Infants aged 0–5 months are not systematically included in assessments of child nutritional status and are generally excluded from surveys conducted in emergencies. We estimated the impact of excluding 0–5-month-old infants on the prevalence of stunting, wasting and underweight among children under 5 years (U5) and under 3 years (U3) of age.

Comparison of the prevalence of stunting, wasting and underweight in U5 and U3 with or without inclusion of the age group 0–5 months.

Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 76 developing countries and countries in transition.

Children under 3 or under 5 years of age included in the surveys.

Excluding 0–5-month-old infants resulted in an overestimation of the prevalence of stunting, wasting and underweight in U5 of 3.0, 0.3 and 2.6 percentage points, respectively, and of 4.8, 1.0 and 5.2 percentage points, respectively, in U3. The overestimation for wasting was negligible. The regions showing the highest overestimations for stunting and underweight were Asia and sub-Saharan Africa. Overall, countries with high prevalences of stunting and underweight showed especially large overestimations. The prevalence of underweight in infants aged 0–5 months was correlated with the prevalence of low maternal body mass index.

All surveys, even in situations of nutrition emergency, should include 0–5-month-old infants. Strictly comparable age ranges are essential in nutrition surveys for monitoring trends and evaluating programme impact. Greater awareness of prenatal and early child undernutrition is needed among policy-makers.

To assess rates of initiation of breast-feeding and exclusive breast-feeding within 2 months after delivery and to determine the factors influencing exclusive breast-feeding.

A health worker-administered questionnaire survey was carried out during the time period 1 August–30 September 2005.

Immunisation clinics of Pokhara, a submetropolitan city in western Nepal.

Three hundred and eighty-five mothers who had delivered a child within the previous 2 months.

The rates of initiation within 1 h and within 24 h of delivery were 72.7 and 84.4%, respectively. Within 2 months after delivery, exclusive breast-feeding was practised by 82.3% of the mothers. Breast milk/colostrum was given as the first feed to 332 (86.2%) babies but 17.2% of them were either given expressed breast milk or were put to the breast of another lactating mother. Pre-lacteal feeds were given to 14% of the babies. The common pre-lacteal feeds given were formula feeds (6.2%), sugar water (5.9%) and cow's milk (2.8%). Complementary feeds were introduced by 12.7% of the mothers. By logistic regression analysis, friends' feeding practices, type of delivery and baby's first feed were the factors influencing exclusive breast-feeding practice of the mothers.

Despite the higher rates of initiation and exclusive breast-feeding, practices such as pre-lacteal feeds and premature introduction of complementary feeds are of great concern in this urban population. There is a need for promotion of good breast-feeding practices among expectant mothers and also the community, especially the families, taking into account the local traditions and customs.

Traditionally, carbohydrate has been the largest contributor to energy intake among people with diabetes, yet different carbohydrate foods produce different glycaemic responses. Glycaemic load represents the total glycaemic effect of the diet and influences glycaemic control. Adequate self-efficacy and outcome expectations are needed to change carbohydrate intake and to evaluate relevant interventions. The purpose of this research was to develop and test instruments regarding self-efficacy and outcome expectations for the adoption of a lower glycaemic load diet.

Participants completed each instrument at their convenience and mailed the instruments to the investigators.

A community sample of individuals 21–75 years of age with type 2 diabetes for ≥ 1 year (n = 108) was recruited.

Principal components analysis revealed three factors on the self-efficacy questionnaire: glycaemic index, negative food selection and self-regulation efficacy which accounted for 62% of the variance in these items. The outcome expectations instrument yielded three factors: barriers to dietary change and glycaemic control, and family support expectations which accounted for 48% of the variance. Coefficient α for each construct was >0.70 and coefficient H for each construct was ≥ 0.80.

The two instruments developed for this study can provide important insights about the self-efficacy and outcome expectations regarding the quantity and quality of carbohydrate consumed and self-monitoring performed for diabetes management. Future research is needed to evaluate the relationship among these constructs, dietary intake and glycaemic control.

To analyse the association between macronutrient intake and body mass index (BMI).

