The effectiveness of geographic targeting in nutrition programmes depends largely on the degree to which malnutrition clusters within particular areas. This study investigates the extent to which the childhood nutrition indicators, stunting (height-for-age Z-score <−2) and wasting (weight-for-height Z-score <−2), are spatially clustered; this information is used to determine the implications of spatial clustering for the effectiveness of geographic targeting.

Analysis of data from Demographic and Health Survey (DHS) results. Clustering is assessed by calculating intra-cluster correlation coefficients (ICCs). Estimating the proportion of malnourished children covered by a programme successfully targeting 10% of clusters with the highest malnutrition prevalences allows an assessment of the effectiveness of geographic targeting.

Fifty-eight DHS III (1992–1997) and DHS IV (1998–2001) reports from 46 developing countries.

Pre-school children of mothers interviewed by DHS.

Main results: The extent of clustering of nutritional status was surprisingly low (median ICC for national samples: stunting=0.054, wasting=0.032) and most countries were characterised by having an ICC <0.1 – i.e. low clustering – for childhood undernutrition (91% of countries for wasting and 78% for stunting). Our assessment of the effectiveness of geographic targeting showed that coverage was better for wasting than for stunting; for wasting, 23% of countries would achieve less than 20% coverage, compared with 76% of countries achieving less than 20% coverage for stunting. Coverage is dependent on the overall prevalence of malnutrition and the ICC.

Childhood nutritional status is determined at the household, or even individual, level; nutrition programmes that are geographically targeted may result in high levels of under-coverage and leakage, thereby compromising their cost-effectiveness; the lack of clustering questions the appropriateness of current nutrition interventions.

To compare trends in the consumption of key foods over 10 years in the most deprived and least deprived quarters in north Glasgow, Scotland as defined by the Carstairs deprivation index for their postcode of domicile.

Four random, cross-sectional, age- and gender-stratified population surveys carried out in 1986, 1989, 1992 and 1995. After assigning a deprivation score, food-frequency questionnaires from 2883 men and 3127 women were examined for compliance with dietary targets, examining trends by gender and within the most and least deprived quarters of the population.

North Glasgow, Scotland.

Over 600 men and 600 women (aged 25–64 years) in each of the four survey years who completed a lifestyle questionnaire including a food frequency section.

Increasing trends in the reported consumption of fruit and vegetables and oil-rich fish were observed over the 10-year period. However, the trend to increased fruit and vegetable consumption in the most deprived groups was not significant, and in 1995 only 8% of men and 12% of women in this group claimed consumption of these foods 4 or more times a day. In general, a higher percentage of those in the least deprived group met the targets for the key foods.

Trends to increasing consumption of fruit and vegetables and fish were in the right direction, but the targets for consumption of certain key foods were met by a minority of the population. The progress towards the target for fruit and vegetables showed widening social gradients with time.

As a means to prevent neural tube defects (NTDs), women planning pregnancy in Denmark are recommended to take a dietary supplement of 400 μg folic acid daily during the periconceptional period. We examined compliance with this recommendation in a national survey.

Cohort study on pregnant women in Denmark.

The Danish National Birth Cohort (DNBC).

From November 2000 to February 2002, 22 000 pregnant women were recruited for DNBC. Use of dietary supplements was recorded at enrolment. Compliance with the recommendation was related to an information campaign that took place during the second half of 2001, and to lifestyle factors provided in a telephone interview by the end of the first trimester of pregnancy.

An increase was seen in the proportion of women complying with the recommendation in the study period and this coincided with the information campaign events. However, even at the end of the period, only 22.3% of the women who had planned their pregnancy fully complied with the recommendation. No increase at all was seen in periconceptional folic acid use among women with unplanned pregnancies. Young age, low education and smoking were identified as factors that determined non-compliance.

Alternative and more effective strategies are needed if the Danish population is to benefit fully from the knowledge that folic acid prevents NTDs. Future strategies should not only target vulnerable groups, such as the less educated and the young, but also women who get pregnant without planning this. The only possible way to reach the last group may be through fortification of foods with folic acid.

