Nutrition-related disorders, including vitamin A deficiency (VAD) and chronic diseases, are serious problems in the Federated States of Micronesia (FSM). Many suggest that these disorders are new problems related to dietary and lifestyle changes. In the past four decades, imported foods, such as white rice, flour, sugar, refined foods and fatty meats, have increasingly replaced local foods in the diet.

A literature review was conducted to understand underlying issues related to dietary change and obtain insights for nutrition research and interventions.

Published and unpublished papers from different disciplines were reviewed and collated for information on food and nutrition in FSM. Topics covered were historical background, local foods, infant and child feeding, dietary assessment, and nutritional status. Particular focus was on information and data relating to VAD, the primary topic that led to the review of the literature.

FSM, a tropical country of abundant agricultural resources, has suffered a great loss in production and consumption of local foods. Inconsistent external and internal government policies and food aid programmes have contributed to the problem. Further research on the nutrient content of local foods and factors affecting production, acquisition and consumption is needed, as well as a broad, well-planned, intersectoral intervention aimed at dietary improvement for all age groups in the population.

The Bangladesh Integrated Nutrition Programme (BINP) experimented with two models of delivery: the first model uses the Government of Bangladesh's (GOB) own management structure and the second uses the non-government organisations (NGOs) working in the local community. This study compares the relative efficiency of GOB and NGO management in the provision of nutrition services.

A detailed costing survey was carried out to estimate the cost of delivering nutrition services from the Community Nutrition Centres (CNCs). The number of individuals enrolled, the number actually participating in the programme and person-days of service delivered were used as effectiveness measures.

Thirty-five CNCs were randomly selected from five BINP areas, of which 21 were in GOB-run areas and 14 in NGO-run areas.

The cost of providing nutrition services per enrolee was US$ 24.43 for GOB-run CNCs and US$ 29.78 for NGO-run CNCs.

Contrary to the widely held view, the analysis implies that the NGO facilities are not more efficient in the delivery of nutrition services when cost per person-days of service delivered is considered. The food cost component of BINP is so high that, irrespective of the delivery mode, policy makers should examine carefully the components of BINP in order to find the most cost-effective mix of services.

There is strong evidence that a high consumption of fruit and vegetables reduces the risk of developing many cancers. This study examined the economic consequences for the healthcare sector if people followed the recommendations and increased their intake of fruit and vegetables.

A life table was used to describe a base case population with respect to life expectancy, cancer incidence and healthcare costs. Relative risks of cancer for a high versus a low intake of fruit and vegetables were obtained from the literature and were used to simulate populations with a higher intake of fruit and vegetables. The empirical data consist of a 20% sample of the Danish population that was followed from 1993 to 1997. Civil registration numbers were used to link various computerised registers, in order to describe each individual in the sample in terms of morbidity, mortality and healthcare costs.

The average daily intake of fruit and vegetables was assumed to be approximately 250g for the general Danish population. Simulated intakes of 400g and 500g increased the life expectancy by 0.8 and 1.3 years, respectively. In addition, it was estimated that 19% and 32% of the cancer incidence could be prevented. The aggregate healthcare costs remained stable, as the resources saved due to a lower cancer incidence were offset by healthcare costs imposed by the fact that healthy people live longer and require more healthcare. However, the variations across age groups and health sectors were substantial.

The study adopted a healthcare sector perspective. Only costs from hospitalisation and primary care were included in the calculations. The costs of changing people's dietary habits, i.e. education, information and promotion as well as other costs that would be relevant from a societal perspective, have not been taken into account. Furthermore, the transition from one level of intake to another is not the focus of the analysis, although it might take decades to observe the full effect of the dietary changes.

Empirical evidence suggests that a considerable fraction of all cancer incidences can be prevented by a higher intake of fruit and vegetables. That may result in improved public health (gain in life years) at no additional cost to the healthcare sector.

To describe the calculations and approaches used to design experimental diets of differing saturated fatty acid (SFA) and monounsaturated fatty acid (MUFA) compositions for use in a long-term dietary intervention study, and to evaluate the degree to which the dietary targets were met.

