To assess predictors of poor anthropometric status among infants and young children.

Cross-sectional survey.

The rural subsistence agricultural district of Hoima, western Uganda.

Seven hundred and twenty children aged 0–23 months with their mothers/carers.

Participants were recruited in September 2002, using a two-stage cluster sampling methodology. A structured questionnaire was administered to mothers in their home settings. Information on health, household socio-economic status, child feeding practices and anthropometric measurement was gathered. Conditional logistic regression analysis was applied taking into account the hierarchical relationships between potential determinants of poor anthropometric status.

The mean Z-score for weight-for-height was −0.2 (95% confidence interval (CI) −0.1, −0.7), for height-for-age was −1.1 (95% CI −1.2, −0.9) and for weight-for-age was −0.7 (95% CI −0.8, −0.6). Wasting was independently associated only with a history of fever in the 2 weeks prior to the survey (odds ratio (OR) = 4.4, 95% CI 1.5, 13), while underweight was associated with a history of fever (OR = 2.4, 95% CI 1.3, 4.4) and cough (OR = 3.0, 95% CI 1.3, 6.8). Stunting was positively associated with a wider range of factors, including: history of a fever episode (OR = 1.7, 95% CI 1.0, 2.9), lack of a latrine in the household (OR = 2.7, 95% CI 1.5, 4.9), failure to de-worm children 12 months or older (OR = 1.7, 95% CI 1.1, 2.8), and being born to a non-formally educated mother compared with mothers educated above primary school (OR = 2.1, 95% CI 1.1, 4.0).

In analyses guided by the hierarchical interrelationships of potential determinants of malnutrition, wasting and underweight turned out to be independently predicted by morbidity (proximal) factors. Stunting, however, was predicted by socio-economic (distal), environmental and health-care (intermediate) factors in addition to morbidity. Strategies aimed at improving the growth of infants and young children in rural communities should address morbidity due to common childhood illness coupled with environmental and socio-economically oriented measures.

To explore the nutritional quality of supplementary foods and additional energy consumption by the recipients in a pilot nutrition initiative of BRAC.

In-depth interviews, observations during feeding at feeding centres, and laboratory analyses of supplementary foods for nutrient contents performed at the Institute of Nutrition and Food Science, University of Dhaka, Bangladesh.

Muktagacha thana (sub-district) in Mymensingh district, a rural area of Bangladesh.

Pregnant and lactating mothers and children below 2 years of age.

Analysis revealed that supplementary food, if taken completely, could provide daily energy equivalent to 752 kcal to a mother and 212 kcal to a child below 2 years of age. Mothers consumed about 75% of the food provided (∼ 564 kcal day−1). The food was shared mostly with young children and husbands. In-depth interview with mothers also suggested that they usually skipped breakfast if the food was given in the morning. The children liked the taste of food, and unless the child was sick or had some food before coming to the centre, she/he ate all the food provided. Although the main purpose of the project was to provide nutrition education, it was observed that activities at feeding centres were limited to food distribution with little time devoted to the communication of nutritional messages.

Training should be given to service providers to communicate nutritional messages effectively as part of understanding the goal of the initiative. It is important to explore whether the regular diets of the recipients are replaced by the food supplementation or not.

The aim of this study was to determine the food sources and acquisition practices used by homeless youth in Adelaide. This work is part of a larger study that aimed to examine the extent and nature of food insecurity among homeless youth.

Cross-sectional design involving quantitative and qualitative methods.

Four health and welfare inner-city agencies serving homeless youth in Adelaide, South Australia.

A sample of 150 homeless youth aged between 15 and 24 years recruited from these agencies. Fifteen were selected via snowball sampling for interview.

Use of welfare food sources was high (63%). Food from welfare agencies was supplemented by unorthodox food acquisition methods such as theft (65%), begging for money for food (61%), begging for food items (44%) and asking for help from friends and relatives (34%). Reasons given for non-usage of welfare food services included affordability, access, being too busy, shame or embarrassment.

