Showing papers in "Public Health Nutrition in 1998"

The nutrition transition and its health implications in lower-income countries.

Abstract: Objective: This article reviews information on the rapid changes in diet, activity and body composition that lower- and middle-income countries are undergoing and then examines some of the potential health implications of this transition. Design and Setting: Data came from numerous countries and also from national food balance (FAOSTAT) and World Bank sources. Nationally representative and nationwide surveys are used. The nationally representative Russian Longitudinal Monitoring Surveys from 1992–96 and the nationwide China Health and Nutrition Survey from 1989–93 are examined in detail. Results: Rapid changes in the structure of diet, in particular associated with urbanization, are documented. In addition, large changes in occupation types are documented. These are linked with rapid increases in adult obesity in Latin America and Asia. Some of the potential implications for adult health are noted. Conclusions: The rapid changes in diet, activity and obesity that are facing billions of residents of lower- and middle-income countries are cause for great concern. Linked with these changes will be a rapid increase in chronic diseases. Little to date has been done at the national level to address these problems.

Mortality in vegetarians and non-vegetarians: a collaborative analysis of 8300 deaths among 76,000 men and women in five prospective studies.

Abstract: Objective To compare the mortality rates of vegetarians and non-vegetarians. Design Collaborative analysis using original data from five prospective studies. Death rate ratios for vegetarians compared to non-vegetarians were calculated for ischaemic heart disease, cerebrovascular disease, cancers of the stomach, large bowel, lung, breast and prostate, and for all causes of death. All results were adjusted for age, sex and smoking. A random effects model was used to calculate pooled estimates of effect for all studies combined. Setting USA, UK and Germany. Subjects 76,172 men and women aged 16-89 years at recruitment. Vegetarians were those who did not eat any meat or fish (n = 27,808). Non-vegetarians were from a similar background to the vegetarians within each study. Results After a mean of 10.6 years of follow-up there were 8330 deaths before the age of 90 years, including 2264 deaths from ischaemic heart disease. In comparison with non-vegetarians, vegetarians had a 24% reduction in mortality from ischaemic heart disease (death rate ratio 0.76, 95% CI 0.62-0.94). The reduction in mortality among vegetarians varied significantly with age at death: rate ratios for vegetarians compared to non-vegetarians were 0.55 (95% CI 0.35-0.85), 0.69 (95% CI 0.53-0.90) and 0.92 (95% CI 0.73-1.16) for deaths from ischaemic heart disease at ages Conclusion Vegetarians have a lower risk of dying from ischaemic heart disease than non-vegetarians.

UK consumer attitudes, beliefs and barriers to increasing fruit and vegetable consumption.

Abstract: Objectives. To assess attitudes, predictors of intention, and identlfy perceived barriers to increasing fruit and vegetable (FV however, scores indicated low perceived social pressure to change. Evidence of unrealistic optimism concerning perceived intakes and the perceived high cost of fruit may also act as barriers. Conclusions Results from this study suggest a lack of perceived social pressure to increase F&V intakes and suggests that public health efforts require stronger and broader health messages that incorporate consumer awareness of low present consumption.

The validation of physical activity instruments for measuring energy expenditure: problems and pitfalls

Abstract: Original article can be found at: http://journals.cambridge.org/ Copyright The Nutrition Society. DOI: 10.1079/PHN19980043

Dietary pattern, nutrient intake and growth of adolescent school girls in urban Bangladesh.

Abstract: Objective: To investigate the dietary pattern and nutritional status of adolescent girls attending schools in Dhaka city and to examine the association with various social factors. Design: Cross-sectional study. Setting: Girls high schools in Dhaka city. Subjects: A total of 384 girls, aged from 10 to 16 years, who were students of classes VI to IX of 12 girls high schools in Dhaka city were selected by systematic random sampling. Nutrient intake was assessed using the 24-h recall method and the usual pattern of food intake was examined using a 7-day food frequency questionnaire. Results: The prevalence of undernutrition among the participants assessed as stunting was 10% overall with younger girls being less stunted (2%) than older girls (16%), whereas 16% were thin with relatively more of the younger girls (21%) being thin than of the older girls (1Ph). Based on the usual pattern of food intake, a substantial proportion of the girls did not consume eggs (26%), milk (35%) or dark green leafy vegetables (20%). By comparison, larger proportions consumed meat (50%) and fish (65%) at least four times a week. For the intake of energy and protein, only 9 and 17% of the girls, respectively, met the recommended daily allowance (RDA). For nearly 77% of the girls, the intake of fat was less than the recommendation. Intakes less than the RDA were found for iron (77% of the girls), calcium (79%), vitamin A (62%), vitamin C (67%), and riboflavin (96%). Based on the food consumption data, cereals were the major source of energy (57%), thiamin (67%), niacin (63%) and iron (37%). Animal sources supplied 50% of dietary protein. Cooking fats were the principal source of fat (67%) in the diet. Milk was the major contributor for riboflavin and preformed vitamin A (retinol). Leafy vegetables and fruits were the main sources of provitamin A (carotenes). The girls from families with less educated parents were more likely to be thin and short for their age. Those girls from families with lower incomes and less educated parents had a dietary pattern which tended to be poor with regard to egg, milk, meat and fruit, with lower intakes of protein, fat and riboflavin. Conclusion: The findings indicate that the diets of these girls tended to be inadequate both for macronutrients and micronutrients, with significant health implications. There was also a relationship between the family income and the education of the parents with the nutritional status of the girls.

