To explore published and unpublished research into consumer understanding and use of nutrition labelling which is culturally applicable in Europe.

A systematic review undertaken between July 2002 and February 2003.

One hundred and three papers were identified that reported on consumer understanding or use of nutrition labelling, most originating from North America or northern Europe. Only a few studies (9%) were judged to be of high or medium–high quality. We found that reported use of nutrition labels is high but more objective measures suggest that actual use of nutrition labelling during food purchase may be much lower. Whether or not consumers can understand and use nutrition labelling depends on the purpose of the task. Available evidence suggests that consumers who do look at nutrition labels can understand some of the terms used but are confused by other types of information. Most appear able to retrieve simple information and make simple calculations and comparisons between products using numerical information, but their ability to interpret the nutrition label accurately reduces as the complexity of the task increases. The addition of interpretational aids like verbal descriptors and recommended reference values helps in product comparison and in putting products into a total diet context.

Improvements in nutrition labelling could make a small but important contribution towards making the existing point-of-purchase environment more conducive to the selection of healthy choices. In particular, interpretational aids can help consumers assess the nutrient contribution of specific foods to the overall diet.

In areas where vitamin A deficiency (VAD) is prevalent, vitamin A repletion reduces child mortality by 23% on average.

To estimate the potential child survival benefits of policies and programmes aimed at controlling VAD in Mozambique, and to make policy and programme recommendations.

The potential contribution of VAD to child mortality in Mozambique was estimated by combining the observed VAD prevalence in the under-5s (71.2%), the measured child mortality effects of VAD (risk of death in children with VAD = 1.75 times higher than in children without VAD) and the observed under-5 mortality rate in the country (210 per 1000 live births).

In Mozambique, an estimated 2.3 million children below the age of 5 years are vitamin-A-deficient. In the absence of appropriate policy and programme action, VAD will be the attributable cause of over 30 000 deaths annually in the under-5s. This represents 34.8% of all-cause mortality in this age group.

Vitamin A supplementation (VAS) has been adopted as a short- to medium-term strategy to control VAD in children, and is integrated into routine child health services. However, the last VAS coverage survey showed that only 46% of children received a vitamin A supplement in the 6 months preceding the survey. If VAS coverage is to increase significantly in the foreseeable future, four areas appear to be of paramount importance: (1) reduce missed opportunities for VAS such as visits of sick children to child health services and community outreach activities; (2) take advantage of all potential opportunities for accelerating VAS coverage, such as additional vaccination campaigns and emergency response activities; (3) strengthen health workers’ training, supervision and monitoring skills; and (4) increase community demand for VAS of children. Biannual VAS, as the primary component of an integrated strategy for VAD control in children, has the promise to be among the most cost-effective/high-impact child survival interventions in Mozambique.

In Mali, an estimated 73% of pregnant women are anaemic largely due to iron deficiency. National policy recommends women to take iron and folic acid supplements daily from first prenatal contact until 3 months postpartum. However, many pregnant women in Mali could benefit from multiple micronutrient supplements.

To assess pregnant women's acceptability of and adherence to a daily multiple micronutrient supplementation scheme compared with the current daily iron and folic acid supplementation scheme.

Seventy pregnant women were allocated to either the daily multiple micronutrient or daily iron and folic acid supplementation scheme. Women started receiving supplements at the end of the first trimester of pregnancy until delivery and throughout the first 3 months postpartum.

No significant differences were observed between comparison groups with respect to women's perceptions about supplement size, colour, taste or flavour. Adherence to the multiple micronutrient supplementation scheme was better (257.5±20.9 tablets; average adherence 95.4%) than that to the iron and folic acid supplementation scheme (238.5±32.7 tablets; average adherence 92.2% P = 0.008) although both were very good, as were women's perceptions about the benefits of micronutrient supplements to their health and that of their newborns.

Malian women adhere to prenatal/postpartum micronutrient supplementation – no matter what supplement is chosen – when access to supplements is guaranteed and when they are provided with minimum, consistent and easily understandable information and counselling, indicating that these are key elements to ensure effective programmes. These findings, together with those of the global research agenda on the efficacy of multiple micronutrient supplements for pregnant women, will inform policy development in Mali for the effective control of iron deficiency and iron-deficiency anaemia in pregnant women.

To describe the current situation regarding protection, promotion and support of breast-feeding in Europe, as a first step towards the development of a blueprint for action.

A questionnaire was completed by 29 key informants and 128 other informants in the EU, including member states, accession and candidate countries.

EU countries do not fully comply with the policies and recommendations of the Global Strategy on Infant and Young Child Feeding that they endorsed during the 55th World Health Assembly in 2002. Some countries do not even comply with the targets of the Innocenti Declaration (1990). Pre-service training on breast-feeding practice is inadequate and in-service training achieves only low to medium coverage. The Baby Friendly Hospital Initiative is well developed only in three countries; in 19 countries, less than 15% of births occur in baby-friendly hospitals. The International Code of Marketing of Breastmilk Substitutes, endorsed in 1981 by all countries, is not fully applied and submitted to independent monitoring. The legislation for working mothers meets on average the International Labour Organization standards, but covers only women with full formal employment. Voluntary mother-to-mother support groups and trained peer counsellors are present in 27 and 13 countries, respectively. Breast-feeding rates span over a wide range; comparisons are difficult due to use of non-standard methods. The rate of exclusive breast-feeding at 6 months is low everywhere, even in countries with high initiation rates.