A series of hospital-based case–control studies.

Selected teaching and general hospitals in several Italian regions.

A total of 6619 subjects from the comparison groups of the case–control studies were included in the analysis.

We obtained data from a validated 78-item food-frequency questionnaire submitted between 1991 and 2002. For various macronutrients, the partial regression coefficient (variation of BMI (kg m− 2) per 100 kcal increment of energy intake) was derived from multiple linear regression models, after allowance for age, study centre, education, smoking habits, number of eating episodes and mutual adjustment for macronutrients.

BMI was directly associated with protein intake among women only (β = 0.68) and with unsaturated fats in both genders (for monounsaturated fats β = 0.27 for men and 0.26 for women; for polyunsaturated fats β = 0.27 for men and 0.54 for women), and inversely related to carbohydrates (β = − 0.05 for men and − 0.21 for women) and number of eating episodes in both genders (β =  − 0.42 for men and − 0.61 for women) and to saturated fats among women only (β =  − 0.57).

These results confirm and provide convincing evidence that, after allowance for selected covariates including total energy intake, a protein-rich diet is not inversely related to BMI, and a carbohydrate-rich diet is not directly related to BMI.

To examine the relationship between mental distress, academic performance and regular breakfast consumption across gender and immigration status.

Cross-sectional population-based study. Two four-page questionnaires were filled in during two school sessions.

All junior high schools in Oslo, Norway using the classroom as the setting for the study.

All 10th grade students 15–16 years olds in 2000 and 2001. Of 8316 eligible students, 7343 (88.3%) participated in the study.

All immigrant groups, except the Western countries group, are skipping breakfast more often than Norwegian students, and girls more often than boys (27 versus 19%). After adjustment for possible confounding factors, the odds ratio (OR) for being mentally distressed when eating breakfast seldom/never compared with every day was 3.0 (2.0–4.5) for boys, 1.6 (1.2–2.1) for girls and 1.6 (1.5–2.6) for the immigrant group. The comparable OR for having low school grades was similar for boys and girls, 2.0 (1.3–3.0), and 1.6 (1.5–2.6) for the immigrant groups.

Skipping breakfast is a common feature among 10th grade students. The implications of skipping breakfast on mental distress and academic performance are stronger for boys than girls and stronger for Norwegians compared with immigrants.

To compare the average out-of-home (OH) consumption of foods and beverages, as well as energy intake, among populations from 10 European countries and to describe the characteristics of substantial OH eaters, as defined for the purpose of the present study, in comparison to other individuals.

Cross-sectional study. Dietary data were collected through single 24-hour dietary recalls, in which the place of consumption was recorded. For the present study, substantial OH eaters were defined as those who consumed more than 25% of total daily energy intake at locations other than the household premises. Mean dietary intakes and the proportion of substantial OH eaters are presented by food group and country. Logistic regression analyses were used to estimate the odds of being a substantial OH eater in comparison to not being one, using mutually adjusted possible non-dietary determinants.

Ten European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC).

The subjects were 34 270 individuals, 12 537 men and 21 733 women, aged 35–74 years.

The fraction of energy intake during OH eating was generally higher in northern European countries than in the southern ones. Among the food and beverage groups, those selectively consumed outside the home were coffee/tea/waters and sweets and, to a lesser extent, cereals, meats, added lipids and vegetables. Substantial OH eating was positively associated with energy intake and inversely associated with age and physical activity. Substantial OH eating was less common among the less educated compared with the more educated, and more common during weekdays in central and north Europe and during the weekend in south Europe.

Eating outside the home was associated with sedentary lifestyle and increased energy intake; it was more common among the young and concerned in particular coffee/tea/waters and sweets.

To demonstrate how dietary data collected from 24-hour dietary recalls were incorporated into the development of a quantitative food-frequency questionnaire (QFFQ) for the Apache in Arizona.

A cross-sectional study was first conducted using 24-hour dietary recalls to identify foods for inclusion on a QFFQ that would be used to evaluate a nutrition intervention.

The White Mountain and San Carlos Apache reservations in East-central Arizona.

