The association between hyporexia/anorexia, reduced food intake and disease-related malnutrition at hospital admission is well established. However, information on fluid intake according to nutritional risk has never been provided. Thus, we assessed the attitude and adequacy of fluid intake among case-mix hospitalised patients according to nutritional risk. A sample of 559 non-critically ill patients randomly taken from medical and surgical wards was evaluated. Nutritional risk was diagnosed by the Nutritional Risk Screening 2002. Usual fluid consumption the week before admission was assessed and categorised as < 5 and ≥ 5 cups/d (1 cup = 240 ml), with the acceptable intake being ≥ 5 cups/d. Prevalence of nutritional risk was 57·2 %, and 46·2 % of the patients reported a fluid intake < 5 cups/d. Multiple-adjusted logistic regression revealed that age ≥ 65 years (OR: 1·88 (95 % CI: 1·03, 3·43); P < 0·04), energy intake (for every 25 % increase in food intake compared with estimated requirements, OR: 0·37 (95 % CI: 0·25, 0·55); P < 0·001) and the number of drugs taken (every three-drug increase, OR: 0·63 (95 % CI: 0·44, 0·90); P < 0·02) were independently associated with inadequate fluid intake ( < 5 cups/d). A significant independent association was also found with nutritional risk (OR: 0·64 (95 % CI: 0·43, 0·95); P < 0·03). Nutritional risk appears to be positively associated with greater fluid intake in non-acute hospitalised patients, but both the reasons and the consequences of this relationship, as well as the impact on clinical practice, need to be explored. However, water replacement by oral nutritional support should take advantage of the patients' attitude to assuming a greater fluid intake, limiting at the same time fluid overload during the refeeding phase.

Prospective epidemiological studies have reported that a higher fruit and vegetable intake is associated with a lower risk of CHD. The aim of the present study was to examine associations between fruit and vegetable consumption, in particular the subgroupings citrus fruits, apples and cruciferous vegetables, and the risk of acute coronary syndrome (ACS). During a median follow-up of 7·7 years, 1075 incident ACS cases were identified among 53 383 men and women, aged 50–64 years at recruitment into the Diet, Cancer and Health cohort study in 1993–7. Fruit and vegetable intake was estimated from a validated FFQ, and ACS incidence rate ratios (IRR) were estimated using Cox proportional hazards models. Overall, a tendency towards a lower risk of ACS was observed for both men and women with higher fruit and vegetable consumption. For men, we found an inverse association for apple intake (IRR per 25 g/d: 0·97; 95 % CI 0·94, 0·99). This association was also seen among women, albeit borderline significant. However, a higher risk was seen among women with higher fruit juice intake (IRR per 25 g/d: 1·04; 95 % CI 1·00, 1·08). The present results provide some support for previously observed inverse associations between fresh fruit intake, particularly apples, and ACS risk.

Our genome adapts slowly to changing conditions of existence. Many diseases of civilisation result from mismatches between our Paleolithic genome and the rapidly changing environment, including our diet. The objective of the present study was to reconstruct multiple Paleolithic diets to estimate the ranges of nutrient intakes upon which humanity evolved. A database of, predominantly East African, plant and animal foods (meat/fish) was used to model multiple Paleolithic diets, using two pathophysiological constraints (i.e. protein < 35 energy % (en%) and linoleic acid (LA) >1·0 en%), at known hunter–gatherer plant/animal food intake ratios (range 70/30–30/70 en%/en%). We investigated selective and non-selective savannah, savannah/aquatic and aquatic hunter–gatherer/scavenger foraging strategies. We found (range of medians in en%) intakes of moderate-to-high protein (25–29), moderate-to-high fat (30–39) and moderate carbohydrates (39–40). The fatty acid composition was SFA (11·4–12·0), MUFA (5·6–18·5) and PUFA (8·6–15·2). The latter was high in α-linolenic acid (ALA) (3·7–4·7 en%), low in LA (2·3–3·6 en%), and high in long-chain PUFA (LCP; 4·75–25·8 g/d), LCP n-3 (2·26–17·0 g/d), LCP n-6 (2·54–8·84 g/d), ALA/LA ratio (1·12–1·64 g/g) and LCP n-3/LCP n-6 ratio (0·84–1·92 g/g). Consistent with the wide range of employed variables, nutrient intakes showed wide ranges. We conclude that compared with Western diets, Paleolithic diets contained consistently higher protein and LCP, and lower LA. These are likely to contribute to the known beneficial effects of Paleolithic-like diets, e.g. through increased satiety/satiation. Disparities between Paleolithic, contemporary and recommended intakes might be important factors underlying the aetiology of common Western diseases. Data on Paleolithic diets and lifestyle, rather than the investigation of single nutrients, might be useful for the rational design of clinical trials.

