To evaluate the long-term effect on micronutrient status of a β-carotene-, iron- and iodine-fortified biscuit given to primary school children as school feeding.

Children receiving the fortified biscuit were followed in a longitudinal study for 2.5 years (n=108); in addition, cross-sectional data from three subsequent surveys conducted in the same school are reported.

A rural community in KwaZulu-Natal, South Africa.

Children aged 6–11 years attending the primary school where the biscuit was distributed.

There was a significant improvement in serum retinol, serum ferritin, haemoglobin, transferrin saturation and urinary iodine during the first 12 months of the biscuit intervention. However, when the school reopened after the summer holidays, all variables, except urinary iodine, returned to pre-intervention levels. Serum retinol increased again during the next 9 months, but was significantly lower in a subsequent cross-sectional survey carried out directly after the summer holidays; this pattern was repeated in two further cross-sectional surveys. Haemoglobin gradually deteriorated at each subsequent assessment, as did serum ferritin (apart from a slight increase at the 42-month assessment at the end of the school year).

This study has shown that fortification of a biscuit with β-carotene at a level of 50% of the Recommended Dietary Allowance (RDA) was enough to maintain serum retinol concentrations from day to day, but not enough to sustain levels during the long school holiday break. Other long-term solutions, such as local food production programmes combined with nutrition education, should also be examined. The choice of the iron compound used as fortificant in the biscuit needs further investigation.

To determine the epidemiology of helminthic infections and the efficacy of parasite treatment among rural South African primary school children in the province of KwaZulu-Natal. To assess the South African government's parasite control policy.

The study recruited 268 school children, aged 8 to 10, and randomly allocated them into treatment and placebo groups (treatment consisted of a single dose of albendazole (400 mg) and praziquantel (40 mg/kg)). Anthropometric measurements and the prevalence and intensity of helminth infections were taken at baseline (prior to treatment) and 16 weeks post treatment. Two weeks after treatment prevalence and intensity were again measured for an approximate 50% sub-sample of the children to investigate efficacy of treatment. An analysis of the South African government's policies concerning parasite control is assessed in the light of these epidemiological findings.

Low levels of both stunting and wasting were observed throughout the study (approximately 10% and 1%, respectively), but did not vary significantly across either treatment group or time period (P>0.50). At baseline the observed prevalences for the three main helminths found in this study among the treated children were Ascaris lumbricoides 29.5%, Trichuris trichiura 51.9% and Schistosoma haematobium 22.3%. These prevalences declined significantly to 4.7% (P<0.0005), 38.0% (P<0.03) and 3.3% (P<0.0002), respectively, 16 weeks post treatment. The majority of infections observed at baseline were of light intensity, namely A. lumbricoides (50%), T. trichiura (80%) and S. haematobium (100%), and following treatment these levels were reduced significantly (P<0.0001, P<0.05 and P<0.005, respectively). The levels of both prevalence and intensity in the untreated group remained constant. The cure rates over the first two weeks of the study were found to be 94.4% for A. lumbricoides, 40% for T. trichiura and 72.2% for S. haematobium.

The benefits of targeted, school-based treatment in reducing the prevalence and intensity of infection supports the South African government's focus of using school-based interventions as part of an integrated parasite control programme. These strategies and programmes are consistent with recommendations of the World Health Organization (WHO) and The United Nations Children's Fund (UNICEF).

To evaluate over two years the effectiveness of multiple interventions targeted at lunches in secondary schools with the aim of increasing the consumption of healthier foods by children during the school day.

Controlled comparison study of two intervention schools targeted with multiple interventions to increase both the availability and the number of pupils consuming healthier foods, and one control school with no interventions but with the same observations over a two-year period.

Three secondary schools in Peterborough, England.

Secondary school children in the three schools taking school lunches between 1996 and 1998.

School Food Groups (SFGs) were set up in both intervention schools. All catering interventions were actioned via the SFGs. Of the food availability targets, only the target to increase the availability of high-fibre bread in both intervention schools was met. The availability of food items at the control school remained stable. The proportion of pupils consuming fruit and vegetables/salad was very low in all schools at baseline. There were positive changes for consumption of fruit and nonfried potato in one intervention school, and for high-fibre bread and non-cream cakes at the other in the short term, but only that for high-fibre bread was close to being sustained at the end of the two years. The dietary consumption target for vegetables/salad was achieved by the final monitoring period in one school.

Overall there were no significant changes in school-based eating at the end of the study. Some positive changes were made, with some of the dietary targets being achieved at an early stage but not sustained. Ultimately this study has shown how difficult it is to achieve sustained dietary changes in the eating habits of secondary school children, even with considerable input.

To assess the proportion of pre-school children meeting reference nutrient intakes (RNIs) and recommendations for daily intakes of iron, zinc, vitamins C and A, and energy from non-milk extrinsic sugars. To assess whether meeting these five dietary requirements was related to a series of socio-economic variables.

