To describe a conceptual framework to assist in the application of capacity-building principles to public health nutrition practice.

A review of the literature and consideration of the determinants of effective public health nutrition practice has been used to inform the development of a conceptual framework for capacity building in the context of public health nutrition practice.

The limited literature supports a greater integration and application of capacity-building strategies and principles in public health nutrition practice, and that this application should be overt and strategic. A framework is proposed that identifies a number of determinants of capacity for effective public health nutrition action. The framework represents the key foundations for building capacity including leadership, resourcing and intelligence. Five key strategic domains supported by these foundation elements, including partnerships, organisational development, project management quality, workforce development and community development, are proposed. This framework can be used to assist the systematic assessment, development and evaluation of capacity-building activity within public health nutrition practice.

Capacity building is a strategy within public health nutrition practice that needs to be central to public health nutrition intervention management. The present paper defines, contextualises and outlines a framework for integrating and making explicit the importance of capacity building within public health nutrition practice at many levels.

To describe which functions potential employers of public health nutritionists in Norway find important for a person trained in public health nutrition to be able to carry out. Further, to illustrate how the findings were used in the development of a curriculum for a bachelor in public health nutrition at Akershus University College.

A non-random, cross-sectional survey using a questionnaire with both pre-coded and open-ended questions.

Ninety-one establishments working in various fields more or less related to nutrition responded (response rate of 45 %).

Local offices of the Norwegian Food Safety Authority were over-represented among respondents. Functions related to communication and food and nutrition laws and regulations were most frequently rated as important by the respondents. Functions in nutrition research, project work and policy and planning were also regarded important by more than half of the respondents. The priorities of the potential employers together with the additional comments and suggestions were taken into account when a new curriculum on public health nutrition was developed.

The assessment of functions prioritised by employers of public health nutritionists gave a valuable input for developing a new curriculum in public health nutrition. It reflected the challenges of the real world that public health nutritionists will work in and therefore helped making the curriculum potentially more relevant.

Physical inactivity poses a major risk for obesity and chronic disease, and is influenced by both genetic and environmental factors. However, the genetic association between physical activity (PA) level and obesity is not well characterized. Our aims were to: (i) estimate the extent of additive genetic influences on physical activity while adjusting for household effects; and (ii) determine whether physical activity and adiposity measures share common genetic effects.

The sample included 521 (42 % male) adult relatives, 18–86 years of age, from five large families in the Southwest Ohio Family Study.

Sport, leisure and work PA were self-reported (Baecke Questionnaire of Habitual Physical Activity). Total body and trunk adiposity, including percentage body fat (%BF), were measured using dual-energy X-ray absorptiometry. Abdominal visceral and subcutaneous adipose tissue mass were measured using MRI.

Heritabilities for adiposity and PA traits, and the genetic, household and environmental correlations among them, were estimated using maximum likelihood variance components methods. Significant genetic effects (P < 0·05) were found for sport (h2 = 0·26) and leisure PA (h2 = 0·17). Significant (P < 0·05) household effects existed for leisure PA (c2 = 0·25). Sport PA had a negative genetic correlation with central adiposity measurements adjusted for height (ρG > |−0·40|). Sport and leisure PA had negative genetic correlations with %BF (ρG > |−0·46|).

The results suggest that the association of sport and leisure PA with lower adiposity is due, in part, to a common genetic inheritance of both reduced adiposity and the predisposition to engage in more physical activity.

The association between obesity and blood pressure is well documented and a series of obesity indices are used as risk factors or indicators of blood pressure and/or the presence of hypertension.

The aim of the present study was to explore and determine which obesity index is the best indicator of blood pressure and the presence of hypertension among five frequently used simple anthropometric indices.

Subjects (n 29 079) were selected by cluster sampling from fourteen Chinese general populations. Weight, height, waist circumference (WC), hip circumference and blood pressure were measured for each participant. BMI, waist:hip ratio (WHR), waist:stature ratio (WSR) and conicity index (CI) were calculated. Pearson correlation, multiple logistic regression, multivariate linear regression and receiver-operating characteristic (ROC) curve analyses were used.

A total of 13 558 men and 15 521 women were investigated. All five obesity indices were positively correlated with blood pressures and hypertension. After adjusting for age, WSR in men and BMI in women had the greatest association with the presence of hypertension, irrespective of the statistical method used. BMI had the strongest correlation with continuous blood pressures in both genders.

