To determine the prevalence of anaemia and maternal and infant factors associated with Hb values in infants at 6 months of age in rural Bangladesh.

Infants (born to mothers supplemented with Fe–folic acid from mid-pregnancy) were visited at birth and 6 months of age. Mothers’ anthropometric status, and infants’ birth weight, gestational age at birth, weight and Hb concentration at 6 months were measured. Household socio-economic and demographic data, infant feeding practices and health status were collected using a pre-tested structured questionnaire.

Rural Bangladesh.

Four hundred and two infants.

For the total cohort (n 402), the range of anaemia prevalence values was from 30·6 % using a cut-off value of Hb < 95 g/l to 71·9 % using a value of Hb < 110 g/l. Birth weight and month of birth were the only factors positively associated with infant Hb in a linear regression model (P = 0·008 and 0·011, respectively).

There was an unexpectedly high prevalence of anaemia in infants at 6 months of age, before the assumed period of vulnerability. Hb at this age tended to be higher in those with higher birth weight. We also found a season effect on Hb, as it tended to be higher as the study progressed. The high prevalence of anaemia at such an early age needs to be addressed to minimize the disease’s long-term consequences.

To assess the adherence to the Mediterranean dietary pattern in the population from a coastal region from north-east Spain and its relationship to diseases, applying the Mediterranean Diet Quality Index (M-DQI) validated by the use of several biomarkers.

Cross-sectional nutrition survey.

Population-based random sample derived from the Catalan Nutrition Survey.

A total of 621 healthy adults.

The Catalan representative sample presented a mean M-DQI score of 6·6 (sd 2·3, median 7, range 0–14). The percentage of adherence to the Mediterranean diet was 53 %; 10 % of subjects showed high adherence to the Mediterranean diet, while only 2 % were categorized as poorest adherence. The plasma fatty acid profile of the Catalan sample progressed with perfect regularity throughout the index ranges. Both EPA and DHA presented a significant correlation to the M-DQI (r = −0·410 for EPA and −0·360 for DHA). A significant increase in palmitic, oleic and α-linolenic acids and a significant decrease in stearic, linoleic and arachidonic acids content were also observed. The mean values for the M-DQI according to the clinical characteristics of the Catalan sample were also calculated.

The M-DQI has been demonstrated a suitable tool for assessment of an individual’s nutritional status according to the Mediterranean dietary pattern and for clinical purposes. Although the current diet followed in Catalonia seems to agree with the main characteristics of the Mediterranean diet, the promotion of the Mediterranean pattern should be reinforced in the Catalan population, especially among young people.

To explore the association between vitamin B12 (B12)-containing supplement use, low B12 concentrations and biochemically defined B12 deficiency in US adults.

A cross-sectional study with adjustment for survey design. Prevalence ratios for two age groups (18–50 and >50 years) were estimated using unconditional logistic models. Outcome measures included prevalence of low serum B12 concentration (<148 pmol/l) and biochemical B12 deficiency (serum B12 < 148 pmol/l with concomitant homocysteine > 10 μmol/l).

A population survey of health and nutritional measures.

Subjects were non-institutionalized adults, aged 18 years and older, who participated in Phase 2 of NHANES III (Third National Health and Nutrition Examination Survey).

Low B12 concentrations were less prevalent among persons consuming B12-containing supplements (P = 0·001) with an adjusted prevalence ratio of 0·6 (95 % CI 0·3, 1·0). Biochemical B12 deficiency showed a similar trend (P = 0·0002), with an adjusted prevalence ratio of 0·3 (95 % CI 0·1, 0·8). Prevalence ratios were similar in adults >50 years of age, although the prevalence of low B12 and biochemical deficiency was proportionally higher.

Consumption of B12-containing supplements was associated with at least 50 % lower prevalence of both low serum B12 and biochemical B12 deficiency in a nationally representative sample of US adults, suggesting increased consumption of B12 from supplements or from fortified foods may reduce the prevalence of B12 deficiency. Additionally, the current Recommended Daily Allowance for B12 of 2·4 μg may be insufficient for those aged >50 years.

Sometimes the suspicion is put forward that nutrition students show more disordered eating patterns, which may be among the motivating factors to study nutrition. At the same time, it is not clear whether the students’ increasing knowledge about diet and nutrition is associated with a more healthy eating behaviour or with an unhealthy obsession with food choices.

