Showing papers in "Public Health Nutrition in 2006"
TL;DR: The long, self-administered IPAQ questionnaire has acceptable validity when assessing levels and patterns of PA in healthy adults and might introduce a source of error in criterion validation studies.
Abstract: IntroductionThe International Physical Activity Questionnaire (IPAQ) was developed to measure health-related physical activity (PA) in populations. The short version of the IPAQ has been tested extensively and is now used in many international studies. The present study aimed to explore the validity characteristics of the long-version IPAQ.Subjects and methodsForty-six voluntary healthy male and female subjects (age, mean±standard deviation: 40.7±10.3 years) participated in the study. PA indicators derived from the long, self-administered IPAQ were compared with data from an activity monitor and a PA log book for concurrent validity, and with aerobic fitness, body mass index (BMI) and percentage body fat for construct validity.ResultsStrong positive relationships were observed between the activity monitor data and the IPAQ data for total PA (ρ = 0.55, P < 0.001) and vigorous PA (ρ = 0.71, P < 0.001), but a weaker relationship for moderate PA (ρ = 0.21, P = 0.051). Calculated MET-h day−1 from the PA log book was significantly correlated with MET-h day−1 from the IPAQ (ρ = 0.67, P < 0.001). A weak correlation was observed between IPAQ data for total PA and both aerobic fitness (ρ = 0.21, P = 0.051) and BMI (ρ = 0.25, P = 0.009). No significant correlation was observed between percentage body fat and IPAQ variables. Bland–Altman analysis suggested that the inability of activity monitors to detect certain types of activities might introduce a source of error in criterion validation studies.ConclusionsThe long, self-administered IPAQ questionnaire has acceptable validity when assessing levels and patterns of PA in healthy adults.
1,461 citations
TL;DR: Either FVS or DDS can be used as a simple and quick indicator of the micronutrient adequacy of the diet of South African children, and a strong relationship between dietary diversity and indicators of child growth is indicated.
Abstract: Department of Human Nutrition,University of Stellenbosch, Stellenbosch and Tygerberg Academic Hospital, Tygervalley, South AfricaSubmitted 5 July 2005: Accepted 21 November 2005AbstractObjective: To assess whether a food variety score (FVS) and/or a dietary diversityscore (DDS) are good indicators of nutrient adequacy of the diet of South Africanchildren.Methods: Secondary data analyses were undertaken with nationally representativedata of 1–8-year-old children (n ¼ 2200) studied in the National Food ConsumptionStudyin 1999.Anaverage FVS(meannumber ofdifferentfooditems consumedfromall possible items eaten) and DDS(mean number of food groups out of nine possiblegroups) were calculated. A nutrient adequacy ratio (NAR) is the ratio of a subject’snutrient intake to the estimated average requirement calculated using the Food andAgriculture Organization/World Health Organization (2002) recommended nutrientintakes for children. The mean adequacy ratio (MAR) was calculated as the sum ofNARs for all evaluated nutrients divided by the number of nutrients evaluated,expressed as a percentage. MAR was used as a composite indicator for micronutrientadequacy. Pearson correlation coefficients between FVS, DDS and MAR werecalculated and also evaluated for sensitivity and specificity, with MAR taken as theideal standard of adequate intake. The relationships between MAR and DDS andbetween anthropometric Z-scores and DDS were also evaluated.Results: ThechildrenhadameanFVSof5.5(standarddeviation(SD)2.5)andameanDDSof3.6(SD1.4).ThemeanMAR(ideal ¼ 100%)was50%,andwaslowest(45%)inthe 7–8-year-old group. The items with the highest frequency of consumption werefromthecereal,rootsandtubergroup(99.6%),followedbythe‘othergroup’(87.6%)comprising items such as tea, sugar, jam and sweets. The dairy group was consumedby 55.8%, meat group by 54.1%, fats by 38.9%, other vegetables by 30.8%,vitamin-A-rich by 23.8%, other fruit by 22%, legumes and nuts by 19.7% and eggs by13.3%. There was a high correlation between MAR and both FVS (r ¼ 0.726;P , 0.0001) and DDS (r ¼ 0.657; P , 0.0001), indicating that either FVS or DDS canbe used as anindicator of the micronutrient adequacy of thediet. Furthermore, MAR,DDS and FVS showed significant correlations with height-for-age and weight-for-ageZ-scores, indicating a strong relationship between dietary diversity and indicators ofchildgrowth.ADDSof4andanFVSof6wereshowntobethebestindicatorsofMARless than 50%, since they provided the best sensitivity and specificity.Conclusion: Either FVS or DDS can be used as a simple and quick indicator of themicronutrient adequacy of the diet.KeywordsDietary diversityFood varietyMean adequacy ratioDietary diversity scoreFood variety scoreMicronutrient malnutrition remains one of the largestnutritional problems worldwide, affecting people in bothdeveloped and developing countries
664 citations
TL;DR: The WHO standards provide a better tool to monitor the rapid and changing rate of growth in early infancy and their adoption will have important implications for child health with respect to the assessment of lactation performance and the adequacy of infant feeding.
Abstract: Objectives: To compare growth patterns and estimates of malnutrition based on the World Health Organization (WHO) Child Growth Standards (‘the WHO standards’) and the National Center for Health Statistics (NCHS)/WHO international growth reference (‘the NCHS reference’), and discuss implications for child health programmes. Design: Secondary analysis of longitudinal data to compare growth patterns (birth to 12 months) and data from two cross-sectional surveys to compare estimates of malnutrition among under-fives. Settings: Bangladesh, Dominican Republic and a pooled sample of infants from North America and Northern Europe. Subjects: Respectively 4787, 10 381 and 226 infants and children. Results: Healthy breast-fed infants tracked along the WHO standard’s weight-for-age mean Z-score while appearing to falter on the NCHS reference from 2 months onwards. Underweight rates increased during the first six months and thereafter decreased when based on the WHO standards. For all age groups stunting rates were higher according to the WHO standards. Wasting and severe wasting were substantially higher during the first half of infancy. Thereafter, the prevalence of severe wasting continued to be 1.5 to 2.5 times that of the NCHS reference. The increase in overweight rates based on the WHO standards varied by age group, with an overall relative increase of 34%. Conclusions: The WHO standards provide a better tool to monitor the rapid and changing rate of growth in early infancy. Their adoption will have important implications for child health with respect to the assessment of lactation performance and the adequacy of infant feeding. Population estimates of malnutrition will vary by age, growth indicator and the nutritional status of index populations.
