Previously recorded rates of obesity in the Baltic Republics have been among the highest in the world although little is known about how they vary within the population. This study investigates the distribution of body mass index (BMI) and obesity in these countries.

Three cross-sectional surveys conducted in the summer of 1997.

Estonia, Latvia and Lithuania.

Representative national samples of adults with measured weight and height (Estonia: n = 1154; Latvia: n = 2292; Lithuania: n = 2096).

Between-country differences are particularly large among women: women from Latvia and Lithuania are approximately three times as likely to be obese as those from Estonia (17.4%, 18.3%, 6.0% respectively); only about one-third of this difference is explained by the sociodemographic and behavioural factors studied. In men, the prevalence of obesity varied only slightly among countries (Estonia: 9.9%; Latvia: 9.5%; Lithuania: 11.4%). While the prevalence of obesity increases with age within each republic, particularly in women, it is not associated with nationality or urban/rural region, and no consistent association is observed with income. Obesity is inversely related to education in Latvia and in Lithuanian women. Latvian men and women and Lithuanian men who smoked had a lower prevalence of obesity than non-smokers. Leisure time physical activity was not associated with obesity.

Obesity is a major health problem in the Baltic Republics, particularly among Latvian and Lithuanian women. The lack of association between obesity and most demographic, socioeconomic and behavioural factors suggests that the problem is generalized. Health promotion strategies aiming at preventing and controlling excess weight gain in the Baltic Republics will need to target the general population.

To study the association between lifetime alcohol consumption and the risk of breast cancer.

A case–control study carried out in eastern Finland. Information about alcohol consumption was obtained by two methods: a self-administered food frequency questionnaire (FFQ) including alcohol consumption during the previous 12 months, and a lifetime alcohol consumption questionnaire (AQ) which was administered by the study nurse.

The study consisted of 301 breast cancer cases (25–75 years old) and 443 population controls.

The subjects reported higher current alcohol consumption in the AQ compared to the FFQ. According to the AQ, premenopausal cases consumed on average 28 g and controls 24 g alcohol week−1; in postmenopausal women the values were 15 and 14 g, respectively. About 30% of premenopausal and 60% of postmenopausal women were classified as non-drinkers. The correlation for current alcohol consumption between the FFQ and the AQ was 0.80 in premenopausal women but only 0.40 in postmenopausal women. Current alcohol consumption seemed to influence the reporting of total lifetime alcohol consumption. Current alcohol consumption was not associated with the risk of breast cancer either in premenopausal or postmenopausal women; neither were associations found between alcohol consumption at age of first use, use before the age of 30, or total lifetime alcohol consumption and the risk of breast cancer.

On average, one to three drinks per week did not increase the risk of breast cancer in this study. Consumption levels were, however, too low to exclude increased risk with high regular consumption. Further research is necessary on lifetime alcohol consumption.

To investigate the protective association between seasonality of consumption of fresh fruit or salad vegetables and cancer and cardiovascular disease (CVD) development.

Face-to-face interviews, including a food frequency questionnaire, were conducted on 1489 men and 1900 women, aged 35–75 years, who were respondents in the British Health and Lifestyle Survey 1984/85 (HALS1). CVD and cancer morbidity and mortality were determined from the 1991/92 British Health and Lifestyle Survey (HALS2) and by NHS Register ‘flagging’.

Risk was assessed by odds ratio (OR) for trend per frequency category. In men, frequent winter salad vegetable consumption was more closely protective than that in summer for cancer (winter OR = 0.79 [0.62–0.99], P = 0.045, summer OR = 0.83 [0.69–1.01], NS) and CVD (winter OR = 0.85 [0.72–1.00], P = 0.049, summer OR = 0.95 [0.82–1.10], NS). Fresh fruit consumption showed no significant protection. In women, frequent salad vegetable consumption at any season was significantly protective of CVD (winter OR = 0.76 [0.65–0.89], P < 0.001, summer OR = 0.76 [0.65–0.89], P < 0.001), although not of cancer. Frequent fresh fruit consumption in women was significantly protective of CVD (winter OR = 0.84 [0.74–0.94], P = 0.004, summer OR = 0.85 [0.74–0.97], P = 0.014) but not quite significant, and only in winter, for cancer (winter OR = 0.87 [0.76–1.00], P = 0.052, summer OR = 0.88 [0.75–1.02], P = 0.097). Maintenance of salad vegetable consumption from summer to winter, to within one frequency category, was associated with further protection for cancer in men (P = 0.050) and CVD in women (P = 0.024).

Diets high in fresh fruit and salad vegetables appear protective against cancer and CVD. It is important to take into account the seasonality of consumption in estimating and establishing significance of risk.

To develop and map indices to illustrate variation in the cost and availability of healthy food.

Two contiguous wards in London were selected by virtue of their high Carstairs deprivation scores. A 2-km area was defined around a randomly chosen central point. All retail outlets selling food within the area were visited and their location recorded. A list of foods, acceptable to the local ethnically diverse population, which met current dietary guidelines, was devised. Data on the availability and price of 71 food items were collected. Indices were developed using SPSS and mapped using Geographic Information System (GIS) software.

