Showing papers in "Public Health Nutrition in 2005"

Consumer understanding and use of nutrition labelling: a systematic review.

Abstract: Objective To explore published and unpublished research into consumer understanding and use of nutrition labelling which is culturally applicable in Europe. Design A systematic review undertaken between July 2002 and February 2003. Results One hundred and three papers were identified that reported on consumer understanding or use of nutrition labelling, most originating from North America or northern Europe. Only a few studies (9%) were judged to be of high or medium-high quality. We found that reported use of nutrition labels is high but more objective measures suggest that actual use of nutrition labelling during food purchase may be much lower. Whether or not consumers can understand and use nutrition labelling depends on the purpose of the task. Available evidence suggests that consumers who do look at nutrition labels can understand some of the terms used but are confused by other types of information. Most appear able to retrieve simple information and make simple calculations and comparisons between products using numerical information, but their ability to interpret the nutrition label accurately reduces as the complexity of the task increases. The addition of interpretational aids like verbal descriptors and recommended reference values helps in product comparison and in putting products into a total diet context. Conclusions Improvements in nutrition labelling could make a small but important contribution towards making the existing point-of-purchase environment more conducive to the selection of healthy choices. In particular, interpretational aids can help consumers assess the nutrient contribution of specific foods to the overall diet.

Basal metabolic rate studies in humans: measurement and development of new equations.

Abstract: To facilitate the Food and Agriculture Organization/World Health Organization/United Nations University Joint (FAO/WHO/UNU) Expert Consultation on Energy and Protein Requirements which met in Rome in 1981, Schofield et al. reviewed the literature and produced predictive equations for both sexes for the following ages: 0–3, 3–10, 10–18, 18–30, 30–60 and >60 years. These formed the basis for the equations used in 1985 FAO/WHO/UNU document, Energy and Protein Requirements . While Schofield's analysis has served a significant role in re-establishing the importance of using basal metabolic rate (BMR) to predict human energy requirements, recent workers have subsequently queried the universal validity and application of these equations. A survey of the most recent studies (1980–2000) in BMR suggests that in most cases the current FAO/WHO/UNU predictive equations overestimate BMR in many communities. The FAO/WHO/UNU equations to predict BMR were developed using a database that contained a disproportionate number – 3388 out of 7173 (47%) – of Italian subjects. The Schofield database contained relatively few subjects from the tropical region. The objective here is to review the historical development in the measurement and application of BMR and to critically review the Schofield et al. BMR database presenting a series of new equations to predict BMR. This division, while arbitrary, will enable readers who wish to omit the historical review of BMR to concentrate on the evolution of the new BMR equations. BMR data collected from published and measured values. A series of new equations (Oxford equations) have been developed using a data set of 10 552 BMR values that (1) excluded all the Italian subjects and (2) included a much larger number (4018) of people from the tropics. In general, the Oxford equations tend to produce lower BMR values than the current FAO/WHO/UNU equations in 18–30 and 30–60 year old males and in all females over 18 years of age. This is an opportune moment to re-examine the role and place of BMR measurements in estimating total energy requirements today. The Oxford equations' future use and application will surely depend on their ability to predict more accurately the BMR in contemporary populations.

Validation of the Spanish version of the physical activity questionnaire used in the Nurses' Health Study and the Health Professionals' Follow-up Study.

Abstract: Objective: The objective of this analysis was to test the validity of the estimates of energy expenditure and sedentary lifestyle obtained through a self-administered questionnaire of physical activity for Spanish-speaking people adapted from US questionnaires (Nurses’ Health Study and Health Professionals’ Follow-up Study) using a triaxial accelerometer (RT3 Triaxial Research Tracker) as the reference. Design and setting: Validation study, calculating the non-parametric correlation coefficients between the level of physical activity and sedentary lifestyle collected by the self-administered questionnaire and the triaxial accelerometer measurements. Percentage of misclassification and kappa coefficients were also calculated. Subjects: The study population consisted of a sample of 40 obese women who were participants of the SUN (Seguimiento Universidad de Navarra) project (a prospective cohort study among Spanish university alumni). They were selected because of their peculiar metabolic characteristics, in the search for a sub-optimal scenario for validity. Results: Physical activity during leisure time (estimated as MET-h week 21 ) derived from the self-administered questionnaire moderately correlated with kcal day 21 assessed through the accelerometer (Spearman’s r ¼ 0.507, 95% confidence interval (CI) 0.232, 0.707). The Spearman correlation between the ratio of sedentary lifestyle to physical activity obtained through the questionnaire and the direct estimation (RT3) was 20.578 (95% CI 20.754, 20.325). The kappa index was 0.25 (P ¼ 0.002) when assessing the cross-classification into quintiles and 0.41 for the dichotomous estimation of a sedentary lifestyle. Only 2.5% of participants were misclassified by the questionnaire more than two quintiles apart from the estimates of the RT3. Conclusions: The moderate values obtained for correlation in a sub-optimal scenario for validity and the low percentage of extreme misclassification suggest the validity of the questionnaire to assess physical activity in Spanish-speaking women aged 20–50 years.

Measurement of energy expenditure.