634 citations
TL;DR: The results indicate that the short, last 7-days version of the IPAQ has acceptable criterion validity for use in Swedish adults, however, the IPAQ instrument significantly overestimated self-reported time spent in PA.
Abstract: OBJECTIVE: To examine the validity of the short, last 7-day, self-administered form of the International Physical Activity Questionnaire (IPAQ). DESIGN: All subjects wore an accelerometer for seven ...
472 citations
TL;DR: The reviewed evaluation methods can be classified into three categories depending on the way they are calculated: those based on a positive or negative scoring of the components, those that add or substract standardised components, and those that arebased on a ratio between components.
Abstract: The purpose of this paper is to review some of the methods that several epidemiological studies use to evaluate the adherence of a population to the Mediterranean diet pattern. Among these methods, diet indexes attempt to make a global evaluation of the quality of the diet based on a traditional Mediterranean reference pattern, described as a priori, general and qualitative. The Mediterranean diet indexes, hence, summarise the diet by means of a single score that results from a function of different components, such as food, food groups or a combination of foods and nutrients. The reviewed evaluation methods can be classified into three categories depending on the way they are calculated: (1) those based on a positive or negative scoring of the components, (2) those that add or substract standardised components, and (3) those that are based on a ratio between components. Dietary scores have been used to explore the multiple associations between the Mediterranean diet, as an integral entity, and health parameters such as life expectancy or the incidence of obesity, cardiovascular diseases and some types of cancers. Moreover, these indexes are also useful tools to measure food consumption trends and to identify the involved factors, as well as to develop comprehensive public health nutrition recommendations. A more precise and quantitative definition of the Mediterranean diet is required if the adherence to such a dietary pattern is intended to be more accurately measured. Other aspects of the Mediterranean diet indexes should also be taken into account, like the inclusion of typical Mediterranean foods such as nuts and fish and the validation of the dietary pattern approach by using biomarkers.
366 citations
TL;DR: In this study, item availability and produce quality varied greatly between store types, which has consequences in terms of food purchasing decisions and dietary quality that public health professionals should acknowledge.
Abstract: Objective The purpose of the present study was to characterise the food landscape of an inner city African American neighbourhood and its mixed-race suburban neighbour. Detailed analysis focuses on the relationship between community store mix and price, availability and produce quality. Design A market basket study was completed by members of the Chicago Food Systems Collaborative. The US Department of Agriculture's standard market basket survey and methodology were used. Additional items and analyses were added in consultation with community members. Setting Austin is a lower-middle-class African American community of 117,500 on the western edge of Chicago. Oak Park, which borders Austin, is an upper-middle-income suburb of 52,500 with a mixed racial profile. Subjects A market basket survey of every retail food store in Austin and Oak Park was completed. A total of 134 were included. Results Results indicate that Austin has many grocery stores and few supermarkets. Many Austin groceries stores carry produce that is usually competitively priced, but often of unacceptable quality. Supermarkets had the best selection. Prices were lowest at discount supermarkets. Prices of packaged items were higher at independent stores than at chain supermarkets, but fresh items were cheaper. Conclusions Food access is related more to store type than number. In this study, item availability and produce quality varied greatly between store types. Price differences were complicated and varied by store type and food category. This has consequences in terms of food purchasing decisions and dietary quality that public health professionals should acknowledge.
360 citations
TL;DR: So-economic differences in food purchasing behaviour may contribute to the relationship between socio-economic position and food and nutrient intakes, and, by extension, to socio- economic health inequalities for diet-related disease.
Abstract: This is the definitive version of the article published in Public Health Nutrition, 9(3) 2006, pp.375-383.
316 citations
TL;DR: Results showed that individual and social factors partly mediated, but did not completely explain, SES variations in fruit and vegetable consumption, and nutrition promotion interventions should focus on enhancing nutrition knowledge and health considerations underlying food purchasing in order to promote healthy eating.
Abstract: Objective: This study employed a multilevel design to test the contribution of individual, social and environmental factors to mediating socio-economic status (SES) inequalities in fruit and vegetable consumption among women. Design: A cross-sectional survey was linked with objective environmental data. Setting: A community sample involving 45 neighbourhoods. Subjects: In total, 1347 women from 45 neighbourhoods provided survey data on their SES (highest education level), nutrition knowledge, health considerations related to food purchasing, and social support for healthy eating. These data were linked with objective environmental data on the density of supermarkets and fruit and vegetable outlets in local neighbourhoods. Results: Multilevel modelling showed that individual and social factors partly mediated, but did not completely explain, SES variations in fruit and vegetable consumption. Store density did not mediate the relationship of SES with fruit or vegetable consumption. Conclusions: Nutrition promotion interventions should focus on enhancing nutrition knowledge and health considerations underlying food purchasing in order to promote healthy eating, particularly among those who are socio-economically disadvantaged. Further investigation is required to identify additional potential mediators of SES–diet relationships, particularly at the environmental level.
307 citations
TL;DR: Both epidemiologic and metabolic studies suggest that individuals can benefit greatly by adopting elements of Mediterranean diets, and suggest that over 80% of coronary heart disease, 70% of stroke, and 90% of type 2 diabetes can be avoided by healthy food choices that are consistent with the traditional Mediterranean diet.
