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 establish an international consensus on the definition of food security, measures and advocacy priorities in high-income countries.

A two-round online Delphi survey with closing in March 2020 and December 2021. Consensus was set a priori at 75 %. Qualitative data were synthesised and priorities were ranked.

High-income countries.

Household food security experts in academia, government and non-government organisations who had published in the last 5 years.

Up to thirty-two participants from fourteen high-income countries responded to the Delphi with a 25 % response rate in Round 1 and a 38 % response rate in Round 2. Consensus was reached on the technical food security definition and its dimensions. Consensus was not reached on a definition suitable for the general public. All participants agreed that food security monitoring systems provide valuable data for in-country decision-making. Favoured interventions were those that focused on upstream social policy influencing income. Respondents agreed that both national and local community level strategies were required to ameliorate food insecurity, reinforcing the complexity of the problem.

This study furthers the conceptual understanding of the commonly used definition of food security and its constituent dimensions. Strong advocacy is needed to ensure food security monitoring, policy and mitigation strategies are implemented. The consensus on the importance of prioritising actions that address the underlying determinants of household food security by experts in the field from across wealthy nations provides evidence to focus advocacy efforts and generate public debate.

The primary objective was to evaluate the rate at which non-English dietary supplement advertisements distributed in a sampled ethnic minority community are in compliance with the federal advertising regulations. The secondary objective was to assess the availability of supporting evidence to substantiate the advertised health claims.

Cross-sectional study.

The contents of dietary supplement advertisements from the Los Angeles Korea Times and the Los Angeles Korea Daily were evaluated during the month of July 2005. After removing duplicate advertisements, the percentage of advertisements making prohibited disease claims and DSHEA (Dietary Supplement Health and Education Act) disclaimer statements was determined. The presence of data substantiating advertised claims was determined by requesting data from the manufacturers and browsing the manufacturers' websites. An observational technique was utilised for content analysis, and data analysis was conducted using quantitative descriptive statistics.

Disease claims were present in 84.5%, while DHSEA disclaimer statements were present in only 18.4% of the advertisements. Data to substantiate the claims were provided by 53.4% of the manufacturers. The majority of the additional information consisted of repetition of the advertised claims and consumer testimonies. Experimental data were available for only 13.6% of the products.

The high rate of non-compliance with federal regulations suggests a need for better oversight of non-English promotions of dietary supplements.

To model effective vegetable parenting practices using the Model of Goal Directed Vegetable Parenting Practices construct scales.

An Internet survey was conducted with parents of pre-school children to assess their agreement with effective vegetable parenting practices and Model of Goal Directed Vegetable Parenting Practices items. Block regression modelling was conducted using the composite score of effective vegetable parenting practices scales as the outcome variable and the Model of Goal Directed Vegetable Parenting Practices constructs as predictors in separate and sequential blocks: demographics, intention, desire (intrinsic motivation), perceived barriers, autonomy, relatedness, self-efficacy, habit, anticipated emotions, perceived behavioural control, attitudes and lastly norms. Backward deletion was employed at the end for any variable not significant at P<0·05.

Houston, TX, USA.

Three hundred and seven parents (mostly mothers) of pre-school children.

Significant predictors in the final model in order of relationship strength included habit of active child involvement in vegetable selection, habit of positive vegetable communications, respondent not liking vegetables, habit of keeping a positive vegetable environment and perceived behavioural control of having a positive influence on child’s vegetable consumption. The final model’s adjusted R2 was 0·486.

This was the first study to test scales from a behavioural model to predict effective vegetable parenting practices. Further research needs to assess these Model of Goal Directed Vegetable Parenting Practices scales for their (i) predictiveness of child consumption of vegetables in longitudinal samples and (ii) utility in guiding design of vegetable parenting practices interventions.

The Mediterranean diet (MD) pattern has important health benefits; however, it seems that Spanish school-aged children have been abandoning this healthy pattern recently. We aimed to identify psychopathological, anthropometric and sociodemographic factors that may influence the risk of low MD adherence.

Longitudinal study in three phases. MD adherence was assessed using the Krece Plus food questionnaire and psychopathological symptoms using the Screen for Childhood Anxiety Related Emotional Disorders, Children’s Depression Inventory, Youth’s Inventory-4 and Eating Disorder Inventory-2. Anthropometric data were collected in the first and third phases.

