Antioxidant intake has been associated with less progression of radiographic knee osteoarthritis (OA), but studies of carotenoid biomarkers and OA have not been done. We examined associations between serum concentrations of nine naturally occurring carotenoids and radiographic knee OA.

The study design was matched case–control. Sera were analysed by high-performance liquid chromatography for nine carotenoids: lutein, zeaxanthin, α- and β-cryptoxanthin, trans- and cis-lycopene, α-carotene, and trans- and cis-β-carotene. Conditional logistic regression was used to estimate the association between tertiles of each carotenoid and radiographic knee OA, independent of body mass index, education, serum cholesterol, and the other carotenoids.

Johnston County, North Carolina, United States of America.

Two-hundred cases with radiographic knee OA (Kellgren–Lawrence grades ≥2) and 200 controls (Kellgren–Lawrence grade = 0) were randomly selected from the Johnston County Osteoarthritis Project, and were matched on age, gender and race.

Participants with serum levels of lutein or β-cryptoxanthin in the highest tertile were approximately 70% less likely to have knee OA than controls {odds ratio (OR) [95% confidence interval (CI)] = 0.28 [0.11, 0.73] and 0.36 [0.14, 0.95], respectively}. Those in the highest tertile of trans-β-carotene (OR = 6.40 [1.86, 22.1]) and zeaxanthin (OR = 3.06 [1.19, 7.85]) were more likely to have knee OA.

While certain carotenoids may protect against knee OA, others may increase the odds of knee OA. Further study of carotenoids and knee OA are warranted before clinical recommendations about these substances and knee OA can be made.

To report on the haemoglobin concentrations and prevalence of anaemia in schoolchildren in eight countries in Africa and Asia.

Blood samples were collected during surveys of the health of schoolchildren as a part of programmes to develop school-based health services.

Rural schools in Ghana, Indonesia, Kenya, Malawi, Mali, Mozambique, Tanzania and Vietnam.

Nearly 14 000 children enrolled in basic education in three age ranges (7–11 years, 12–14 years and Ä15 years) which reflect the new UNICEF/WHO thresholds to define anaemia.

Anaemia was found to be a severe public health problem (defined as >40% anaemic) in five African countries for children aged 7–11 years and in four of the same countries for children aged 12–14 years. Anaemia was not a public health problem in the children studied in the two Asian countries. More boys than girls were anaemic, and children who enrolled late in school were more likely to be anaemic than children who enrolled closer to the correct age. The implications of the four new thresholds defining anaemia for school-age children are examined.

Anaemia is a significant problem in schoolchildren in sub-Saharan Africa. School-based health services which provide treatments for simple conditions that cause blood loss, such as worms, followed by multiple micronutrient supplements including iron, have the potential to provide relief from a large burden of anaemia.

An outbreak of contagious bovine pleuropneumonia (CBPP) in the northern part of Botswana in 1996 was contained through eradication of all heads of cattle in Ngamiland district (Ngami East and West) in the period April 1996 to February 1997. This disaster posed a serious threat to those who depended on the livestock sector for sustenance and to the nutrition security of the population, especially the under five's.

The aim of this study was to assess the impact of the cattle eradication on the nutritional status of children.

A secondary analysis of existing data from the Botswana National Nutrition Surveillance System enabled us to study the impact of this disaster on malnutrition in the under five's by comparing quarterly malnutrition rates for Ngami East with national figures for the period of January 1995 to March 1998.

While the risk for malnutrition among under five's in Ngami East increased from 0.046 to 0.105 during the study period, giving a relative risk of 2.299, the increase in risk for Botswana was from 0.133 to 0.139, giving a relative risk of 1.048. The attributable risk for cattle eradication impact on malnutrition was 4.6% for Botswana and 54.4% for Ngami East.

The cattle eradication impacted seriously on the food and nutrition security of the under five's in Ngami East, compared with the country as a whole.

To examine the relationship between the nutritional status and handgrip strength of older people in rural Malawi.

Cross-sectional study.

Lilongwe rural, Malawi, situated approximately 35–50 km from the city.

Ninety seven males and 199 females participated in this study.

Selected anthropometric measurements were taken and nutrition indices were computed using standard equations. Handgrip strength was measured using an electronic grip strength dynamometer.

