Showing papers in "Public Health Nutrition in 2007"

Prevention and control of iodine deficiency in pregnant and lactating women and in children less than 2-years-old: conclusions and recommendations of the Technical Consultation

Abstract: The Consultation reached a general consensus on several important issues. First, that universal salt iodisation‡ (USI) remains the key strategy to eliminate iodine deficiency disorders. Second, that where USI has been effective for at least 2 years, with salt adequately iodised and consumed by more than 90% of the population 1 , it can be reasonably expected that the iodine needs of women of child-bearing age and pregnant and lactating women are covered by their diet, and that the iodine stored in the thyroid gland is sufficient to ensure adequate hormone synthesis and secretion. Third, that iodised salt may not provide enough iodine to meet a child’s needs during complementary feeding, especially if the mother is only marginally iodine sufficient, unless complementary foods are fortified with iodine. It may be necessary therefore to give additional iodine to makesure that requirements are met until such time as the child starts to eat the normal family food. Finally, there was consensus that monitoring of both iodised salt quality and iodine nutrition are important to ensure that an optimal state of iodine nutrition is reached and then sustained. The Consultation made several specific recommendations concerning requirements, indicators and strategies to control iodine deficiency disorders in pregnant and lactating women, and in children less than 2-years-old.

Disparities in the availability of fruits and vegetables between racially segregated urban neighbourhoods

Abstract: Objective Public health professionals continue to see the benefits of fruit and vegetable consumption on population health. While studies that evaluate the availability of produce are sparse in the medical literature, disparities in availability may explain the disproportional intake of produce for some people. Therefore, the purpose of this study was to evaluate the availability and variety of produce located in two racially and economically diverse urban neighbourhoods. Design A cross-sectional study was conducted in which 50% of the supermarkets, small grocery stores, delicatessens, and fruit and vegetable markets located in specific neighbourhoods were randomly sampled and surveyed between September 2004 and July 2005. Food stores were evaluated for the availability of 20 types of fresh fruits and 19 types of fresh vegetables, as well as their varieties and whether they were canned, frozen or previously prepared. 2000 US Census information was used to determine characteristics of the geo-coded census tracts where the food stores were located. Setting Brooklyn, New York. Results A supermarket was located in approximately every third census tract in predominantly white areas (prevalence = 0.33) and every fourth census tract in racially mixed areas (prevalence = 0.27). There were no supermarkets located in the predominantly black areas. With the exception of bananas, potatoes, okra and yucca, a lower proportion of predominantly black area stores carried fresh produce, while supermarkets carried the largest variety of produce types. Canned and frozen fruits and vegetables were found in the majority of stores, whereas prepared and organic produce was limited to predominantly white area stores. Conclusions These data demonstrate that the availability and variety of fresh produce is associated with neighbourhood racial composition and may be a factor contributing to differences in intake among residents.

Fast food for family meals: relationships with parent and adolescent food intake, home food availability and weight status.

Abstract: Objective The purpose of the present study was to examine the prevalence of fast-food purchases for family meals and the associations with sociodemographic variables, dietary intake, home food environment, and weight status in adolescents and their parents. Design This study is a cross-sectional evaluation of parent interviews and adolescent surveys from Project EAT (Eating Among Teens). Subjects Subjects included 902 middle-school and high-school adolescents (53% female, 47% male) and their parents (89% female, 11% male). The adolescent population was ethnically diverse: 29% white, 24% black, 21% Asian American, 14% Hispanic and 12% other. Results Results showed that parents who reported purchasing fast food for family meals at least 3 times per week were significantly more likely than parents who reported purchasing fewer fast-food family meals to report the availability of soda pop and chips in the home. Adolescents in homes with fewer than 3 fast-food family meals per week were significantly more likely than adolescents in homes with more fast-food family meals to report having vegetables and milk served with meals at home. Fast-food purchases for family meals were positively associated with the intake of fast foods and salty snack foods for both parents and adolescents; and weight status among parents. Fast-food purchases for family meals were negatively associated with parental vegetable intake. Conclusions Fast-food purchases may be helpful for busy families, but families need to be educated on the effects of fast food for family meals and how to choose healthier, convenient family meals.

Iodine deficiency and brain development in the first half of pregnancy

Abstract: An inadequate supply of iodine during gestation results in damage to the foetal brain that is irreversible by mid-gestation unless timely interventions can correct the accompanying maternal hypothyroxinemia. Even mild to moderate maternal hypothyroxinemia may result in suboptimal neurodevelopment. This review mainly focuses on iodine and thyroid hormone economy up to mid-gestation, a period during which the mother is the only source for the developing brain of the foetus. The cerebral cortex of the foetus depends on maternal thyroxine (T4) for the production of the 3',3,5-tri-iodothyronine (T3) for nuclear receptor-binding and biological effectiveness. Maternal hypothyroxinemia early in pregnancy is potentially damaging for foetal brain development. Direct evidence has been obtained from experiments on animals: even a relatively mild and transient hypothyroxinemia during corticogenesis, which takes place mostly before mid-gestation in humans, affects the migration of radial neurons, which settle permanently in heterotopic locations within the cortex and hippocampus. Behavioural defects have also been detected. The conceptus imposes important early changes on maternal thyroid hormone economy that practically doubles the amount of T4 secreted something that requires a concordant increase in the availability of iodine, from 150 to 250-300 microg I day- 1. Women who are unable to increase their production of T4 early in pregnancy constitute a population at risk for having children with neurological disabilities. As a mild to moderate iodine deficiency is still the most widespread cause of maternal hypothyroxinemia, the birth of many children with learning disabilities may be prevented by advising women to take iodine supplements as soon as pregnancy starts, or earlier if possible, in order to ensure that their requirements for iodine are met.

