To explore socio-economic factors associated with rising rates of overweight among Vietnamese adults.

The study was based on three national surveys of socio-economic factors and health conducted over a 10-year period. The studies were: the Vietnamese Living Standard Survey 1992–1993 (11 982 participants); the Vietnamese Living Standard Survey 1997–1998 (15 975 participants); and the Vietnamese National Health Survey 2001–2002 (94 656 participants).

Male and female adults >18 years old were stratified by gender, age group, area of residence, occupation, education and relative food expenditures. Overweight was defined using body mass index (BMI) ≥ 25 kg m− 2.

Overweight rates in Vietnam more than doubled between 1992 and 2002 (from 2.0 to 5.7%). Significant increases were observed for men and women, in urban and rural areas, and for all age groups. In univariate analyses, both age and higher socio-economic status were associated with higher rates of overweight. Using the most recent survey, urban populations were more likely to be overweight than rural ones (odds ratio (OR) = 1.79), white-collar workers were more likely to be overweight than manual labourers (OR = 1.95) and persons in the top level of food expenditures were more likely to be overweight than persons in the bottom level (OR = 4.96) after adjustment for other factors. Education was inversely associated with overweight after adjusting for covariates.

Economic growth and improved standard of living are associated with higher rates of overweight in nations in early stages of economic development. In Vietnam, higher rates of overweight were observed among the higher income and occupation groups.

To determine the relationship of diet to overweight and obesity among populations of African origin.

Cross-sectional data were obtained from adults aged 25–74 years in rural Cameroon (n = 686), urban Cameroon (n = 975), Jamaica (n = 924) and Afro-Caribbeans in the UK (n = 257). Dietary data were collected using food-frequency questionnaires specifically designed for each site. Body mass index (BMI) was used as a measure of overweight.

The expected gradient in the distribution of overweight across sites was seen in females (rural Cameroon, 9.5%; urban Cameroon, 47.1%; Jamaica, 63.8%; UK, 71.6%); however, among males overweight was less prevalent in Jamaica (22.0%) than urban Cameroon (36.3%). In developing countries increased risks of overweight (BMI ≥ 25 kg m− 2) were influenced by higher energy (urban Cameroonian men) and protein (Jamaican women) intakes. No dietary variables were associated with obesity (BMI ≥ 30 kg m− 2) in Cameroon or Jamaica. In the UK, energy intakes were inversely related with overweight whereas increased risks of being overweight were associated with higher protein (men) and fat (women) intakes. Similarly, whereas higher protein and fat intakes in UK men and women were associated with obesity, carbohydrate intakes were associated with decreased risks of obesity in men.

Diet and overweight were associated in the UK but few dietary variables were related to overweight in Jamaica and the Cameroon. These findings suggest that associations between diet and overweight/obesity are not generalisable among populations.

To assess the impact of urbanisation on the prevalence of the metabolic syndrome in Chinese adults.

As part of a community-based cross-sectional survey conducted in 2002, a sample from rural and urban populations in East China was obtained. The metabolic syndrome is defined by the National Cholesterol Education Program Adult Treatment Panel III criteria (ATP III) and the modified ATP III, which recommended a lower waist circumference cut-off for Asians.

Field sites in Jiangxi and Anhui provinces and the Jing'an District of Shanghai, China.

A total of 529 non-pregnant, non-lactating urban and rural adults, aged 20–64 years without diagnosed diabetes.

Dwelling in urban areas was associated with higher dietary fat intake and slightly lower total energy intake, and with significantly lower occupational physical activity. Using the ATP III criteria, the prevalence of the metabolic syndrome was significantly higher for urban than rural men (12.7 vs. 1.7%, P < 0.001), and was similar between urban and rural women (10.1 vs. 9.7%, P = 0.17). These urban–rural differences were greatly enhanced when the modified ATP III criteria for the syndrome were used, for men (34.3 vs. 2.7%, P < 0.01) and women (24.1 vs. 11.4%, P = 0.07). The Asian waist circumference cut-offs (90 and 80 cm for men and women, respectively) had a better combination of sensitivity and specificity in identifying other metabolic disorders, which included high glucose, high blood pressure, high triglycerides and low high-density lipoprotein cholesterol, for this population.

For the Chinese population, urban dwelling was associated with higher prevalence of the metabolic syndrome, especially in men.

To compare the prevalence of overweight and obesity among adolescents using international and ethnic-specific cut-off points and to examine patterns of physical activity and dietary behaviours.