Food insecurity is a salient issue for some homeless youth in Adelaide. Clarifying food acquisition practices of food-insecure homeless youth is essential for rational planning and improvement of food-related services to meet their needs. Such an understanding also underpins the development of broader public policy responses that improve individual and household skills and resources to acquire food and ensure food security. Nutrition professionals, welfare professionals and policy-makers need to work sensitively with welfare food agencies and others to improve food access and food security for homeless youth.

To assess the prevalence of anaemia in rural Vietnam and to determine its risk factors.

A cross-sectional survey.

Vietnam, Nghe An Province.

The total number of participants was 439. Of these participants, one was excluded from the study due to a mental disorder. Forty-seven did not participate in the test for parasites and 68 did not complete at least one of the questions.

The prevalence of anaemia (haemoglobin (Hb) < 11.0 g dl−1) was 43.2% and of severe anaemia (Hb < 8.0 g dl−1) was 0.5%. Taking iron tablets, the consumption of eggs and the preference for Western medicine significantly and positively correlated with Hb concentration in the pregnant women in a multiple regression analysis. Pregnancy duration and hookworm infestation significantly and negatively correlated with Hb concentration in the pregnant women.

The prevalence of anaemia in rural Vietnam has remained as high as that found in the national anaemia survey in 2000. The results of the present study could aid in the development of an iron-deficiency anaemia programme among pregnant women in rural Vietnam that emphasises iron supplementation, parasite control and improved diet, including the consumption of eggs. The programme's focus should be on women who prefer traditional medicine to Western medicine.

The adherence to a Mediterranean Dietary Pattern ensures an adequate intake of B vitamins and w-3 fatty acids. A protective role on depression has been suggested for both nutrients.

Cross-sectional analysis from the SUN (Seguimiento Universidad de Navarra) prospective cohort study. Data from 9670 participants (4211 men and 5459 women) were analised. Logistic regression analyses were fitted to assess the association between B-vitamins and w-3 fatty acids intake (quintiles) and the prevalence of depression.

Folate intake was inversely associated with depression prevalence among men, especially smokers. Among women, B12 vitamin intake was inversely associated with depression, especially among smokers and physically active women. No significant associations were observed for w-3 fatty acids intake.

The adherence to a Mediterranean Dietary Pattern ensures an adequate intake of fruits, nuts, vegetables, cereals, legumes or fish, important sources of nutrients linked to depression prevention.

The present study aimed to investigate whether organic conversion in catering has positive effects on the nutritional quality of menus offered.

The methodology was based on a self-administered questionnaire. The self-declared priority given to the use of organic foods was measured as the basis for assigning catering managers to one of two groups: ‘green’ or ‘non-green’ caterers. These groups were then compared with regard to the relative nutritional quality of the menu options offered to customers.

The study was carried out among randomly selected Danish worksite catering outlets.

The subjects participating in the study comprised 526 Danish worksite catering managers.

The results showed a strong correlation between caterers' ‘green-ness’ and the nutritional quality of the menu options offered. Green caters had more healthy options in their menus than non-green caters, which is likely to result in improved nutritional quality of the diets of end consumers. The reason for this may partly be the increased service training efforts that green caterers practise in order to be able to implement organic foods successfully. It may also be associated with the fact that the price premiums and availability of the organic products forces caterers to serve menus with higher amounts of root and non-green leafy vegetables, pulses and seasonal vegetables.

The present findings suggest that organic conversion of public canteens may be a good opportunity to promote healthier eating in public catering.

To study individual determinants of differential benefit from the Senegal Community Nutrition Project (CNP) by monitoring improvement in children's weight-for-age index (WA) or underweight status (WA  < –2 Z-scores) during participation.

A follow-up study using the CNP child monitoring data. Linear general models compared variations in WA according to 14 factors describing the beneficiaries and CNP services.

Poor neighbourhoods of Diourbel, a large city in Senegal, West Africa. Over a 6-month period, the CNP provided underweight or nutritionally at-risk 6–35-month-old children with monthly growth monitoring and promotion and weekly food supplementation, provided that mothers attended weekly nutrition education sessions.

All the children who participated in the first two years of the project (n = 4084).