Low vitamin D levels during pregnancy may account for reduced fetal growth and for altered neonatal development. The present study explored the association between maternal vitamin D status measured early in pregnancy and birth weight, prevalence of small-for-gestational-age (SGA) infants and postnatal growth (weight and length), as well as the potential role of vitamin D status in explaining ethnic disparities in these outcomes. Data were derived from a large multi-ethnic cohort in The Netherlands (Amsterdam Born Children and their Development (ABCD) cohort), and included 3730 women with live-born singleton term deliveries. Maternal serum vitamin D was measured during early pregnancy (median 13 weeks, interquartile range: 12–14), and was labelled ‘deficient’ ( ≤ 29·9 nmol/l), ‘insufficient’ (30–49·9 nmol/l) or ‘adequate’ ( ≥ 50 nmol/l). Six ethnic groups were distinguished: Dutch, Surinamese, Turkish, Moroccan, other non-Western and other Western. Associations with neonatal outcomes were analysed using multivariate regression analyses. Results showed that compared with women with adequate vitamin D levels, women with deficient vitamin D levels had infants with lower birth weights ( − 114·4 g, 95 % CI − 151·2, − 77·6) and a higher risk of SGA (OR 2·4, 95 % CI 1·9, 3·2). Neonates born to mothers with a deficient vitamin D status showed accelerated growth in weight and length during the first year of life. Although a deficient vitamin D status influenced birth weight, SGA risk and neonatal growth, it played a limited role in explaining ethnic differences. Although vitamin D supplementation might be beneficial to those at risk of a deficient vitamin D status, more research is needed before a nationwide policy on the subject can be justified.

To investigate the part played by undernutrition in malaria severity, some biomarkers of nutritional status were assessed in children with severe malarial anaemia (MA) and cerebral malaria (CM) in comparison with healthy children or those with uncomplicated malaria. Undernutrition was assessed using the weight-for-age Z score (WAZ). Retinol was determined by HPLC; lipid profile, Ca, Mg and albumin were determined by spectrophotometry. Severe and moderate undernutritions were more prevalent in children with MA and those with the combined symptoms of CM and MA, but not in those with CM alone. Some perturbations were noticed in the lipid profile, but most of the values remained within the normal ranges. The risk of vitamin A deficiency, as assessed by plasma retinol concentration, was noteworthy in children with severe malaria: 0·48 × 10− 6 and 0·50 × 10− 6 mol/l, respectively, in children with MA and CM (reference value: >0·7 × 10− 6 mol/l). A significant difference was obtained for retinol values after an ANOVA of all the groups (P = 0·0029), with the value in the MA group being significantly low than that in the control group (P < 0·05); likewise, a significant difference was obtained after comparison of all the groups for Mg and albumin (P = 0·0064 and 0·0082, respectively). Despite their low number (n 6), fatal cases of CM had a normal mean WAZ on admission, but low values of retinol, albumin and HDL:LDL ratio. Despite these associations, undernutrition itself did not appear to be a primary factor associated with fatal outcome.

