To measure dietary salt intake in a Swedish population.

A cross-sectional study with measured 24 h urinary excretion of Na and K. Completeness of urine collection was assessed using p-aminobenzoic acid. The subjects were interviewed on their habitual food intake.

Sahlgrenska University Hospital, Gothenburg, Sweden.

Eighty-six young men (age 18–20 years), randomly selected from the population of Gothenburg. Seven men were excluded due to incomplete urine collection.

The mean excretion of Na and K over 24 h was 198 and 84 mmol, respectively (corresponding to 11·5 g NaCl and 3·3 g K). The mean 24 h excretion in the highest quartile of Na excretion was 297 mmol Na and 105 mmol K, and in the lowest quartile, 100 mmol Na and 68 mmol K. The mean Na:K ratio was 2·3, and respectively 3·2 and 1·8 in the highest and lowest Na excretion quartiles. Calculated energy intake did not differ between the highest and lowest quartiles of Na excretion, but body weight, BMI and the intake of certain foods known to be Na-rich did.

Salt intake in young men was alarming high and even subjects in the lowest quartile of Na excretion did not meet present recommendations to limit salt intake to 5–6 g/d. At this point we can only speculate what the consequences of the high salt intake may be for CVD and stroke later in life. Regulation of the salt content in processed and fast food and in snacks is advocated, to curtail the salt burden on society imposed by the food industry.

Evaluation of a dietary Na reduction trial in a community setting.

Community-based randomized trial. Ten-week nutrition intervention activities focused on lifestyle modification to decrease dietary Na intake, under the supervision of a registered dietitian. Twenty-four hour urine specimens were collected at baseline and follow-up visits to determine 24 h urinary Na excretion.

The University of Pittsburgh Center for Healthy Aging, Key to Life Nutrition Program.

Hypertensive adults at least 65 years of age.

Mean age of participants was 75 years. Twenty-four hour mean urinary Na excretion at baseline was 3174 mg/d. This reduced to 2944 mg/d (P = 0·30) and 2875 mg/d (P ≤ 0·03) at 6- and 12-month follow-ups, respectively. In a sub-sample (urine volume of ≥1000 ml, baseline to 12 months), mean urinary Na excretion decreased from 3220 mg/d to 2875 mg/d (P ≤ 0·02).

Significant reductions in mean 24 h urinary Na were reported, but results fell short of the recommended guidelines of 1500 mg/d for at-risk individuals. Our results reiterate the difficulty in implementing these guidelines in community-based programmes. More aggressive public health efforts, food industry support and health policy changes are needed to decrease Na levels in older adults to the recommended guidelines.

With the upsurge in online dietary modification programmes, online dietary assessment tools are needed to capture food intake. Although the DASH (Dietary Approaches to Stop Hypertension) diet is recommended by the US Department of Agriculture, there are no online instruments that capture DASH food servings. Our objective was to assess the validity of a new, short, online dietary questionnaire developed to capture intake of DASH food servings. The DASH Online Questionnaire (OLQ) was validated against the well-known Block Food Frequency Questionnaire (FFQ).

This was a cross-sectional validation of the DASH OLQ, which contained eleven food groups (breakfast cereals; dairy; drinks; fats and oils; fruits; grains and snacks; meat, fish and poultry; mixed dishes; sweets; vegetables; and nuts, seeds and legumes). Each subject completed a DASH OLQ once weekly for four weeks and one 98.2 Block FFQ (110 questions) between weeks 2 and 4. DASH OLQ were averaged and then compared with the Block FFQ for nutrient intakes as well as intakes of DASH food groups.

Boston University Medical Center, Boston, Massachusetts.

One hundred and ninety-one faculty and staff at Boston University Medical Center aged 20–70 years.

There were significant positive correlations between the Block FFQ and the DASH OLQ for all food groups ranging from r = 0·8 for the nuts/seeds/legumes category to r = 0·3 for vegetables and mixed dishes. A comparison of nutrient intakes found strong positive correlations in all nutrient categories. Of particular interest in the DASH diet and the web-based nutrition and physical activity programme were total fat (r = 0·62), total carbohydrate (r = 0·67), total K (r = 0·68), total Ca (r = 0·69), total vitamin C (r = 0·60) and total energy intake (r = 0·68).