Mean WA varied from − 2.13 (standard deviation (SD) 0.82) to − 1.58 (SD 0.81) Z-scores between recruitment and the end of the follow-up. The lower the child's initial WA, the greater was their increase in WA but the lower was the probability of recovery from underweight. Only 61% of underweight children recovered. Six months of CNP services may not be sufficient for catch-up growth of severely underweight children. The number of food supplement rations received was not a direct indicator of the probability of recovery. After adjustment for services received and initial WA, probability of recovery was lower in girls, in younger children, in twins and when mothers belonged to a specific ethnic group.

Determinants of benefit from CNP differed from the risk factors for underweight. Identification of participants with a lower probability of recovery can help improve outcome. Moreover, an explanation for the lack of recovery could be that many underweight children are stunted but not necessarily wasted.

To identify individual and contextual factors associated with the practice of exclusive breast-feeding (EBF).

We analysed 34 435 children under 6 months of age living in 111 municipalities in the state of São Paulo, south-eastern Brazil, who participated in a survey investigating feeding practices during the first year of life, carried out during the 1999 national vaccination campaign. The questionnaire employed included questions on the consumption, in the last 24 h, of breast milk, water, tea, other types of milk and other foods, in addition to mother and child characteristics. Information on the pro-breast-feeding measures implemented in the municipalities was also collected. The effects of individual and contextual characteristics on EBF were analysed using multilevel models.

The final model showed a greater chance of EBF in women with tertiary education (odds ratio (OR) = 1.91; 95% confidence interval (CI) 1.75–2.06); women aged between 25 and 29 years (OR = 1.52; 95% CI 1.41–1.63); multiparae (OR = 1.42; 95% CI 1.33–1.49); female babies (OR = 1.12; 95% CI 1.05–1.18); birth weight ≥3000 g (OR = 1.73; 95% CI 1.49–1.97); child follow-up in the private health-care network (OR = 1.10; 95% CI 1.02–1.18); and municipalities with four or five pro-breast-feeding measures (OR = 2.4; 95% CI 2.19–2.88). An analysis of the interactions between individual and contextual variables showed that the presence of at least four pro-breast-feeding measures in the municipality attenuated the risk of early termination of EBF associated with low maternal schooling and low birth weight, and transformed child follow-up in the public network into a protective factor against the early termination of breast-feeding.

The presence of measures aimed at protecting, promoting and supporting breast-feeding in the municipality had a positive influence on EBF and attenuated the impact of risk factors for the termination of breast-feeding.

To describe women's views about aspects of infants' diets around the time of weaning, making comparisons with national guidelines.

A survey of women with a 9-month-old child.

Adelaide, South Australia.

Five hundred and five women who joined a longitudinal study during pregnancy.

Sources of information varied, with written material most commonly used (37%). Cows' milk was considered suitable as the main drink for weaned infants by 14% of women. There were divergent views about the suitability of eggs, with many women concerned about allergy. The majority of women (84%) viewed fruit juice as suitable although many qualified their response, often by stating that fruit juice should be diluted. Almost all women considered the amount of sugar mattered, primarily because of tooth decay, and that salt mattered although the reason was often uncertain. It was widely believed (77%) that additives in food could cause health problems, in particular hyperactivity and allergies, and half of the women reported avoiding specific foods because of concerns about allergies. Many women thought that giving their child food that was high in fat would encourage a liking for ‘junk’ food or lead to fatness in adulthood.

There is considerable diversity in the views women express about aspects of infant feeding that have been the subject of guidelines. Further health promotion efforts are needed to achieve greater consistency with recommendations and to address other concerns women have. This will entail greater engagement with parents and shared development of responses.

Cohort study (the SUN project) to identify dietary determinants of hypertension, diabetes, obesity and coronary heart disease (CHD), among other conditions.

The SUN project is a Mediterranean dynamic prospective follow-up (cohort) study assessing participants every 2 years. The recruitment started in 2000 and it is permanently open (this is a dynamic cohort). A preliminary case–control study of myocardial infarction was also conducted, selecting incident cases of myocardial infarction and matched hospital controls.

The SUN study is conducted in Spain with university graduates, most of them being former students of the University of Navarra. The case–control study was conducted in three tertiary hospitals in the city of Pamplona (Spain).