All five representative areas in Reus, Spain.

Adolescents (n 241).

Regardless of past and current BMI, socio-economic status was a protective factor for low MD adherence (OR=0·805, P=0·003) and a risk factor for high BMI (OR=0·718, P=0·002; OR=0·707, P=0·001). Regardless of socio-economic status, depression was involved with risk of low adherence (OR=1·069, P=0·021). Girls with lower MD adherence presented significantly higher scores for eating disorders measured using the Eating Disorder Inventory-2 (low adherence, mean 18·9 (sd 13·5); high adherence, mean 8·9 (sd 9·0), P=0·020) and the Youth Inventory-4 (low adherence, mean 5·2 (sd 4·3); medium adherence, mean 3·6 (sd 3·2), P=0·044). They also presented higher depression symptoms (low adherence, mean 17·7 (sd 9·6); medium adherence, mean 12·3 (sd 7·2), P=0·01) than girls with high adherence.

The results highlight the influence of psychosocial factors on levels of MD adherence. These factors need to be taken into account when developing prevention and health promotion initiatives.

To examine the frequency of television (TV) food and beverage advertisements (F&B ads) to which children (4–11 years) are likely exposed and the nutrient profile of products advertised.

TV broadcasting between September and November 2016 was recorded (288 h of children’s programming; 288 h of family programming) resulting in 8980 advertisements, of which 1862 were F&B ads. Of those, 1473 could be classified into one of the seventeen food groups, and into permitted/non-permitted according to the WHO-EU nutrient profile model. Persuasive marketing techniques used were also identified.

TV programming was recorded for four weekdays and four weekend days, between 06.00 and 00.00 hours (576 total hours), for four channels (two national and two cable), in Costa Rica.

Mean (sd) number of F&B ads/h was greater in cable than national channels (3·7 (0·4) v. 2·8 (0·4), P < 0·05) and during children’s peak viewing hours (4·4 (0·4) v. 2·9 (0·3)). Of F&B ads classified with WHO-EU nutrient profile model (n 1473, 71·1 %), 91·1 % were non-permitted to be marketed to children. Categories most frequently advertised were ready-made/convenience foods (16 %), chocolates/confectionery/desserts (15 %), breakfast cereals (14 %), beverages (15 %), edible ices (9 %) and salty snacks (8 %). Non-permitted F&B ads were more likely to use promotional characters, brand benefit claims, and nutrition and health claims than permitted F&B ads.

Children watching popular TV channels in Costa Rica are exposed to a high number of unhealthy F&B ads daily. Our findings help justify the need for regulatory actions by national authorities.

To simplify body weight measurement and, particularly, to encourage children and their parents to participate in the Italian nutritional surveillance system OKkio alla SALUTE, children were measured with clothes and then the weight was corrected for the estimated weight of the clothes. In the present study we compared the children's weight measured in underwear, as recommended by the WHO (WWHO), with that obtained using the OKkio alla SALUTE protocol (WOK) and investigated how the latter affects the calculation of BMI and the assessment of overweight and obesity prevalence.

Weight (twice in close sequence, with and without clothing) and height were measured. A checklist was used to describe the type of clothing worn. The estimated weight of clothing was subtracted from the WOK. BMI was calculated considering both values of weight and height; ponderal status was defined using both the International Obesity Task Force and WHO BMI cut-offs.

Thirty-seven third grade classes of thirteen primary schools in Rome and in two towns in the Lazio Region were recruited.

The anthropometric measurements were taken on 524 children aged 8–9 years.

The error in the calculation of BMI from WOK was very low, 0·005 kg/m2 (95 % CI −0·185, 0·195 kg/m2); the agreement between the percentages of overweight (not including obesity) and obese children calculated with the two methods was very close to 1 (κ = 0·98).

The error in BMI and in nutritional classification can be considered minor in a surveillance system for monitoring overweight/obesity, but eases the procedure for measuring children.

The Dietary Guidelines for Americans (DGA) promote healthy dietary choices for all Americans aged 2 years and older; however, the majority of Americans do not meet recommendations. The goal of the present study was to identify both barriers and facilitators to adherence to DGA recommendations for consumption of five recommended food groups: grains (specifically whole grains), vegetables, fruits, meat/beans and milk (specifically reduced-fat/non-fat), among American-Indian children.

