To examine the potential of anthropometry as a tool to measure gender discrimination, with particular attention to the WHO growth standards.

Surveillance data collected from 1990 to 1999 were analysed. Height-for-age Z-scores were calculated using three norms: the WHO standards, the 1978 National Center for Health Statistics (NCHS) reference and the 1990 British growth reference (UK90).

Bangladesh.

Boys and girls aged 6–59 months (n 504 358).

The three sets of growth curves provided conflicting pictures of the relative growth of girls and boys by age and over time. Conclusions on sex differences in growth depended also on the method used to analyse the curves, be it according to the shape or the relative position of the sex-specific curves. The shapes of the WHO-generated curves uniquely implied that Bangladeshi girls faltered faster or caught up slower than boys throughout their pre-school years, a finding consistent with the literature. In contrast, analysis of the relative position of the curves suggested that girls had higher WHO Z-scores than boys below 24 months of age.

Further research is needed to help establish whether and how the WHO international standards can measure gender discrimination in practice, which continues to be a serious problem in many parts of the world.

To assess the effect of famine exposure during early life on dietary patterns, chronic diseases, and the interaction effect between famine exposure and dietary patterns on chronic diseases in adulthood.

Cross-sectional study. Dietary patterns were derived by factor analysis. Multivariate quantile regression and log-binomial regression were used to evaluate the impact of famine exposure on dietary patterns, chronic diseases and the interaction effect between famine exposure and dietary patterns on chronic diseases, respectively.

Hefei, China.

Adults aged 45–60 years (n 939).

‘Healthy’, ‘high-fat and high-salt’, ‘Western’ and ‘traditional Chinese’ dietary patterns were identified. Early-childhood and mid-childhood famine exposure were remarkably correlated with high intake of the traditional Chinese dietary pattern. Compared with the non-exposed group (prevalence ratio (PR); 95 % CI), early-childhood (3·13; 1·43, 6·84) and mid-childhood (2·37; 1·05, 5·36) exposed groups showed an increased PR for diabetes, and the early-childhood (2·07; 1·01, 4·25) exposed group showed an increased PR for hypercholesterolaemia. Additionally, relative to the combination of non-exposed group and low-dichotomous high-fat and high-salt dietary pattern, the combination of famine exposure in early life and high-dichotomous high-fat and high-salt dietary pattern in adulthood had higher PR for diabetes (4·95; 1·66, 9·05) and hypercholesterolaemia (3·71; 1·73, 7·60), and significant additive interactions were observed.

Having suffered the Chinese famine in childhood might affect an individual’s dietary habits and health status, and the joint effect between famine and harmful dietary pattern could have serious consequences on later-life health outcomes.

Poor nutrition and limited sunlight exposure (season) can be related to reduced serum 25-hydroxyvitamin D (25(OH)D) concentrations. Thus, elderly people in the Nordic countries might be at high risk for vitamin D deficiency. The aims of the study were to describe the prevalence of vitamin D deficiency in elderly hospitalized patients in Reykjavik, Iceland, and to investigate the effects of nutritional status and season on serum 25(OH)D.

Cross-sectional study. Nutritional status was assessed and fasting blood was drawn and analysed for serum 25(OH)D and other clinical routine measurements.

Departments of Geriatrics, Landspitali-University Hospital, Reykjavik, Iceland.

Sixty hospitalized patients (mean age 83·0 (sd 7·9) years) were randomly assigned.

Of the patients, 12·3 % suffered from vitamin D deficiency (serum 25(OH)D < 25 nmol/l) and 71·9 % suffered from hypovitaminosis D (serum 25(OH)D = 25–75 nmol/l). There were no significant effects of gender or nutritional status on serum 25(OH)D. Anthropometric variables correlated significantly with serum 25(OH)D, but on stepwise linear regression modelling for the prediction of serum 25(OH)D, BMI remained the only predictor variable (B = −1·454, 95 % CI −2·535, −0·373, P = 0·009).

BMI was significantly negatively associated with serum 25(OH)D in hospitalized elderly patients. Neither nutritional status nor season significantly affected serum 25(OH)D in our patient group. Higher levels of serum 25(OH)D in elderly subjects with lower BMI are most likely explained by volume of distribution rather than by mobilization of vitamin D from its storage in adipose tissue due to age and disease-related catabolism.

