In view of the fact that height differences between socio-economic groups are apparent early in childhood, it is of interest to examine whether skeletal growth is reflective of the social class gradient in CVD risk. The present study examined blood pressure levels, adiposity and growth of adolescent boys from high and low social classes.

In a cross-sectional study, skeletal growth (height and sitting height), adiposity (weight, BMI and body fat) and blood pressure levels of the adolescents were measured.

Pune, India.

Adolescent schoolboys (9–16 years) from high socio-economic (HSE; n 1146) and low socio-economic (LSE; n 932) class.

LSE boys were thin, short and undernourished (mean BMI: 15·5 kg/m2v. 19·3 kg/m2 in HSE boys, P = 0·00). Social gradient was revealed in differing health risks. The prevalence of high systolic blood pressure (HSBP) was high in HSE class (10·5 % v. 2·7 % in LSE class, P = 0·00) and was associated with adiposity, while the prevalence of high diastolic blood pressure (HDBP) was high in LSE class (9·8 % v. 7·0 % in HSE class, P = 0·00) and had only a weak association with adiposity. Despite this, lower ratio of leg length to height was associated with significantly higher respective health risks, i.e. for HDBP in LSE class (OR = 1·99, 95 % CI 1·14, 3·47) and for HSBP in HSE class (OR = 1·69, 95 % CI 1·02, 2·77).

As stunting in childhood is a major problem in India and Asia, the leg length to height indicator needs to be validated in different populations to understand CVD risks.

Guatemala is a country severely affected by malnutrition, particularly in its child population. The present study aimed to assess the impact of recognised aetiological factors on the prevalence of malnutrition and to establish the efficacy of a Guatemalan malnutrition clinic by examining the changes in the prevalence of malnutrition in the ten surrounding communities served by the clinic.

Records of children (n 7681) aged 5–16 years seen by the clinic between 2004 and 2006 were examined. Anthropometric data for each child were taken from these records and used as an indicator for their nutritional status to estimate the change in rates of malnutrition during this period.

An overall reduction was seen in all forms of malnutrition over the 3-year period, although over 50 % of the study population remained malnourished in 2006. A consistent reduction was also seen in rates of moderate and severe malnutrition, but not in rates of mild malnutrition.

The results demonstrate that clinics such as Primeros Pasos can have a beneficial effect on schoolchildren, particularly those who are severely malnourished. A need has been highlighted for more research in this area, particularly how clinics such as Primeros Pasos can be best used in the fight against malnutrition.

To investigate the associations and relative impact of illness, socio-economic and social indicators for nutritional status among elderly persons in rural Bangladesh.

A multidisciplinary, cross-sectional study employing home interviews to collect information on demographic, socio-economic and social status; clinical examination to classify medical diagnoses; and Mini Nutritional Assessment (MNA) to assess the nutritional status of each participant.

Matlab, Bangladesh.

A total of 625 randomly selected individuals (≥60 years of age) participated in home interviews and 473 underwent clinical examination. Complete information on nutritional status was available for 457 individuals, median age 68 years, 55 % women.

Twenty-six per cent of the elderly participants were undernourished and 62 % were at risk of malnutrition according to MNA. More than three-quarters of the participants had acute infections, 66 % suffered from chronic illnesses, 36 % had sensory impairments and 81 % were suffering from gastrointestinal disorders. Acute infections (P < 0·001), gastrointestinal disorders (P < 0·01), depressive symptoms (P < 0·001) and impaired cognitive function (P < 0·01) were significantly and independently associated with poorer nutritional status. Moreover, female gender (P < 0·05), having no income (P < 0·01), being illiterate (P < 0·01) and not receiving regular financial support (P < 0·05) were also independently associated with poor nutritional status.

Malnutrition among elderly people in rural Bangladesh is associated with female gender, medical, psychological, socio-economic and social indicators. A multidimensional approach is probably needed to reduce undernutrition in older populations in low-income countries like Bangladesh.

To determine iodine intake and urinary iodine excretion (UIE) in a group of pregnant Thai women and the concentration of thyroid-stimulating hormone (TSH) in their neonates.

A prospective cohort study.

Three districts of Songkhla, southern Thailand.

Two hundred and thirty-six pregnant women.

A quarter of the participants lacked knowledge of iodine and the prevention of iodine deficiency, although 70 % used iodized salt. Those who did not use iodized salt stated that they had no knowledge about iodine (57 %) and no iodized salt was sold in their village (36 %). The median iodine intake in the three districts was 205–240 μg/d, with 53–74 % of pregnant women having iodine intake <250 μg/d. The median UIE in the three districts was 51–106 μg/l, with 24–35 % having UIE < 50 μg/l. The mean neonatal TSH was 2·40 (sd 1·56) mU/l, with 8·9 % of neonates having TSH > 5 mU/l.