Abstract: ObjectiveTo provide an overview of research relevant to the Mediterranean dietDesignPersonal perspectivesSettingInternationalSubjectPopulations in Europe, North America, AsiaResultsApproximately 50 years ago, Keys and colleagues described strikingly low rates of coronary heart disease in the Mediterranean region, where fat intake was relatively high but largely from olive oil Subsequent controlled feeding studies have shown that compared to carbohydrate, both monounsaturated and polyunsaturated fats reduce LDL and triglycerides and increase HDL cholesterol Importantly, these beneficial metabolic effects are greater in the presence of underlying insulin resistance In a detailed analysis within the Nurses' Health Study, trans fat from partially hydrogenated vegetable oils (absent in traditional Mediterranean diets) was most strongly related to risk of heart disease, and both polyunsaturated and monounsaturated fat were inversely associated with risk Epidemiologic evidence has also supported beneficial effects of higher intakes of fruits and vegetables, whole grains, fish, and daily consumption of moderate amounts of alcohol Together with regular physical activity and not smoking, our analyses suggest that over 80% of coronary heart disease, 70% of stroke, and 90% of type 2 diabetes can be avoided by healthy food choices that are consistent with the traditional Mediterranean dietConclusionBoth epidemiologic and metabolic studies suggest that individuals can benefit greatly by adopting elements of Mediterranean diets
302 citations
TL;DR: Analysis of sociodemographic differences in TV viewing and associations with the consumption of sweets, soft drinks, fruit and vegetables in different countries indicates that many young people are at increased risk of overweight or obesity.
Abstract: Objective: Several environmental factors influence adolescents’ food habits and television (TV) viewing is thought to be one of these factors. The purpose of the present study was to describe sociodemographic differences in TV viewing and to examine associations of TV viewing with the consumption of sweets, soft drinks, fruit and vegetables in different countries. Methods: Data were collected from 162305 young people completing the 2001/02 Health Behaviour in School-Aged Children survey, a World Health Organization cross-national study on health and health behaviours among 11-, 13- and 15-year-old school pupils. Analyses of variance were used to examine sociodemographic differences in TV viewing and logistic regression analyses to examine associations between TV viewing and food habits. Results: Large differences were found between countries in reported daily TV viewing time, from an average of 2.0h in Switzerland to 3.7h in Ukraine. The results indicate that those most likely to watch TV are boys, 13-year-olds and pupils of lower socioeconomic status. Those who watched more TV were more likely to consume sweets and soft drinks on a daily basis and less likely to consume fruit and vegetables daily, although the latter associations were not so apparent among Central and Eastern European countries. Conclusions: Given the high TV viewing rates among adolescents and the association with less healthy food options, many young people are at increased risk of overweight or obesity. Interventions to modify TV viewing behaviour are needed. The findings underscore the importance of tackling socio-economic differences.
283 citations
TL;DR: The validity and reliability of the most recent adaptation of Block's full-diet food-frequency questionnaire (FFQ) were moderate to high, supporting its use in future studies among Canadian women.
Abstract: Department of Public Health, University of California, Berkeley, CA, USASubmitted 14 December 2004: Accepted 18 May 2005AbstractObjective:ToassessthevalidityandreliabilityofthemostrecentadaptationofBlock’sfull-diet food-frequency questionnaire (FFQ) among a sample of Canadian women.Design: Participants completed a self-administered FFQ (FFQ1), two unannounced24-hour recalls(weekday and weekend) andasecond FFQ(FFQ2) betweenOctober2003 and February 2004. FFQs and recalls were analysed for 32 nutrients using BlockDietary Data Systems and the University of Minnesota’s Nutrient Data System. Meanand median intakes were computed, along with crude and deattenuated Pearsoncorrelation coefficients between FFQ1 and the average of two recalls (validity) andbetween FFQ1 and FFQ2 (reliability).Setting: Ontario, Canada.Subjects: A random population-based sample (n ¼ 166) of women aged 25 to 74years.Results:Onehundredandfifteen(69%)womencompletedFFQ1,96completedFFQ1and both recalls, and 93 completed both FFQs, about 56 days apart. Mean intakeswere similar for most nutrients. FFQ reliability was high, with Pearson correlationcoefficients having a median of 0.75, ranging from 0.57 to 0.90 (macronutrients) andfrom 0.65 to 0.88 (micronutrients from supplements and food). FFQ validity wasmoderatetohigh,withdeattenuatedPearsoncorrelationcoefficientshavingamedianof 0.59, ranging from 0.11 to 0.73 (macronutrients) and from 0.50 to 0.76(micronutrients from supplements and food). Our micronutrient correlations weresimilar to or higher than those of other studies that included supplements. Twocorrelations ,0.40 were associated with fats.Conclusions:Thevalidityandreliabilityofthisfull-dietversionoftheBlockFFQweremoderate to high, supporting its use in future studies among Canadian women.KeywordsFood-frequency questionnaireDietary recallValidityReliabilityWomenCanadaFood-frequency questionnaires (FFQs) provide the mostpractical and economical method for collecting data on‘usual’dietary intakeinpopulation-based epidemiologicalstudies. In aetiological research, it is preferable to useFFQs that query the whole diet rather than a limitednumber of foods for specific hypotheses, since compre-hensiveness will improve the ability to adjust forconfounding nutrients and energy intake, when appro-priate, and to explore future dietary hypotheses
TL;DR: The AHEI was twice as strong at predicting major chronic disease and CVD risk compared to the original HEI, suggesting that major Chronic disease risk can be further reduced with more comprehensive and detailed dietary guidance.
Abstract: Harvard School of Public Health, Departments of Nutrition, Epidemiology, and theChanning Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School,Boston, MA 02115, USAAbstractObjective: The Healthy Eating Index (HEI), designed to assess adherence to theDietary Guidelines for Americans and the Food Guide Pyramid, was previouslyassociated with only a small reduction in major chronic disease risk in US adult menand women. We assessed whether an alternate index would better predict risk.Design: Dietary intake reported by men and women from two prospective cohortswas scored according to an a priori designed Alternate Healthy Eating Index (AHEI).In contrast with the original HEI, the AHEI distinguished quality within food groupsand acknowledged health benefits of unsaturated oils. The score was then used topredict development of CVD, cancer or other causes of death in the same populationpreviously tested.Subjects: 67271 women from the Nurses’ Health Study and 38615 men from theHealth Professionals’ Follow-up Study.Results: Men and women with AHEI scores in the top vs. bottom quintile had asignificant 20% and 11% reduction in overall major chronic disease, respectively.Reductions were stronger for CVD risk in men (RR ¼ 0.61, 95% CI 0.49–0.75) andwomen (RR ¼ 0.72, 95% CI 0.60–0.86). The score did not predict cancer risk.Conclusions: The AHEI was twice as strong at predicting major chronic disease andCVD risk compared to the original HEI, suggesting thatmajor chronic disease risk canbe further reduced with more comprehensive and detailed dietary guidance.KeywordsAlternate Healthy Eating IndexDietary patternsMediterranean dietCardiovascular diseaseCancerCohort studiesCardiovascular disease (CVD) and cancer are the twoleading causes of death in the USA
TL;DR: It is suggested that longer duration of TV watching (thus, more frequent exposure to advertising) influences the frequency of consumption of soft drinks, some sweets and snacks, and some fast foods among children and young adolescents.