The DASH OLQ captures food and nutrient intake well in relation to the more established Block FFQ.

Although goitre and cretinism were brought under control in Kyrgyzstan during the 1960s by centrally directed iodized salt supplies, iodine-deficiency disorders (IDD) had made a comeback when the USSR broke up in 1991. Upon independence, Kyrgyzstan started developing its own salt processing industry and by 2001 the Government enacted a law on IDD elimination, mandating universal salt iodization (USI) at 25–55 mg/kg. The present study aimed to evaluate the effectiveness of the USI strategy on the iodine consumption, iodine status and burden of IDD in the population of Kyrgyzstan.

A national, population-representative survey during autumn 2007 collected household salt and urine samples of school-age children and pregnant women for quantitative iodine measurements. Thyroid volume was measured by ultrasound.

The median iodine content in household salt was 11·2 mg/kg; 97·9 % of salt samples were iodized, but only 39·5 % had ≥15 mg iodine/kg. The median urinary iodine concentration (UIC) of 114 μg/l in children did not differ from the UIC of 111 μg/l in pregnant women. Thyroid volume in pregnant women increased with the duration of pregnancy. Strong relationships existed between salt iodine levels and the UIC values in children and women.

The iodine nutrition status of the Kyrgyz population is highly responsive to household salt iodization. Although the results in children suggest adequate iodine nutrition, the iodine consumption among pregnant women did not assure their dietary requirements. In-depth analysis of the survey data suggest that excess iodine intake is not likely to become a public health concern in Kyrgyzstan when the salt supply meets agreed standards.

To analyse changes in the distribution of BMI in Australia between 1980 and 2000.

Data were from the 1980, 1983 and 1989 National Heart Foundation Risk Factor Prevalence Study, the 1995 National Nutrition Survey and the 1999/2000 Australian Diabetes, Obesity and Lifestyle Study. Survey participants were aged 25–64 years and resident in Australian capital cities. BMI was calculated as weight divided by height squared (kg/m2), where weight and height were measured using standard procedures.

Mean BMI was higher in 2000 than 1980 in all sex and age groups. The age-adjusted increase was 1·4 kg/m2 in men and 2·1 kg/m2 in women. The BMI distribution shifted rightwards for all sex and age groups and became increasingly right-skewed. The change between 1980 and 2000 ranged from a decrease of 0·04 kg/m2 at the lower end of the distribution for men aged 25–34 years to an increase of 7·4 kg/m2 at the higher end for women aged 55–64 years. While the prevalence of obesity (BMI ≥ 30 kg/m2) doubled, the prevalence of obesity class III (BMI ≥ 40 kg/m2) increased fourfold.

BMI in urban Australian adults has increased and its distribution has become increasingly right-skewed. This has resulted in a large increase in the prevalence of obesity, particularly the more severe levels of obesity. It will be important to monitor changes in the different classes of obesity and the extent to which obesity interventions both shift the BMI distribution leftwards and decrease the skew of the distribution.

To examine the relative contribution for the prediction of hypertension by waist circumference (WC), waist:stature ratio (WSR) or waist:hip ratio (WHR) with that by BMI, to ascertain if WC, WSR or WHR enhances the prediction of hypertension by BMI.

Population-based, cross-sectional study. A change of ≥10 % in the prevalence ratio of BMI (PR) or the area under the receiver-operating characteristic curve (AUC) when WC, WSR or WHR was added to a model with BMI was used as the criterion for significant contribution to the prediction of hypertension by BMI. For greater contributions (≥10 %) these waist measures were considered as better predictors.

Nine provinces in China.

Chinese adults aged 18 to 65 years (n 7336) who participated in the 2004 China Health and Nutrition Survey.

The prevalence of hypertension (17 % and 23 % for women and men, respectively) was significantly related to increased BMI, WC, WSR and WHR (P for trend <0·001). Although there was a better model fit when WC, WSR or WHR was added to a model with BMI (P < 0·05; likelihood ratio test), the changes in PR and AUC were <10 % and <5 %, respectively. The sex-specific AUC for the prediction of hypertension by BMI (of 0·7–0·8) was similar to that by WC, WSR or WHR.

The waist indices do not perform better than BMI or markedly enhance the prediction of increased hypertension risk by BMI in Chinese adults.