Fifty-one students living in a university hall of residence consumed a reference (SFA) diet for 8 weeks followed by either a moderate MUFA (MM) diet or a high MUFA (HM) diet for 16 weeks. The three diets were designed to differ only in their proportions of SFA and MUFA, while keeping total fat, polyunsaturated fatty acids (PUFA), trans-fatty acids, and the ratio of palmitic to stearic acid, and n – 6 to n – 3 PUFA, unchanged.

Using habitual diet records and a standardised database for food fatty acid compositions, a sequential process of theoretical fat substitutions enabled suitable fat sources for use in the three diets to be identified, and experimental margarines for baking, spreading and the manufacture of snack foods to be designed. The dietary intervention was largely successful in achieving the fatty acid targets of the three diets, although unintended differences between the original target and the analysed fatty acid composition of the experimental margarines resulted in a lower than anticipated MUFA intake on the HM diet, and a lower ratio of palmitic to stearic acid compared with the reference or MM diet.

This study has revealed important theoretical considerations that should be taken into account when designing diets of specific fatty acid composition, as well as practical issues of implementation.

This study aimed to determine the accuracy with which children aged 5 to 7 years were able to report the food eaten at a school lunch.

Two hundred and three children (103 boys, 100 girls) aged 5–7 years were recruited from three primary schools in Oxford.

Trained investigators made observational records of the school dinner and packed lunch intakes of four or five children per session. Children were interviewed within two hours of finishing the lunchtime meal and asked to provide a free recall of their meal. When the child had completed the recall, non-directive prompts were used to assess if the child was able to remember anything else. Foods recalled were classified as matches (recalled food agreed with observation), omissions (failed to report a food observed) or phantoms (recalled food was not observed).

The percentage of accurate recall was significantly higher (P<0.01) in children eating packed lunch (mean 70±29%) than in children consuming school dinners (mean 58±27%). This difference may have been due to increased familiarity of foods in packed lunches. Leftovers were not readily reported in this age group. Prompts and cues enhanced recall by all children.

This study indicated that there was a wide range in the ability of children aged 5–7 years to recall intake from a packed lunch and/or school dinner. This dietary assessment method is unlikely to be suitable at an individual level. Investigators using dietary recall to estimate food intake in children aged 5–7 years need to be aware of the limitations of this method.

We investigated behavioural and socio-economic factors associated with obesity and weight dissatisfaction among Finnish adolescents.

A total of 60252 Finnish adolescents aged 14 to 16 years filled in a questionnaire about their health, health behaviour and socio-economic background. Food choices were obtained by using a short food-frequency questionnaire. Obesity was defined as a weight at least 120% of the sex- and height-specific mean weight for subjects.

Of girls and boys, 54% and 66%, respectively, were satisfied with their weight. Among dissatisfied normal-weight adolescents, 81% of girls but only 48% of boys thought they were overweight. Of obese boys, 25% were satisfied with their weight. For both genders, obesity and weight dissatisfaction were associated with economic problems in the family. In girls, an association was also found with poor school performance, low educational level of parents and not having evening meals at home; and in boys, with physical inactivity and not eating school lunch. Smoking was more common among girls who were dissatisfied with their weight. Differences in food choices were small between different weight and weight satisfaction categories.

Having normal weight and being satisfied with that weight are favourable for an adolescent. Obesity and weight dissatisfaction are associated mostly with disadvantageous health behaviours and low socio-economic status. Health behaviour seems to be associated more with weight satisfaction than with actual weight.

To measure the effect of a school fruit and vegetable subscription on children's intake of fruit and vegetables after 5 weeks of intervention.

Seven primary schools in Denmark.

Design and methods: Intervention schools (n = 4) were offered a fruit and vegetable subscription comprising one piece per day. Control schools (n = 3) situated in another municipality were not offered the subscription. Intake of fruit and vegetables was measured at baseline and 5 weeks after the start of the subscription. Two methods were used for dietary assessment: a pre-coded 24-hour recall form including total food intake and a food-frequency questionnaire (FFQ) including only fruit and vegetables.

Children aged 6–10 years (n = 804 from intervention schools and n = 689 from control schools). Response rate in the dietary assessment was 31%.