The studied women and their fetuses were at risk of mild iodine deficiency. About a quarter of the participants lacked knowledge of the importance of iodine. Education regarding the importance of iodine supplements and the promotion of iodized salt should be added to national health-care policies in order to prevent iodine-deficiency disorders, diseases that are subclinical but have long-term sequelae.

To examine changes in breast-feeding take-up rates among young children in Scotland and to assess whether maternal education or occupation-based social class is a stronger and better predictor of breast-feeding take-up.

Binary logistic regression models were developed from the first sweep of the Growing Up in Scotland longitudinal survey, for the two cohorts of children.

A national representative survey for Scotland.

A baby cohort of 5012 singletons born over a 12-month period between June 2004 and May 2005, and a toddler cohort of 2732 singletons born over a 12-month period between June 2002 and May 2003.

Mothers from more privileged social classes and those with more educational qualifications resulted as more likely to breast-feed. However, maternal education was a better and more robust predictor of breast-feeding take-up compared with social class. There were no significant differences in breast-feeding take-up between the two cohorts and only minor differences between mothers aged 20–29 years and those who stated an intention to bottle-feed prior to birth.

The study suggests that the importance of maternal education in influencing breast-feeding has been somewhat overlooked in research based in more developed countries. The results indicate that, compared with occupation-related social class, maternal education is a more informative, accurate and useful lens through which to understand and explain patterns of breast-feeding take-up.

We explore the association between a neighbourhood’s ethnic composition and the foods and nutrients consumed by Mexican-Americans.

Cross-sectional survey of a large national sample, from the Third National Health and Nutrition Examination Survey (1988–94), was linked to the 1990 Census. The outcomes were food frequencies and serum levels of micronutrients. The variable of interest was percentage of Mexican-Americans at the census tract level.

United States.

A total of 5306 Mexican-American men and women aged 17–90 years.

Increased percentage of Mexican-Americans at the census tract level was associated with less consumption of fruits, carrots, spinach/greens and broccoli and with lower serum levels of Se, lycopene, α-carotene, vitamin C and folate. By contrast, increased percentage of Mexican-Americans at the census tract level was associated with more consumption of corn, tomatoes, hot red chilli peppers and legumes such as beans, lentils or chickpeas.

An increased percentage of Mexican-Americans at the census tract level was associated with less consumption of selective foods (e.g. some fruits, broccoli) and low levels of serum Se or vitamin C, but it was associated with more consumption of other foods (e.g. legumes, tomatoes, corn products) that may have positive effects on health in this population.

To determine the prevalence of anaemia and associated factors among under-fives and their mothers in a rural area of Western Uganda.

A cross-sectional investigation using both qualitative and quantitative methods of data collection. Stratified multistage sampling methods were used to select the study sample. A haemoglobinometer was used to assess Hb levels in the blood.

A rural district in Western Uganda.

Children aged 6–59 months and their mothers aged 15–49 years.

The overall prevalence of Fe-deficiency anaemia among children and their mothers was 26·2 % and 17·9 %, respectively. There was a significant correlation (r = 0·5, P = 0·008) between the Hb levels of the mothers and their children. Place of birth, age of the child, factors related to complementary foods, and formal education and nutrition knowledge of the mother were major factors that were significantly associated (r = 0·05, P = 0·05) with low Hb levels among the children. The most important factors that were associated with low Hb levels of the mothers were their formal education, nutrition knowledge and health status.

Fe-deficiency anaemia was found to be a major problem in this cohort of children and their mothers. Dietary factors and sociodemographic factors were the major factors associated with high levels of anaemia among the children and their mothers. It is therefore recommended that rural mothers should be sensitized on best practices for prevention of anaemia among both women and children.

To test equations for calculating infants’ energy requirements as a simple and reliable instrument for estimating the amount of breast milk consumed in epidemiological studies where test-weighing is not possible.

Infants’ energy requirements were calculated using three different equations based on reference data and compared with actual energy intakes assessed using the 3 d weighed dietary records of breast-fed infants from the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study.

A sub-sample of 323 infants from the German DONALD Study who were predominantly breast-fed for at least the first four months of life, and who had 3 d weighed dietary records and repeated body weight measurements within the first year of life.

Healthy, term infants breast-fed for at least 4 months, 0–12 months of age.

