This study aimed at assessing the effectiveness regarding implementation and impact of a take-home nutrition supplementation programme, the Protein Energy Malnutrition (PEM) Scheme, that targets malnourished pre-school children and pregnant and lactating women in the Northern Cape Province of South Africa.

In assessing implementation of the PEM Scheme, a cross-sectional descriptive study was undertaken over a 6-month period in the six regions of the Northern Cape Province. Interviews were conducted with programme managers and health personnel at clinics who were responsible for implementing the PEM Scheme. In assessing the impact of the PEM Scheme on growth, a retrospective review was done of the clinic records (including anthropometric data) of children enrolled in the PEM Scheme over a 1-year period.

About 76% of the budget allocated to the PEM Scheme had been utilised over the 1-year period. The budget for the following financial year was based solely on food supplements purchased in the previous year. Coverage of malnourished pre-school children and eligible pregnant and lactating women for enrolment was estimated to be 50% and 60%, respectively. Eighty-five per cent of health facilities in the province participated in the PEM Scheme. Some of the main problems identified included: lack of training, inappropriate targeting of certain groups, incorrect application especially of discharge criteria for pregnant and lactating women, inadequate assessment for nutrition-related disease, inadequate nutrition counselling and no standardised monitoring. Of the 319 children enrolled over a year, the mean age was 16.2 (standard deviation 16.2) months, 41% had been low-birth-weight and 18% had been diagnosed with tuberculosis. Ten per cent of the children with a weight-for-age Z-score of <−2 moved into the normal Z-score range after being on the PEM Scheme for a mean duration of 8 months. There was an overall improvement in the weight-for-age Z-scores of 25% of the sample, with a significant difference between the mean weight-for-age Z-scores at enrolment and follow-up (t = 4.8, P < 0.001). This was mainly related to significant improvement in the mean weight-for-age Z-scores of children <2 years.

Numerous problems with the PEM Scheme have been identified which could have limited its impact. Recommendations are proposed for improving the effectiveness and impact of the PEM Scheme in the province.

The aim of this study was to determine the iron status, and the risk factors for iron deficiency (ID) and iron-deficiency anaemia (IDA), of non-pregnant adult women working in a fruit-packing factory.

A cross-sectional analytical study was done on 338 women, 18 to 55 years of age. Information on demographic data, risk factors for ID, smoking, and the consumption of red meat, chicken and fish was collected by questionnaire. Height and weight were measured and the body mass index (BMI) calculated. A non-fasting venous blood sample was analysed for haemoglobin (Hb), serum ferritin (SF), serum iron, serum transferrin and C-reactive protein; transferrin saturation (TFS) was calculated.

Fruit-packing factory in the Western Cape, South Africa.

The mean value for Hb was 13.06 (standard deviation (SD) 1.16) g dl−1 and for SF 48.0 (SD 47.8) μgl−1 (geometric mean 26.44 μgl−1). Women (n = 325) were categorised on the basis of iron status: 60% had a normal iron status (NIS); 12.6% had low TFS (<16%) but normal Hb (≥12 g dl−1) and SF (≥12 μgl−1) concentrations (LTS); and 27.4% had low iron status (LIS), defined as combinations of low SF (<12 μgl−1 or <20 μgl−1), low TFS (<16%) and low Hb (<12 gdl−1). More than 30% of the women were obese (BMI ≥ 30 kgm−2). The risk ratio for LIS (LIS vs. NIS) was 3.8 (95% confidence interval (CI) 1.9–7.6) if women were still menstruating or 3.2 (95% CI 1.6–6.2) if they were pregnant during the past 12 months. Women with LIS consumed significantly smaller portions of red meat, chicken and fish than did women in the other two groups.

IDA (low Hb, SF and TFS) and ID (low SF and TFS) did not seem to be a major problem. Women who were still menstruating or were pregnant during the past 12 months were at greater risk for ID. The consumption of smaller portions of red meat, chicken and fish was related to LIS. A high prevalence of obesity, which demonstrated the coexistence of both under- and overnutrition, was observed.

To investigate the prevalence of vitamin A deficiency among lactating women in a poor urban population of Bangladesh, and to examine the relationship between various factors and vitamin A status.

Cross-sectional study.

Maternal and child health clinic in Dhaka City, Bangladesh.

