To assess the applicability and use of infant nutrition and health indicators during emergencies.

Indicators recommended by international health and nutrition organisations for assessing infant feeding practice were compiled and analysed to evaluate their consistency and applicability for use in surveys of emergency-affected populations. These indicators included measures of breast-feeding status, use of artificial feeding, anthropometric status and morbidity. Health and nutrition surveys performed on the resident or refugee population of Kosovo during the years 1996–1999 were then reviewed and the use of infant feeding and morbidity indicators were compared.

A number of recommended indicators exist for assessing infant and child feeding practice which have been generated by different international organisations. A comparison of these indicators revealed a number of inconsistencies, both in target population and measurement method. Their use during the Kosovo crisis was likewise inconsistent and prevented conclusions being drawn about the effectiveness of the international response in protecting infant health and nutrition.

Standard indicators need to be agreed and promoted for use during surveys of emergency-affected populations. Failure to do so will lead to a continued inability to monitor the health and nutrition of infants at a population level during international relief operations.

To assess the 1999–2000 food security situation and the food relief programmes in Ethiopia, and evaluate the need for a national food and nutrition policy.

A systematic search of data sources from the Ethiopian Disaster Prevention and Preparedness Commission (DPPC), the Ethiopian Central Statistical Authority, the World Food Programme (WFP) and United Nations Children's Fund (UNICEF), the bibliographic database Medline and direct contacts with associations, institutions and people concerned with food security in Ethiopia.

Consultations to WFP Ethiopia.

Food availability was severely restricted due to recurrent disasters such as drought, flood, war and a lack of diversity of food items. Food accessibility was limited due to a weak subsistence-agriculture-based economy, depletion of assets, absence of income diversity and a lack of alternative coping mechanisms. Food intake adequacy was rarely achieved due to food shortages, improper diet and poor sanitary conditions. There was a lack of early warning data to monitor food security indicators. Food aid programmes did not meet the requirements for food quantities and composition, and faced major obstacles in logistics and targeting of the vulnerable population.

Improvements in food security and the eradication of famine will require investment in sustainable projects. There is an immediate need for better planning and targeting of food aid and a national food security monitoring system. A national food and nutrition policy is recommended, focusing both on relief efforts and on underlying factors contributing to the famine.

Household food insecurity is a major determinant of undernutrition, yet there is little information on its prevalence in the South African population. This paper assesses household food insecurity in South Africa using a quantitative and objective measure, known as food poverty, and provides prevalence estimates by geographic area and socio-economic condition.

Secondary data analysis combining two sources: Statistics South Africa's household-based 1995 Income and Expenditure Survey; and the University of Port Elizabeth's Household Subsistence Level series, a nationally-conducted, market-based survey.

South Africa.

A nationally representative sample of the entire country – stratified by race, province, and urban and non-urban areas – consisting of 28 704 households.

A household is defined to be in food poverty when monthly food spending is less than the cost of a nutritionally adequate very low-cost diet. The prevalence of food poverty in South Africa in 1995 was 43%. Food poverty rates were highest among households headed by Africans, followed by coloureds, Indians and whites. Higher food poverty rates were found with decreasing income, increasing household size, and among households in rural areas or those headed by females.

The widespread nature of household food insecurity in South Africa is documented here. Prevalence rates by geographic and socio-economic breakdown provide the means for targeting of nutritional interventions and for monitoring progress in this field. The corroboration of these findings with both internal validation measures and external sources suggests that food poverty is a useful, objective measure of household food insecurity.

To determine the effects of birth weight and early childhood stunting on body mass index (BMI), body fat and fat distribution at ages 7 and 11 years, and the change from 7 to 11 years.

Prospective cohort study.

Kingston, Jamaica.

One hundred and sixteen stunted children (height-for-age below two standard deviations (<-2SD) of the National Center for Health Statistics (NCHS) references) and 190 non-stunted children (height-for-age > -1SD), identified at age 9–24 months. The stunted group was divided into a previously stunted group (height-for-age at 11 years ≥ -1SD) and a chronically stunted group (height-for-age <-1SD).