Growth hormone (GH) affects linear growth and body composition, by increasing the secretion of insulin-like growth factor-I (IGF-I), muscle protein synthesis and lipolysis. The intake of protein (PROT) as well as the specific amino acids arginine (ARG) and lysine (LYS) stimulates GH/IGF-I secretion. The present paper aimed to investigate associations between PROT intake as well as intake of the specific amino acids ARG and LYS, and subsequent 3-year-change in linear growth and body composition among 6-year-old children.

Children’s data were collected from Copenhagen (Denmark), during 2001–2002, and again 3 years later. Boys and girls were separated into normal weight and overweight, based on BMI quintiles. Fat-free mass index (FFMI) and fat mass index (FMI) were calculated. Associations between change (Δ) in height, FMI and FFMI, respectively, and habitual PROT intake as well as ARG and LYS were analysed by multiple linear regressions, adjusted for baseline height, FMI or FFMI and energy intake, age, physical activity and socio-economic status.

Eighteen schools in two suburban communities in the Copenhagen (Denmark) area participated in the study.

In all, 223 children’s data were collected for the present study.

High ARG intake was associated with linear growth (β = 1·09 (se 0·54), P = 0·05) among girls. Furthermore, in girls, ΔFMI had a stronger inverse association with high ARG intake, if it was combined with high LYS intake, instead of low LYS intake (P = 0·03). No associations were found in boys.

In prepubertal girls, linear growth may be influenced by habitual ARG intake and body fat gain may be relatively prevented over time by the intake of the amino acids ARG and LYS.

To describe the relative validity and reliability of the FFQ used for assessing nutrient intakes of participants in the Tehran Lipid and Glucose Study (TLGS).

A total of 132 subjects (sixty-one males and seventy-one females) were included in the study. Dietary data were collected monthly by means of twelve 24 h dietary recalls (24hDR). Subjects completed two, 168-item semi-quantitative FFQ. Blood and urine samples were taken every season for measurement of plasma biomarkers and urinary N and K.

Mean age and BMI of the participants were 35·5 (sd 16·8) years and 25·5 (sd 5·2) kg/m2, respectively. The mean energy-adjusted and deattenuated correlation coefficients for overall nutrient intake between the 24hDR and FFQ2 were 0·44 and 0·37 in ≤35-year-olds and >35-year-olds, respectively, and for individual nutrients ranged from 0·24 to 0·71 in men (mean r = 0·53) and from 0·11 to 0·60 in women (mean r = 0·39). The mean energy-adjusted reliability coefficients varied from 0·48 in ≤35-year-olds to 0·65 in >35-year-olds, and ranged from 0·41 to 0·79 in men (mean r = 0·59) and from 0·39 to 0·74 in women (mean r = 0·60). The FFQ2 and 24hDR produced exact agreement rates ranging between 39·6 % and 68·3 % in men and between 39·6 % and 54·1 % in women. The ranges of questionnaire validity coefficients, with the sample correlation between the questionnaires and biochemical marker as the lower limit and the estimate obtained by the method of triads as the upper limit, were 0·21–0·56 (protein) and 0·37–0·61 (K).

The FFQ developed for the TLGS has reasonable relative validity and reliability for nutrient intakes in Tehranian adults.

Previous studies in Western populations have linked caffeine intake with health status. While detailed dietary assessment studies in these populations have shown that the main contributors to caffeine intake are coffee and tea, the wide consumption of Japanese and Chinese teas in Japan suggests that sources of intake in Japan may differ from those in Western populations. Among these teas, moreover, caffeine content varies widely among the different forms consumed (brewed, canned or bottled), suggesting the need for detailed dietary assessment in estimating intake in Japanese populations. Here, because a caffeine composition database or data obtained from detailed dietary assessment have not been available, we developed a database for caffeine content in Japanese foods and beverages, and then used it to estimate intake in a Japanese population.

The caffeine food composition database was developed using analytic values from the literature, 16 d weighed diet records were collected, and caffeine intake was estimated from the 16 d weighed diet records.

Four areas in Japan, Osaka (Osaka City), Okinawa (Ginowan City), Nagano (Matsumoto City) and Tottori (Kurayoshi City), between November 2002 and September 2003.

Two hundred and thirty Japanese adults aged 30–69 years.