Abstract: Objectives: To explore how time spent watching television (TV) is associated with the dietary behaviours of New Zealand children and young adolescents. Design: Secondary data analysis of a nationally representative, cross-sectional survey. Setting: In homes or schools of New Zealand school students. Participants: In total, 3275 children aged 5 to 14 years. Results: The odds of being overweight or obese increased with duration of TV viewing for children and adolescents when controlling for age, sex, ethnicity, socio-economic status and physical activity. Children and adolescents who watched the most TV were significantly more likely to be higher consumers of foods most commonly advertised on TV: soft drinks and fruit drinks, some sweets and snacks, and some fast foods. Both children and adolescents watching two or more hours of TV a day were more than twice as likely to drink soft drinks five times a week or more (P = 0.03 and P = 0.04, respectively), eat hamburgers at least once a week (both P = 0.02), and eat French fries at least once a week (both P < 0.01). Conclusions: These findings suggest that longer duration of TV watching (thus, more frequent exposure to advertising) influences the frequency of consumption of soft drinks, some sweets and snacks, and some fast foods among children and young adolescents. Efforts to curtail the amount of time children spend watching TV may result in better dietary habits and weight control for children and adolescents. Future studies examining the impact of advertising on children's diets through interventions and international comparisons of legislation would provide more definitive evidence of the role of advertising in child and adolescent obesity.
TL;DR: Smaller households, inactivity and increasing age for girls were found to be determinants that influence the development of overweight/obesity, while female gender and age post-menarche were identified as determinants of higher body fat content.
Abstract: Aim: To investigate the determinants of overweight and obesity among 10- to 15-yearold schoolchildren in a population in the transitional phase in the North West Province of South Africa. Methods: A cross-sectional survey was used to investigate weight status (anthropometric indicators) and determinants of overweight/obesity including dietary intake, physical activity and socio-economic status. A single, random sample (n ¼ 1257), stratified for gender, type of school and ethnic group, was used. Data were collected on demographics, family circumstances, habitual physical activity, dietary intake and anthropometry to evaluate weight status and body fat content. One-way analysis of variance, the generalised linear models procedure of SAS and the Tukey post hoc honest significant difference test were used to analyse the data. Results: Few children were overweight or obese (7.8%) according to International Obesity Task Force (IOTF) standards (body mass index (BMI)-for-age). These standards were compared with other accepted standard values. Both Cole’s IOTF/BMI-for-age standard and the sum of skinfold thicknesses standard classified normal-weight status similarly at a level of 92% (P , 0.01) and were found to be useful in determining overweight/obesity. The prevalence rate was higher in females and white children, and was more apparent in urban areas, smaller households and children of parents with low- or high-income occupations. Boys and pre-menarcheal girls had mean body fat percentage in the normal/optimal range, whereas that of post-menarcheal girls was moderately high. Few variables showed a significant association with high body fat percentage: in boys, only the number of members in the household and physical activity levels over the weekend; in girls, only age. The overweight/obese boys mostly lived in smaller households, and the overweight/obese post-menarcheal girls were most inactive on both weekdays and weekends, and more overweight with increasing age. Conclusion: Smaller households, inactivity and increasing age for girls were found to be determinants that influence the development of overweight/obesity, while female gender and age post-menarche were identified as determinants of higher body fat content. For overweight/obesity prevention, the focus should be on pre-menarcheal girls, aged 10‐13 years, using these determinants to identify overweight/obesity risk. Preventive programmes should aim to increase the physical activity of children to improve their current and future weight status.
TL;DR: Accumulating evidence suggests that olive oil, an integral component of the MD, may have health benefits, including the reduction of the risk of coronary heart disease, the prevention of several types of cancer and the modification of the immune and inflammatory responses.
Abstract: Objective: Analyse the importance of components of Mediterranean diet in functional feeding. Design: We have based the study in a bibliographic review. Results: Many of the characteristic components of the traditional Mediterranean diet (MD)areknowntohavepositiveeffectsonhealth,capacityandwell-being,andcanbe used to design functional foods. Vegetables, fruits and nuts are all rich in phenols, flavonoids, isoflavonoids, phytosterols and phytic acid—essential bioactive compounds providing health benefits. The polyunsaturated fatty acids found in fish effectively regulate haemostatic factors, protect against cardiac arrhythmias, cancer and hypertension, and play a vital role in the maintenance of neural functions and the prevention of certain psychiatric disorders. Accumulating evidence suggests that olive oil,anintegralcomponentoftheMD,mayhavehealthbenefits,includingthereduction of the risk of coronary heart disease, the prevention of several types of cancer and the modificationoftheimmuneandinflammatoryresponses.Oliveoilisknownforitshigh levels of monounsaturated fatty acids and is a good source of phytochemicals, such as polyphenolic compounds, squalene and a-tocopherol. In the context of the MD, the benefits associated with the consumption of several functional components may be intensified by certain forms of food preparation. In addition, the practice of more physicalactivity(oncecommonamongMediterraneanpopulations)andthefollowing of other healthy lifestyle habits may have additive effects. Conclusions: The identification of the active constituents of the MD is crucial in the formulation of appropriate dietary guidelines. Research into the pharmacological properties of the minor components of this diet (vitamins, sterols, polyphenols, etc.) is very active and could lead to the formulation of functional foods and nutraceuticals.
TL;DR: One of the most important results is a protective effect of high fibre intake and fish consumption against colorectal cancer, while high red and processed meat intake increase the risk of lung cancer.