The overall differences between measured energy intake and calculated energy requirements were quite small, never more than 10 % of total energy intake, and smaller than the mean variance of energy intake between the three days of recording. The equation of best fit incorporated body weight and recent growth, while the worst fit was found for the equation not considering body weight.

Breast milk consumption in fully and partially breast-fed infants can be reasonably quantified by calculating the infants’ individual energy requirements via simple equations. This provides a feasible approach for estimating infant energy intake in epidemiological studies where test-weighing of breast milk is not possible.

Every society follows its own traditional health-care beliefs and practices during and after pregnancy, which is intimately linked to its socio-cultural environment. The objective of the present study was to document pregnancy-related food practices and the social-cultural factors linked with them.

The present study was a cross-sectional one conducted among a group of women residing in five villages in east Sikkim, India. Mothers who had given birth to a child one year before the survey participated in the study. The mothers answered a pre-tested questionnaire on food habits and practices followed antepartum and for 6 weeks postpartum.

The study group consisted of 199 women of Nepali caste groups with variations in economic condition.

More than 86 % of mothers consumed special foods during the postpartum period. Taboos on different food categories during the postpartum were reported only by 65·3 % of mothers. Factors found to be significantly associated with special food consumption were literacy status during the antepartum and parity during the postpartum.

The change in consumption patterns reflects the success of a safe motherhood campaign propagated by the government. Detailed investigation in this area, involving per capita daily consumption during pregnancy and the postpartum period, is needed.

The possibility of mother-to-child transmission (MTCT) of HIV through breast-feeding has focused attention on how best to support optimal feeding practices especially in low-resource and high-HIV settings, which characterizes most of sub-Saharan Africa. To identify strategic opportunities to minimize late postnatal HIV transmission, we undertook a review of selected country experiences on HIV and infant feeding, with the aims of documenting progress over the last few years and determining the main challenges and constraints.

Field teams conducted national-level interviews with key informants and visited a total of thirty-six facilities in twenty-one sites across the three countries – eighteen facilities in Malawi, eleven in Kenya and seven in Zambia. During these visits interviews were undertaken with key informants such as the district and facility management teams, programme coordinators and health workers.

A rapid assessment of HIV and infant feeding counselling in Kenya, Malawi and Zambia, undertaken from February to May 2007.

Infant feeding counselling has, until now, been given low priority within programmes aimed at prevention of MTCT (PMTCT) of HIV. This is manifest in the lack of resources – human, financial and time – for infant feeding counselling, leading to widespread misunderstanding of the HIV transmission risks from breast-feeding. It has also resulted in lack of space and time for proper counselling, poor support and supervision, and very weak monitoring and evaluation of infant feeding. Finally, there are very few examples of linkages with community-based infant feeding interventions. However, all three countries have started to revise their feeding policies and strategies and there are signs of increased resources.

In order to sustain this momentum it will be necessary to continue the advocacy with the HIV community and stress the importance of child survival – not just minimization of HIV transmission – and hence the need for integrating MTCT prevention.

To evaluate levels of vitamin D3 and HDL-cholesterol (HDL-C), and the ratio of HDL-C to LDL-cholesterol (LDL-C), in schoolchildren receiving vitamin-D-fortified, fat-depleted, high-Ca milk in schools.

Cross-sectional study of previously randomised schools receiving supplemental milk, compared with a matched control group.

Low-decile Year 1–6 schools in the Waikato region of New Zealand.

Year 3 children from either milk schools or control schools, consenting to blood sampling.

For eighty-nine children receiving supplementary daily milk, vitamin D3 levels were significantly higher than in eighty-three control children matched for age, sex, body composition and ethnicity (mean (sd): 49·6 (15·8) v. 43·8 (14·7) nmol/l, P = 0·011), as were HDL-C levels (mean (sd): 1·47 (0·35) v. 1·35 (0·29) mmol/l, P = 0·024) and HDL-C:LDL-C (median: 0·79 v. 0·71, P = 0·026). LDL-C levels were similar in both groups (mean (sd): 2·07 (0·55) v. 2·16 (0·60) mmol/l, P = 0·31). Of control children, 32/83 (20·2 %) of the milk group (Pearson’s χ2 = 7·00, P = 0·008). Mean 25-hydroxyvitamin D (vitamin D3) levels in the milk group were still below the lower end of the recommended normal range (60 nmol/l).

Vitamin D3 levels are low in low-decile Year 3 children in midwinter. Levels are improved with vitamin-D-fortified milk but still below the recommended range. HDL-C and HDL-C:LDL-C levels are improved in the milk-supplemented group. This supports the supply of vitamin-D-fortified, fat-reduced milk to schools.

