To adapt a scale to measure perceptions on food insecurity and hunger among households in urban and rural communities in Peru.

Qualitative and quantitative methodology including consultation with regional experts, key informant interviews and focus groups. A field survey trial was conducted in urban and rural communities using an adapted version of the US Department of Agriculture (USDA) Food Insecurity and Hunger Module (FIHM).

Five communities in three regions in Peru – Lima (coast), Ayacucho (Andean highlands) and San Martín (Amazon basin).

The qualitative component included forty intentionally selected people (fourteen key informants and twenty-six focus group participants). For the quantitative component 300 households that complied with selection criteria (poor or non-poor with at least one child below 12 years of age) were surveyed.

Qualitative research showed that concern about food availability and access was common among the three regions but its main cause varied across them. Participation in food aid programmes was a strategy to face constraints in food access. Mothers’ perceptions on the importance of balanced meals varied across households from different regions. Quantitative results showed robust findings for the reliability of the adapted FIHM’s fifteen-item scale (r > 0·863). In addition, descriptive results confirmed parallelism of item responses in the scale for variables such as farm ownership, family size and use of Communal Kitchens.

This mixed-method study allowed us to adapt the USDA module to assess food insecurity in Peru.

To determine how much of the variation in nutritional status of Bangladeshi children under 5 years old can be attributed to the socio-economic status of the family.

Nutritional status used reference Z-scores of weight-for-age (WAZ), height-for-age (HAZ) and weight-for-height (WHZ). A ‘possession score’ was generated based on ownership of a radio, television, bicycle, motorcycle and telephone, and the availability of electricity, with categories of 0 to 4+ possessions. A five-point (quintile) ‘poverty index’ was created using principal component analysis.

The Bangladesh Demographic and Health Survey 2004 was the source of data.

A sample of 4891 children aged <5 years was obtained.

Some 57·8 % of the sample was either stunted, wasted or underweight (7·7 % were stunted, wasted and underweight). Of those stunted (48·4 %), 25·7 % were also underweight. Underweight and wasting prevalences were 40·7 % and 14·3 %, respectively. Mean WAZ, HAZ and WHZ did not differ by sex. Children of mothers with no education or no possessions were, on average, about 1 sd more underweight and stunted than those with higher educated mothers or with 4+ possessions. The possession score provided much greater discrimination of undernutrition than the poverty index. Nearly 50 % of children from households with no possessions were stunted, wasted or underweight (only 27 % in the poorest quintile), compared with only 3–6 % of children from households with 4+ possessions (over 13 % in the richest quintile).

Maternal education and possession score were the main predictors of a child’s nutritional status. Possession score was a much better indicator of undernutrition than the poverty index.

To evaluate nutritional recovery patterns in 106 undernourished children assisted by the Center of Nutritional Recovery and Education (CREN, in Portuguese) between January 1995 and December 1999.

CREN assists undernourished children aged 0 to 72 months living in the southern regions of Sao Paulo, in an outpatient setting. Nutritional status was assessed by Z-scores of weight-for-age, height-for-age and weight-for-height. Nutritional recovery evaluation considered Z-score gains in weight-for-age and height-for-age, grouping into four categories (Z-score increment of 0·50 between groups). Children with birth weight less than 2500 g were classified as low birth weight (LBW), while those born at term and with LBW were classified as small for gestational age.

CREN (Center of Nutritional Recovery and Education in Portuguese), Sao Paulo, Brazil.

One hundred and six children from CREN.

Among the 106 evaluated children, ninety-eight (92·5 %) recovered their weight or height and seventy-two (67·9 %) recovered both. Nearly half of studied children presented a nutritional recovery (increase in Z-score) of more than 0·50 in height-for-age (46·2 %) and about 40 % in weight-for-age (38·7 %). Multivariate analysis showed that treatment duration and initial weight-for-age contributed to weight-for-age Z-score increment, explaining 25 % of the variation; and treatment duration, initial height-for-age and weight-for-age Z-score increment contributed to height-for-age Z-score increment, explaining 62 % of the variation.