Information on availability and prices were collected from 199 outlets. The mean price index shows how expensive a shop is relative to other shops in the area. The least cost index shows the relative expense of a shop using the cheapest ways of buying their range of foods. Shorthand indices were tested, using data on 19 of the 71 prices. Availability indices are also discussed, including a green availability index and a fresh green availability index. Illustrative maps of the shop locations and the mean price index and fresh green availability index are shown.

Data can be collected and indices developed which indicate geographic variation in shop ‘expensiveness’, and in the price and availability of healthy food. GIS software can be used to map these indices, to identify areas with high food prices or low availability.

To assess the relative importance of socioeconomic and maternal/prenatal determinants of the nutritional situation of children < 6 years old in an urban African area after several years of economic crisis.

Cross-sectional cluster sample survey.

Brazzaville, capital city of the Congo.

Information on socioeconomic characteristics was gathered from a random sample of 1368 households by house visits and anthropometric measurements were performed using standardized procedures on preschool children (n=2373) and their mothers (n=1512).

The influence of socioeconomic factors on the nutritional status of children, taking into account adjustment variables such as mother's age and child's age and sex was assessed. For stunting, as well as for the mean height-for-age index among children, the main determinants were economic level of the household (P=0.048 and P=0.004, respectively), schooling of the mother (P=0.004 and P < 10−3) and living in the peripheral district (P=0.005 and P < 10−3). The influence of socioeconomic determinants on weight-for-age and wasting was less straightforward. When adjusting, in addition, for maternal and prenatal factors (mother's height and body mass index (BMI) and birth weight), most of the effects of the socioeconomic determinants on the nutritional status of children persisted somewhat, but the effect of the economic level on the stunting became not significant (P=0.11). The mean BMI of mothers appeared to be related to the economic level of the household (P < 10−4), to the marital status (P=0.01) and to the occupation of the mother (P < 10−4).

Among the socioeconomic determinants of malnutrition in children, some, such as economic level of the household or schooling of the mother, seem to act mainly through prenatal factors, whereas others, mainly dwelling district characteristics, seem to influence more directly the children's nutritional status.

This paper examines socioeconomic, demographic, epidemiological and nutrition changes that have occurred in Chile in the last decades using concepts of epidemiological and nutrition transition, and discusses policies related to nutrition.

This is a descriptive, population-based study to analyse changes in the Chilean diet and nutrition situation including some of the main demographic, socioeconomic and epidemiological variables. Data came from the FAO, the National Institute of Statistics, the Ministry of Health and national surveys.

In Chile, the epidemiological and nutrition situation shifted from a pretransition stage with high rates of undernutrition to a post-transition stage with increasing rates of obesity in all groups aged less than 20 years. However, changes were not accompanied by modifications in nutrition policy, which had been successful in reducing undernutrition. Despite changes in diet to a ‘western’ diet and in nutritional status of the population from undernutrition to obesity, food and nutrition programmes have been maintained unaltered. Governmental and university organizations were created in 1994 and 1995 to address the current food and nutrition problems. The accomplishments of these institutions have been the elaboration of dietary guidelines, reformulating the food and nutrition programmes and the promulgation of the Food Sanitary Regulations for Chile.

Education for the prevention of nutrition excess problems should be a main food and nutrition policy in developing countries.

To examine the relationship between sociodemographic factors (sex, age, education, occupation and region of birth) and absolute levels of energy, fat and fibre intake in adults at the national level.

The 1983 National Dietary Survey of Adults (NDSA), covering six Australian capital cities, collected food and nutrient intake data using the 24-hour recall method, from subjects aged 25–64 years (n = 6255).

Interactions of variables occurred, especially for males. The greatest effect on male intake of all three dietary components was a combination of age and education. For females, the main explanatory variable for fat and energy intake was age, but that for fibre was a combination of region of birth and education. Both education (alone or in combination) and region of birth (alone or in combination) had a greater effect than occupation (alone or in combination).

Energy, fat and fibre intakes vary considerably between sociodemographic groups. Such variability must be taken into account in formulating policy and planning decisions and in assessing temporal change.

Objective: The purpose of this study was to analyse the associations between the food variety score (FVS), dietary diversity score (DDS) and nutritional status of children, and to assess the associations between FVS, DDS and socioeconomic status (SES) on a household level. The study also assessed urban and rural differences in FVS and DDS.

Design: Cross-sectional studies in 1994/95, including a simplified food frequency questionnaire on food items used in the household the previous day. A socioeconomic score was generated, based on possessions in the households. Weight and height were measured for all children aged 6–59 months in the households, and anthropometric indices were generated.

Subjects and setting: Three hundred and twenty-nine urban and 488 rural households with 526 urban and 1789 rural children aged 6–59 months in Koutiala County, Sikasso Region, Mali.

Results: Children from urban households with a low FVS or DDS had a doubled risk (OR>2) for being stunted and underweight. Those relations were not found in the rural area. There was an association between SES and both FVS and DDS on the household level in both areas. The FVS and DDS in urban households with the lowest SES were higher than the FVS and DDS among the rural households with the highest SES.