Abstract: Objective To describe the main finding produced so far by the EPIC project, which aims to improve the scientific knowledge of nutritional factors involved in cancer. Design and setting Prospective cohort study in 23 centres from 10 European countries. Dietary assessment method varied by countries: in some cases a diet history by personal interview was carried out, while in most countries a self-administered semi-quantitative food-frequency questionnaire was used; in one case the questionnaire was combined with a food record. Information on a wide range of lifestyle factors and anthropometric measurements were also collected for most participants. Subjects The cohort includes 521,468 men and women mostly aged between 39 and 69 years, whereas blood samples are available for 387,889 subjects. Results To date 24 185 cancer cases have been identified in the follow-up of the cohort. The publications produced by each centre can be consulted on the EPIC website (http://www.iarc.fr/epic/). Among initial findings concerning the associations between cancer and dietary factors, one of the most important results is a protective effect of high fibre intake and fish consumption against colorectal cancer, while high red and processed meat intake increase the risk. Regarding lung cancer the first analyses found a protective effect of fruit intake but no association with vegetable consumption. No association was observed between vegetables and fruit intake and the risk of prostate cancer or breast cancer. Finally, data from Cambridge point to an interesting result regarding breast cancer: no association was observed with saturated fat intake measured by food-frequency questionnaire, but according to the food diary a daily intake of 35 g doubles the risk of breast cancer compared to women with daily intake of 10 g or less.
TL;DR: Even small doses of omega-3 fatty acids might be very protective in the context of a diet rich in oleic acid, poor in saturated fats and low in omega-6 fatty acids (a dietary pattern characterising the traditional Mediterranean diet), underline the importance of the accompanying diet in any dietary strategy using fatty acid complements.
Abstract: Objectives To discuss present knowledge about Mediterranean diet and cardiovascular diseases. Design Review of existing literature. Setting and results Epidemiological studies as well as randomised dietary trials suggest that Mediterranean diet may be important in relation to the pathogenesis (and prevention) of CHD. For instance, a striking protective effect of an ALA-rich Mediterranean diet was reported in the Lyon Diet Heart Study with a 50 to 70% reduction of the risk of recurrence after 4 years of follow-up in CHD patients. According to our current knowledge, dietary ALA should represent about 0.6 to 1% of total daily energy or about 2 g per day in patients following a Mediterranean diet, whereas the average intake in linoleic acid should not exceed 7 g per day. Supplementation with very-long-chain omega-3 fatty acids (about 1 g per day) in patients following a Mediterranean type of diet was shown to decrease the risk of cardiac death by 30% and of sudden cardiac death by 45% in the GISSI trial. Conclusions In the context of a diet rich in oleic acid, poor in saturated fats and low in omega-6 fatty acids (a dietary pattern characterising the traditional Mediterranean diet), even small doses of omega-3 fatty acids (about 1 g EPA+DHA the form of fish oil capsules or 2 g alpha-linolenic acid in canola oil and margarine) might be very protective. These data underline the importance of the accompanying diet in any dietary strategy using fatty acid complements.
TL;DR: Folate intake was inversely associated with depression prevalence among men, especially smokers and physically active women, and no significant associations were observed for w-3 fatty acids intake.
Abstract: Objective: The adherence to a Mediterranean Dietary Pattern ensures an adequate intake of B vitamins and w-3 fatty acids. A protective role on depression has been suggested for both nutrients. Design: Cross-sectional analysis from the SUN (Seguimiento Universidad de Navarra) prospective cohort study. Data from 9670 participants (4211 men and 5459 women) were analised. Logistic regression analyses were fitted to assess the association between B-vitamins and w-3 fatty acids intake (quintiles) and the prevalence of depression. Results: Folate intake was inversely associated with depression prevalence among men, especially smokers. Among women, B12 vitamin intake was inversely associated with depression, especially among smokers and physically active women. No significant associations were observed for w-3 fatty acids intake. Conclusions: The adherence to a Mediterranean Dietary Pattern ensures an adequate intake of fruits, nuts, vegetables, cereals, legumes or fish, important sources of nutrients linked to depression prevention.
TL;DR: The size of the gap between current practice and recommendations is striking when one considers breast-feeding involves no out-of-pocket costs, that there exists universal consensus on best practices, and that implementing current international recommendations could potentially save 1.45 million children's lives each year.
Abstract: OBJECTIVE We estimate attributable fractions, deaths and years of life lost among infants and children < or = 2 years of age due to suboptimal breast-feeding in developing countries. DESIGN We compare actual practices to a minimum exposure pattern consisting of exclusive breast-feeding for infants < or = 6 months of age and continued breast-feeding for older infants and children < or = 2 years of age. For infants, we consider deaths due to diarrhoeal disease and lower respiratory tract infections, and deaths due to all causes are considered in the second year of life. Outcome measures are attributable fractions, deaths, years of life lost and offsetting deaths potentially caused by mother-to-child transmission of HIV through breast-feeding. SETTING Developing countries. SUBJECTS Infants and children < or = 2 years of age. RESULTS Attributable fractions for deaths due to diarrhoeal disease and lower respiratory tract infections are 55% and 53%, respectively, for the first six months of infancy, 20% and 18% for the second six months, and are 20% for all-cause deaths in the second year of life. Globally, as many as 1.45 million lives (117 million years of life) are lost due to suboptimal breast-feeding in developing countries. Offsetting deaths caused by mother-to-child transmission of HIV through breast-feeding could be as high as 242,000 (18.8 million years of life lost) if relevant World Health Organization recommendations are not followed. CONCLUSIONS The size of the gap between current practice and recommendations is striking when one considers breast-feeding involves no out-of-pocket costs, that there exists universal consensus on best practices, and that implementing current international recommendations could potentially save 1.45 million children's lives each year.
TL;DR: The adult Lebanese population is at increased risk of cardiovascular diseases, obesity and other non-communicable diseases, which provides the basis for recommending increased intakes of fish, particularly fatty fish, and fruits and vegetables.