The mean handgrip strength (in kg) for men was significantly higher than for women (28.0±5.9 vs. 21.7±4.5). In addition, there was a significant decline in handgrip strength with age in both sexes. Furthermore, handgrip strength was positively correlated to the following nutritional status indicators: BMI (r = 0.40 in males and r = 0.34 in females), mid-upper arm circumference (MUAC) (r = 0.45 in males and r = 0.38 in females) and arm-muscle area (AMA) (r = 0.39 in males and r = 0.37 in females). After controlling for potential confounders, namely sex, height and age, the correlations between handgrip strength and the nutrition indices were still significant.

The results of this study support the hypothesis that poor nutritional status is associated with poor handgrip strength. Malawian males had both lower handgrip strength and lower arm muscle area than their counterparts from industrialised countries. However, Malawian females had similar handgrip strength despite lower arm muscle area, in comparison with women from industrialised countries, reflecting perhaps their higher level of physical activity. Further studies are required to determine whether by alleviating nutritional problems a concomitant improvement in handgrip strength can be obtained.

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

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

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

The benefits of targeted, school-based treatment in reducing the prevalence and intensity of infection supports the South African government's focus of using school-based interventions as part of an integrated parasite control programme. These strategies and programmes are consistent with recommendations of the World Health Organization (WHO) and The United Nations Children's Fund (UNICEF).

To describe vitamin intakes in Spanish food patterns, identify groups at risk for inadequacy and determine conditioning factors that may influence this situation.

Pooled-analysis of eight cross-sectional regional nutrition surveys.

Ten thousand two hundred and eight free-living subjects (4728 men, 5480 women) aged 25–60 years. Respondents of population nutritional surveys carried out in eight Spanish regions (Alicante, Andalucía, Balearic Islands, Canary Islands, Catalunya, Galicia, Madrid and Basque Country) from 1990 to 1998. The samples were pooled together and weighted to build a national random sample.

Dietary assessment by means of repeated 24-hour recall using photograph models to estimate portion size. Adjusted data for intra-individual variation were used to estimate the prevalence of inadequate intake. A Diet Quality Score (DQS) was computed considering the risk for inadequate intake for folate, vitamin C, vitamin A and vitamin E. DQS scores vary between 0 (good) and 4 (very poor). Influence of lifestyle (smoking, alcohol consumption and physical activity) was considered as well.

Inadequate intakes (<⅔ Recommended Dietary Intake) were estimated in more than 10% of the sample for riboflavin (in men), folate (in women), vitamin C, vitamin A, vitamin D and vitamin E. More than 35% of the sample had diets classified as poor quality or very poor quality. Factors identified to have an influence on a poor-quality diet were old age, low education level and low socio-economical level. A sedentary lifestyle, smoking, usual consumption of alcohol and being overweight were conditioning factors for a poor-quality diet as well.

Results from The eVe Study suggest that a high proportion of the Spanish population has inadequate intakes for at least one nutrient and nearly 50% should adjust their usual food pattern towards a more nutrient-dense, healthier diet.

The purpose of this survey was to establish a database of habitual food and drink consumption in a representative sample of Irish adults, aged 18–64 years. The present paper describes the sampling protocol, response rate and characteristics of the survey population in terms of sex and age groups, seasonality, geographical location, marital status, social class, socio-economic status and education level.

A cross-sectional food consumption survey was carried out. In the Republic of Ireland, a nationally representative sample of adults was randomly selected with a validated two-stage clustered design, using the electoral register as the sampling frame. This method produced a self-weighting or ‘epsem’ sample of individuals, where each adult who was registered to vote had an equal opportunity of being selected. Similarly, in Northern Ireland, a two-stage random sampling procedure was used. The sampling frame was the electoral register, and the sample was stratified by urban/rural and by an index of material deprivation, to ensure representation of each sector of the community. The recruitment procedure was the same in the North and South. An introductory letter with an information leaflet was posted to each selected individual and these were followed up by a visit from a fieldworker, who invited participation in the survey.

Northern Ireland and Republic of Ireland between 1997 and 1999.

The response rate, which is the percentage of the total number of people who completed a 7-day food diary (n = 1379) out of the total eligible sample (n = 2177), was 63%. Non-respondents and dropouts constituted 34% and 3%, respectively, of the total eligible sample. Compared with the most recent census figures available, the sample was generally found to be representative in terms of sex and age group profiles, geographical location, marital status, seasonality, social class, socio-economic group and education level. Data on sex and age group and geographical location were collected from non-respondents for comparison with the survey sample. There were no apparent differences between them.