The present study aimed to assess the adequacy of Ca intake and major food sources of Ca in Korean children and adolescents.

A cross-sectional study.

Data from the Korean National Health and Nutrition Examination Survey (KNHANES) 2007–2010. We analysed the daily Ca intake, major food sources of Ca and the prevalence of inadequate Ca intake in the study population. Ca intake was categorized as inadequate when the participant's daily Ca intake was less than the Estimated Average Requirement.

The study population consisted of 7233 children and adolescents (3973 boys, 3260 girls; aged 1–18 years).

Mean Ca intake was 510·2 mg/d in boys and 431·7 mg/d in girls. Overall, 75·0 % of adolescents (boys 71·6 %, girls 79·1 %) had inadequate Ca intake. The prevalence of inadequate Ca intake increased significantly from toddlers (45–55 %) to adolescents (78–86 %) in both genders. The highest ranked food sources for Ca were dairy products (35·0 %), followed by vegetables (17·3 %), grains (11·3 %) and seafood (9·9 %). Ca intake from dairy products decreased significantly from 57 % in toddlers to 30 % in adolescents, while Ca intakes from other foods increased with age.

Inadequate Ca intake is highly prevalent and increased with age in Korean children and adolescents. It should be emphasized to encourage children and adolescents to eat more Ca-rich products to meet their Ca needs.

To explore the nature, role and utility of mentoring in the development of competence in advanced-level Australian public health nutritionists.

Qualitative study using in-depth interviews.

Eighteen advanced-level public health nutritionists working in academic and practice settings in Australia.

The attributes and career pathways of the subjects were consistent with previous findings. Dissatisfaction with clinical practice was a key reason for choosing a career in public health. Experiential learning, postgraduate education and mentoring from both peers and senior colleagues were the most significant contributors to competency development. The subjects supported mentoring as an important strategy for public health nutrition workforce development and articulated the characteristics and models important for mentoring relationships in public health nutrition.

The present study suggests mentoring was an important part of competency development for advanced-level public health and community nutritionists in Australia. Mentoring programmes based on experiential learning may assist in developing public health nutrition workforce competence.

The present study aimed to understand the relationship between need and help-seeking behaviour in older adults by examining the patterns of food insecurity and participation in food assistance programmes (FAP), i.e. the Food Stamp Program and home-delivered meals.

Data from two longitudinal studies were used. The studies were designed to obtain nationally representative information on health, insurance coverage, financial status, family support systems, labour market status and retirement planning, every two years: the Health and Retirement Study (HRS, 1996–2002) and Asset and Health Dynamics Among the Oldest Old (AHEAD, 1995–2002).

USA.

There were 7623 participants for HRS and 3378 for AHEAD.

The older adults appeared to have persistent patterns between food insecurity and participation in FAP, especially in the Food Stamp Program. More persistently food-insecure older adults had higher participation in FAP (P < 0·001). Food-insecure older adults at one time were more likely to shift from non-participation to participation in FAP the next time than food-secure older adults (P < 0·001). Regardless of previous food insecurity status, previous participants in FAP were more likely to participate subsequently.

The relationship between need and help-seeking behaviour in older adults was found to follow a persistent positive pattern, determined by looking at the patterns of food insecurity and participation in FAP. Although food insecurity as a need is a good predictor of participation in FAP, it is not enough to fully predict participation in FAP. Help-seeking behaviour (i.e. previous programme participation) is also important in predicting participation in FAP.

To investigate how intakes of whole grains and cereal fibre were associated to risk factors for CVD in UK adults.

Cross-sectional analyses examined associations between whole grain and cereal fibre intakes and adiposity measurements, serum lipid concentrations, C-reactive protein, systolic blood pressure, fasting glucose, HbA1c, homocysteine and a combined CVD relative risk score.

The National Diet and Nutrition Survey (NDNS) Rolling Programme 2008–2014.

A nationally representative sample of 2689 adults.

