In adult bone, vitamin K contributes to bone health, probably through its role as co-factor in the carboxylation of osteocalcin. In children, the significance of vitamin K in bone-mass acquisition is less well known. The objective of this longitudinal study was to determine whether biochemical indicators of vitamin K status are related to (gains in) bone mineral content (BMC) and markers of bone metabolism in peripubertal children. In 307 healthy children (mean age 11·2 years), BMC of the total body, lumbar spine and femoral neck was determined at baseline and 2 years later. Vitamin K status (ratio of undercarboxylated (ucOC) to carboxylated (cOC) fractions of osteocalcin; UCR) was also measured at both time points. Markers of bone metabolism, sex steroids, vitamin D status and growth hormones were measured at baseline only. Large variations in the levels of the UCR were found at both time-points, indicating a substantial interindividual difference in vitamin K status. Improvement of vitamin K status over 2 years (n 281 children) was associated with a marked increase in total body BMC (r − 49·1, P < 0·001). The UCR was associated with pubertal stage, markers of bone metabolism, sex hormones and vitamin D status. A better vitamin K status was associated with more pronounced increase in bone mass in healthy peripubertal children. In order to determine the significance of these findings for childhood bone health, additional paediatric studies are needed.

Severe anaemia is associated with increased low birth weight and Barker's hypothesis of ‘fetal origins’ proposes that a nutritional insult during critical periods of development results in adaptations that predispose individuals to adult onset diseases. We hypothesize that endocrine alterations may occur in the maternal–fetal milieu as a consequence of nutritional anaemia during pregnancy. We examined the quantitative variations in hormonal profiles in paired maternal and cord blood samples obtained from mothers and their neonates who were classified based on maternal anaemia status. Our results show that: (1) 74·6 % of the mothers enrolled in the study were anaemic, of which 85·2 % had moderate anaemia and 14·7 % had severe anaemia; (2) anthropometric parameters measured in the mothers indicate that severely anaemic mothers had a significantly low pre- and post-pregnancy weight, a significantly decreased maternal fundal height and abdominal circumference; (3) anthropometric measures in the neonates born to severely anaemic mothers show a significant reduction in ponderal index, birth weight and placental weight; (4) significant increase in both maternal, fetal insulin-like growth factor 1, ferritin levels and increased maternal erythropoietin levels were observed with an increase in severity of anaemia; (5) decreased T3 and increased prolactin levels were observed in the maternal blood of severely anaemic mothers as compared with the control group. An insight into the endocrine modulation to overcome a growth disadvantage due to nutritional anaemia in pregnancy may lead to a better understanding of fetal adaptations invoked when the maternal-placental nutrient supply fails to meet the fetal nutrient demand.

Exposure to the sight and smell of food influences our momentary desire to consume it. This study explored the process by which cue exposure promotes greater consumption of food. Three hypotheses were explored, cue exposure: (i) increases the planned consumption of food; (ii) increases tolerance of larger portion sizes; (iii) arrests the development of satiety. Female participants (n 50) were each tested in two conditions. In a ‘cue condition’ they were exposed to the sight and smell of pizza for 60 s. Before and after this period they provided information about prospective and maximum tolerated portion sizes and their desire to eat pizza and other non-cued foods. Participants then consumed a fixed portion of pizza, rated their hunger and were finally offered ad libitum access to pizza. In the ‘no-cue condition’, cue exposure was replaced with a cognitive task. Cueing had little effect on tolerance of larger portion sizes or on hunger after consuming the fixed portion. Instead, it increased prospective pizza portion size and subsequent intake of pizza. Together, these results suggest that cueing increases the amount of food that people actively plan to eat. This plan is then executed, leading to greater intake. Pizza cueing also increased prospective portion size of other foods. Thus, contrary to previous reports, effects of exposure may generalise to other foods. Finally, we found evidence that restrained eaters are less ‘cue reactive’ than unrestrained eaters. In future, our approach might be adapted to consider whether heightened ‘cue reactivity’ represents a risk factor for obesity.

