To describe how urbanisation influences the nutrition and health transition in South Africa by using data from the THUSA (Transition and Health during Urbanisation of South Africans) study.

The THUSA study was a cross-sectional, comparative, population-based survey.

The North West Province of South Africa.

In total, 1854 apparently healthy volunteers, men and women aged 15 years and older, from 37 randomly selected sites. Pregnant and lactating women, those with diagnosed chronic diseases and taking medication, with acute infections or inebriated were excluded but screened for hypertension and diabetes mellitus. Subjects were stratified into five groups representing different levels of urbanisation in rural and urban areas: namely, deep rural, farms, squatter camps, townships and towns/cities. Outcome measures and methods: Socio-economic and education profiles, dietary patterns, nutrient intakes, anthropometric and biochemical nutrition status, physical and mental health indicators, and risk factors for non-communicable diseases (NCDs) were measured using questionnaires developed or adapted and validated for this population, as well as appropriate, standardised methods for the biochemical analyses of biological samples.

Subjects from the rural groups had lower household incomes, less formal education, were shorter and had lower body mass indices than those in the urban groups. Urban subjects consumed less maize porridge but more fruits, vegetables, animal-derived foods and fats and oils than rural subjects. Comparing women from rural group 1 with the urban group 5, the following shifts in nutrient intakes were observed: % energy from carbohydrates, 67.4 to 57.3; from fats, 23.6 to 31.8; from protein, 11.4 to 13.4 (with an increase in animal protein from 22.2 to 42.6 g day-1); dietary fibre, 15.8 to 17.7 g day-1; calcium, 348 to 512 mg day-1; iron from 8.4 to 10.4 mg day-1; vitamin A from 573 to 1246 μg retinol equivalents day-1; and ascorbic acid from 30 to 83 mg day-1. Serum total cholesterol, low-density lipoprotein cholesterol and plasma fibrinogen increased significantly across groups; systolic blood pressure >140 mmHg was observed in 10.4–34.8% of subjects in different groups and diabetes mellitus in 0.8–6.0% of subjects. Women in groups 1 to 5 had overweight plus obesity rates of 48, 53, 47, 61 and 61%, showing an increase with urbanisation. Subjects from group 2 (farm dwellers) showed the highest scores of psychopathology and the lowest scores of psychological well-being. The same subjects consistently showed the lowest nutrition status.

Urbanisation of Africans in the North West Province is accompanied by an improvement in micronutrient intakes and status, but also by increases in overweight, obesity and several risk factors for NCDs. It is recommended that intervention programmes to promote nutritional health should aim to improve micronutrient status further without leading to obesity. The role of psychological strengths in preventing the adverse effects of urbanisation on health needs to be examined in more detail.

To examine the contribution of the food service sector to the nutrient quality of the Irish diet, and to compare intakes at home, work and outside the home (‘ut’) and within the subgroups of the out location (pub, deli, takeaway)

Random sample of adults from the Republic of Ireland. Food intake data were collected using a 7-day food diary. Respondents recorded the location of every eating occasion determined by where the food was prepared rather than consumed

Intakes of energy, protein, fat and carbohydrate were significantly greater at home than at work or out (P <0.05). The intake of alcohol was significantly (P <0.001) greater out than at home or work. The percentage contribution of fat to energy was above the recommendations (33% of total energy and 35% of food energy) for both men and women at all locations, with the exception of the contribution of fat to total energy for men at the out location. Within the subgroups of the out location, the contribution of alcohol to total energy was greatest in pubs and the contribution of fat to both total and food energy was greatest in takeaways. Intakes of fibre and most micronutrients per 10 MJ of food energy were greater (P <0.05) at home than at work or out

Foods eaten outside the home contribute a disproportionately high level of fat intake and should be targeted in public health nutrition strategies

In Mali, an estimated 73% of pregnant women are anaemic largely due to iron deficiency. National policy recommends women to take iron and folic acid supplements daily from first prenatal contact until 3 months postpartum. However, many pregnant women in Mali could benefit from multiple micronutrient supplements.

To assess pregnant women's acceptability of and adherence to a daily multiple micronutrient supplementation scheme compared with the current daily iron and folic acid supplementation scheme.

