To evaluate the accuracy of a simplified inventory procedure for assessing nutrient intake from vitamin and mineral supplements.

Participants brought their supplements to a clinic. An interviewer conducted the supplement inventory procedure, which consisted of recording data on the type of multiple vitamin and single supplements used. For the multiple vitamins, the interviewer recorded the exact dose for a subset of nutrients (vitamin C, calcium, selenium). For other nutrients, we imputed the dose in multiple vitamins. The dose of all single supplements was recorded. Labels of the supplements were photocopied and we transcribed the exact nutrient label data for the criterion measure. Spearman correlation coefficients were used to assess precision of nutrient intakes from the simplified inventory compared to the criterion measure.

Data are from 104 adult vitamin supplement users in Washington state.

Correlation coefficients between nutrient intake estimated from the simplified inventory compared to the criterion measure were high (0.8–1.0) for those nutrients (vitamin C, calcium, selenium) for which the interviewer recorded the exact dose contained in multiple vitamins. However, for nutrients for which imputations were made regarding dose in multiple vitamins, correlation coefficients ranged from good (0.8 for vitamin E) to poor (0.3 for iron).

The simplified inventory is rapid (4–5 min) and practical for large-scale studies. The precision of nutrient estimates using this procedure was variable, although excellent for the subset of nutrients for which the dose was recorded exactly. This study illustrates many of the challenges of collecting high quality supplement data.

To report on energy and nutrient intakes, as a risk factor for coronary heart disease in Indian South Africans.

Cross-sectional dietary study as part of a coronary heart disease survey.

Metropolitan area of Durban, South Africa.

Free-living Indian men (n = 406) and women (n = 370) 15–69 years of age.

Dietary data were collected by three interviewers using a 24-h dietary recall and expressed as median intakes of macronutrients.

Results reported a low energy intake and the percentage of energy derived from total fat varied between 32.3 and 34.9% in men and between 33.1 and 36.1% in women. The energy intake to basal metabolic rate (EI: BMR) ratios were low for all age groups suggesting potential under-reporting. Intake of polyunsaturated fatty acids was high, more than 10% of energy, with a median polyunsaturated to saturated fatty acid ratio (P: S ratio) that varied between 1.38 and 1.96 for the various age and sex groups. Dietary cholesterol varied between 66 and 117 mg per 4.2 MJ in men and between 76 and 109 mg per 4.2 MJ in women. Dietary fibre intakes were low and varied between 8.0 and 11.0 g per 4.2 MJ in men and between 7.6 and 9.6 g per 4.2 MJ in women.

The dietary P:S ratios were high and the effect of such a high P:S ratio on the oxidation of low density lipoprotein in this population, with a high prevalence of coronary heart disease (CHD), should be investigated as a possible risk factor for CHD.

To assess the accuracy and helpfulness of labelling on products containing probiotic bacteria.

52 such products – 44 from the UK (21 supplements, 15 fermented functional foods, eight ‘health-care’ products) and eight from continental Europe – have been tested for microbiological content, and results compared to the information available on their labels. Products were stored in the dark at 4°C and analysed before their expiry or sell-by date. Careful note was taken of wording on labels, package inserts, packaging, promotional literature and catalogue descriptions, as applicable. Products were cultured on appropriate bacteriological media, and organisms grown were counted and identified.

Bioyoghurts gave no indication of numbers, and only five accurately described their bacterial content; results of culture were usually satisfactory. ‘Health-care’ products (mostly intended for the bowel) usually indicated the presence of bacteria, but the numerical content was hard to ascertain, and cultural results fell short of label claims. Supplements were sometimes incorrectly labelled in bacteriological terms, and often contained markedly reduced numbers and/or had extraneous strains and/or strains specified on the label were missing. Products from continental Europe (that were sold for specific medical indications) seemed of a higher microbiological standard. The potential pathogen Enterococcus faecium was found in nine products. The most successful of the new functional foods in Britain now contain probiotics, and probiotic preparations are prominent among the expanding range of nutritional supplements presently available to consumers.

Our findings have public health implications, and suggest that improvements are needed in labelling and quality assurance procedures for products containing probiotic organisms. The presence of the potential pathogen Enterococcus faecium (intentionally or as a contaminant) in some products calls for a review of the value of this species as a probiotic.

To assess how well supermarket sales data from a major supermarket chain can reflect on regional differences in dietary behaviour by comparing the sales data with the results provided by the annual health behaviour surveys.