The 24-hour dietary recalls were collected from a random sample of 53 adults (34 women and 19 men).

A QFFQ was developed that included all foods reported by two or more respondents, plus traditional and seasonal foods. Portion size was assessed using familiar household units and culturally appropriate food models. The final instrument contains 155 foods. Frequency of consumption is assessed using eight categories ranking from ‘never or less than once a month’ to ‘2 or more times a day’. Nutrient intakes and the five major food sources of energy, fat and sugar are presented.

The QFFQ developed is complete and up-to-date for assessing usual food and nutrient intake for the Apache in Arizona. The instrument will be used to evaluate a food store-based nutrition intervention to reduce risk of chronic diseases.

To document infant feeding methods in the first six months of life in Xinjiang Uygur Autonomous Region, People's Republic of China, 2003–2004. Some problems with breast-feeding in the area are explained.

A longitudinal study of infant feeding practices was undertaken. A total of 1219 mothers who delivered babies during 2003 and 2004 were interviewed in five hospitals or institutes, and after discharge were contacted in person or by telephone at approximately monthly intervals to obtain details of infant feeding practices. Multivariate logistic regression analysis was used to explore factors associated with breast-feeding initiation.

‘Any breast-feeding’ rates at discharge and at 0.5, 1.5, 2.5, 3.5, 4.5 and 6 months were 92.2, 91.3, 89.9, 88.8, 87.7, 86.0 and 73.0%, respectively. ‘Exclusive breast-feeding’ rates at discharge and at 0.5, 1.5, 2.5, 3.5, 4.5 and 6 months were 66.2, 47.6, 30.1, 25.8, 22.1, 13.0 and 6.2%, respectively. The main problem of breast-feeding in Xinjiang was the early introduction of formula or water. The average duration of ‘exclusive breast-feeding’ was 1.8 months (95% confidence interval (CI) 1.7–2.0), of ‘full breast-feeding’ 2.8 months (95% CI 2.7–2.9) and of ‘any breast-feeding’ 5.3 months (95% CI 5.2–5.4).

Infant feeding methods in Xinjiang were documented in this study and the main problems with infant feeding in Xinjiang are discussed. Further studies are needed to identify factors associated with ‘exclusive breast-feeding’ and duration.

This study reports on the energy, macro- and micronutrient intakes of a true longitudinal group of 143 urban black South African children from the Birth-to-Twenty (Bt20) study at two interceptions (2000 and 2003) when they were 10 and 13 years old, respectively.

Subjects resided in the urban Johannesburg/Soweto area of the Gauteng Province in South Africa. Dietary intake was assessed using a semi-quantitative food-frequency questionnaire. The coded data were analysed using SAS.

Mean daily intake of energy, all six macronutrients and most micronutrients (17/19) increased from 2000 to 2003. Of the 19 micronutrients investigated, the mean daily intake of eight (calcium, iron, zinc, vitamin A, riboflavin, nicotinic acid, pantothenic acid and biotin) fell below the recommended dietary allowance (RDA) at both interceptions. More than 70% of the children consumed less than the RDA for these same eight nutrients. From 2000 to 2003, there was a decrease in the percentage of children falling below the RDA for energy (from 73 to 59%), but an increase in the percentage of children falling below the RDA for most of the micronutrients. There was a positive percentage change in mean daily intake for all 26 macro- and micronutrients from 2000 to 2003.

Mean daily intake of nutrients increased from 2000 to 2003, but intakes for most micronutrients were still below the RDA at both interceptions for a large percentage of the children. The study has provided valuable information on the nutrient intake and change in intake over time among a longitudinal group of South African adolescents.

The purpose of this study was to investigate the knowledge and health beliefs regarding osteoporosis risk factors of New Zealand women aged 20–49 years.

A descriptive, web-based survey.

An opportunistic sample of 622 women aged between 20 and 49 years living in Auckland, New Zealand was recruited by email.