Relationship between cigarette smoking and nutrient intakes and blood status indices of older people living in the UK: further analysis of data from the National Diet and Nutrition Survey of people aged 65 years and over, 1994/95

Abstract: OBJECTIVE To examine the relationships between alcohol consumption and a range of nutrient intakes and blood status indices in older people. DESIGN National Diet and Nutrition Survey: cross-sectional survey of nationally representative sample of people aged 65 years or over. SETTING Mainland Britain during 1994/5. SUBJECTS 1198 people (623 males, 575 females) aged 65 years or over, of whom 925 were living in private households and 273 were living in institutions. RESULTS Intermediate alcohol consumption (particularly 0.1-14 units week(-1); 1 unit = 8 g) derived from a 4-day diet diary or a 12-month recall questionnaire, was associated with higher intakes of vitamins C, E, B1, iron, calcium, energy from food, carbohydrate and non-starch polysaccharides than heavy alcohol consumption (28 + units week(-1)) or abstinence, after adjustment for a number of factors (age, sex, domicile, social class, cigarette smoking, self-reported health, grip strength and total energy intake). Intermediate alcohol consumption was also associated with higher blood concentrations (independent of intake) of vitamin C, beta-cryptoxanthin, lutein and calcium, with the lowest concentrations being found in heavy alcohol users. The lowest concentrations of serum ferritin were found in light drinkers and the highest levels in heavier alcohol drinkers. Alcohol consumption ranging from 0.1 to >28 units week(-1) was directly correlated with intakes of B vitamins, total energy and fat, with blood concentrations (independent of intake) of lycopene, high density lipoprotein (HDL)-cholesterol, plasma pyridoxal phosphate and retinol, and with blood pressure and grip strength. CONCLUSIONS Compared with abstinence and heavy drinking, light to moderate alcohol consumption in older people is associated with higher intakes of certain nutrients, and higher blood concentrations (independent of intake) of some micronutrient status indices, including antioxidants. The explanation for the latter associations remains unclear and further investigation is recommended. Heavier alcohol consumption is associated with both beneficial and adverse effects with respect to nutrient intakes and health status.

Development and testing of a quantitative food frequency questionnaire for use in Gujarat, India

Abstract: Objective: To develop and test a food frequency questionnaire (FFQ) for use in rural areas of Kerala, India. Design: Based on food use and market surveys of the study area, a quantitative 81item interviewer-administered FFQ was developed. A validation study was conducted consisting of 24-h diet recalls (24HR) administered on 8 days randomly selected over an entire year and two administrations of the FFQ, one at the beginning of the l-year period and the other at the end. FFQ and 24HR-derived nutrient scores were compared using correlation and regression analyses and by examining differences in the nutrient scores. Setting: Rural villages in Ernakulum district, Kerala, South India. Subjecrs: In each of 30 households, the male head of household and female food preparer were enrolled. Results: Pearson (parametric) correlation coefficients (Y,) averaged about 0.50 in comparing nutrient scores derived from the 24HR with those from the first FFQ and about 0.55 in comparing the second FFQ. On average, Spearman correlation coefficients (YJ were slightly lower than the Y, in comparing the scores derived from the first FFQ, but virtually identical for the second FFQ. Regression analyses indicated better agreement in the comparison of the 24HR-derived scores with the first FFQ than the second FFQ. Difference scores, however, tended to be larger in comparing the first FFQ scores with the 24HR. Conclusions: This FFQ produces results broadly comparable to those used in Europe and North America, indicating its suitability for comparing exposures within a study population in reference to health-related endpoints.

Intake of fruits, vegetables, folic acid and related nutrients and risk of breast cancer in postmenopausal women.