Cross-sectional observational study.

The study was carried out in six Finnish cities situated in different parts of Finland. For the study supermarket sales data of milk, sour milk, fats and oils for 1 month, September 1997, were obtained from eight supermarkets. Proportional sales of different types of dairy products were calculated as well as mean salt and fat per cent and the proportion of saturated fat to total fat. The health behaviour surveys from spring 1995, 1996 and 1997 provided information about dietary habits of the adult population in the cities. The reported use of dairy products was compared with the percentage sales.

The proportional sales of dairy products varied between the cities. In Pori in western Finland the sale of milk fat was highest in all food groups. In Oulu, northern Finland, the sale of non-fat milk was high. In the capital region the sale of oil was highest. Regional differences could also be seen in the survey data. The similarity between the two different datasets was high.

The use of supermarket sales data for assessing regional differences in health behaviour is feasible. The challenge will be to get supermarket managers willing to provide sales data on a routine basis for monitoring and research.

To compare vitamin B6 status indices with each other and with potential confounding factors, in the datasets from two national British surveys and associated studies.

Vitamin B6 status was measured by plasma pyridoxal phosphate (PLP) and plasma pyridoxic acid (PA) in both surveys, and also by erythrocyte aspartate aminotransferase activation coefficient (EAATAC) in one of the surveys. Plasma α1-antichymotrypsin was measured as an index of acute phase status; plasma creatinine was measured as an index of renal function; and plasma total alkaline phosphatase activity was measured as a proxy for PLP hydrolase activity.

The survey of people aged 65 years and over was carried out in 80 postcode sectors across mainland Britain during 1994–95 and the survey of young people was carried out in 132 postcode sectors across mainland Britain during 1997.

Blood samples from c. 1000 subjects of both sexes in each survey permitted measurements of plasma PLP and PA. There were also measurements of EAATAC in the young people's survey.

According to published limits of normality, only 5% or less of the young people had unacceptable vitamin B6 status as measured by plasma PLP. About half had apparently unacceptable status by EAATAC, but this observation is difficult to interpret. The young people had considerably higher plasma concentrations of PLP and lower concentrations of PA than the older people. In both surveys, plasma PLP was strongly correlated with plasma PA and in the young persons’ survey it was also correlated, although much less strongly, with the basal activity and activation coefficient of aspartate aminotransferase. Both plasma PLP and EAATAC (but not PA nor basal aspartate aminotransferase activity) were influenced by acute phase status in young people, as indicated by significant correlations with α1-antichymotrypsin. In people aged 65 years and over, PA (but not PLP) was correlated with renal function, as indicated by its relation with plasma creatinine; however PLP (but not PA) was correlated with plasma alkaline phosphatase activity.

Several potential confounders — acute phase reaction, kidney malfunction and hydrolase activity — may influence vitamin B6 status indices, although differently for different indices and different age groups. Since older people have relatively poor vitamin B6 status, which may have important health implications for them, more reliable vitamin B6 status indices are needed.

The aim of this paper is to describe recent weight changes and weight loss practices in the EU, and in particular to describe the group of subjects who were in a recent state of weight gain.

Overall, 15 239 adults aged 15 years and upwards composed of 1000 from each EU member state were selected to complete the interview-assisted face-to-face questionnaire. In each member state, sample selection was quota-controlled to ensure national representativeness.

This survey points to a fairly alarming tendency of more normal weight, overweight or obese European people being in a state of weight gain rather than weight loss. But it is also worrying that almost a fifth of underweight people are in the process of losing more weight. The recommendations for interventions to promote weight loss might be somewhat different between countries in the EU as the common weight loss practices differ between such countries. Overall, a campaign alone may not be effective in encouraging people to do more physical activity in Europe. Additional methods should be found. Furthermore, a combination of diet and exercise as a method of weight control is underestimated or undervalued by the general population who are either overweight or obese.

To assess the quality of a narrative form diet history (DH).

Reproducibility assessed with data obtained at 6-week intervals. Criterion validity assessed using energy intake to estimated energy expenditure (EI: BMR) cut-off limits. Relative validity assessed by comparing results for energy and macronutrients at baseline and month 2 of an intervention trial with those obtained from 3-day food records (FR).

Community-based dietary intervention trials for the study of metabolic syndrome in the Illawarra region of New South Wales, Australia.