Abstract: Measurement of energy expenditure in humans is required to assess metabolic needs, fuel utilisation, and the relative thermic effect of different food, drink, drug and emotional components. Indirect and direct calorimetric and non-calorimetric methods for measuring energy expenditure are reviewed, and their relative value for measurement in the laboratory and field settings is assessed. Where high accuracy is required and sufficient resources are available, an open-circuit indirect calorimeter can be used. Open-circuit indirect calorimeters can employ a mask, hood, canopy or room/chamber for collection of expired air. For short-term measurements, mask, hood or canopy systems suffice. Chamber-based systems are more accurate for the long-term measurement of specified activity patterns but behaviour constraints mean they do not reflect real life. Where resources are limited and/or optimum precision can be sacrificed, flexible total collection systems and non-calorimetric methods are potentially useful if the limitations of these methods are appreciated. The use of the stable isotope technique, doubly labelled water, enables total daily energy expenditure to be measured accurately in free-living subjects. The factorial method for combining activity logs and data on the energy costs of activities can also provide detailed information on free-living subjects.

Energy requirements during pregnancy and lactation.

Abstract: Objective: To estimate the energy requirements of pregnant and lactating women consistent with optimal pregnancy outcome and adequate milk production. Design: Total energy cost of pregnancy was estimated using the factorial approach from pregnancy-induced increments in basal metabolic rate measured by respiratory calorimetry or from increments in total energy expenditure measured by the doubly labelled water method, plus energy deposition attributed to protein and fat accretion during pregnancy. Setting: Database on changes in basal metabolic rate and total energy expenditure during pregnancy, and increments in protein based on measurements of total body potassium, and fat derived from multi-compartment body composition models was compiled. Energy requirements during lactation were derived from rates of milk production, energy density of human milk, and energy mobilisation from tissues. Subjects: Healthy pregnant and lactating women. Results: The estimated total cost of pregnancy for women with a mean gestational weight gain of 12.0kg, was 321 or 325MJ, distributed as 375, 1200, 1950kJday 21 , for the first, second and third trimesters, respectively. For exclusive breastfeeding, the energy cost of lactation was 2.62MJday 21 based on a mean milk production of 749gday 21 , energy density of milk of 2.8kJg 21 , and energetic efficiency of 0.80. In well-nourished women, this may be subsidised by energy mobilisation from tissues on the order of 0.72MJday 21 , resulting in a net increment of 1.9MJday 21 over non

Effect of iron supplementation on mental and motor development in children: systematic review of randomised controlled trials.

Abstract: Objective: To evaluate the effect of iron supplementation on mental and motor development in children through a systematic review of randomised controlled trials (RCTs). Data sources: Electronic databases, personal files, hand search of reviews, bibliographies of books, abstracts and proceedings of international conferences. Review methods: RCTs with interventions that included oral or parenteral iron supplementation, fortified formula milk or cereals were evaluated. The outcomes studied were mental and motor development scores and various individual development tests employed, including Bayley mental and psychomotor development indices and intelligence quotient. Results: The pooled estimate (random effects model) of mental development score standardised mean difference (SMD) was 0.30 (95% confidence interval (CI) 0.15 to 0.46, P , 0.001; P , 0.001 for heterogeneity). Initial anaemia and iron-deficiency anaemia were significant explanatory variables for heterogeneity. The pooled estimate of Bayley Mental Development Index (weighted mean difference) in younger children (,27 months old) was 0.95 (95% CI 20.56 to 2.46, P ¼ 0.22; P ¼ 0.016 for heterogeneity). For intelligence quotient scores ($8 years age), the pooled SMD was 0.41 (95% CI 0.20 to 0.62, P , 0.001; P ¼ 0.07 for heterogeneity). There was no effect of iron supplementation on motor development score (SMD 0.09, 95% CI 20.08 to 0.26, P ¼ 0.28; P ¼ 0.028 for heterogeneity). Conclusions: Iron supplementation improves mental development score modestly. This effect is particularly apparent for intelligence tests above 7 years of age and in initially anaemic or iron-deficient anaemic subjects. There is no convincing evidence that iron treatment has an effect on mental development in children below 27 months of age or on motor development.

Associations between parental report of the home food environment and adolescent intakes of fruits, vegetables and dairy foods.

Abstract: Objective: This study examines parental report of household food availability parent dietary intake and associations with adolescent intakes of fruits vegetables and dairy foods. Design: Cross-sectional study. Adolescents completed the Project EAT survey and the Youth Adolescent Food Frequency Questionnaire at school. Parents of adolescents were interviewed by telephone about the home food environment eating habits and weight-related behaviours. General linear modelling was used to compare dietary intakes of adolescents across different levels of household food availability and parental intakes. Subjects/setting: The study sample included 902 adolescents and their parent or guardian. Results: Many parents were not consuming the minimum number of daily recommended fruit (44.5%) vegetable (69.9%) or dairy (46.9%) servings. While most parents reported that fruits and vegetables were available at home (90.3%) and vegetables were usually served at dinner (87.0%) fewer parents reported milk was served at meals (66.6%). Soft drinks were usually available at home (56.8%). Among girls household availability was positively associated with fruit and vegetable intake (t(-trend)=2.70 P < 0.01) and soft drink availability was inversely associated with dairy intake (t(-trend)=2.08 P=0.04). Among boys serving milk at meals was positively associated with dairy intake (t(-trend)=3.65 P<0.01). Parental intakes were positively associated with dairy intake for boys (t(-trend)=2.04 P=0.04) and with dairy (t(- trend)=2.43 P=0.01) vegetable (t(-trend)=3.72 P<0.01) and fruit (t(- trend)=3.17 P<0.01) intakes for girls. Conclusions/applications: Interventions designed to help adolescents improve consumption of fruits vegetables and dairy foods may be enhanced by including a parental component aimed at increasing household availability and parents intake of healthful food choices. (authors)

The National Food Consumption Survey (NFCS): South Africa, 1999.