To assess the nutritional status and dietary practices of 0–24-month-old children living in Brazilian Amazonia.

Cross-sectional study. Information on children’s dietary intakes was obtained from diet history data. Weight and length were measured for anthropometric evaluation. Fe status was assessed using fasting venous blood samples; Hb, serum ferritin and soluble transferrin receptor concentrations were measured.

The towns of Assis Brasil and Acrelândia in the state of Acre, north-west Brazil.

A total of sixty-nine randomly selected 0–24-month-old children.

Of these children, 40·3 % were anaemic, 63·1 % were Fe-deficient, 28·1 % had Fe-deficiency anaemia and 11·6 % were stunted. Breast-feeding was initiated by 97·1 % of mothers, followed by early feeding with complementary foods. The dietary pattern reflected a high intake of carbohydrate-rich foods and cow’s milk, with irregular intakes of fruit, vegetables and meat. All infants and 92·3 % of toddlers were at risk of inadequate Fe intakes. Fe from animal foods contributed on average 0·5 % and 14·3 % to total dietary Fe intake among infants and toddlers, respectively.

Poor nutritional status and inadequate feeding practices in this study population reinforce the importance of exclusive breast-feeding during the first 6 months of life. Greater emphasis is required to improve the bioavailability of dietary Fe during complementary feeding practices.

To examine the relationship between psychological distress (PD) and plasma n-3 long-chain (LC) PUFA, i.e. EPA, docosapentaenoic acid (DPAn-3) and DHA.

Population-based, cross-sectional Santé-Québec Health Survey (1991). Participants were categorized as high-level PD if they scored over the 80th percentile of the PD Index in the Santé-Québec Survey; non-distressed subjects were those who scored less than this cut-off. Associations between tertiles of n-3 fatty acids (FA) and the risk of high-level PD were expressed as odds ratios, with the lowest tertile as the reference group.

Québec, Canada.

Data were analysed from a representative sample of 852 James Bay Cree Indian adults aged 18 years and over.

Proportions of n-3 FA were statistically significantly lower in the PD than in the non-distressed group. After adjustment for confounders, EPA was the only individual n-3 FA significantly associated with the risk of high-level PD. Combinations of EPA + DHA or EPA + DPAn-3 + DHA or the sum of n-3 were also associated with the risk of high-level PD. Compared with the lowest tertile of EPA + DHA, the OR for high-level PD was 0·89 (95 % CI 0·59, 1·36) for the second and 0·56 (95 % CI 0·32, 0·98) for the third tertile, after controlling for confounders.

In the present retrospective, cross-sectional study, we found that proportions of n-3 LC PUFA in plasma phospholipids, markers of n-3 LC PUFA consumption from fish, were inversely associated with PD.

To examine whether an FFQ can be used for assessing exposure to methylmercury (MeHg) by estimating MeHg intake from seafood consumption using the FFQ and confirming the accuracy of the estimated value.

Seafood consumption of pregnant women was assessed using the FFQ. Total mercury (T-Hg) concentrations of maternal red blood cells (RBC) and hair were measured as exposure indices of MeHg.

A prospective birth cohort study, the Tohoku Study of Child Development (TSCD), which has been ongoing since 2001.

The subjects were 609 pregnant Japanese women who were enrolled in the TSCD.

MeHg intake was estimated from seafood consumption determined using the FFQ and the MeHg concentrations in each type of seafood. The accuracy of the estimated value was confirmed by comparison with T-Hg in RBC and hair. Estimated MeHg intake was 42·3 μg/week, and 43·0 % of that was from large predatory fish. Compared with the Japanese tolerable weekly intake, in total 12·5 % of the subjects exceeded it. T-Hg concentrations in RBC and hair were significantly correlated with estimated MeHg intake: r = 0·325 (P < 0·0001) for RBC and r = 0·305 (P < 0·0001) for hair.

Estimated MeHg intake based on the FFQ was significantly associated with T-Hg concentrations in RBC and hair. Although the estimated value involves uncertainties, the FFQ appears to be a useful tool for assessment of exposure to MeHg.

To assess the reproducibility of a 135-item self-administered semi-quantitative FFQ.

Control subjects who had previously completed an FFQ relating to usual dietary intake in a nationwide case–control study of cancer between November 2003 and April 2004 were randomly selected, re-contacted, and invited to complete the same FFQ a second time approximately one year later (between January and April 2005). Agreement between the two FFQ was compared using weighted kappa statistics and intraclass correlation coefficients (ICC) for food groups and nutrients. Summary questions, included in the FFQ, were used to assess overall intakes of vegetables, fruits and meat.

