To propose a policy framework for the regulation of functional foods and health claims within a public health context.

This article reviews the empirical evidence and public health principles associated with functional foods and health claims to analyse the issues, challenge the assumptions that have emerged and explore options for moving forward.

Functional foods and health claims are among the more controversial and complex issues being debated by food regulators internationally. Proponents of functional foods and health claims state that functional foods may reduce health care expenditure and health claims are a legitimate nutrition education tool that will help them inform consumers of the health benefits of certain food products. Conversely, opponents of these developments respond that it is the total diet that is important for health, not so-called ‘magic bullets’. Moreover, they argue that health claims will enable manufacturers to indulge in marketing hyperbole and essentially blur the distinction between food and drugs. This topic provides a valuable case study of public policy in relation to food and health.

The need to maintain a general prohibition on health claims while accommodating specific exemptions supported by scientific substantiation is recommended. Nutrition education and monitoring and evaluation are integral to the proposed regulatory framework. The intention of this policy position is to encourage research and development of innovative food products while avoiding an inappropriate medicalization of the general food supply.

To investigate the dietary pattern and nutritional status of adolescent girls attending schools in Dhaka city and to examine the association with various social factors.

Cross-sectional study.

Girls high schools in Dhaka city.

A total of 384 girls, aged from 10 to 16 years, who were students of classes VI to IX of 12 girls high schools in Dhaka city were selected by systematic random sampling. Nutrient intake was assessed using the 24-h recall method and the usual pattern of food intake was examined using a 7-day food frequency questionnaire.

The prevalence of undernutrition among the participants assessed as stunting was 10% overall with younger girls being less stunted (2%) than older girls (16%), whereas 16% were thin with relatively more of the younger girls (21%) being thin than of the older girls (12%). Based on the usual pattern of food intake, a substantial proportion of the girls did not consume eggs (26%), milk (35%) or dark green leafy vegetables (20%). By comparison, larger proportions consumed meat (50%) and fish (65%) at least four times a week. For the intake of energy and protein, only 9 and 17% of the girls, respectively, met the recommended daily allowance (RDA). For nearly 77% of the girls, the intake of fat was less than the recommendation. Intakes less than the RDA were found for iron (77% of the girls), calcium (79%), vitamin A (62%), vitamin C (67%), and riboflavin (96%). Based on the food consumption data, cereals were the major source of energy (57%), thiamin (67%), niacin (63%) and iron (37%). Animal sources supplied 50% of dietary protein. Cooking fats were the principal source of fat (67%) in the diet. Milk was the major contributor for riboflavin and preformed vitamin A (retinol). Leafy vegetables and fruits were the main sources of provitamin A (carotenes). The girls from families with less educated parents were more likely to be thin and short for their age. Those girls from families with lower incomes and less educated parents had a dietary pattern which tended to be poor with regard to egg, milk, meat and fruit, with lower intakes of protein, fat and riboflavin.

The findings indicate that the diets of these girls tended to be inadequate both for macronutrients and micronutrients, with significant health implications. There was also a relationship between the family income and the education of the parents with the nutritional status of the girls.

To assess iron status in a sample of clinically well, Caucasian children and explore the complex factors which contribute to iron deficiency during infancy.

Infants recruited at birth and followed longitudinally at 1, 2, 3, 4, 5, 6, 9, 12, 24 and 36 months; feeding practices and socioeconomic data recorded. Iron status assessed using venous blood at 12, 24 and 36 months.

Baseline data recorded in the maternity unit. Follow-up visits took place in the infants' homes and blood sampling in a paediatric hospital.

Subjects comprised a mixed socioeconomic group of healthy children (n=121). Blood samples taken from 85, 72 and 67% at 12, 24 and 36 months, respectively.

Prevalence of anaemia (Hb < 110 gl−1) in the longitudinal sample (n=76) increased from 2.6% at age 12 months to 9.2% at 24 months, and at age 36 months (n=70) was 8%. The most significant finding was that at age 12 months, cows' milk consumption was negatively associated with iron status. Other variables also had an influence. At both 24 and 36 months the most significant predictor of iron status was earlier iron status.

Infants born to anaemic mothers or mothers who smoke and infants who consume cows' milk during infancy are at increased risk of developing anaemia. Breast milk is the ideal, but for the infant who is not breast fed an iron fortified formula should be used. Advice to mothers should focus on the importance of introducing nutrient dense complementary foods, such as meat, which contains readily absorbable iron.

The aim of the study was to examine the daily variations in sales data for individual food items in a supermarket and to assess the usefulness of the computerized sales data of supermarkets for reliable monitoring and evaluation of shopping behaviour.

Longitudinal observational study.

The study was carried out in one supermarket in Mikkeli, Finland. Seventy-nine packed food items from food groups important for salt and fat intake were monitored. In all food groups both ‘healthier’ and ‘reference’ products were included for assessment of both direct sales and proportional sales. The sales data were collected daily for 2 months in May and September 1996 by reading the European Article Numbering (EAN) codes of the packed foods.

The proportional sales turned out to be a more stable and useful measure than the direct sales data and the variation remained the same when the monitoring time was increased from 1 week to 1 month.

Proportional sales data are proposed as a tool for measuring the effect of nutrition interventions and also as a possible indirect assessment for population salt and fat intake.

To compare the effects on serum lipoproteins of three isocaloric diets with reduced total fat and saturated fatty acid (SFA) contents but with different proportions of monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA).