Birth weight was positively related to the children's BMI but not to measures of body fat. Birth weight was negatively associated with the subscapular/triceps skinfold (SSF/TSF) ratio at age 11 years, and to the change between 7 and 11 years. Controlling for birth weight, the chronically stunted group remained significantly smaller than the non-stunted children at both ages and increased less from 7 to 11 years in all measures except the SSF/TSF ratio, which was significantly greater at age 7 years. The previously stunted group had significantly lower BMI and percentage body fat at age 7 years than the non-stunted group. Change from 7 to 11 years was not significantly different from that of the non-stunted group except for a smaller increase in TSF. At age 11 years they had significantly lower TSF and percentage body fat1.

Children stunted in early childhood had less fat and lower BMI than non-stunted children but had a more central fat distribution that was partially explained by their lower birth weights. The association between birth weight and central fat distribution developed between 7 and 11 years.

Food insecurity has become an important issue in many countries of the former Soviet Union following the transition to a market economy. This study examined three aspects of food security in the Baltic Republics: reasons for choosing foods; level of dependence on home-grown or raised foods; and use of home-grown vegetables.

Cross-sectional surveys.

Data from surveys conducted in Estonia, Latvia and Lithuania in the summer of 1997 were used to describe the three aspects of food security and their socio-economic correlates (using descriptive statistics and logistic regression).

Representative samples of adults were selected in each country (Estonia, n = 2018; Latvia, n = 2308; Lithuania, n = 2153).

Cost was the most commonly reported reason for choosing foods, particularly in Lithuania (67%) and Latvia (60%) (Estonia 41%), and especially among people with lower income levels. In each country, large proportions of respondents depended partially or entirely on home-grown or raised foods (Latvia 47%, Lithuania 42%, Estonia 32%) or used home-grown vegetables frequently (Lithuania 66%, Latvia 53%, Estonia 29%); this was particularly the case in rural areas.

The issue of food security needs to be examined further in the Baltic Republics and other transitional economies as increased access to safe, healthy foods for all could help improve dietary intake and reduce the high mortality from non-communicable diseases. Access to affordable, high-quality fresh foods by different social groups should be monitored and the potential contribution of home-grown and raised foods to reduce food poverty should be explored further1.

To assess the energy and nutrient intakes of healthy infants from low-income families and to compare intakes with current recommendations.

We interviewed mother–infant pairs longitudinally when the infants were 3, 6, 9, 12, 18 and 24 months old. Food intake data were obtained by 24-hour dietary recalls. Selected nutrient intakes were calculated and compared with the Recommended Dietary Allowances (RDAs).

Infants (n = 200) were the offspring of low-income, pregnant women recruited at the Albany County Department of Health, New York for the Albany Pregnancy and Infancy Lead Study, a prospective investigation of factors related to blood lead levels, including nutrition. Interviews were conducted during paediatric clinic visits.

Means and standard deviations were used to describe energy and micronutrient intakes for age groups. The probability approach was utilised to examine the prevalence of inadequate intakes.

Mean energy and nutrient intakes generally met or exceeded the RDA. The exceptions were vitamin D and zinc for which observed means were below the RDA at several data points. Protein consumption was exceptionally high in this sample. The highest estimated prevalences of inadequate intakes were observed for iron, zinc and vitamin D at the older ages.

This study identified several potential concerns about the diets of infants during the transition from infant food and formula to table foods. Low intakes of vitamin D, zinc and iron, especially at 12 and 18 months, were observed. High protein intakes were noted at all ages.

To assess the effect on the haemoglobin concentrations of schoolchildren of weekly iron tablets administered by teachers.

Sixty schools were randomly assigned to two groups: in 30 schools children were given weekly for 10 weeks a tablet providing 65 mg of iron and 0.25 mg of folic acid; in the other 30 schools no iron tablets were given. All children were dewormed and given vitamin A before the study began. The haemoglobin concentration of up to 20 randomly selected children in each school was estimated before and 2 weeks after the end of treatment.

Rural community schools in Kolondieba district of Mali.

Some 1113 schoolchildren aged 6–19 years with a mean of 11.4 years.