Abstract: Objectives: To investigate, measure and assess the food consumption pattern of the adult population living in Beirut, Lebanon, and to identify inadequate or excessive intake of food groups particularly linked to non-communicable diseases. Design: A cross-sectional food consumption survey was conducted in 2001. Dietary habits were assessed by means of a quantitative food-frequency questionnaire. Setting: Dietary survey of the urban population (Beirut). Subjects: Random sample of 444 adult subjects (aged 25–54 years) in Beirut. Results: The mean consumption of food by the study population was estimated to be 3030 g day 21 , providing an energy intake of 2523.57 kcal day 21 . Fat contributed 38.9% to the average daily energy intake, protein 13.4% and carbohydrates 47.2%. Mean consumption of fruits and vegetables was approximately 367 g day 21 and 45.3% of subjects consumed less than the recommended 400 g daily. Cereals contributed 324.5 g day 21 , providing 35.0% of daily energy intake, with bread being the most highly consumed (146.2 g day 21 ) in this food group. The mean intake of meat and poultry products was 91.7 g day 21 and provided 8.8% of daily energy intake, with consumption of butchery products especially beef being the highest (47.6 g day 21 ) followed by poultry (36.1 g day 21 ). A low consumption of fish was noted (19.7 g day 21 ), with 73.6% of subjects consuming less than the recommended 2 servings of fish per week. Dairy products contributed 243.1 g day 21 or 10.9% of daily energy intake, and milk was the least consumed dairy product (56.8% of consumers). The intake of added fats and oils, excluding those in cooked recipes, was 20.4 g day 21 ; olive oil was not used in cooking but was added solely at the table and its mean intake was 5 g day 21 . The consumption of butter was low (0.86 g day 21 ) and vegetable oil was the type of fat mostly used in cooking. The average intake of alcoholic beverages was low (33.6 g day 21 ), accounting for 0.7% of total energy intake. Women had significantly higher intakes of milk, dairy products, vegetables and coffee than men (P , 0.05). The percentage of women who reported the use of low-fat items was significantly higher than that of men. Younger people (25–34 years) ate significantly more meat, sugar, alcoholic beverages and soft drinks, and consumed significantly less cooked vegetables and legumes, than older ones (P , 0.05). Conclusions: The rather high contribution of fat to daily energy intake, the low intake of fish and the relatively high percentage of people consuming less than the recommended amount of fruits and vegetables observed in this study suggest that the adult Lebanese population is at increased risk of cardiovascular diseases, obesity and other non-communicable diseases, which provides the basis for recommending increased intakes of fish, particularly fatty fish, and fruits and vegetables.
TL;DR: DDS was inversely associated with cardiovascular risk factors in Tehranian adults and increased diversity scores of diets, to increase the variety score for vegetables, may be emphasised in programmes attempting to bring about changes in lifestyle.
Abstract: Aim To evaluate the relationship between dietary diversity score (DDS) and cardiovascular risk factors in Tehranian adults. Methods In this population-based cross-sectional study, a representative sample of 581 subjects (295 males and 286 females) aged over 18 years, residents of Tehran, participated. Hypercholesterolaemia, hypertriglyceridaemia and low high-density lipoprotein cholesterol were defined according to the Adult Treatment Panel III guidelines of the National Cholesterol Education Program. Diabetes was defined as fasting plasma glucose concentration > or = 126 mg dl(-1) or 2-h post challenge glucose concentration > or = 200 mg dl(-1). Hypertension was defined on the basis of the sixth report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Dietary diversity was defined according to the Diet Quality Index revised. Results Mean (+/- standard deviation) DDS was 6.15 +/- 1.02. The probability of having diabetes (odds ratio (OR) among quartiles: 1.45, 1.26, 1.11 and 1.00, respectively; P for trend = 0.04) and hypertriglyceridaemia (OR = 1.41, 1.23, 1.05 and 1.00, respectively; P for trend=0.04) decreased with increasing quartile of the diversity score for whole grains. The probability of having obesity (OR among quartiles: 1.39, 1.06, 1.03 and 1.00, respectively; P for trend = 0.03), hypercholesterolaemia (OR = 1.46, 1.28, 1.11 and 1.00, respectively; P for trend = 0.03), hypertension (OR = 1.32, 1.17, 1.13 and 1.00, respectively; P for trend = 0.03) and high low-density lipoprotein cholesterol (LDL-C) (OR = 1.25, 1.12, 1.07 and 1.00, respectively; P for trend = 0.04) decreased with increasing quartile of the diversity score for vegetables. The probability of having hypercholesterolaemia, high LDL-C, hypertension and diabetes decreased with quartile of the DDS. But the probability of being obese increased with quartile of the DDS (P for trend = 0.03). Conclusion DDS was inversely associated with cardiovascular risk factors in this cross-sectional study. Increased diversity scores of diets, to increase the variety score for vegetables, may be emphasised in programmes attempting to bring about changes in lifestyle.
TL;DR: Analysis guided by the hierarchical interrelationships of potential determinants of malnutrition, wasting and underweight turned out to be independently predicted by morbidity (proximal) factors, while Stunting was predicted by socio-economic, environmental and health-care factors in addition to morbidity.
Abstract: The objective was to assess predictors of poor anthropometric status among infants and young children. Design: Cross-sectional survey. Setting: The rural subsistence agricultural district of Hoima western Uganda. Subjects: Seven hundred and twenty children aged 0--23 months with their mothers/carers. Methods: Participants were recruited in September 2002 using a two-stage cluster sampling methodology. A structured questionnaire was administered to mothers in their home settings. Information on health household socio-economic status child feeding practices and anthropometric measurement was gathered. Conditional logistic regression analysis was applied taking into account the hierarchical relationships between potential determinants of poor anthropometric status. The mean Z-score for weight-for-height was 20.2 (95% confidence interval (CI) 20.1 20.7) for height-for-age was 21.1 (95% CI 21.2 20.9) and for weight-for-age was 20.7 (95% CI 20.8 20.6). Wasting was independently associated only with a history of fever in the 2 weeks prior to the survey (odds ratio (OR) = 4.4 95% CI 1.5 13) while underweight was associated with a history of fever (OR = 2.4 95% CI 1.3 4.4) and cough (OR = 3.0 95% CI 1.3 6.8). Stunting was positively associated with a wider range of factors including: history of a fever episode (OR = 1.7 95% CI 1.0 2.9) lack of a latrine in the household (OR = 2.7 95% CI 1.5 4.9) failure to deworm children 12 months or older (OR = 1.7 95% CI 1.1 2.8) and being born to a non-formally educated mother compared with mothers educated above primary school (OR = 2.1 95% CI 1.1 4.0). In analyses guided by the hierarchical interrelationships of potential determinants ofmalnutrition wasting and underweight turned out to be independently predicted by morbidity (proximal) factors. Stunting however was predicted by socioeconomic (distal) environmental and health-care (intermediate) factors in addition to morbidity. Strategies aimed at improving the growth of infants and young children in rural communities should address morbidity due to common childhood illness coupled with environmental and socio-economically oriented measures. (authors)
TL;DR: Public health programmes are required to raise parental recognition of childhood overweight and of related risk behaviours, and to provide parents with practical strategies to prevent unhealthy weight gain in their children.