At intervention schools 45% of the children enrolled in the subscription. After 5 weeks of intervention, both subscribers and non-subscribers had increased their intake of fruit by 0.4 (P = 0.019) and 0.3 (P = 0.008) pieces per school day, respectively, but no change was observed in vegetable intake. Total intake increased only for non-subscribers by 0.4 piece/school day (P = 0.008), mainly due to the consistent increase in fruit intake. No change in intake was measured at control schools. Only the 24-hour recall questionnaire was sensitive enough to pick up the changes of the subscription, whereas the FFQ was not.

Five weeks with the subscription affected both subscribers and non-subscribers to increase intake of fruit. This may indicate that the subscription had an additional effect of stimulating parents of non-subscribers to supply their children with fruit. The results stress the importance of evaluating the effect of this type of programme, and the carefulness needed in designing the evaluation study.

To elucidate status and trends in portion size of foods rich in fat and/or added sugars during the past decades, and to bring portion size into perspective in its role in obesity and dietary guidelines in Denmark.

Information about portion sizes of low-fat and full-fat food items was obtained from a 4-day weighed food record (Study 1). Trends in portion sizes of commercial foods were examined by gathering information from major food manufacturers and fast food chains (Study 2). Data on intakes and sales of sugar-sweetened soft drinks and confectionery were obtained through nation-wide dietary surveys and official sales statistics (Study 3).

Study 1: Subjects ate and drank significantly more when they chose low-fat food and meal items (milk used as a drink, sauce and sliced cold meat), compared with their counterparts who chose food and meal items with a higher fat content. As a result, almost the same amounts of energy and fat were consumed both ways, with the exception of sliced cold meat (energy and fat) and milk (fat). Study 2: Portion sizes of commercial energy-dense foods and beverages, and fast food meals rich in fat and/or added sugars, seem to have increased over time, and in particular in the last 10 years. Study 3: The development in portion sizes of commercial foods has been paralleled by a sharp increase of more than 50% in the sales of sugar-sweetened soft drinks and confectionery like sweets, chocolate and ice creams since the 1970s.

Larger portion sizes of foods low in fat and commercial energy-dense foods and beverages could be important factors in maintaining a high energy intake, causing over-consumption and enhancing the prevalence of obesity in the population. In light of this development, portion size ought to take central place in dietary guidelines and public campaigns.

To identify consumer attitudes and beliefs about (liquid) milk that may be barriers to consumption.

Two random-quota telephone surveys conducted in Auckland one year apart. Respondents were questioned about their usual milk intake and their attitudes to milk. The questionnaire included attitude items that reflected the main themes of consumer interest in milk.

New Zealand.

Seven hundred and thirteen respondents in the baseline survey and a separate sample of 719 respondents in the follow-up survey.

At least one-third of the respondents consumed less than a glass (250ml) of milk a day. Non-consumption was highest in young women (15%). People's concerns about milk related to what was important in their lives; what threatens them physically and emotionally. Women held more positive attitudes but they were concerned about the fat content of milk. Men were less aware of milk's nutritional benefits and as a result were less appreciative of its value.

There is an opportunity to develop public health initiatives to address the barriers to drinking milk. Industry–health alliances may be an effective means to provide positive nutrition messages about milk and to engage the support of health professionals.

For proper interpretation of results from epidemiological studies that use food-frequency questionnaires (FFQs), it is necessary to know the relationship between reported intakes from the FFQ and true usual intake. In this paper, we report a calibration study conducted to investigate the performance of the FFQ used in a cohort study, the Canadian Study of Diet, Lifestyle and Health.

Over a 1-year period, 151 men and 159 women completed a full set of questionnaires including a self-administered baseline FFQ, three 24-hour diet recalls administered by telephone, and a second FFQ self-administered subsequently. The association between the nutrient estimates derived from the FFQs and the diet recalls was evaluated by calculating deattenuated Pearson's correlation coefficients.

The FFQs estimated mean daily nutrient intakes higher than the diet recalls. When the log-transformed and energy-adjusted nutrient intakes from the average of three 24-hour recalls were compared against the baseline FFQ, the following deattenuated correlations were obtained in men and women, respectively: total energy 0.44 and 0.32, total fat 0.64 and 0.68, saturated fat 0.68 and 0.70, dietary fibre 0.65 and 0.44, vitamin E 0.32 and 0.37, vitamin C 0.40 and 0.37, β-carotene 0.34 and 0.29, alcohol 0.74 and 0.67, caffeine 0.81 and 0.76, with a median correlation of 0.49 and 0.53. Correlations between the second FFQ and diet recalls were similar. The correlations between the two FFQs as a test of reliability had a median value 0.64 for men and 0.63 for women for selected nutrients.