The North/South Ireland Food Consumption Survey has established a Samplino relational database of habitual food and drink consumption, in addition to data on Response rate habitual physical activity, anthropometric measurements, socio-demographic factors, Demographics lifestyle, health status indicators and attitudes, in a nationally representative sample Socio-economic factors of the population of the island of Ireland.

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

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

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

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

The estimated dietary soy isoflavone intake in Japanese American women living in King County, Washington State was about a quarter to a half that of women living in Japan. Dietary soy isoflavone intake was associated with speaking Japanese and healthy lifestyle and dietary habits.

To review studies on the morbidity, mortality and nutrition of migrant populations in France.

A systematic search of the bibliographic database Medline, and direct contact with associations and institutions concerned with migrants' health.

In France, as in other host countries, migrants belong to the lowest socio-economic strata. They have on average better health and lower mortality than the local-born population. Health benefits are particularly noticeable in Mediterranean men, especially for affluence-related diseases such as cancer and cardiovascular diseases. North African men smoke as heavily as the local-born of the same occupational categories, and yet their mortality rates from lung cancer are notably lower. Such a paradox may be the result of a synergy between different phenomena such as the selection of the fittest applicants for immigration and the maintenance of healthy lifestyles from the countries of origin. In contrast, migrant women do not enjoy the same health advantages, possibly because they are less likely to be selected on the basis of their health and because they are often non-working. Adult migrants from southern Europe and North Africa report dietary practices consistent with the typical Mediterranean diet, which is renowned for its positive effects on health.

The diet of Mediterranean adults living in France may partly explain the low rates of chronic diseases and high adult life expectancy observed in migrant men from northern Africa. Information about their diets might provide clues for the design of nutritional education campaigns aimed at low-income people.

The over-all strategy given by the joint FAO/WHO consultation 1995 was used as the starting point, i.e. target foods or food patterns for public health nutrition programmes should be identified from an analysis of prevailing food and nutrient intakes. Prevailing data for food and nutrient intakes in 14 EU countries were examined and different principles and options for the derivation of FBDG were explored. Methodological issues and their influence on the interpretation of data for the development of FBDG were also examined.

The process from nutrients to foods can be briefly: 1) identification of major food sources of the nutrient of interest, 2) identification of foods contributing substantially to population intakes, 3) identification of foods or food patterns compatible with desirable nutrient intakes or explaining variations in nutrient intakes, 4) formulation of FBDG into foods, portion sizes, frequency of intake, meal composition taking attainability and acceptability as well as compatibility of co-existing guidelines into account.

The level of complexity that can be applied in the analytical approaches depends on the characteristics of available intake data. A detailed analysis requires data on an individual level for nutrients, foods, food patterns, eating and meal habits etc. When individual data are available different analytical approaches (examination of distribution of intakes, correlation analysis between foods and nutrients, examination of food intakes in compliers/non-compliers to nutrient goals, discriminant analysis, cluster/factor analysis) can be used to identify key foods or food patterns fulfilling nutrient goals.

The examination of prevailing food and nutrient intake data in the EU revealed:

– a number of methodological differences in approaches to dietary surveys exist in the EU countries e.g. regarding mediods used, selection of population, classification of foods, which have to be kept in mind in pan-EU comparisons at present there is a substantial gap between actual intakes and present nutrient goals suggesting that major changes of dietary habits are needed

– while some food patterns were consistently related to intake of specific nutrients in most EU countries, other patterns showed large variations between countries

– methodological issues, such as survey duration, survey techniques, under- or over-reporting, could have substantial influence on the identification of target foods or food patterns.

A science-based analysis of nutrient and food intakes allows development of FBDG, which, if implemented, are likely to result in mean population intakes closer to nutrient goals. Acknowledging the social and cultural differences within the EU as well as the need to focus on the most relevant public health problem in die population, FBDG should first be developed widiin member states. Harmonisation of survey methods within the EU would facilitate development of regional and EU FBDG.

To provide an overview of vitamin and mineral intakes among children and adolescents in European countries and to present results from studies showing the impact of food fortification.

Comparative analysis of a number of nutritional studies among children and adolescents performed during the last decade in certain European countries.

Spain, France, UK, North Ireland, Portugal, Germany.