Abstract: Objective:To determine the role of fruit and vegetable consumption and dietary intake of folic acid and related nutrients such as methionine, cysteine and alcohol in the aetiology of breast cancer.Design:Population based case-control study.Setting:Part of the European Community Multicentre Study on Antioxidants, Myocardial Infarction, and Cancer of the Breast (EURAMIC) in Berlin, Germany.subjects:As part of the EURAMIC study, dietary intake data were collected in 43 postmenopausal women diagnosed with breast cancer between 191 and 1992 in Berlin, Germany, and compared to 106 population-based controls.Results:Odds ratios (ORs) adjusted for major risk factors of breast cancer but not for total energy intake showed a non-significant inverse association between a high intake of vegetables (OR=0.76, 95% CI=0.48–1.20) and fruits (OR=0.74, 95% CI=0.48–1.15) and breast cancer. Once results were adjusted for total energy intake the associations became much weaker (vegetables: OR=0.86, 95% CI=0.51–1.46; fruits: OR=0.82, 95% CI=0.51–1.32). For all nutrients, the effect of energy adjustment was more profound and the inverse associations disappeared when results were adjusted for energy intake (total folate—not energy adjusted: OR=0.79, 95% CI=O.51–1.21; energy adjusted: OR=1.14, 95% CI=0.73–1.79; folate equivalents-not energy adjusted: OR=0.81, 95% CI= 0.53–1.23; energy adjusted: OR=1.16, 95% CI=0.78–1.74; methionine—not energy adjusted: OR=0.60, 95% CI=0.35–1.03; energy adjusted: OR=1.29, 95% CI=0.76–2.19; cysteine—not energy adjusted: OR=0.52, 95% CI=0.29–0.94; energy adjusted: OR=1.22, 95% CI=0.75–1.97). Alcohol intake was inversely associated with breast cancer in a non-significant way, possibly due to the relatively low alcohol intake of the study population.Conclusions:The results of this study do not provide firm evidence that a high intake of fruits and vegetables, folic acid, methionine or cysteine reduces the risk of getting breast cancer.

Reducing iron deficiency anaemia due to heavy menstrual blood loss in Nigerian rural adolescents.

Abstract: Objective Menstrual disorders are common in young women, and heavy menstrual blood losses (MBL) are an important cause of anaemia. Menstrual morbidity normally goes untreated in developing countries where cultural barriers also serve to mask the problems. We investigated the prevalence of menstrual morbidity, and measured MBL and its relationship to iron deficiency in a rural adolescent population. The rationale was to assess whether or not reducing heavy MBL could be part of a strategy to reduce iron deficiency anaemia. Setting Rural village in south-east Nigeria. Design Cross-sectional survey. Subjects The study included all non-pregnant, unmarried nulliparous girls ( Methods A field worker allocated to each girl completed a questionnaire, and supervised recovery and collection of soiled pads and ensured blood sampling. MBL was measured using the standard alkaline haematin method. Haemoglobin (Hb), serum iron, transferrin saturation and protoporphyrin levels (ZPP) were also measured. Results 307 girls completed MBL measurements; 11.9% refused to participate. 12.1% had menorrhagia (> 80 ml); median MBL was 33.1 ml. Menorrhagia was more frequent in girls who had menstruated for > 2 years (P = 0.048), and had longer duration of menses (P Conclusions The level of menorrhagia detected (12%) may be an 'expected' level for a condition which often has no underlying pathology. Heavy MBL is one of the most important factors contributing to iron deficiency anaemia. Measures are needed to alleviate menstrual disorders, and improve iron status. Oral contraceptives can be part of a strategy to reduce anaemia, particularly for adolescents at high risk of unwanted pregnancies.

A comparison of selected nutrient intakes derived from three diet assessment methods used in a low-fat maintenance trial.

Abstract: Objective In the vast majority of surveys and research in humans, dietary data are obtained from self-reports: recalls; records; or historical methods, usually food frequency questionnaires (FFQ). This study provides a rare opportunity to compare data derived from all three methods. Design A crossover study of dietary fat in which data were collected using an average of 11.4 food records and 11.7 24-h diet recalls. Using simple subtraction and correlation, energy and nutrient intakes derived from the three methods were compared to each other and with those derived from a single FFQ. Analysis of variance was used to evaluate sources of variability in nutrient intakes estimated from the individual days of records and recalls. Setting An independent, free-standing medical research institute. Subjects 13 men who were compliant with study procedures. Results FFQ-derived estimates of energy and nutrient intake were highest (e.g. 1967 kcal versus 1858 kcal and 1936 kcal for the records and recalls, respectively). Mean differences in energy and nutrient intakes and their variances were lowest and correlation coefficients highest in comparing the records and recalls (e.g. for fat the mean difference was 5.0 g, and r = 0.85). Analysis of variance of individual days of record- and recall-derived data (n = 300) revealed that there was no effect due to either method (record or recall) or the sequence of administration. Conclusions Results of this study indicate that the FFQ overestimated dietary intake. Energy and nutrient results obtained from the records and recalls were interchangeable. However, based on smaller SDs around the means, it appears that the recalls may perform slightly better in estimating dietary intake in groups such as these well-educated, highly compliant men.

Factors which influence 'healthy' eating patterns: results from the 1993 Health Education Authority health and lifestyle survey in England.