Nominal group technique sessions were conducted to identify and prioritize children’s perceived barriers and facilitators to following the DGA, as presented in the ‘MyPyramid’ consumer education icon. After response generation to a single question about each food group (e.g. ‘What sorts of things make it harder (or easier) for kids to follow the MyPyramid recommendation for vegetables?’), children individually ranked their top five most salient responses. Ranked responses are presented verbatim.

A rural Northern Plains American-Indian reservation, USA.

Sixty-one self-selected fifth-grade children.

Core barriers for all food groups studied included personal preference (i.e. ‘don’t like’) and environmental (i.e. ‘cost too much’; ‘store is too far to get them’; ‘grandma don’t have’). Core facilitators included suggestions, i.e. ‘make a garden and plant vegetables’; ‘tell your friends to eat healthy’.

Barriers and facilitators are dissimilar for individual food groups, suggesting that dietary interventions should target reduction of barriers and promotion of facilitators specific to individual food groups recommended by the DGA.

The aim of the present work was to evaluate the influence of two front-of-pack nutrition information schemes (traffic-light system and Chilean warning system) on consumer purchase of ultra-processed foods in a simulated online grocery store.

Following a between-subjects design, participants completed a simulated weekly food purchase in an online grocery store under one of three experimental conditions: (i) a control condition with no nutrition information, (ii) a traffic-light system and (iii) the Chilean warning system. Information about energy (calories), sugar, saturated fats and salt content was included in the nutrition information schemes.

Participants were recruited from a consumer database and a Facebook advertisement.

People from Montevideo (Uruguay), aged 18–77 years (n 437; 75 % female), participated in the study. All participants were in charge of food purchase in the household, at least occasionally.

No significant differences between experimental conditions were found in the mean share of ultra-processed foods purchased by participants, both in terms of number of products and expenditure, or in the mean energy, sugar, saturated fat and salt content of the purchased items. However, the Chilean warning system decreased intended purchase of sweets and desserts.

Results from this online simulation provided little evidence to suggest that the traffic-light system or the Chilean warning system in isolation could be effective in reducing purchase of ultra-processed foods or improving the nutritional composition of the purchased products.

Bread is a staple of the Mediterranean diet but contributes substantially to its salt content (19 % in Spain). The objective of the present study was to assess the feasibility and acceptability of salt reduction in partially baked breads, partly replacing salt (NaCl) with a potassium salt, with subsequent follow-up.

During 2013, nine breads already on the market (1·8 % NaCl flour basis) had 0·5 % of NaCl replaced with potassium citrate (27·7 % reduction in sodium) and were commercialized in Spain. Later, breads were baked in bake-off stores and sold ready-to-eat to consumers. This market test was evaluated by comparing the sales between standard- v. reduced-salt breads and the complaints related to flavour attributes. The wholesalers involved in the market test were then surveyed.

Spain.

The market test confirmed good acceptance of the reduced-salt breads, as 2013 sales were 3678 tonnes v. 2012 sales of 3577 tonnes for the same standard breads. No complaints were received. The wholesaler survey showed, in general, little awareness of salt reduction.

It is feasible that potassium citrate can reduce the salt content of bread without negatively affecting sales or complaints. This shows potential for introducing this type of bread on a larger scale.

We evaluated the effect of home fortification with multiple micronutrient powder (MNP) on anaemia and micronutrient status of young Amazonian children.

A pragmatic controlled trial was performed. A control group (CG) of children aged 11–14 months was recruited in the routine of primary health-care centres for assessing anaemia and micronutrient status. At the same time, an intervention group (IG) of infants aged 6–8 months was recruited in the same health centres to receive MNP daily in complementary feeding for 2 months. The IG children were assessed 4–6 months after enrolment (n 112) when they had reached the age of the CG participants (n 128) for comparisons.

Primary health centres in Rio Branco city, Brazilian Amazon.

A total of 240 children aged<2 years.