Abstract: Objective: The aim of the National Food Consumption Survey (NFCS) in South Africa was to determine the nutrient intakes and anthropometric status of children (1–9 years old), as well as factors that influence their dietary intake. Design: This was a cross-sectional survey of a nationally representative sample of all children aged 1–9 years in South Africa. A nationally representative sample with provincial representation was selected using 1996 Census information. Subjects: Of the 3120 children who were originally sampled data were obtained from 2894, a response rate of 93%. Methods: The sociodemographic status of each household was assessed by a questionnaire. Dietary intake was assessed by means of a 24-hour recall and a foodfrequency questionnaire from the caregivers of the children. Food purchasing practices were determined by means of a food procurement questionnaire. Hunger was assessed by a modified hunger scale questionnaire. Nutritional status was determined by means of anthropometric measurements: height, weight, head circumference and arm circumference. Results: At the national level, stunting (height-for-age below minus two standard deviations ( ,2 2SD) from the reference median) was by far the most common nutritional disorder, affecting nearly one in five children. The children least affected (17%) were those living in urban areas. Even with regard to the latter, however, children living in informal urban areas were more severely affected (20%) compared with those living in formal urban areas (16%). A similar pattern emerged for the prevalence of underweight (weight-for-age ,2 2SD), with one in 10 children being affected at the national level. Furthermore, one in 10 (13%) and one in four (26%) children aged 1–3 years had an energy intake less than half and less than two-thirds of their daily energy needs, respectively. For South African children as a whole, the intakes of energy, calcium, iron, zinc, selenium, vitamins A, D, C and E, riboflavin, niacin, vitamin B6 and folic acid were below two-thirds of the Recommended Dietary Allowances. At the national level, data from the 24-hour recalls indicated that the most commonly consumed food items were maize, sugar, tea, whole milk and brown bread. For South African children overall, one in two households (52%) experienced hunger, one in four (23%) were at risk of hunger and only one in four households (25%) appeared food-secure. Conclusion: The NFCS indicated that a large majority of households were foodinsecure and that energy deficit and micronutrient deficiencies were common, resulting in a high prevalence of stunting. These results were used as motivation for the introduction of mandatory fortification in South Africa.

Obesity in South Africa: challenges for government and health professionals.

Abstract: Objectives: To review data on the prevalence, causes and health consequences of obesity in South Africa and propose interventions to prevent and treat obesity and related outcomes. Methods: Data from existing literature were reviewed with an emphasis on changing eating and activity patterns, cultural factors, perceptions and beliefs, urbanisation and globalisation. Results of studies on the health consequences of obesity in South Africans are also reviewed. Results: Shifts in dietary intakes and activity patterns to higher fat intakes and lower physical activity are contributing to a higher prevalence of obesity. Few overweight black women view themselves as overweight, and some associate thinness with HIV/AIDS. Glucose and lipid toxicity, associated with insulin resistance, play roles in the pathogenesis of the co-morbid diseases of obesity. Elevated free fatty acids in the black population predispose obese black patients to type 2 diabetes. Conclusion and recommendations: Obesity prevention and treatment should be based on education, behaviour change, political support, intersectoral collaboration and community participation, local actions, wide inclusion of the population, adequately resourced programmes, infiltration of existing initiatives, evidence-based planning, and proper monitoring and evaluation. Interventions should have the following components: reasonable weight goals, healthful eating, physical activity and behavioural change. Genes and mutations affecting susceptibility to the development of co-morbidities of obesity and vulnerable periods of life for the development of obesity should be prioritised. Prevention should be managed in community services, identification of high-risk patients in primary healthcare services and treatment of co-morbid diseases in hospital services.

Consumer perception versus scientific evidence about health benefits and safety risks from fish consumption.

Abstract: Objective To investigate the gap between consumer perception and scientific evidence related to health benefits and safety risks from fish consumption Design Consumer perceptions from a cross-sectional survey in March 2003 in Belgium were compared with scientific evidence based on a literature review Method A quota sampling procedure was used with age as quota control variable Subjects completed a self-administered questionnaire including health benefit beliefs from fish, fish content and effect beliefs for nutrients and harmful substances Subjects Adults (n=429), who were the main person responsible for food purchasing in the household (284 women; 145 men), aged 18-83 years, from different regional, education, family size and income groups Results Fish is predominantly perceived as a healthy food that reduces risk for coronary heart disease, which corroborates scientific evidence This perception is stronger among women than among men In contrast with scientific evidence, 46% of the consumers believe that fish contains dietary fibre, whereas less than one-third is aware that fish contains omega-3 fatty acids and that this nutrient has a positive impact on human health The gap between perception and evidence is larger among consumers with lower education In general, consumers are better aware of the content and effect of harmful substances than of nutrients in fish Conclusions Despite conclusive evidence about the content and positive effect of omega-3 fatty acids in fish, related consumer awareness and beliefs are poor and often wrong This study exemplifies the need for nutrition education and more effective communication about the health benefits of fish consumption

Dietary intake measurements.

Abstract: To provide a concise summary of field and laboratory methods for the measurement of dietary intake with particular reference to the assessment of energy and protein intake and to the pitfalls and difficulties that may be encountered in practice when implementing the methods both in the field and under laboratory conditions.

Public health implications of meat production and consumption.