A total of 120 lactating women aged 17–37 years were randomly selected from women who attended a local maternal and child health clinic in Dhaka City for immunisation of their children. Various socio-economic, personal characteristics, dietary intakes of vitamin A and anthropometric data were collected. Serum retinol (vitamin A) concentration was determined as a measure of vitamin A status.

Of the subjects, 37% had low serum vitamin A levels (<30 μg dl−1), with 13.3% having sub-clinical vitamin A deficiency (<20 μg dl−1). Eighty-seven per cent had vitamin A intakes below the recommended dietary allowance. The lactating women who were either illiterate or received only informal education had significantly (P = 0.002) lower serum vitamin A levels compared with those who received formal education. The women whose husbands received formal education had significantly (P = 0.05) higher serum vitamin A levels than those whose husbands were either illiterate or received only informal education. The serum vitamin A levels of women in households with poor sanitation/latrine practice were significantly (P = 0.03) lower than those of women in households with good sanitation/latrine practice. The women with one child had significantly (P = 0.015) lower serum vitamin A levels than those with two or more children. Women with a lactation period of 6 months or more had significantly (P = 0.034) lower serum vitamin A levels than women with a lactation period of less than 6 months. The women who consumed less than the median vitamin A intake (274.8 μg day−1) had significantly (P = 0.01) lower serum vitamin A levels than those who consumed more than the median vitamin A intake. By multiple regression analysis, education level of the women, number of living children, duration of lactation and dietary intake of vitamin A were found to have significant independent relationships with serum vitamin A. The overall F-ratio (6.8) was highly significant (P = 0.000), the adjusted R2 was 0.16 (multiple R = 0.44).

A significant proportion of poor, urban, lactating women in Bangladesh have vitamin A deficiency. Among the various factors, education level of the women, number of living children, duration of lactation and dietary intake of vitamin A appear to be important in influencing the vitamin A status of these women.

This review examines the extent to which differences in nutrition could explain the diversity of health in Europe and how dietary patterns might contribute to the overall burden of disease in the region.

Europe.

Between-country variations and time trends in dietary and health patterns in Europe are described, taking into account recent evidence on east-west mortality differentials. Existing information on the contribution of dietary factors to the overall burden of disease in Europe and to the burden of cardiovascular diseases and cancer is then reviewed, including a discussion of the methodological challenges that face those seeking to quantify this burden accurately.

While evidence from ecological data have long suggested that variations in health patterns in Europe may be at least partly attributed to differences in dietary intake, recent research into the major risks to disease, disability and death is confirming the importance of poor nutrition to major health problems and overall disease burden in Europe. Findings from the Global Burden of Disease 2000 study suggest that 4.4% of the overall burden of disease in the region could be attributed to low fruit and vegetable intake, and 7.8% to overweight and obesity.

The burden of disease attributed to poor nutrition in Europe appears to be substantial and probably underestimated. However, better quantification of the contribution of nutrition to the region's burden of disease awaits further research to assess the dietary intake of Europeans and to explore the relationship between nutritional factors and health outcomes in diverse parts of Europe.

Iodine deficiency disorders (IDD) are endemic in the mountain regions of Armenia. Universal salt iodisation has been chosen as the control measure.

(1) To measure the prevalence of iodine deficiency in the Armenian population; (2) to evaluate household use of iodised salt; and (3) to monitor iodised salt promotion strategies.

Cross-sectional study on a nationally representative sample of 2627 households, including 3390 children under five and 2649 women of fertile age. Cluster sampling design on four population strata: residents, refugees, rural and urban.

Thyroid was palpable in one-third of the women, 6% of them having a visible goitre. Median of urinary iodine excretion in children was 139.5 μgl−1. One-third of the children showed low urinary iodine concentration. Iodised salt was consumed in 66% of the households. The national IDD control programme included modernisation of the Yerevan Salt Factory, legislative regulation of the iodine content of the salt, and public information by the media.

Armenia was still an endemic zone for goitre in 1997. The iodine status of children under five in 1997 was not considered alarming even though 33% of them had low values of urinary iodine. After four years of intervention strategies, the use of iodised salt has increased by 17%. Further efforts should be made to control salt imports and to monitor IDD indicators in vulnerable groups.