Reproducibility: 43 healthy female volunteers. Mean age 58.72 years (range 50–67), mean body mass index (BMI) 25.79 (range 21–36). Validity: 45 healthy volunteers—18 males (mean age 46.9 years, mean BMI 27.8), and 27 females (mean age 45.7 years, mean BMI 26.2), attending a study on the effect of diet on metabolic variables.

Reproducibility: wide SD values indicated a high degree of intraindividual variation, but correlation coefficients were comparable to those of similar studies. Validity: underreporting was inconsistent with individuals, but was greater with the DH than the FR at each stage of the dietary trial (significant at month 1, P > 0.01). Underreporters indicated higher intakes of protein during the trial (P > 0.05). Weaker associations were found between the DH and FR data for energy values, but there was strong agreement for per cent fat consumed as saturated and monounsaturated fat at each stage of the trial.

The narrative form DH performs as well as standardized interviews, but more work needs to be done at the micro level, focusing on aspects which deal with foods likely to be underreported in the particular study context. This can be achieved through continued research using combined methodologies.

To describe the characteristics of dietary supplement users in a large cohort of women and test the hypothesis that supplement users would be more likely to have a healthier lifestyle than non-users.

Comparison of nutrient intakes from food frequency questionnaire (FFQ) data for 8409 supplement users and 5413 non-users. Use of logistic regression modelling to determine predictors of supplement use in this cohort.

13,822 subjects from the UK Women's Cohort Study (UKWCS) for whom data on supplement use was available.

Significant differences in nutrient intakes from FFQ were seen between the two groups, with supplement users having higher intakes of all nutrients, except for fat and vitamin B12. Use of dietary supplements was associated with being vegetarian, vegan or fish-eating, consuming more fruit and vegetables, being more physically active and having a lower alcohol intake. Supplement use was less likely in those with a body mass index above 25 and those who reported smoking regularly.

The findings are consistent with the hypothesis that supplement use is associated with a healthier lifestyle profile and an adequate nutritional intake, suggesting that supplement users do not need to take supplements to meet a nutrient deficiency.

To determine if blood levels of 25-hydroxyvitamin D (25-D) or its active metabolite, 1,25-dihydroxyvitamin D (1,25-D), are lower in women at the time of first diagnosis of breast cancer than in comparable women without breast cancer.

This was a clinic-based case–control study with controls frequency-matched to cases on race, age, clinic and month of blood drawing.

University-based breast referral clinics.

One hundred and fifty-six women with histologically documented adenocarcinoma of the breast and 184 breast clinic controls.

There were significant mean differences in 1,25-D levels (pmol ml−1) between breast cancer cases and controls; white cases had lower 1,25-D levels than white controls (mean difference ± SE: −11.08 ± 0.76), and black cases had higher 1,25-D levels than black controls (mean difference ± SE: 4.54 ± 2.14), although the number of black women in the study was small. After adjustment for age, assay batch, month of blood draw, clinic and sample storage time, the odds ratio (95% confidence interval, CI) for lowest relative to highest quartile was 5.2 (95% CI 2.1, 12.8) for white cases and controls. The association in white women was stronger in women above the median age of 54 than in younger women, 4.7 (95% CI 2.1, 10.2) vs. 1.5 (95% CI 0.7, 3.0). There were no case–control differences in 25-D levels in either group.

These data are consistent with a protective effect of 1,25-D for breast cancer in white women.

To assess body image perception and satisfaction with current body image across the EU and to explore the influence of sociodemographic variables, body-weight change and strategies for losing weight on body image perception.

A cross-sectional study in which quota-controlled, nationally representative samples of approximately 1000 adults from each country completed a face-to-face interview-assisted questionnaire.

The survey was conducted in the 15 member states of the EU between March and April 1997.

The questionnaire was completed by 15 239 subjects (aged 15 years and upwards). Data were weighted by population size for each country and by sex, age and regional distribution within each member state.

Just 39% of respondents in the EU were satisfied with their weight and these were more likely to be male (46%) rather than female (31%). Across the EU 29% of Finnish subjects were content with their weight compared with 47% in Belgium and 48% in Luxembourg. The highest percentage of subjects who were content with their body weight was among females who were underweight (58%) and males who were normal weight (66%). A further 20% of underweight females wished to be lighter compared to only 5% of males. Diet was the most frequently selected method for losing weight especially among females wishing to be considerably lighter (27%) while males were as likely to use exercise as diet as a strategy to lose weight.