The importance of iodine nutrition during pregnancy.

Abstract: Objective: To examine the importance of iodine nutrition during pregnancy. Design: Review of existing literature of iodine in pregnancy. Setting: Population surveys and metabolic studies. Subjects: Pregnant women. Results: The main changes in thyroid function associated with pregnancy are due to an increase in hormone requirements that begin in the first trimester of gestation. This increase can only be met by a proportional increase in hormone production, something that depends directly upon the availability of iodine. When dietary iodine is lacking, an adequate physiological adaptation is difficult to achieve and is progressively replaced by pathological alterations that occur in parallel with the degree and duration of iodine deprivation. Conclusions: Iodine prophylaxis should be given systematically to women during pregnancy. In most public health programmes dealing with the correction of iodine deficiency disorders, iodised salt has been used as the preferred means to deliver iodine to households. Iodised salt, however, is not the ideal means of delivering iodine in the specific instances of pregnancy, breast-feeding and complementary feeding because of the need to limit salt intake during these periods. In European countries, presently it is proposed that iodine is given to pregnant women and breast-feeding mothers by systematically administering multivitamin tablets containing iodine in order to reach the recommended dietary allowance of 250 mg iodine day -1 .

Inflammation, obesity and comorbidities: the role of diet.

Abstract: The adipocyte metabolism has been shown to change during the fat enlargement process associated to obesity. Several procoagulant proteins such as plasminogen activator inhibitor type 1, tissue factor or factor VII and also inducible nitric oxide synthase show higher expression in adipose tissue of obese people in comparison to lean. This overexpression could explain at least a part of the atherogenic and cardiovascular risk associated with obesity. In addition to cytokine secretion, many other features have been observed to be common to adipocyte and monocyte/macrophage lines: for example, phagocytic and microbicidal activities, and possibly a cellular plasticity of adipose precursors. Overweight and obesity are associated with an increased risk of such metabolic abnormalities as dyslipidemia, hypertension or type 2 diabetes mellitus and cardiovascular diseases, common features of the metabolic syndrome. Initially, insulin resistance or hyperinsulinemia was suggested as the origin of these abnormalities. More recent studies indicate that adipokynes have an important role in obesity-associated metabolic complications, and suggest that chronically elevated local or systemic concentrations of adipokynes contribute to the development of complications associated with obesity and metabolic syndrome. Considering all the evidence relating to diet and inflammation, the best diet for protecting against the metabolic derangements associated with obesity and metabolic syndrome would be high in fibre-rich cereals, fruit, vegetables, fish, virgin olive oil and nuts; moderate in wine; and low in meat, processed meat foods and trans-fatty acids.

Plant breeding to control zinc deficiency in India: How cost-effective is biofortification?

Abstract: The objective was to estimate the potential impact of zinc biofortification of rice and wheat on public health in India and to evaluate its cost-effectiveness compared with alternative interventions and international standards. The burden of zinc deficiency (ZnD) in India was expressed in disability-adjusted life years (DALYs) lost. Current zinc intakes were derived from a nationally representative household food consumption survey (30-day recall) and attributed to household members based on adult equivalent weights. Using a dose-response function projected increased zinc intakes from biofortified rice and wheat were translated into potential health improvements for pessimistic and optimistic scenarios. After estimating the costs of developing and disseminating the new varieties the costeffectiveness of zinc biofortification was calculated for both scenarios and compared with alternative micronutrient interventions and international reference standards. The study took place in India. The subjects were a representative household survey (n = 119 554). The calculated annual burden of ZnD in India is 2.8 million DALYs lost. Zinc biofortification of rice and wheat may reduce this burden by 20-51% and save 0.6-1.4 million DALYs each year depending on the scenario. The cost for saving one DALY amounts to $US 0.73-7.31 which is very cost-effective by standards of the World Bank and the World Health Organization and is lower than that of most other micronutrient interventions. Not only may zinc biofortification save lives and prevent morbidity among millions of people it may also help accommodate the need to economise and to allocate resources more efficiently. Further research is needed to corroborate these findings. (authors)

The impact of a community-based food skills intervention on cooking confidence food preparation methods and dietary choices – an exploratory trial

Abstract: Objective: To evaluate the feasibility of undertaking a food skills intervention study in areas of social deprivation aimed at altering cooking confidence, food preparation methods and dietary choices. Design: A standardised skills programme was implemented in community-based settings. Pre- (T1) and post-intervention (T2) and 6-month follow-up (T3) measures (7-day diaries and self-administered questionnaires) were undertaken in intervention and comparison groups. Setting: Eight urban communities in Scotland. Subjects: One hundred and thirteen adults living in areas of social deprivation. Results: It was clear that many subjects led fragmented lives and found commitment to intervention classes problematic. Sixty-three subjects completed the final (T3) assessments. The response to each component varied due to inability to attend sessions, illness, study requirements, employment, moving out of the area, change in circumstances, loss of interest and loss of postal questionnaires. At baseline, reported consumption of fruit and vegetables was low (mean frequency 8.1 ^ 4.78 times per week). Fruit intake increased significantly (P,0.05) between T1 and T2 in the intervention group (1.7 ^ 2.36 to 2.7 ^ 3.28 times per week) only. Between T1 and T3, there was a significant increase (P ,0.05) in intervention subjects who reported confidence in following a recipe (67‐90%,). Conclusions: This exploratory trial shows that a food skills intervention is likely to have a small but positive effect on food choice and confidence in food preparation. A full-scale randomised controlled trial in this hard-to-reach group would require a range of flexible approaches rather than a fully defined intervention, and presents challenges for trial design.