Lactoferrin (LF), a multifunctional glycoprotein in mammalian milk, is reported to exert a modulatory effect on lipid metabolism. The aim of the present study was to elucidate whether enteric-coated LF (eLF) might improve visceral fat-type obesity, an underlying cause of the metabolic syndrome. Using a double-blind, placebo-controlled design, Japanese men and women (n 26; aged 22–60 years) with abdominal obesity (BMI>25 kg/m2, and visceral fat area (VFA)>100 cm2) consumed eLF (300 mg/d as bovine LF) or placebo tablets for 8 weeks. Measurement of the total fat area, VFA and subcutaneous fat area from computed tomography images revealed a significant reduction in VFA ( − 14·6 cm2) in the eLF group, as compared with the placebo controls ( − 1·8 cm2; P = 0·009 by ANCOVA). Decreases in body weight, BMI and hip circumference in the eLF group ( − 1·5 kg, − 0·6 kg/m2, − 2·6 cm) were also found to be significantly greater than with the placebo (+1·0 kg, +0·3 kg/m2, − 0·2 cm; P = 0·032, 0·013, 0·041, respectively). There was also a tendency for a reduction in waist circumference in the eLF group ( − 4·4 cm) as compared with the placebo group ( − 0·9 cm; P = 0·073). No adverse effects of the eLF treatment were found with regard to blood lipid or biochemical parameters. From these results, eLF appears to be a promising agent for the control of visceral fat accumulation.

Although increased concentrations of plasma inflammatory markers are not one of the criteria to diagnose the metabolic syndrome, low-grade systemic inflammation is receiving large attention as a metabolic syndrome component and cardiovascular risk factor. As several epidemiological studies have suggested a negative relationship between low-fat dairy consumption and the metabolic syndrome, we decided to investigate the effects of low-fat dairy consumption on inflammatory markers and adhesion molecules in overweight and obese subjects in an intervention study. Thirty-five healthy subjects (BMI>27 kg/m2) consumed, in a random order, low-fat dairy products (500 ml low-fat milk and 150 g low-fat yogurt) or carbohydrate-rich control products (600 ml fruit juice and three fruit biscuits) daily for 8 weeks. Plasma concentrations of TNF-α were decreased by 0·16 (sd 0·50) pg/ml (P = 0·070), and soluble TNF-α receptor-1 (s-TNFR-1) was increased by 110·0 (sd 338·4) pg/ml (P = 0·062) after the low-fat dairy period than after the control period. s-TNFR-2 was increased by 227·0 (sd 449·0) pg/ml (P = 0·020) by the dairy intervention. As a result, the TNF-α index, defined as the TNF-α:s-TNFR-2 ratio, was decreased by 0·000053 (sd 0·00 012) (P = 0·015) after the dairy diet consumption. Low-fat dairy consumption had no effect on IL-6, monocyte chemoattractant protein-1, intracellular adhesion molecule-1 and vascular cell adhesion molecule-1 concentrations. The present results indicate that in overweight and obese subjects, low-fat dairy consumption for 8 weeks may increase concentrations of s-TNFR compared with carbohydrate-rich product consumption, but that it has no effects on other markers of chronic inflammation and endothelial function.

Increasing prevalence of childhood obesity calls for comprehensive and cost-effective educative measures in developing countries such as India. School-based educative programmes greatly influence children's behaviour towards healthy living. We aimed to evaluate the impact of a school-based health and nutritional education programme on knowledge and behaviour of urban Asian Indian school children. Benchmark assessment of parents and teachers was also done. We educated 40 196 children (aged 8–18 years), 25 000 parents and 1500 teachers about health, nutrition, physical activity, non-communicable diseases and healthy cooking practices in three cities of North India. A pre-tested questionnaire was used to assess randomly selected 3128 children, 2241 parents and 841 teachers before intervention and 2329 children after intervention. Low baseline knowledge and behaviour scores were reported in 75–94 % government and 48–78 % private school children, across all age groups. A small proportion of government school children gave correct answers about protein (14–17 %), carbohydrates (25–27 %) and saturated fats (18–32 %). Private school children, parents and teachers performed significantly better than government school subjects (P < 0·05). Following the intervention, scores improved in all children irrespective of the type of school (P < 0·001). A significantly higher improvement was observed in younger children (aged 8–11 years) as compared with those aged 12–18 years, in females compared with males and in government schools compared with private schools (P < 0·05 for all). Major gaps exist in health and nutrition-related knowledge and behaviour of urban Asian Indian children, parents and teachers. This successful and comprehensive educative intervention could be incorporated in future school-based health and nutritional education programmes.

