To develop a composite index to describe the overall breast-feeding performance of infants < 6 months of age; and, using this index, to identify the factors associated with poor breast-feeding practices and the association between breast-feeding and infant morbidity.

The 2003 Demographic and Health Survey was a multi-stage cluster sample survey of 4320 households in Timor-Leste which covered 573 infants aged < 6 months. Breast-feeding Performance Index (BPI) was constructed by allocating one point for each of seven infant feeding practices: first suckling within an hour of birth; absence of prelacteals; non-use of feeding bottles; current breast-feeding; not receiving liquids; not receiving formula or other milk; and not receiving solids in the last 24 hours. BPI was treated as the dependent variable in univariate and multivariate analyses to identify the factors associated with poor breast-feeding.

Exclusive breast-feeding rate was 29.9%. The BPI (mean 4.4, standard deviation 1.77) was categorised as low, average and high according to tertiles. Multivariate analysis indicated that infants from the richest households were 1.70 (95% confidence interval (CI) 1.04–2.77) times more likely to have ‘low BPI’ than the poorest. Maternal BMI < 18.5 kg m− 2 was predictive of poor breast-feeding (odds ratio = 1.79; 95% CI 1.27–2.52). In the ‘low’ BPI group, the incidence of diarrhoea (13.4%) and acute respiratory infections (20.7%) during the previous two weeks was significantly higher than in ‘average’ (4.3 and 9.3%) and ‘high’ BPI groups (4.6 and 5.5%).

Creating a composite index to assess the overall breast-feeding performance among infants < 6 months of age is feasible. BPI can be effectively used to identify target groups for breast-feeding promotion interventions.

Dietary surveys of 11- to 12-year-old Northumbrian children in 1980 and 1990 revealed that consumption of non-milk extrinsic sugars (NMES) was 16–17% of energy intake. This study reports dietary sugars consumption in 2000 and compares it with data collected in 1980 and 1990, using identical methods.

A repeat cross-sectional dietary survey of children aged 11–12 years attending the same schools as in the 1980 and 1990 surveys.

Seven middle schools in south Northumberland.

All children aged 11–12 years old attending the seven schools.

Food consumption was recorded using two 3-day diet diaries. Food composition tables were used to calculate energy and nutrient intakes. NMES, and milk and intrinsic sugars were calculated using previously described methods.

The numbers of children completing the surveys in 1980, 1990 and 2000 were 405, 379 and 424, respectively; ~60–70% of eligible children. Total sugars provided 22% of energy consistently over the three surveys. NMES consumption in 2000 provided 16% of energy compared with 16% in 1980 and 17% in 1990. Sources of NMES changed over the three surveys. NMES from soft drinks doubled from 15 to 31 g day− 1, and from breakfast cereals increased from 2 to 7 g day− 1 over the 20 years. Confectionery and soft drinks provided 61% of NMES. Over 20 years, the proportion of energy from fat decreased by 5% and from starch increased by 4%, creating a welcome tilt in the fat–starch see-saw, without an adverse effect on sugars intake.

Consumption of NMES in 2000 was substantially higher than recommended, and there has been little change over 20 years. Continued and coordinated efforts are required at a national, community and individual level to reduce the intake of NMES.

To assess vitamin A supplementation (VAS) coverage of children aged 6–59 months and the factors that favour or limit this coverage during the National Nutrition Weeks in Mali.

Cross-sectional study. Interviews about demographic factors and children's adherence to the vitamin A capsule distribution programme were conducted. Professionals' knowledge of vitamin A and various aspects related to the supplementation strategy were assessed.

Five regions out of the eight regions in the country, in addition to Bamako District. Three rural communes were selected in three regions to represent rural areas.

Parents or caregivers of children under 5 years of age, health agents who participated in the weeks, and community and administrative leaders.

At least 80% of the children received the supplement. More ‘traditional’ communication channels (town criers, friends and family members) appeared to be more effective in reaching the target groups than modern methods, i.e. radio and television. Mothers' possession of a radio (Pearson χ2 = 5.03; P = 0.025) and fathers' education (Pearson χ2 = 19.02; P < 0.001), possession of a radio (Pearson χ2 = 8.93; P = 0.003) and listening to it (Pearson χ2 = 7.62; P = 0.006) all appeared to be statistically and significantly associated with children's coverage. In multivariate logistic regression analysis, only the study site (urban/rural) (P = 0.004), ‘traditional channels’ (P = 0.02) and fathers' education (P = 0.04) were significantly associated with children's coverage. Knowledge about VAS was high among community and administrative leaders, and health professionals. The planning and implementation of activities at the district level were found to be good in general.