Participants in the highest quartile (Q4) of whole grain intake had lower waist–hip ratio (Q1 0·872; Q4 0·857; P = 0·04), HbA1c (Q1 5·66 %; Q4 5·47 %; P = 0·01) and homocysteine (Q1 9·95 µmol/l; Q4 8·76 µmol/l; P = 0·01) compared with participants in the lowest quartile (Q1), after adjusting for dietary and lifestyle factors, including cereal fibre intake. Whole grain intake was inversely associated with C-reactive protein using multivariate analysis (P = 0·02), but this was not significant after final adjustment for cereal fibre. Cereal fibre intake was also inversely associated with waist–hip ratio (P = 0·03) and homocysteine (P = 0·002) in multivariate analysis.

Similar inverse associations between whole grain and cereal fibre intakes to CVD risk factors suggest the relevance of cereal fibre in the protective effects of whole grains. However, whole grain associations often remained significant after adjusting for cereal fibre intake, suggesting additional constituents may be relevant. Intervention studies are needed to compare cereal fibre intake from non-whole grain sources to whole grain intake.

To examine associations between maternal employment and time spent engaging in nutrition-related behaviours among mothers and children using a nationally representative sample of households in West and East Germany.

A cross-sectional analysis was performed using time-use data for a sample of mother–child dyads. Associations between maternal employment and time spent in nutrition-related activities such as eating at home, eating away from home and food preparation were estimated using a double-hurdle model.

German Time Budget Survey 2001/02.

The overall sample included 1071 households with a child between 10 and 17 years of age. The time-use data were collected for a 3 d period of observation (two weekdays and one weekend day).

Maternal employment was associated with the time children spent on nutrition-related behaviours. In households with employed mothers, children spent more time eating alone at home and less time eating meals with their mothers. Moreover, employed mothers spent less time on meal preparation compared with non-employed mothers. There were regional differences in time spent on nutrition-related behaviours, such that East German children were more likely to eat at home alone than West German children.

Maternal employment was associated with less time spent eating with children and preparing food, which may be related to the increasing childhood obesity rates in Germany. Future national surveys that collect both time-use data and health outcomes could yield further insight into mechanisms by which maternal time use might be associated with health outcomes among children.

The World Health Organization (WHO) recommends a daily intake of at least 400?g of vegetables and fruit. The aim of this paper was to evaluate the public health benefit of meeting this WHO recommendation by applying a statistical method that combines estimated intake distributions and simulated intake changes.

The benefit of an increased consumption of vegetables and fruit was quantified by the preventable proportion of diseases. This proportion was estimated by a general formula derived in the paper that incorporates individual relative risks. Three different strategies of increasing usual intake were simulated and compared. The first strategy assumes that all individuals increase their intake by the same amount, the second assumes a constant increase among low consumers, and the third simulates individual increments necessary to meet the WHO recommendation. Calculations were made for three different scenarios with varying relative risks.

The third simulation strategy turned out to be the most appropriate one to quantify the potential health gain of the current dietary recommendation. Applying this strategy to prevent cancer, the proportion of preventable cases was country-specific. Estimates for France and Sweden were 21.9% and 19.3%, respectively, which are somewhat lower than the non-specific figure published by the World Cancer Research Fund.

To improve estimates of the preventable proportion of diseases, the estimation formula presented here can be applied. Its application requires intake data to estimate the initial intake distribution in the population and to simulate adequate dietary changes.

We investigated the association between adherence to the recommendations of the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) and breast cancer (BC) risk in the Cancer de Màma (CAMA) study in a Mexican population.

Population-based case–control study.

Incident BC cases (n 1000) and controls (n 1074) matched on age, region and health-care system were recruited.

In-person interviews were conducted to assess BC risk factors and habitual diet was assessed with an FFQ. Conformity to the WCRF/AICR recommendations was evaluated through a score incorporating seven WCRF/AICR components (body fatness, physical activity, foods and drinks that promote weight gain, plant foods, animal foods, alcoholic drinks and breast-feeding), with high scores indicating adherence to the WCRF/AICR recommendations.