Seventy pregnant women were allocated to either the daily multiple micronutrient or daily iron and folic acid supplementation scheme. Women started receiving supplements at the end of the first trimester of pregnancy until delivery and throughout the first 3 months postpartum.

No significant differences were observed between comparison groups with respect to women's perceptions about supplement size, colour, taste or flavour. Adherence to the multiple micronutrient supplementation scheme was better (257.5±20.9 tablets; average adherence 95.4%) than that to the iron and folic acid supplementation scheme (238.5±32.7 tablets; average adherence 92.2% P = 0.008) although both were very good, as were women's perceptions about the benefits of micronutrient supplements to their health and that of their newborns.

Malian women adhere to prenatal/postpartum micronutrient supplementation – no matter what supplement is chosen – when access to supplements is guaranteed and when they are provided with minimum, consistent and easily understandable information and counselling, indicating that these are key elements to ensure effective programmes. These findings, together with those of the global research agenda on the efficacy of multiple micronutrient supplements for pregnant women, will inform policy development in Mali for the effective control of iron deficiency and iron-deficiency anaemia in pregnant women.

To estimate the energy requirements of pregnant and lactating women consistent with optimal pregnancy outcome and adequate milk production.

Total energy cost of pregnancy was estimated using the factorial approach from pregnancy-induced increments in basal metabolic rate measured by respiratory calorimetry or from increments in total energy expenditure measured by the doubly labelled water method, plus energy deposition attributed to protein and fat accretion during pregnancy.

Database on changes in basal metabolic rate and total energy expenditure during pregnancy, and increments in protein based on measurements of total body potassium, and fat derived from multi-compartment body composition models was compiled. Energy requirements during lactation were derived from rates of milk production, energy density of human milk, and energy mobilisation from tissues.

Healthy pregnant and lactating women.

The estimated total cost of pregnancy for women with a mean gestational weight gain of 12.0 kg, was 321 or 325 MJ, distributed as 375, 1200, 1950 kJ day-1, for the first, second and third trimesters, respectively. For exclusive breastfeeding, the energy cost of lactation was 2.62 MJ day-1 based on a mean milk production of 749 g day-1, energy density of milk of 2.8 kJ g-1, and energetic efficiency of 0.80. In well-nourished women, this may be subsidised by energy mobilisation from tissues on the order of 0.72 MJ day-1, resulting in a net increment of 1.9 MJ day-1 over non-pregnant, non-lactating energy requirements.

Recommendations for energy intake of pregnant and lactating women should be updated based on recently available data.

To evaluate the impact of a low-cost nutritional intervention in changing the lifestyle of adults.

Randomised clinical trial.

Primary health-care centre in São José do Rio Preto, São Paulo State, Brazil.

We randomly assigned 104 adults (83 women and 21 men aged 30–65 years, body mass index 24–35 kg m−2, non-diabetic) into two groups: nutrition counselling and control. Each subject in the intervention group received three individualised nutritional counselling sessions during the first 6 months aimed at increasing intakes of fruits, vegetables and olive oil, reducing saturated fat and improving physical activity. Body composition, biochemical indicators and lifestyle were assessed at baseline and at 6 months and 1 year in both groups.

After 6 months of follow-up, body weight, waist circumference, diastolic blood pressure, fasting blood glucose, total and low-density lipoprotein cholesterol, total and saturated fat, and dietary energy and cholesterol levels showed a more significant decrease among subjects in the intervention group than in the control group (P<05). Moreover, the intervention group showed significantly greater improvement in each intervention goal, such as reduced intake of saturated fat and increased intakes of fruits, vegetables, fibre and olive oil (P<0.05). After 12 months of follow-up, most of the outcomes were maintained.

The low-cost nutritional intervention programme improved serum lipids profile and weight control, and appeared to be feasible for use at a primary health-care centre in a developing country.

To outline the history of dietetics since its beginnings in recorded history, and of nutrition science in its first phase beginning in the mid-nineteenth century and then its second phase in the second half of the twentieth century.

Three narrative overviews: of dietetics from its beginnings until after the end of the mediaeval and then Renaissance periods in Europe; of nutrition science in its first phase from its beginnings in the mid-nineteenth century until the middle of the twentieth century, with reasons for its rise; and of nutrition science in its second phase in the second half of the twentieth century, with reasons for its decline.