The extent to which the quality of dietary carbohydrates (CHO) changes throughout puberty is not known. We analysed trends in the quantity and quality of CHO intake among German adolescents by separately examining trends during puberty (pubertal trends) and trends in CHO intake from 1988 to 2007 (secular trends). Linear mixed-effects regression analyses were performed in 216 participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study who had provided weighed 3 d dietary records at the onset of the pubertal growth spurt (defined by age at take-off) and over the subsequent 4 years. Over the course of puberty, CHO quality changed little: added sugar intake from beverages increased in girls (0·25 (se 0·12) % energy (% E)/year, P = 0·04) and added sugar intake from sweets decreased in both sexes (boys: − 0·22 (se 0·11) % E/year, P = 0·049; girls: − 0·20 (se 0·10) % E/year, P = 0·04). For both sexes, significant upward secular trends were observed for CHO (% E), glycaemic load (g/MJ) and added sugar intakes from sources other than sweets and soft drinks (% E), while absolute fibre intake (g/d) decreased (P ≤ 0·04). Concomitant increases in total added sugar intake (% E) and decreases in fibre and whole-grain densities (g/MJ) (P = 0·001–0·02) were confined to boys only. The quality of dietary CHO consumed by healthy German adolescents shows notable secular declines, but does not change markedly during puberty. Public health initiatives should be tailored to improve the overall quality of CHO nutrition.

In Norway, children and adolescents consume only about half of the national five-a-day recommendation. There are also rather large social inequalities in health, and in eating behaviours. In order to increase fruit and vegetable (FV) intake, a subscription programme was initiated in 1996 and made nationwide in 2003, and a free programme (without parental payment) has been implemented nationwide from 2007. The objective of the present study is to evaluate the effect of these efforts. Pupils in the sixth and seventh grades (age 10–12 years) at twenty-seven schools responded to a questionnaire in 2001 (n 1488, 85 %) and in 2008 (n 1339, 78 %). FV intake was measured by a 24-h recall. In 2001, none of the schools had any organised school fruit programme. In 2008, five schools participated in the free school fruit programme, ten schools participated in the subscription programme and twelve schools did not participate in any official programme. The increases in fruit intake at school were 0·49, 0·29 and 0·18 portions/school day, respectively, for the Free Fruit 08, Subscription 08 and No Programme 08 schools (time × group P < 0·001), and 0·74, 0·39 and 0·16 portions/d for fruit intake all day (time × group P = 0·04). No group effect was observed for vegetable intake. There has been an increase in pupils' fruit intake from 2001 to 2008 in Norway, and the school fruit programmes seem to have been effective. A great challenge remains in increasing vegetable intake.

Previous studies on the relationship of local food environment with residents' diets have relied exclusively on self-reported information on diet, producing inconsistent results. Evaluation of dietary intake using biomarkers may obviate the biases inherent to the use of self-reported dietary information. This cross-sectional study examined the association between neighbourhood food store availability and 24 h urinary Na and K excretion. The subjects were 904 female Japanese dietetic students aged 18–22 years. Neighbourhood food store availability was defined as the number of food stores within a 0·5-mile (0·8-km) radius of residence. Urinary Na and K excretion and the ratio of urinary Na to K were estimated from a single 24 h urine sample. After adjustment for potential confounding factors, neighbourhood availability of confectionery stores/bakeries was inversely associated with urinary K, and was positively associated with the ratio of Na to K (P for trend = 0·008 and 0·03, respectively). Neighbourhood availability of rice stores showed an independent inverse association with urinary K (P for trend = 0·03), whereas neighbourhood availability of supermarkets/grocery stores conversely showed an independent positive association with this variable (P for trend = 0·03). Furthermore, neighbourhood availability of fruit/vegetable stores showed an independent inverse association with the ratio of Na to K (P for trend = 0·049). In a group of young Japanese women, increasing neighbourhood availability of supermarkets/grocery stores and fruit/vegetable stores and decreasing availability of confectionery stores/bakeries and rice stores were associated with favourable profiles of 24 h urinary K (and Na) excretion.