In the CG, the prevalence of anaemia (Hb<110 g/l), iron deficiency (ID; plasma ferritin <12 μg/l or soluble transferrin receptor >8·3 mg/l) and vitamin A deficiency (VAD; serum retinol <0·70 μmol/l) was 20·3 %, 72·4 % and 18·6 %, respectively. Among the IG participants (aged 11–14 months), the prevalence of anaemia, ID and VAD was 15·2 %, 25·2 % and 4·7 %, respectively. The IG had a lower likelihood of ID (prevalence ratio (95 % CI): 0·34 (0·24, 0·49)) and VAD (0·25 (0·09, 0·64)).

Home fortification of complementary feeding delivered through primary health care was effective in reducing iron and vitamin A deficiencies among young Amazonian children.

To determine if voluntary policies on supermarket checkout foods are associated with a difference in the healthfulness of foods displayed at, or near, supermarket checkout areas.

Cross-sectional survey of foods at, or near, supermarket checkouts categorised as less healthy or not according to the Food Standards Agency’s Nutrient Profiling Model.

One city in Eastern England (population about 125 000).

All stores in nine supermarket groups open for business in June–July 2017 in the study city. Supermarket checkout food policies were categorised as clear and consistent, vague or inconsistent, or none.

In thirty-three stores, 11 434 checkout food exposures were recorded, of which 8010 (70·1 %) were less healthy; and 2558 foods in areas near checkouts, of which 1769 (69·2 %) were less healthy. After adjusting for a marker of store size, the odds of a checkout food exposure being ‘less healthy’ was lower in stores with vague or inconsistent checkout policies (OR=0·63; 95 % CI 0·49, 0·80) and in stores with clear and consistent checkout policies (OR=0·33; 95 % CI 0·24, 0·45), compared with no policy. There was no difference in the odds of foods near, but not at, checkouts being less healthy according to checkout food policy.

Supermarket checkout food policies were associated with lower odds of checkout foods but not foods near, but not at, checkouts being less healthy. Further research is required to explore impacts on purchasing and consumption.

To test the effectiveness of a social network intervention (SNI) to improve children’s healthy drinking behaviours.

A three-arm cluster randomised control trial design was used. In the SNI, a subset of children were selected and trained as ‘influence agents’ to promote water consumption–as an alternative to sugar-sweetened beverages (SSB)–among their peers. In the active control condition, all children were simultaneously exposed to the benefits of water consumption. The control condition received no intervention.

Eleven schools in the Netherlands.

Four hundred and fifty-one children (Mage = 10·74, SDage = 0·97; 50·8 % girls).

Structural path models showed that children exposed to the SNI consumed 0·20 less SSB per day compared to those in the control condition (β = 0·25, P = 0·035). There was a trend showing that children exposed to the SNI consumed 0·17 less SSB per day than those in the active control condition (β = 0·20, P = 0·061). No differences were found between conditions for water consumption. However, the moderation effects of descriptive norms (β = –0·12, P = 0·028) and injunctive norms (β = 0·11–0·14, both P = 0·050) indicated that norms are more strongly linked to water consumption in the SNI condition compared to the active control and control conditions.

These findings suggest that a SNI promoting healthy drinking behaviours may prevent children from consuming more SSB. Moreover, for water consumption, the prevailing social norms in the context play an important role in mitigating the effectiveness of the SNI.

To examine the prevalence of and factors associated with different forms of household-level double burden of malnutrition (DBM) in Ethiopia.

We defined DBM using anthropometric measures for adult overweight (BMI ≥ 25 kg/m2), child stunting (height-for-age Z-score <-2 sd) and overweight (weight-for-height Z-score ≥2 sd). We considered sixteen biological, environmental, behavioural and socio-demographic factors. Their association with DBM forms was assessed using generalised linear models.

We used data from two cross-sectional studies in an urban (Addis Ababa, January–February 2018), and rural setting (Kersa District, June–September 2019).

Five hundred ninety-two urban and 862 rural households with an adult man, adult woman and child <5 years.