Europeans aged 6 to 18.

Dietary surveys across Europe showed that varying levels of nutrient adequacy existed from one country to another, and that even within the same country, there were important nutritional gaps between different regions. In general, studies are difficult to compare, and information for many countries was missing. The results suggest that children and adolescents are the population group most likely to have higher risk of nutritional deficiencies, particularly for iron, vitamins C, E, B6 and folates. In France, Ireland, UK and Spain, food fortification, and particularly of breakfast cereals, has positively contributed to increasing vitamin and mineral intakes in childhood and adolescence.

Information on vitamin and mineral intakes in European children is less available than in adults. Fortified foods may contribute to reducing nutrient inadequacy in European children and adolescents, but should not replace nutrition education.

The purpose of this survey was to establish a database of habitual food and drink consumption in a representative sample of Irish adults aged 18-64 years.

A cross-sectional food consumption survey was carried out. Food intake data were collected using a 7-day estimated food diary. Anthropometric data included measurements of weight, height, waist and hip circumferences and body composition using bioelectrical impedance analysis. Questionnaire data included assessments of health, lifestyle and socio-demographic status, levels of physical activity, attitudes to diet and health and restrained eating.

Northern Ireland and Republic of Ireland between 1997 and 1999.

In total, 1379 adults aged 18–64 years participated in the survey and completed the 7-day food diary. This paper gives details of the methods used to carry out the survey. Sampling, respondent recruitment, dietary assessment, collection of anthropometric and questionnaire data and data management and analysis are described.

The North/South Ireland Food Consumption Survey is unique in being the first food consumption survey ever to be carried out in the Republic of Ireland and Northern Ireland concurrently using the same methodology.

A Mediterranean diet quality index (MDQI) was devised to give an overall assessment of dietary habits and to identify groups at risk.

The MDQI was based on scores given for selected levels of consumption of selected nutrients and foods.

Mediterranean southern France.

The sample included 473 men and 491 women in three age classes recruited at random.

Only 9.5% of men, 9.0% of women, 4.7% of 20–34 year old subjects, 6.6% of 35–54 year old subjects and 14.0% of 55–76 year old subjects were shown to have a healthy diet. However, 10.1% of men, 8.6% of women, 19.4% of 20–34 year old subjects, 10.2% of 35–54 year old subjects and 4.6% of 55–76 year old subjects were shown to have a poor diet. There were significantly fewer smokers among subjects with a good diet but the distribution of moderate wine drinkers was comparable between those with a good diet and those with a poor diet. Correspondence analysis associated a healthy diet with 55–76 year old men and women living in rural areas, who had received primary schooling only and who were manual workers. Both men and women with a poor MDQI score tended to be young and smokers. In addition, women with a poor MDQI tended to be heavy drinkers and obese.

This study showed that the Mediterranean model, which is generally recognized as a healthy diet, appears restricted to older people and to rural areas, whereas urbanized young people depart from it. A nutritional prevention policy targeted at young adults is required to encourage them to adhere to the Mediterranean model. Smoking and drinking showed different distribution patterns in the sample under study.

Studies performed on the nutritional status of the Spanish population have been very heterogeneous with respect to methodology, sample size, geographical location, socio-economic level and health status of the subjects involved. In order to gain an overall view of the state of knowledge in this area, a meta-analysis was performed on the results of all such studies undertaken in Spain between 1990 and 1999.

The dietetic data reviewed showed mean intakes similar to those recommended. The results obtained for the biochemical parameters analysed were within normal limits. However, results for some vitamins were very close to the lower established limits for the reference intervals (recommended intakes or blood levels), meaning that a variable percentage of subjects show values lower than those recommended. The percentage of subjects with intakes below those recommended for niacin, vitamin B12 and C was small. The percentage of inadequate intakes of thiamine and riboflavin was small as well. However, for all other vitamins, especially D and E, the number of people with intakes below recommended was rather high, particularly so in some studies. At blood level, deficiencies of vitamins B12, A and E were infrequent. However, for all other vitamins, prevalence of deficiency varied within a wide range. With respect to vitamins D, B1, B2 and B6, over 50% of the population showed inadequate levels.

The methodologies used in the studies included in this review were very varied and the knowledge gained is still incomplete. Despite the average Spanish diet often being regarded as satisfactory, this review and other studies show the situation can be improved.