An objective examination of consumer perception of nutrition information based on healthiness ratings and eye movements.

Abstract: Objective. Previous research on nutrition labelling has mainly used subjective measures. This study examines the effectiveness of two types of nutrition label using two objective measures: eye movements and healthiness ratings. Design. Eye movements were recorded while participants made healthiness ratings for two types of nutrition label: standard and standard plus the Food Standards Agency’s ‘traffic light’ concept. Setting. University of Derby, UK. Subjects. 92 participants (mean age 31.5 years) were paid for their participation. None of the participants worked in the areas of food or nutrition. Results. For the standard nutrition label, participant eye movements lacked focus and their healthiness ratings lacked accuracy. The traffic light system helped to guide the attention of the consumer to the important nutrients and improved the accuracy of the healthiness ratings of nutrition labels. Conclusions. Consumer’s have a lack of knowledge regarding how to interpret nutrition information for standard labels. The traffic light concept helps to ameliorate this problem by indicating important nutrients to pay attention to.

Secular trends in the association of socio-economic position with self-reported dietary attributes and biomarkers in the US population: National Health and Nutrition Examination Survey (NHANES) 1971–1975 to NHANES 1999–2002

Abstract: ObjectiveRecent reports suggest persistence of health disparities related to socio-economic position (SEP). To understand if diet may be a contributor to these trends, we examined secular trends in the association of diet and indicators of SEP from 1971–1975 to 1999–2002.DesignWe used data from the National Health and Nutrition Examination Surveys (NHANES) I (1971–1975), II (1976–1980), III (1988–1994) and 1999–2002 to examine the independent associations of poverty income ratio (PIR) and education with diet and biomarkers of diet and disease in 25–74-year-olds (n = 36 600). We used logistic and linear regression methods to adjust for multiple covariates and survey design to examine these associations.ResultsA large PIR differential in the likelihood of reporting a fruit or all five food groups and vitamin C intake, and an education differential in likelihood of obesity and carbohydrate intake, was noted in 1971–1975 but narrowed in 1999–2002 (P < 0.007). The positive association of education with intake of a fruit, vegetable or all five food groups, vitamins A and C, calcium and potassium intake remained unchanged across surveys (P < 0.001). Similarly, the positive association of PIR with the amount of foods and intakes of energy and potassium remained unchanged over three decades (P < 0.001). The education and the PIR differential in energy density, and the PIR differential in the likelihood of obesity, persisted over the period of the four surveys (P < 0.001).ConclusionsPersistence of unfavourable dietary and biomarker profiles in Americans with low income and education suggests continued need for improvement in the quality of diets of these high-risk groups.

Parental eating behaviours, home food environment and adolescent intakes of fruits, vegetables and dairy foods: longitudinal findings from Project EAT.

Abstract: Objective To examine longitudinal associations of parental report of household food availability and parent intakes of fruits, vegetables and dairy foods with adolescent intakes of the same foods. This study expands upon the limited research of longitudinal studies examining the role of parents and household food availability in adolescent dietary intakes. Design Longitudinal study. Project EAT-II followed an ethnically and socio-economically diverse sample of adolescents from 1999 (time 1) to 2004 (time 2). In addition to the Project EAT survey, adolescents completed the Youth Adolescent Food-Frequency Questionnaire in both time periods, and parents of adolescents completed a telephone survey at time 1. General linear modelling was used to examine the relationship between parent intake and home availability and adolescent intake, adjusting for time 1 adolescent intakes. Associations were examined separately for the high school and young adult cohorts and separately for males and females in combined cohorts. Subjects/setting The sample included 509 pairs of parents/guardians and adolescents. Results Vegetables served at dinner significantly predicted adolescent intakes of vegetables for males ( P = 0.037), females ( P = 0.009), high school ( P = 0.033) and young adults ( P = 0.05) at 5-year follow-up. Among young adults, serving milk at dinner predicted dairy intake ( P = 0.002). Time 1 parental intakes significantly predicted intakes of young adults for fruit ( P = 0.044), vegetables ( P = 0.041) and dairy foods ( P = 0.008). Parental intake predicted intake of dairy for females ( P = 0.02). Conclusions The findings suggest the importance of providing parents of adolescents with knowledge and skills to enhance the home food environment and improve their own eating behaviours.