A low-fat diet (LF) provided 20 en% fat, 7.9% SFA, 7.8% MUFA, 3.0% PUFA; a high-PUFA diet (HP) 26 en% fat, 7.5% SFA, 8.2% MUFA, 8.1% PUFA; and a high-MUFA diet (HM) 26 en% fat, 7.3% SFA, 14.1% MUFA, 3.2% PUFA. Diets were consumed for 8 weeks in a parallel design, after 2 weeks on a habitual diet with 33–34 en% fat, 13–14% SFA, 12% MUFA, 6% PUFA, and followed by an 8-week period on habitual diet. Compliance to diet was monitored by repeated food records and weekly visits to a nutritionist.

45 free-living, middle-aged couples who were randomly allocated into the three diet groups; 43 men and 44 women completed the study.

During the diet periods, a small but significant reduction in body weight of 0.4–1.0kg was observed in all groups. Similar and significantreductions of mean weight-adjusted serum total cholesterol (4–8%), low-density lipoprotein (LDL) cholesterol (7–11%), and high-densitylipoprotein (HDL) cholesterol (8–11%) were observed during the diets. HDL2-cholesterol and apoprotein (apo) A-I levels were reduced whereas HDL3-cholesterol and apoA-II increased. ApoB was significantly decreased during the HM diet only. Serum triglycerides increased significantly during diets LF (25%, P< 0.01) and HP (19%, P< 0.05) but not during diet HM (5%, NS).

Reduction in the intake of total fat and saturated fatty acids reduced serum LDL-cholesterol and HDL2-cholesterol concentrations irrespective of the relative proportions of MUFA and PUFA in the diets. The results suggest that there might be some advantage in increasing the proportion of MUFA in low-fat diets, since the HM diet rich in MUFA reduced apoB and slightly attenuated the increase in serum triglycerides that is commonly associated with dietary fat reduction.

To estimate the incidence of Wernicke's encephalopathy (WE) and Korsakoffs psychosis (KP) before and after the introduction of thiamin enrichment of bread in Australia.

Inpatient records were examined in 17 major public general hospitals in greater Sydney for the 4 years 1993–96 (inclusive) with the International Classification of Diseases (ICD) 9 diagnoses 265.1 (WE), 291.1 and 294.0 (KP). Relevant clinical data were recorded on a specially designed form so that cases could be classified as confirmed or probable WE, confirmed or probable KP, confirmed or probable Wernicke–Korsakoff syndrome (WE + KP) or not WE or KP. The average number of cases of WE + KP was 38 acute (new) cases and 69 total (acute+chronic) cases per annum for all the hospitals combined.

This study used the same methods as our earlier retrospective examination of Wernicke–Korsakoff cases in essentially the same hospitals for 1978–93. Records for 1993 were thus pulled twice and, while individual cases (using hospital index number) did not always coincide, the total numbers for 1993 were 69 and 70.

For the 5 years after 1991 the number of acute cases of WE and KP in Sydney hospitals was 61% of the number for the 5 years before 1991 (P<0.01). There is, however, no continuing downward trend.

These results are consistent with a 40% reduction of the incidence of acute WE and KP since bread has been enriched with thiamin. The disease complex has, however, not been eliminated. To achieve this, further public health action would be needed, such as addition of thiamin to beer.

To develop and test a food frequency questionnaire (FFQ) for use in rural areas of Kerala, India.

Based on food use and market surveys of the study area, a quantitative 81-item interviewer-administered FFQ was developed. A validation study was conducted consisting of 24-h diet recalls (24HR) administered on 8 days randomly selected over an entire year and two administrations of the FFQ, one at the beginning of the l-year period and the other at the end. FFQ and 24HR-derived nutrient scores were compared using correlation and regression analyses and by examining differences in the nutrient scores.

Rural villages in Ernakulum district, Kerala, South India.

In each of 30 households, the male head of household and female food preparer were enrolled.

Pearson (parametric) correlation coefficients (rp) averaged about 0.50 in comparing nutrient scores derived from the 24HR with those from the first FFQ and about 0.55 in comparing the second FFQ. On average, Spearman correlation coefficients (rs) were slightly lower than the rp in comparing the scores derived from the first FFQ, but virtually identical for the second FFQ. Regression analyses indicated better agreement in the comparison of the 24HR-derived scores with the first FFQ than the second FFQ. Difference scores, however, tended to be larger in comparing the first FFQ scores with the 24HR.

This FFQ produces results broadly comparable to those used in Europe and North America, indicating its suitability for comparing exposures within a study population in reference to health-related endpoints.

To investigate the frequency and the determinants of under-reporting in a semi-quantitative food frequency questionnaire used in the Greek segment of the European Prospective Study on Nutrition, Cancer and Health (EPIC study).

A food frequency questionnaire was completed by 9262 adult men and women. The questions included in this questionnaire covered the average intake of approximately 150 food items and beverages over 1 year. Evaluation of under-reporting was conducted on an individual basis taking into account the expected daily variation of nutritional intakes during the time period of recording. Individuals whose energy intake was lower than 1.14*BMR (basal metabolic rate) were defined as under-reporters.

Urban and rural population of Greece.

The data indicated underestimation of energy intake by 11.8% of individuals enrolled. Results from a logistic regression model indicated that body mass index (BMI), gender, age and educational level were significant predictors of under-reporting. The proportion of overweight participants (BMI>30) who tend to under-report energy intake was more than twice that of normal-weight individuals. Men were significantly more prone to under-reporting compared to women, while low education individuals under-report more often than others. Exclusion of under-reporters generated, as expected, mean nutrient values that were significantly higher (by about 6%) than those derived from the total number of participants. When the nutrient values were energy-adjusted, however, or were expressed as percentages of energy intake for macronutrients or as nutrient densities for micronutrients, the emerging differences were minimal and generally statistically not significant.

Under-reporting does exist and it is more extensive among men, those with low education levels and the overweight participants. Adjustment for energy intake minimizes the bias generated by under-reporting with respect to particular nutrients and their association with various disease outcomes in the cohort.