Geographical and sociodemographical influences on body image perception are evident across the EU. There were clear gender differences in the desire to be thinner with a high proportion of females who were underweight being content to be so.

To evaluate the food and nutrient intake of members of a birth cohort study when young children in 1950 and investigate differences from present-day children's diets.

One-day recall diet records from the MRC National Survey of Health and Development (NSHD) (1946 Birth Cohort) at age 4 years were analysed for energy and selected nutrients and compared to the published results for 4-year-olds in the 1992/93 National Diet and Nutrition Survey (NDNS).

England, Scotland and Wales in 1950 and 1992/93.

4599 children in 1950 and 493 children in 1992/93.

Mean (SD) daily intakes in 1950 were energy 1445 (343) kcal, or 6.1 (1.4) MJ, protein 46 (11)g, fat 64 (20)g, starch 117 (33)g, sugar 62 (24)g, unavailable carbohydrate 13 (4)g, calcium 736 (230)mg, iron 7.7 (2.1)mg, retinol 738 (1273) μg, carotene 1049 (1130) μg and vitamin C 40 (26) mg. Compared to 1992/93, the 1950 diet contained substantially more bread and vegetables and less sugar and soft drinks, giving it a higher starch and fibre content and making it more in line with current recommendations on healthy eating. However, fat provided 40% of energy in 1950, compared to 35% in 1992/93. In 1950, red meat was an important source of iron, but by 1992 most iron came from fortified breakfast cereals. Vitamin C came mainly from vegetables in 1950, but from soft drinks in 1992.

The relative austerity of post-war food supplies resulted in food and nutrient intakes in 1950 which in many respects may well have been beneficial to the health of young children, despite fat intake being higher than present-day recommendations.

To examine the attitudes of consumers, in particular their perceived benefits and barriers to physical activity from all EU member states, and having a measure of prevailing levels of activity, inactivity and self-reported body weight and body shape.

Cross-sectional survey using an interview-assisted face-to-face questionnaire.

The survey was conducted between March and April 1997 in the 15 member states of the EU.

Overall, 15 239 EU subjects, classified according to sex, age (six levels) and highest level of education attained (primary, secondary or tertiary), completed the survey. Sample selection of subjects in each EU member state was quota-controlled to ensure they were nationally representative.

The most important motivation for people to participate in physical activity is to maintain good health (42%), to release tension (30%) and to get fit (30%). The importance of the health argument is highest in older persons and in subjects with a primary education level. Only 13% of the EU population (16% of women, 10% of men) perceived losing weight as a benefit of physical exercise. The most important barriers to increase physical activity are work or study commitments (28%) and the subjects' belief that they are not ‘the sporty type’ (25%). There is considerable between-country variation in the answering pattern within the EU.

To assess the reproducibility and validity of a semiquantitative food frequency questionnaire (FFQ) to classify children and adolescents in terms of daily servings of fruits and vegetables and intake of calories, protein, fat, carbohydrate, dietary fibre, vitamin C, phosphorous, calcium and iron.

FFQs were collected in the autumn of 1993 and 1994. Four 24-hour diet recalls were collected during the same 1-year period and their mean was compared to the FFQ diet estimates.

Low income, inner-city state schools.

A sample of 109 inner-city fourth to seventh grade students.

The 1-year reproducibility of the FFQ, assessed with Spearman correlations, was lower among the fourth and fifth (range: r = −0.26 to 0.40) than the sixth and seventh grade students (range: r = 0.18–0.47). After adjusting for day-to-day variation in dietary intake, for most nutrients and foods the correlations between the FFQ and the 24-hour recalls remained greater among the junior high school students (fourth to fifth grade range: r = 0.0–0.42; sixth to seventh grade range: = 0.07–0.76).

Inner-city sixth and seventh grade students demonstrated the ability to provide valid estimates of intake of calories, carbohydrate, calcium, phosphorous, iron and vitamin C over the past year. However, children in the fourth and fifth grades experienced some difficulty in completing the FFQ. Our results suggest that, before using this instrument with fourth and fifth grade children, investigators should assess whether study participants can think abstractly and are familiar with the concept of ‘average intake’.

To consider how physical activity interacts with diet to modify lipoprotein metabolism and comment on implications for human health.

An overview of lipoprotein metabolism is followed by a summary of the main effects of physical activity on lipoprotein metabolism. Interactions with dietary practice and the disposition of dietary lipid are reviewed, with comment on links with body fatness.