Abstract: The high level of meat and saturated fat consumption in the USA and other high-income countries exceeds nutritional needs and contributes to high rates of chronic diseases such as cardiovascular disease, diabetes mellitus and some cancers. Affluent citizens in middle- and low-income countries are adopting similar high-meat diets and experiencing increased rates of these same chronic diseases. The industrial agricultural system, now the predominant form of agriculture in the USA and increasingly world-wide, has consequences for public health owing to its extensive use of fertilisers and pesticides, unsustainable use of resources and environmental pollution. In industrial animal production there are public health concerns surrounding feed formulations that include animal tissues, arsenic and antibiotics as well as occupational health risks and risks for nearby communities. It is of paramount importance for public health professionals to become aware of and involved in how our food is produced.

The CATCH Kids Club: a pilot after-school study for improving elementary students’ nutrition and physical activity

Abstract: Background Although many school-based diet and physical activity interventions have been designed and evaluated, relatively few have been tested for the after-school setting. After-school day-care programmes at either elementary schools or private locations provide a ready-made opportunity for health programmes that may be difficult to incorporate into an already-full school day. The purpose of this paper is to report on a pilot study of an after-school adaptation of the CATCH (Coordinated Approach To Child Health) elementary school programme called the CATCH Kids Club (CKC). Methods The CKC was pilot-tested and formatively evaluated in 16 Texas after-school programmes: eight in El Paso and eight in Austin (four intervention and four reference sites each). Evaluation consisted of direct observation of moderate to vigorous physical activity during play time, self-reported food intake and physical activity, and focus group interviews with after-school programme staff. Results Students responded well to the physical activity and snack components and were less interested in the five-module education component. Routine staff training was a key variable in achieving proper implementation; the ideal would be a full day with repeated follow-up model teaching visits. Staff turnover was a logistic issue, as was programme leader readiness and interest in conducting the programme. Strong and significant effects were observed for the physical activity but not for the education component. The results of the physical education component suggest it is feasible, effective and ready for larger-scale evaluation or dissemination.

The role of foreign direct investment in the nutrition transition.

Abstract: Objective: To examine the role of foreign direct investment (FDI) in the nutrition transition, focusing on highly processed foods. Design: Data on FDI were identified from reports/databases and then compiled and analysed. A review of published literature on FDI into the food sector was conducted. Setting: The nutrition transition is a public health concern owing to its connection with the rising burden of obesity and diet-related chronic diseases in developing countries. Global health leaders are calling for action to address the threat. Highly processed foods often have considerable fat, sugar and salt content, and warrant closer examination. Results: FDI into food processing, service and retail has risen rapidly since the 1980s, mainly from transnational food companies (TFCs) in developed countries. As FDI has risen, so has the proportion invested in highly processed foods for sale in the host market. FDI has proved more effective than trade in generating sales of highly processed foods, and enables TFCs to cut costs, gain market power and obtain efficiencies in distribution and marketing. The amount of FDI targeted at developing countries is increasing; while a disproportionate share enters the larger developing economies, foreign affiliates of TFCs are among the largest companies in low- and low- to middle-income countries. The effect of FDI is to make more highly processed foods available to more people. FDI has made it possible to lower prices, open up new purchasing channels, optimise the effectiveness of marketing and advertising, and increase sales. Conclusion: FDI has been a key mechanism in shaping the global market for highly processed foods. Notwithstanding the role of demand-side factors, it has played a role in the nutrition transition by enabling and promoting the consumption of these foods in developing countries. Empirical data on consumption patterns of highly processed foods in developing countries are critically needed, but since FDI is a long-term investment vehicle, it is reasonable to assume that availability and consumption of highly processed foods will continue to increase. FDI can, however, bring considerable benefits as well as risks. Through its position ‘upstream’, FDI would therefore be an appropriate entry-point to implement a range of public health policies to ‘redirect’ the nutrition transition.

Protection, promotion and support of breast-feeding in Europe: current situation

Abstract: OBJECTIVE: To describe the current situation regarding protection, promotion and support of breast-feeding in Europe, as a first step towards the development of a blueprint for action.DESIGN AND SE ...

Reliability and validity of a questionnaire to measure personal, social and environmental correlates of fruit and vegetable intake in 10-11-year-old children in five European countries.

Abstract: Objectives To investigate the internal consistency of the scales and the test-retest reliability and predictive validity of behaviour theory-based constructs measuring personal, social and environmental correlates of fruit and vegetable intake in 10-11-year-old children. Design Test-retest with one-week interval. Setting Five European countries: Norway, Spain, Denmark, Portugal, Belgium. Subjects Three hundred and twenty-six children completed the questionnaire during class hours. Results For the total sample across all countries, the test-retest reliability was good to very good (intra-class correlation coefficient (ICC) >0.60) for 12 out of the 15 fruit constructs and also for 12 out of the 15 vegetable constructs. Acceptable ICCs, ranging between 0.50 and 0.59, were found for the remaining constructs. Test-retest reliability was comparable across countries. Only in Portugal were some significantly lower ICCs found for some constructs (knowledge and barriers related to fruit, general self-efficacy related to fruit and vegetables) compared with the other countries. Cronbach's alpha values were moderate to high (range 0.52 to 0.89) with the exception of the general self-efficacy scale, which had a value below 0.50 for both fruit (alpha=0.42) and vegetables (alpha=0.49). Spearman correlations with intake ranged between -0.16 and 0.54 for personal determinants and between 0.05 and 0.38 for environmental determinants. Compared with other studies, predictive validity can be considered moderate to good. Conclusions The questionnaire provides a reliable, valid and easy-to-administer tool for assessing personal, social and environmental factors of potential influence on fruit and vegetable intake in 10-11-year-olds.

The nutrition and health transition in the North West Province of South Africa: a review of the THUSA (Transition and Health during Urbanisation of South Africans) study.