Abstract: Objective: This study explores the factors that influence eating patterns in a nationally representative sample of the English population. Design: Subjects were interviewed in 1993; questions covered basic demographic details, attitudes about nutrition, and they completed a short food frequency questionnaire that had previously been validated. Cluster analysis was used to summarize dietary intake into more or less healthy clusters. Setting: A random sample ofthe English population. Subjects: A cross-sectional survey of 5553 men and women (response rate 70%) aged between 16 and 74 years. Results: As defined from the cluster analysis about half the sample were currently reporting a more healthy diet; respondents in the better educated middle-aged demographic cluster were more likely to report eating a more healthy diet than respondents in the younger lower-income family cluster. About three-quarters of all respondents believed that they either already ate a healthy diet or had changed to a healthy diet in the last 3 years. For those respondents who said they were eating a healthy diet about half of them were eating a more healthy diet. Respondents who had not changed their diet were more likely than those who had to believe that healthy foods were just another fashion (men 34% v. 13%; women 30% v. 12%). or expensive (men 50% v. 35%; women 53% v. 40%); they were less likely to care about what they ate (men 45% v. 13%; women 27% v. 7%). Nearly three-quarters of all respondents agreed that experts never agree about what foods are good for you. Younger, low-income families, and those who smoked, were the group least likely to be eating a more healthy diet. Conclusions: The results of this study suggest that about half of the population has reported a change to a healthier diet over the last 3 years and that overall about half of the population report eating a healthy diet. Those who had not made any change and were currently reporting a less healthy diet were more likely to smoke and come from the 'worse off' group in the survey; they were also more likely to hold negative attitudes about healthy eating. A more focused and integrated approach to promoting Dietary change healthy lifestyle in general is required, while at the same time ensuring that there is healthy eating continued support for the majority of the population who have made healthy dietary Cluster analysis changes.

Feast and famine: Socioeconomic disparities in global nutrition and health

Abstract: Objective:To review current information on under- and over-malnutrition and the consequences of socioeconomic disparities on global nutrition and health.Design:Malnutrition, both under and over, can no longer be addressed without considering global food insecurity, socioeconomic disparity, both globally and nationally, and global cultural, social and epidemiological transitions.Setting:The economic gap between the more and less affluent nations is growing. At the same time income disparity is growing within most countries, both developed and developing. Concurrently, epidemiological, demographic and nutrition transitions are taking place in many countries.Results:Fully one-third of young children in the world's low-income countries are stunted because of malnutrition. One-half of all deaths among young children are, in part, a consequence of malnutrition. Forty per cent of women in the developing world suffer from iron deficiency anaemia, a major cause of maternal mortality and low birth weight infants. Despite such worrying trends, there have been significant increases in life expectancy in nearly all countries of the world, and continuing improvements in infant mortality rates. The proportion of children malnourished has generally decreased, although actual numbers have not in sub-Saharan Africa and south Asia. Inequalities are increasing between the richest developed countries and the poorest developing countries. Social inequality is an important factor in differential mortality in both developed and developing countries. Many countries have significant pockets of malnutrition and increased mortality of children, while obesity and non-communicable disease (NCDs) prevalences are increasing. Not infrequently it is the poor and relatively disadvantaged sectors of the population who are suffering both. In the industrialized countries. cardiovascular disease incidence has declined, but less so in the poorer socioeconomic strata.conclusions:The apparent contradicitions found represent a particular point in time (population responses generally lag behind social and environmental transitions). They do also show encouraging evidence that interventions can have a positive impact, sometimes despite disadvantageous circumstances. However, it seems increasingly unlikely that food production will continue to keep up with population growth. It is also unlikely present goals for reducing protein-energy malnutrition prevalence will be reached. The coexistence of diseases of undernutrition and NCDs will have an impact on allocation of resources. Action needs to be continued and maintained at the international, national and individual level.

Magnitude, determinants and impact of under-reporting of energy intake in a cohort study in Greece.

Abstract: Objectives: To investigate the frequency and the determinants of under-reporting in a semiquantitative food frequency questionnaire used in the Greek segment of the European Prospective Study on Nutrition, Cancer and Health (EPIC study). Lksign: A food frequency questionnaire was completed by 9262 adult men and women. The questions included in this questionnaire covered the average intake of approximately 150 food items and beverages over 1 year. Evaluation of underreporting was conducted on an individual basis taking into account the expected daily variation of nutritional intakes during the time period of recording. Individuals whose energy intake was lower than 1.14’BMR (basal metabolic rate) were defined as under-reporters. Setting: Urban and rural population of Greece. Results: The data indicated underestimation of energy intake by 11.8% of individuals enrolled. Results from a logistic regression model indicated that body mass index (BMI), gender, age and educational level were significant predictors of underreporting. The proportion of overweight participants (BMI>30) who tend to under-report energy intake was more than twice that of normal-weight individuals. Men were significantly more prone to under-reporting compared to women, while low education individuals under-report more often than others. Exclusion of underreporters generated, as expected, mean nutrient values that were significantly higher (by about 6%) than those derived from the total number of participants. When the nutrient values were energy-adjusted, however, or were expressed as percentages of energy intake for macronutrients or as nutrient densities for micronutrients, the emerging differences were minimal and generally statistically not significant. Conclusions; Under-reporting does exist and it is more extensive among men, those with low education levels and the overweight participants. Adjustment for energy intake minimizes the bias generated by under-reporting with respect to particular nutrients and their association with various disease outcomes in the cohort. Koywords

A longitudinal study of iron status in children at 12, 24 and 36 months.