In Turkey, the incidence of neural tube defects (NTDs) is 30.1 per 10 000 births. For this reason it seems an important problem for women of childbearing age. Adequate periconceptional consumption of folic acid could prevent NTDs. Most women are unaware of this recommendation. The objectives of this study were to evaluate women' knowledge and beliefs with regard to folic acid, and to estimate the consumption frequency of vitamin supplements periconceptionally and during the first trimester of pregnancy.

Eight hundred and eighteen married women who had delivered a live-born infant within the previous 12 months completed the questionnaire. Each subject participated in a 20-minute interview, with the questionnaire comprising multiple-choice statements. A random sample of 10 public health centres was drawn from 27 in three districts in Konya where about 50% of the population lives.

Only 22% of subjects had heard or read about folic acid. Thirteen per cent of women indicated knowledge of the direct link between folic acid supplementation and NTD prevention. The knowledge was greatest among 26- to 35-year-olds. Women with a university degree were more likely to have heard about folic acid than were less-educated women.

The results indicate that further government efforts are needed to inform the population and promote the optimal use of folic acid supplements and folate-enriched foods. It is the responsibility of national authorities to increase health education concerning folic acid and the prevention of NTDs in their countries.

To identify the prevalence of breast-feeding at discharge and the determinants of breast-feeding initiation amongst Aboriginal women.

A prospective cohort study using a self-administered baseline questionnaire and telephone-administered follow-up interviews.

Six hospitals with maternity wards in Perth, Western Australia.

Four hundred and twenty-five Aboriginal mothers of newborn infants.

At discharge, 89.4% of Aboriginal mothers were breast-feeding. Breast-feeding at discharge was most positively associated with perceived paternal support of breast-feeding, with an adjusted odds ratio (OR) of 6.65 (95% confidence interval (CI) 2.81–15.74), and with maternal age (OR 1.12, 95% CI 1.03–1.22), but negatively associated with parity and having delivered vaginally.

The factors independently associated with breast-feeding at discharge were similar to those previously identified for a group of non-Aboriginal Perth women, suggesting that separate breast-feeding interventions specially targeted at Aboriginal women are not warranted. The findings do, however, highlight the importance of including the father in the breast-feeding discussions.

Malnutrition in drug abusers has been attributed to poor diet. However, previous studies are conflicting. Many studies have not considered possible concurrent HIV disease. The purpose of this study was to determine the relationship between drug abuse and dietary intake in Hispanic Americans with and without HIV infection.

Dietary intake was measured using 3-day food records and 24-hour dietary recalls in three groups: HIV-positive drug abusers, HIV-negative drug abusers and HIV-positive persons who do not use drugs (‘non-drug abusers’).

The baseline data from a prospective cohort study of the role of drug abuse in HIV/AIDS weight loss and malnutrition conducted in Boston, Massachusetts, USA.

The first 284 participants to enrol in the study.

HIV-positive drug abusers had a body mass index (BMI) that was significantly lower than that of HIV-positive non-drug abusers. Reported energy, fat and fibre intakes did not differ between groups. All groups had median reported intakes of vitamin A, vitamin B6, vitamin B12, selenium and zinc that were in excess of the dietary reference values (DRI). Intakes of α-tocopherol were below the DRI, but did not differ from intakes of the general US population. However, increasing levels of drug abuse were associated with lower reported intakes of vitamin B6, vitamin B12, selenium and zinc.

Overall, this study does not support the notion that dietary intake can explain the lower BMI of HIV-positive drug abusers. Further studies examining non-dietary determinants of nutritional status in drug abusers are warranted.

This paper describes the development of the UK Women's Cohort Study and presents cohort baseline characteristics.

In total, 35 372 women, aged 35–69 years at recruitment, were selected to ensure a wide range of dietary intakes. Diet was assessed by a 217-item food-frequency questionnaire (FFQ). Detailed lifestyle information was collected by postal questionnaire. Vegetarians, fish-eaters and meat-eaters were compared.