No statistically significant associations between WCRF/AICR score and risk of BC were observed. After excluding BMI from the WCRF/AICR score, the top quartile was associated with a decreased BC risk overall, with ORQ4–Q1=0·68 (95 % CI 0·49, 0·92, Ptrend=0·03), and among postmenopausal women, with ORQ4–Q1=0·60 (95 % CI 0·39, 0·94, Ptrend=0·03). Inverse associations were observed between BMI and risk of BC overall and among premenopausal women, with OR=0·57 (95 % CI 0·42, 0·76, Ptrend<0·01) and 0·48 (95 % CI 0·31, 0·73, Ptrend<0·01), respectively. Physical activity level was inversely associated with BC risk.

The WCRF/AICR index was not related with BC risk in the CAMA study. A combination of six components excluding BMI showed strong protective associations, particularly in postmenopausal women. Further prospective studies are required to clarify the role of adherence to WCRF/AICR recommendations, particularly with respect to BMI, in the Mexican population.

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.

To document the prevalence and the socio-spatial variations of obesity and to identify individual and household characteristics, lifestyles and dietary practices contributing to obesity and its socio-spatial distribution.

Population-based cross-sectional survey. We selected 1570 households from four strata characterised as unstructured and low building-density (ULBD), unstructured and high building-density (UHBD), structured and low building-density (SLBD) and structured and high building-density (SHBD) areas. Structured areas are those that were allotted by the township authority (cadastral services), with public services; unstructured areas refer to those developed with no cadastral organisation.

Ouagadougou, the capital city of Burkina Faso.

BMI was calculated in 2022 adults aged 35 years and above who were classified as obese when their BMI was ≥30 kg/m2. Obesity was investigated in relation to household and individual characteristics, lifestyles and dietary practices; adjusted odds ratios with 95 % confidence intervals were derived from a logistic regression model.

The overall prevalence of obesity was 14·7 % (males 5·5 % and females 21·9 %). Age, gender, household equipment index, usual transport with motor vehicles and micronutrient-rich food consumption were associated with obesity. After adjustment for these factors, obesity remained associated with the area of residence: residents from SHBD areas were more likely to be obese than those from ULBD areas (OR = 1·41; 95 % CI 2·59,4·76).

Obesity in Ouagadougou is a preoccupant problem that calls for more consideration. Thorough investigation is needed to assess the environmental factors that contribute to the socio-spatial disparity of obesity.

The Health-promotion through Obesity Prevention across Europe (HOPE) project aims to bring the European scientific knowledge on overweight, obesity and their determinants together and use the expertise of researchers across Europe to contribute to tackling the obesity epidemic.

This special issue of Public Health Nutrition presents important results from one of the work packages of the HOPE project that aims at gaining and integrating knowledge on the determinants of nutrition, physical activity and obesity among schoolchildren and adolescents (aged 10–18 years) in different European regions. It includes contributions from Northern Europe (Norway), Central and Eastern Europe (Germany, Poland and the Czech Republic), Southern Europe (Greece) and Western Europe (Belgium and The Netherlands), as well as an overview of the availability of good-quality data on prevalence rates and trends in overweight (including obesity) among adolescents in European Union (EU) countries. The studies that are included report prevalence differences, data on relevant nutrition and physical activity behaviours, as well as potential physical and environmental behavioural determinants.

These papers provide further evidence on differences in obesity and overweight prevalence among different EU regions and countries, and contribute to the further exploration of risk factors that may or should be addressed in obesity prevention efforts for school-aged children and adolescents in EU countries.

To examine the growth of infants and toddlers in a population that is both under-represented in the literature and at high risk for childhood obesity.

Weight and height measurements were extracted from all visits for a sample of 0–4-year-old, low-income, Latino and non-Latino patients of an urban, academic general paediatric practice. Early growth was characterized as change in weight-for-length Z-score (WLZ) from birth to 3 years. The outcome of interest was BMI Z-score (BMIZ) at age 3 years. Mixed-effects models and multivariate linear regression were used to analyse the association between infant growth and early childhood obesity.

Baltimore, MD, USA.

Latino (n 210) and non-Latino (n 253) children, born in 2003–2004.