The study suggests that the FFQ method gives acceptable levels of nutrients or food component estimates, as assessed by this calibration study against diet recalls, when limited to energy-adjusted and deattenuated values.

An extensive dataset on individual food consumption was analysed in order to study all pairwise correlations between the consumption rates of 11 major food groups. Additionally, the project aimed to examine and quantify the accuracy of a recently proposed estimator of total food consumption to be used for the estimation of radiation exposure by food. Such an inquiry seems justified, because the proposed estimator implicitly presumes an essentially positive correlation structure in food consumption rates.

Statistical analysis using representative data gathered in Germany in a nation-wide food consumption survey.

Germany.

Individuals aged between 4 and 94 years namely 10901 males and 12308 females.

The consumption rates of 11 major food categories showed several significantly positive, but also a number of significantly negative, correlations. Negative associations between cereal and potato products persisted consistently over all age groups, independent of sex. Other significantly negative correlations were limited to certain age groups. Reflecting these negative correlations, a subsequent analysis of relative ranks of consumption revealed that no person in the sample had the highest consumption rates in all food groups simultaneously. Based on representative samples, overestimations of 34 to 53% were obtained if – as recently suggested in the context of radiation exposure prediction – the 95th percentiles of total food consumption were determined as sums of the corresponding percentiles of the food groups.

The complex correlation structure of food group consumption rates, as identified in this study, bears important implications for various health-related issues. Ignoring them could lead to overly conservative estimations of radiation exposure due to food ingestion or to confounding effects in epidemiological studies on nutritional risk factors of diseases. The results also indicate that a distinction into different dietary patterns might be useful in characterising different consumption habits.

Pregnancy is accompanied by profound alterations in thyroid economy and relative iodine deficiency. The aim of this study was to evaluate urinary iodine excretion of pregnant women in cities with adequate and more than adequate iodine intake.

A cross-sectional study was performed on schoolchildren and pregnant women in four cities in the Islamic Republic of Iran. Urinary iodine excretion was measured for 438 schoolchildren and 403 pregnant women. In addition, in Isfahan City, thyroid volume was measured by sonography for 30 pregnant women in each trimester of pregnancy and for 90 non-pregnant women who also had urinary iodine measurement.

Median urinary iodine of schoolchildren was 31.2, 25.0, 20.2 and 19.3 μg/dl in Rasht, Isfahan, Ilam and Tehran, respectively. Corresponding values for pregnant women were 33.8, 21.2, 19.0 and 18.6μg/dl. The percentage of pregnant women with urinary iodine below 20μg/dl was 16, 45, 55 and 54, and below 10μg/dl was 1, 7, 7 and 13, in Rasht, Isfahan, Ilam and Tehran, respectively. In Isfahan, urinary iodine was significantly decreased in the third trimester of pregnancy, compared with controls. Mean thyroid volume was 7.8±3.1 ml and 7.8±2.8 ml in pregnant and non-pregnant women, respectively.

Recommended values for dietary iodine through universal salt iodisation may not be adequate for pregnant women, and the specific problem of iodine and pregnancy should be considered further in the light of the latest recommendations.

The purpose of this overview is to synthesise and summarise the findings and recommendations of all 14 projects funded between 1997 and 2002 under Phase 2 of the Department of Health's Policy Research Programme Nutrition Initiative. This is aimed at end users, including policy makers, practitioners, researchers and research funding bodies.

The main findings and recommendations for policy and practice, as well as for future research, contained in the peer-reviewed final report of each project are summarised under headings identified as being useful for policy groups and practitioners: Maintenance of a healthy weight; Functional outcomes related to different markers of iron status; Nutritional aspects of bone health in humans; and Dietary interventions.

The overview draws together the key findings and recommendations for current and future policy and practice from the second phase of the research programme and identifies research gaps.

The findings and recommendations of the Department of Health's Nutrition Research Initiative have contributed to the scientific evidence base for policy development, policy evaluation, and will inform practitioners as well as researchers and research funding bodies.