General community in Australia.

One hundred men and women aged 22–79 years, randomly selected from the previous control population.

The weighted κ and ICC measures of agreement for food groups were moderate to substantial for seventeen of the eighteen food groups. For nutrients, weighted κ ranged from 0·44 for starch to 0·83 for alcohol while ICC ranged from 0·51 to 0·91 for the same nutrients. Estimates of meat, fruit and vegetable intake using summary questions were similar for both survey periods, but were significantly lower than estimates from summed individual food items.

The FFQ produced reproducible results and is reasonable in assessing the usual intake of various foods and nutrients among an Australian adult population.

Low Ca intake is common among Japanese women, but its effect on bone metabolism has not been fully elucidated. The aim of the present study was to determine the relationship between Ca intake and serum markers of bone turnover in postmenopausal Japanese women.

A cross-sectional study.

A community setting.

Subjects were 595 home-dwelling postmenopausal Japanese women. Ca intake was assessed by a validated FFQ. Serum type I collagen cross-linked N-telopeptides (NTX) and osteocalcin were measured as markers of bone turnover. The relationships between demographic characteristics, lifestyles, serum Ca, vitamin D and intact serum parathyroid hormone and bone turnover were also assessed.

The average age of the subjects was 64·5 (sd 5·8) years and the mean Ca intake was 527 (sd 160) mg/d. Ca intake was significantly associated with serum NTX (P = 0·0104), but not with serum osteocalcin. Mean serum NTX concentration in the lowest quartile of Ca intake (<417 mg/d) was significantly higher than in the fourth, referent quartile. Among these Japanese postmenopausal women, very low Ca intake (less than ∼400 mg/d) was associated with increased bone resorption but not bone formation.

Increased bone resorption may be one mechanism by which this Ca-depleted population normalizes bone metabolism and prevents osteoporosis.

Se is an essential trace element in human nutrition associated with antioxidant activity. Previous studies on predictors of toenail Se or serum Se have mostly concentrated on demographic factors such as age and gender. The present paper examines the association between apoE genotype and Se levels in nail samples in a rural elderly Chinese cohort.

Two thousand Chinese aged 65 years and over from four counties in China were enrolled in a cohort to study the association of Se with cognitive decline. Nail samples were collected from each participant and analysed for Se levels. Dietary Se intake was estimated from an FFQ using Se contents measured in food items collected from each village. Blood samples on filter cards were collected and analysed for apoE genotype. Mixed-effect models were constructed with nail Se level as the dependent variable and each village as the random effect, which controlled for the potential confounding effect from correlation in Se measures obtained from participants residing in the same village.

In this elderly Chinese cohort, carriers of the apoE ε4 allele had significantly lower Se levels measured in nail samples than non-carriers after adjusting for other significant covariates and controlling for estimated dietary Se intake. There was no significant difference between the two genotypes on estimated Se dietary intake (P = 0·6451).

Future studies are needed to examine the mechanism underlying the association between the apoE ε4 allele and Se levels, including the role of oxidative stress and that of reduced lipid metabolism in the apoE ε4 carriers.

Many Iranian adolescent girls are Fe-deficient, but it is unclear whether Fe deficiency is associated with other nutritional risk indicators. The present study aimed to investigate the association between Fe deficiency and weight status (measured as BMI) among a representative sample of adolescent girls.

A cross-sectional study. Fe-deficient high-school girls (with or without anaemia) were selected by systematic random sampling among all students in grades 1 to 4 from high schools for girls. Blood samples were collected and analysed for Hb, haematocrit, serum ferritin, Fe and total Fe binding capacity. Weight and height were measured. BMI was calculated and compared with age- and gender-specific BMI reference values.

South Iran.

A total of 431 adolescent girls aged 13–20 years.

Some 15·3 % of the participants were at risk for overweight and 9·5 % of them were overweight. An inverse association was found between serum ferritin and BMI (r = −0·38, β = −0·21, P < 0·001). Anaemia was more prevalent among overweight Fe-deficient adolescents than among those Fe-deficient and at risk for overweight or normal weight (34·1 % v. 28·8 % v. 27·8 %, respectively; P < 0·001).

An inverse association was found between BMI and serum ferritin. Overweight adolescents demonstrated an increased prevalence of Fe-deficiency anaemia. It seems that both abnormalities of weight and Fe status should simultaneously be targeted in overweight female adolescents.