National Nutrition Weeks provide a successful example of a periodic VAS strategy with high coverage among children aged 6–59 months in Mali. Campaigns aimed at informing and sensitising populations during the Nutrition Weeks should also target children's fathers.

To examine the association between fruit and vegetable (F&V) availability and consumption, the possible influences on this association, research gaps, and implications for developing strategies to increase F&V consumption.

Systematic review of studies that have examined associations between F&V availability and consumption.

Qualitative studies conducted among children and adults indicated that greater availability was associated with greater consumption. This finding was supported by cross-sectional studies among children. Availability was associated with dietary psychosocial variables such as preferences, and it appears that availability may moderate the relationship between these psychosocial variables and consumption. Intervention studies attempting to increase availability have resulted in increased consumption, and availability has predicted change in consumption over an 18-month period.

Availability appears to be a key proximal determinant of consumption, especially of F&V, and thereby provides a target for change. However, the mechanisms that relate these variables are unclear and there is a need to clarify the direction of causality. We suggest that the possible causal mechanisms may include: (1) availability simply facilitates increased consumption; (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.

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.

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.

Cohort study.

Babies aged 9 months in the Millennium Cohort Study, born between September 2000 and January 2002.

A total of 6917 British/Irish white employed mothers with singleton babies.

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.

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.

To assess the prevalence of hyperthyroidism just after implementation of iodine prophylaxis among adults from an area with iodine deficiency.

A total of 1648 adults (age 16 years and older) were sampled from an area of southern Poland during two nationwide epidemiological surveys. Of these, 1424 adults with negative medical history for thyroid disorders qualified for final analysis. The authors compared thyroid dysfunction in participants prior to (1989–1990) and after implementation of iodine prophylaxis (1997–1999).

The southern part of Poland.

We found an increase in the serum concentration of anti-thyroid microsomal antibodies from 4.9% in the years 1989–1990 to 12.1% after introduction of iodised household salt (P < 0.0001). The prevalence of hyperthyroidism (defined as thyroid-stimulating hormone < 0.4 μU ml− 1) significantly increased in the equivalent period from 4.8 to 6.5% (P = 0.009).

We concluded that a sudden rise in iodine intake after implementation of iodine prophylaxis among adults from the area with iodine deficiency may lead to an increase in thyroid autoimmunity and prevalence of hyperthyroidism. Those possible early side-effects appear to be only temporary and are acceptable when compared with the evident benefits of adequate iodine intake.

There is an increasing awareness that the provision of healthy food relies on the co-ordinated efforts of a number of diverse disciplines, not merely those traditionally linked with food. This paper documents the development of a food and health strategy, commissioned by the health alliance for the city of Cardiff, and focuses on the areas of sustainability, education and training as well as nutrition, food provision and food safety.

The aim of the strategy was to increase the uptake of a healthy, safe and sustainable diet for all those living in Cardiff.

The methodology included a rapid appraisal of food initiatives operating within the city, establishing a food and health strategy working group and the production of strategy documentation. Multi-agency collaboration and consultation were key components of the approach.

As the strategy developed, seven action areas became apparent, including education and training, public sector procurement and rewarding excellence. These action areas were incorporated into seven ‘action tables’, which constitute the core of the strategy. The food and health strategy document was ratified by the Local Health Alliance board in August 2004. But, far greater benefits were realised as a consequence of setting up the strategy working group. Long before the document was written, the strategy process was operating as ‘multidisciplinary public health in action’.

The network that comprised the food and health strategy working group was already able to commence delivery of a more integrated approach to food and health within Cardiff.

To identify key predictors of fast-food consumption from a range of demographic, attitudinal, personality and lifestyle variables.

We analysed data from a nationwide survey (n = 20 527) conducted in Australia by Nielsen Media Research. Items assessing frequency of fast-food consumption at (1) eat in and (2) take away were regressed onto 12 demographic, seven media consumption, and 23 psychological and lifestyle variables, the latter derived from factor analysis of responses to 107 attitudinal and behavioural items.

Stepwise multiple regression analyses explained 29.6% of the variance for frequency of take-away and 9.6% of the variance for frequency of eat-in consumption of fast foods. Predictors of more frequent consumption of fast food at take away (and, to a lesser extent, eat in) included lower age – especially under 45 years, relative indifference to health consequences of behaviour, greater household income, more exposure to advertising, greater receptiveness to advertising, lesser allocation of time for eating, and greater allocation of time to home entertainment. There were no effects for occupational status or education level.