The present results indicate that hypertension is associated with different obesity indices in men and in women. The best indicator for hypertension is WSR in men while it is BMI in women.

To investigate the accuracy of self-reported weight status over the adult lifespan.

Estimates of self-report bias were obtained from a linear regression analysis and the magnitude of the discrepancy was studied for demographic groups (based on gender, race and educational attainment), weight status, number of years from the age of the reported weight and current age of the respondent.

A subset of 6101 individuals from the National Health and Nutrition Examination Epidemiological Follow-Up constituted the study sample.

Gender, elapsed time and BMI contributed to self-report bias. Effects of gender and elapsed time were small relative to the effects of BMI, with women tending to underestimate weight by 0·82 kg (1·8 lb), men overestimating by 2·27 kg (5·0 lb) and bias increasing by 0·09 kg (0·2 lb) for each year of retrospection. Every increase of one unit in BMI was associated with an additional 0·91 kg (2·0 lb) underestimate in self-reported weight.

Accuracy of adult self-reported weight profiles will be greatly underestimated if samples have individuals of current or past high relative weight. Adjusting for underestimation based on the respondent’s weight status alone will considerably improve the validity of weight information.

To assess the association of indicators of general and abdominal obesity with the prevalence of type 2 diabetes (T2DM) and intermediate hyperglycaemia (IHG) in the Chinese population.

We used data of 50 905 adults aged 18–79 years in the 2002 China National Nutrition and Health Survey. Recommended Chinese cut-off values were used for BMI (24 kg/m2) and waist circumference (WC; 85 cm in men, 80 cm in women). Optimal cut-offs for waist:height ratio (WHtR) were determined from analyses of receiver-operating characteristic (ROC) curves.

The prevalence of T2DM and IHG was 2·6 % and 1·9 % respectively. ROC curve analyses indicated 0·5 as the optimal cut-off value for WHtR in both sexes. High BMI, WC and WHtR were all associated with the prevalence of glucose tolerance abnormalities, with the highest prevalence ratio (PR) for high WHtR (men: PR = 2·85, 95 % CI 2·54, 3·21; women: PR = 3·10, 95 % CI 2·74, 3·51). When combining BMI and WHtR, in men either a high BMI or a high WHtR alone was associated with increased risk. Among women, a high BMI without a concomitant high WHtR was not associated with increased glucose tolerance abnormalities risk, whereas a high WHtR was associated with risk irrespective of BMI.

Among the Chinese adult population measures of central obesity are better predictors of glucose tolerance abnormalities prevalence than BMI. A WHtR cut-off point of 0·5 for both men and women can be considered as optimum for predicting (pre-) diabetes and may be a useful tool for screening and health education.

To examine the potential of anthropometry as a tool to measure gender discrimination, with particular attention to the WHO growth standards.

Surveillance data collected from 1990 to 1999 were analysed. Height-for-age Z-scores were calculated using three norms: the WHO standards, the 1978 National Center for Health Statistics (NCHS) reference and the 1990 British growth reference (UK90).

Bangladesh.

Boys and girls aged 6–59 months (n 504 358).

The three sets of growth curves provided conflicting pictures of the relative growth of girls and boys by age and over time. Conclusions on sex differences in growth depended also on the method used to analyse the curves, be it according to the shape or the relative position of the sex-specific curves. The shapes of the WHO-generated curves uniquely implied that Bangladeshi girls faltered faster or caught up slower than boys throughout their pre-school years, a finding consistent with the literature. In contrast, analysis of the relative position of the curves suggested that girls had higher WHO Z-scores than boys below 24 months of age.

Further research is needed to help establish whether and how the WHO international standards can measure gender discrimination in practice, which continues to be a serious problem in many parts of the world.

Little is known about the relationship of dietary cost to health status. The present cross-sectional study examined the association between the monetary cost of dietary energy (Japanese yen/4184 kJ) and several metabolic risk factors.

Monetary cost of dietary energy was estimated based on dietary intake assessed by a self-administered diet history questionnaire and retail food prices. Body height and weight, from which BMI was derived, waist circumference and blood pressure were measured and fasting blood samples were collected for biochemical measurements.

A total of fifteen universities and colleges in Japan.