There was a moderate level of knowledge about osteoporosis risk factors among the women surveyed, with a mean total score for all subjects of 16.4 (standard deviation (SD) 4.0) out of a possible 26 correct responses. Mean scores for osteoporosis knowledge were statistically different by age group, with women aged 40–49 years scoring higher than those aged 30–39 years and 20–29 years (17.3 (SD 4.0), 16.4 (SD 4.1) and 15.8 (SD 3.9), respectively, P < 0.001). Overall, about a third of the women perceived that they were likely to develop osteoporosis and 22% believed the disease to be potentially crippling. Most women were aware of the benefits of exercise and optimal calcium nutrition in preventing osteoporosis. Few women perceived barriers to exercise participation and eating calcium-rich foods. Older women (40–49 years) were more motivated to take care of their health than younger women (P < 0.001). A large percentage of subjects (77%) thought that calcium-rich foods contained too much cholesterol.

Despite reporting higher than average educational attainment and health consciousness, these women demonstrated average levels of knowledge about osteoporosis risk factors. They had low feelings of susceptibility towards development of osteoporosis, but most considered it to be a serious disease.

To estimate the impact of foetal nutritional status on cardiovascular risk among children with the Foetal Nutritional Status Index (FNSI), calculated by dividing the child's birth weight (BW, kg) by the mother's height (m2).

Cross-sectional survey analysis.

A sample of children from the US Third National Health and Nutrition Examination Survey.

A total of 3109 children who were 5–11 years of age and had data on BW and mother's height. Non-fasting blood samples were included.

Overall, the FNSI was positively associated with BW and negatively associated with mother's height (P < 0.0001). Within sex-specific quintiles of FNSI (third quintile as reference) adjusted for potential confounding variables, cardiovascular risk factors tended to be ‘higher’ in the lower quintiles for males while the opposite was true for females. Multivariate logistic regression analyses indicated that the odds for males in quintile 1 was 2.4 for having a low level of high-density lipoprotein cholesterol (P < 0.01) and 2.1 for having a cluster of cardiovascular risk factors (P = 0.01); for females, the odds of having a cluster of cardiovascular risk factors was approximately two times higher for those in the first and fifth quintiles, who also had a significantly higher prevalence of central obesity.

The FNSI may be a potential proxy indicator of foetal nutritional status and it may be used to test specific hypotheses of whether foetal nutrition restriction or overnutrition programmes future cardiovascular risk.

Modification of lifestyle is the main therapeutical approach in the treatment of obesity, but use to fail on long terms of time. Addition of anti-obesity drugs allows keeping the weight loss during years and improving obesity-related comorbidities.

This review is an actualisation on efficacy, safety and tolerability of the approved drugs on the long-term treatment of obesity (orlistat and sibutramine). New indications and effects of their use far beyond the weight loss are as well commented. Finally, potential benefits of the administration of CB1 antagonist rimonabant on the weight loss and cardiometabolic risk factors are analysed in detail.

A decade of experience on the use of orlistat and sibutramine has demonstrated their higher efficacy on the weight loss when compared to placebo either on adult or teenage population as well as safety and tolerability on long-term administration. Beneficial effects on the lipid profile, glycosilated haemoglobin on diabetic patients, blood pressure and levels of inflammatory cytokines, contribute to decrease the cardiovascular risk on obese patients. Phase III clinical trials using rimonabant show additional benefits to the expected weight loss, mainly reducing visceral fat and cardiometabolic risk factors.

Pharmacological treatment of obesity must be considered as a therapeutical tool that has to be used together with long-term lifestyle changes, contributing to the body weight reduction as well as to the improvement of the cardiometabolic risk related to obesity.

To examine educational differences among people who consume foods containing fat in Finland and the Baltic countries.

Data were collected from cross-sectional postal Finbalt Health Monitor surveys that were carried out in 1998, 2000 and 2002.

Estonia, Finland, Latvia and Lithuania.

For each survey, nationally representative random samples of adults aged 20–64 years were drawn from population registers (Estonia, n = 3656; Finland, n = 9354, Latvia, n = 6015; Lithuania, n = 5944).