The cohort women are mainly white, well-educated, middle-class and married with children. They are health-conscious with only 11% current smokers and 58% taking dietary supplements. Twenty-eight per cent of subjects self-report as being vegetarian and 1% as vegan. However, only 18% are defined as 'vegetarian' from the FFQ. Fat provides 32% of energy; vitamin and mineral intakes are high, with a broad range of intakes. Meat-eaters are older, with a higher body mass index (BMI) and the lowest intakes of carbohydrate, fibre, vitamin C, folate, iron and calcium. Other fish-eaters are similar to vegetarians. Vegetarians have the lowest intakes of protein, fat and saturated fat. Oily fish-eaters have the lowest BMI; are the least likely to smoke or use full-fat milk; and are the most likely to use dietary supplements and consume the most fruit and vegetables. Oily fish-eaters have the highest total energy intake and vegetarians the lowest. Semi-skimmed milk, bread, potatoes, wine, bananas and muesli are important contributors to energy for all groups.

A large cohort of middle-aged women has been created encompassing a wide range of different eating patterns, including diets currently of interest to research into protection against cancer and coronary heart disease. Participants will be followed up to study the effects of different food and nutrient intakes on long-term health outcomes.

To analyse the alcohol consumption behaviour of the German adult population, with a focus on the characteristics of persons drinking more than the tolerable upper alcohol intake level (TUAL) of 10–12 g day−1 for healthy adult women and 20–24 g day−1 for healthy adult men.

Design and setting: For the German National Health Interview and Examination Survey 1998, a representative sample of free-living adults was drawn. A total of 7124 participants were interviewed comprehensively about their sociodemographic background, lifestyle and eating habits including alcohol consumption.

A sub-sample of 4030 women and men, 18–79 years old, who were involved in the integrated German Nutrition Survey.

About 16% of women and 31% of men had mean alcohol consumption above the TUAL. Among other factors, the inclination to exceed the TUAL was related to middle-age, high socio-economic status, smoking and use of soft drugs. Among both women and men, a high proportion of persons drinking above the TUAL was observed among those consuming low amounts of soft drinks, fruit, poultry, milk products, bread and cake/biscuits. Women preferred to drink wine, whereas men preferred to drink beer.

Many Germans have an alcohol consumption level above the TUAL and thus are supposed to be at increased risk for alcohol-associated diseases.

To investigate associations between diet and non-dietary lifestyle factors and the onset of overactive bladder (OAB) in men.

Random sample of community-dwelling men aged 40 years plus.

Design and methods: Baseline data on urinary symptoms and diet were collected from 5454 men using a postal questionnaire and a food-frequency questionnaire. Follow-up data on urinary symptoms were collected from 4887 men in a postal survey one year later. Logistic regression analysis was used to investigate diet and lifestyle factors associated with onset of OAB in the men without OAB at baseline.

There was a highly significant negative association between beer intake at baseline and subsequent OAB onset (P = 0.001), with reduced risk at all levels of intake compared with those who seldom/never drank beer. Adjustment for total alcohol intake (g ethanol day−1) reduced the significance of the association (P = 0.02). None of the food groups studied was associated with OAB onset, with the possible exception of potatoes (P = 0.05), which showed an increased risk of onset at the highest level of consumption. Physical activity, smoking and obesity were not significantly associated.

While most diet and lifestyle factors were not associated with OAB onset, the evidence from this prospective longitudinal study suggests that beer may have a protective role in the development of OAB. This could be due to a non-alcoholic ingredient as well as the alcohol content.

The aim of this study was to validate the EAR cut-point method for assessing the prevalence of nutrient inadequacy at the population level.

Different methods for estimating the prevalence of inadequate intake were compared: the cut-off point method, with cut-off points at the Recommended Dietary Allowance (RDA), 0.66 RDA, 0.50 RDA and the Estimated Average Requirement (EAR); the probability approach; and a Monte Carlo simulation. In total, 591 men and 674 women, aged 20–55 years, were included in the analyses.

The prevalence of inadequate intake as estimated by the EAR cut-point method was similar to the prevalence of inadequacy estimated by both probabilistic methods. The cut-point method with RDA, 0.66 RDA and 0.50 RDA as cut-off limits induced an over- or an underestimation of the real prevalence of inadequacy.

Probabilistic methods consider both the intake variability and the requirement variability, and, as a result, their estimation should be closer to the real prevalence of inadequacy. The use of the EAR cut-point method yields a good estimation of the prevalence of inadequate intake, comparable to the probability approach, and limits over- and underestimation of the prevalence induced by other cut-off points.