Abstract: Objective: To describe how urbanisation influences the nutrition and health transition in South Africa by using data from the THUSA (Transition and Health during Urbanisation of South Africans) study. Design: The THUSA study was a cross-sectional, comparative, population-based survey. Setting: The North West Province of South Africa. Subjects: In total, 1854 apparently healthy volunteers, men and women aged 15 years and older, from 37 randomly selected sites. Pregnant and lactating women, those with diagnosed chronic diseases and taking medication, with acute infections or inebriated were excluded but screened for hypertension and diabetes mellitus. Subjects were stratified into five groups representing different levels of urbanisation in rural and urban areas: namely, deep rural, farms, squatter camps, townships and towns/cities. Outcome measures and methods: Socio-economic and education profiles, dietary patterns, nutrient intakes, anthropometric and biochemical nutrition status, physical and mental health indicators, and risk factors for non-communicable diseases (NCDs) were measured using questionnaires developed or adapted and validated for this population, as well as appropriate, standardised methods for the biochemical analyses of biological samples. Results: Subjects from the rural groups had lower household incomes, less formal education, were shorter and had lower body mass indices than those in the urban groups. Urban subjects consumed less maize porridge but more fruits, vegetables, animal-derived foods and fats and oils than rural subjects. Comparing women from rural group 1 with the urban group 5, the following shifts in nutrient intakes were observed: % energy from carbohydrates, 67.4 to 57.3; from fats, 23.6 to 31.8; from protein, 11.4 to 13.4 (with an increase in animal protein from 22.2 to 42.6 g day-1); dietary fibre, 15.8 to 17.7 g day-1; calcium, 348 to 512 mg day-1; iron from 8.4 to 10.4 mg day-1; vitamin A from 573 to 1246 g retinol equivalents day-1; and ascorbic acid from 30 to 83 mg day-1. Serum total cholesterol, low-density lipoprotein cholesterol and plasma fibrinogen increased significantly across groups; systolic blood pressure >140 mmHg was observed in 10.4–34.8% of subjects in different groups and diabetes mellitus in 0.8–6.0% of subjects. Women in groups 1 to 5 had overweight plus obesity rates of 48, 53, 47, 61 and 61%, showing an increase with urbanisation. Subjects from group 2 (farm dwellers) showed the highest scores of psychopathology and the lowest scores of psychological well-being. The same subjects consistently showed the lowest nutrition status. Conclusions: Urbanisation of Africans in the North West Province is accompanied by an improvement in micronutrient intakes and status, but also by increases in overweight, obesity and several risk factors for NCDs. It is recommended that intervention programmes to promote nutritional health should aim to improve micronutrient status further without leading to obesity. The role of psychological strengths in preventing the adverse effects of urbanisation on health needs to be examined in more detail.

Energy requirements of children and adolescents.

Abstract: Total energy expenditure (TEE) was calculated at 1-18 years of age from measurements with doubly labelled water (DLW) in 483 boys and 646 girls, and heart rate monitoring (HRM) in 318 boys and 162 girls. Studies on obese, underweight and stunted groups were not included. TEE of populations with different lifestyles was estimated by factorial calculations in 42 studies on time allocation involving 1982 boys and 1969 girls in developed industrialised countries, and 1236 boys and 1116 girls in developing countries. Quadratic polynomial models were best to predict TEE in boys (TEE(MJ day(-1)) = 1.298 + 0.265 kg - 0.0011 kg2, r = 0.982, SEE = 0.518) and girls (TEE(MJ day(-1)) = 1.102 + 0.273 kg - 0.0019 kg2, r = 0.955, SEE = 0.650). TEE at 1-2 years was reduced by 7% based on DLW measurements and TEE estimates of infants. Energy requirements (ER) were calculated adding 8.6 kJ (2 kcal) for each gram of weight gained during growth. Compared with the 1985 FAO/WHO/UNU values, ER were 18-20% lower from 1 to 7 years of age, 12% lower for boys and 5% lower for girls at 7-10 years, and 12% higher for either gender from 12 years onwards. Differences between industrialised and developing countries, the variance in DLW and HRM studies, and the standard error of the estimate (SEE) of the quadratic predictive equations, suggested that ER should be adjusted after 5 years of age by +/-15% in populations with more or less physical activity than an average lifestyle. Physical activity recommendations must accompany dietary recommendations in order to maintain optimal health and reduce the risk of diseases associated with sedentary lifestyles.

The impact of a school-based nutrition education intervention on dietary intake and cognitive and attitudinal variables relating to fruits and vegetables.

Abstract: Objective: To assess the impact of a school-based nutrition education intervention aimed at increasing the consumption of fruits and vegetables. Design: The intervention programme increased the provision of fruits and vegetables in schools and provided a range of point-of-purchase marketing materials, newsletters for children and parents, and teacher information. Curriculum materials at age 6–7 and 10–11 years were also developed and utilised. Evaluation was undertaken with groups of younger (aged 6–7 years) and older (aged 10–11 years) children. Methods included 3-day dietary records with interview and cognitive and attitudinal measures at baseline, with follow-up at 9 months, in intervention and control schools. Setting: The work was undertaken in primary schools in Dundee, Scotland. Subjects: Subjects comprised 511 children in two intervention schools with a further 464 children from two schools acting as controls. Results: Children (n ¼ 64) in the intervention schools had an average increase in fruit intake (133 ^ 1.9 to 183 ^ 17.0 g day 21 ) that was significantly (P , 0.05) greater than the increase (100 ^ 11.7 to 107 ^ 14.2 g day 21 ) estimated in children (n ¼ 65) in control schools. No other changes in food or nutrient intake were detected. Increases in scores for variables relating to knowledge about fruits and vegetables and subjective norms were also greater in the intervention than in the control group, although taste preferences for fruits and vegetables were unchanged. Conclusions: It is concluded that a whole school approach to increasing intakes of fruits and vegetables has a modest but significant effect on cognitive and attitudinal variables and on fruit intake.