Cross-sectional comparison of nutrition students from German universities during the first year of their studies (n 123) and during higher semesters (n 96), with a control group from other study programmes (n 68 and n 46, respectively). Dietary restraint, disinhibition, the tendency towards orthorexia nervosa and healthy food choices were assessed using a questionnaire.

Nutrition students showed higher levels of dietary restraint than the control group. Disinhibition and orthorexia nervosa did not differ between nutrition students and controls. Orthorexic tendencies were lower in the more advanced nutrition students. Healthy food choices did not differ among students in the first year. More advanced nutrition students showed healthier food choices, whereas the corresponding controls showed slightly more unhealthy food choices.

Nutrition students, more than other students, tend to restrict their food intake in order to control their weight, but they do not have more disturbed or disordered eating patterns than other students. Moreover, during the course of their studies, they adopt slightly more healthy food choices and decrease their tendency to be obsessive in their eating behaviour.

The present paper describes the systematic development of an FFQ to assess the intake of fatty acids and antioxidants in school-aged children. In addition, a validation study applying 24 h dietary recalls was performed.

Using the variance-based Max_r method, a list of eighty-two foods was compiled from data obtained by 3 d weighed dietary records. The foods were used to design an FFQ, the comprehensibility of which was evaluated in a feasibility study. In addition, the FFQ was validated in a subset of 101 children from the German Infant Nutritional Intervention Study (GINI PLUS) against one 24 h dietary recall.

The feasibility study attested a good acceptance of the FFQ. Mean intake of foods compared well between the FFQ and the 24 h dietary recall, although intake data generated from the FFQ tended to be higher. This difference became less apparent at the nutrient level, although the estimated average consumption of arachidonic acid and EPA using the FFQ still exceeded values recorded with the 24 h recall method by 45 % and 29 %, respectively.

On the basis of the systematic selection process of the food list, the established practicability of the FFQ and the overall plausibility of the results, the use of this FFQ is justified in future epidemiological studies.

To validate questionnaire-based physical activity level (PAL) against accelerometry and a 24 h physical activity diary (24 h AD) as reference methods (Protocol 2), after validating these reference methods against the heart rate–oxygen consumption (HRVO2) method (Protocol 1).

Cross-sectional study.

Two villages in Andhra Pradesh state and Bangalore city, South India.

Ninety-four participants (fifty males, forty-four females) for Protocol 2; thirteen males for Protocol 1.

In Protocol 2, mean PAL derived from the questionnaire (1·72 (sd 0·20)) was comparable to that from the 24 h AD (1·78 (sd 0·20)) but significantly higher than the mean PAL derived from accelerometry (1·36 (sd 0·20); P < 0·001). Mean bias of PAL from the questionnaire was larger against the accelerometer (0·36) than against the 24 h AD (−0·06), but with large limits of agreement against both. Correlations of PAL from the questionnaire with that of the accelerometer (r = 0·28; P = 0·01) and the 24 h AD (r = 0·30; P = 0·006) were modest. In Protocol 1, mean PAL from the 24 h AD (1·65 (sd 0·18)) was comparable, while that from the accelerometer (1·51 (sd 0·23)) was significantly lower (P < 0·001), than mean PAL obtained from the HRVO2 method (1·69 (sd 0·21)).

The questionnaire showed acceptable validity with the reference methods in a group with a wide range of physical activity levels. The accelerometer underestimated PAL in comparison with the HRVO2 method.

Few biomarkers for dietary intake of various food groups have been established. The aim of the present study was to explore whether selenium (Se), iodine, mercury (Hg) or arsenic may serve as a biomarker for total fish and seafood intake in addition to the traditionally used n-3 fatty acids EPA and DHA.

Intake of fish and seafood estimated by an FFQ was compared with intake assessed by a 4 d weighed food diary and with biomarkers in blood and urine.

Validation study in the Norwegian Mother and Child Cohort Study (MoBa).

One hundred and nineteen women.

Total fish/seafood intake (median 39 g/d) calculated with the MoBa FFQ was comparable to intake calculated by the food diary (median 30 g/d, rS = 0·37, P < 0·001). Erythrocyte DHA and blood Hg, Se and arsenic concentrations were positively correlated with intake of fish and seafood, but the association for DHA was weakened by the widespread use of supplements. The main finding was the consistent positive association between the intake of fish/seafood and blood arsenic concentration. In multivariate analyses, blood arsenic was associated with blood Hg and fish and seafood intake. In these models, arsenic turned out to be the best indicator of intake of fish and seafood, both totally and in subgroups of fish/seafood intake.