Iodine requirements during pregnancy, lactation and the neonatal period and indicators of optimal iodine nutrition

Abstract: Objective: This paper re-evaluates the requirements for iodine during pregnancy, lactation and the neonatal period, and formulates original proposals for the median concentrations of urinary iodine (UI) that indicate optimal iodine nutrition during these three critical periods of life. This paper also discusses the measurements that are used to explore thyroid functions during the same periods. Design: An extensive and critical review of the literature on thyroid physiopathology during the perinatal period. Setting: Human studies conducted in various regions throughout the world. Subjects: Pregnant women, lactating women, and newborns. Results: The following proposals are made after extensive review of the literature: the requirement for iodine by the mother during pregnancy is 250-300 mg day -1 ; during lactation the requirement is 225-350 mg day -1 ; and during the neonatal period the requirement of the infant is 90 mg day -1 . The median UI that indicates an optimal iodine nutrition during these three periods should be in the range of 150-230 mg day -1 . These figures are higher than recommended to date by the international agencies. Conclusions: Pregnantwomenandyounginfants,butespeciallythesecondgroup,are more sensitive to the effects of an iodine deficiency (ID) than the general population because their serum thyroid-stimulating hormone (TSH) and thyroxine are increased and decreased, respectively, for degrees of ID that do not seem to affect thyroid function in the general population. Systematic neonatal thyroid screening using primaryTSHcouldbethemostsensitiveindicatortomonitortheprocessofIDcontrol.

Adipogenesis and lipotoxicity: role of peroxisome proliferator-activated receptor gamma (PPARgamma) and PPARgammacoactivator-1 (PGC1).

Abstract: Obesity is characterised by an increase in the adipose deposits, resulting from an imbalance between food intake and energy expenditure. When expansion of the adipose tissue reaches its maximum limit, as in obesity, fat accumulates in non-adipose tissues such as liver, heart, muscle and pancreas, developing a toxic response known as lipotoxicity, a condition that promotes the development of insulin resistance and other metabolic complications. Thus, the lipotoxic state may contribute to the increased risk of insulin resistance, diabetes, fatty liver and cardiovascular complications associated with obesity. We are interested in studying adipose tissue, specifically how mechanisms of adipogenesis and remodelling of adipose tissue, in terms of size and function of the adipocytes, could be considered a strategy to increase the capacity for lipid storage and prevent lipotoxicity. The peroxisome proliferator-activated receptors (PPARs) are a family of transcription factors that regulate energy balance by promoting either energy deposition or energy dissipation. Under normal physiological conditions, PPARgamma is mainly expressed in adipose tissue and regulates diverse functions such as the development of fat cells and their capacity to store lipids. The generation of PPARgamma knockout mice, either tissue specific or isoform specific, has provided new models to study PPARgamma's role in adipose tissue differentiation and function and have highlighted the essential role of PPARgamma in adipogenesis and lipogenesis.A second strategy to prevent lipotoxicity is to increase the capacity of tissues to oxidise fatty acids. PPARgammacoactivator-1alpha is a coactivator of PPARgamma that induces the expression of genes that promote the differentiation of preadipocytes to brown adipocytes. Recently, it has been implicated in increasing the oxidation of fatty acids via increasing mitochondrial capacity and function, making this co-factor a key candidate for the treatment of lipotoxicity.

Eating out of home and its correlates in 10 European countries. The European Prospective Investigation into Cancer and Nutrition (EPIC) study.

Abstract: OBJECTIVE: To compare the average out-of-home (OH) consumption of foods and beverages, as well as energy intake, among populations from 10 European countries and to describe the characteristics of substantial OH eaters, as defined for the purpose of the present study, in comparison to other individuals. DESIGN: Cross-sectional study. Dietary data were collected through single 24-hour dietary recalls, in which the place of consumption was recorded. For the present study, substantial OH eaters were defined as those who consumed more than 25% of total daily energy intake at locations other than the household premises. Mean dietary intakes and the proportion of substantial OH eaters are presented by food group and country. Logistic regression analyses were used to estimate the odds of being a substantial OH eater in comparison to not being one, using mutually adjusted possible non-dietary determinants. SETTING: Ten European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). SUBJECTS: The subjects were 34 270 individuals, 12 537 men and 21 733 women, aged 35-74 years. RESULTS: The fraction of energy intake during OH eating was generally higher in northern European countries than in the southern ones. Among the food and beverage groups, those selectively consumed outside the home were coffee/tea/waters and sweets and, to a lesser extent, cereals, meats, added lipids and vegetables. Substantial OH eating was positively associated with energy intake and inversely associated with age and physical activity. Substantial OH eating was less common among the less educated compared with the more educated, and more common during weekdays in central and north Europe and during the weekend in south Europe. CONCLUSIONS: Eating outside the home was associated with sedentary lifestyle and increased energy intake; it was more common among the young and concerned in particular coffee/tea/waters and sweets.

Association of key foods and beverages with obesity in Australian schoolchildren.

Abstract: Objective: To examine the pattern of intake of key foods and beverages of children aged 4–12 years and the association with weight status. Design and setting: A computer-assisted telephone interview was used to determine the intake of fruit, vegetables, packaged snacks, fast foods and sweetened drinks ‘yesterday’ and ‘usually’ as reported by parents/guardians of a representative sample of 2184 children from the Barwon South-Western region of Victoria, Australia. Results: Children who consumed .2–3,.3–4 and .4 servings of fruit juice/drinks ‘yesterday’ were, respectively, 1.7 (95% confidence interval (CI) 1.2–2.2), 1.7 (95% CI 1.2–2.5) and 2.1 (95% CI 1.5–2.9) times more likely to be overweight/obese compared with those who had no servings of fruit juice/drink ‘yesterday’, adjusted for age, gender and socio-economic status (SES). Further, children who had $3 servings of soft drink ‘yesterday’ were 2.2 (95% CI 1.3–3.9) times more likely to be overweight/obese compared with those who had no servings of soft drink ‘yesterday’, adjusted for age, gender and SES. In addition, children who ‘usually’ drank fruit juice/drinks twice or more per day were 1.7 (95% CI 1.2–2.4) times more likely to be overweight/obese compared with those who drank these beverages once or less per week, adjusted for age, gender and SES. Although fast foods and packaged snacks were regularly eaten, there were no associations between weight status and consumption of these foods. Conclusions: Intake of sweetened beverages was associated with overweight and obesity in this population of Australian schoolchildren and should be a target for intervention programmes aimed at preventing unhealthy weight gain in children.