Abstract: Objectives:To assess iron status in a sample of clinically well, Caucasian children and explore the complex factors which contribute to iron deficiency during infancy.Design:Infants recruited at birth and followed longitudinally at 1, 2, 3, 4, 5, 6, 9, 12, 24 and 36 months; feeding practices and socioeconomic data recorded. Iron status assessed using venous blood at 12, 24 and 36 months.Setting:Baseline data recorded in the maternity unit. Follow-up visits took place in the infants' homes and blood sampling in a paediatric hospital.Subjects:Subjects comprised a mixed socioeconomic group of healthy children (n=121). Blood samples taken from 85, 72 and 67% at 12, 24 and 36 months, respectively.Results:Prevalence of anaemia (Hb < 110 gl−1) in the longitudinal sample (n=76) increased from 2.6% at age 12 months to 9.2% at 24 months, and at age 36 months (n=70) was 8%. The most significant finding was that at age 12 months, cows' milk consumption was negatively associated with iron status. Other variables also had an influence. At both 24 and 36 months the most significant predictor of iron status was earlier iron status.Conclusions:Infants born to anaemic mothers or mothers who smoke and infants who consume cows' milk during infancy are at increased risk of developing anaemia. Breast milk is the ideal, but for the infant who is not breast fed an iron fortified formula should be used. Advice to mothers should focus on the importance of introducing nutrient dense complementary foods, such as meat, which contains readily absorbable iron.

Validation with biological markers for food intake of a dietary assessment method used by Swedish women with three different dietary preferences.

Abstract: Objectives:To validate a dietary assessment method, a 4-day food record together with a duplicate portion technique, with biological markers for food intake.Design:Four days of duplicate portions were collected in parallel with food recording. A 24-h urine sample and the faeces corresponding to the food intake (using a coloured marker) were collected. Completeness of urine and faeces collections was assessed using para-aminobenzoic acid (PABA) in urine and cadmium in faeces, respectively. Biomarkers of food intake (energy, protein, fibre, sodium, potassium, calcium) were measured in urine and faeces.Setting:Swedish west coast.Subjects:Non-smoking Swedish women, 20–50 years of age, consuming a mixed diet (n=34), a mixed diet rich in shellfish (n=17) or a vegetarian/high-fibre diet (n=23).Results:The average ratio (food intake according to the dietary assessment methods/biological marker) for protein, sodium, potassium and calcium was 0.86. This indicates an underestimation of the food intake by approximately 15%. The ratio of stated fibre intake to biological marker was 1.20 for the mixed diet and the vegetarian diet group, indicating an overestimation by approximately 20%.Conclusions:The underestimation of the intake of protein, sodium, potassium and calcium by all three groups and the overestimation of the fibre intake by two groups indicate that underreporting is selective to certain nutrients and foods and to various groups of people. The two dependent dietary assessment methods were equally good in measuring protein intake, which indicates that the women recorded what they actually duplicated.

Food consumption patterns in the adult population of the Basque Country (EINUT-I).

Abstract: OBJECTIVE Dietary surveys are a valuable tool in nutrition surveillance programmes to monitor the nutritional status of a group or population of a country. The objective of this study was to assess the food consumption pattern in the adult population of the Basque Country (Spain). DESIGN A cross-sectional nutritional survey was carried out in 1990. Dietary habits were assessed by means of '24-h recall' during 3 non-consecutive days and a food frequency questionnaire. SETTING Population survey in the Basque Country (Spain). SUBJECTS Random sample of the adult population (25-60 years) in the Basque Country (n = 2348). RESULTS Results draw a food pattern characterized by a high consumption of meat, 163+/-3.04 g day(-1) (mean +/- SEM), supplied mainly by poultry, butchery products, veal and fish (88+/-2.68 g day(-1)). The average consumption of milk and dairy products was 359+/-5.19 g day(-1), although 39% of the sample did consume less than 2 portions from this group of foods daily. Olive oil was the most widely used fat for cooking (45%), followed by sunflower seed oil (30%). Cereals supplied 21.5% of the average energy intake and the consumption of vegetables and garden products was 159+/-3.13 g day(-1). Only 29% of the group usually had 2 or more portions of vegetables per day. Women consumed higher amounts of chocolate, cookies, sweets and coffee (P < 0.01) than men. Younger adults consumed more meat (P < 0.01), while the older community consumed more fish, vegetables and fruit (P < 0.01). More highly educated people consumed more dairy products, vegetables and butter (P < 0.01). Conversely, less educated people consumed higher amounts of olive oil, pulses and bread (P < 0.01). CONCLUSIONS The dietary pattern observed in the Basque Country, although in keeping with its traditions, is in harmony with the actual dietary trends in Mediterranean countries. In order to satisfy the dietary guidelines suggested by the Spanish Society of Community Nutrition, it would be desirable to gradually increase the consumption of vegetables, fresh garden produce, fruit and cereals. At the same time, it would be advisable to decrease the consumption of animal products (whole fat dairy products, meat, added fats) so the proportion of energy intake from fat can be reduced by 5% (3% from saturated fatty acids).

