To identify social, behavioural and cultural factors that explain the thinness of young women relative to their men in rural Maharashtra, India.

Twelve focus group discussions were conducted to explore the villagers' understanding of why women in their area might be thinner than men.

Pabal village and surrounding hamlets, in the Pune district of Maharashtra, India.

Samples of young mothers and fathers, grandmothers and grandfathers were selected from families in the village with children below 10 years of age.

Four factors were identified that the villagers felt contributed to the disparity in thinness. First, marriage isolated girls from their own families and villages, and brought the expectation of early motherhood. Young brides were often unable to relax and eat adequately. Second, marriage increased the workload of young women. They were expected to do the heaviest household chores as well as farm work in this predominantly agricultural community. Third, women had no financial autonomy or freedom of movement, and were therefore denied access to supplementary food sources available to men. Fourth, young women felt responsible for their household's health and success. They were encouraged to fast regularly to ensure this. Despite feeling responsible, young women had no control over factors that might affect the household's well being. This made them anxious and worried a great deal of the time.

Interventions to improve the nutritional status of young women in this region need to recognise the roles and responsibilities taken up by young brides.

A study was conducted among the Onge tribe of the Andaman and Nicobar Islands with the objectives of identifying demographic factors responsible for the decline in their population and assessing their nutritional status, which is an important determinant of child survival.

The study included estimation of indices of fertility and child mortality, and assessment of nutritional status. All individuals of the Onge community settled on Little Andaman Island were included.

The mean total marital fertility rate was estimated to be 5.15 live births per woman and the general fertility rate was 200 live births per 1000 married-woman-years. Although the gross reproduction rate was estimated to be 2.2 female children per married woman, the net reproduction rate was only 0.9 surviving female child per married woman. The mean infant mortality rate during the past 30 years was 192.7 per 1000 live births, and the child survival rate was found to be only 53.2%. A mild to moderate degree of malnutrition was found in 85% of children of pre-school age and severe malnutrition in 10%. The Onges had low intakes of iron, vitamin A and vitamin C. All the screened Onges were found to be infested with one or more intestinal parasites.

High childhood mortality appears to be the predominant demographic factor responsible for the decline in the Onge population. The high prevalence of undernutrition and micronutrient deficiency disorders could be important factors contributing to the high childhood mortality.

To investigate the prevalence of anaemia (haemoglobin < 11.0 to 13.0 g dl−1 depending on age and sex group), iron deficiency (transferrin receptor concentration > 8.3 μg ml−1) and vitamin A deficiency (serum retinol < 0.7 μmoll−1) in adolescent refugees.

Cross-sectional surveys.

Kakuma refugee camp in Kenya and seven refugee camps in Nepal.

Adolescent refugee residents in these camps.

Anaemia was present in 46% (95% confidence interval (CI): 42–51) of adolescents in Kenya and in 24% (95% CI: 20–28) of adolescents in Nepal. The sensitivity of palmar pallor in detecting anaemia was 21%. In addition, 43% (95% CI: 36–50) and 53% (95% CI: 46–61) of adolescents in Kenya and Nepal, respectively, had iron deficiency. In both surveys, anaemia occurred more commonly among adolescents with iron deficiency. Vitamin A deficiency was found in 15% (95% CI: 10–20) of adolescents in Kenya and 30% (95% CI: 24–37) of adolescents in Nepal. Night blindness was not more common in adolescents with vitamin A deficiency than in those without vitamin A deficiency. In Kenya, one of the seven adolescents with Bitot's spots had vitamin A deficiency.

Anaemia, iron deficiency and vitamin A deficiency are common among adolescents in refugee populations. Such adolescents need to increase intakes of these nutrients; however, the lack of routine access makes programmes targeting adolescents difficult. Adolescent refugees should be considered for assessment along with other at-risk groups in displaced populations.

To assess the iodine status of long-term refugees dependent on international food aid and humanitarian assistance.

A series of cross-sectional two-stage cluster or systematic random sample surveys which assessed urinary iodine excretion and the prevalence of visible goitre. Salt samples were also collected and tested for iodine content by titration.

Six refugee camps in East, North and Southern Africa.

Male and female adolescents aged 10–19 years.

The median urinary iodine concentration (UIC) ranged from 254 to 1200 μg l−1 and in five of the camps exceeded the recommended maximum limit of 300 μg l−1, indicating excessive iodine intake. Visible goitre was assessed in four surveys where it ranged from 0.0 to 7.1%. The camp with the highest UIC also had the highest prevalence of visible goitre. The iodine concentrations in 11 salt samples from three camps were measured by titration and six of these exceeded the production-level concentration of 20 to 40 ppm recommended by the World Health Organization (WHO), but were all less than 100 ppm.

Excessive consumption of iodine is occurring in most of the surveyed populations. Urgent revision of the level of salt iodisation is required to meet current WHO recommendations. However, the full cause of excessive iodine excretion remains unknown and further investigation is required urgently to identify the cause, assess any health impact and identify remedial action.