Cross-sectional analytical study.

Schools on Tongatapu, Vava'u and Hapa'ai islands in the Kingdom of Tonga.

A total of 443 school students aged 11–16 years underwent anthropometric measures of height and weight and provided self-reported measures of physical activity and dietary behaviours.

Mean body mass index (BMI) was higher among girls than boys (23.7 kg m− 2 vs. 21.8 kg m− 2) and tended to increase with age. A total of 36.0% of boys and 53.8% of girls were overweight or obese using the international cut-off points, whereas 25.0% of boys and 37.6% of girls were classified in this way using Polynesian-specific cut-off points. Tinned mutton or beef was the food that most participants (56.9%) reported eating once or more per day. Over half of the young people did not eat taro, fruit or vegetables at least once per day. Regular physical activity outside of school hours was reported by 20.7% of respondents, and 58.2% watched 1 h or more of television per day. Physical activity participation was the only behaviour independently associated with a lower risk of overweight or obesity.

Using Polynesian-specific cut-off points for overweight and obesity the prevalence of these conditions was still among the highest found in adolescents. The prevalence of physical inactivity and poor dietary habits indicate that risk factors for chronic disease are well established during adolescence in Tonga.

Cross-sectional data indicate that a relationship between household food insecurity and overweight exists among women in the USA. Cross-sectional data cannot determine if food insecurity leads to overweight as some have hypothesised. The purpose of the present study was to examine the relationship of food insecurity with subsequent weight gain in women using data from the Panel Study of Income Dynamics (PSID).

Panel data from the 1999 and 2001 PSID, a nationally representative sample of households, were analysed using multivariate regression procedures.

Average weight gain among all women (n = 5595) was 1.1 kg on average over the two years. There were no significant differences in the percentages of women who gained a clinically significant amount (2.3 kg) by food insecurity status. Overweight women who were on a weight-gain trajectory during the 2-year period gained less if they were food-insecure. This relationship was not observed among healthy-weight or obese women.

Overall, food insecurity does not appear to be strongly associated with subsequent weight gain in women.

To examine the pattern of intake of key foods and beverages of children aged 4–12 years and the association with weight status.

A computer-assisted telephone interview was used to determine the intake of fruit, vegetables, packaged snacks, fast foods and sweetened drinks ‘yesterday’ and ‘usually’ as reported by parents/guardians of a representative sample of 2184 children from the Barwon South-Western region of Victoria, Australia.

Children who consumed >2–3, >3–4 and >4 servings of fruit juice/drinks ‘yesterday’ were, respectively, 1.7 (95% confidence interval (CI) 1.2–2.2), 1.7 (95% CI 1.2–2.5) and 2.1 (95% CI 1.5–2.9) times more likely to be overweight/obese compared with those who had no servings of fruit juice/drink ‘yesterday’, adjusted for age, gender and socio-economic status (SES). Further, children who had ≥ 3 servings of soft drink ‘yesterday’ were 2.2 (95% CI 1.3–3.9) times more likely to be overweight/obese compared with those who had no servings of soft drink ‘yesterday’, adjusted for age, gender and SES. In addition, children who ‘usually’ drank fruit juice/drinks twice or more per day were 1.7 (95% CI 1.2–2.4) times more likely to be overweight/obese compared with those who drank these beverages once or less per week, adjusted for age, gender and SES. Although fast foods and packaged snacks were regularly eaten, there were no associations between weight status and consumption of these foods.

Intake of sweetened beverages was associated with overweight and obesity in this population of Australian schoolchildren and should be a target for intervention programmes aimed at preventing unhealthy weight gain in children.

Recent reports suggest persistence of health disparities related to socio-economic position (SEP). To understand if diet may be a contributor to these trends, we examined secular trends in the association of diet and indicators of SEP from 1971–1975 to 1999–2002.

We used data from the National Health and Nutrition Examination Surveys (NHANES) I (1971–1975), II (1976–1980), III (1988–1994) and 1999–2002 to examine the independent associations of poverty income ratio (PIR) and education with diet and biomarkers of diet and disease in 25–74-year-olds (n = 36 600). We used logistic and linear regression methods to adjust for multiple covariates and survey design to examine these associations.