In Addis Ababa, overweight adult and stunted child was the most prevalent DBM form (9 % (95 % CI 7, 12)). Duration of residence in Addis Ababa (adjusted OR (aOR) 1·03 (95 % CI 1·00, 1·06)), Orthodox Christianity (aOR 1·97 (95 % CI 1·01, 3·85)) and household size (aOR 1·24 (95 % CI 1·01, 1·54)) were associated factors. In Kersa, concurrent child overweight and stunting was the most prevalent DBM form (11 % (95 % CI 9, 14)). Housing quality (aOR 0·33 (95 % CI 0·20, 0·53)), household wealth (aOR 1·92 (95 % CI 1·18, 3·11) and sanitation (aOR 2·08 (95 % CI 1·07, 4·04)) were associated factors. After adjusting for multiple comparisons, only housing quality remained a significant factor.

DBM prevalence was low among urban and rural Ethiopian households. Environmental, socio-economic and demographic factors emerged as potential associated factors. However, we observed no common associated factors among urban and rural households.

We explored how Americans aged ≥2 years who consumed the recommended amount of fruits and vegetables on a given day incorporated fruits and vegetables into their diet compared with those who did not consume recommended amounts.

We used 1 d of dietary recall data from the National Health and Nutrition Examination Survey (NHANES) 2007–2010 to examine cross-sectional differences in mean intakes of fruits and vegetables in cup-equivalents by meal, source and form between the two groups.

USA.

NHANES 2007–2010 participants aged ≥2 years (n 17 571) with 1 d of reliable 24 h recall data.

On a given day, the proportions of fruits and vegetables consumed at different meals were similar between those who consumed recommended amounts and those who did not. Among adults, 59–64 % of their intake of fruits was consumed at breakfast or as a snack and almost 90 % came from retail outlets regardless of whether they consumed the recommended amount or not. Adults who consumed the recommended amount of fruits ate more fruits in raw form and with no additions than those who did not. Among children and adults, 52–57 % of vegetables were consumed at dinner by both groups. Retail outlets were the main source of vegetables consumed (60–68 %).

Our findings indicate that habits of when, where and how consumers eat fruits and vegetables might not need to change but increasing the amount consumed would help those not currently meeting the recommendation.

To study plasma 25-hydroxyvitamin D (25(OH)D) status of children in Kerala, southern India, and its relationship with sociodemographic variables.

Cross-sectional observational study.

Tertiary government hospital.

Children (n 296) with trivial acute illness were enrolled. Sun exposure and Ca and vitamin D intakes (7 d dietary recall) were documented. Serum Ca, P, alkaline phosphatase, plasma 25(OH)D and parathyroid hormone (PTH) were measured.

Prevalence of vitamin D deficiency (plasma 25(OH)D <30 nmol/l) was 11·1% (median, interquartile range (IQR): 52·6, 38·4–65·6 nmol/l). Children who ate fish daily had significantly higher plasma 25(OH)D than those who did not (median, IQR: 52·5, 40·8–68·9 v. 49·1, 36·2–60·7 nmol/l; P = 0·02). Those investigated in the months of March–May showed highest 25(OH)D v. those enrolled during other times (median, IQR: 58·7, 45·6–81·4 v. 45·5, 35·6–57·4 nmol/l; P <0·001). Plasma 25(OH)D correlated positively with serum P (r = 0·24, P <0·001) and Ca intake (r = 0·16, P 0·03), negatively with age (r = −0·13, P 0·03) and PTH (r = −0·22, P <0·001.). On linear regression, summer season (March–May), lower age, daily fish intake and higher Ca intake were independently associated with plasma 25(OH)D.

Prevalence of vitamin D deficiency is low in Kerala. The natural fish diet of coastal Kerala and the latitude may be protective. Public health policy in India should take account of this geographical diversity.

To promote the new field of ‘public nutrition’ as a means to address, in a more efficient, sustainable and ethical manner, the world-wide epidemic of malnutrition – undernutrition and specific nutrient deficiencies, and also obesity and other nutrition-related chronic diseases.

Grounded in the health promotion model, public nutrition applies the population health strategy to the resolution of nutrition problems. It encompasses ‘public health nutrition’, ‘community nutrition’ and ‘international nutrition’ and extends beyond them. It fits within the conceptual framework of ‘the new nutrition science’ and is an expression of this reformulated science in practice. Its fundamental goal is to fulfil the human right to adequate food and nutrition. It is in the interest of the public, it involves the participation of the public and it calls for partnerships with other relevant sectors beyond health. Public nutrition takes a broader view of nutritional health, addressing the three interrelated determinant categories of food systems and food security; food and health practices; and health systems. It assesses and analyses how these influence the immediate determinants that are dietary intake and health status so as to direct action towards effective progress. To further enhance the relevance and effectiveness of action, public nutrition advocates improved linkages between policies and programmes, research and training. A renewed breed of professionals for dietetics and nutrition, trained along those lines, is suggested.