Functional foods and health claims: a public health policy perspective

Abstract: Objective: To propose a policy framework for the regulation of functional foods and health claims within a public health context. Design: This article reviews the empirical evidence and public health principles associated with functional foods and health claims to analyse the issues, challenge the assumptions that have emerged and explore options for moving forward. Setting: Functional foods and health claims are among the more controversial and complex issues being debated by food regulators internationally. Proponents of functional foods and health claims state that functional foods may reduce health care expenditure and health claims are a legitimate nutrition education tool that will help them inform consumers of the health benefits of certain food products. Conversely, opponents of these developments respond that it is the total diet that is important for health, not so-called ‘magic bullets’. Moreover, they argue that health claims will enable manufacturers to indulge in marketing hyperbole and essentially blur the distinction between food and drugs. This topic provides a valuable case study of public policy in relation to food and health. Conclusion: The need to maintain a general prohibition on health claims while accommodating specific exemptions supported by scientific substantiation is recommended. Nutrition education and monitoring and evaluation are integral to the proposed regulatory framework. The intention of this policy position is to encourage research and development of innovative food products while avoiding an inappropriate medicalization of the general food supply.

Plasma fibrinogen of black South Africans: the BRISK study

Abstract: OBJECTIVE To describe the distribution of plasma fibrinogen and relationships with other risk factors for coronary heart disease (CHD) and stroke in the black population of the Cape Peninsula. DESIGN A cross-sectional survey of a stratified proportional sample of randomly selected black men and women. SETTING Households in Gugulethu, Langa, Nyanga, New Crossroads, KTC, Old Crossroads and Khayelitsha in the Cape Peninsula, South Africa. SUBJECTS One subject per household (352 men and 447 women), aged 15-64 years, voluntarily participated. Visitors, pregnant, lactating, ill, mentally retarded and intoxicated subjects were excluded. RESULTS Mean fibrinogen (thrombin time coagulation method) of men and women were higher than published data for Europeans but slightly lower than values of black Americans. Women aged 45-54 years had the highest level (3.13+/-0.89 g l(-1)) and men aged 15-24 years had the lowest (2.13+/-0.88 g l(-1)). Fifteen per cent of the men and 12% of the women had a level greater than 1 standard deviation of the mean for their age group. Univariate and multivariate analyses revealed significant (P<0.05) positive correlations of fibrinogen with smoking habit, age, body mass index (BMI), total and low-density lipoprotein (LDL) cholesterol, triglycerides, blood pressure and white blood cell count, and significant negative correlations with high-density lipoprotein (HDL) cholesterol, gamma glutamyl transferase (GGT), serum iron and ferritin. The correlations with BMI, serum lipoproteins, iron, ferritin, and GGT suggest that nutritional status and therefore diet influences plasma fibrinogen. CONCLUSION Relatively high fibrinogen levels, tending to cluster with other, including diet-related, risk factors for CHD and stroke, were observed in black South Africans. It is suggested that fibrinogen may contribute to the high stroke incidence of this population group.

The nutritional status of older Rwandan refugees.

Abstract: OBJECTIVE To assess the nutritional status of older people in an unstable situation. DESIGN Anthropometric and socioeconomic data were collected cross-sectionally. Body mass index (BMI), arm muscle area (AMA) and arm fat area (AFA) were calculated to evaluate nutritional status. For 41 subjects with kyphosis, height was estimated from arm span using sex-specific regression equations from the non-kyphotic group. SETTING The study was carried out in the post-emergency phase in a Rwandan refugee camp in Karagwe district, north-west Tanzania. SUBJECTS Measurements were obtained from 413 men and 415 women aged 50-92 years. RESULTS The prevalence of undernutrition (BMI < 18. 5) was 19.5% in men and 13.1% in women and was higher above age 60 years in both sexes: in men the prevalences were 23.2% and 15.0% (P < 0.05) and in women 15.1% and 10.9% for the older and younger age groups respectively. AMA, which is important in relation to the ability to remain active and independent, was also significantly lower in older age groups. No difference was found in AFA. The proportion with low BMI was much higher in the group with kyphosis. CONCLUSIONS Even in this population of older Rwandans who managed to reach the camp and survive in exile for more than a year, undernutrition does occur and is more prevalent at an advanced age. The higher prevalence of undernutrition in kyphotic people illustrates the importance of including this group in nutritional status assessments.

Curriculum design for professional development in public health nutrition in Britain.

