitudes expressed were largely negative, highlighting elements of confusion and scepticism. Articles were more likely to be disregarded than acted upon, although some value was attached to newspapers providing nutrition information.

Tabloid reporting on nutrition research is not sufficiently accurate, balanced or contextualised, and public attitudes towards the reporting are not wholly favourable. Guidance for journalists via registered dietitians and a strengthening of present links could serve to utilise this form of mass media more effectively.

To determine the prevalence of iodine deficiency, its causes and its association with intelligence quotient (IQ) in Mexican schoolchildren.

Cross-sectional analytical study, in which determinations of thyroid gland size, urinary iodine excretion, IQ, iron nutritional status, physical anthropometry, family consumption of goitrogenic foods, type/origin and iodine saturation of salt consumed at home and coliform organisms in drinking water were performed, and the association of each variable with IQ scores was evaluated by multiple regression analyses.

Municipality of Cuauhtémoc, in Colima, Mexico (altitude: 600–2700 m above sea level). Sea salt is extracted manually nearby and often used for human consumption. Goitre remains present in the region despite over half a century of mandatory salt iodination in the country.

Three hundred and three children, similar proportions of boys and girls, mean age 9·3 years, randomly selected from 19 public elementary schools.

Overall goitre rate was 21·4 %; low urinary iodine excretion was found in 19·5 % of the children, high urinary iodine excretion in 32·0 %. IQ scores were transformed into percentile values, with the following categorisation: ≤P5 (low IQ), 48·5 %; >P5 to ≤P25 (below average), 24·2 %; >P25 to <P75 (average), 18·8 %; ≥P75 to <P95 (above average), 3·6 %; ≥P95 (high IQ), 4·9 %. Ninety-two per cent of the population used iodinated salt, but deficient iodine saturation (<50 ppm) was found in 86·8 % of salt samples. The main goitrogenic foods consumed were peanuts (by 31·5 % of the sample), cabbage (30·1 %), broccoli (27·7 %) and cauliflower (25·7 %). Median counts of coliform organisms (colony-forming units/100 ml of drinking water) were: 207·5 (well water), 151 (cisterns), 52 (private homes), 25 (elementary schools) and 12 (kindergartens). Moderate iodine deficiency was associated (P < 0·05) with a 4·26 times higher risk of low IQ.

There is a perturbing negative impact of these findings on human capital acquisition for the region and the country. More attention is needed to ensure effective salt iodination processes, particularly in regions where goitrogens may contribute to the negative effects of iodine deficiency on the intellectual development of children.