The association of early postnatal growth with diseases in adults such as hypertension, type 2 diabetes and CHD has generated interest in studying postnatal growth. Bioelectrical impedance analysis (BIA) is a useful measure to estimate total body water (TBW) and fat-free mass (FFM). We evaluated three published equations (Fjeld et al. (Pediatr Res (1990) 27, 98–102), Bocage (MSc Thesis (1988) University of West Indies) and Kushner et al. (Am J Clin Nutr (1992) 56, 835–839) to measure TBW and derived FFM based on BIA, using 2H2O dilution as a reference method for suitability in infants in India. In a cross-sectional study in seventy-eight apparently healthy infants aged 6–24 months from the urban poor attending an immunisation clinic at a hospital in Kolkata, we measured their length to the nearest 0·1 cm, weight to the nearest 10 g, resistance at 50 kHz using BIA and TBW using 2H2O dilution. TBW was derived using three published BIA-based equations and compared with TBW using 2H2O dilution. Based on the BIA equations of Fjeld et al., Bocage and Kushner et al., the mean TBW values were 2·46 % (P < 0·001), 4·62 % (P < 0·001) and 9·50 % (P < 0·001) lower than the reference 2H2O method, respectively. All three published BIA-based equations consistently underestimated the TBW and FFM and appeared inadequate for studying infants in India. The equation described by Fjeld et al. gave the smallest deviation from the reference method and may be used for field studies. New equations based on population-specific data are desirable for a more precise measure of TBW.

K-rich fruit and vegetables may lower blood pressure (BP) and improve vascular function. A randomised controlled trial (ISRCTN50011192) with a cross-over design was conducted in free-living participants with early stages of hypertension (diastolic BP>80 and < 100 mmHg, not receiving BP-lowering medication) to test this hypothesis. Following a 3-week run-in period on a control diet, each subject completed four dietary 6-week dietary interventions (control+placebo capsules, an additional 20 or 40 mmol K+/d from fruit and vegetables or 40 mmol potassium citrate capsules/d) using a Latin square design with a washout period ≥ 5 weeks between the treatment periods. Out of fifty-seven subjects who were randomised, twenty-three male and twenty-five female participants completed the study; compliance to the intervention was corroborated by food intake records and increased urinary K+ excretion; plasma lipids, vitamin C, folate and homocysteine concentrations, urinary Na excretion, and body weight remained were unchanged. On the control diet, mean ambulatory 24 h systolic/diastolic BP were 132·3 (sd 12·0)/81·9 (sd 7·9) mmHg, and changes (Bonferroni's adjusted 95 % CI) compared with the control on the diets providing 20 and 40 mmol K+/d as fruit and vegetables were 0·8 ( − 3·5, 5·3)/0·8 ( − 1·9, 3·5) and 1·7 ( − 3·0, 5·3)/1·5 ( − 1·5, 4·4), respectively, and were 1·8 ( − 2·1, 5·8)/1·4 ( − 1·6, 4·4) mmHg on the 40 mmol potassium citrate supplement, and were not statistically significant. Arterial stiffness, endothelial function, and urinary and plasma isoprostane and C-reactive protein (CRP) concentrations did not differ significantly between the diets. The present study provides no evidence to support dietary advice to increase K intake above usual UK intakes in the subjects with early stages of hypertension.

Chronic mild dehydration has been associated with several diseases, including fatal IHD and stroke. It has been suggested that hydration through total fluid intake (or water) is inversely associated with IHD or stroke mortality. The objective of the present study was to evaluate the relationship between total fluid (and specific beverage) intake and IHD or stroke mortality in the Netherlands Cohort Study (NLCS). In 1986, 120 852 participants aged 55–69 years were enrolled into the NLCS. Mortality data were collected over a 10-year follow-up period. Analysis was done through a case–cohort approach, and it was based on the subjects without a history of heart disease, stroke or diabetes at baseline. A total of 1789 IHD mortality cases and 708 stroke mortality cases occurred during the follow-up. Higher total fluid consumption was not associated with either IHD mortality or stroke mortality in men or women. When analysing specific beverages, a positive association between coffee consumption (increment 270 ml/d) and IHD mortality was observed in men (hazard ratio (HR) 1·09, 95 % CI 1·00, 1·18), while an inverse relationship was observed in women (HR: 0·88, 95 % CI 0·78, 1·00). For tea consumption (increment of 253 ml/d), an inverse relationship with IHD mortality was observed in men (HR: 0·91, 95 % CI 0·83, 1·00). No association with water intake was observed. In the study population, fresh water consumption was very low. In conclusion, total fluid intake was not associated with IHD or stroke mortality in either men or women. Coffee consumption was inversely associated with IHD mortality in women only, while a higher tea intake was associated with lower IHD mortality in men only.