The haemoglobin concentration of treated children rose on average by 1.8 g l-1 (P < 0.001) and the prevalence of anaemia fell by 8.2% (P < 0.001); in untreated children the haemoglobin concentration fell by an average of -2.7 g l-1 (P < 0.001) and the prevalence of anaemia rose by 9.4% (P < 0.001). The fall in haemoglobin concentration among untreated girls of -4.0 g l-1 was greater than in untreated boys (-0.3 g l-1, P < 0.001).

Weekly iron tablets given by teachers prevented a general fall in the haemoglobin concentrations of untreated children, and led to a small but statistically significant rise among treated children (P < 0.001). Young children benefited more than children aged ≥12 years, and girls benefited more than boys.

This study examines the relationship between tea consumption and colon cancer risk in the US population.

Data from the NHANES I Epidemiologic Follow-up study (NHEFS) were used to examine the hypothesis. Cox proportional hazard models were used to examine the hypothesis of a protective effect of frequent tea consumption on colon cancer occurrence.

Due to differences in the precision of the exposure data, we analysed two cohort periods based on the NHEFS. Cohort I was based on the survey conducted at the NHEFS baseline and Cohort II began at the first follow-up.

After excluding non-incidence cases and cases lost to follow-ups, there were 2359 tea users and 6498 non-tea users at baseline and 7656 tea users and 4514 non-tea users at the first follow-up.

After adjusting for confounders, the relative risks of colon cancer are 0.57 (95% confidence interval (CI) 0.42, 0.78) and 0.59 (95% CI = 0.35, 1.00) for subjects who consumed ≤1.5 cups and ≥1.5 cups per day, respectively, compared with non-tea users in Cohort II. Although more women consumed tea and the mean intake was higher, the preventive effect of tea consumption on colon cancer was found predominantly in men. The relative risks of colon cancer are 0.41 (95% CI = 0.25, 0.66) for men who consumed ≤1.5 cups day-1 and 0.30 (95% CI = 0.09, 0.98) for >1.5 cups day-1 of tea consumption (P-value for trend <0.01). No significant results were found in Cohort I.

This study suggests an inverse association between colon cancer risk and habitual tea consumption.

The aim of this study was to assess whether self-reported mental health status, measured using the SF-36 questionnaire, was associated with fish consumption, assessed using a food-frequency questionnaire.

The cross-national data were collected in the 1996/97 New Zealand Health Survey and 1997 Nutrition Survey, which were conducted using the same sampling frame. Survey respondents were categorised into those who consumed no fish of any kind and those who consumed some kind of fish, at any frequency. Data were adjusted for age, household income, eating patterns, alcohol use and smoking. Other demographic variables and potential confounding nutrients were included in the preliminary analyses but were not found to have a significant relationship with fish consumption.

Data from a nationally representative sample of 4644 New Zealand adults aged 15 years and over were used in this analysis.

Fish consumption was significantly associated with higher self-reported mental health status, even after adjustment for possible confounders. Differences between the mean scores for fish eaters and those who never eat fish were 8.2 for the Mental Health scale (P = 0.005) and 7.5 for the Mental Component score (P = 0.001). Conversely, the association between fish consumption and physical functioning was in the opposite direction (P = 0.045).

This is the first cross-sectional survey to demonstrate a significant relationship between fish intake and higher self-reported mental health status, therefore offering indirect support for the hypothesis that ω-3 polyunsaturated fatty acids may act as mood stabilisers.

To assess longitudinal changes in the consumption of nutrients and the impact of socio-economic factors on diet transition in the Melbourne Chinese Health Study (MCHS) cohort.

Longitudinal study including two phases: baseline (1989/90) and follow-up (1995/97).

Melbourne metropolitan areas in Victoria, Australia.

Two hundred and sixty-two Chinese men and women aged 25 years and over, recruited at baseline, who had completed the both baseline and follow-up food-frequency questionnaires.

Women increased their daily intakes of energy (+549 kJ), protein (+7.8 g), fat (+7.3 g) and dietary fibre (+5.6 g) whereas men decreased their daily consumption of carbohydrate (-38.5 g) over an average period of 8 years. Energy contributions from protein and fat rose while that from carbohydrate dropped for all cohort subjects. Increased intakes of riboflavin, β-carotene and iron were observed in men, while an increased consumption of thiamine, riboflavin, niacin and minerals (except sodium) was observed in women. Socio-economic factors such as education, family income levels and occupational categories appeared to have a far more powerful influence on changes in individual daily nutrient intakes than age or length of stay in Australia. Changes in nutrient intake in women were less affected by sociodemographic variables.