An increase in WLZ from birth to 2 years was observed for this cohort as well as a high incidence of overweight and obesity. WLZ at birth and change in WLZ from birth to 2 years were both significantly and positively associated with increases in BMIZ at 3 years of age. The effect of the change in WLZ was twofold higher than the effect of WLZ at birth.

An increase in WLZ during the first 2 years of life increased the risk of early childhood obesity. Latino children had a higher incidence of early childhood obesity than non-Latino children in this low-income sample.

To discuss present knowledge about the relation between sexual dysfunction, metabolic factors and the Mediterranean-style diet.

Review of the literature and personal perspectives.

Sexual problems appear to be widespread in society, influenced by both health-related and psychosocial factors, and are associated with impaired quality of life. Epidemiological studies suggest that modifiable health behaviours, including physical activity and leanness, are associated with a reduced risk for erectile dysfunction (ED) among men. Data from other surveys also indicate a higher prevalence of impotence in obese men. Obesity and the metabolic syndrome may be a risk factor for ED. The high prevalence of ED in patients with cardiovascular risk factors suggests that abnormalities of the vasodilator system of penile arteries play an important role in the pathophysiology of ED. We have shown that one-third of obese men with ED can regain their sexual activity after 2 years of adopting health behaviours, including a Mediterranean-style diet associated with regular exercise.

Western societies actually spend a huge part of their health care costs on chronic disease treatment and interventions for risk factors. The adoption of healthy lifestyles can reduce the prevalence of obesity and the metabolic syndrome, and hopefully the burden of sexual dysfunction.

To examine associations between nutrition screening checklists and the health of older women.

Cross-sectional postal survey including measures of health and health service utilisation, as well as the Australian Nutrition Screening Initiative (ANSI), adapted from the Nutrition Screening Initiative (NSI).

Australia, 1996.

In total, 12 939 women aged 70–75 years randomly selected as part of the Australian Longitudinal Study on Women's Health.

Responses to individual items in the ANSI checklist, and ANSI and NSI scores, were associated with measures of health and health service utilisation. Women with high ANSI and NSI scores had poorer physical and mental health, higher health care utilisation and were less likely to be in the acceptable weight range. The performance of an unweighted score (TSI) was also examined and showed similar results. Whereas ANSI classified 30% of the women as ‘high-risk’, only 13% and 12% were classified as ‘high-risk’ by the NSI and TSI, respectively. However, for identifying women with body mass index outside the acceptable range, sensitivity, specificity and positive predictive values for all of these checklists were less than 60%.

Higher scores on both the ANSI and NSI are associated with poorer health. The simpler unweighted method of scoring the ANSI (TSI) showed better discrimination for the identification of ‘at risk’ women than the weighted ANSI method. The predictive value of individual items and the checklist scores need to be examined longitudinally.

Pregnancy is one of the most critical periods for iodine deficiency. The aim of the present study was to assess the iodine status and dietary intake of pregnant women in a population changing from high to lower consumption of milk and fish.

Cross-sectional observational study. Urine samples were collected for measuring urinary iodine concentration (UIC) and creatinine, and blood samples for measuring serum thyroid-stimulating hormone (TSH). Frequency of consumption of selected food and beverages was obtained through a semi-quantitative validated FFQ. The difference in the distribution of UIC, ratio of iodine to creatinine (I:Cr) and TSH between groups following recommendations on fish and dairy product intake or not (fish ≥2 times/week as a main meal, diary products ≥2 portions/d) was assessed.

Primary Health Care of the Capital Area, Reykjavik, Iceland.

Randomly selected pregnant women (19–43 years old, n 162).

The median UIC was 180 μg/l, I:Cr 173 μg/g and TSH 1·5 mmol/l. Women who did not consume fish ≥2 times/week and also did not consume dairy products in line with the recommended intake level of ≥2 portions/d had median UIC of 160 μg/l (I:Cr 149 μg/g) compared with 220 μg/l (I:Cr 190 μg/g) in the group following both the recommendations for fish and those for dairy products. Use of dietary supplements in the two groups was similar.

Iodine status in the population studied was within the optimal range (150–249 μg/d) defined by the WHO.

The aims of the present study were to assess the reliability and validity of the Food Choice Questionnaire (FCQ) and to determine the factors associated with food-choice motives in public junior-high-school students in Jakarta, Indonesia.