The effects of incremental exercise on appetite, energy intake (EI), expenditure (EE) and balance (EB) in lean men and women were examined. Six men (age 29·7 (sd 5·9) years, weight 75·2 (sd 15·3) kg, height 1·75 (sd 0·11) m) and six women (age 24·7 (sd 5·9) years, weight 66·7 (sd 9·10) kg, height 1·70 (sd 0·09) m) were each studied three times during a 16 d protocol, corresponding to no additional exercise (Nex), moderate-intensity exercise (Mex; 1·5–2·0 MJ/d) and high-intensity exercise (Hex; 3·0–4·0 MJ/d) regimens. Subjects were fed to EB during days 1–2, and during days 3–16 they fed ad libitum from a medium-fat diet of constant composition. Daily EE, assessed using the doubly labelled water method, was 9·2, 11·6 and 13·7 MJ/d (P < 0·001; sed 0·45) for the women and 12·2, 14·0 and 16·7 MJ/d (P = 0·007; sed 1·11) for the men on the Nex, Mex and Hex treatments, respectively. EI was 8·3, 8·6 and 9·9 MJ/d (P = 0·118; sed 0·72) for the women and 10·6, 11·6 and 12·0 MJ/d (P = 0·031; sed 0·47) for the men, respectively. On average, subjects compensated for about 30 % of the exercise-induced energy deficit. However, the degree of compensation varied considerably among individuals. The present study captured the initial compensation in EI for exercise-induced energy deficits. Total compensation would take a matter of weeks.

We tested the validity and reliability of the BioSpace InBody 320, Omron and Bod-eComm body composition devices in men and women (n 254; 21–80 years) and boys and girls (n 117; 10–17 years). We analysed percentage body fat (%BF) and compared the results with dual-energy X-ray absorptiometry (DEXA) in adults and compared the results of the InBody with underwater weighing (UW) in children. All body composition devices were correlated (r 0·54–0·97; P ≤ 0·010) to DEXA except the Bod-eComm in women aged 71–80 years (r 0·54; P = 0·106). In girls, the InBody %BF was correlated with UW (r 0·79; P ≤ 0·010); however, a more moderate correlation (r 0·69; P ≤ 0·010) existed in boys. Bland–Altman plots indicated that all body composition devices underestimated %BF in adults (1·0–4·8 %) and overestimated %BF in children (0·3–2·3 %). Lastly, independent t tests revealed that the mean %BF assessed by the Bod-eComm in women (aged 51–60 and 71–80 years) and in the Omron (age 18–35 years) were significantly different compared with DEXA (P ≤ 0·010). In men, the Omron (aged 18–35 years), and the InBody (aged 36–50 years) were significantly different compared with DEXA (P = 0·025; P = 0·040 respectively). In addition, independent t tests indicated that the InBody mean %BF in girls aged 10–17 years was significantly different from UW (P = 0·001). Pearson's correlation analyses demonstrated that the Bod-eComm (men and women) and Omron (women) had significant mean differences compared with the reference criterion; therefore, the %BF output from these two devices should be interpreted with caution. The repeatability of each body composition device was supported by small CV ( < 3·0 %).

The aim of the present study was to investigate the interaction between the angiotensin-converting enzyme 1 (ACE) I/D polymorphism and energy and macronutrient intakes on adiposity-related phenotypes among toddlers and preschoolers. A representative sample of 2374 Greek children aged 1 to 5 years old was examined (Growth, Exercise and Nutrition Epidemiological Study in preSchoolers (GENESIS)). Dietary and anthropometric (i.e. BMI, waist circumference (WC)) assessments were carried out using standard procedures. DNA samples were obtained from 2102 children and were genotyped for the ACE I/D polymorphism. Among the entire population, 17 % were ‘at risk of overweight’ and a similar percentage were ‘overweight’. The frequencies of the II, ID and DD genotypes were 16, 46 and 38 %, respectively. Significant interactions were found between the ACE I/D polymorphism and total energy intake on WC (P = 0·004 for interaction) and the ACE I/D polymorphism and protein intake on BMI and being overweight (P < 0·05 for interaction). Furthermore, it was found that the ACE I/D polymorphism may modify the effect of fat intake on WC and BMI, but this interaction disappeared after adjustment for additional potential confounders. Stratified analyses revealed that total energy is correlated with WC and protein intake is associated with BMI and being overweight only among carriers of the D-allele (i.e. DD or ID genotypes). These results suggest that the ACE I/D polymorphism may act as a modifying factor in the response of adiposity-related phenotypes to diet.