In its third phase in the twenty-first century, the new nutrition science should regain much of the vision and scope of its preceding disciplines.

To study changes in lifestyle in relation to changes in body weight and waist circumference associated with occupational retirement in men.

A prospective cohort study with 5 years of follow-up. At baseline and at follow-up, questionnaires were completed and body weight and waist circumference were measured.

The Doetinchem Cohort Study, consisting of inhabitants of Doetinchem, a town in a rural area of The Netherlands.

In total 288 healthy men aged 50–65 years at baseline, who either remained employed or retired over follow-up.

The effect of retirement on changes in weight and waist circumference was dependent on type of former occupation. Increase in body weight and waist circumference was higher among men who retired from active jobs (0.42 kg year−1 and 0.77 cm year−1, respectively) than among men who retired from sedentary jobs (0.08 kg year−1 and 0.23 cm year−1, respectively). Weight gain and increase in waist circumference were associated with a decrease in fruit consumption and fibre density of the diet, with an increase in frequency of eating breakfast, and with a decrease in several physical activities, such as household activities, bicycling, walking and doing odd jobs.

Retirement was associated with an increase in weight and waist circumference among those with former active jobs, but not among those with former sedentary jobs. Retirement may bring opportunities for healthy changes in diet and physical activity, which could be used in health promotion programmes.

To determine the level of knowledge regarding iodine nutrition and its relationship with socio-economic status in the South African population.

A cross-sectional population survey collecting questionnaire information on knowledge of iodine nutrition and sociodemographic variables in a multistage, stratified, cluster study sample, representative of the adult South African population.

Home visits and personal interviews in the language of the respondent.

Data were collected from one adult in each of the selected 2164 households, and the participation rate was 98%.

Only 15.4% of respondents correctly identified iodised salt as the primary dietary source of iodine, 16.2% knew the thyroid gland needs iodine for its functioning, and a mere 3.9% considered brain damage, and 0.8% considered cretinism, as the most important health consequence of iodine deficiency. Compared with respondents from high socio-economic households, respondents from low socio-economic households were considerably less informed about aspects of iodine nutrition covered in this study.

The knowledge level of iodine nutrition is low among South Africans, particularly among the low socio-economic groups. These data suggest that the international emphasis on brain damage resulting from iodine deficiency has not been conveyed successfully to the consumer level in this country.

To identify, using the novel application of multivariate classification trees, the socio-economic, sociodemographic and health-related lifestyle behaviour profile of adults who comply with the recommended 4 or more servings per day of fruit and vegetables.

Cross-sectional 1998 Survey of Lifestyle, Attitudes and Nutrition.

Community-dwelling adults aged 18 years and over on the Republic of Ireland electoral register.

Six thousand five hundred and thirty-nine (response rate 62%) adults responded to a self-administered postal questionnaire, including a semi-quantitative food-frequency questionnaire.

The most important determining factor of compliance with the fruit and vegetable dietary recommendations was gender. A complex constellation of sociodemographic and socio-economic factors emerged for males whereas the important predictors of 4 or more servings of fruit and vegetable consumption among females were strongly socio-economic in nature. A separate algorithm was run to investigate the importance of health-related lifestyle and other dietary factors on compliance with the fruit and vegetable recommendations. Following an initial split on compliance with dairy recommendations, a combination of non-dietary behaviours showed a consistent pattern of healthier options more likely to lead to compliance with fruit and vegetable recommendations. There did, however, appear to be a compensatory element between the variables, particularly around smoking, suggesting the non-existence of an exclusive lifestyle for health risk.

Material and structural influences matter very much for females in respect to compliance with fruit and vegetable recommendations. For males, while these factors are important they appear to be mediated through other more socially contextual-type factors. Recognition of the role that each of these factors plays in influencing dietary habits of men and women has implications for the manner in which dietary strategies and policies are developed and implemented.

To develop an activity questionnaire for objective and rapid assessment of maternal habitual physical activity with the aim of describing its relationship with birth size.

Prospective observational study.

Six villages near Pune, Maharashtra, India.