EU countries need to revise their policies and practices to meet the principles inscribed in the Global Strategy on Infant and Young Child Feeding in order to better protect, promote and support breast-feeding.

To explore the relationship between family average income (FAI; an index of socio-economic status) and body mass index (BMI; a widely used, inexpensive indicator of weight status) above the healthy weight range in a region of Mainland China.

Population-based cross-sectional study, conducted between October 1999 and March 2000 on a sample of regular local residents aged 35 years or older who were selected by random cluster sampling.

Forty-five administrative villages selected from three urban districts and two rural counties of Nanjing municipality, Mainland China, with a regional population of 5.6 million.

In total, 29 340 subjects participated; 67.7% from urban and 32.3% from rural areas; 49.8% male and 50.2% female. The response rate among eligible participants was 90.1%.

The proportion of participants classified as overweight was 30.5%, while 7.8% were identified as obese. After adjusting for possible confounding variables (age, gender, area of residence, educational level, occupational and leisure-time physical activity, daily vegetable consumption and frequency of red meat intake), urban participants were more likely to be overweight or obese relative to their rural counterparts, more women than men were obese, and participants in the lowest FAI tertile were the least likely to be above the healthy weight range.

The proportion of adults with BMI above the healthy weight range was positively related to having a higher socio-economic status (indexed by FAI) in a regional Chinese population.

To determine the prevalences of overweight, obesity, type 2 diabetes mellitus (DM) and hypertension (HT) in the Mexican population and compare them with those of a previous Mexican urban survey and an American survey.

A structured, randomised, nationally representative Mexican sample was compared with a 1993 Mexican urban survey and the US Third National Health and Nutrition Examination Survey (NHANES III) of non-Hispanic Whites.

The Mexican National Health Survey 2000.

Subjects were 12856 men and 28332 women, aged 20–69 years, who had their body weight, height, waist circumference (WC), blood pressure and fasting capillary blood glucose measured.

Mexican adult men and women had a high prevalence of overweight (41.3 and 36.3%, respectively) and obesity (19.4 and 29.0%, respectively), similar to those in the USA in 1988–1992 and exceeding those of the 1993 Mexican survey. The prevalence of HT was 33.3% in men and 25.6% in women, with inferred DM rates of 5.6 and 9.7%, respectively. Abdominal obesity affected 46.3% of men (WC ≥ 94 cm) and 81.4% of women (WC ≥ 80 cm). There was a high prevalence of abdominal obesity in normal-weight women, with co-morbidities relating better to WC than to body mass index (BMI) in both sexes. Rates of DM and HT exceeded US rates on a comparable BMI or WC basis in adults aged <50 years.

The high prevalence of obesity and abdominal obesity in Mexicans is associated with markedly increased prevalences of DM and HT to levels comparable with, or even higher than, those in NHANES III of non-Hispanic Whites.

There is a widely held view that the lower weight of drug abusers is attributable to diet. However, many studies on the dietary intake of drug abusers have failed to find energy insufficiency, while non-dietary factors have rarely been examined. The purpose of this study was to examine non-dietary factors that could affect the weight of drug abusers with and without HIV infection.

Participants were recruited into one of three groups: HIV-positive drug abusers (n=85), HIV-negative drug abusers (n=102) and HIV-positive persons who do not use drugs (‘non-drug abusers’, n=98). Non-dietary factors influencing weight included infection with HIV and/or hepatitis, malabsorption, resting energy expenditure and physical activity.

The baseline data from a prospective cohort study of the role of drug abuse in HIV/AIDS weight loss conducted in Boston, USA.

The first 286 participants to enrol in the study.

HIV-positive drug abusers had a body mass index (BMI) that was significantly lower than that of HIV-positive non-drug abusers. The differences in weight were principally differences in fat. In the men, cocaine abuse, either alone or mixed with opiates, was associated with lower BMI, while strict opiate abuse was not. Infection with HIV or hepatitis, intestinal malabsorption, resting energy expenditure and physical activity, as measured in this study, did not explain the observed differences in weight and BMI.

Drug abuse, and especially cocaine abuse, was associated with lower weight in men. However, infection with HIV and/or hepatitis, malabsorption and resting energy expenditure do not explain these findings.

To examine the utility of using external estimates of within-person variation to adjust usual nutrient intake distributions.

Analyses of the prevalence of inadequate intake of an example nutrient by the Estimated Average Requirement (EAR) cut-point method using three different methods of statistical adjustment of the usual intake distribution of a single 24-hour recall in Russian children in 1996, using the Iowa State University method for adjustment of the distribution. First, adjusting the usual intake distribution with day 2 recalls from the same 1996 sample (the correct method) second, adjusting the distribution using external variance estimates derived from US children in 1996; and third, adjusting the distribution using external estimates derived from Russian children of the same age in 2000. We also present prevalence estimates based on naïve statistical analysis of the unadjusted distribution of intakes.