To identify individual and contextual factors associated with the practice of exclusive breast-feeding (EBF).

We analysed 34 435 children under 6 months of age living in 111 municipalities in the state of São Paulo, south-eastern Brazil, who participated in a survey investigating feeding practices during the first year of life, carried out during the 1999 national vaccination campaign. The questionnaire employed included questions on the consumption, in the last 24 h, of breast milk, water, tea, other types of milk and other foods, in addition to mother and child characteristics. Information on the pro-breast-feeding measures implemented in the municipalities was also collected. The effects of individual and contextual characteristics on EBF were analysed using multilevel models.

The final model showed a greater chance of EBF in women with tertiary education (odds ratio (OR) = 1.91; 95% confidence interval (CI) 1.75–2.06); women aged between 25 and 29 years (OR = 1.52; 95% CI 1.41–1.63); multiparae (OR = 1.42; 95% CI 1.33–1.49); female babies (OR = 1.12; 95% CI 1.05–1.18); birth weight ≥3000 g (OR = 1.73; 95% CI 1.49–1.97); child follow-up in the private health-care network (OR = 1.10; 95% CI 1.02–1.18); and municipalities with four or five pro-breast-feeding measures (OR = 2.4; 95% CI 2.19–2.88). An analysis of the interactions between individual and contextual variables showed that the presence of at least four pro-breast-feeding measures in the municipality attenuated the risk of early termination of EBF associated with low maternal schooling and low birth weight, and transformed child follow-up in the public network into a protective factor against the early termination of breast-feeding.

The presence of measures aimed at protecting, promoting and supporting breast-feeding in the municipality had a positive influence on EBF and attenuated the impact of risk factors for the termination of breast-feeding.

The purpose of this study was to investigate the prevalence of food insecurity and factors related to it among homeless and runaway adolescents.

Computer-assisted personal interviews were conducted with homeless and runaway adolescents directly on the streets and in shelters.

Interviews were conducted in eight Midwest cities: Des Moines, Cedar Rapids, Iowa City, Kansas City, Lincoln, Omaha, St. Louis and Wichita.

The subjects were 428 (187 males; 241 females) homeless and runaway adolescents aged 16–19 years. Average age of the adolescents was 17.4 (standard deviation 1.05) years.

About one-third of the adolescents had experienced food insecurity in the past 30 days. Factors associated with food insecurity were age of adolescent, a history of caretaker neglect and abuse, having ever spent time directly on the street, a small post-runaway social network, and engaging in deviant and non-deviant street food-acquisition strategies.

Based on these findings, our conservative estimate is that nationally more than 165 000 homeless and runaway adolescents experienced food insecurity in the past 30 days. These adolescents are largely hidden from public notice and they are usually missed in studies that address national hunger.

To describe geographical differences and time trends in the supply of the most important food components of the traditional Mediterranean diet.

Food supply data collected from national food balance sheets for the period 1961–2001.

Selected Mediterranean countries: Spain, Italy, France, Greece, Algeria, Morocco, Tunisia and Turkey.

Differences of almost 30-fold and five-fold were found in the supply of olive oil and fruits and vegetables, respectively, among the Mediterranean countries studied during the 1960s. A favourable increasing trend for the supply of fruit and vegetables was observed in most Mediterranean countries. However, an increase in the supply of meats and dairy products and a decrease in the supply of cereals and wine were observed in European Mediterranean countries from 1961 until 2001. Only in African and Asiatic Mediterranean countries were cereals the base of food supply. During the 1990s, Greece's food supply pattern was closest to the traditional Mediterranean diet, while Italy and Spain maintained a high availability of fruits, vegetables and olive oil, but were losing the other typical components. Among African and Asiatic Mediterranean countries, only Turkey presented a traditional Mediterranean dietary pattern except with respect to olive oil, the supply of which was very low. France showed a Western dietary pattern, with a high supply of animal products and a low supply of olive oil.

Dietary supplies in the Mediterranean area were quite heterogeneous in the 1960s and have experienced a process of Westernization, especially in European Mediterranean countries.

To compare the ability of waist circumference (WC), body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) to predict cardiovascular risk factors in an urban adult population of Tehranian women.

Population-based cross-sectional study.

Tehran, the capital of Iran.

This study was conducted on 5073 women aged 18–74 years, participants of the Tehran Lipid and Glucose Study. Demographic data were collected. Anthropometric indices were measured according to standard protocols. Cut-off points of BMI, WC, WHR and WHtR were considered as 25 kg m−2, 80 cm, 0.8 and 0.5, respectively. Blood pressure was measured and hypertension was defined based on the sixth report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Biochemical analyses were conducted on fasting blood samples. Diabetes was defined as fasting plasma glucose ≥126 mg dl−1 or 2-hour plasma glucose ≥200 mg dl−1 and dyslipidaemia based on the third report of the National Cholesterol Education Program Expert Panel. The presence of ‘at least one risk factor’ from the three major cardiovascular risk factors (hypertension, dyslipidaemia and diabetes) was also evaluated.