This paper reports the distribution and determinants of body mass index (BMI) and obesity in Tirana City (Albania).

Cross-sectional survey conducted in mid-2001.

Tirana City.

One thousand one hundred and twenty adults aged 25 years and over (response rate 72.7%), selected using multi-stage cluster sampling.

Over three-quarters of male and female respondents had an excess body weight. The overall population prevalence of obesity in Tirana was estimated to be 22.0% in men and 30.9% in women. Obesity affected both genders (age-standardised prevalence in males 22.0%, females 30.9%; age-adjusted odds ratio (OR) 1.89; 99% confidence interval (CI) 1.33–2.67) and all age groups, but most particularly middle-aged women. The age-standardised overall prevalence of central obesity was 21.6% in men and 29.4% in women (age-adjusted OR 1.58; 99% CI 1.11–2.25), increasing with age (P <0.01). In women, the likelihood of being obese was inversely related to educational achievement (trend P = 0.001) and alcohol consumption (trend P = 0.009). Income, smoking and leisure-time physical activity were not associated with obesity.

Excess weight and obesity are major public health problems in the adult population of Tirana, but most particularly in middle-aged women. The high obesity prevalence observed along with the recent decrease in physical activity, dietary changes and increase in smoking prevalence make it probable that there will be substantial increases in many non-communicable diseases in Albania in the coming decades. Health promotion strategies are needed that prevent excess weight gain in the Albanian population.

To assess the consumption of whole-grain foods in different age and sociodemographic groups in Great Britain, using data from two national surveys.

Cross-sectional analysis of the consumption of whole-grain foods.

The 1986–87 Dietary and Nutritional Survey of British Adults and the 1994–95 National Diet and Nutrition Survey of people aged 65 years and over.

In 1986–87, 2086 British adults aged 16–64 years; 1189 British adults aged 65 years and over in 1994–95.

In the 1986–87 survey population, consumption of whole-grain foods increased with age. Median consumption of whole-grain foods was 1 serving per week in 16–24-year-olds and 3 servings per week in the 35–64-year-olds (P <0.0001). In 1994–95, median consumption was 5 servings per week in adults aged 65 years and over. Overall, one-third of British adults ate no whole-grain foods on a daily basis, and less than 5% ate 3 or more servings per day. Manual occupation and smoking were consistently associated with a higher proportion of non-consumers and fewer servings per week of whole-grain foods, independent of age, sex, region and season (each P < 0.001). The main sources of whole-grain foods were wholemeal bread and breakfast cereals, which accounted for more than three-quarters of all servings.

Consumption of whole-grain foods in the adult UK populations is more prevalent in the non-smoking, higher socio-economic groups. Amongst consumers of whole-grain foods, the frequency is similar to that reported in the USA and Norway.

To examine the prevalence and dietary, sociodemographic and lifestyle risk factors of low iron intake and poor iron status in British young people.

National Diet and Nutrition Survey of young people aged 4–18 years.

Great Britain, 1997.

In total, 1699 young people provided 7-day weighed dietary records, of which 11% were excluded because the participant reported being unwell with eating habits affected. Blood was obtained from 1193 participants, with iron status indicated by haemoglobin, serum ferritin and transferrin saturation.

Iron intakes were generally adequate in most young people aged 4–18 years. However, low iron intakes (below the Lower Reference Nutrient Intake) occurred in 44% of adolescent girls (11–18 years), being less prevalent with high consumption of breakfast cereals. Low haemoglobin concentration (<115 gl−1, 4–12 years; <120 or <130 gl−1, 13+ years for girls and boys, respectively) was observed in 9% of children aged 4–6 years, pubertal boys (11–14 years) and older girls (15–18 years). Adolescent girls who were non-Caucasians or vegetarians had significantly poorer iron status than Caucasians or meat eaters, independent of other risk factors. The three iron status indices were correlated significantly with haem, but not non-haem, iron intake.

Adolescent girls showed the highest prevalence of low iron intake and poor iron status, with the latter independently associated with non-Caucasian ethnicity and vegetarianism. Risk of poor iron status may be reduced by consuming (particularly lean red) meat or enhancers of non-haem iron absorption (e.g. fruit or fruit juice) in vegetarians.