Seven hundred and ninety-seven rural Indian mothers were studied after excluding abortions and termination of pregnancies, foetal anomalies, etc.

Principal components analysis (PCA) was used to identify a few leading questions from an elaborate questionnaire involving 36 questions related to 14 typical maternal activities.

On the basis of high loading (>0.8), PCA identified three activities, i.e. farming, fetching water and washing clothes. Questions and sub-questions related to these activities only were considered for defining an activity score for rapid assessment. Validation of this new activity score, with the score based on the elaborate questionnaire, showed 70% sensitivity as well as specificity. New activity scores showed strong inverse relationships similar to those observed using the elaborate questionnaire, at early as well as late gestation, with neonatal head circumference (P=0.001 and 0.055) and mid-arm circumference (P=0.02 and 0.03).

Simple questionnaires, based on leading activities identified by PCA, can be as informative as longer and detailed questionnaires. This method has potential for adaptation, especially in rural communities in developing countries.

To compare dietary intake and sources of phylloquinone (vitamin K1) in 4-year-old British children between 1950 and the 1990s, and report their variation by sociodemographic factors.

Nationally representative samples of 4-year-olds from the longitudinal Medical Research Council National Survey of Health and Development (NSHD) (1950) and the cross-sectional National Diet and Nutrition Surveys (NDNS, 1992/93 and 1997).

Great Britain.

Subjects were 4599 children born on 3–9 March 1946 (NSHD) and 307 children in the 1990s (NDNS).

Geometric mean dietary phylloquinone intake was significantly higher in 1950 (39 μg day−1, 95% confidence interval (CI) 37, 40) compared with the 1990s (24 μg day−1, 95% CI 22, 25) (P < 0.001). This difference remained when intake was expressed per MJ energy intake and per kilogram body weight, and after accounting for sex, region and occupational social class of the family. In 1950, phylloquinone intake in Scotland was significantly lower than in the rest of Britain. By the 1990s these regional differences had disappeared. Food sources of phylloquinone intake changed significantly between 1950 and the 1990s, with fats and oils contributing more and vegetables less, although vegetables contributed most (60% and 48%, respectively) to phylloquinone intake in both surveys.

Phylloquinone intakes of children have decreased significantly since 1950. With the suggested need for adequate phylloquinone intake for optimal development and maintenance of bone and the cardiovascular system, the substantially lower phylloquinone intakes reported in children of the 1990s, compared with 1950, may have implications for the health of these two systems in later adulthood.

To assess iodine status and its determinants in women of childbearing age in a rural area in the Kayes region, Mali, West Africa.

Cross-sectional study where women's iodine status was indicated by urinary iodine concentration (UIC) and level of goitre based on palpation. Salt iodine was assessed semi-quantitatively at household level. Individual characteristics were collected using questionnaires.

Fifteen villages in a rural area in the Kayes region of Mali.

Women aged 15–45 years (n = 423).

Median UIC was 2.7 μg dl−1, and only 6% of the women had adequate iodine status of UIC > 10 μg dl−1. Most women (60%) had visible goitre, and only 9% were classified as without goitre. Only 39% of the households were using salt with any iodine, and level of knowledge about salt iodisation was low. Main determinants of UIC were breast-feeding and level of salt iodisation; currently breast-feeding women had lower UIC, and UIC increased with increasing level of iodine in household salt. Prevalence of goitre was lower in older women with higher body mass index.

The study indicates severe iodine deficiency in the study area. Urgent action is needed to improve the situation through enforcing salt iodisation legislation and increasing the level of knowledge about the importance of iodised salt in the population.

The fluid recommendation for adults aged 70+ years has been criticised on the basis of a low prevalence of dehydration in community-dwelling older adults. This study explores whether the low prevalence might reflect limitations of individual dehydration indices.

Cross-sectional data on plasma sodium, blood urea nitrogen (BUN), creatinine, glucose and potassium were used to classify 1737 participants of the 1992 Established Populations for Epidemiologic Studies of the Elderly (EPESE) (70+ years) according to multiple dehydration indices. Associations between dehydration indices, health and functional status were evaluated.