Abstract: Objectives: To describe parental concerns about their child’s weight, to determine the proportion of parents taking preventive action to avoid obesity in their children and the predictors of taking preventive action, and to describe the strategies adopted by parents. Design: A cross-sectional survey was conducted. Children’s heights and weights were measured, and parents completed a questionnaire that included measures of their own weight status, perceptions of their child’s weight, concerns about their child’s current weight and future weight as an adolescent and adult, and the strategies used to prevent obesity. Setting: The study was conducted in Melbourne, Australia. Subjects: A total of 291 families of children aged 5–6 years and 919 families of children aged 10–12 years participated. Results: Eighty-nine per cent of parents of overweight 5–6-year-olds and 63% of parents of overweight 10–12-year-olds were unaware their child was overweight. Seventy-one per cent of parents of overweight 5–6-year-olds and 43% of parents of overweight 10–12-year-olds were not concerned about their child’s current weight. Although 31% of parents of 5–6-year-olds and 43% of parents of 10–12-year-olds were taking action to prevent unhealthy weight gain in their children, less-educated parents were less likely to do so. Conclusions: Public health programmes are required to raise parental recognition of childhood overweight and of related risk behaviours, and to provide parents with practical strategies to prevent unhealthy weight gain in their children.
TL;DR: The present review summarises the main results of epidemiological studies and feeding trials, and explains the possible mechanisms through which monounsaturated fatty acids, and specifically olive oil as the major dietary source of this type of fat in Mediterranean countries, could exert a favourable effect on blood pressure.
Abstract: Diet has an important role in the prevention and treatment of hypertension. In early epidemiological studies, conducted mainly in the USA, monounsaturated fatty acids showed a deleterious association with blood pressure or no relationship at all. However, more recent studies, conducted in Mediterranean countries, have shed new light on this issue. In the present review we summarise the main results of epidemiological studies and feeding trials, and explain the possible mechanisms through which monounsaturated fatty acids, and specifically olive oil as the major dietary source of this type of fat in Mediterranean countries, could exert a favourable effect on blood pressure.
TL;DR: Dietary supplies in the Mediterranean area were quite heterogeneous in the 1960s and have experienced a process of Westernization, especially in European Mediterranean countries.
Abstract: Objective: To describe geographical differences and time trends in the supply of the most important food components of the traditional Mediterranean diet. Design: Food supply data collected from national food balance sheets for the period 1961-2001. Setting: Selected Mediterranean countries: Spain, Italy, France, Greece, Algeria, Morocco, Tunisia and Turkey. Results: Differences of almost 30-fold and five-fold were found in the supply of olive oil and fruits and vegetables, respectively, among the Mediterranean countries studied during the 1960s. A favourable increasing trend for the supply of fruit and vegetables was observed in most Mediterranean countries. However, an increase in the supply of meats and dairy products and a decrease in the supply of cereals and wine were observed in European Mediterranean countries from 1961 until 2001. Only in African and Asiatic Mediterranean countries were cereals the base of food supply. During the 1990s, Greece's food supply pattern was closest to the traditional Mediterranean diet, while Italy and Spain maintained a high availability of fruits, vegetables and olive oil, but were losing the other typical components. Among African and Asiatic Mediterranean countries, only Turkey presented a traditional Mediterranean dietary pattern except with respect to olive oil, the supply of which was very low. France showed a Western dietary pattern, with a high supply of animal products and a low supply of olive oil. Conclusions: Dietary supplies in the Mediterranean area were quite heterogeneous in the 1960s and have experienced a process of Westernization, especially in European Mediterranean countries.
TL;DR: The FFQ-25 gives reasonable valid estimates of protein, retinol and folic acid intakes, but seems to overestimate intake of n–3 fatty acids.
Abstract: Objective: To validate intakes of protein, folic acid, retinol and n-3 fatty acids estimated from a food-frequency questionnaire in week 25 of pregnancy (FFQ-25). Design: Validation was done against a 7-day weighed food diary (FD) and biomarkers of the nutrients in gestation week 32-38. Subjects and setting: The FFQ-25 to be validated was used in the Danish National Birth Cohort comprising 101042 pregnant Danish women, of whom 88 participated in the present validation study. Results: Estimated intakes of protein, retinol and folic acid did not differ significantly between the two dietary methods, but intake of n-3 fatty acids was one third larger when estimated from the FFQ-25. The intakes estimated from the two dietary methods were all significantly correlated, ranging from 0.20 for retinol intake to 0.57 for folic acid intake. Sensitivities of being correctly classified into low and high quintiles were between 0.22 and 0.77, and specificities were between 0.62 and 0.89. Urinary protein content did not correlate significantly with protein estimated from the FFQ (r = 0.17, P > 0.05), but did with intake estimated from the FD (r = 0.56, P < 0.0001). Erythrocyte folate correlated significantly with the estimated total intake from the FFQ (r= 0.55, P< 0.0001) and the FD (r = 0.52, P < 0.0001). No correlations with plasma retinol were found. Erythrocyte eicosapentaenoic acid (C20:5n-3) correlated significantly with n-3 fatty acids intake estimated from both the FFQ-25 (r = 0.37, P < 0.001) and the FD (r = 0.62, P < 0.0001). Conclusion: The FFQ-25 gives reasonable valid estimates of protein, retinol and I folic acid intakes, but seems to overestimate intake of n-3 fatty acids.
TL;DR: The presence of measures aimed at protecting, promoting and supporting breast-feeding in the municipality had a positive influence on EBF and attenuated the impact of risk factors for the termination of breast- feeding.