Our findings show that nutritional recovery among children who attended CREN was influenced primarily by the degree of nutritional deficit at admission. It has also been shown that biological variables are more important than socio-economic status in determining the rate of nutritional recovery.

To report the prevalence of anaemia by demographic characteristics and its secular trend over 13 years for south-east Chinese pregnant women, and to determine the focus of anaemia prevention in Chinese pregnant women.

Prospective study of the data on Hb concentration and other demographic information from a large-scale population-based perinatal health surveillance system in south-east China.

Fourteen cities or counties in Jiangsu and Zhejiang provinces.

A total of 467 057 prenatal women who had participated in the perinatal health-care surveillance system and delivered babies from 1 January 1993 to 31 December 2005 and had a record of Hb in all three pregnancy trimesters.

The overall prevalence of anaemia among pregnant women was 39·6 % from 1993 to 2005. Anaemia prevalence increased from the first (29·6 %) to the second (33·0 %) and third (56·2 %) trimesters. The prevalence of anaemia was higher in villagers, in women with less education and in women with higher gravidity or parity. The prevalence of anaemia in all of the trimesters was higher in the spring, summer and autumn and lower in the winter. The prevalence decreased from 1993 to 2005, from 53·3 % to 11·4 % for the first trimester, 45·6 % to 22·8 % for the second trimester and 64·6 % to 44·6 % for the third trimester.

The prevalence of anaemia among pregnant women in Jiangsu and Zhejiang provinces decreased substantially from 1993 to 2005. However, anaemia in the third trimester is still a severe public health problem among pregnant women in these areas.

The present study examined the prevalence of underweight and overweight in a group of primary-school children in Zahedan, south-east Iran.

A cross-sectional study in a randomly selected population of schoolchildren.

Primary-school children in Zahedan city.

A random sample of 1079 students (boys = 500 and girls = 579). Data on child’s age, parental educational levels, body weight and height were collected.

The rate of overweight/obesity among boys and girls was 8·9 % and 10·3 %, respectively; and of underweight among boys and girls was 22·8 % and 19·9 %, respectively. Prevalence of overweight increased as the boys and girls approached adolescence and it was more prevalent among girls than boys. Prevalence of overweight was directly related to maternal education in this population.

High prevalence of underweight in young children as well as increase in the prevalence of overweight in girls and boys near adolescence are of concern. Early poor growth and subsequent rapid weight gain near to adolescent stage is related to adulthood obesity.

Bone mineral density (BMD) loss has been described in adult women in the 12-month postpartum period. However, little is known about the precise BMD pattern in adolescent mothers. The present study aimed to evaluate BMD in Argentinean adolescent mothers followed up during the 12-month postpartum period.

Analytical, prospective clinical trial. BMD and body composition were determined by dual-energy X-ray absorptiometry; bone mineral content (BMC) and BMD were measured in the lumbar spine (L2–L4), femoral neck (FN), femur trochanter (TR), total hip (TH) and total body. Changes in BMD and BMC were analysed using ANOVA for pairwise comparisons. Other comparisons were performed with the paired-sample t test and Wilcoxon test; Pearson’s correlation coefficient was used to analyse the relationship among continuous variables.

La Plata, Argentina.

Adolescent mothers (n 35; 17 years old or less) were recruited within 15 d after delivery. Studies and follow-up were performed at 15 d and 3, 6 and 12 months postpartum.

BMD and BMC losses at 3 and 6 months and recovery at 12 months fitted a quadratic curve (ANOVA) at the three sites studied (FN, TH, TR), in total-body BMD (P = 0·000) and BMC (P = 0·038). At hip sites, BMD loss occurred at 3 months (FN, P = 0·000; TR, P = 0·000; TH, P = 0·000) and 6 months (FN, P = 0·000; TR, P = 0·000; TH, P = 0·000) compared with basal values. Percentage BMD loss immediately after delivery up to 6 months was about 5 %.