Depending on the indicator used, the prevalence of dehydration ranged from 0.5% for hypotonic hypovolaemia only (plasma tonicity <285 mOsm l−1 with orthostatic hypotension) to 60% with dehydration defined as either plasma sodium ≥145 mEq l−1, BUN/creatinine ratio ≥20, tonicity ≥295 mOsm l−1, or hypotonic hypovolaemia. Elevated tonicity and BUN/creatinine ratio were respectively associated with chronic disease and functional impairment.

The true prevalence of dehydration among community-dwelling adults may be low or high, depending on the indicator(s) used to define dehydration. Before we can pinpoint a generalisable prevalence of dehydration for community-dwelling seniors and draw conclusions about fluid recommendations, validation studies of dehydration indices and longitudinal studies of dehydration, health and functional status are needed.

To summarise the literature on energy requirements and aging.

An analysis and review of published data on components of energy expenditure and total energy expenditure (TEE).

Data on basal metabolic rate (BMR) and TEE were obtained from the US Institute of Medicine of the National Academies database (all available data from studies published before 2001, collected from 20 researchers willing to provide individual subject results).

Those individuals from the database who were 20–100 years of age.

TEE and physical activity level (PAL, defined as the ratio of total to resting energy expenditure) declined progressively throughout adult life in both normal weight and overweight men and women. In normal weight individuals (defined as body mass index (BMI) 18.5–25.0 kg m-2) TEE fell by ≈150 kcal per decade, and PAL fell from an average of 1.75 in the second decade of life to 1.28 in the ninth decade. Thermic effect of feeding data from other published studies indicated no consistent change associated with aging.

Aging is associated with progressive declines in resting and TEE, which have implications for defining dietary energy requirements at different stages of adult life.

To review data on the prevalence, causes and health consequences of obesity in South Africa and propose interventions to prevent and treat obesity and related outcomes.

Data from existing literature were reviewed with an emphasis on changing eating and activity patterns, cultural factors, perceptions and beliefs, urbanisation and globalisation. Results of studies on the health consequences of obesity in South Africans are also reviewed.

Shifts in dietary intakes and activity patterns to higher fat intakes and lower physical activity are contributing to a higher prevalence of obesity. Few overweight black women view themselves as overweight, and some associate thinness with HIV/AIDS. Glucose and lipid toxicity, associated with insulin resistance, play roles in the pathogenesis of the co-morbid diseases of obesity. Elevated free fatty acids in the black population predispose obese black patients to type 2 diabetes.

Obesity prevention and treatment should be based on education, behaviour change, political support, intersectoral collaboration and community participation, local actions, wide inclusion of the population, adequately resourced programmes, infiltration of existing initiatives, evidence-based planning, and proper monitoring and evaluation. Interventions should have the following components: reasonable weight goals, healthful eating, physical activity and behavioural change. Genes and mutations affecting susceptibility to the development of co-morbidities of obesity and vulnerable periods of life for the development of obesity should be prioritised. Prevention should be managed in community services, identification of high-risk patients in primary healthcare services and treatment of co-morbid diseases in hospital services.

To show that current rates of global population growth, production and consumption of food, and use of living and physical resources, are evidently not sustainable. To consider ways in which nutrition and allied sciences can respond to this great challenge of the twenty-first century.

Past, current and future projected trends in production and consumption patterns are examined. These show that overall present and projected patterns cannot be sustained; and also show increasing unacceptable inequity between and within rich and poor regions and countries.

Nutrition science classically focuses on nutrients in relation to human physiology, metabolism, growth, health and disease. The social and environmental conditions of the modern, interconnected, market-oriented world, and the consequences for food production and consumption, are extending the research and policy agenda with which nutrition science must now urgently engage. Historically, much attention has been paid to eliminating nutritional deficiency states, and this remains an important task. In modern urban populations ‘malnutrition’ encompasses new forms of dietary imbalance, especially excesses of certain nutrients. These contribute to various non-communicable diseases and, particularly, to overweight/obesity and its attendant metabolic derangements and disease risks. As a mass phenomenon the current surge in obesity has no historical precedent. The escalating impact of humankind on the natural environment, with its ramifications for present and future food production, is also unprecedented.