Differences were revealed between the countries in the consumption of foods that contain fat. Finnish people consumed butter on bread, high-fat milk, meat and meat products, and vegetable oil for cooking less frequently than people in the Baltic countries. Cheese was most popular in Finland. Educational differences in fat-related food habits were examined by applying logistic regression analysis. A positive association was found between level of education and consumption of vegetable oil used in food preparation. Drinking high-fat milk was associated with low education in all countries. People with higher education tended to consume cheese more often. Educational patterns in the consumption of butter on bread and in the consumption of meat and meat products differed between countries.

The consumption of foods containing fat was related to educational levels in all four countries. The diet of better-educated people was closer to recommendations for the consumption of saturated and unsaturated fats than the diet of people with lower level of education. The educational gradient was more consistent in Finland than in the Baltic countries. These existing educational differences in sources of fat consumed should be taken into account in the development of national cardiovascular disease prevention programmes.

The aim of the present study was to examine parents' reported and desired frequencies (practices vs. attitudes) of their 6-year-old children's meals, nutritional intake and lifestyle components, as well as possible obstacles and desired support with respect to higher or lower educational backgrounds.

Cross-sectional questionnaire study.

Five elementary schools in Uppsala, Sweden.

Parents of 176 6-year-old pupils attending the first grade. The total response rate was 89.7%.

Parents with a college degree reported that their 6-year-olds had a higher frequency of milk, fruit and vegetable intake, more physical activity and fewer hours watching television compared with parents with a secondary school degree. Congruent to these differences in reported practices, more parents with a college degree desired a higher frequency of milk, fruit and vegetable intake, more physical exercise and less television viewing for their children. Regarding parents' desired meal frequencies during the week, no differences between the groups with higher and lower levels of education were found. Despite similar attitudes, however, parents with a college degree reported that their children ate mostly all meals significantly more often during the week. Both parent groups stated lack of time as the most common obstacle in providing their children with desired lifestyle practices, although parents with a secondary school education added lack of money as a contributing factor.

As attitudes are not always reflected in reported practices, it seems a fruitful approach to assess both, as well as obstacles perceived by parents, before planning interventions to enhance healthy lifestyle habits in children.

To assess the intake inadequacy and food sources of zinc of people in China.

Diets of 68 962 subjects aged 2–101 years (urban 21 103, rural 47 859) in the 2002 China National Nutrition and Health Survey were analysed. Dietary intake was assessed using 24-hour recall for three consecutive days. Zinc intake inadequacy was calculated based on values suggested by the World Health Organization.

The median zinc intake ranged from 4.9 mg day− 1 (urban girls, 2–3 years) to 11.9 mg day− 1 (rural males, 19+ years). The zinc density of urban residents (2–3 to 19+ years) was 5.0–5.3 mg day− 1 (1000 kcal)− 1, significantly higher than that of their rural counterparts (4.7–4.8 mg day− 1 (1000 kcal)− 1). Differences in food sources of zinc from cereal grains (27.4–45.1 vs. 51.6–63.2%) and animal foods (28.4–54.8 vs. 16.8–30.6%) were found between urban and rural residents. Zinc from vegetables and fruits (8.2–13.8 vs. 9.7–12.4%) and legumes (1.3–3.3 vs. 2.5–3.4%) was comparable between urban and rural residents. The proportion of zinc intake inadequacy ranged between 2.8% (urban females, 19+ years) and 29.4% (rural lactating women). Rural residents had higher proportions of zinc intake inadequacy than their urban counterparts. Significantly higher proportions of zinc inadequacy were found in the category of phytate/zinc molar ratio >15 for both rural and urban residents.

About 20% of rural children are at risk of inadequate zinc intake, with phytate as a potential important inhibitor. Moreover, lactating women are also considered a vulnerable group.

Despite assumed similarities in Canadian and US dietary habits, some differences in food availability and nutrient fortification exist. Food-frequency questionnaires designed for the USA may therefore not provide the most accurate estimates of dietary intake in Canadian populations. Hence, we undertook to evaluate and modify the National Cancer Institute's Diet History Questionnaire (DHQ) and nutrient database.