A low-grade inflammatory response (‘metaflammation’) has been found to be associated with certain chronic diseases. Proposed inducers of this have been aspects of the modern lifestyle, including newly introduced foods. Plasma TAG, and the inflammatory cytokines C-reactive protein (CRP), TNF-α and IL-6 were compared in a randomised, cross-over trial using ten healthy subjects before and after eating 100 g of kangaroo, or a ‘new’ form of hybridised beef (wagyu) separated by about 1 week. Postprandial levels for 1 and 2 h of TAG, IL-6 and TNF-α were significantly higher after eating wagyu compared with kangaroo (P = 0·002 for TAG at 1 h, P < 0·001 at 2 h; P < 0·001 for IL-6 and TNF-α at 1 and 2 h). CRP was significantly higher 1 h postprandially after wagyu (P = 0·011) and non-significantly higher 2 h postprandially (P = 0·090). We conclude that the metaflammatory reaction to ingestion of a ‘new’ form of hybridised beef (wagyu) is indicative of a low-grade, systemic, immune reaction when compared with lean game meat (kangaroo). Further studies using isoenergetic intake and isolating fatty acid components of meats are proposed.

Recognition of the important non-skeletal health effects of vitamin D has focused attention on the vitamin D status of individuals across the lifespan. To examine the vitamin D status of newborns, we measured serum levels of 25-hydroxyvitamin D (25(OH)D) in the cord blood of 929 apparently healthy newborns in a population-based study in New Zealand, a country at 41°S latitude, with strong anti-skin cancer (sun avoidance) campaigns and without vitamin D food fortification. Randomly selected midwives in two regions recruited children. The median cord blood level of 25(OH)D was 44 nmol/l (interquartile range, 29–78 nmol/l). Overall, 19 % of newborns had 25(OH)D levels < 25 nmol/l and 57 % had levels < 50 nmol/l; only 27 % had levels of 75 nmol/l or higher, which are levels associated with optimal health in older children and adults. A multivariable ordinal logistic regression model showed that the strongest determinants of low vitamin D status were winter month of birth and non-European ethnicity. Other determinants of low cord blood 25(OH)D included longer gestational age, younger maternal age and a parental history of asthma. In summary, low levels of vitamin D are common among apparently healthy New Zealand newborns, and are independently associated with several easily identified factors. Although the optimal timing and dosage of vitamin D supplementation require further study, our findings may assist future efforts to correct low levels of 25(OH)D among New Zealand mothers and their newborn children.

Different European institutions have developed mathematical models to propose maximum safe levels either for fortified foods or for dietary supplements. The objective of the present study was to compare and check the safety of these different maximum safe levels (MSL) by using a probabilistic risk assessment approach. The potential maximum nutritional intakes were estimated by taking into account all sources of intakes (base diet, fortified foods and dietary supplements) and compared with the tolerable upper intake levels for vitamins and minerals. This approach simulated the consequences of both food fortification and supplementation in terms of food safety. Different scenarios were tested. They are the result of the combination of several MSL obtained using the previous models. The study was based on the second French Individual and National Study on Food Consumption performed in 2006–7, matched with the French food nutritional composition database. The analyses were based on a sample of 1918 adults aged 18–79 years. Some MSL in fortified foods and dietary supplements obtained independently were protective enough, although some others could lead to nutritional intakes above the tolerable upper intake levels. The simulation showed that it is crucial to consider the inter-individual variability of fortified food intakes when setting MSL for foods and supplements. The risk assessment approach developed here by integrating the MSL for fortified foods and dietary supplements is useful for ensuring consumer protection. It may be subsequently used to test any other MSL for vitamins and minerals proposed in the future.