A total of 1136 female Japanese dietetic students aged 18–22 years.

After adjustment for potential confounding factors, monetary cost of dietary energy was significantly and negatively associated with BMI (P for trend = 0·0024). Monetary cost of dietary energy also showed a significant and negative association with waist circumference independently of potential confounding factors, including BMI (P for trend = 0·0003). No significant associations were observed for other metabolic risk factors examined (P for trend = 0·10–0·88).

The monetary cost of dietary energy was independently and negatively associated with both BMI and waist circumference, but not other metabolic risk factors, in a group of young Japanese women.

The objective of the present work was to quantify mothers’ misclassification of pre-school children’s weight status and to determine factors associated with the maternal misperception.

A representative sample of 2287 children aged 2–5 years was examined (GENESIS study). Mothers’ perceptions of their child’s weight status and the children’s and mothers’ anthropometric and other characteristics (sociodemographic and lifestyle) were recorded.

Almost 38 % of mothers underestimated their child’s weight status. The frequency of underestimation was much higher among ‘at risk of being overweight’ and ‘overweight’ children (88·3 % and 54·5 %, respectively) compared with ‘underweight/normal-weight’ children (18·0 %, P < 0·001). Multiple logistic regression modelling revealed that the likelihood of mothers’ underestimation of their child’s weight status was significantly higher in boys, in children engaging in physical activity for less than 3 h/week and in children whose mothers had low education status, compared with their counterparts. Moreover, the higher the BMI-for-age Z-score, the greater the odds that the mother would underestimate her child’s weight status.

The current study demonstrated that more than one-third of mothers misclassify their children’s weight status as being lower than the actual. Given that mother’s weight perception might be an important determinant of child’s body weight development, clinicians and health professionals should help mothers correctly classify their children’s weight status, which could potentially help in the early prevention of overweight and obesity.

Overweight and obesity have increased to epidemic proportions among adolescents and are associated with chronic non-communicable diseases and excess mortality in adulthood. The association of overweight/obesity with poor dietary habits has not been studied in adolescents in middle-income developing countries. The present study aimed to estimate the prevalence of overweight, obesity and high waist circumference (WC) in 15–19-year-old Jamaican adolescents and to investigate the association with fast-food and sweetened beverage consumption.

The study enrolled 1317 (598 male, 719 female) adolescents aged 15–19 years using multistage, nationally representative sampling. Age-specific prevalence calculation used internal Z-score lines connecting with the WHO adult cut-off points. Logistic regression was used to examine the association of overweight or high WC with fast-food and sweetened beverage consumption, adjusting for potential confounders.

The overall prevalence of overweight, obesity and high WC was approximately 15 %, 6 % and 10 %, respectively. Prevalence estimated using internal Z-scores was similar to that using the International Obesity Taskforce cut-off points. Obesity (8·0 % in females, 3·3 % in males) and high WC (16·2 % in females, 1·7 % in males) were significantly more prevalent in females when using internal Z-score cut-offs. High WC was associated with the absence of fruit consumption (P = 0·043) and overweight with high sweetened beverage consumption (P = 0·018).

Overweight occurs frequently among Jamaican 15–19-year-olds and is associated with increased consumption of sweetened beverages. High WC is more prevalent among females and is related to low consumption of fruits and vegetables. Measures to reduce the consumption of sweetened beverages and increase fruit intake may reduce the prevalence of excess body fat among adolescents.

To describe the meal patterns of Jena schoolchildren and their associations with children’s weight status and parental characteristics.

Cross-sectional study.

Twenty schools in Jena (∼100 000 inhabitants), south-east Germany.

A total of 2054 schoolchildren aged 7–14 years with information on BMI standard deviation score (BMI-SDS) and weight status (based on German reference values), of whom 1571 had additional information about their parents (parental education and employment status, weight status according to WHO guidelines) and meal patterns (school lunch participation rate, meal frequencies, breakfast consumption and frequency of family meals).

Weight status of the children was associated with weight status, education and employment status of the parents. Meal patterns were strongly dependent on children’s age and parental employment. As age increased, the frequency of meal consumption, participation rate in school lunches and the number of family meals decreased. Using linear regression analysis, a high inverse association between BMI-SDS and meal frequency was observed, in addition to relationships with parental weight status and paternal education.