Of the foods queried on the DHQ, those most likely to differ in nutrient composition were identified. Where possible these foods were matched to comparable foods in the Canadian Nutrient File. Nutrient values were examined and modified to reflect the Canadian content of minerals (calcium, iron, zinc) and vitamins (A, C, D, thiamin, riboflavin, niacin, B6, folate and B12). DHQs completed by 13 181 Alberta Cohort Study participants aged 35–69 years were analysed to estimate nutrient intakes using the original US and modified versions of the DHQ databases. Misclassification of intake for meeting the Dietary Reference Intake (DRI) was determined following analysis with the US nutrient database.

Twenty-five per cent of 2411 foods deemed most likely to differ in nutrient profile were subsequently modified for folate, 11% for vitamin D, 10% for calcium and riboflavin, and between 7 and 10% for the remaining nutrients of interest. Misclassification with respect to meeting the DRI varied but was highest for folate (7%) and vitamin A (7%) among men, and for vitamin D (7%) among women over 50 years of age.

Errors in nutrient intake estimates owing to differences in food fortification between the USA and Canada can be reduced in Canadian populations by using nutrient databases that reflect Canadian fortification practices.

The risk factors for fractures are incompletely understood. An outstanding question concerns the optimal amount of dietary calcium needed to minimise the risk of fracture.

We examined the associations of dietary calcium and other nutrients with self-reported fracture risk in a prospective cohort study. Nutrient intakes were estimated using a semi-quantitative food-frequency questionnaire administered at recruitment.

The UK.

A total of 26 749 women and 7947 men aged 20–89 years.

Over an average of 5.2 years of follow-up, 1555 women and 343 men reported one or more fractures, 72% of these resulting from a fall. Among women, fracture risk was higher at lower calcium intakes, with a relative risk of 1.75 (95% confidence interval (CI) 1.33–2.29) among women with a calcium intake of < 525 mg day− 1 compared with women with a calcium intake of at least 1200 mg day− 1 (test for linear trend, P < 0.001). The association of dietary calcium with fracture risk was stronger among women aged under 50 years at recruitment than among women aged 50 and above. Dietary calcium intake was not associated with fracture risk in men. Fracture risk was not related to the dietary intake of any other nutrient examined.

In this population, women with a low dietary calcium intake had an increased risk of bone fracture, and this association was more marked among younger women than among older women.

To examine UK country and ethnic variations in infant feeding practices.

Cohort study.

Infants enrolled in the Millennium Cohort Study, born between September 2000 and January 2002.

A total of 18 150 natural mothers (11 286 (8207 white) living in England) of singleton infants.

Breast-feeding initiation, breast-feeding discontinuation and introduction of solid foods before 4 months.

Maternal ethnic group, education and social class.

Seventy per cent of UK mothers started to breast-feed, of whom 62% stopped before 4 months. Median age at discontinuing breast-feeding was 14, 13, 10 and 6 weeks in Scotland, England, Wales and Northern Ireland, respectively. Thirty-six per cent of UK mothers (34% in England) introduced solids before 4 months. White mothers were more likely to discontinue breast-feeding (62%) and introduce solids early (37%) than most other ethnic minority groups; those stopping before 4 months were more likely to introduce solids early compared with those continuing to breast-feed beyond this age (adjusted rate ratio (95% confidence interval): 1.3 (1.1–1.2)). Educated mothers were less likely to stop breast-feeding before 4 months (white mothers, 0.8 (0.8–0.9); non-white mothers, 0.9 (0.8–1.0)) than those with no/minimal qualifications but, among ethnic minorities, were more likely to introduce solids early (1.3 (1.0–1.6)). Socio-economic status was positively associated with breast-feeding continuation among white women, and with age at introduction of solids among non-white women.

We have identified important geographic, ethnic and social inequalities in breast-feeding continuation and introduction of solids within the UK, many of which have not been reported previously. The factors mediating these associations are complex and merit further study to ensure that interventions proposed to promote maternal adherence to current infant feeding recommendations are appropriate and effective.