Adolescents showed significant BMD and BMC losses at 6 months postpartum, with an almost total recovery at 12 months in all sites studied.

While vitamin D deficiency is well recognized in Middle Eastern women as a result of cultural norms of remaining covered, Middle Eastern men are an under-reported group. Vitamin D is now known to have multiple effects, including an impact on muscle function, thereby increasing the relevance for sportsmen. The aim of the present study was to evaluate serum 25-hydroxyvitamin D (25(OH)D) levels in young male Middle Eastern athletes.

Cross-sectional study.

Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.

Ninety-three Middle Eastern men presenting to hospital for an annual screening undertook a blood test to evaluate their vitamin D status.

Ninety-one per cent of athletes were found to be deficient in 25(OH)D (serum concentration <20 ng/ml). Athletes with severe deficiencies were significantly younger than those with less marked deficiency. A subset of athletes underwent bone mineral density assessment and 59 % were shown to have at least one Z-score less than −1; despite this, however, no athletes reported a stress fracture. There was no correlation between 25(OH)D concentration and sunlight exposure, skin coverage and skin colouring.

The study revealed that 25(OH)D deficiency is very common among otherwise healthy Middle Eastern male athletes. Given the potentially significant long- and short-term effects of 25(OH)D deficiency, serum 25(OH)D evaluation should be part of the routine assessment in this region.

Obesity in children is a serious public health issue in Greece. The purpose of the current study was to identify risk factors such as birth weight, breast-feeding, dietary patterns, family history of obesity and sedentary behaviours that are possibly associated with paediatric obesity.

Two hundred and five overweight and obese children (OW/OB; group 1) aged 7–15 years from eight primary and secondary schools and a control group (group 2) of normal-weight children were matched for age and sex. Overweight and obesity were calculated based on the International Obesity Taskforce criteria. Lifestyle parameters as well as anthropometric data were collected in all children. Conditional logistic regression analysis was used to identify risk factors for obesity.

Breast-feeding (≥3 months) and leisure-time physical activity proved to be protector factors against obesity (OR = 0·21, 95 % CI 0·11, 0·79, P < 0·001 and OR = 0·87, 95 % CI 0·85, 0·89, P < 0·001 respectively). On the other hand, family history of obesity (OR = 3·79, 95 % CI 2·61, 4·18, P < 0·001), sugar-sweetened beverage consumption (OR = 1·77, 95 % CI 1·03, 2·76, P < 0·001) and watching television (OR = 1·99, 95 % CI 1·54, 2·76, P = 0·04) were found to be positively associated with a higher obesity risk.

The current findings support the literature according to which duration of breast-feeding (<3 months), a family history of obesity, watching television, sedentary lifestyle and consumption of sugar-sweetened beverages are important risk factors for childhood obesity. More studies are needed to elucidate the relationship of paediatric obesity and possible predictor factors in order to avoid health consequences in these children later on in life.

Multivitamin supplements are used by nearly half of middle-aged women in the USA. Despite this high prevalence of multivitamin use, little is known about the effects of multivitamins on health outcomes, including cancer risk. Our main objective was to determine the association between multivitamin use and the risk of breast cancer in women.

We conducted a population-based case–control study among 2968 incident breast cancer cases (aged 20–69 years), diagnosed between 2004 and 2007, and 2982 control women from Wisconsin, USA. All participants completed a structured telephone interview which ascertained supplement use prior to diagnosis, demographics and risk factor information. Odds ratios and 95 % confidence intervals were calculated using multivariable logistic regression.

Compared with never users of multivitamins, the OR for breast cancer was 1·02 (95 % CI 0·87, 1·19) for current users and 0·99 (95 % CI 0·74, 1·33) for former users. Further, neither duration of use (for ≥10 years: OR = 1·13, 95 % CI 0·93, 1·38, P for trend = 0·25) nor frequency (>7 times/week: OR = 1·00, 95 % CI 0·77, 1·28, P for trend = 0·97) was related to risk in current users. Stratification by menopausal status, family history of breast cancer, age, alcohol, tumour staging and postmenopausal hormone use did not significantly modify the association between multivitamin use and breast cancer.