The effects for age suggest that fast-food take-away consumption is associated with a general cultural shift in eating practices; individual differences in attitudinal and lifestyle characteristics constitute additional, cumulative, predictive factors. The role of advertising and the reasons for the lesser explanatory value of the eat-in models are important targets for further research.

To determine the nutritional behaviour of Tehranian adolescents.

This study was undertaken on 7669 adolescents (4070 boys and 3599 girls) of 22 junior high schools and high schools as a representative sample of Tehranian adolescents. A validated knowledge, attitudes and practices (KAP) questionnaire and a food-frequency questionnaire (FFQ) were used. Factor analysis was used to determine the key questions.

The mean ( ± standard deviation) age and body mass index of the adolescents was 14 ± 1 years and 27.2 ± 11 kg m− 2. Although 82% of girls and 75% of boys had good nutritional knowledge, only 25% of boys and 15% of girls had good nutritional practice. Eighty-five per cent of adolescents knew that drinking too many soft beverages resulted in overweight or obesity, but only 4.5% of them did not drink soft beverages. Although 89% of adolescents knew that crisps and corn balls are not healthy snacks, 45% of them used such snacks during their break time. Thirty-seven per cent of adolescents preferred whole-grain biscuits to creamy wafer ones but only 10% of adolescents used whole-grain biscuits as a snack. The most frequently consumed snacks among Tehranian adolescents were sausage sandwiches, cocoa cola, crisps and corn balls, creamy wafers, cakes, chocolate and toffee.

A low percentage of Tehranian adolescents have good nutritional behaviour and in most of them their nutritional practice does not accord with their nutritional knowledge. These results indicate the necessity of nutritional intervention in Tehranian adolescents.

To compare two approaches to analysing energy- and nutrient-converted data from dietary validation (and relative validation) studies – conventional analyses, in which the accuracy of reported items is not ascertained, and reporting-error-sensitive analyses, in which reported items are classified as matches (items actually eaten) or intrusions (items not actually eaten), and reported amounts are classified as corresponding or overreported.

Subjects were observed eating school breakfast and lunch, and interviewed that evening about that day's intake. For conventional analyses, reference and reported information were converted to energy and macronutrients; then t-tests, correlation coefficients and report rates (reported/reference) were calculated. For reporting error-sensitive analyses, reported items were classified as matches or intrusions, reported amounts were classified as corresponding or overreported, and correspondence rates (corresponding amount/reference amount) and inflation ratios (overreported amount/reference amount) were calculated.

Sixty-nine fourth-grade children (35 girls) from 10 elementary schools in Georgia (USA).

For energy and each macronutrient, conventional analyses found that reported amounts were significantly less than reference amounts (every P < 0.021; paired t-tests); correlations between reported and reference amounts exceeded 0.52 (every P < 0.001); and median report rates ranged from 76% to 95%. Analyses sensitive to reporting errors found median correspondence rates between 67% and 79%, and that median inflation ratios, which ranged from 7% to 17%, differed significantly from 0 (every P < 0.0001; sign tests).

Conventional analyses of energy and nutrient data from dietary reporting validation (and relative validation) studies may overestimate accuracy and mask the complexity of dietary reporting error.

To review the literature examining associations between environmental factors, energy and fat intakes among adults, and to identify issues for future research.

Literature searches of studies published between 1980 and 2004 were conducted in major databases (i.e. PubMed, Human Nutrition, Web of Science, PsychInfo, Sociofile). Additional articles were located by citation tracking.

Twenty-one articles met the inclusion criteria. No study provided a clear conceptualisation of how environmental factors may influence these dietary intakes. Availability, social, cultural and material aspects of the environment were relatively understudied compared with other factors such as seasonal/day of the week variation and work-related factors. Few studies examined the specific environmental factors implicated in the obesity epidemic, and there was little study replication. All studies were observational and cross-sectional.

It is too premature to conclude whether or not environmental factors play a role in obesogenic and unhealthy dietary intakes. More studies need to examine associations with those environmental factors thought to contribute to obesogenic environments. There needs to be more development in theories that conceptualise the relationship between environmental factors and dietary intakes.

To develop a quantitative food-frequency questionnaire (QFFQ) for the Barbados National Cancer Study (BNCS) that will permit examination of associations of diet with breast and prostate cancer.

Population intake data from the year 2000 Barbados Food Consumption and Anthropometric Surveys (BFCAS 2000) were used to derive a list of foods consumed by the population. A 192-item draft QFFQ was developed from this list.