Use of national food balance data to estimate the adequacy of zinc in national food supplies: methodology and regional estimates.

Abstract: ObjectivesAdequate zinc nutriture is critically important for human health, but the development of programmes to control zinc deficiency is limited by the lack of reliable information on population zinc status. The present analyses were conducted to: (1) estimate the absorbable zinc content of national food supplies; (2) compare this information with theoretical population requirements for zinc; and (3) use these results to predict national risks of inadequate zinc intake.Setting and design: National food balance data were obtained for 176 countries from the Food and Agriculture Organization of the United Nations. The amount of absorbable zinc in these foods was estimated from food composition data, and zinc absorption was predicted using a model developed by the International Zinc Nutrition Consultative Group (IZiNCG). Demographic data were obtained from United Nations estimates, and age- and sex-specific physiological requirements for absorbable zinc were estimated using IZiNCG recommendations.Results and conclusions: The mean per capita absorbable zinc content of national food supplies ranged from 2.98–3.01 mg day−1 in Western Europe and USA & Canada to 2.09 mg day−1 in Southeast Asia. The estimated percentage of individuals at risk of inadequate zinc intake ranged from 9.3–9.5% in the regions of North Africa & Eastern Mediterranean and USA & Canada to 33.1% in Southeast Asia. Overall, approximately 20.5% of the world's population is estimated to be at risk of inadequate zinc intake. Data on the absorbable zinc content of national food supplies can be used to determine whether further assessments of population zinc status and development of intervention programmes are warranted.

Prevalence and determinants of stunting and overweight in 3-year-old black South African children residing in the Central Region of Limpopo Province, South Africa

Abstract: Objectives: To determine the prevalence of stunting, wasting and overweight and their determinants in 3-year-old children in the Central Region of Limpopo Province, South Africa. Design: Prospective cohort study. Setting: Rural villages in the Central Region of the Limpopo Province, South Africa. Subjects: One hundred and sixty-two children who were followed from birth were included in the study. Anthropometric measurements and sociodemographic characteristics of the children were recorded. Results: Height-for-age Z-scores were low, with a high prevalence of stunting (48%). The children also exhibited a high prevalence of overweight (22%) and obesity (24%). Thirty-one (19%) children were both stunted and overweight. Gaining more weight within the first year of life increased the risk of being overweight at 3 years by 2.39 times (95% confidence interval (CI) 1.96‐4.18) while having a greater length at 1 year was protective against stunting (odds ratio (OR) 0.41; 95% CI 0.17‐0.97). Having a mother as a student increased the risk for stunting at 3 years by 18.21 times (95% CI 9.46‐34.74) while having a working mother increased the risk for overweight by 17.87 times (95% CI 8.24‐38.78). All these factors also appeared as risks or as being protective in children who were both overweight and stunted, as did living in a household having nine or more persons (OR 5.72; 95% CI 2.7‐12.10). Conclusion: The results of this study highlight the importance of evaluating anthropometric status in terms of both stunting and overweight. Furthermore, it is important to realise the importance of normal length and weight being attained at 1 year of age, since these in turn predict nutritional status at 3 years of age.

Taxing food: implications for public health nutrition.

Abstract: Aim: To set out a policy analysis of food taxes as a way of influencing food consumption and behaviour. Design: The study draws on examples of food taxes from the developed world imposed at national and local levels. Studies were identified from a systemised search in six databases with criteria designed to identity articles of policy relevance. Results: The dominant approach identified from the literature was the imposition of food taxes on food to raise general revenue, such as Value Added Tax in the European Union. Food taxes can be applied in various ways, ranging from attempts to directly influence behaviour to those which collect taxes for identified campaigns on healthy eating through to those applied within closed settings such as schools. There is a case for combining taxes of unhealthy foods with subsidies of healthy foods. The evidence from the literature concerning the use and impact of food taxes on food behaviour is not clear and those cases identified are mainly retrospective descriptions of the process. Many food taxes have been withdrawn after short periods of time due to industry lobbying. Conclusions for policy: Small taxes with the clear purpose of promoting the health of key groups, e.g. children, are more likely to receive public support. The focus of many tax initiatives is unclear; although they are generally aimed at consumers, another focus could be food manufacturers, using taxes and subsidies to encourage the production of healthier foods, which could have an effect at a population level. Further consideration needs to be given to this aspect of food taxes. Taxing food (and subsidies) can influence food behaviour within closed systems such as schools and the workplace.

Environmental and psychosocial correlates of physical activity in Portuguese and Belgian adults.

Abstract: Objectives: To investigate differences in reported physical activity levels and in perceived environmental and psychosocial correlates of activity between Portuguese and Belgian adults; and to analyse the relative contribution of environmental and psychosocial variables in explaining physical activity within different contexts in Portugal and Belgium. Design: Cross-sectional study. Setting: One city in Portugal (Oeiras) and one in Belgium (Ghent). Subjects: In total 526 participants, 247 from Portugal and 279 from Belgium, completed the long International Physical Activity Questionnaire and a validated questionnaire on environmental and psychosocial correlates. Results: For the sum of all activities of at least moderate intensity, a significantly higher mean level of activity was found in Belgian adults (P , 0.001). However, comparable percentages of the Belgian (38%) and Portuguese (42%) samples did not meet the recommendation of 30 min per day. The variance explained by environmental factors was lower (1% to 8%) than by psychosocial factors (maximum 42%). Regression analyses showed activity-specific relations with environmental variables which were analogous in both countries. Walking/cycling for transportation and walking for recreation were related to social support from family and/or friends and to walkability and walking facilities in the neighbourhood. Recreational physical activity was mainly determined by social support, self-efficacy, and perceived benefits and barriers. Conclusions: Activity campaigns addressing psychosocial determinants are needed to encourage leisure-time activity, while a combination of neighbourhood design changes and encouragement of social support in walking is warranted to increase walking in different contexts.