The case–control study included 171 cases and 171 controls. We have currently enrolled more than 17 500 participants in the SUN cohort. Approximately 7500 of them were enrolled less than 2 years ago, and have not received yet the invitation to complete the 2-year follow-up assessment. The follow-up rate for the first 10 000 participants approaches 90%.

The case–control study found inverse associations between olive oil (or adherence to a Mediterranean food pattern) and myocardial infarction. In the SUN cohort, after 28.5 months of follow-up a higher adherence to a Mediterranean food pattern rich in olive oil was associated with a reduced risk of hypertension, though the results were statistically significant only among men.

The SUN study and the accompanying case–control study support the benefits of a Mediterranean diet and olive oil against CHD and hypertension.

To report the nutritional status of children aged up to 15 years and their mothers living in a remote Amazonian area of Bolivia, and to study its main social, familial and maternal determinants.

Fifteen Beni River communities located at the foot of the Andes.

Cross-sectional survey of riverside populations. All childbearing mothers and their children in the 15 communities were examined.

Information on household production, dietary habits and demography was collected. Individual clinical, anthropometric and parasitological examinations were carried out.

A total of 631 persons were examined: 171 mothers and 460 children and adolescents aged 0 to 15 years.

There were no cases of severe wasting, but 41% of 0–5-year-olds and 36% of 5–10-year-olds were stunted. Among 346 stool specimens examined, 75% were positive for at least one helminth. Diversity of food and quality of diet were satisfactory in 54% of households, but 27% had low diversity scores. Mothers were lighter and shorter than those observed at the national level: 20% had height below 145 cm. Prevalence of anaemia (42%) was also higher. In pre-school children, multivariate analysis indicated a relationship between growth retardation and household factors such as dietary quality, ethnic group and clinical state, but not maternal anthropometry. In contrast, in school-age children and adolescents, growth retardation was related to maternal characteristics.

Growth retardation appeared mainly during the weaning period and did not seem to improve thereafter. To ameliorate this situation, an effort should be made to prevent common parasitic and infectious diseases in young children. Follow-up of pregnant mothers during pregnancy and delivery also needs to be reinforced.

To describe the process of establishing and implementing a social support infant feeding intervention.

This paper outlines the initial stages of a randomised controlled trial which assessed the effectiveness of a social support intervention on a range of infant feeding outcomes. Details are presented of the processes involved in recruiting, training and supporting a group of volunteers who provided support to the study sample.

Camden and Islington, London, UK.

Initial networking with local agencies and organisations provided invaluable information and contacts. Employing a dedicated volunteer co-ordinator is vitally important in the recruitment, training and support of volunteers. Providing child care and travel expenses is an essential incentive for volunteers with young children. Advertisements placed in local newspapers were the most successful means of recruiting volunteers. Appropriate training is needed to equip volunteers with the necessary knowledge and skills to provide effective support. Particular emphasis in the training focused upon developing the necessary interpersonal skills and self-confidence. The evaluation of the training programme demonstrated that it improved volunteers’ knowledge and reported confidence. The provision of ongoing support is also essential to maintain volunteers’ interest and enthusiasm. The retention of volunteers is, however, a key challenge.

The processes outlined in this paper have demonstrated the feasibility of successfully establishing, implementing and maintaining a community-based social support infant feeding programme. The experiences described provide useful insights into the practical issues that need to be addressed in setting up a social support intervention.

The purpose of this study was to investigate the prevalence of food insecurity and factors related to it among homeless and runaway adolescents.

Computer-assisted personal interviews were conducted with homeless and runaway adolescents directly on the streets and in shelters.

Interviews were conducted in eight Midwest cities: Des Moines, Cedar Rapids, Iowa City, Kansas City, Lincoln, Omaha, St. Louis and Wichita.

The subjects were 428 (187 males; 241 females) homeless and runaway adolescents aged 16–19 years. Average age of the adolescents was 17.4 (standard deviation 1.05) years.

About one-third of the adolescents had experienced food insecurity in the past 30 days. Factors associated with food insecurity were age of adolescent, a history of caretaker neglect and abuse, having ever spent time directly on the street, a small post-runaway social network, and engaging in deviant and non-deviant street food-acquisition strategies.