Health-enhancing physical activity among Saudi adults using the International Physical Activity Questionnaire (IPAQ)

Abstract: Objectives: To describe the physical activity profile of Saudi adults living in Riyadh, using the International Physical Activity Questionnaire (IPAQ) short-version telephone format. Methods: Physical activity was assessed using the official Arabic short form of IPAQ, intended for use in telephone interview. The instrument asks for times spent in walking, moderate- and vigorous-intensity physical activity of at least 10min duration. The sample consisted of 1616 Saudis, between 15 and 78 years of age, living in Riyadh. Participants were drawn from a list of names in the telephone book using a simple random method. Telephone interviews were administered during the spring of 2003 by trained male interviewers. Results: The final sample size was 1064 Saudi males and females (response rate of 66%), with males comprising about 66% of the respondents. Over 43% of Saudis did not participate in any type of moderate-intensity physical activity lasting for at least 10min. More than 72% of the sample did not engage in any type of vigorous-intensity physical activity lasting for at least 10min. The proportion of Saudis who walked for 150min or more per week was 33.3%. Females were engaged more in moderate physical activity than males, whereas males participated more in vigorous activity compared with females. Activity levels did not show significant relationships with education level or job hours per week. Based on the three activity categories established by IPAQ, 40.6% of Saudis were inactive, 34.3% were minimally active and 25.1% were physically active. Physical inactivity increased with advancing age. Conclusion: The data suggest that the prevalence of physical inactivity among Saudis adults is relatively high. Efforts are needed to encourage Saudis to be more physically active, with the goal of increasing the proportion of Saudis engaging in healthenhancing physical activity.

Which food-related behaviours are associated with healthier intakes of fruits and vegetables among women?

Abstract: Objective: To examine associations between shopping, food preparation, meal and eating behaviours and fruit and vegetable intake among women. Design: Cross-sectional survey. Setting: Community-based sample from metropolitan Melbourne, Australia. Subjects: A sample of 1136 women aged 18-65 years, randomly selected from the electoral roll. Results: Food-related behaviours reflecting organisation and forward-planning, as well as enjoyment of and high perceived value of meal shopping, preparation and consumption were associated with healthier intakes of fruits and vegetables. For example, women who more frequently planned meals before they went shopping, wrote a shopping list, enjoyed food shopping, planned in the morning what they will eat for dinner that night, planned what they will eat for lunch, reported they enjoy cooking, liked trying new recipes and who reported they sometimes prepare dishes ahead of time were more likely to consume two or more servings of vegetables daily. Conversely, women who frequently found cooking a chore, spent less than 15 minutes preparing dinner, decided on the night what they will eat for dinner, ate in a fast-food restaurant, ate takeaway meals from a fast-food restaurant, ate dinner and snacks while watching television and who frequently ate on the run were less likely to eat two or more servings of vegetables daily. Conclusions: Practical strategies based on these behavioural characteristics could be trialled in interventions aimed at promoting fruit and vegetable consumption among women.

Acculturation, economics and food insecurity among refugees resettled in the USA: a case study of West African refugees.

Abstract: Objectives: To assess the occurrence and severity of food insecurity, and examine associations between food insecurity and measures of socio-economic status and indicators of acculturation Design: Structured interviews among a non-probability sample of West African refugees at baseline and 6 months’ follow-up Setting: Mid-sized city in north-eastern USA Subjects: One hundred and one caregivers with children under the age of 5 years and who have been living the USA for fewer than 4 years Results: Food insecurity was indicated in approximately half of households (53%) The occurrence of food insecurity was associated with measures of socio-economic status such as income, employment status and participation in the Food Stamp Program (P , 005) Measures of acculturation such as difficulty in the shopping environment and language difficulty were also associated with the occurrence and severity of food insecurity, as was time lived in the USA (P , 005) Among households who had been in the USA for 1 year or less, food insecurity was indicated in 73%, whereas among households who had been in the USA for at least 3 years food insecurity was indicted in 33% Conclusions: Refugees are a potentially vulnerable group and our results echo others in suggesting a need for more thorough monitoring of the health and well-being of recently resettled refugees These results also suggest that reliance on employment as the sole indicator of success in the resettlement process may be too narrow an indicator Future research should focus on a wider range of measures of health and well-being

Television food advertising to children: the extent and nature of exposure.