Abstract: The objective was to identify individual and contextual factors associated with the practice of exclusive breast-feeding (EBF). Methodology: We analysed 34 435 children under 6 months of age living in 111 municipalities in the state of Sao Paulo south-eastern Brazil who participated in a survey investigating feeding practices during the first year of life carried out during the 1999 national vaccination campaign. The questionnaire employed included questions on the consumption in the last 24 h of breast milk water tea other types of milk and other foods in addition to mother and child characteristics. Information on the pro-breast-feeding measures implemented in the municipalities was also collected. The effects of individual and contextual characteristics on EBF were analysed using multilevel models. The final model showed a greater chance of EBF in women with tertiary education (odds ratio (OR) = 1.91; 95% confidence interval (CI) 1.75-2.06); women aged between 25 and 29 years (OR = 1.52; 95% CI 1.41-1.63); multiparae (OR = 1.42; 95% CI 1.33-1.49); female babies (OR = 1.12; 95% CI 1.05-1.18); birth weight $3000 g (OR = 1.73; 95% CI 1.49-1.97); child follow-up in the private healthcare network (OR = 1.10; 95% CI 1.02-1.18); and municipalities with four or five probreast-feeding measures (OR = 2.4; 95% CI 2.19-2.88). An analysis of the interactions between individual and contextual variables showed that the presence of at least four pro-breast-feeding measures in the municipality attenuated the risk of early termination of EBF associated with low maternal schooling and low birth weight and transformed child follow-up in the public network into a protective factor against the early termination of breast-feeding. The presence of measures aimed at protecting promoting and supporting breast-feeding in the municipality had a positive influence on EBF and attenuated the impact of risk factors for the termination of breast-feeding. (authors)
TL;DR: Providing children with food photographs depicting age-appropriate portion sizes greatly increases the accuracy of portion size estimates compared with estimates using photographs designed for use with adults.
Abstract: Background In order to obtain a measure of nutrient intake, a measure or estimate of the amount of food consumed is required. Weighing foods imposes a large burden on subjects, often resulting in underreporting. Tools are available to assist subjects in providing an estimate of portion size and these include food photographs. The application of these tools in improving portion size estimation by children has not been investigated systematically. Objectives To assess the accuracy with which children are able to estimate food portion sizes using food photographs designed for use with adults, and to determine whether the accuracy of estimates is improved when age-appropriate portion size photographs are provided. Design Original data from three separate studies, on the accuracy of portion size estimates by adults using food photographs, by children using adult photographs and by children using age-appropriate photographs, are analysed and compared. Subjects One hundred and thirty-five adults aged 18 to 90 years and 210 children aged 4 to 11 years. Results Children's estimates of portion sizes using age-appropriate food photographs were significantly more accurate (an underestimate of 1% on average) than estimates using photographs designed for use with adults (an overestimate of 45% on average). Accuracy of children's estimates of portion size using age-appropriate photographs was not significantly different from that of adults. Children overestimated a food's weight by 18% on average and adults underestimated by 5%. Conclusions Providing children with food photographs depicting age-appropriate portion sizes greatly increases the accuracy of portion size estimates compared with estimates using photographs designed for use with adults.
TL;DR: A systematic review of RCTs evaluating change in anthropometry with interventions that included oral or parenteral iron supplementation, or iron-fortified formula milk or cereals found no positive effect of iron supplementation on the physical growth of children.
Abstract: OBJECTIVE: To evaluate the effect of iron supplementation on physical growth in children through a systematic review of randomised controlled trials (RCTs). DATA SOURCES: Electronic databases, personal files, and hand search of reviews, bibliographies of books, abstracts and proceedings of international conferences. REVIEW METHODS: RCTs evaluating change in anthropometry with interventions that included oral or parenteral iron supplementation, or iron-fortified formula milk or cereals, were analysed. RESULTS: Twenty-five trials (26 cohorts) had relevant information. There was no evidence of publication bias. The pooled estimates (random effects model) did not document a statistically significant (P>0.05) positive effect of iron supplementation on any anthropometric variable (weight-for-age, weight-for-height, height-for-age, mid upper-arm circumference, skinfold thickness, head circumference). Significant heterogeneity was evident, and its predictors included greater weight-for-age in supplemented children in malaria hyperendemic regions and greater weight-for-height for children above 5 years of age, but a negative effect on linear growth in developed countries and with supplementation for 6 months or longer. CONCLUSIONS: This review did not document a positive effect of iron supplementation on the physical growth of children. The identified predictors of heterogeneity should be considered as exploratory and requiring confirmation, not conclusive.
TL;DR: In this paper, the influence of individual-and area-level socio-economic characteristics on food choice behavior and dietary intake was examined by the authors in the city of Eindhoven in south-east Netherlands.
Abstract: Objective: To examine the influence of individual- and area-level socio-economic characteristics on food choice behaviour and dietary intake. Setting: The city of Eindhoven in the south-east Netherlands. Design: A total of 1339 men and women aged 25-79 years were sampled from 85 areas (mean number of participants per area = 18.4, range 2-49). Information on socio-economic position (SEP) and diet was collected by structured face-to-face interviews (response rate 80.9%). Individual-level SEP was measured by education and household income, and area-level deprivation was measured using a composite index that included residents' education, occupation and employment status. Diet was measured on the basis of (1) a grocery food index that captured compliance with dietary guidelines, (2) breakfast consumption and (3) intakes of fruit, total fat and saturated fat. Multilevel analyses were performed to examine the independent effects of individual- and area-level socio-economic characteristics on the dietary outcome variables. Results: After adjusting for individual-level SEP, few trends or significant effects of area deprivation were found for the dietary outcomes. Significant associations were found between individual-level SEP and food choice, breakfast consumption and fruit intake, with participants from disadvantaged backgrounds being less likely to report food behaviours or nutrient intakes consistent with dietary recommendations. Conclusions: The findings suggest that an individual's socio-economic characteristics play a more important role in shaping diet than the socio-economic characteristics of the area in which they live. In this Dutch study, no independent influence of area-level socio-economic characteristics on diet was detected, which contrasts with findings from the USA, the UK and Finland.