To identify effects of revision of the Japanese food composition tables from the fourth version to the fifth version on nutrient intake estimation.

A database on 783 samples of 24-hour food duplicate portions was re-visited. Nutrients in the duplicate portions were estimated by use of the fourth and fifth versions of the Japanese food composition tables in parallel, together with supplemental use of other databases. The two sets of estimates were subjected to comparison.

The sample collection was conducted at 31 sites all over Japan.

The sample donors were 783 women aged 20–78 years.

Compared with the estimates by use of the fourth version of the tables, the estimates by the fifth version were substantially higher for intakes of energy, carbohydrate, dietary fibre, vitamin A and niacin, and lower for iron intake. The increase in carbohydrate intake estimates was more evident in older women than in young women, whereas the decrease in the intake estimation of iron and the increase in that of dietary fibre were more marked in young women than in older women.

The recent revision of food composition tables in Japan induced substantial changes in the estimation of nutrient intakes, i.e. an increase in energy, carbohydrate, dietary fibre, vitamin A and niacin, and a decrease in iron. The extent of the changes varied depending on age.

To evaluate the ratio of energy intake to basal metabolic rate (EI/BMR) among young female Japanese adults, and to compare the lifestyle and dietary characteristics between relatively low and high reporters.

Dietary intakes were assessed over a 1-month period with a validated, self-administered, diet history questionnaire, and lifestyle variables were assessed by a second questionnaire designed for this survey. The ratio of EI/BMR was calculated from reported energy intake and estimated basal metabolic rate.

In total, 1889 female Japanese university students aged 18–20 years who were enrolled in dietetics courses.

Ninety-five per cent of the subjects were classified into a non-obese group (body mass index (BMI) <25 kg m−2; mean±standard deviation (SD): 20.8±2.6 kg m−2). EI/BMR was 1.43±0.40 (mean±SD). Sixty-eight per cent of the subjects showed an EI/BMR level below the possibly balanced value of 1.56, 37% showed EI/BMR below the minimum survival value of 1.27 and 2% of the subjects showed EI/BMR exceeding the maximum value for a sustainable lifestyle of 2.4. BMI, body weight and BMR decreased significantly with the increase in EI/BMR (P<0.001). The percentage of energy from carbohydrate was significantly higher, whereas those from fat and protein were significantly lower, among the lower EI/BMR groups. As for food groups, a significantly declining trend from the lowest to the highest EI/BMR groups was observed for cereals.

Underreporting, rather than overreporting, of energy intake was predominant in this relatively lean Japanese female population. BMI was the most important factor affecting the reporting accuracy of energy intake.

To determine the relative quantities of two hepatotoxic pyrrolizidine alkaloids, symphytine and echimidine, in teas prepared from comfrey leaves (Symphytum officinale), and to determine the potential contribution of the N-oxide forms of these alkaloids to levels of the parent alkaloids.

Comfrey leaves were purchased from three commercial sources and used to prepare tea in a manner consistent with the methods used by consumers. An extraction scheme was devised for extraction of the alkaloids, and a gas chromatographic method was developed to quantify the two major alkaloids, symphytine and echimidine. Recognising that the N-oxide derivatives of these alkaloids have also been identified in comfrey preparations, chemical reduction was applied to determine the total quantities of the alkaloids as free bases and as N-oxide derivatives.

The concentration of symphytine and echimidine varied considerably between teas prepared from leaves purchased from the different vendors of plant material. Moreover, a much higher concentration of symphytine was found in the tea when steps were included to reduce N-oxides prior to analysis. The treatment of pure symphytine with hot water did not generate the N-oxide derivative de novo.

Since the pyrrolizidine alkaloids are known to be hepatotoxic, consumption of herbal teas made from comfrey leaves may be ill-advised. The concentration of pyrrolizidine alkaloids in such teas may be underestimated substantially unless the concentration of N-oxides is taken into consideration.

To evaluate dietary habits in Spanish children and adolescents based on a Mediterranean Diet Quality Index tool, which considers certain principles sustaining and challenging traditional healthy Mediterranean dietary patterns.