Barbados has been experiencing increasing rates of obesity and chronic non-communicable diseases characteristic of a country in nutrition transition. However, few studies have been carried out on how precisely the diet has changed in recent decades. Our aim was to analyse the FAO food balance sheets for Barbados from 1961 to 2003 in order to characterise the changes that have taken place in the macronutrient supply of the country during that period. Annual food balance sheets were downloaded from the FAOSTAT database, and per capita supply for twelve commodity groupings was analysed for energy and macronutrient levels using WISP dietary analysis software (Tinuviel Software, Llanfechell, Anglesey, UK). The food supply in 2003 provided over 2500 kJ (about 600 kcal) more energy per capita per d than it did in 1961. Energy from carbohydrate as a percentage of total energy has fallen from 70 % in 1961 to 57 % in 2003 and is now at the lower end of WHO recommendations. Energy from fat as a percentage of total energy increased from 19 % to 28 % and now lies at the upper end of WHO recommendations. Sugars, at over 17 % of dietary energy, are well above the upper limit set by the WHO. Despite having methodological limitations associated with the use of food balance statistics, our data suggest that these imbalances need to be addressed as a matter of priority in order to try to reverse the incidence of nutrition-related chronic diseases that are projected to cause increasing disability and premature death in the country in the coming years.

Bioimpedance spectroscopy (BIS) has been used to track changes in total body water (TBW). Accurate TBW estimations can be influenced by both methodological and biological factors. One methodological variation that contributes to BIS TBW errors is the electrode placement. The purpose of the present study was to compare the reproducibility and validity of fixed-distance electrode placements (5 cm) with the standard single-site electrode placements. Twenty-nine subjects (fifteen men and fourteen women) participated in the reproducibility study, while sixty-nine subjects (thirty-three men and thirty-six women) participated in the validity study. The reproducibility study included two measurements that were taken 24 h apart, while the validity study consisted of a 12-week exercise intervention with measurements taken at weeks 1 and 12. TBW was estimated using BIS and 2H techniques. Reproducibility results indicated that fixed-distance electrodes reduced the day-to-day standard error of the measurement in men (from 1·13 to 0·81 litres) but not in women (0·47 litres). sem values were lower for women than for men, suggesting that BIS TBW estimates are sex dependent. Validity results produced similar accurate findings (mean difference < 0·21 litres). However, fixed-distance electrodes improved delta TBW errors (mean difference improvements>0·04 litres in men, women, and men and women combined). When tracking changes in TBW, fixed-distance electrodes may reduce reproducibility errors and allow for smaller changes to be detected. However, the reduction of reproducibility errors may be greater for men than for women. Therefore, reproducibility calculations should be based on the sex of the sample population.

Serotonergic hypofunction is associated with a depressive mood state, an increased drive to eat and preference for sweet (SW) foods. High-trait anxiety individuals are characterised by a functional shortage of serotonin during stress, which in turn increases their susceptibility to experience a negative mood and an increased drive for SW foods. The present study examined whether an acute dietary manipulation, intended to increase circulating serotonin levels, alleviated the detrimental effects of a stress-inducing task on subjective appetite and mood sensations, and preference for SW foods in high-trait anxiety individuals. Thirteen high- (eleven females and two males; anxiety scores 45·5 (sd 5·9); BMI 22·9 (sd 3·0)kg/m2) and twelve low- (ten females and two males; anxiety scores 30·4 (sd 4·8); BMI 23·4 (sd 2·5) kg/m2) trait anxiety individuals participated in a placebo-controlled, two-way crossover design. Participants were provided with 40 g α-lactalbumin (LAC; l-tryptophan (Trp):large neutral amino acids (LNAA) ratio of 7·6) and 40 g casein (placebo) (Trp:LNAA ratio of 4·0) in the form of a snack and lunch on two test days. On both the test days, participants completed a stress-inducing task 2 h after the lunch. Mood and appetite were assessed using visual analogue scales. Changes in food hedonics for different taste and nutrient combinations were assessed using a computer task. The results demonstrated that the LAC manipulation did not exert any immediate effects on mood or appetite. However, LAC did have an effect on food hedonics in individuals with high-trait anxiety after acute stress. These individuals expressed a lower liking (P = 0·012) and SW food preference (P = 0·014) after the stressful task when supplemented with LAC.