The current study found no association between multivitamin supplement use and breast cancer risk in women.

The estimation of dietary intake in population-based studies is often assessed by the FFQ. The objective of our study is to evaluate the validity of an FFQ used to assess dietary fatty acid intake among middle-aged Chinese adults in Southern China.

The method of triads was applied to obtain the validity coefficients (VC) of the FFQ for specific fatty acids. A subsample was randomly selected from an earlier cross-sectional study. The FFQ and 3d dietary records were used for dietary assessment, and the fatty acid composition of erythrocyte membranes was determined as the biomarker.

The Spearman correlation coefficients between the FFQ and 3d dietary records were moderate to good (r = 0·28–0·66). The VC of the FFQ estimated by the method of triads were 0·72, 0·61, 0·65, 0·75 and 0·67 for MUFA, total n-6 fatty acids, α-linolenic acid, EPA and DHA, respectively. The VC could not be calculated for SFA, PUFA and total n-3 fatty acids because of negative correlations among the three measurements. But, the correlations between the FFQ and the dietary records were moderate for these fatty acids.

Our FFQ applied in Southern Chinese adults was valid to estimate their dietary fatty acid intake and was thus suitable for use in a large cohort study.

To examine the utility of a shorter FFQ compared with a longer FFQ, both of which are commonly used in Australia.

Comparative study.

Community setting.

One hundred and fifty-nine men (mean 55 (sem 7) years) screened for participation in an intervention study completed both the Commonwealth Scientific and Industrial Research Organisation FFQ and the Cancer Council of Victoria FFQ. Agreement between both questionnaires was assessed according to Bland–Altman plots and limits of agreement (LOA) and ordinary least products regression to test for the presence of fixed and proportional bias.

There was good relative agreement between the methods for energy and macronutrients (Pearson’s correlation coefficients: energy r = 0·7, protein r = 0·6, fat r = 0·8, carbohydrate r = 0·7, alcohol r = 0·8; P < 0·01). Mean group-level agreement for the majority of nutrients (70 %) fell between 80 % and 110 %. According to the criteria used (maximum LOA was 50–200 % and no significant proportional bias), there was acceptable agreement between the FFQ for energy and total saturated and monounsaturated fat, but not for protein, carbohydrate and fibre. Micronutrients that did not meet the agreement criteria including calcium, iron, thiamin, niacin, riboflavin and folate. When the data were analysed according to quintiles, the majority of subjects were either in exactly the same quintile or within one quintile for most nutrients, and 1–2 % were grossly misclassified by three or four quintiles.

We conclude that there is sufficient agreement between the instruments for group-level comparisons in men, but they are not interchangeable for estimation of individual intakes.

Nutrition evaluation tools should be developed both for scientific purposes and to encourage and facilitate healthy nutritional practices. The purpose of the present study was to develop and validate a simple food-based Healthy Meal Index (HMI) reflecting the nutritional profile of individual canteen meals.

The development process included overall model selection, setting nutritional goals and defining scoring systems and thresholds. Three index components were included: (i) contents of fruit and vegetables, (ii) fat content and quality and (iii) contents of wholegrain products and potatoes. The development was built on the principles embodied by the Plate Model, but providing more specificity in some areas. The simple HMI was validated against weighed and chemically analysed food and nutrient content of a representative sample of canteen meals. The sample was split into four categories according to the total index score and compared across categories.

A total of 180 meals from fifteen worksite canteens.

Average energy density decreased significantly across categories (from 876 kJ/100 g to 537 kJ/100 g, P < 0·001). Also, the content of total and saturated fat, carbohydrate and fruit and vegetables varied across categories with higher score values being closer to dietary guidelines (P < 0·001).

The simple HMI was successful in ranking canteen meals according to their nutritional quality. The index provides a valuable tool to both researchers and food and nutrition professionals, e.g. caterers and dietitians, who wish to evaluate nutritional quality of meals in line with the recommendations for healthier eating without the use of nutrition calculation programs.