Severe vitamin D deficiency is common among Muslim immigrants. The dose necessary to correct the deficiency and its consequence for bone health are not known for immigrants. The aim was to assess the effect of relatively low dosages of supplemental vitamin D on vitamin D and bone status in Pakistani immigrants. This 1-year-long randomised double-blinded placebo-controlled intervention with vitamin D3 (10 and 20 μg/d) included girls (10·1–14·7 years), women (18·1–52·7 years) and men (17·9–63·5 years) of Pakistani origin living in Denmark. The main endpoints were serum 25-hydroxyvitamin D (S-25OHD), parathyroid hormone, bone turnover markers and bone mass. The study showed that supplementation with 10 and 20 μg vitamin D3 per d increased S-25OHD concentrations similarly in vitamin D-deficient Pakistani women (4-fold), and that 10 μg increased S-25OHD concentrations 2-fold and 20 μg 3-fold in Pakistani men. S-25OHD concentrations increased at 6 months and were stable thereafter. Baseline S-25OHD concentrations tended to be lower in girls and women than in men; females achieved about 46 nmol/l and men 55 nmol/l after supplementation. Serum intact parathyroid hormone concentrations decreased at 6 months, but there was no significant effect of the intervention on bone turnover markers and dual-energy X-ray absorptiometry measurements of the whole body and lumbar spine.

Vitamin D insufficiency is common particularly during wintertime. After the recommendation by the Ministry of Social Affairs and Health, Finnish fluid milks and margarines have been fortified with vitamin D since February 2003. The aims of the present study were to examine the impact of vitamin D fortification of food supplies on serum 25-hydroxyvitamin D (S-25(OH)D) concentrations and on daily dietary vitamin D intake among adolescent females. One hundred and forty-two girls of Caucasian ethnicity aged 12–18 years completed semi-quantitative FFQ from which the dietary vitamin D and Ca intakes were calculated. S-25(OH)D was measured by radioimmunoassay. The study was performed from February–March 2000 to February–March 2004, one year after the initiation of fortification. The mean dietary intake of vitamin D was < 7·5 μg in 91·5 % of the adolescent girls in 2000 and 83·8 % in 2004. The midwinter mean S-25(OH)D concentration did not change significantly during the follow-up period (48·3 v. 48·1 nmol/l, NS). The proportion of participants who had S-25(OH)D concentration < 50 nmol/l was 60·6 % in 2000 and 65·5 % in 2004. Only 7·0 % of the participants had an adequate S-25(OH)D ( ≥ 75 nmol/l) level in 2000 or 4 years later. The vitamin D fortification of fluid milks and margarines was inadequate to prevent vitamin D insufficiency. There are numerous adolescent girls and women who are not reached by the current fortification policy. Therefore new innovative and feasible ways of improving vitamin D nutrition are urged.

Mild metabolic acidosis, which can be caused by diet, may adversely affect cardiometabolic risk factors, possibly by increasing cortisol production. Methodologies for estimating diet-induced acid–base load using dietary-intake information have been established. To our knowledge, however, the possible association between dietary acid–base load and cardiometabolic risk factors has not been investigated. We cross-sectionally examined associations between dietary acid–base load and cardiometabolic risk factors in a free-living population. The subjects were 1136 female Japanese dietetic students aged 18–22 years. Dietary acid–base load was characterized as the potential renal acid load (PRAL), which was determined using an algorithm including dietary protein, P, K, Ca and Mg, as well as the ratio of dietary protein to K (Pro:K). Estimates of each nutrient were obtained from a validated comprehensive self-administered diet history questionnaire. Body height and weight, waist circumference and blood pressure were measured. Fasting blood samples were collected. After adjustment for potential confounding factors, higher PRAL and Pro:K (more acidic dietary acid–base loads) were associated with higher systolic and diastolic blood pressure (P for trend = 0·028 and 0·035 for PRAL and 0·012 and 0·009 for Pro:K, respectively). PRAL was also independently positively associated with total and LDL-cholesterol (n 1121; P for trend = 0·042 and 0·021, respectively). Additionally, Pro:K showed an independent positive association with BMI and waist circumference (P for trend = 0·024 and 0·012, respectively). In conclusion, more acidic dietary acid–base load was independently associated with adverse profile of several cardiometabolic risk factors in free-living young Japanese women.