Availability of confectionery from vending machines in secondary schools provides a convenient point of purchase. There is concern that this may lead to ‘over-indulgence’ and hence an increase in susceptibility to obesity and poor ‘dietary quality’. The study objective was to investigate the association between the frequency of consumption of confectionery purchased from vending machines and other sources and related lifestyle factors in adolescent boys and girls.

A secondary school-based, cross-sectional study.

A total of 504 subjects were investigated (age range 12–15 years), from three schools in southern and northern England. Using a lifestyle questionnaire, frequency of confectionery consumption (CC) from all sources (AS) and vending machines (VM) was recorded for a typical school week. Subjects were categorised into non-consumers, low, medium and high consumers using the following criteria: none, 0 times per week; low, 1–5 times per week; medium, 6–9 times per week; high, 10 times per week or greater.

No differences were found in the frequency of CC from AS or VM between those who consumed breakfast and lunch and those who did not. No differences were found in the frequency of fruit and vegetable intake in high VM CC vs. none VM CC groups, or in any of the VM CC groups. Confectionery consumption from AS (but not VM) was found to be higher in subjects who were physically active on the journey to school (P <0.01) but also higher in those who spent more time watching television and playing computer games (P <0.01). No associations were found between smoking habits or alcohol consumption and frequency of CC.

These results do not show a link between consumption of confectionery purchased from vending machines and ‘poor’ dietary practice or ‘undesirable’ lifestyle habits. Findings for total confectionery consumption showed some interesting trends, but the results were not consistent, either for a negative or positive effect.

The aim of this study was to examine consumers' perceived benefits and barriers to the consumption of a vegetarian diet.

Survey (written questionnaire) that included questions on perceived benefits and barriers to the consumption of a vegetarian diet.

South Australia.

Six hundred and one randomly selected South Australians.

The main perceived barriers to adopting a vegetarian diet were enjoying eating meat and an unwillingness to alter eating habits. This was the case for men, women and all age groups, although there were sex and age differences present in over half of the barrier items. For example, family food preferences were a greater problem for women than for men, while the oldest group was more likely to agree that humans are ‘meant’ to eat meat than the younger groups. The main benefits associated with vegetarian diets were health benefits: increased fruit and vegetable intake, decreased saturated fat intake, weight control. Animal welfare-related benefits and disease prevention were also important. Age and sex differences were apparent, although age differences were more important than sex differences.

The majority of respondents perceived there to be health benefits associated with the consumption of a vegetarian diet, but also, predictably, enjoyed eating meat. Given this, it is likely that interest in plant-based diets that contain some meat is higher than that in no-meat diets. An understanding of the perceived benefits and barriers of consuming a vegetarian diet will allow the implementation of strategies to influence meat and vegetarianism beliefs, dietary behaviour and, hence, public health.

Conventional mixed models for the analysis of diet diary data have introduced several simplifying assumptions, such as that of a single standard deviation for within-person day-to-day variation which is common to all individuals.

We developed a model in which the within-person standard deviation was allowed to differ from person to person.

The model was demonstrated using data on daily retinol intake from the Dietary and Nutritional Survey of British Adults. The data were from 7-day weighed dietary diaries. Estimation was performed by Markov chain Monte Carlo. Reliability of the model was assessed from the accuracy of estimation of the percentage of days on which various intakes were exceeded. For levels above the median retinol intake, estimation of percentages of days with excessive intakes was most accurate using the model with varying within-person standard deviation.

A survey of British adults aged 16–64 years.

In total 2197 adults living in the UK, 1087 males and 1110 females.

Under the traditional model, estimated daily intake ranged from 716.4 to 1421.8 μg depending on age and sex, with a within-person standard deviation of 4298.9 μg. Under the new model, estimated average daily intake ranged from 388.9 to 518.3 μg depending on age and sex, but with a within-person standard deviation varying between subjects with a 95% range of 29 to 8384 μg. The new model was shown to predict the percentage of days of exceeding large intakes more successfully than the traditional model. For example, the percentage of days of exceeding the maximum recommended intake (9000 μg for men and 7500 μg for women) was 2.4%. The traditional model predicted no excessive intakes, whereas the new model predicted 2.9%.

This model is potentially useful in dietary research in general and for analysis of data on chemical contaminants in foods, in particular.