Abstract: Objectives To describe how the Nutrition Society developed public health nutrition as a profession between 1992 and 1997, and to analyse the influences propelling on this professionalization. Design Qualitative case study. Setting Britain. Results The Nutrition Society of Britain consulted with various stakeholders (such as dietitians, researchers, professionals and practitioners and educators from the UK, and latterly from mainland Europe) to build a consensus about the definition, roles and functions of public health nutritionists and the need for, and scope of, this new profession. Building on this consensus, the Society developed a curriculum in line with British national nutrition policy. Analysis shows that the design and philosophy of the curriculum is explicitly international and European in orientation, in keeping with the tradition of the discipline and the Society. The curriculum is designed in terms of specialist competencies in public health nutrition, defining competency so that registered public health nutritionists are advanced practitioners or leaders: this is in keeping with contemporary trends in professional education generally and as expressed by the UNU/IUNS and at Bellagio, in nutrition in particular. Conclusions Despite a unique relationship with British state and policy, this case of professionalization contributes to contemporary international inter- and intraprofessional debates about the nature of public health nutrition and is consistent with professional educational theory.

The relationship between spermine content of human milk during the first postnatal month and allergy in children

Abstract: Design: Qualitative case study and mathematical model. Setting: Belgium. Objectives: To evaluate the correlation between the polyamine mean concentration of the milk drunk during the first postnatal month and the appearance of allergy in children who drank this milk. Results: A model that describes the dependence of the allergy appearance with the spermine mean concentration of milk drunk during the first postnatal month was established. Conclusions: This model shows that 5.02 nmol ml-' of spermine is a critical value to prevent the appearance of allergy. Polyamines (spermine, spermidine and putrescine) are small aliphatic polycationic molecules that are ubiquitous in nature and are synthesized by all cell types. These molecules are involved in intestinal growth'. In the rat, mucosal polyamine concentrations show a dramatic increase at the moment of postnatal intestinal maturation. Moreover, we have shown in previous studies that it is possible to induce precocious intestinal maturation in rats by giving them spermidine or spermine orally2. We have also previously shown3 that human milk contains generally more polyamines than infant formulas. Romain et uL3 proposed that the putative protective effect of human milk against allergies4, as compared to classical infant formulas, could at least partially be explained by its polyamine (spermine, spermidine, putrescine) concentration and the role of these compounds in the postnatal maturation of the small intestine. Allergy is an important health problem as it restricts people suffering from it in their activities and social life. In this study we evaluated the correlation between the polyamine mean concentration of the milk drunk during the first postnatal month and the appearance of allergy in children who drank this milk.

Predicting percentage of individuals consuming foods from percentage of households purchasing foods to improve the use of household budget surveys in estimating food chemical intakes.

Abstract: Objective: To examine the hypothesis that there is sufficient agreement between percentage of households purchasing selected foods using household budget surveys and percentage of individuals consuming these foods as determined in individual-based surveys to allow the former to act as a surrogate for the latter when estimating food chemical intakes using household budget data. Design: Database study. Setting: Databases from Sweden, The Netherlands, Ireland and the UK. Subjects: 319 foods (Sweden n = 60, The Netherlands n= 80, Ireland n=90, UK n=89). Results: Pearson correlations demonstrated a high degree of linear association between % households purchasing and % consumers (r=0.86). Regression analysis defined a close positive relationship between the two datasets (slope 0.95, intercept +2.74). Across countries, using the regression equation, the % households predicted % consumers to within 5% of the true value for between 33 and 48% of foods and to within 10% for between 53 and 78% of foods. Conclusions: Values for % households can be used as a crude surrogate for % consumers and can thus play a role in improving estimates of food additive intake.

Wernicke-Korsakoff syndrome in Sydney hospitals after 6 years of thiamin enrichment of bread.

Abstract: OBJECTIVES To estimate the incidence of Wernicke's encephalopathy (WE) and Korsakoff's psychosis (KP) before and after the introduction of thiamin enrichment of bread in Australia. DESIGN AND SUBJECTS Inpatient records were examined in 17 major public general hospitals in greater Sydney for the 4 years 1993-96 (inclusive) with the International Classification of Diseases (ICD) 9 diagnoses 265.1 (WE), 291.1 and 294.0 (KP). Relevant clinical data were recorded on a specially designed form so that cases could be classified as confirmed or probable WE, confirmed or probable KP, confirmed or probable Wernicke-Korsakoff syndrome (WE + KP) or not WE or KP. The average number of cases of WE + KP was 38 acute (new) cases and 69 total (acute + chronic) cases per annum for all the hospitals combined. RESULTS This study used the same methods as our earlier retrospective examination of Wernicke-Korsakoff cases in essentially the same hospitals for 1978-93. Records for 1993 were thus pulled twice and, while individual cases (using hospital index number) did not always coincide, the total numbers for 1993 were 69 and 70. For the 5 years after 1991 the number of acute cases of WE and KP in Sydney hospitals was 61% of the number for the 5 years before 1991 (P<0.01). There is, however, no continuing downward trend. CONCLUSIONS These results are consistent with a 40% reduction of the incidence of acute WE and KP since bread has been enriched with thiamin. The disease complex has, however, not been eliminated. To achieve this, further public health action would be needed, such as addition of thiamin to beer.

Schoolchildren's diets and participation in school feeding programmes in Jamaica.