Barbados, West Indies provides an ideal environment to understand cancer risk in African-origin populations, with high relevance to African-Americans. The BNCS is a population-based case–control study examining risk factors for breast and prostate cancer in such populations.

A total of 1600 persons, 18 years and older, completed a 24-hour recall in the BFCAS 2000. Fifty of 63 randomly selected residents (79% response rate) gave additional updated information on foods consumed.

The 50 participants provided a one-time 24-hour recall and completed the draft QFFQ. The final instrument contains 148 items: breads, cakes, cereals = 17; rice, pastas, noodles = 8; dairy = 10; meat, fish, poultry = 42; fruit = 16; vegetables = 26; soft drinks = 14; alcoholic beverages = 5; others = 10. Additional questions include supplement use and food preparation methods such as grilling.

The final instrument is concise, complete and the most up-to-date for assessing the food and nutrient intake of African-origin Barbadians and the associations with breast and prostate cancer.

To report on the fruit, vegetable and salad intakes of Liverpool schoolchildren aged 9–10 years over a 5-year period (2000–2005).

Cross-sectional observational study.

Between 75 and 100 Liverpool primary schools took part in each survey year.

Subjects consisted of five separate cohorts of 9–10-year-old children from all areas of the city.

Number and proportion of boys and girls who reported eating fruit, vegetables and salad on the previous day.

There was an upward trend in the reported intake of fruit between 2002 and 2005. Girls were more likely than boys to report eating fruit (P < 0.001). The trend in salad intake was positive. Between 2000 and 2005 there were significant increases in the number of boys (χ2 = 17.57, P = 0.001) and girls (χ2 = 80.56, P = 0.001) eating salad. Girls were significantly more likely to eat salad than boys in all years (χ2 = 58.75, P = 0.001). Trends in vegetable intake were similar to those for salad, with both sexes reporting yearly increases over the 5-year period. The increase in the number of boys who reported eating vegetables between 2000 and 2005 was 23.5% (χ2 = 32.9, P = 0.000). In girls there was a 44.8% increase over the same period (χ2 = 110.3, P < 0.000).

The data reveal positive trends in the fruit, vegetable and salad intakes of Liverpool schoolchildren between 2000 and 2005. Further research is needed to elucidate the specific factors that have enabled the changes to take place.

To identify factors associated with food insecurity in California women.

The California Women's Health Survey is an ongoing annual telephone survey that collects data about health-related attitudes and behaviours from a randomly selected sample of women. Food insecurity of the women was measured by a 6-item subset of the Food Security Module. Statistical procedures included chi-square tests, t-tests, logistic regression analysis and analysis of covariance.

California, USA.

Four thousand and thirty-seven women (18 years or older).

Prevalence of food insecurity was 25.7%. After controlling for income, factors associated with greater food insecurity were Hispanic or Black race/ethnicity; less than a 12th grade education; being unmarried; less than 55 years old; being Spanish-speaking; having spent less than half of one's life in the USA; sadness/depression; feeling overwhelmed; poor physical/mental health interfering with activities; and fair to poor general health. Among Food Stamp Program (FSP) participants, 71% were food-insecure. Among FSP-eligible women who had not applied for the programme, the prevalence of food insecurity was lower among women responding that they did not need food stamps than in women giving other reasons for not applying (23.9% vs. 66.9%, P < 0.001). Factors associated with food insecurity in FSP recipients included being unable to make food stamps last for 30 days, feeling overwhelmed, and having a birthplace in Mexico or Central America.

Along with several socio-economic variables, poor physical and mental health is associated with food insecurity. Whether food insecurity is a cause or effect of poor health remains in question.

With obesity and nutrition-related diseases rising, public health authorities have recently insisted nutritional quality be included when advertising and labelling food. The concept of nutritional quality is, however, difficult to define. In this paper we present an innovative, science-based nutrient profiling system, Nutrimap®, which quantifies nutritional assets and weaknesses of foods.

The position of a food is defined according to its nutritional composition, food category, the consumer's nutritional needs, consumption data and major public health objectives for nutrition. Amounts of each of 15 relevant nutrients (in 100 kcal) are scored according to their ability to ‘rebalance’ or ‘unbalance’ the supply in the whole diet, compared with current recommendations and intakes. These scores are weighted differently in different food categories according to the measured relevance of the category to a nutrient's supply. Positive (assets) and negative (weaknesses) scores are totalled separately.

Nutrimap® provides an overall estimate of the nutritional quality of same-category foods, enabling easy comparisons as exemplified for cereals and fruit/vegetables. Results are consistent with major nutritional recommendations and match classifications provided by other systems. Simulations for breakfasts show that Nutrimap® can help design meals of controlled nutritional value.