Our aim was to investigate how socio-demographic factors influence trends and age-related trajectories of fish consumption. We examined consumption of total, fried and recommended fish (white and oily fish, and shellfish) in the Whitehall II study over 11 years in participants aged 39–59 years at phase 3. The cohort included 8358 British civil servants who completed a FFQ at phase 3 (1991–3), phase 5 (1997–9, n 5430) and phase 7 (2002–4, n 5692). Occupational grade, ethnicity, marital and retirement status were collected at each phase. To analyse changes in age-related trends of fish intake over time according to socio-demographic characteristics, we applied a random mixed-effect model. Over the follow-up a significant increase in consumption of ‘recommended’ (mean: 1·85 to 2·22 portions/week) and total fish (mean: 2·32 to 2·65 portions/week) and a decreasing trend in fried-fish intake (mean: 0·47 to 0·43 portions/week) was observed. Recommended, fried and total fish consumption differed by occupational status, ethnicity, marital status and sex. The trend of age-related fish intake diverged significantly by ethnicity. In South Asian participants (n 432), slope of recommended-fish consumption was significantly higher compared with white participants (0·077 v. 0·025 portions/week per year). For black participants (n 275) slope of fried-fish intake was significantly higher compared with white participants (0·0052 v. − 0·0025 portions/week per year). In terms of public health, our descriptive and analytical work allows detailed understanding of the impact of socio-demographic factors on fish intake and its age-related trends. Such information is valuable for food policies that seek to promote health equity.

Based on the hypothesis that isoflavones are absorbed more efficiently from fermented than from non-fermented soya foods, we compared the urinary isoflavonoid excretion (UIE) after intake of miso soup or soya milk. We recruited twenty-one women with Japanese ancestry who consumed standardized soya portions containing 48 mg isoflavones. On day 1, half the women consumed soya milk, the other half started with miso soup. On day 3, the subjects ate the other soya food and on day 5, they repeated the first food. Each participant collected a spot urine sample before and an overnight urine sample after soya food intake. All urine samples were analysed for daidzein, genistein and equol using LC–MS and were expressed as nmol/mg creatinine. We applied mixed models to evaluate the difference in UIE by food while including the baseline values and covariates. Relative to baseline, both groups experienced significantly higher UIE after consuming any of the soya foods. We observed no significant difference in UIE when soya milk was compared to miso soup (P = 0·87) among all women or in the seven equol producers (P = 0·88). Repeated intake of the same food on different days showed high reproducibility within subjects. These preliminary results indicate similar UIE after consuming a fermented soya food (miso) as compared to a non-fermented soya food (soya milk). Therefore, recommendations favouring fermented soya foods are not justified as long as the intestinal microflora is capable of hydrolysing the isoflavone glucosides from non-fermented soya foods.

Interventions aimed at improving glucose regulatory mechanisms have been suggested as a possible source of cognitive enhancement in the elderly. In particular, previous research has identified episodic memory as a target for facilitation after either moderate increases in glycaemia (after a glucose drink) or after improvements in glucose regulation. The present study aimed to extend this research by examining the joint effects of glucose ingestion and glucose regulation on cognition. In addition, risk factors associated with the development of poor glucose regulation in middle-aged adults were considered. In a repeated measures design, thirty-three middle-aged adults (aged 35–55 years) performed a battery of memory and non-memory tasks after either 25 g or 50 g glucose or a sweetness matched placebo drink. To assess the impact of individual differences in glucose regulation, blood glucose measurements were taken on four occasions during testing. A lifestyle and diet questionnaire was also administered. Consistent with previous research, episodic memory ability benefited from glucose ingestion when task demands were high. Blood glucose concentration was also found to predict performance across a number of cognitive domains. Interestingly, the risk factors associated with poor glucose regulation were linked to dietary impacts traditionally associated with poor health, e.g. the consumption of high-sugar sweets and drinks. The research replicates earlier work suggesting that task demands are critical to the glucose facilitation effect. Importantly, the data demonstrate clear associations between elevated glycaemia and relatively poor cognitive performance, which may be partly due to the effect of dietary and lifestyle factors.