Mean (±standard deviation) age of women was 39.9 ± 14.6 years; mean BMI, WC, WHR and WHtR were 27.1 ± 1.5 kg m−2, 86.5 ± 13.5 cm and 0.83 ± 0.08 and 0.55 ± 0.08, respectively. Of the four anthropometric measures, WC had the highest sensitivity and specificity to identify subjects with risk factors in both the 18–39 year and the 40–74 year age categories. WC was seen to have a higher percentage of correct prediction than BMI, WHR and WHtR.

It is concluded that WC is the best screening measure for cardiovascular risk factors, compared with BMI, WHR and WHtR, in Tehranian adult women.

Iron has been suggested to play a role in the development of cardiovascular disease (CVD) through its pro-oxidant properties. However, epidemiological studies on iron status and the risk of CVD have yielded conflicting results. We therefore carried out a prospective study to evaluate the relationship between iron status and CVD in a middle-aged French population.

In total, 9917 subjects (3223 men aged 45–60 years and 6694 women aged 35–60 years) included in the SU.VI.MAX (SUpplementation en VItamines et Minéraux AntioXydants) cohort were followed prospectively for 7.5 years. All cases of ischaemic heart disease (IHD) were identified and validated. CVD risk factors, haemoglobin and serum ferritin concentrations were measured at baseline.

Of men 4.3%, and of women 37.8%, presented at baseline a serum ferritin concentration <30 μg l−1. During the follow-up, 187 subjects (148 men, 39 women) developed IHD. Serum ferritin was positively associated with total cholesterol, serum triglycerides, systolic and diastolic blood pressure, body mass index and haemoglobin. No linear association was found between serum ferritin and IHD risk in men or in women.

Our data do not support a major role of iron status in the development of IHD in a healthy general population.

To examine the influence of individual- and area-level socio-economic characteristics on food choice behaviour and dietary intake.

The city of Eindhoven in the south-east Netherlands.

A total of 1339 men and women aged 25–79 years were sampled from 85 areas (mean number of participants per area = 18.4, range 2–49). Information on socio-economic position (SEP) and diet was collected by structured face-to-face interviews (response rate 80.9%). Individual-level SEP was measured by education and household income, and area-level deprivation was measured using a composite index that included residents' education, occupation and employment status. Diet was measured on the basis of (1) a grocery food index that captured compliance with dietary guidelines, (2) breakfast consumption and (3) intakes of fruit, total fat and saturated fat. Multilevel analyses were performed to examine the independent effects of individual- and area-level socio-economic characteristics on the dietary outcome variables.

After adjusting for individual-level SEP, few trends or significant effects of area deprivation were found for the dietary outcomes. Significant associations were found between individual-level SEP and food choice, breakfast consumption and fruit intake, with participants from disadvantaged backgrounds being less likely to report food behaviours or nutrient intakes consistent with dietary recommendations.

The findings suggest that an individual's socio-economic characteristics play a more important role in shaping diet than the socio-economic characteristics of the area in which they live. In this Dutch study, no independent influence of area-level socio-economic characteristics on diet was detected, which contrasts with findings from the USA, the UK and Finland.

To assess the validity and reliability of the most recent adaptation of Block's full-diet food-frequency questionnaire (FFQ) among a sample of Canadian women.

Participants completed a self-administered FFQ (FFQ1), two unannounced 24-hour recalls (weekday and weekend) and a second FFQ (FFQ2) between October 2003 and February 2004. FFQs and recalls were analysed for 32 nutrients using Block Dietary Data Systems and the University of Minnesota's Nutrient Data System. Mean and median intakes were computed, along with crude and deattenuated Pearson correlation coefficients between FFQ1 and the average of two recalls (validity) and between FFQ1 and FFQ2 (reliability).

Ontario, Canada.

A random population-based sample (n = 166) of women aged 25 to 74 years.

One hundred and fifteen (69%) women completed FFQ1, 96 completed FFQ1 and both recalls, and 93 completed both FFQs, about 56 days apart. Mean intakes were similar for most nutrients. FFQ reliability was high, with Pearson correlation coefficients having a median of 0.75, ranging from 0.57 to 0.90 (macronutrients) and from 0.65 to 0.88 (micronutrients from supplements and food). FFQ validity was moderate to high, with deattenuated Pearson correlation coefficients having a median of 0.59, ranging from 0.11 to 0.73 (macronutrients) and from 0.50 to 0.76 (micronutrients from supplements and food). Our micronutrient correlations were similar to or higher than those of other studies that included supplements. Two correlations <0.40 were associated with fats.

The validity and reliability of this full-diet version of the Block FFQ were moderate to high, supporting its use in future studies among Canadian women.