While DHA reflected the intake of fatty fish and n-3 PUFA supplements, blood arsenic concentration also reflected the intake of lean fish and seafood. Blood arsenic appears to be a useful biomarker for total fish and seafood intake.

To quantify marine food product consumption and EPA + DHA intake among Quebecers, and to compare the results with the most recent recommendations.

Data were obtained from a representative cross-sectional telephone survey (June 2006). Intakes of marine food product species and EPA + DHA were estimated from a validated FFQ on the consumption of marine food products during the previous month. Prevalence of fish oil consumption in the last 6 months was also assessed.

Province of Quebec (Canada).

A representative sample (n 1001) of adults in the province of Quebec. Of these, eight were excluded from the present analysis (n 993).

Mean and median EPA + DHA intakes for all participants were estimated to be 291 mg/d (sem 11) and 207 mg/d, respectively. 85·0 % (95 % CI 82·7, 87·3) of Quebecers had an EPA + DHA intake lower than 500 mg/d, which is the amount internationally recommended for the prevention of CVD. Mean and median DHA intakes among women of childbearing age (n 128, 18–34 years) were estimated to be 169 mg/d (sem 17) and 126 mg/d, respectively. Of these women, 27·7 % had a daily intake >200 mg DHA and 15·9 % had an intake >300 mg DHA. We noted that 13 % of Quebecers take ≥1 capsule of fish oil/d.

Consumption of marine food products and EPA + DHA among Quebecers clearly appears to be lower than international recommendations. Since EPA + DHA confer health benefits and may reduce health costs, strategies to increase their consumption should be implemented to improve public health in Quebec.

To investigate the association between self-esteem, physical activity, engaging in risky behaviours, social and cultural capital, attitudes towards thinness, parental and personal characteristics with weight-control behaviours among adolescents in Beirut, Lebanon.

A community-based cross-sectional study. A stratified cluster sampling design was used and information gathered by means of a questionnaire. Associations were investigated using multinomial logistic regression, accounting for the survey design. Odds ratios were calculated for trying to lose weight, or trying to gain weight, compared with no weight-control behaviour.

The study was conducted in three underprivileged urban areas of Beirut in 2003.

The sample size was 1294 adolescents aged 13–19 years.

Determinants of weight-control behaviour among girls included their attitudes towards thinness (ORloss = 4·29, ORgain = 0·38), dissatisfaction with weight (ORloss = 10·9, ORgain = 9·63), engaging in physical activity (ORloss = 2·22), smoking (ORloss≈3) and the mother working (ORloss = 2·77). Determinants of weight-control behaviour in boys included their attitudes towards thinness (ORloss = 14·7, ORgain = 0·35), dissatisfaction with weight (ORloss = 15·6, ORgain = 17·7), being involved in a cultural activity (ORgain = 2·51), engaging in a fight (ORloss = 5·25, ORgain = 1·64) and engaging in physical activity (ORloss = 2·56, ORgain = 2·17).

Attitudes towards thinness, weight dissatisfaction and physical activity are common determinants for weight-control among boys and girls, although to varying degrees of influence. Self-esteem, social capital, cultural capital and parental characteristics were not significant predictors when accounting for the other variables.

We examined factors affecting compliance to antenatal micronutrient supplementation and women’s perceptions of supplement use.

Randomized controlled supplementation trial of four alternative combinations of micronutrients given during pregnancy through to 3 months postpartum. Women were visited twice weekly to monitor compliance and to replenish tablets by female study workers. At 6 weeks postpartum women with live births (n 4096) were interviewed regarding their perceptions of the supplement. Median compliance calculated as percentage of total eligible doses received by women was high (84 %).

Rural southern Nepal.

Pregnant women.

Women with high compliance (above the median of 84 %) were likely to be older, less educated, poorer, undernourished, belong to lower caste and of Pahadi (hill) ethnicity compared with women with low compliance (at or below the median of 84 %). Smoking and drinking alcohol in the past week during pregnancy were strongly associated with low compliance. The major reason for irregular intake was forgetting to take supplements. A higher proportion of the high compliers liked taking the supplements but only half of them were willing to purchase them in the future. A large proportion of women (91 %) perceived a benefit from taking the supplement such as improved strength and health, whereas only about 10 % perceived any side-effects which were not a major barrier to compliance.