The aim of the present study was to compare individual associations of BMI, triceps skinfold (TSF), waist circumference (WC) and percentage fat mass (%FM) with blood pressure (BP) and blood lipids in children and adolescents. Cross-sectional data on BMI, TSF, WC, %FM as well as on BP, TAG and HDL were analysed in 4220 (BP) and 729 (lipids) 9–11-year-old children and 3174 (BP) and 536 (lipids) 13–16-year-old adolescents as part of the Kiel Obesity Prevention Study. All obesity indices were similarly associated with BP and blood lipids. In girls, WC had closer correlations to BP than BMI (systolic BP: 0·27 and 0·24 for BMI, 0·34 and 0·28 for WC in 9–11- and 13–16-year-olds). Subjects with an obesity index ≥ 90th percentile had higher prevalences of elevated BP and blood lipids than subjects with a normal index. In children with normal BMI or WC, an additionally elevated second obesity index was associated with a 2·5–7·4-fold higher prevalence of high BP when compared with children with normal indices. In adolescents, an elevated WC plus an elevated second obesity index was associated with a 2·6–8·2-fold higher prevalence of high BP when compared with adolescents with an elevated WC plus a normal second index. We conclude that (i) both BMI and WC are appropriate to estimate CVD risk, (ii) the use of a second obesity index is recommended in children with normal BMI or normal WC as well as in adolescents with elevated WC and (iii) all obesity indices seemed to be appropriate for risk assessment.

Increased postmenopausal bone turnover leads to bone loss and fragility fracture risk. In the absence of osteoporosis, risk preventive measures, particularly those modifying nutritional lifestyle, are appropriate. We tested the hypothesis that milk supplementation affects bone turnover related to biochemical markers in a direction that, in the long term, may be expected to reduce postmenopausal bone loss. Thirty healthy postmenopausal women aged 59·3 (sd 3·3) years were enrolled in a prospective crossover trial of 16 weeks. After a 4-week period of adaptation with diet providing 600 mg calcium plus 300 mg ingested as 250 ml semi-skimmed milk, participants were maintained during 6 weeks under the same 600 mg calcium diet and randomized to receive either 500 ml semi-skimmed milk, thus providing a total of 1200 mg calcium, or no milk supplement. In the next 6 weeks they were switched to the alternative regimen. At the end of the each period, i.e. after 4, 10 and 16 weeks, blood and urinary samples were collected. The changes in blood variables between the periods of 6 weeks without and with milk supplementation were: for parathyroid hormone, − 3·2 pg/ml (P = 0·0054); for crosslinked telopeptide of type I collagen, − 624 pg/ml (P < 0·0001); for propeptide of type I procollagen, − 5·5 ng/ml (P = 0·0092); for osteocalcin, − 2·8 ng/ml (P = 0·0014). In conclusion, a 6-week period of milk supplementation induced a decrease in several biochemical variables compatible with diminished bone turnover mediated by reduction in parathyroid hormone secretion. This nutritional approach to postmenopausal alteration in bone metabolism may be a valuable measure in the primary prevention of osteoporosis.

We read the paper by Danzeisen et al.(1) with interest and would like to take issue with the authors on a number of topics.

It has been documented that green tea (GT) and its catechin components improve renal failure and inhibit the growth of mesangial cells. In the present study we examined the long-term effect of GT extract on streptozotocin (STZ)-induced diabetic nephropathy and on the glycogen accumulation in the kidney tubules. Male Sprague–Dawley rats were randomly assigned to normal control groups (2, 6, 8 and 12 weeks) and five diabetic groups (n 10) of comparable age. A GT diabetic group received 16 % concentration of GT for 12 weeks post-diabetes induction as their sole source of drinking water. GT treatment significantly (P < 0·01) reduced the serum glucose, glycosylated protein, serum creatinine and blood urea N levels by 29·6 (sem 3·7), 22·7 (sem 5·2), 38·9 (sem 10) and 41·7 (sem 1·9) %, respectively, compared with the diabetic group of comparable age. In addition, the GT-treated group showed a significant 44 (sem 10·8) % higher creatinine clearance (Ccr) compared with the untreated diabetic group. Likewise, GT reduced the urea N, creatinine, glucose and protein excretion rates by 30 (sem 7·6), 35·4 (sem 5·3), 34·0 (sem 5·3) and 46·0 (sem 13·0) % compared with the 12 weeks diabetic group. Administration of GT to 12 weeks diabetic rats significantly (P < 0·001) prevented (99·98 (sem 0·27) % less) the accumulation of glycogen in the kidney tubules. These results indicate that in STZ diabetes, kidney function appears to be improved with GT consumption which also prevents glycogen accumulation in the renal tubules, probably by lowering blood levels of glucose. Therefore, GT could be beneficial additional therapy in the management of diabetic nephropathy.