Mean caffeine intake was 256·2 mg/d for women and 268·3 mg/d for men. The major contributors to intake were Japanese and Chinese teas and coffee (47 % each). Caffeine intake above 400 mg/d, suggested in reviews to possibly have negative health effects, was seen in 11 % of women and 15 % of men.

In this Japanese population, caffeine intake was comparable to the estimated values reported in Western populations.

Associations between diet and physical activity may identify behaviours that could be changed together to prevent childhood obesity. The present study examines associations between physical activity and obesogenic dietary behaviours in a large UK adolescent cohort.

Cross-sectional analysis of a UK cohort. Adolescents aged 10–11 years completed three 1 d diet diaries. Average daily energy consumption, percentage energy from fat and carbohydrate, energy density and grams of fruit and vegetables were estimated. To assess physical activity participants wore an accelerometer for three or more days. Regression models were run by sex to examine the extent to which dietary variables predicted physical activity before and after controlling for pubertal status, maternal education and adiposity.

The Avon Longitudinal Study of Parents and Children (ALSPAC), south-west England.

Adolescents who provided diet data at age 10 years and physical activity data at age 11 years.

Among boys, percentage energy from fat was consistently negatively associated with accelerometer-determined indicators of physical activity (standardized beta (β) = −0·055 to −0·101, P < 0·05) while total energy (β = 0·066 to 0·091, P < 0·05) and percentage energy from carbohydrate (β = 0·054 to 0·106, P < 0·05) were positively associated before and after adjustment for confounders. For girls fruit and vegetable intake was consistently positively associated with physical activity (β = 0·056 to 0·074, P < 0·005). However all associations were weak. Associations were broadly comparable when participants with non-plausible dietary reports were included or excluded from the analyses.

Obesogenic diet and physical activity behaviours were weakly associated, suggesting that interventions should focus on implementing strategies that are independently successful at changing diet or physical activity behaviours either separately or in combination.

Although there is growing awareness of the impact of diet on health, little attention has been given to the food available in our sports stadia. We used a football club (Citygrene FC) – Citygrene is a fictional name – in the English Premier League as a case study to examine the attitudes of male and female football supporters to the food and drink available at their home stadium (Citygrene Stadium).

The research design used five focus groups of male and female fans. The discourse was audiotaped, transcribed, coded and analysed for themes.

A football stadium in the English Premier League, England.

The participants were season ticket holders drawn from two stands at Citygrene Stadium.

The research showed a high level of dissatisfaction with the food and drink supplied. There were key differences in the views of the male and female participants in the focus groups, with the women more concerned about wider issues such as the lack of healthy food. Both men and women were aware of their role as consumers and felt that there was an opportunity for Citygrene to improve their catering profits, if they provided a better selection of food and drink and an improved service.

The study shows that there is a demand for healthier food options (and a wider choice of food and drink in general), which may provide an economic opportunity for stadium and catering managers. In addition, a stadium may be considered a potential ‘healthy setting’, which can serve as a supportive environment for healthier food choices.

The US Food and Drug Administration (FDA) proposes to establish standardized and mandatory criteria upon which front-of-pack (FOP) nutrition labelling must be based. The present study aimed to estimate the relative contribution of declared amounts of different nutrients to the perception of the overall ‘healthfulness’ of foods by the consumer.

Protein, fibre, vitamin A, vitamin C, calcium and iron were nutrients to encourage. Total fat, saturated fat, cholesterol, total and added sugar, and sodium were the nutrients to limit. Two content claims per nutrient used the FDA-approved language. An online consumer panel (n 320) exposed to multiple messages (n 48) rated the healthfulness of each hypothetical food product. Utility functions were constructed using conjoint analysis, based on multiple logistic regression and maximum likelihood estimation.

Consumer perception of healthfulness was most strongly driven by the declared presence of protein, fibre, calcium and vitamin C and by the declared total absence of saturated fat and sodium. For this adult panel, total and added sugar had lower utilities and contributed less to the perception of healthfulness. There were major differences between women and men.

Conjoint analysis can lead to a better understanding of how consumers process information about the full nutrition profile of a product, and is a powerful tool for the testing of nutrient content claims. Such studies can help the FDA develop science-based criteria for nutrient profiling that underlies FOP and shelf labelling.