Secondary analysis of data on daily consumption of foods and drinks from the National Diet and Nutrition Survey (NDNS) of children aged 1.5–4.5 years based on 4-day weighed intakes.

One thousand six hundred and seventy-five British pre-school children aged 1.5–4.5 years in 1993.

Only 1% of children met all five RNIs/recommendations examined; 76% met only two or fewer. Very few children met the recommendations for intakes of zinc (aged over four years) and non-milk extrinsic sugars (all ages). The number of RNIs/recommendations met was related to measures of socio-economic class. Children from families in Scotland and the North of England, who had a manual head of household and whose mothers had fewest qualifications, met the least number of RNIs/recommendations.

Very few pre-school children have diets that meet all the RNIs and recommendations for iron, zinc, vitamins C and A, and energy from non-milk extrinsic sugars. Dietary adequacy with respect to these five parameters is related to socio-economic factors. The findings emphasise the need for a range of public health policies that focus upon the social and economic determinants of food choice within families.

To examine the relationship between non-milk extrinsic sugars (NMES) concentration and micronutrient intakes and status in free-living older people.

The National Diet and Nutrition Survey of people aged 65 years and over; a cross-sectional study in Britain in 1994/5.

Eight hundred and six men and women living in private households who were not on medication for nutritional disorders. Subjects were classified into four groups (Q1 to Q4), using cut-off points corresponding to quartiles of energy from NMES. Relationships were examined between dietary NMES concentration and intakes of calcium, iron, riboflavin, folate, vitamin C and vitamin D. Status indices were also assessed in each group.

Overall, a small proportion of men and women had intakes below the Lower Reference Nutrient Intake (LRNI) for calcium, iron, folate, riboflavin or vitamin C, while vitamin D intakes were universally low. Intakes of micronutrients tended to be highest at moderate levels of NMES in the diet (Q2 and Q3, equivalent to 8–15% of energy from NMES). Micronutrient status was low for riboflavin in 38% of the sample, while 15% had low vitamin C status and more than 10% were anaemic. There was little evidence that poorer nutrient status was associated with higher levels of dietary NMES. Although some indices of folate status were lower in Q4, this is most likely to reflect confounding by smoking. Energy intake accounted for 20–40% of the variance in micronutrient intakes, compared with less than 5% for NMES concentration.

A diet moderately high in NMES (up to around 15% of energy) is unlikely to have a detrimental impact on micronutrient intake or status in this age group. Energy intake is the major determinant of micronutrient adequacy.

To assess relationships between TV viewing and body composition, energy expenditure, physical activity, fitness and nutrition habits in prepubertal children.

Cross-sectional study.

Sixty prepubertal children (mean body mass index: 20.8 kg m−2, age: 5–11 years, overweight: n=52, normal weight: n=8).

TV consumption, socio-economic status (SES) and nutrition habits were estimated by questionnaires. Fat mass and fat-free mass were assessed by anthropometrics and bioelectrical impedance analysis, and resting energy expenditure by indirect calorimetry. Total energy expenditure was measured by a combination of indirect calorimetry and individually calibrated 24-hour heart rate (HR) monitoring. Activity-related energy expenditure and physical activity level were calculated. Aerobic fitness (VO2 submax) was determined by ergometry, muscle strength (musculus quadriceps, musculus ischiocruralis) was measured by computer tensiometry. Children were stratified according to their daily TV consumption: <=1 h of TV per day (group I) and >1 h of TV per day (group II).

When compared with children of group I, children of group II had increased body weight, body mass index, skinfolds, fat mass and prevalence of overweight (P<0.05 and <0.01, respectively). By contrast, fat-free mass, energy expenditure, measures of physical activity and muscle strength were similar. Children of group II had normal absolute VO2 submax but reduced adjusted VO2 submax (P<0.05). They also had parents with a lower educational level (P<0.05). Similar nutritional habits were observed in both groups. There were no significant differences in the observed parameters between children with high (1–3 h day−1) and very high (>3 h day−1) TV viewing.

There is a positive relationship between TV viewing and fatness. Increased TV viewing does not reflect reduced 24-hour energy expenditure as assessed by 24-hour HR monitoring, submaximal VO2, muscle strength or poor dietary intake. Increased TV consumption is associated with a low SES.

A new data-entry system (DINER – Data Into Nutrients for Epidemiological Research) for food record methods has been devised for the European Prospective Investigation into Cancer (EPIC) cohort study of 25 000 men and women in Norfolk. DINER has been developed to address the problems of efficiency and consistency of data entry, comparability of data, maximising information and future flexibility in large long-term population studies of diet and disease that use record methods to assess dietary intakes. DINER captures more detail than traditional systems and enables provision of new variables for specific food types or groups. The system has been designed to be fully flexible and easy to update. Analysis of consistency of data entry was tested in a group of 3525 participants entered by 25 coders.