Conclusions: Food variety and dietary diversity seem to be associated with nutritional status (weight/age and height/age) of children in heterogeneous communities, as our data from urban areas showed. In rural areas, however, this association could not be shown. Socioeconomic factors seem to be important determinants for FVS and DDS both in urban and rural areas. FVS and DDS are useful variables in assessing the nutritional situation of households, particular in urban areas.

Stature is a powerful indicator of poor nutrition early in life in nations where undernutrition is a public health problem. Hypertension in adults has been associated with factors present early in life such as low birth weight. We tested the hypothesis that short stature is associated with hypertension among adults.

A household survey of representative adults in Rio de Janeiro city, Brazil was carried out in 1996.

Blood pressure and anthropometric measures were collected from 2802 adults in their own households. Prevalence estimates and modelling incorporated the sample design and weights.

Age-adjusted prevalence of hypertension for both sexes was lower in the third quartile of stature distribution. In women, but not in men, the odds ratio comparing the first quartile of stature with the fourth quartile was statistically significant with an odds ratio of 1.68 (95% CI 1.02–2.76). Adjusting for known risk factors for hypertension such as age, income, smoking, sodium and alcohol intake and race, the association among women, comparing the first with the fourth quartile for stature, was 1.84 (95% CI 1.03–3.30). With further adjustment for residual of weight on height the ratio reduced to 1.76 (95% CI 0.97–3.19, P value of trend = 0.03). Systolic blood pressure showed a U-shaped association with quartiles of stature, mainly among women, with a β-coefficient significantly lower at the third quartile.

This association of stature with hypertension supports the theory of an important ontogenetic dependence of adult blood pressure, at least among women.

To explore the relationships between biochemical indicators of vitamin A and iron status and the intestinal helminths Ascaris lumbricoides and hookworm in primary school children.

Two rural governmental schools in northwestern Bangladesh.

Cross-sectional study.

The sample consisted of 164 children in grades 3–5.

Serum retinol and β-carotene (by high-performance liquid chromatography, HPLC), haemoglobin (HemoCue), ferritin (enzyme-linked immunoadsorbent assay, ELIZA) and height and weight were measured. Dietary intake of vitamin A was assessed using a food frequency questionnaire and faecal analyses were done using Stoll's egg-count technique.

The mean serum retinol was 26.8 μg dl−1 and 20% had a level of <20 μg dl−1, the cut-off value for low vitamin A status. There was a strong positive association between serum β-carotene and serum retinol (r = 0.44, P <0.001), suggesting those with higher retinol levels had a higher carotene intake. Thirty-one per cent were anaemic (Hb <11.5 g dl−1), 30% had iron deficiency (serum ferritin <12.0 μg l−1) and 14% were suffering from iron deficiency anaemia. Children with a serum retinol level of 20 μg dl−1 had significantly lower ferritin (14.0 compared to 26.0 μg l−1, P = 0.005) and Hb levels (11.7 compared to 12.4 g dl−1, P = 0.005) than those with higher levels. The proportion of iron deficiency anaemia was significantly greater among children with hookworm. Our data suggest that hookworm exerts its impact on iron status independently of the vitamin A status of the host.

Programmes to improve iron status should consider including both vitamin A prevention programmes and deworming.

To review and discuss the effect of n-3 polyunsaturated fatty acids (PUFA) from fish in the prevention and, primarily, in the treatment of coronary artery disease (CAD).

Overview of the literature.

Denmark.

There is good evidence that fish consumption may reduce the risk of CAD.

Fish can be recommended to reduce the risk of CAD both in healthy subjects and in patients with a high risk of CAD or with documented CAD. The use of fish oil concentrates can not be recommended in general, but may be considered in patients after a myocardial infarction or in patients with hypertriglyceridaemia. An increased intake of n-3 polyunsaturated fatty acids from fish may have substantial implications for public health and health economy by decreasing the risk of coronary events and sudden cardiac death.

We quantified the public health benefit of fruits and vegetables on the prevention of cancer and cardiovascular disease (CVD), using currently available human data.

We reviewed over 250 observational studies on cancer and CVD. Relative risks (RRs) for high versus low intake of fruits and vegetables were obtained. The preventable proportion of chronic diseases, i.e. the per cent of cases attributable to low consumption of fruits and vegetables, was estimated using three scenarios: best guess, optimistic (using stronger RRs) and conservative (using weaker RRs and eliminating the contribution of smoking and/or drinking). The preventable proportion was calculated for increasing average intake from the current 250 g day−1 to the recommended 400 g day among the general Dutch population.

It is estimated that in the Netherlands cancer incidence could be reduced by 19% (12 000 cases annually, best guess), ranging from 6% (conservative) to 28% (optimistic). Cardiovascular deaths could be reduced by 16% (8000 deaths annually, best guess), ranging from 6% to 22%. Evidence is most abundant for gastrointestinal cancers, followed by hormone-related cancers, but limited for other sites and CVD.

Increasing consumption of fruits and vegetables carries a large public health potential. Population trials and biological mechanisms should eventually provide scientific proof of their efficacy. The available evidence is sufficient to justify public health education and promotion aimed at a substantial increase in the consumption of fruits and vegetables.