To investigate how socio-economic position, demographic factors, degree of integration and dietary indicators are related to BMI/waist:hip ratio (WHR) and to weight dissatisfaction and slimming among South Asians in Oslo, Norway.

Cross-sectional study consisting of a health check including anthropometric measures and two self-administered questionnaires.

Oslo, Norway.

Pakistanis and Sri Lankans (n 629), aged 30–60 years, residing in Oslo.

BMI was positively associated with female gender (P = 0·004) and Pakistani origin (P < 0·001), and inversely associated with years of education (P = 0·011) and eating more hot meals (P = 0·016). WHR was positively associated with male gender (P < 0·001), age (P < 0·001) and a dietary pattern with high-fat foods (P = 0·005), and inversely associated with degree of integration (measured by a composite index, independent of duration of residence; P = 0·017). One-third of those with normal weight and most of those obese were dissatisfied with their weight. Among these, about 40 % had attempted to slim during the past year. Dissatisfaction with weight was positively associated with education in women (P = 0·006) and with integration in men (P = 0·026), and inversely associated with physical activity (P = 0·044) in men. Women who had made slimming attempts had breakfast and other meals less frequently than others (P < 0·05).

Weight dissatisfaction exists among South Asian immigrants. More research is needed regarding bodily dissatisfaction and the relationship between perception of weight and weight-change attempts among immigrants in Norway, in order to prevent and treat both obesity and eating disorders.

To examine the use of nutrition and health claims on packaged foods commonly eaten in Ireland.

An assessment of the labels of packaged food products that are commonly eaten in Ireland to determine the level of use of nutrition and health claims. Where present, the exact text of the claims as observed was recorded for seventeen different food categories and the claims categorised in accordance with EU Regulation 1924/2006 on nutrition and health claims made on foods.

Four retailers in Dublin, Ireland.

Of the foods surveyed, 47·3 % carried a nutrition claim and 17·8 % carried a health claim. Frozen fruit & vegetables and Breakfast cereals were the food categories with the highest proportion of nutrition claims. The most widespread nutrition claim was that referring to ‘fat’ and, within this group, the most commonly used text was ‘low fat’. The largest category of health claims observed in the present survey was general health claims. Claims referring to the digestive system were the most common followed by claims that a product will ‘lower/reduce/regulate your cholesterol’. Yoghurt & yoghurt drinks was the food category with the highest proportion of health claims, of which improving or boosting the digestive system was the most common.

The use of nutrition and health claims on the Irish market is widespread. EU Regulation 1924/2006 requires monitoring of the market for these types of claims. The current study could provide baseline data for the food industry and regulators to monitor the development of this market in the future.

To assess the short-term (15-d) and long-term (12-month) effects of a school-based health and nutrition education intervention on diet, nutrition intake and BMI.

The 12-week teacher-implemented intervention in combination with seminars organized for parents was aimed at improving children’s diet and nutrition knowledge. The intervention took place between September 2007 and January 2008. The participants were randomized to two study groups, the intervention group (IG) and control group (CG), and were examined prior to the intervention on a variety of health knowledge, dietary, behavioural and anthropometric indices. The same measurements were collected 15 d and 1 year after the intervention.

All high schools in Vyronas, a densely populated district of Athens, Greece.

The sample consisted of 191 students aged 12–13 years.

Twelve months after the intervention, the programme was effective in reducing various indices in the IG compared with baseline findings (BMI: 23·3 (sd 2·8) v. 24·0 (sd 3·1) kg/m2, P < 0·001; daily energy intake: 8112·4 (sd 1412·4) v. 8503·3 (sd 1419·3) kJ/d, P < 0·001; total fat intake: 31·3 (sd 4·4) v. 35·4 (sd 4·7) % of daily energy, P < 0·001). Except for BMI, decreases in the aforementioned indices were also observed 15 d after the intervention. In addition, students of the IG reduced their weekly consumption of red meat and non-home-made meals and increased their frequency of fruit and breakfast cereal consumption.

The beneficial effects of this nutrition education intervention among adolescents may highlight the potential of such programmes in the prevention of obesity.

To assess the impact of the 1996–2005 integrated community-based micronutrient and health (MICAH) programme on linear growth retardation (stunting) in Malawian preschool children living in rural areas.