The observed changes in nutrient intakes indicated a progressive approach towards the Australian Recommended Dietary Intakes within this Chinese cohort population.

To determine the proportion of energy from foods prepared outside the home (FPOH) and the relationships with energy and nutrient intakes and body mass index (BMI).

A nutrition survey of a representative sample of the Australian population aged 18 years and over (n = 10 863). Measure used was a 24-hour dietary recall. Underreporters (energy intake/estimated basal metabolic rate (EI/BMR) <0.9) were excluded from analysis. Daily energy and selected nutrient intakes were calculated using a 1996 nutrient composition database for all foods/beverages during the 24-hour period.

On average FPOH contributed a significant 13% to total energy intake. About a third of the sample had consumed FPOH in the last 24 hours and on average this group consumed a third of their total energy as FPOH. The relative contributions of fat (for men and women) and alcohol (for women) were significantly higher for those in the top tertile of FPOH consumers. The intakes of fibre and selected micronutrients (calcium, iron, zinc, folate and vitamin C) were significantly lower in this group. After adjustment for age and income no relationship between FPOH and BMI was observed.

FPOH make a significant contribution to the energy intake of a third of the Australian population. FPOH contribute to poor nutritional intakes. Altering the supply of FPOH may be an effective means of improving diets at a population level.

To describe the eating habits of children in Liverpool and compare two age groups that bridge the transition from primary to secondary school.

Two cross-sectional studies carried out one year apart using a food intake questionnaire that records whether or not each child claims to have eaten specific marker foods on the previous day.

Primary and secondary schools in Liverpool.

Six hundred and forty-nine children aged 11 or 12 years and 3556 children aged 9 or 10 years.

Fewer older children ate breakfast (68–82%), especially the girls, and not eating breakfast was associated with eating on the way to school in the younger children. More of the older girls ate nothing at breakfast or on the way to school. Overall, the less desirable foods were reported to have been eaten by more children, of both ages, than the more desirable foods. Fruit, however, was mentioned by most children (69–77%) but the next 10 foods mentioned by most children were all less desirable ones. Only 31% of primary and 21% of secondary children ate both fruit and vegetables but 23% of primary and 26% of secondary children ate neither fruit nor vegetables. Overall, more of the girls of both age groups claimed to have eaten foods that would normally be encouraged.

Food choice changes appreciably between primary and secondary school and, in some key respects, for the worse. In particular, far more children of both age groups need to be eating fruit and vegetables every day.

The aim of this study was to identify differences in food habits and lifestyle behaviours by dieting status among young people in Ireland.

Cross-sectional survey. Participants responded to a self-completion questionnaire designed by researchers on the World Health Organization's collaborative study – Health Behaviour in School Aged Children. Pupils were selected by school and classroom and the sample was stratified to be representative of the geographical distribution of school students in Ireland.

Data were collected by teachers from school pupils in their classrooms.

Data were collected from 187 schools which included 8497 pupils (51% girls) aged 9–17 years.

While a minority of pupils (12% of girls, 4% of boys) reported that they were on a diet to lose weight, a substantial proportion (28% of girls, 18% of boys) said that they should be on a diet. Dieters reported consuming unhealthy foods less frequently than non-dieters, but did not report an increased consumption of fruit and vegetables. Rather, some categories of dieters reported higher levels of coffee and tobacco use and lower exercise levels than non-dieters.

The results could indicate substitution of unhealthy foods by other unhealthy behaviours as opposed to an increased consumption of healthier foodstuffs, and suggest that both smoking and exercise need to be addressed alongside nutrition in youth health promotion.

To describe the use of dietary supplements in a group of Danish adults and to investigate the differences between users and non-users with respect to age, gender, health and lifestyle factors.

Cross-sectional study in two Danish cities.

The Danish Investigation on Iodine Intake and Thyroid Diseases, 1997–1998.