A large PIR differential in the likelihood of reporting a fruit or all five food groups and vitamin C intake, and an education differential in likelihood of obesity and carbohydrate intake, was noted in 1971–1975 but narrowed in 1999–2002 (P < 0.007). The positive association of education with intake of a fruit, vegetable or all five food groups, vitamins A and C, calcium and potassium intake remained unchanged across surveys (P < 0.001). Similarly, the positive association of PIR with the amount of foods and intakes of energy and potassium remained unchanged over three decades (P < 0.001). The education and the PIR differential in energy density, and the PIR differential in the likelihood of obesity, persisted over the period of the four surveys (P < 0.001).

Persistence of unfavourable dietary and biomarker profiles in Americans with low income and education suggests continued need for improvement in the quality of diets of these high-risk groups.

The aims of this study were to assess the changes that have occurred in food patterns in Europe over the last 40 years based on food availability data and to compare the stability of the traditional Mediterranean diet in the south of Europe in this period.

An ecological study carried out on the basis of Food and Agriculture Organization food balance sheets for three geographical areas of Europe (Mediterranean, north and east) over two time periods: 1961–1963 and 1998–2000. The average availability of total energy, energy provided from macronutrients and food groups was calculated for each area and each period studied.

Over the last 40 years total energy availability and energy availability from lipids have increased considerably in the three European areas, while the percentage of energy from carbohydrates has fallen. The greatest changes have occurred in Mediterranean Europe, with an increase of 20.1% in total energy availability, an increase of 48.1% in energy availability from lipids and a fall of 20.5% from carbohydrates. Moreover, Mediterranean Europe showed a significant fall in the energy supplied by cereals (29.9%) and wine (55.2%), while the contribution of milk (77.8%) and dairy products (23.6%) increased.

The results of this study suggest that European Mediterranean countries should take nutrition policy action to maintain their traditional healthy food pattern, with a cultural added value. This implies actions at all levels, including raising awareness of consumers, collaboration with the food sector and a call to set the agenda of the concerned politicians and stakeholders.

To validate a 171-item semi-quantitative food-frequency questionnaire (FFQ) for measurement of nutrient intake in an intervention trial based on walnut supplementation.

Free-living adults from Southern California were randomly assigned to either an intervention (walnut-supplemented) or a control diet. The prescribed 6-month intervention was ≥ 28 g of walnuts per day for the walnut-supplemented group and ≤ 2 g of walnuts per day for the control group. Participants provided at least six 24-hour dietary recalls and completed a self-administered FFQ.

Eighty-seven adults aged 30–72 years (48 females, 39 males).

Our findings from validation (by correlation with six diet recall measures) of the measurement of 32 nutrients by the FFQ are as follows. We found significant positive correlations (corrected for measurement error) between the FFQ and diet recalls for total energy (r = 0.34), total carbohydrate (r = 0.42), vegetable protein (r = 0.43), total fat (r = 0.51), polyunsaturated fat (r = 0.77), total fibre (r = 0.60), linoleic acid (r = 0.78) and α-linolenic acid (r = 0.79) – the last nutrient being an excellent nutrient biomarker of the intervention (walnut supplementation). Significant positive correlations were also found for vitamin C (r = 0.96) and certain minerals (r = 0.46–0.80 for calcium, phosphorus, magnesium, iron and potassium). Uncorrected correlations were also high (r>0.40) for retinol, β-carotene, folate and alcohol. Both diet recalls and FFQ showed a similar significant difference in α-linolenic acid content between the walnut-supplemented and control diets.

The FFQ demonstrated good relative validity in the estimation intake of some of the major nutrients in a dietary intervention trial and was a particularly valid estimate of an important nutrient biomarker of walnut supplementation.

To evaluate the prevalence and identify some predictors of misreporting in an elderly Belgian population and to assess the effect of underreporting on estimated intakes of macronutrients and foods.

A 1-day food record was completed by 2083 adult men and women aged 65 years or more. Individuals whose energy intake was lower than 0.90 × BMR (basal metabolic rate) were defined as underreporters. Overreporting was defined as energy intake greater than 2 × BMR.

Underreporting and overreporting occurred in 13.6% and 7.9% of food records, respectively. Results from logistic regression models indicated that gender and body mass index (BMI) were predictors of misreporting. Whereas women were more likely to underreport energy intake, the prevalence of overreporting was higher in men. Underreporting was more prevalent among obese people and overreporting more prevalent in normal-weight subjects. Smoking status and education level did not predict underreporting; however, overreporting was more likely to occur in more highly educated subjects. A cultural difference in reporting of nutrient intakes was also found, with the percentage of underreporters being higher among Walloons compared with Flemish.