The essential challenge for nutrition science is to develop new understanding and strategies to enable a balance between promoting, equitably, the health of humans while sustaining the long-term health of the biosphere. Extension of nutrition science and food policy to meet those goals will be aided by understanding better how dietary conditions shaped the biological evolution of humankind. The fundamental long-term task is to integrate human health with the health of the biosphere.

To evaluate the impact of a low-cost nutritional intervention in changing the lifestyle of adults.

Randomised clinical trial.

Primary health-care centre in São José do Rio Preto, São Paulo State, Brazil.

We randomly assigned 104 adults (83 women and 21 men aged 30–65 years, body mass index 24–35 kg m−2, non-diabetic) into two groups: nutrition counselling and control. Each subject in the intervention group received three individualised nutritional counselling sessions during the first 6 months aimed at increasing intakes of fruits, vegetables and olive oil, reducing saturated fat and improving physical activity. Body composition, biochemical indicators and lifestyle were assessed at baseline and at 6 months and 1 year in both groups.

After 6 months of follow-up, body weight, waist circumference, diastolic blood pressure, fasting blood glucose, total and low-density lipoprotein cholesterol, total and saturated fat, and dietary energy and cholesterol levels showed a more significant decrease among subjects in the intervention group than in the control group (P<05). Moreover, the intervention group showed significantly greater improvement in each intervention goal, such as reduced intake of saturated fat and increased intakes of fruits, vegetables, fibre and olive oil (P<0.05). After 12 months of follow-up, most of the outcomes were maintained.

The low-cost nutritional intervention programme improved serum lipids profile and weight control, and appeared to be feasible for use at a primary health-care centre in a developing country.

To describe the current situation regarding protection, promotion and support of breast-feeding in Europe, as a first step towards the development of a blueprint for action.

A questionnaire was completed by 29 key informants and 128 other informants in the EU, including member states, accession and candidate countries.

EU countries do not fully comply with the policies and recommendations of the Global Strategy on Infant and Young Child Feeding that they endorsed during the 55th World Health Assembly in 2002. Some countries do not even comply with the targets of the Innocenti Declaration (1990). Pre-service training on breast-feeding practice is inadequate and in-service training achieves only low to medium coverage. The Baby Friendly Hospital Initiative is well developed only in three countries; in 19 countries, less than 15% of births occur in baby-friendly hospitals. The International Code of Marketing of Breastmilk Substitutes, endorsed in 1981 by all countries, is not fully applied and submitted to independent monitoring. The legislation for working mothers meets on average the International Labour Organization standards, but covers only women with full formal employment. Voluntary mother-to-mother support groups and trained peer counsellors are present in 27 and 13 countries, respectively. Breast-feeding rates span over a wide range; comparisons are difficult due to use of non-standard methods. The rate of exclusive breast-feeding at 6 months is low everywhere, even in countries with high initiation rates.

EU countries need to revise their policies and practices to meet the principles inscribed in the Global Strategy on Infant and Young Child Feeding in order to better protect, promote and support breast-feeding.

This study presents an overview of national nutrition action plans in the member states of the European Union (EU), before its enlargement in 2004. In addition, their compliance with key recommendations of the World Health Organization, as documented in the First Action Plan for Food and Nutrition Policy and the Global Strategy on Diet, Physical Activity and Health, has tentatively been evaluated on the basis of the policy documents published.

Literature review of publicly available policy national plans on nutrition and physical activity.

Member states of the EU before enlargement in May 2004.

The development of national nutrition action plans is gaining momentum. Six of the 15 EU member states – namely, Sweden, Finland, Denmark, France, The Netherlands and the UK – have an operational nutrition policy and four of them have published an elaborated description of their nutrition policy in English. By the end of 2004, another four countries are expected to have their plan finalised. The available nutrition action plans generally seem to comply with international recommendations, although large variations are observed between the member states in terms of terminology, nutritional recommendations, institutional framework, nutritional scope, social groups targeted and monitoring and evaluation structures.

Although the importance of nutritional surveillance, a comprehensive approach to nutritional problems and stakeholder involvement is recognised by the action plans, the justification for it is vaguely described. This paper advocates for proper evaluation and documentation of interventions in public health nutrition and nutrition policies.