Children drawn from the Russia Longitudinal Monitoring Survey in 1996 and 2000 and from the 1996 Continuing Survey of Food Intakes by Individuals.

When the EAR cut-point method is applied to a single recall, the resulting prevalence estimate in this study is inflated by 100–1300%. When the intake distribution is adjusted using an external variance estimate, the prevalence estimate is much less biased, suggesting that any adjustment may give less biased estimates than no adjustment.

In moderately large samples, adjusting distributions with external estimates of variances results in more reliable prevalence estimates than using 1–day data.

This study examines parental report of household food availability, parent dietary intake and associations with adolescent intakes of fruits, vegetables and dairy foods.

Cross-sectional study. Adolescents completed the Project EAT survey and the Youth Adolescent Food Frequency Questionnaire at school. Parents of adolescents were interviewed by telephone about the home food environment, eating habits and weight-related behaviours. General linear modelling was used to compare dietary intakes of adolescents across different levels of household food availability and parental intakes.

The study sample included 902 adolescents and their parent or guardian.

Many parents were not consuming the minimum number of daily recommended fruit (44.5%), vegetable (69.9%) or dairy (46.9%) servings. While most parents reported that fruits and vegetables were available at home (90.3%) and vegetables were usually served at dinner (87.0%), fewer parents reported milk was served at meals (66.6%). Soft drinks were usually available at home (56.8%). Among girls, household availability was positively associated with fruit and vegetable intake (ttrend = 2.70, P < 0.01) and soft drink availability was inversely associated with dairy intake (ttrend = 2.08, P = 0.04). Among boys, serving milk at meals was positively associated with dairy intake (ttrend = 3.65, P < 0.01). Parental intakes were positively associated with dairy intake for boys (ttrend = 2.04, P = 0.04), and with dairy (ttrend = 2.43, P = 0.01), vegetable (ttrend = 3.72, P < 0.01) and fruit (ttrend = 3.17, P < 0.01) intakes for girls.

Interventions designed to help adolescents improve consumption of fruits, vegetables and dairy foods may be enhanced by including a parental component aimed at increasing household availability and parents' intake of healthful food choices.

To describe food sources of nutrient intake for white and African American adults in the Lower Mississippi Delta (LMD), and their use in the development of a regional food-frequency questionnaire (FFQ) based on an earlier version of the National Cancer Institute's Health Habits and History Questionnaire.

We ranked food sources of energy, macronutrients, vitamins and minerals, and examined portion size distributions for 842 white and 857 African American residents aged 19 years and older, using 24-hour dietary intake recall data from a telephone survey of 36 LMD counties. These values were used to develop a regional FFQ, which was then field-tested with 100 subjects and revised to improve interpretability.

The LMD region of the USA.

White and African American adult residents of the LMD.

LMD African Americans obtained more of their energy and nutrient intakes from poultry, processed meat, salty snacks, fruit drinks, pork and cornbread; and less from milk, alcohol, legumes, salad dressing, butter/margarine and sweetened tea than did white residents. Regional foods not on nationally used FFQs included grits, turnip greens, okra, ham hocks, chitterlings, crawfish, catfish, cracklings, jambalaya, potato logs, chicken and dumplings, and sweet potato pie. Based on responses during field-testing, the questionnaire was also designed to add four portion sizes for each food item, presented as questions, rather than in grid format.

Regional food use patterns differ from national patterns and furthermore differ between African American and white adults in the LMD. The resulting Delta NIRI FFQ for Adults should contribute to improved assessment of usual intake for use in studies of diet and health in this region.

To validate a fat intake questionnaire (FIQ) developed to assess habitual dietary intake while focusing on the assessment of detailed fatty acid intake including total trans unsaturated fatty acids (TUFA).

An 88 food item/food group FIQ was developed using a meal pattern technique. Validation was achieved by comparison with dietary intake assessed by a modified diet history (DH) in a cross-over design. Eighty-four individuals supplied adipose tissue biopsies for linoleic acid and total TUFA analysis as an independent validation of the FIQ and DH.

Medical Centre, Dublin Airport, Republic of Ireland.

One hundred and five healthy volunteers (43 females and 62 males aged 23–63 years).

Significant correlations (P < 0.0005) were achieved for intakes of energy (0.78), total fat (0.77), saturated fat (0.77), monounsaturated fat (0.63), polyunsaturated fat (0.73), TUFA (0.67) and linoleic acid (0.71) assessed by the FIQ compared with the DH. Linoleic acid intake assessed by the FIQ and the DH was significantly correlated with adipose tissue concentrations (r = 0.58 and 0.49, respectively; P<0.005); however, total TUFA intake was poorly correlated with adipose tissue concentrations (r = 0.17 and 0.10 for FIQ and DH, respectively).

The FIQ compared favourably with the DH in assessing habitual diet, in particular fatty acid intake. In addition, the FIQ was successfully validated against the linoleic acid composition of adipose tissue, an independent biomarker of relative fatty acid status. The FIQ could therefore be used as an alternative to the DH as it is a shorter, less labour-intensive method.