It has been observed that the levels of brain monoamine oxidase B (MAO-B) increase during ageing. MAO catalyses the oxidative deamination of neurotransmitters, in which the by-product H2O2 is subsequently generated. Se exists naturally in inorganic and organic forms and is considered to play a key role in antioxidation functioning. The objective of the present study was to investigate two chemical forms of Se compounds for their inhibition effect on rat brain MAO-B. The total antioxidant capacity and lipid peroxidation of rats were also examined. The rats (age 7 weeks) were divided into four groups: the control group, tocopherol group (T group, positive control), selenite group (SE group, representing the inorganic Se group) and seleno-yeast group (SY group, representing the organic Se group). The rats were fed for 11 weeks with normal diets and 12 weeks with test diets. The serum total antioxidant capacity of the SE and SY groups was significantly higher than that in the control and T groups. In rat brains and livers, the lipid peroxidation levels were significantly decreased in the T, SE and SY groups. MAO-B activity showed a significant decrease in the T, SE and SY groups in rat brains but no significant change could be noted in the rat livers. In conclusion, the present study indicates that inorganic or organic Se supplementation can decrease the brain MAO-B enzyme activity in adult rats and can be accomplished by the effect of the Se antioxidation capability.

The association between black tea consumption and iron status was investigated in a sample of African adults participating in the cross-sectional THUSA (Transition and Health during Urbanization of South Africans) study in the North West Province, South Africa. Data were analysed from 1605 apparently healthy adults aged 15–65 years by demographic and FFQ, anthropometric measurements and biochemical analyses. The main outcome measures were Hb and serum ferritin concentrations. No associations were seen between black tea consumption and concentrations of serum ferritin (men P = 0·059; women P = 0·49) or Hb (men P = 0·33; women P = 0·49). Logistic regression showed that tea consumption did not significantly increase risk for iron deficiency (men: OR 1·36; 95 % CI 0·99, 1·87; women: OR 0·98; 95 % CI 0·84, 1·13) nor for iron deficiency anaemia (men: OR 1·28; 95 % CI 0·84, 1·96; women: OR 0·93; 95 % CI 0·78, 1·11). Prevalence of iron deficiency and iron deficiency anaemia was especially high in women: 21·6 and 14·6 %, respectively. However, the likelihood of iron deficiency and iron deficiency anaemia was not significantly explained by tea consumption in sub-populations which were assumed to be at risk for iron deficiency. Regression of serum ferritin levels on tea consumption in women ≤ 40 years, adults with a daily iron intake ≤ 5·80 mg and adults with ferritin levels ≤ 26·60 μg/l, respectively, showed P values in the range of 0·28–0·88. Our findings demonstrate that iron deficiency and iron deficiency anaemia is not significantly explained by black tea consumption in a black adult population in South Africa. Tea intake was also not shown to be related to iron status in several sub-populations at risk for iron deficiency.

The objective of the present study was to determine differences in predicting total and regional adiposity using the waist:height ratio (WHtR) calculated using different ‘waist’ measurements. Body composition of ninety-five males and 121 female Australian adults (aged 20 years and above) was measured using dual-energy X-ray absorptiometry. The WHtR was calculated using: (1) the narrowest point between the lower costal border and the top of the iliac crest (WHtR-W), and (2) at the level of the umbilicus (WHtR-A). Relationships between calculated WHtR and measured body composition, such as percentage body fat (%BF) and percentage trunk fat (%TF) were determined. Values obtained from WHtR-A were significantly greater than WHtR-W in both groups (P < 0·05). While no correlation differences between WHtR-W and WHtR-A in relation to body composition variables were observed, females showed significantly lower correlation with lean mass compared with BMI. Regression analyses showed that neither WHtR had an age influence on %TF estimation. Estimated %BF and %TF were comparable for both WHtR and also with estimated values using a BMI of 25 kg/m2. Sensitivity of excess %BF and %TF increased by using WHtR-A, particularly in females. In conclusion, the umbilicus measurement may be better than using the narrowest site in the WHtR calculation, particularly in females. To improve the screening ability of the WHtR and make comparisons between studies easier there may be a need to standardise the measurement location. Further studies are recommended to confirm the findings across different ethnic groups.

The response by Brewer & Althaus to our recent review on biomarkers for Cu(1) bears testimony that the subject is topical and of public, scientific and commercial interest.