Cross-sectional study with self-administered questionnaires. Trained research assistants measured height and weight of the participants on the day of the data collection.

Fourteen randomly selected public junior-high schools in East Jakarta, Indonesia.

Public junior-high-school students (n 681) in grades 7 and 8, aged 13–14 years (377 girls and 304 boys).

Three food-choice motives (subscales) were obtained from factor analysis and reliability testing: (i) comfort; (ii) convenience and price; and (iii) health. The subscale with the greatest mean value was health. Family affluence was inversely associated with the convenience and price subscale (β=−0·05, P=0·01) and with the health subscale (β=−0·04; P=0·02). Females were less likely than males to consider health when choosing foods (β=−0·16; P=0·03).

While its factor structure differed from those found in previous studies of adults, the FCQ can provide reliable measures of food-choice motives among these adolescents. Students from less affluent families placed more importance on food’s convenience and price, but more affluent students did not necessarily make healthier choices. Compared with females, males were more likely to choose healthy foods. Future interventions should be tailored based on the socio-economic status of the target group.

The aim of the present study was to assess anthropometric status in South African children and women in 2005 in order to document temporal trends in selected anthropometric parameters.

Heights and weights were measured in a cross-sectional study of children aged 1–9 years and women aged 16–35 years. The WHO reference values and BMI cut-off points were used to determine weight status.

South Africa, representative sample based on census data.

Children (n 2157) and women (n 2403).

Stunting was the most common nutritional disorder affecting 21·7 % of children in 1999 and 20·7 % in 2005. The difference was not statistically significant. Underweight prevalence remained unchanged, affecting 8·1 % of children, whereas wasting affected 5·8 % of children nationally, a significant increase from 4·3 % of children in 1999. Rural children were most severely affected. According to the international BMI cut-off points for overweight and obesity, 10 % of children nationally were classified as overweight and 4 % as obese. The national prevalence of overweight and obesity combined for women was 51·5 %. The prevalence of overweight in children based on weight-for-height Z-score did not change significantly (8·0 % to 6·8 %, P = 0·138), but the combined overweight/obesity prevalence based on BMI cut-off points (17·1 % to 14·0 %, P = 0·02) decreased significantly from 1999 to 2005.

The double burden of undernutrition in children and overweight among women is evident in South Africa and getting worse due to increased childhood wasting combined with a high prevalence of obesity among urban women, indicating a need for urgent intervention.

Vitamin B12 deficiency is associated with many adverse health outcomes and is highly prevalent worldwide. The present study assesses the prevalence of vitamin B12 deficiency and marginal deficiency in Colombian children and women and examines the sociodemographic correlates of serum vitamin B12 concentrations in these groups.

Cross-sectional, nationally representative survey.

Colombia.

Children <18 years old (n 7243), pregnant women (n 1781), and non-pregnant women 18–49 years old (n 499).

The overall prevalence of vitamin B12 deficiency (serum vitamin B12<148 pmol/l) and marginal deficiency (serum vitamin B12=148–221 pmol/l) was, respectively, 6·6 % (95 % CI 5·2 %, 8·3 %) and 22·5 % (95 % CI 21·1 %, 23·9 %). Pregnant women had the highest prevalence of deficiency (18·9 %; 95 % CI 16·6 %, 21·5 %) compared with non-pregnant adult women (18·5 %; 95 % CI 4·4 %, 53·1 %) and children (2·8 %; 95 % CI 2·3 % %, 3·3 %). In multivariable analyses among children, mean serum vitamin B12 was positively associated with female sex (12 pmol/l higher compared with males; P=0·004), secondary or higher education of the household head (12 pmol/l higher compared with primary or less; P=0·009) and food security (21 pmol/l higher compared with severe food insecurity; P=0·003). In multivariable analyses among pregnant women, mean serum vitamin B12 was positively associated with education of the household head and inversely associated with living in the National territories, Eastern or Pacific regions.

The prevalence of vitamin B12 deficiency and marginal deficiency in Colombian women and children is substantial. The burden falls largely on adult women, those with lowest education and those living in the poorest, most rural regions of the country.