Age-specific prevention programmes should encourage greater meal frequency. The close involvement of parents is essential in any strategy for improving children’s (families’) diets.

To determine the impact of BMI on post-operative outcomes and resource utilization following elective total hip arthroplasty (THA).

A retrospective cohort analysis on all primary elective THA patients between 1996 and 2004. Primary outcomes investigated using regression analyses included length of stay (LOS) and costs (US dollars).

Mayo Clinic Rochester, a tertiary care centre.

Patients were stratified by pre-operative BMI as normal (18·5–24·9 kg/m2), overweight (25·0–29·9 kg/m2), obese (30·0–34·9 kg/m2) and morbidly obese (≥35·0 kg/m2). Of 5642 patients, 1362 (24·1 %) patients had a normal BMI, 2146 (38·0 %) were overweight, 1342 (23·8 %) were obese and 792 (14·0 %) were morbidly obese.

Adjusted LOS was similar among normal (4·99 d), overweight (5·00 d), obese (5·02 d) and morbidly obese (5·17 d) patients (P = 0·20). Adjusted overall episode costs were no different (P = 0·23) between the groups of normal ($17 211), overweight ($17 462), obese ($17 195) and morbidly obese ($17 655) patients. Overall operative and anaesthesia costs were higher in the morbidly obese group ($5688) than in normal ($5553), overweight ($5549) and obese ($5593) patients (P = 0·03). Operating room costs were higher in morbidly obese patients ($3418) than in normal ($3276), overweight ($3291) and obese ($3340) patients (P < 0·001). Post-operative costs were no different (P = 0·30). Blood bank costs differed (P = 0·002) and were lower in the morbidly obese group ($180) compared with the other patient groups (P < 0·05). Other differences in costs were not significant. Morbidly obese patients were more likely to be transferred to a nursing home (24·1 %) than normal (18·4 %), overweight (17·9 %) or obese (16·0 %) patients (P = 0·001 each). There were no differences in the composite endpoint of 30 d mortality, re-admissions, re-operations or intensive care unit utilization.

BMI in patients undergoing primary elective THA did not impact LOS or overall institutional acute care costs, despite higher operative costs in morbidly obese patients. Obesity does not increase resource utilization for elective THA.

The purpose of the present study was to examine the relationship between household food insecurity and maternal depression in a rural sample to determine whether food insecurity predicted mothers’ depression over time or vice versa.

The study employed a prospective design using three waves of data from ‘Rural Families Speak’, a multi-state study of low-income rural families in the USA. Food insecurity was measured using the Core Food Security Module and depression was measured using the Center for Epidemiologic Studies–Depression Scale. A structural equation model was fit to the data using the AMOS software package.

Sixteen states in the USA (California, Indiana, Kentucky, Louisiana, Massachusetts, Maryland, Michigan, Minnesota, Nebraska, New Hampshire, New York, Ohio, Oregon, South Dakota, West Virginia, Wyoming) between 2000 and 2002.

Subjects included 413 women with at least one child under the age of 13 years living in the home.

Findings based on the 184 subjects with complete data indicated that the causal relationship between household food insecurity and depression is bidirectional (P = 0·034 for causation from depression to food insecurity, P = 0·003 for causation from food insecurity to depression, χ2/df = 1·835, root-mean-square error of approximation = 0·068, comparative fit index = 0·989). Findings based on all 413 subjects after imputation of missing values also indicated bidirectionality.

The recursive relationship between food insecurity and depression has implications for US nutrition, mental health and poverty policies. The study highlights the need to integrate programmes addressing food insecurity and poor mental health for the population of rural, low-income women.

Stunting is a chronic condition reflecting poor nutrition and health. Our aim was to ascertain major predictors of stunting in children <5 years old in Libya.

A nationally representative, cross-sectional, two-stage stratified cluster sample survey enrolled 4549 under-fives from 6707 households. Logistic regression was used to determine individual risk factors in bivariate and multivariate analyses.