The present analysis highlights that poor, undernourished, uneducated women can have high compliance to antenatal supplementation if they are supplied with the tablets and reminded to take them regularly, and counselled about side-effects.

Parents may influence children’s fruit and vegetable (F&V) consumption in many ways, but research has focused primarily on counterproductive parenting practices, such as restriction and pressure to eat. The present study aimed to assess the association of diverse parenting practices to promote F&V and its consumption among pre-school children.

An exploratory analysis was performed on cross-sectional data from 755 Head Start pre-school children and their parents collected in 2004–5. Data included parent practices to facilitate child F&V consumption (grouped into five categories); parent-reported dietary intake of their child over 3 d; and a number of potential correlates. K-means cluster analysis assigned parents to groups with similar use of the food parenting practice categories. Stepwise linear regression analyses investigated the association of parent clusters with children’s consumption of F&V, after controlling for potential confounding factors.

A three-cluster solution provided the best fit (R2 = 0·62), with substantial differences in the use of parenting practices. The clusters were labelled Indiscriminate Food Parenting, Non-directive Food Parenting and Low-involved Food Parenting. Non-directive parents extensively used enhanced availability and teachable moments’ practices, but less firm discipline practices than the other clusters, and were significantly associated with child F&V intake (standardized β = 0·09, P < 0·1; final model R2 = 0·17) after controlling for confounders, including parental feeding styles.

Parents use a variety of parenting practices, beyond pressuring to eat and restrictive practices, to promote F&V intake in their young child. Evaluating the use of combinations of practices may provide a better understanding of parental influences on children’s F&V intake.

To quantify the environmental component of aetiology of overweight and obesity by examining the relationship between the degree of overweight in dogs and cats and the degree of overweight in their owners.

Cross-sectional study. Main outcome measures of the owners were weight, height (stature) and BMI. Of the animals, weight and divergence from ideal weight were measured by a veterinarian.

Three veterinary clinics in Amsterdam, The Netherlands.

Dogs and cats, together with their owners, who visited the veterinary clinic. Dogs and cats had to be older than 1 year, and their owners had to be at least 21 years old. After exclusion, there remained forty-seven pairs of dogs and their owners and thirty-six pairs of cats and their owners.

We found a significant relationship between the degree of overweight of dogs and the BMI of their owners (r = 0·31). Correction for length of ownership, gender and age of the animal, and gender, age, education level and activity score of the owner did not materially affect this relationship. However, after correction for the amount of time the dog was being walked each day, this relationship disappeared. No significant relationship was found between the degree of overweight of cats and the BMI of their owners.

The degree to which dogs are overweight is, in contrast to the degree to which cats are overweight, related to the BMI of their owners.

To evaluate the effectiveness of stainless steel (Fe alloy) cooking pots in reducing Fe-deficiency anaemia in food aid-dependent populations.

Repeated cross-sectional surveys. Between December 2001 and January 2003, three surveys among children aged 6–59 months and their mothers were conducted in 110 households randomly selected from each camp. The primary outcomes were changes in Hb concentration and Fe status.

Two long-term refugee camps in western Tanzania.

Children (6–59 months) and their mothers were surveyed at 0, 6 and 12 months post-intervention. Stainless steel pots were distributed to all households in Nduta camp (intervention); households in Mtendeli camp (control) continued to cook with aluminium or clay pots.

Among children, there was no change in Hb concentration at 1 year; however, Fe status was lower in the intervention camp than the control camp (serum transferrin receptor (sTfR) concentration: 6·8 v. 5·9 μg/ml; P < 0·001). There was no change in Hb concentration among non-pregnant mothers at 1 year. Subjects in the intervention camp had lower Fe status than those in the control camp (sTfR concentration: 5·8 v. 4·7 μg/ml; P = 0·003).

Distribution of stainless steel pots did not increase Hb concentration or improve Fe status in children or their mothers. The use of stainless steel prevents rusting but may not provide sufficient amounts of Fe and strong educational campaigns may be required to maximize use. The distribution of stainless steel pots in refugee contexts is not recommended as a strategy to control Fe deficiency.

The purpose of the present analysis was to examine secular trends in school performance indicators in relationship to the implementation of a programme targeting the school food and physical activity environment.

Data on available school performance indicators were obtained; retrospective analyses were conducted to assess trends in indicators in association with programme implementation; each outcome was regressed v. year, beginning with the year prior to programme implementation.