Based on these findings, our conservative estimate is that nationally more than 165 000 homeless and runaway adolescents experienced food insecurity in the past 30 days. These adolescents are largely hidden from public notice and they are usually missed in studies that address national hunger.

The aim of the present study was to examine the relationships between genetic susceptibility to obesity, physical activity (PA), dietary fibre, sugar and fat intakes and 4-year changes in body mass index (BMI) and attained waist circumference (WC) in a cohort of 287 monozygotic and 189 dizygotic young adult male twin pairs. Increased knowledge about interactions between genes and environment may provide insight into why some individuals are more prone to obesity than others.

Information about PA, BMI, dietary habits, WC and potential confounders was collected by questionnaire in 1998 and 2002. The cohort data were analysed by mixed linear models.

Twins with low PA attained larger WC than twins with high PA (difference 2.5 cm; 95% confidence interval (CI) 1.3, 3.6). The twins with the lowest fibre intake were found to have attained the highest WC and to have increased most in BMI (difference between highest and lowest fibre intakes: 1.6 cm, 95% CI 0.4, 2.9 and 0.45 kg m−2, 95% CI 0.15, 0.76, respectively). Furthermore, our results suggested the presence of interactions so that twins with genetic susceptibility to obesity were more prone to have larger WC if sedentary than twins without genetic susceptibility.

PA and a diet rich in fibre may be protective against weight gain among younger adult men. An interaction between PA, genes and attained WC is a novel finding which needs confirmation by other studies.

To identify the extent of food insecurity (defined as running out of food in the last 12 months and being unable to afford to buy more) amongst older Australians, and the characteristics of those who experience this condition.

Cross-sectional population survey.

Respondents (n = 8881) were community-dwelling older people (65 years and older) living independently in New South Wales, Australia, randomly sampled to participate in a computer-assisted telephone interview conducted during 1999–2000. The response rate was 71%. Responses to a food insecurity questionnaire item were collected along with sociodemographic information, living arrangements, lifestyle and self-rated health. Univariate analyses and logistic regression modelling of factors for reporting food insecurity were conducted.

Approximately one in 50 older people reported experiencing food insecurity in the previous 12 months attributable to inadequate finances. The analyses revealed that those at risk can be identified as more likely to report poorer health, limited financial resources, not owning their own home and living alone. Gender and age differences were also evident.

While only a minority of older Australians reported experiencing food insecurity attributable to inadequate finances, such people are at higher risk of malnutrition and associated morbidity. Food insecurity is an important public health and equity issue in older people that can be addressed through implementing appropriate income and social support policies.

To describe the infant feeding practices and attitudes of women who used prevention of mother-to-child transmission of HIV (PMTCT) services in rural Zimbabwe.

A cross-sectional study including structured interviews and focus group discussions was conducted between June 2003 and February 2004.

The study took place in Murambinda Mission Hospital (Buhera District, Manicaland Province), the first site offering PMTCT services in rural Zimbabwe.

The interviews targeted HIV-infected and HIV-negative women who received prenatal HIV counselling and testing and minimal infant feeding counselling, and who delivered between 15 August 2001 and 15 February 2003. The focus groups were conducted among young and elderly men and women.

Overall, 71 HIV-infected and 93 HIV-negative mothers were interviewed in clinics or at home. Most infants (97%) had ever been breast-fed. HIV-negative mothers introduced fluids/foods other than breast milk significantly sooner than HIV-infected mothers (median 4.0 vs. 6.0 months, P = 0.005). Infants born to HIV-negative mothers were weaned significantly later than HIV-exposed infants (median 19.0 vs. 6.0 months, P = 10−5). More than 90% of mothers reported that breast-feeding their infant was a personal decision, a third of whom also mentioned having taken into account health workers' messages.

The HIV-infected mothers interviewed were gradually implementing infant feeding practices recommended in the context of HIV. Increased infant feeding support capacity in resource-limited rural populations is required, i.e. training of counselling staff, decentralised follow-up and weaning support.

To assess the efficacy of the Food and Agriculture Organization's global school-based nutrition education initiative, Feeding Minds, Fighting Hunger (FMFH), in improving nutrition-related knowledge levels of schoolchildren.