The waist-to-height ratio (WHtR) assesses abdominal adiposity and has been proposed to be of greater value in predicting obesity-related cardiovascular health risks in children than BMI. The present study aims to develop WHtR cut-offs for overweight and obesity based on the 85th and 95th percentiles for the percentage body fat (%BF) in a cohort of children and adolescents.

Waist circumference (WC), height, triceps and subscapular skinfolds were used to calculate WHtR and %BF. Correlations between WHtR and %BF and WHtR/mid-abdominal skinfold were made. Receiver-operating characteristic (ROC) curve analysis was used to select WHtR cut-offs to define overweight and obesity. Subjects were grouped by WHtR cut-offs, and mean values for anthropometry, blood lipids and blood pressure (BP) variables were compared.

Australian primary and secondary schools.

A total of 2773 male (M) and female (F) subjects of the 1985 Australian Health and Fitness Survey, aged 8–16 years.

Correlation coefficients between WHtR and %BF were M: r = 0·73, F: r = 0·60, P < 0·01 and WHtR/mid-abdominal skinfold were M: r = 0·78, F: r = 0·65, P < 0·01. WHtR of 0·46(M) and 0·45(F) best identified subjects with ≥85th percentile for %BF and 0·48(M) and 0·47(F) identified subjects with ≥95th percentile for %BF. When comparing the highest WHtR group to the lowest, both sexes had significantly higher means for weight, WC, %BF, TG (male subjects only), systolic BP (female subjects only) and lower means for HDL cholesterol (P < 0·05).

WHtR is useful in clinical and population health as it identifies children with higher %BF at greater risk of developing weight-related CVD at an earlier age.

To identify lifestyle and sociodemographic risk factors of overweight among male college students.

A retrospective cohort study.

Annual health checkup in a single university in Japan.

Male students who underwent two successive health checkups from their third school year between 2000 and 2007 and whose BMI at baseline of this study was 22·0 kg/m2 or more (n 4634).

During the 1-year follow-up, 598 students (12·9 %) reached the study endpoint, i.e. more than a 5 % increase in BMI. Independent risk factors for substantial BMI increase included infrequent exercise (OR = 1·33; 95 % CI 1·11, 1·60), no or infrequent alcohol drinking (OR = 1·30; 95 % CI 1·08, 1·57), frequently skipping breakfast (OR = 1·34; 95 % CI 1·12, 1·61), preference for fatty food (OR 1·36; 95 % CI 1·04, 1·78) and living alone (OR = 1·23; 95 % CI 0·99, 1·52). Students were readily stratified according to risk for substantial BMI gain by counting the number of their risk factors. OR (95 % CI) for the risk between the no risk factor group and students with two, three, four and five risk factors were 1·61 (0·96, 2·70), 2·24 (1·34, 3·75), 2·42 (1·39, 4·23) and 6·22 (2·58, 15·0), respectively.

These data suggest that avoidance of certain risk factors in college life is associated with a decrease in incidence of overweight among male students.

We evaluated the effects of peanut consumption on lipid profiles, atherogenic index of plasma (AIP) and CHD risk in hypercholesterolaemic men.

Randomised crossover clinical trial.

Participants were randomly assigned to two groups. They were asked to consume peanut supplements (about 77 g) with their habitual diet for 4 weeks.

Fifty-four hypercholesterolaemic men with total cholesterol (TC) concentrations between 200 and 350 mg/dl.

Compared with the habitual diet, peanut supplementation of the habitual diet significantly reduced TC/HDL cholesterol (HDL-C) ratio (mean 1 (se 0·3) P = 0·001) and LDL cholesterol (LDL-C)/HDL-C ratio (mean 0·7 (se 0·2); P = 0·001). Peanut consumption increased HDL-C (mean 6·1 (se 1·5) mg/dl; P < 0·001) and total antioxidant capacity (TAC) (mean 1·2 (se 0·6) U/mL P = 0·04). In addition, peanut consumption significantly reduced the AIP (mean 0·1 (se 0·03) P = 0·01) and CHD estimated risk over 10 years based on systolic and diastolic blood pressures (mean 1·4 % (se 0·5 %) P = 0·004 and mean 2·2 % (se 0·5 %) P < 0·001, respectively).