Energy requirements and aging.

Abstract: Objective To summarise the literature on energy requirements and aging. Design An analysis and review of published data on components of energy expenditure and total energy expenditure (TEE). Setting Data on basal metabolic rate (BMR) and TEE were obtained from the US Institute of Medicine of the National Academies database (all available data from studies published before 2001, collected from 20 researchers willing to provide individual subject results). Subjects Those individuals from the database who were 20-100 years of age. Results TEE and physical activity level (PAL, defined as the ratio of total to resting energy expenditure) declined progressively throughout adult life in both normal weight and overweight men and women. In normal weight individuals (defined as body mass index (BMI) 18.5-25.0 kg m(-2)) TEE fell by approximately 150 kcal per decade, and PAL fell from an average of 1.75 in the second decade of life to 1.28 in the ninth decade. Thermic effect of feeding data from other published studies indicated no consistent change associated with aging. Conclusions Aging is associated with progressive declines in resting and TEE, which have implications for defining dietary energy requirements at different stages of adult life.

The stability of soft drinks intake from adolescence to adult age and the association between long-term consumption of soft drinks and lifestyle factors and body weight.

Abstract: Objectives: To investigate the tracking of sugar-sweetened, carbonated soft drinks intake from age 15 to 33 years and the association between this intake and lifestyle factors and body weight. Design: A longitudinal study with 18-20 years of follow-up. Data about diet, physical activity, smoking and dieting were collected in 1981/1979, 1991 and 1999. Body weight and height were measured in 1981/1979 and self-reported in 1999. Setting: Oslo, Norway. Subjects: Four hundred and twenty-two men and women. Results: Tracking of soft drinks intake from adolescence into early adulthood (age 25 years) and from early adulthood into later adulthood (33 years) was moderate to high, while tracking from adolescence into later adulthood was low. Comparing those reporting a high intake of soft drinks in both 1991 and 1999 with those reporting a low intake at both times, male long-term high consumers were more likely to smoke (48 vs. 21%, P = 0.002) and reported higher intakes of energy (12.2 vs. 10.2 MJ day - 1 , P = 0.005) and sugar (142 vs. 50 g day - 1 , P < 0.001) in 1999 than did long-term low consumers. Women high consumers were less likely to be physically active (14 vs. 42%, P = 0.03) and had higher sugar intake (87 vs. 41 g day - 1 , P < 0.001) in 1999 than did women low consumers. There were no differences in body mass index, overweight or obesity in 1999 between long-term high and low consumers. Conclusion: In this study, stability of soft drinks intake from age 15 to 25 years and from age 25 to 33 years was moderate to high, while from age 15 to 33 years it was low. Soft drinks intake from age 25 to 33 years was associated with smoking and physical inactivity, but not with body weight.

Why do adolescents eat what they eat? Personal and social environmental predictors of fruit, snack and breakfast consumption among 12-14-year-old Dutch students

Abstract: Objective: The aim of the study was to investigate the relative importance of personal and social environmental predictors of the consumption of fruit, high-fat snacks and breakfast Design: A school-based cross-sectional survey Data were collected through written questionnaires Setting: Students from eight schools in the southern part of The Netherlands Subjects: Six hundred and one students from preparatory secondary vocational education schools Results: About a quarter of the variation in actual behaviours and intentions to change the behaviours could be explained Stepwise multiple regression analysis revealed that, for all three behaviours, higher intention to change was especially associated with a more positive attitude and subjective norm, and higher intentions to increase fruit intake with more positive self-efficacy expectations With regard to actual consumption, a more positive attitude towards eating fruit was the only significant correlate of a higher consumption of fruit A more positive attitude towards eating high-fat snacks, perceived lower intake of the mother, and higher food availability and accessibility were associated with consumption of high-fat snacks, and a more positive attitude to breakfast more frequently was associated with more frequent breakfast consumption Conclusion: The results indicate that adolescents' attitudes are the most important determinants of different health-related eating behaviours and intentions to change Interventions promoting a healthy diet for adolescents should include creative strategies to achieve positive associations with healthy dietary changes

Review of the evidence linking protein and energy to mental development

Abstract: Objective: To examine the evidence as to whether the relationship between undernutrition and poor child development is causal. Design: Selected studies from developing countries were discussed. Observational studies were first considered then experimental studies of preventative and remedial supplementation. The type of functions affected, the presence of sensitive periods and the role of protein and energy versus that of micronutrients were reviewed. Results: Childhood undernutrition is generally associated with concurrent and longer term deficits in cognition, behaviour and motor skills, although the relationship is likely to be confounded by socio-economic factors. Supplementation trials have had many design problems. However, those beginning at any age from pregnancy up to 24 months have consistently had concurrent benefits suggesting a causal relationship. Supplement begun in older children had little or no effect, albeit there are too few studies to conclude with confidence. The limited evidence suggests that benefits are more likely to be sustained if supplementation begins in late pregnancy or at birth and is continued until the child is at least 24 months old. Deficits in cognition tend to be global and there is insufficient evidence of specific deficits. There is some evidence that the first 2 years of life are most sensitive to the effects of undernutrition. Most studies have failed to separate the effects of energy and protein from those of micronutrients. One study showed that energy and/or protein affects children's development. Psychosocial stimulation has had consistent benefits on undernourished childrens' development Conclusions: Public health nutrition programmes should include a component in which children who are at risk are targeted during the first 2 years of life with combined interventions involving nutrition, health care and early stimulation

Development and validation of instruments measuring body image and body weight dissatisfaction in South African mothers and their daughters.