Observational population-based cross-sectional study. A 16-item Mediterranean Diet Quality Index was included in data gathered for the EnKid study (in which two 24-hour recalls, a quantitative 169-item food-frequency questionnaire and a general questionnaire about socio-economic, demographic and lifestyle items were administered).

Spain.

In total, 3850 children and youths aged 2–24 years residing in Spain.

Of the sample, 4.2% showed very low KIDMED index results, 49.4% had intermediate values and 46.4% had high index results. Important geographical differences were seen, with subjects from the Northeast showing the most favourable outcomes (52% with elevated scores vs. 37.5% of those from the North). Lower percentages of high diet quality were observed in low socio-economic groups, compared with middle and upper income cohorts (42.8%, 47.6% and 54.9%, respectively). Large cities had more positive results and only slight variations were seen for gender and age.

The KIDMED index, the first to evaluate the adequacy of Mediterranean dietary patterns in children and youth, confirms that this collective is undergoing important changes, which makes them a priority target for nutrition interventions. Results challenge certain commonly perceived notions tied to income level, population size and diet quality.

To assess, particularly in longitudinal studies, how close or far the food intakes of population groups are from a reference dietary pattern.

Computation of an index, called the Mediterranean Adequacy Index (MAI), by dividing the sum of the percentage of total energy from typical Mediterranean food groups by the sum of the percentage of total energy from non-typical Mediterranean food groups. The reference Italian–Mediterranean diet utilised was that of subjects from Nicotera in 1960.

Different areas in Italy.

Men aged 45–65 years at the start of the study from rural areas of Italy in the Seven Countries Study followed for 26 years (Crevalcore and Montegiorgio), elderly men and women from Perugia followed for 11 years, men and women from Pollica (Salerno) followed for 32 years, and families from Rofrano (Salerno) followed for 41 years.

The median value of MAI among 40–59-year-old men from Nicotera in 1960 was 7.2; in Crevalcore it was 2.9 in 1965 and 2.2 in 1991; and in Montegiorgio, 5.6 in 1965 and 3.9 in 1991. In Pollica, the values in men ranged from 5.6 to 6.3 in 1967 and from 2.4 to 4.5 in 1999; for women, the corresponding ranges were 4.2–7.2 and 2.7–4.1. In elderly men of Perugia, median MAI value was 4.9 in 1976 and 3.2 in 1987; for women, the corresponding values were 3.1 and 2.6.

The diet of these Italian population groups has changed over the last four decades, progressively abandoning the nutritional characteristics of the reference Italian–Mediterranean diet. The MAI proposed is simple to compute; it has satisfactory discriminating power particularly for longitudinal dietary data with only a few limitations.

To review the evidence that the traditional Mediterranean diet is associated with longevity.

Elderly persons of both genders in Greece, Spain, Denmark and Australia studied by different groups of investigators.

Adherence to the principles of the Mediterranean diet was operationalised through a score devised a priori, and study participants were followed up until death or the end of the study. Proportional hazard models were used.

Closer adherence to the Mediterranean diet was associated with a significant decrease in general mortality among the elderly persons studied.

The Mediterranean diet is positively associated with longevity among the elderly. If the assumption holds that there is no interaction between age and diet with respect to general mortality, it can be inferred that the traditional Mediterranean diet represents a healthy nutritional pattern.

To assess whether the Mediterranean diet contributes to overall mortality differences and trends between Mediterranean and non-Mediterranean European Union (EU) countries.

Routinely recorded adjusted overall mortality and food availability data in Mediterranean and non-Mediterranean EU countries. A Mediterranean diet score designed a priori was used as instrument.

Fifteen EU countries in the 1960s and the 1990s.

The general population in the 15 EU countries.

The difference between Mediterranean and non-Mediterranean EU countries in a 7-point Mediterranean diet score was reduced from 2.9 in the 1960s to 1.6 in the 1990s. This reduction may underlie the reduction in the difference in general mortality between these countries, from about 100 deaths per 100 000 person-years in the early 1970s to about 50 deaths per 100 000 person-years in the 1990s.

The decline in overall mortality in the 15 EU countries over the last 25 years is probably unrelated to diet. However, the gradual loss of the survival advantage of Mediterranean EU citizens, compared with other EU citizens, may be linked to the gradual abandonment by the former of their dietary traditions.