Short-term peanut consumption might improve lipid profiles, the AIP and CHD risk in free-living hypercholesterolaemic men.

To examine the relationship of 6-n-propylthiouracil (PROP) sensitivity to BMI while statistically controlling for demographic characteristics in two age groups of children: 9–10 years and 17–18 years (n 1551).

Cross-sectional design with a multi-ethnic (White, African-American, Hispanic, Other) sample of 813 children aged 9–10 years and 738 children aged 17–18 years. Children were recruited from local elementary and high schools with at least 30 % minority ethnic enrolment. Children’s height, weight and waist circumference were measured along with their PROP taster status. PROP was measured using two paper discs, one impregnated with NaCl (1·0 mol/l) and the other with PROP solution (0·50 mmol/l).

A significant PROP sensitivity by socio-economic status (SES) interaction term (P = 0·010) was detected wherein supertasters had the largest BMI percentile and Z-score, but only among the group with highest SES.

The results suggest that other factors overwhelmed the influence of PROP sensitivity on adiposity in lower-SES groups. The percentage of variance accounted for by the interaction term was about 1 %. Thus, PROP supertasters had the largest BMI percentile and Z-score, but only among the highest-SES group.

Various studies in the USA and Canada have consistently shown a positive association between length of residence of immigrants and obesity. Studies in European countries have obtained less consistent results. The present work assesses the influence of length of residence on the frequency of obesity in immigrants in the city of Madrid, Spain.

We studied a sample of 7155 persons aged 18 years and over residing in the city of Madrid, who were was surveyed between November 2004 and May 2005. Information was collected on immigrant status (country of birth), length of residence in Spain, obesity, sociodemographic characteristics and lifestyle.

Compared with the Spanish population, the odds for obesity in the immigrant population by length of residence was less than one in all groups, becoming closer to one with increasing time of residence (OR = 0·67, 0·73 and 0·81 for immigrants with less than 2, 2–4 and 5–9 years of residence in Spain, respectively), up to 10 or more years of residence, when it declined (OR = 0·69). The magnitude of this association was considerably reduced after adjusting for sociodemographic variables and for perceived health, but was not further modified after adjusting for lifestyle variables.

Length of residence of immigrants in the city of Madrid is not associated with the frequency of obesity. It is possible that the circumstances immigrants encounter after arriving in Spain do not involve an overexposure to factors favouring obesity, relative to those they bring with them.

To examine the association between energy density and energy costs in single food items and composed diets, and to explore differences in energy density and energy cost between income levels.

A cross-sectional study using data from two Dutch cohort studies and recent national food prices. Food prices were retrieved from two market leader supermarkets. Data on dietary intake were measured using a computerized face-to-face interview (cohort 1) and 24 h recalls (cohort 2).

The Netherlands.

A sample of 373 young adults from the Amsterdam Growth and Health Longitudinal Study (AGHLS, measured in 2000) and a sample of 200 community-dwelling elderly from the Longitudinal Ageing Study Amsterdam (LASA, measured in 2007).

We found significant inverse associations between energy density and energy costs in single food items (r = −0·436, P < 0·01) and composed diets (AGHLS men r = −0·505, women r = −0·413, P < 0·001; LASA men r = −0·559, women r = −0·562, P < 0·001). Furthermore, we found that people stratified into higher energy density quartiles consumed significantly more energy per day, less fruits and vegetables, and had significantly lower diet costs. Explorative analyses on income did not reveal significant differences regarding energy density, costs, or fruit and vegetable intake.

In the Netherlands also, energy density was inversely related with energy costs, implying that healthier diets cost more. However, we could not find differences in energy density or costs between income levels. Future research, using precise food expenditures, is of main importance in studying the economics of obesity and in the aim of making the healthier choice easier.