Abstract: Objective: To describe the pattern and prevalence of food and drink advertisements to children on commercial television in Sydney, Australia, and compare these with advertising regulations set out in the Children's Television Standards and results from a similar study in 2002. Design: Data were collected by recording television from 06.00 hours until 23.00 hours on all three commercial channels from Sunday 14 May 2006 to Saturday 20 May 2006 (357 h). The study analysed advertisements in two children's viewing periods, one as defined in the 2002 study and the other according to current standards. Food advertisements were coded using 18 food categories and were analysed by time period and popular children's programmes. Results: Food advertisements occurred in similar proportions during children's viewing hours and adult's viewing hours (25.5 vs. 26.9% of all advertisements, respectively), although there was a higher rate of high-fat/high-sugar food advertisements during children's viewing hours (49 vs. 39% of all food advertisements, P < 0.001). There were even more advertisements for high-fat/high-sugar foods during popular children's programmes, contributing to 65.9% of all food advertisements. Estimates of exposure indicate that children aged 5-12 years were exposed to 96 food advertisements, including 63 high-fat/high-sugar advertisements per week. Since 2002, there has been a reduction in overall food and high-fat/high-sugar food advertisements. Conclusion: Despite reductions in overall levels of food advertising, children continue to experience high levels of exposure to food advertisements, which remain skewed towards unhealthy foods. Further food advertising regulation should be required to curtail the current levels of advertising of high-fat/high-sugar foods to children, to make them commensurate with recommended levels of consumption.

Is breakfast consumption related to mental distress and academic performance in adolescents

Abstract: Objective: To examine the relationship between mental distress, academic performance and regular breakfast consumption across gender and immigration status. Design: Cross-sectional population-based study. Two four-page questionnaires were filled in during two school sessions. Setting: All junior high schools in Oslo, Norway using the classroom as the setting for the study. Subjects: All 10th grade students 15-16 years olds in 2000 and 2001. Of 8316 eligible students, 7343 (88.3%) participated in the study. Results: All immigrant groups, except the Western countries group, are skipping breakfast more often than Norwegian students, and girls more often than boys (27 versus 19%). After adjustment for possible confounding factors, the odds ratio (OR) for being mentally distressed when eating breakfast seldom/never compared with every day was 3.0 (2.0-4.5) for boys, 1.6 (1.2-2.1) for girls and 1.6 (1.5-2.6) for the immigrant group. The comparable OR for having low school grades was similar for boys and girls, 2.0 (1.3-3.0), and 1.6 (1.5-2.6) for the immigrant groups. Conclusions: Skipping breakfast is a common feature among 10th grade students. The implications of skipping breakfast on mental distress and academic performance are stronger for boys than girls and stronger for Norwegians compared with immigrants.

Pregravid body mass index is negatively associated with diet quality during pregnancy.

Abstract: Objective To investigate the association between pregravid weight status and diet quality. Design Institute of Medicine body mass index (BMI) cut-off points of 26.0-29.0 kg m- 2 for overweight and >29 kg m- 2 for obese were used to categorise women's weight status. Dietary information was obtained by self-report at 26-28 weeks' gestation using a modified Block food-frequency questionnaire. The Diet Quality Index for Pregnancy (DQI-P) included: servings of grains, vegetables and fruits, folate, iron and calcium intake, percentage calories from fat, and meal pattern score. Multinomial logistic regression models were used to estimate the association between weight status and tertiles of DQI-P controlling for potential individual confounders. Setting A clinical-based population recruited through four prenatal clinics in central North Carolina. Subjects A total of 2394 women from the Pregnancy, Infection and Nutrition study were included in this analysis. Results Evidence of a dose-response relationship was found between BMI and inadequate servings of grains and vegetables, and iron and folate intake. Pregravid obesity was associated with 76% increased odds of falling into the lowest diet quality tertile compared with underweight women after controlling for potential confounders. Conclusion A modest association was found between pregravid weight status and diet quality. If corroborated, these findings suggest that overweight pregnant women should be targeted for nutrition counselling interventions aimed to improve diet quality.

Breakfast habits affect overall nutrient profiles in adolescents

Abstract: Objective To describe breakfast consumption patterns, on a nutrient and food item level, in Belgian adolescents. Design A 7-day estimated food record was administered in a cross-sectional survey. Setting Secondary schools in Ghent, Belgium. Subjects A total of 341 adolescents (13–18 years old), multistage clustered sampling. Results The energy contribution of breakfast to daily energy intake was on average 15.7% in boys and 14.9% in girls. Significantly more overweight girls and significantly more girls following vocational training were categorised as eating a low-quality breakfast. In boys, the energy contribution of polysaccharides was significantly higher in consumers of good-quality breakfasts. The intake of all selected micronutrients was significantly higher in consumers of good-quality breakfasts. In girls, the total energy intake and the proportional intake of proteins and polysaccharides were significantly higher in consumers of good-quality breakfasts, while the proportional contribution of total fat, monounsaturated and polyunsaturated fatty acids was significantly lower in these girls. The intake of all micronutrients was significantly higher in girls consuming a good-quality breakfast. In all adolescents, consumers of a good-quality breakfast had significantly higher intakes of bread, fruit, vegetables, milk and milk products, and fruit juice, while intake of soft drinks was significantly lower than in consumers of low-quality breakfasts. Conclusions Consumers of a good-quality breakfast had a better overall dietary pattern – on a nutrient and food group level – than consumers of a low-quality breakfast. A daily breakfast, including whole-grain products, fruit and (semi-) skimmed milk products or an alternative source of calcium, is recommended.

Adaptation and evaluation of the National Cancer Institute's Diet History Questionnaire and nutrient database for Canadian populations.