Abstract: Objective:To describe food consumption during the school day of rural Jamaican children and participation in two government school feeding programmes. To determine factors which were related to these.Design:Cross sectional.Setting:16 primary schools in rural Jamaica.Subjects:415 children in grades 2 and 5 (ages 7 and 10 years).Results:Consumption of sweets, sweet drinks and snacks was high. Mean intakes at lunch were: energy 1537 kJ (SD 756), protein 10.4 g (SD 7.6) and iron 1.5 mg (SD 1.2). The mean energy intake was 17–20% of the daily requirement for this age group. Two types of school feeding programmes were available in the schools, one provided a cooked meal and the other a bun and milk. Median availability of school meals (as a percentage of children enrolled in the schools) over three terms was 24.6% (range 0–85.4%). Twenty per cent of the children participated in one or other programme. Poorer children were more likely to participate in the bun and milk programme (odds ratio 2.1, 95% C1 1.3–3.5) but children with more money to purchase food participated in the more costly cooked meal programme (odds ratio 2.4, 95% CI 1.3–4.6).Conclusions:Energy intakes at lunch in Jamaican children were somewhat below optimal levels and the reliance on sweets and snacks is an area of concern. Programme characteristics such as meal cost, may affect access to school feeding by poor children.

Effects of reduced-fat diets with different fatty acid compositions on serum lipoprotein lipids and apolipoproteins.

Abstract: Objective: To compare the effects on serum lipoproteins of three isocaloric diets with reduced total fat and saturated fatty acid (SFA) contents but with different proportions of monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA). Design: A low-fat diet (LF) provided 20 en% fat, 7.9% SFA, 7.8% MUFA, 3.0% PUFA; a high-PUFA diet (HP) 26 en% fat, 7.5% SFA, 8.2% MUFA, 8.1% PUFA; and a high-MUFA diet (HM) 26 en% fat, 7.3% SFA, 14.1% MUFA, 3.2% PUFA. Diets were consumed for 8 weeks in a parallel design, after 2 weeks on a habitual diet with 33-34 en% fat, 13-14% SFA, 12% MUFA, 6% PUFA, and followed by an 8-week period on habitual diet. Compliance to diet was monitored by repeated food records and weekly visits to a nutritionist. Subjects: 45 free-living, middle-aged couples who were randomly allocated into the three diet groups; 43 men and 44 women completed the study. Results: During the diet periods, a small but significant reduction in body weight of 0.4-1.0kg was observed in all groups. Similar and significant reductions of mean weight-adjusted serum total cholesterol (4-8%), low-density lipoprotein (LDL) cholesterol (7-1 1%), and high-density lipoprotein (HDL) cholesterol (8-1 1%) were observed during the diets. HDL2-cholesterol and apoprotein (apo) A-I levels were reduced whereas HDL3-cholesterol and apoA-I1 increased. ApoB was significantly decreased during the HM diet only. Serum triglycerides increased significantly during diets LF (25%, P< 0.01) and HP (19%, P< 0.05) but not during diet HM (5%, NS). Conclusions: Reduction in the intake of total fat and saturated fatty acids reduced serum LDL-cholesterol and HDL2-cholesterol concentrations irrespective of the relative proportions of MUFA and PUFA in the diets. The results suggest that there might be some advantage in increasing the proportion of MUFA in low-fat diets, since the HM diet rich in MUFA reduced apoB and slightly attenuated the increase in serum triglycerides that is commonly associated with dietary fat reduction. Reduction of dietary fat intake reduces serum cholesterol levels in people who consume typical Western diets'. Both low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol are generally reduced. The decrease in LDLcholesterol is due to a reduction in dietary saturated fatty acid (SFA) intake. SFA with 12-16 carbon atoms increase serum LDL-cholesterol levels while monounsaturated fatty acids (MUFA) are considered neutral and polyunsaturated fatty acids (PUFA) slightly hypocholesterolaemic'. Very large amounts of PUFA may decrease serum HDL-ch~lesterol~ ~~

Sales data of a supermarket--a tool for monitoring nutrition interventions.

Abstract: OBJECTIVE The aim of the study was to examine the daily variations in sales data for individual food items in a supermarket and to assess the usefulness of the computerized sales data of supermarkets for reliable monitoring and evaluation of shopping behaviour. DESIGN Longitudinal observational study. SETTING The study was carried out in one supermarket in Mikkeli, Finland. Seventy-nine packed food items from food groups important for salt and fat intake were monitored. In all food groups both 'healthier' and 'reference' products were included for assessment of both direct sales and proportional sales. The sales data were collected daily for 2 months in May and September 1996 by reading the European Article Numbering (EAN) codes of the packed foods. RESULTS The proportional sales turned out to be a more stable and useful measure than the direct sales data and the variation remained the same when the monitoring time was increased from 1 week to 1 month. CONCLUSION Proportional sales data are proposed as a tool for measuring the effect of nutrition interventions and also as a possible indirect assessment for population salt and fat intake.