Adopting the cluster randomisation technique, five schools each in experimental and control groups were randomly chosen from the member schools of a voluntary organisation. Repeated measures of knowledge levels were carried out at three points in time to assess pre-, post-intervention and retention of knowledge gained during the intervention. Children from experimental schools were given nutrition education by teachers in the classroom setting using FMFH material.

Schoolchildren (n = 358 in the control group and n = 312 in the experimental group) of grades VIII and IX from schools in Hyderabad, India.

The classroom-based intervention resulted in a significant improvement (P < 0.01) in nutrition knowledge levels of schoolchildren in the experimental group. Significant improvement in knowledge was also observed in the control group. The effect size indicated that the improvement in knowledge levels of schoolchildren in experimental schools over control schools was medium (d = 0.40), indicating the efficacy of the FMFH programme in improving nutrition-related knowledge. No significant decrease (P>0.05) in knowledge levels was observed after 2 months, indicating retention of the knowledge acquired through the intervention.

The FMFH programme provides an opportunity for schoolchildren to learn more about nutrition through their teachers in a classroom setting if the lesson plans are adapted to the local circumstances. Furthermore, it has the potential to make nutrition education interactive, effective and sustainable.

We examined associations between two Mediterranean diet (MD) adherence indexes (the MD index, MDI, and the MD score, MDS) and several blood biomarkers of diet and disease.

We studied 328 individuals from Catalonia (Northeastern Spain), ages 18–75, who provided fasting blood samples, a subset of the 2346 individuals as part of a larger representative and random sample from the 1992–1993 Catalan Nutritional Survey.

Diet was measured using 24-h recalls. Biomarkers studied were plasma levels of β-carotene, α-tocopherol, retinol, vitamins B12, C and folates as well as serum total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides. Multivariate linear regression was used to analyse associations of the nutrient biomarkers with the dietary pattern indexes, adjusting for potential confounders.

Subjects with higher MD adherence, as measured by the two dietary indexes, had significantly higher plasma concentrations of β-carotene, folates, vitamin C, α-tocopherol and HDL cholesterol. The most highly significant relationship was that between folates and the adherence to the MD Pattern, as determined by both indexes.

These research findings suggest the potential usefulness of biomarkers as complementary tools for assessing adherence to a dietary pattern. This type of data not only informs the development of robust dietary adherence indexes, but it also provides specific clues about the potential physiological mechanisms that explain the beneficial effects of the MD pattern on chronic disease risk.

There is increasing evidence for a significant effect of processed meat (PM) intake on cancer risk. However, refined knowledge on how components of this heterogeneous food group are associated with cancer risk is still missing. Here, actual data on the intake of PM subcategories is given; within a food-based approach we considered preservation methods, cooking methods and nutrient content for stratification, in order to address most of the aetiologically relevant hypotheses.

Standardised computerised 24-hour diet recall interviews were collected within the framework of the European Prospective Investigation into Cancer and Nutrition (EPIC), a prospective cohort study in 27 centres across 10 European countries.

Subjects were 22 924 women and 13 031 men aged 35–74 years.

Except for the so-called ‘health-conscious’ cohort in the UK, energy-adjusted total PM intake ranged between 11.1 and 47.9 g day−1 in women and 18.8 and 88.5 g day−1 in men. Ham, salami-type sausages and heated sausages contributed most to the overall PM intake. The intake of cured (addition of nitrate/nitrite) PM was highest in the German, Dutch and northern European EPIC centres, with up to 68.8 g day−1 in men. The same was true for smoked PM (up to 51.8 g day−1). However, due to the different manufacturing practice, the highest average intake of NaNO2 through PM consumption was found for the Spanish centres (5.4 mg day−1 in men) as compared with German and British centres. Spanish centres also showed the highest intake of NaCl-rich types of PM; most cholesterol- and iron-rich PM was consumed in central and northern European centres. Possibly hazardous cooking methods were more often used for PM preparation in central and northern European centres.

We applied a food-based categorisation of PM that addresses aetiologically relevant mechanisms for cancer development and found distinct differences in dietary intake of these categories of PM across European cohorts. This predisposes EPIC to further investigate the role of PM in cancer aetiology.