Abstract: Background and objective: Despite assumed similarities in Canadian and US dietary habits, some differences in food availability and nutrient fortification exist. Food-frequency questionnaires designed for the USA may therefore not provide the most accurate estimates of dietary intake in Canadian populations. Hence, we undertook to evaluate and modify the National Cancer Institute's Diet History Questionnaire (DHQ) and nutrient database. Methods: Of the foods queried on the DHQ, those most likely to differ in nutrient composition were identified. Where possible these foods were matched to comparable foods in the Canadian Nutrient File. Nutrient values were examined and modified to reflect the Canadian content of minerals (calcium, iron, zinc) and vitamins (A, C, D, thiamin, riboflavin, niacin, B 6 , folate and B 12 ). DHQs completed by 13 181 Alberta Cohort Study participants aged 35-69 years were analysed to estimate nutrient intakes using the original US and modified versions of the DHQ databases. Misclassification of intake for meeting the Dietary Reference Intake (DRI) was determined following analysis with the US nutrient database. Results: Twenty-five per cent of 2411 foods deemed most likely to differ in nutrient profile were subsequently modified for folate, 11% for vitamin D, 10% for calcium and riboflavin, and between 7 and 10% for the remaining nutrients of interest. Misclassification with respect to meeting the DRI varied but was highest for folate (7%) and vitamin A (7%) among men, and for vitamin D (7%) among women over 50 years of age. Conclusion: Errors in nutrient intake estimates owing to differences in food fortification between the USA and Canada can be reduced in Canadian populations by using nutrient databases that reflect Canadian fortification practices.

Fruit and vegetable availability: a micro environmental mediating variable?

Abstract: Objectives To examine the association between fruit and vegetable (FV (2) the visual cues of available food may stimulate consumption; and (3) available food exposure may increase preference, which leads to increased consumption. Each of these possibilities requires close examination, as do policy-level interventions. Conclusion F&V availability is associated with increased consumption. Research that elucidates the mechanisms between availability and intake, and tests policy-level interventions, is needed to advance increased availability as a public health procedure.

Dietary patterns and survival of older Europeans: The EPIC-Elderly Study (European Prospective Investigation into Cancer and Nutrition)

Abstract: Objective: To investigate the association of a posteriori dietary patterns with overall survival of older Europeans. Design and setting: This is a multi-centre cohort study. Cox regression analysis was used to investigate the association of the prevailing, a posteriori-derived, plant-based dietary pattern with all-cause mortality in a population of subjects who were 60 years or older at recruitment to the European Prospective Investigation into Cancer and Nutrition (EPIC-Elderly cohort). Analyses controlled for all known potential risk factors. Subjects: in total, 74 607 men and women, 60 years or older at enrolment and without previous coronary heart disease, stroke or cancer, with complete information about dietary intakes and potentially confounding variables, and with known survival status as of December 2003, were included in the analysis. Results: An increase in the score which measures the adherence to the plant-based diet was associated with a lower overall mortality, a one standard deviation increment corresponding to a statistically significant reduction of 14% (95% confidence interval 5-23%). In country-specific analyses the apparent association was stronger in Greece, Spain, Denmark and The Netherlands, and absent in the UK and Germany. Conclusions: Greater adherence to the plant-based diet that was defined a posteriori in this population of European elders is associated with lower all-cause mortality. This dietary score is moderately positively correlated with the Modified Mediterranean Diet Score that has been constructed a priori and was also shown to be beneficial for the Survival of the same EPIC-Elderly cohort.

Comparison of diet measures from a food-frequency questionnaire with measures from repeated 24-hour dietary recalls. The Norwegian Women and Cancer Study.

Abstract: Objective: To compare diet measures from a food-frequency questionnaire (FFQ) with measures from 24-hour dietary recalls (24HDRs). Design: The participants answered an FFQ after completing four, repeated 24HDRs during a year. Setting: Norway, nationwide. Subjects: Of 500 women randomly selected from The Norwegian Women and Cancer Study (the Norwegian arm of the European Prospective Investigation into Cancer and Nutrition), 286 agreed to participate and 238 completed the study. Results: On the group level, the FFQ overestimated absolute intake in seven and underestimated intake in six of 21 food groups. Intakes of energy, fat, added sugar and alcohol were lower in the FFQ than in the 24HDRs, whereas intake of fibre was higher. Spearman’s rank correlation coefficient ranged from 0.13 (desserts) to 0.82 (coffee) for foods, and from 0.25 (b-carotene) to 0.67 (alcohol) for nutrients. Three per cent of the observations on nutrient intake fell in the opposite quintile when classified according to the FFQ as compared with the 24HDR. The median calibration coefficient, calculated by regression of the 24HDR data on the FFQ data, was 0.57 for foods and 0.38 for nutrients. Conclusions: The FFQ’s ability to rank subjects was good for foods eaten frequently and fairly good for macronutrients in terms of energy percentages. Weaker ranking abilities were seen for foods eaten infrequently and for some micronutrients. The results underline the necessity of performing measurement error corrections.