Prospective study of three large-scale cross-sectional surveys conducted in 1996, 2000 and 2004 in MICAH and Comparison populations.

Rural areas in Malawi.

Preschool children (6·0–59·9 months) from randomly selected households (474 from the 1996 baseline survey; 1264 from 2000 MICAH areas; 1500 from 2000 Comparison areas; 1959 from 2004 MICAH areas; and 1008 from 2004 Comparison areas), who responded to a household questionnaire, were weighed and measured using standard protocols.

At the baseline in 1996, the prevalence of stunting (60·2 %) was very high. By 2000, the prevalence of stunting had declined to 50·6 % and 56·0 % (χ2 = 7·8, P = 0·005) in MICAH and Comparison areas, respectively. In 2004, the prevalence of stunting did not differ significantly between MICAH and Comparison areas (43·0 % v. 45·1 %; χ2 = 1·11, P = 0·3). Severe stunting affected 34·7 % of children at baseline, which declined to 15·8 % and 17·1 % (χ2 = 0·86, P = 0·4) in MICAH and Comparison areas, respectively, by 2004. Regional variations existed, with proportionately fewer children from the Northern region being stunted compared to their Central and Southern region counterparts.

Given the length of implementation, wide-scale coverage and positive impact on child growth in Phase I (1996–2000), the MICAH programme is a potential model for combating linear growth retardation in rural areas in Malawi, although the catch-up improvement in Comparison areas during Phase II (2000–2004) cannot be adequately explained.

Tea has been reported to reduce cardiovascular mortality, but the underlying mechanisms are largely unknown. The aim of the current project was to investigate the effect of green tea (Japanese Sencha), black tea (Indian Assam B.O.P.) and Rooibos tea (South Africa) on angiotensin-converting enzyme (ACE) and nitric oxide (NO).

Seventeen healthy volunteers received a single oral dose of 400 ml green tea, black tea or Rooibos tea in a randomized, three-phase, crossover study. ACE activity and NO concentration were measured (at 0, 30, 60 and 180 min) in all phases. ACE activity was analysed by means of a commercial radioenzymatic assay. Nitrite was analysed as a marker of NO concentration. In addition, ACE genotype was determined using a PCR method.

Oral intake of a single dose of Rooibos tea significantly inhibited ACE activity after 30 min (P < 0·01) and after 60 min (P < 0·05). A significant inhibition of ACE activity was seen with green tea for the ACE II genotype 30 min after intake of the tea (P < 0·05) and for the ACE ID genotype 60 min after intake (P < 0·05). A significant inhibition of ACE activity was also seen with Rooibos tea for the ACE II genotype 60 min after intake (P < 0·05). No significant effect on NO concentration was seen.

These results suggest that green tea and Rooibos tea may have cardiovascular effects through inhibition of ACE activity.

Childhood obesity is increasingly being recognized as a major public health problem in the Caribbean. The objective of the present study was to evaluate the effectiveness of a short-term, school-based, multi-component education intervention on improving the knowledge, attitudes and behaviour of primary-school children towards better dietary and activity habits.

The study was a randomized, controlled, school-based nutrition education and physical activity intervention. Participating schools were randomly assigned to the intervention (IVG) and non-intervention (NIVG) groups.

All primary schools in Sangre Grande, north-east Trinidad.

Five hundred and seventy-nine pupils in their sixth year of primary-school education were enrolled from twelve schools in Sangre Grande, north-east Trinidad.

Approximately 23 % of participants had BMI ≥ 85th percentile of the Centers for Disease Control and Prevention age- and gender-specific cut-off values. In multivariate regression equations controlling for age, gender, BMI and baseline value, intervention was associated with lower intake levels of fried foods, snack foods high in fat, sugar and salt (HFSS) and sodas (P < 0·05). In similar analyses, intervention was associated with higher knowledge scores (P < 0·01). Intervention was not significantly associated with physical activity and Children’s Eating Attitude Test-26 (ChEAT26) scores after controlling for age, gender, BMI and the relevant baseline values.

The intervention was associated with lower intake levels of fried foods, HFSS foods, sodas and higher knowledge scores independent of age, gender, BMI, ethnicity and the appropriate baseline value. Finally, the intervention was not associated with changes in physical activity behaviours in multivariate analyses.