Combining objective scientific bases with pragmatic concerns, Nutrimap® appears to be effective in comparing food items. Decision-makers can set their own limits within the Nutrimap®-defined assets and weaknesses of foods and reach categorisations consistent with their objectives – from regulatory purposes to consumer information or support for designing meals (catering) or new products (food industry).

Cross-sectional data indicate that a relationship between household food insecurity and overweight exists among women in the USA. Cross-sectional data cannot determine if food insecurity leads to overweight as some have hypothesised. The purpose of the present study was to examine the relationship of food insecurity with subsequent weight gain in women using data from the Panel Study of Income Dynamics (PSID).

Panel data from the 1999 and 2001 PSID, a nationally representative sample of households, were analysed using multivariate regression procedures.

Average weight gain among all women (n = 5595) was 1.1 kg on average over the two years. There were no significant differences in the percentages of women who gained a clinically significant amount (2.3 kg) by food insecurity status. Overweight women who were on a weight-gain trajectory during the 2-year period gained less if they were food-insecure. This relationship was not observed among healthy-weight or obese women.

Overall, food insecurity does not appear to be strongly associated with subsequent weight gain in women.

To analyse the degree of compliance with the nutrition objectives and population-based food guides and to indicate possible recommendations for their development within the framework of a Nutrition and Health Policy in Catalonia.

Using data derived from the latest Catalan Nutrition Survey (ENCAT 2002–03) conducted by the Department of Health, compliance was analysed with respect to the recommendations derived as a result of a previously conducted Survey. In addition, compliance to the recommendations elaborated by the Spanish Society of Community Nutrition (SENC) was also evaluated.

Catalonian region located in the Northeast of Spain.

Analysis is based on a total of 2160 individuals (996 males and 1164 females) aged 10–80 years interviewed in 2002–03.

The analysis of compliance with the recommendations established in 1995 showed: (a) recommendation to maintain and increase consumption of fruits and vegetables was not achieved; (b) continued use of olive oil as the dietary fat of choice was met; (c) incomplete compliance with maintaining the Mediterranean diet traditions, especially in the younger cohorts; (d) compliance with the recommendation to decrease consumption of red meat and sausages, but non-compliance with guidance to maintain or increase fish consumption and (e) compliance with partially substituting whole milk and dairy for low-fat products.

Compliance with the SENC Healthy Eating Guide revealed that those food groups with the worst results were meat and sausages (excessive), pulses (below recommendations) and fruits and vegetables (below recommendations).

Compliance with dietary guidelines is low in Catalonia, and reflects the need for an effective nutrition policy in the region defined by the Autonomous Government as the Plan for the Promotion of Physical Activity and Healthy Eating (PAAS).

To investigate the relationships between food poverty and food consumption, health and life satisfaction among schoolchildren.

Analysis of the 2002 Health Behaviour in School-aged Children (HBSC) study, a cross-sectional survey that employs a self-completion questionnaire in a nationally representative random sample of school classrooms in the Republic of Ireland.

A total of 8424 schoolchildren (aged 10–17 years) from 176 schools, with an 83% response rate from children.

Food poverty was found to be similarly distributed among the three social classes (15.3% in the lower social classes, 15.9% in the middle social classes and 14.8% in the higher social classes). It was also found that schoolchildren reporting food poverty are less likely to eat fruits, vegetables and brown bread, odds ratio (OR) from 0.66 (95% confidence interval (CI) 0.45–0.87) to 0.81 (95% CI 0.63–0.99); more likely to eat crisps, fried potatoes and hamburgers, OR from 1.20 (95% CI 1.00–1.40) to 1.62 (95% CI 1.39–1.85); and more likely to miss breakfast on weekdays, OR from 1.29 (95% CI 0.33–1.59) to 1.72 (95% CI 1.50–1.95). The risk of somatic and mental symptoms is also increased, OR from 1.48 (95% CI 1.18–1.78) to 2.57 (95% CI 2.33–2.81); as are negative health perceptions, OR from 0.63 (95% CI 0.43–0.83) to 0.52 (95% CI 0.28–0.76) and measures of life dissatisfaction, OR from 1.88 (95% CI 1.64–2.12) to 2.25 (95% CI 2.05–2.45). Similar results were found for life dissatisfaction in an international comparison of 32 countries. All analyses were adjusted for age and social class.

Food poverty in schoolchildren is not restricted to those from lower social class families, is associated with a substantial risk to physical and mental health and well-being, and requires the increased attention of policy makers and practitioners.