Anthropometric measurements were available for 4498 children. Among the 929 stunted children (20·7 %), 495 were boys (53·3 %) and 434 were girls (46·5 %). In multivariate analysis, risk factors were young age (1–2 years: OR = 2·32, 95 % CI 1·67, 3·22; 2–3 years: OR = 1·64, 95 % CI 1·22, 2·21), resident of Al-Akhdar (OR = 1·67, 95 % CI 1·08, 2·58), being a boy (OR = 1·28, 95 % CI 1·05, 1·55), having a less educated father (illiterate: OR = 2·10, 95 % CI 1·17, 3·77; preparatory school: OR = 1·71, 95 % CI 1·11, 2·65), poor psychosocial stimulation (no family visits or trips: OR = 1·52, 95 % CI 1·07, 2·16; father rarely/never plays with child: OR = 2·24, 95 % CI 1·20, 4·16), filtered water (OR = 8·45, 95 % CI 2·31, 30·95), throwing garbage in the street (OR = 13·81, 95 % CI 2·33, 81·72), diarrhoea (OR = 1·58, 95 % CI 1·09, 2·29) and low birth weight (OR = 1·8, 95 % CI 1·17, 2·40). Protective factors were older age of father (OR = 0·53, 95 % CI 0·32, 0·90) and water storage (OR = 0·70, 95 % CI 0·54, 0·90). These variables only explained 20 % of cases of stunting.

Various multilevel actions are needed to improve nutritional status of under-fives in Libya. At risk-groups include those with young age (1–3 years), resident of Al-Akhdar region, boys, father’s low educational level, poor psychosocial stimulation, poor housing environment, diarrhoea and low birth weight.

Canada’s Aboriginal population is vulnerable to food insecurity and increasingly lives off-reserve. The Canadian Community Health Survey, Cycle 2.2 Nutrition, was used to compare the prevalence and sociodemographic correlates of food insecurity between non-Aboriginal and off-reserve Aboriginal households.

Food insecurity status was based on Health Canada’s revised interpretation of responses to the US Household Food Security Survey Module. Logistic regression was used to assess if Aboriginal households were at higher risk for food insecurity than non-Aboriginal households, adjusting for household sociodemographic factors.

Canada.

Households (n 35,107), 1528 Aboriginal and 33 579 non-Aboriginal.

Thirty-three per cent of Aboriginal households were food insecure as compared with 9 % of non-Aboriginal households (univariate OR 5·2, 95 % CI 4·2, 6·3). Whereas 14 % of Aboriginal households had severe food insecurity, 3 % of non-Aboriginal households did. The prevalence of sociodemographic risk factors for household food insecurity was higher for Aboriginal households. Aboriginal households were more likely to have three or more children (14 % v. 5 %), be lone-parent households (2 1 % v. 5 %), not have home ownership (52 % v. 31 %), have educational attainment of secondary school or less (43 % v. 26 %), have income from sources other than wages or salaries (38 % v. 29 %), and be in the lowest income adequacy category (33 % v. 12 %). Adjusted for these sociodemographic factors, Aboriginal households retained a higher risk for food insecurity than non-Aboriginal households (OR 2·6, 95 % CI 2·1, 3·2).

Off-reserve Aboriginal households in Canada merit special attention for income security and poverty alleviation initiatives.

To study the association between diet quality and the new health messages in the Danish Dietary Guidelines 2005, i.e. ‘Eat a varied diet’, ‘Engage in regular physical activity’ and ‘Maintain a healthy body weight’.

The study was cross-sectional, comprising a random sample of 3151 Danish adults aged 18–75 years. Dietary intake was estimated using a 7 d pre-coded food diary. Information on social background, leisure-time physical activity, height, body weight and intention to eat healthily was obtained by in-person interviews. Logistic regression models were used to explore the independent effects of energy intake, leisure-time physical activity, food variety, BMI, age, gender, education, household income, location of residence and intention to eat healthily on the likelihood to have high diet quality measured by an index based on the intake of dietary fibre and saturated fat.

Greater food variety (OR = 1·32 for women, 1·13 for men), high leisure-time physical activity (OR = 2·20 for women, 1·91 for men), frequent intentions to eat healthily (OR = 8·19 for women, 5·40 for men) and low energy intake (OR=0·78 for women, 0·85 for men) were significantly associated with high diet quality. For women education was positively associated with diet quality. The study did not demonstrate any association between BMI and diet quality.

The health behaviours ‘Eat a varied diet’ and ‘Engage in regular physical activity’ were positively associated with healthy eating. The dietary habits reported were strongly influenced by personal intentions. Thus, the biggest challenge for public health nutritionists will be to reach non-compliers who seldom have intentions to eat healthily.