BMI seemed to be one of the most important factors in misreporting. This calls for special attention when dietary surveys are performed on obese or lean people.

To assess rates of initiation of breast-feeding and exclusive breast-feeding within 2 months after delivery and to determine the factors influencing exclusive breast-feeding.

A health worker-administered questionnaire survey was carried out during the time period 1 August–30 September 2005.

Immunisation clinics of Pokhara, a submetropolitan city in western Nepal.

Three hundred and eighty-five mothers who had delivered a child within the previous 2 months.

The rates of initiation within 1 h and within 24 h of delivery were 72.7 and 84.4%, respectively. Within 2 months after delivery, exclusive breast-feeding was practised by 82.3% of the mothers. Breast milk/colostrum was given as the first feed to 332 (86.2%) babies but 17.2% of them were either given expressed breast milk or were put to the breast of another lactating mother. Pre-lacteal feeds were given to 14% of the babies. The common pre-lacteal feeds given were formula feeds (6.2%), sugar water (5.9%) and cow's milk (2.8%). Complementary feeds were introduced by 12.7% of the mothers. By logistic regression analysis, friends' feeding practices, type of delivery and baby's first feed were the factors influencing exclusive breast-feeding practice of the mothers.

Despite the higher rates of initiation and exclusive breast-feeding, practices such as pre-lacteal feeds and premature introduction of complementary feeds are of great concern in this urban population. There is a need for promotion of good breast-feeding practices among expectant mothers and also the community, especially the families, taking into account the local traditions and customs.

To document infant feeding methods in the first six months of life in Xinjiang Uygur Autonomous Region, People's Republic of China, 2003–2004. Some problems with breast-feeding in the area are explained.

A longitudinal study of infant feeding practices was undertaken. A total of 1219 mothers who delivered babies during 2003 and 2004 were interviewed in five hospitals or institutes, and after discharge were contacted in person or by telephone at approximately monthly intervals to obtain details of infant feeding practices. Multivariate logistic regression analysis was used to explore factors associated with breast-feeding initiation.

‘Any breast-feeding’ rates at discharge and at 0.5, 1.5, 2.5, 3.5, 4.5 and 6 months were 92.2, 91.3, 89.9, 88.8, 87.7, 86.0 and 73.0%, respectively. ‘Exclusive breast-feeding’ rates at discharge and at 0.5, 1.5, 2.5, 3.5, 4.5 and 6 months were 66.2, 47.6, 30.1, 25.8, 22.1, 13.0 and 6.2%, respectively. The main problem of breast-feeding in Xinjiang was the early introduction of formula or water. The average duration of ‘exclusive breast-feeding’ was 1.8 months (95% confidence interval (CI) 1.7–2.0), of ‘full breast-feeding’ 2.8 months (95% CI 2.7–2.9) and of ‘any breast-feeding’ 5.3 months (95% CI 5.2–5.4).

Infant feeding methods in Xinjiang were documented in this study and the main problems with infant feeding in Xinjiang are discussed. Further studies are needed to identify factors associated with ‘exclusive breast-feeding’ and duration.

To evaluate the feasibility of undertaking a food skills intervention study in areas of social deprivation aimed at altering cooking confidence, food preparation methods and dietary choices.

A standardised skills programme was implemented in community-based settings. Pre- (T1) and post-intervention (T2) and 6-month follow-up (T3) measures (7-day diaries and self-administered questionnaires) were undertaken in intervention and comparison groups.

Eight urban communities in Scotland.

One hundred and thirteen adults living in areas of social deprivation.

It was clear that many subjects led fragmented lives and found commitment to intervention classes problematic. Sixty-three subjects completed the final (T3) assessments. The response to each component varied due to inability to attend sessions, illness, study requirements, employment, moving out of the area, change in circumstances, loss of interest and loss of postal questionnaires. At baseline, reported consumption of fruit and vegetables was low (mean frequency 8.1 ± 4.78 times per week). Fruit intake increased significantly (P < 0.05) between T1 and T2 in the intervention group (1.7 ± 2.36 to 2.7 ± 3.28 times per week) only. Between T1 and T3, there was a significant increase (P < 0.05) in intervention subjects who reported confidence in following a recipe (67–90%,).

This exploratory trial shows that a food skills intervention is likely to have a small but positive effect on food choice and confidence in food preparation. A full-scale randomised controlled trial in this hard-to-reach group would require a range of flexible approaches rather than a fully defined intervention, and presents challenges for trial design.