Abstract: Objective: We sought to validate questionnaires concerning body image perception, body size dissatisfaction and weight-related beliefs in multi-ethnic South African mothers and their daughters. Settings and subjects: Girls attending primary school (ages 9–12 years, n ¼ 333) and their mothers (n ¼ 204) were interviewed regarding their demographics and body image. Weight, height and skinfold thicknesses were measured. Body image questions and body mass index (BMI) were compared with silhouettes adapted from the Pathways Study for girls and Stunkard’s body image figures for mothers. A Feel– Ideal Difference (FID) index score was created by subtracting the score of the silhouette selected by the participants as ‘Ideal’ from the one selected as most closely representing their current appearance or ‘Feel’. We hypothesised that a higher FID index score would be associated with greater body size dissatisfaction. Results: BMI percentiles in girls (r ¼ 0.46, P , 0.05) and BMI in mothers (r ¼ 0.68, P , 0.05) were positively correlated with the selected silhouettes based on size. Participants who reported feelings of being ‘fat’ and those who perceived that their family and friends were more dissatisfied with their body size had significantly higher FID index scores. Scores were lower in black than white girls (all P , 0.05). No differences were found in FID index scores between ethnic groups of mothers. Internal reliability of the ‘thin’ and ‘fat’ belief constructs for girls was demonstrated by standardised Cronbach’s a values $0.7. Conclusion: Silhouettes, FID index, ‘fat’ and ‘thin’ belief constructs (in girls) are ageappropriate, culturally sensitive and can be used in further intervention studies to understand body image.

Alcohol intake in relation to body mass index and waist-to-hip ratio: the importance of type of alcoholic beverage.

Abstract: Objective: Alcohol consumption may play a role in the development of obesity but the relationship between alcohol and weight is still unclear. The aim of our study was to assess the cross-sectional association of intakes of total alcohol and of specific alcoholic beverages (wine, beer and spirits) with waist-to-hip ratio (WHR) and body mass index (BMI) in a large sample of adults from all over France. Design: Cross-sectional. Setting: Participants were free-living healthy volunteers of the SU.VI.MAX study (an intervention study on the effects of antioxidant supplementation on chronic diseases). Subjects: For 1481 women aged 35-60 years and 1210 men aged 45-60 years, intakes of total alcohol and specific alcoholic beverages were assessed by six 24-hour dietary-records. BMI and WHR were measured during a clinical examination the year after. Results: A J-shaped relationship was found between total alcohol consumption and WHR in both sexes and between total alcohol consumption and BMI in men only (P < 0.05). The same relationships were observed with wine (P < 0.05); men and women consuming less than 100 g day - 1 had a lower BMI (men only) and WHR than non-drinkers or those consuming more. Spirits consumption was positively associated with BMI (linear regression coefficient β = 0.21, 95% confidence interval (CI): 0.09-0.34 and β = 0.22, 95% CI: 0.06-0.39 for men and women, respectively) and WHR (β = 0.003, 95% CI: 0.001-0.005 and β = 0.003, 95%CI: 0.0002-0.006) in both sexes in a linear fashion. No relationship between beer consumption and BMI or WHR was found. Conclusion: If confirmed in longitudinal studies, our results indicate that consumption of alcoholic beverages may be a risk factor for obesity.

Diabetes and hypertension increases in a society with abdominal obesity: results of the Mexican National Health Survey 2000.

Abstract: Objectives: To determine the prevalences of overweight, obesity, type 2 diabetes mellitus (DM) and hypertension (HT) in the Mexican population and compare them with those of a previous Mexican urban survey and an American survey. Design: A structured, randomised, nationally representative Mexican sample was compared with a 1993 Mexican urban survey and the US Third National Health and Nutrition Examination Survey (NHANES III) of non-Hispanic Whites. Setting: The Mexican National Health Survey 2000. Subjects: Subjects were 12 856 men and 28 332 women, aged 20–69 years, who had their body weight, height, waist circumference (WC), blood pressure and fasting capillary blood glucose measured. Results: Mexican adult men and women had a high prevalence of overweight (41.3 and 36.3%, respectively) and obesity (19.4 and 29.0%, respectively), similar to those in the USA in 1988–1992 and exceeding those of the 1993 Mexican survey. The prevalence of HT was 33.3% in men and 25.6% in women, with inferred DM rates of 5.6 and 9.7%, respectively. Abdominal obesity affected 46.3% of men (WC $ 94 cm) and 81.4% of women (WC $ 80 cm). There was a high prevalence of abdominal obesity in normal-weight women, with co-morbidities relating better to WC than to body mass index (BMI) in both sexes. Rates of DM and HT exceeded US rates on a comparable BMI or WC basis in adults aged ,50 years. Conclusion: The high prevalence of obesity and abdominal obesity in Mexicans is associated with markedly increased prevalences of DM and HT to levels comparable with, or even higher than, those in NHANES III of non-Hispanic Whites.