Literature is reviewed in relation to the risk of atherosclerotic disease.

Although some data are presented on athletic groups, evidence relating to individuals with normal physical activity habits is mainly discussed.

Physical inactivity is a risk factor for cardiovascular disease and one mechanism may involve changes to lipoprotein metabolism. The consensus is that aerobic activity involving an expenditure of >= 8 MJ · week-1 results in an increase in HDL cholesterol and probably decreases in fasting triacylglycerol. These changes occur despite the spontaneous increase in the proportion of dietary energy from carbohydrate which accompanies increased exercise. For this reason, exercise may be a means of reducing the hypertriglyceridaemic and HDL-lowering effects of low fat (high carbohydrate) diets. Decreases in total and low density lipoprotein cholesterol are sometimes, but not always, reported in sedentary individuals beginning exercise. One mechanism linking all these changes may be alterations to the dynamics of triacylglycerol-rich particles, particularly in the fed state.

The expenditure of considerable amounts of energy through regular, frequent physical activity increases the turnover of lipid substrates, with effects on their transport and disposition which may reduce the progression of atherosclerosis.

To assess the impact and suitability of a pilot dietary educational programme for primary school pupils. The Nutrition Education at Primary School (NEAPS) programme aimed to build awareness of the benefits of healthy eating, induce positive behaviour change and increase the children's knowledge.

A comparative quasi-experimental study with follow-up after 3 months.

Eight primary schools in the Eastern and North Western Health Boards and three control schools in the same board regions.

Data were used from 821 Irish school children aged 8–10 years old.

The education programme comprised 20 sessions over 10 weeks including circular worksheets, homework assignments and an aerobic exercise regime. At baseline and after 3 months pupils completed food diaries and a validated food pairing questionnaire on food behaviour, knowledge and preferences.

Significant differences were found in the intervention children's behaviour and preference levels after the NEAPS programme (P < 0.01 in both sections). Knowledge levels were very high at baseline and though some individual items improved, average change overall was not significant. Rural children appeared to benefit more in behaviour and preferences from the programme (P < 0.01). The NEAPS programme appeared to be less effective in pupils in disadvantaged areas (P < 0.01 for each of the sections: behaviour, preference and knowledge). One hundred and eighty-seven children completed food diaries. The intervention children's consumption of fruit and vegetables increased, and they consumed less salty snacks after the programme. Rural children were confirmed to have healthier diets at baseline.

Following the NEAPS pilot programme positive changes were seen in the school children's eating behaviour and preferences for healthier foodstuffs. This suggests successful development of a culturally sensitive nutrition education programme for school children aged 8–10 years.

This review summarises the evidence for the effectiveness of primary care based interventions of diet and physical activity aimed at reducing blood pressure.

As blood pressure rises so does the risk of heart disease and stroke. There is a large literature on the effects on blood pressure of changing various aspects of diet either as single nutrient interventions, patterns of food consumption, or the addition of dietary supplements (potassium, magnesium, and fish oil). Controlled trials have been undertaken to assess the relative benefits of lifestyle changes in activity (walking etc) compared with more structured exercise programmes. There is sufficient evidence to suggest that changes in diet and activity under controlled conditions can reduce blood pressure and delay or reduce the need for drug treatment in subjects who are hypertensive. What is less clear is how to achieve these lifestyle changes in the primary care setting as part of routine clinical management.

There have been a number of systematic reviews undertaken to evaluate the evidence. The interventions were either delivered alone or in combination with other advice, either with or without aids, and by various practice nurse staff (GP, nurse, Dietitian); follow-up varied from 3 months to a year. Compliance with the advice was generally not measured. The variability in the quality of the studies and interventions made it difficult to draw conclusions: any effects seen tended to be small.

Equivocal results (non statistically significant reductions) should not be considered as proof of no effect without careful consideration of the effects of chance, bias and confounding, and without better measures of compliance. There is little debate that, under investigator control, blood pressure can be reduced by changes in diet and activity. Changes to a ‘healthy’ diet (low in total and saturated fat; energy intake balanced with expenditure to maintain or achieve optimal body weight; low in salt; high in fruits, vegetables, legumes; and whole grains) and increases in modest levels of physical activity (walking etc) would be expected to reduce blood pressure by between two and four mmHg. A shift in the population distribution of this order would be expected to have a substantial impact on population mortality patterns and could be achieved cost-effectively in primary care.