The Healthy Kids, Smart Kids programme, a grass-roots effort to enhance the school food and physical activity environment in the Browns Mill Elementary School in Georgia.

Data included publicly available school records from the years 1995 to 2006.

The number of nurse, counselling and disciplinary referrals per 100 students demonstrated a downward trend, while standardized test scores demonstrated an upward trend beginning in the year of programme implementation. School year was a significant predictor of all indicators.

Promoting nutrition and physical activity within the school environment may be a promising approach for enhancing both student health and educational outcomes.

To evaluate the acceptability of iron and iron-alloy cooking pots prior to an intervention trial and to investigate factors affecting retention and use.

Pre-trial research was conducted on five types of iron and iron-alloy pots using focus group discussions and a laboratory evaluation of Fe transfer during cooking was undertaken. Usage and retention during the subsequent intervention trial were investigated using focus group discussions and market monitoring.

Three refugee camps in western Tanzania.

Refugee health workers were selected for pre-trial research. Mothers of children aged 6–59 months participated in the investigation of retention and use.

Pre-trial research indicated that the stainless steel pot would be the only acceptable type for use in this population due to excessive rusting and/or the high weight of other types. Cooking three typical refugee dishes in stainless steel pots led to an increase in Fe content of 3·2 to 17·1 mg/100 g food (P < 0·001). During the trial, the acceptability of the stainless steel pots was lower than expected owing to difficulties with using, cleaning and their utility for other purposes. Households also continued to use their pre-existing pots, and stainless steel pots were sold to increase household income.

Pre-trial research led to the selection of a stainless steel pot that met basic acceptability criteria. The relatively low usage reported during the trial highlights the limitations of using high-value iron-alloy cooking pots as an intervention in populations where poverty and the availability of other pots may lead to selling.

To assess the impact of a classroom-based nutrition and health education intervention among student community volunteers in improving their knowledge on individual topics.

Prospective follow-up study. Topic-wise knowledge change among student volunteers on individual topics (twenty-one questions related to nutrition and health, eight questions related to infectious diseases and two questions related to obesity and hypertension) pertaining to nutrition and health was evaluated at baseline and after intervention, using the McNemar test.

Six different colleges affiliated to Osmania University, Andhra Pradesh, India.

Six hundred and eighty-seven student volunteers under the National Service Scheme, of both genders, average age 19 years.

A significant mean improvement of 11·36 (sd 8·49, P < 0·001) was observed in the overall nutrition and health knowledge scores of the student volunteers after the education intervention. The McNemar test showed that knowledge on individual topics related to energy, proteins, fats, adolescent phase, obesity, some lifestyle diseases and infectious diseases improved significantly (P < 0·01). No significant (P > 0·05) improvement was observed in knowledge on the nutritional content of milk and sprouted grams, hypertension, HIV/AIDS, ELISA and malaria.

Topics on which our educational intervention could not bring about significant knowledge improvement have been identified and suitable modifications can be carried out to strengthen them.

To develop policy and public health recommendations for implementation at all levels by individuals and organisations working in, or related to, the field of breast-feeding promotion in developed country settings, where breast-feeding rates remain low.

Two research phases, comprising (i) an assessment of the formal evidence base in developed country settings and (ii) a consultation with UK-based practitioners, service managers and commissioners, and representatives of service users. The evidence base included three systematic reviews and an Evidence Briefing. One hundred and ten studies evaluating an intervention in developed country settings were assessed for quality and awarded an overall quality rating. Studies with a poor quality rating were excluded. The resulting seventy studies examined twenty-five types of intervention for breast-feeding promotion. These formed the basis of the second consultation phase to develop the evidence-based interventions into recommendations for practice, which comprised (i) pilot consultation, (ii) electronic consultation, (iii) fieldwork meetings and (iv) workshops. Draft findings were synthesised for two rounds of stakeholder review conducted by the National Institute for Health and Clinical Excellence.

Twenty-five recommendations emerged within three complementary and necessary categories, i.e. public health policy, mainstream clinical practice and local interventions.

The need for national policy directives was clearly identified as a priority to address many of the barriers experienced by practitioners when trying to work across sectors, organisations and professional groups. Routine implementation of the WHO/UNICEF Baby Friendly Initiative across hospital and community services was recommended as core to breast-feeding promotion in the UK. A local mix of complementary interventions is also required.