Participants were 3707 women (selected age groups between 18 and 65 years) and 942 men (60–65 years). Participation rate was 50%. Supplement data were collected in a personal interview. Data on education, smoking, alcohol intake, physical activity, use of medication and self-perceived health were derived from a self-administered questionnaire. Multiple logistic regression was used for the statistical analysis.

Participants were asked about all kinds of supplements, ranging from products containing vitamins and minerals, to fish oils and products of herbal origin. On average 59% reported use of some kind of dietary supplement. Most common were combined multivitamin/mineral products (48%) followed by single vitamin C products (10%). Twelve per cent used three or more different supplements. Supplement use was strongly associated with age and gender, being highest among elderly women (78%). Ex-smokers were more likely to use supplements than subjects who had never smoked (odds ratio (OR) 1.36, 95% confidence interval (CI) 1.09–1.76). Supplement use was more likely among subjects who had many days of illness (OR = 1.37, 95% CI 1.12–1.66) and among users of medication (OR = 1.22, 95% CI 1.04–1.42). Subjects who perceived their health as poor were more likely to use supplements other than just a multivitamin/mineral tablet (OR = 2.2, 95% CI 1.31–3.77).

Use of dietary supplements was related to age, gender and smoking, but also to poor self-perceived health status and absence from work. This indicates that a group of people use supplements as a form of self-medication.

This paper investigates the roles of the individual stakeholders involved in the development of functional foods and the implications of their actions for public perception of this new food concept.

At a time when consumer awareness of the link between diet and health is strong, a new food concept incorporating of a wide spectrum of foods has captured the imagination of the food industry and consumers alike. Functional foods provide a new category of foods that appear to be offering the public the opportunity to achieve a healthy lifestyle with minimal effort. Public perception may determine whether this new food concept is to become the next successful breakthrough in nutritional science or just another marketing gimmick devised by food manufacturers. The paper also addresses issues that arise directly as a result of the emergence of functional foods, such as appropriate legislation in connection to health claims in order to ensure consumer protection and also the lack of clarity in relation to definitions of what constitutes a functional food.

The paper concludes that functional foods can only reach their maximum potential if the food industry, government and health professionals work together to improve communication between themselves and consumers and also to educate consumers, thereby allowing them to make informed decisions about dietary choices.

To investigate how the priorities of high consumers of fruit and vegetables differ from those of low consumers, with respect to food choice motivations, and to identify what value high and low consumers place on different aspects of food choice behaviour.

A 4-day food diary and a questionnaire, including The Food Choice Questionnaire (FCQ) and a measure of Stage of Change (SOC) for fruit and vegetable consumption, were administered to subjects. Motivation scores from the FCQ were compared with fruit and vegetable intake and SOC data.

Nine hundred and ninety-eight females, aged 35–69 years, participating in the UK Women's Cohort Study.

In a multiple linear regression model, including age, education level and all FCQ motivations, the strongest motivations specifically affecting fruit and vegetable intake were health and natural content. It was found that, for a one point increase (measured on a scale of 0–4) in health and natural content scores, fruit and vegetable consumption increased by 1.11 portions (95% confidence interval (CI) 0.5–1.7) and 0.84 portions (95% CI 0.4–1.3), respectively (P>0.01). The SOC evaluation showed significant associations with portions of fruit and vegetables consumed (P>0.01). Women whose SOC was classed as maintenance phase were found to score higher on health, natural content, weight control and ethical concern factors (P>0.01). These women also scored lower on convenience questions (P>0.01).

In this particular group of women the most important motivating factors for food choice, within the high fruit and vegetable consumers, were health and natural content of the food.

To evaluate the reproducibility of, and to compare and calibrate, diet measures by the Northern Sweden 84-item food-frequency questionnaire (FFQ) with measures from 24-hour diet recalls (24-HDR).

Randomly selected respondents (n=246) from the EPIC (diet-cancer) and MONICA (diet-cardiovascular disease) study cohort in Northern Sweden were invited to answer the FFQ twice over a one-year interval (FFQ1 and FFQ2), and to complete ten 24-hour recalls (reference method) in the months between. Plasma β-carotene concentrations were determined from a subset of 47 participants.