A food list of 9000 food items and values for 24 000 portion sizes have been incorporated into the database, using information from the 5979 diaries coded since 1995. Analysis of consistency of entry indicated that this has largely been achieved. The effect of coders in a multivariate regression model was significant only if the three coders involved in early use of the program were included (P<0.013).

The development of DINER has facilitated the use of more accurate record methods in large-scale epidemiological studies of diet and disease. Furthermore, the retention of original information as an extensive food list allows greater flexibility in later analyses of data of multiple dietary hypotheses.

The purpose of this study was to validate a quantitative food-frequency questionnaire (QFFQ) created for assessing the usual intake of foods and nutrients in the prevailing season in Western Mali.

Intake of foods and nutrients over the week preceding the interview was measured with a 69-item QFFQ. Intakes were compared with intakes as measured with 2-day combined weighed and recalled diet records.

A rural village in Western Mali, West Africa.

Twenty-seven men and 48 women (15–59 years of age) representing 18 households.

Spearman rank correlations between intake of food groups from the QFFQ and the diet record ranged from 0.09 (meat/fish) to 0.58 (tea/coffee). Median coefficient was 0.37. Median Spearman correlation coefficient for nutrient intake was 0.40. Men had higher median correlation coefficients than did women. The proportion of subjects being classified into the same quartile of food intake was on median 33%, while a median of 7% was misclassified into extreme quartiles. Correct classification into the same quartile for intake of nutrients was on median 34% while a median of 4% was grossly misclassified. Intakes of most food groups and nutrients as measured by the QFFQ were higher than those measured by the diet records. However, while men had higher estimated intakes for foods eaten in-between meals, women in general had higher intake of foods eaten in the main meals.

This QFFQ can be used for comparing the intake of foods and nutrients between groups within this study population. It therefore represents a useful tool in the surveillance of food intake in the population, both in identifying vulnerable groups and for tracking food intake over time. The differences between men and women in overestimating food intake need to be taken into account when using the method.

To validate the use of supermarket receipts as an index of fat and energy intake in a population that buys most of its food from supermarkets.

Cross-sectional, prospective dietary survey – feasibility study.

Households situated within a 20-mile radius of a large (Tesco) supermarket in Leeds.

Two hundred and fourteen households who spend ≥=60% of their food purse in (Tesco and other) supermarkets.

Mean daily household purchase of fat, energy and percentage energy from fat contained in food from supermarkets were 185 g, 19.2 MJ and 35.9%. Mean daily household intakes of fat and energy were 190 g and 20.7 MJ, and 35% of energy was derived from fat. Mean household size was 2.4 persons. The association between the amount of fat and energy purchased from supermarkets and the amount of fat and energy consumed by households was strong. 0.90 MJ (95% confidence interval (CI): 0.8–1.0) of energy were consumed for every 1 MJ purchased from supermarkets and 0.76 g (95% CI: 0.64–0.87) of fat were consumed for every 1 g of fat purchased.

The results show a strong association between estimates of the intakes of fat and energy and percentage energy from fat using 4-day food diaries and 28 days of receipts, in populations who buy most of their food from supermarkets. They also show that the fat content of total food purchases from supermarkets is 35.9% energy from fat compared with 33% energy from fat recommended by the Department of Health. This preliminary research indicates the feasibility of and potential for utilising large quantities of readily available data generated from supermarket checkouts in dietary surveys.

To monitor trends in Danish food habits with respect to selected key elements, from 1995 to 1998, and to evaluate the appropriateness of the method developed for that purpose.

Two cross-sectional population surveys, in 1995 and 1998. Data collection by computer-assisted telephone interviews including 10 food-frequency questions, questions on type of fat used on sandwiches and drinking milk, and check questions on the previous day. Reproducibility was tested in a subgroup (n=222) in the 1998 survey.

The Danish Nutrition Council initiated the survey.

Men and women aged 15–90 years, 1007 in 1995 and 1024 in 1998. Samples of private telephone numbers were drawn from regional telephone registers, geographically stratified. Participation rates were 62%.

Significant differences were observed between 1995 and 1998, some of these in accordance with dietary guidelines (decreased use of whole milk and fat spread on bread, increased use of skimmed milk, salad vegetables, rice/pasta and fish). Other changes were opposite to dietary guidelines (increased use of soft butter, decreased use of soft margarine and low-fat spreads, potatoes, and fresh fruit). Differences in average consumption frequency amounted to 4–13%. Several results were confirmed by comparison with other data, and the reproducibility of the method was acceptable. Data were suitable for analysis of food use patterns, a relevant approach when assessing food habits in a lifestyle context.

The changes observed illustrate the dynamics of food habits and the need for frequent monitoring. This simple telephone method may be a valuable tool for that purpose, as a supplement to national dietary surveys, also in a public health context.