There is a critical need to develop new knowledge, approaches and skills to meet the pressing nutrition challenges of our times.

Despite public health campaigns based on Fe and folic acid supplements, Fe-deficiency anaemia remains highly prevalent among women in India. We investigated leaf concentrate as an alternative to Fe and folic acid supplements for treating anaemia in adolescent girls.

Randomised controlled two-arm trial over 3 months: one group received daily Fe and folic acid (IFA; 60 mg Fe, 500 μg folic acid); the other daily leaf concentrate (LC; 5 mg Fe, 13 μg folic acid). Hb concentration, mean cell volume, serum Fe, serum ferritin and total Fe-binding capacity were measured pre- and post-intervention.

Jaipur, India.

One hundred and two adolescent girls aged 14–18 years.

Of the 102 girls randomized to the two arms of the trial, four (3·9 %) were severely anaemic (Hb < 7 g/dl), twenty-eight (27·5 %) were moderately anaemic (Hb ≥ 7 g/dl, <10 g/dl) and seventy (68·6 %) were mildly anaemic (Hb ≥ 10 g/dl, <12 g/dl). In the IFA group, eleven girls (20·4 %) withdrew due to side-effects, compared with one girl (2·1 %) in the LC group (P = 0·005). Total losses to follow-up were 14/54 in the IFA group and 2/48 in the LC group. At the end of the trial, none of the eighty-six remaining girls were severely anaemic, nine (10·5 %) were moderately anaemic and twenty-six (30·2 %) were mildly anaemic; fifty-one (59·3 %) had normal Hb levels (≥12 g/dl). After adjustment for baseline values, LC was as effective as IFA in improving serum Fe parameters and treating anaemia.

Leaf concentrate is an effective, and more palatable, alternative to Fe and folic acid supplements for treating anaemia in adolescent girls.

In 2007 the Australian Division of World Action on Salt and Health (AWASH) launched a campaign to encourage the Australian government to take action to reduce population salt intake. The objective of the present research was to assess the impact of the Drop the Salt! campaign on government policy.

A review of government activities related to salt reduction was conducted and an advocacy strategy implemented to increase government action on salt. Advocacy actions were documented and the resulting outcomes identified. An analysis of stakeholder views on the effectiveness of the advocacy strategy was also undertaken.

Advocacy activities were coordinated through AWASH at the George Institute for Global Health in Sydney.

All relevant State and Federal government statements and actions were reviewed and thirteen stakeholders with known interests or responsibilities regarding dietary salt, including food industry, government and health organisations, were interviewed.

Stakeholder analysis affirmed that AWASH influenced the government's agenda on salt reduction and four key outputs were attributed to the campaign: (i) the Food Regulation Standing Committee discussions on salt, (ii) the Food and Health Dialogue salt targets, (iii) National Health and Medical Research Council partnership funding and (iv) the New South Wales Premier's Forum on Fast Foods.

While it is not possible to definitively attribute changes in government policy to one organisation, stakeholder research indicated that the AWASH campaign increased the priority of salt reduction on the government's agenda. However, a coordinated government strategy on salt reduction is still required to ensure that the potential health benefits are fully realised.

Extracts of St. John's wort have been widely used in the treatment of depression. Our aim was to review information related to the efficacy and safety of St. John's wort as an antidepressant.

Primary and review articles were identified by a search of Medline (1960 to February 2000) and through secondary sources.

All the articles identified from the data sources were evaluated and all relevant information was included in this review. The pharmacokinetics, mechanism of action, efficacy, side effects and drug interactions of St. John's wort have been examined in various studies.

St. John's wort is a promising investigational antidepressant, but the data are not yet sufficient to accept hypericum as a first line antidepressant preparation for treatment of depression. Besides the need for dose standardization and adequate trial lengths, there is a need for studies in severely depressed patients and long-term studies to assess the risk of relapse and recurrence.