Vasterbotten and Norrbotten, Northern Sweden.

Ninety-six men and 99 women, who completed the study.

The reproducibility of the FFQ was high in terms of both mean energy and nutrient intakes and relative ranking of participants by intake levels (median Pearson correlation of 0.68). Moderately higher food intake frequencies were recorded by FFQ1 compared with 24-hour recalls for dairy products, bread/cereals, vegetables, fruits and potato/rice/pasta, whereas meat, fish, sweet snacks and alcoholic beverage intakes were lower. The median Spearman coefficient of correlation between FFQ1 and the average of ten 24-HDR measurements was 0.50. Daily energy and nutrient intakes were similar for FFQ1 and 24-HDR measurements, except for fibre, vitamin C, β-carotene and retinol (FFQ1<24-HDR) and sucrose and cholesterol (FFQ1>4-HDR). Pearson coefficients of correlation between FFQ1 and 24-HDR corrected for attenuation due to residual day-to-day variation in the 24-HDR measurements ranged from 0.36 to 0.79 (median 0.54). Adjustment for energy had only very moderate effects on the correlation estimates. Calibration coefficients estimated by linear regression of the 24-HDR on the FFQ1 measurements varied between 0.30 and 0.59 for all nutrients except alcohol, which had calibration coefficients close to 1.0. These low calibration coefficients indicate that relative risk estimates corresponding to an absolute difference in dietary intake levels measured by the FFQ will generally be biased towards 1.0. Plasma β-carotene levels had a Pearson coefficient of correlation of 0.47 with the 24-HDR measurements, and of 0.23 with FFQ1 measurements.

The Northern Sweden FFQ measurements have good reproducibility and an estimated level of validity similar to that of FFQ measurements in other prospective cohort studies. The results from this study will form the basis for the correction of attenuation and regression dilution biases in relative risk estimates, in future studies relating FFQ measurements to disease outcomes.

This study describes an evaluation of validity and reliability measures in a questionnaire designed to assess knowledge of applied nutrition in children participating in an after-school care dietary intervention programme being undertaken in an area of high social disadvantage.

Three domains were assessed: Knowledge of Applied Nutrition (KN), Knowledge of Food Preparation (KP) and Perceived Confidence in Cooking Skills (PC). Four pilot studies were undertaken to determine item reliability, test–retest reliability, discrimination and difficulty indices, and content, cognitive and face validity.

Primary schools in Dundee, Scotland and Newcastle upon Tyne, England.

Ninety-eight children aged 11 years.

The final instrument comprised 36 questions (18 KN items, 9 KP items and 9 PC items) presented on four sides of paper, which could be self-completed in less than 15 minutes. Question formatting included open and closed structures (KP) and multiple choice (KN and PC) items. All knowledge questions could be answered correctly by 5 to 95% of the target population, with discrimination scores ranging from 0.06 to 0.83. Retest reliability scores were significant (KN 0.458, P>0.001; KP 0.577, P>0.001; PC 0.381, P>0.001) and internal reliability (Cronbach's alpha) of each component was also significant.

The test meets basic psychometric criteria for reliability and validity and forms a suitable instrument for measuring changes associated with intervention work aimed at improving food and dietary knowledge.

To examine folic acid and vitamin B12 status in a group of 1000 persons sampled from the community of Umeå, Sweden, and aged 35, 40, 45, 50, 55, 60, 65, 70, 75 or 80 years. Reference data for folate and age-stratified reference data for vitamin B12 are presented, together with an examination of potential confounders.

All subjects participated in extensive health examinations and interviews, and laboratory blood testing was performed.

A series of exclusion criteria were applied, and data from 961 subjects were analysed. Vitamin B12 levels were found to decrease with increasing age, whereas folate levels remained constant across the age span studied. None of the vitamins was found to vary with sex, education, smoking or alcohol consumption, body mass index, prescription-free vitamin supplements, level of haemoglobin, or mean cell volume of erythrocytes. Further, none of these factors was associated with the age-related decrease of vitamin B12 level.

The offered reference ranges should be used only in order to rule out deficiency. For B12 levels, the age of the subject should be considered such that, for elderly people in particular, values above the medians should be considered as indicative of normal vitamin status.