Developing nutrient profile models : a systematic approach

Abstract: British Heart Foundation Health Promotion Research Group, Department of Public Health,Old Road Campus, Headington, Oxford OX3 7LF, UKSubmitted 21 November 2005: Accepted 8 March 2006AbstractObjective: Nutrient profiling can be defined as the ‘the science of categorising foodsaccording to their nutritional composition’. The purpose of the present paper is todescribe a systematic and logical approach to nutrient profiling.Design: A seven-stage decision-making process is proposed and, as an illustration ofhow the approach might operate in practice, the development of a nutrient profilingmodel for the purpose of highlighting breakfast cereals that are ‘high in fat, sugar orsalt’ is described.Results: The nutrient profile model developed for this paper calculates scores forfoods using a simple equation. It enables breakfast cereals to be compared with eachother and with other foods eaten at breakfast.Conclusion: Nutrient profiling is not new, but hitherto most nutrient profiling modelshave been developed in an unsystematic and illogical fashion. Different nutrientprofiling models are needed for different purposes but a key requirement should bethat they are developed using a systematic, transparent and logical process. Thispaper provides an example of such a process; approaches to validating nutrientprofiling models are described elsewhere.KeywordsNutritionNutrition assessmentFoodLabellingFood promotionConsumer understandingUnhealthy diets lead to an increased risk of coronaryheart disease, stroke, some forms of cancer and a rangeof other diseases

The impact of maternal employment on breast-feeding duration in the UK Millennium Cohort Study.

Abstract: Objective: To examine the relationship of maternal employment characteristics, day care arrangements and the type of maternity leave pay to breast-feeding for at least 4 months. Design: Cohort study. Setting: Babies aged 9 months in the Millennium Cohort Study, born between September 2000 and January 2002. Subjects: A total of 6917 British/Irish white employed mothers with singleton babies. Results: Mothers employed part-time or self-employed were more likely to breast-feed for at least 4 months than those employed full-time (adjusted rate ratio (aRR) and 95% confidence interval (CI) 1.30 (1.17-1.44) and 1.74 (1.46-2.07), respectively). The longer a mother delayed her return to work postpartum, the more likely she was to breast-feed for at least 4 months (P for trend < 0.001). Mothers were less likely to breast-feed for at least 4 months if they returned to work for financial reasons (aRR 0.86, 95% CI 0.80-0.93) or used informal day care arrangements rather than care by themselves or their partner (aRR 0.81, 95% CI 0.71-0.91). Mothers were more likely to breastfeed for at least 4 months if their employer offered family-friendly (aRR 1.14, 95% CI 1.02-1.27) or flexible work arrangements (aRR 1.24, 95% CI 1.00-1.55), or they received Statutory Maternity Pay (SMP) plus additional pay during their maternity leave rather than SMP alone (aRR 1.13, 95% CI 1.02-1.26). These findings were independent of confounding factors, such as socio-economic status and maternal education. Conclusions: Current policies may encourage mothers to enter or return to employment postpartum, but this may result in widening inequalities in breast-feeding and persistence of low rates. Policies should aim to increase financial support and incentives for employers to offer supportive work arrangements.

Effect of economic inequality on chronic childhood undernutrition in Ghana.

Abstract: Objective: Food insecurity and undernutrition remain particularly severe in developing countries where improvements in economic conditions have tended to benefit the advantaged groups and resulted in widespread inequalities in health. This study examined how economic inequality is associated with chronic childhood undernutrition. Design: A child was defined as chronically undernourished (stunted) if his or her height-for-age index was more than two standard deviations below the reference median. Household economic status was measured by an index based on household ownership of durable assets. Bivariate and multivariate analyses were used to estimate the effects of household economic status on stunting. Setting: A nationally representative sample of 6251 household interviews in Ghana. Subjects: A total of 3077 children aged 0‐59 months included in the 2003 Ghana Demographic and Health Survey. Results: Children in the poorest 20% of households are more than twice as likely to suffer from stunting as children in the richest 20% of households independent of the child’s age, sex, birth order, breast-feeding duration, birth weight; mother’s age at childbirth, body mass index, education; and household access to safe drinking water, hygienic toilet facilities, residence and geographic region (odds ratio ¼ 2.3; 95% confidence interval 1.4‐3.7). Also children in the next poorest and in the middle quintiles are significant more likely to be chronically undernourished than children in the richest 20% of households. Conclusion: This study concludes that economic inequality is strongly associated with chronic childhood undernutrition; and reducing economic inequalities and making services more accessible to the poor will be key to improving the health and nutritional status of children in Ghana.

Testing nutrient profile models using data from a survey of nutrition professionals.

Abstract: OBJECTIVE To compare nutrient profile models with a standard ranking of 120 foods. DESIGN Over 700 nutrition professionals were asked to categorise 120 foods into one of six positions on the basis of their healthiness. These categorisations were used to produce a standard ranking of the 120 foods. The standard ranking was compared with the results of applying eight different nutrient profile models to the 120 foods: Models SSCg3d and WXYfm developed for the UK Food Standards Agency, the Nutritious Food Index, the Ratio of Recommended to Restricted nutrients, the Naturally Nutrient Rich score, the Australian Heart Foundation's Tick scheme, the American Heart Association's heart-check mark and the Netherlands tripartite classification model for foods. Rank correlation was assessed for continuous models, and dependence was assessed for categorical models. RESULTS The continuous models each showed good correlation with the standard ranking (Spearman's rho = 0.6-0.8). The categorical models achieved high chi(2) results, indicating a high level of dependence between the nutrition professionals' and the models' categorisations (P < 0.001). Models SSCg3d and WXYfm achieved higher scores than the other models, implying a greater agreement with the standard ranking of foods. CONCLUSIONS The results suggest that Models SSCg3d and WXYfm rank and categorise foods in accordance with the views of nutrition professionals.