The aim of this study was to determine the practices of primary health care (PHC) nurses in targeting nutritionally at-risk infants and children for intervention at a PHC facility in a peri-urban area of the Western Cape Province of South Africa.

Nutritional risk status of infants and children < 6 years of age was based on criteria specified in standardised nutrition case management guidelines developed for PHC facilities in the province. Children were identified as being nutritionally at-risk if their weight was below the 3rd centile, their birth weight was less than 2500 g, and their growth curve showed flattening or dropping off for at least two consecutive monthly visits. The study assessed the practices of nurses in identifying children who were nutritionally at-risk and the entry of these children into the food supplementation programme (formerly the Protein–Energy Malnutrition Scheme) of the health facility. Structured interviews were conducted with nurses to determine their knowledge of the case management guidelines; interviews were also conducted with caregivers to determine their sociodemographic status.

One hundred and thirty-four children were enrolled in the study. The mean age of their caregivers was 29.5 (standard deviation 7.5) years and only 47 (38%) were married. Of the caregivers, 77% were unemployed, 46% had poor household food security and 40% were financially dependent on non-family members. Significantly more children were nutritionally at-risk if the caregiver was unemployed (54%) compared with employed (32%) (P = 0.04) and when there was household food insecurity (63%) compared with household food security (37%) (P < 0.004). Significantly more children were found not to be nutritionally at-risk if the caregiver was financially self-supporting or supported by their partners (61%) compared with those who were financially dependent on non-family members (35%) (P = 0.003). The weight results of the nurses and the researcher differed significantly (P < 0.001), which was largely due to the different scales used and weighing methods. The researcher's weight measurements were consistently higher than the nurses' (P < 0.00). The researcher identified 67 (50%) infants and children as being nutritionally at-risk compared with 14 (10%) by the nurses. The nurses' poor detection and targeting of nutritionally at-risk children were largely a result of failure to plot weights on the weight-for-age chart (55%) and poor utilisation of the Road to Health Chart.

Problems identified in the practices of PHC nurses must be addressed in targeting children at nutritional risk so that appropriate intervention and support can be provided. More attention must be given to socio-economic criteria in identifying children who are nutritionally at-risk to ensure their access to adequate social security networks.

Iron has been suggested to play a role in the development of cardiovascular disease (CVD) through its pro-oxidant properties. However, epidemiological studies on iron status and the risk of CVD have yielded conflicting results. We therefore carried out a prospective study to evaluate the relationship between iron status and CVD in a middle-aged French population.

In total, 9917 subjects (3223 men aged 45–60 years and 6694 women aged 35–60 years) included in the SU.VI.MAX (SUpplementation en VItamines et Minéraux AntioXydants) cohort were followed prospectively for 7.5 years. All cases of ischaemic heart disease (IHD) were identified and validated. CVD risk factors, haemoglobin and serum ferritin concentrations were measured at baseline.

Of men 4.3%, and of women 37.8%, presented at baseline a serum ferritin concentration <30 μg l−1. During the follow-up, 187 subjects (148 men, 39 women) developed IHD. Serum ferritin was positively associated with total cholesterol, serum triglycerides, systolic and diastolic blood pressure, body mass index and haemoglobin. No linear association was found between serum ferritin and IHD risk in men or in women.

Our data do not support a major role of iron status in the development of IHD in a healthy general population.

To investigate the determinants of overweight and obesity among 10- to 15-year-old schoolchildren in a population in the transitional phase in the North West Province of South Africa.

A cross-sectional survey was used to investigate weight status (anthropometric indicators) and determinants of overweight/obesity including dietary intake, physical activity and socio-economic status. A single, random sample (n=1257), stratified for gender, type of school and ethnic group, was used. Data were collected on demographics, family circumstances, habitual physical activity, dietary intake and anthropometry to evaluate weight status and body fat content. One-way analysis of variance, the generalised linear models procedure of SAS and the Tukey post hoc honest significant difference test were used to analyse the data.

Few children were overweight or obese (7.8%) according to International Obesity Task Force (IOTF) standards (body mass index (BMI)-for-age). These standards were compared with other accepted standard values. Both Cole's IOTF/BMI-for-age standard and the sum of skinfold thicknesses standard classified normal-weight status similarly at a level of 92% (P<0.01) and were found to be useful in determining overweight/obesity. The prevalence rate was higher in females and white children, and was more apparent in urban areas, smaller households and children of parents with low- or high-income occupations. Boys and pre-menarcheal girls had mean body fat percentage in the normal/optimal range, whereas that of post-menarcheal girls was moderately high. Few variables showed a significant association with high body fat percentage: in boys, only the number of members in the household and physical activity levels over the weekend; in girls, only age. The overweight/obese boys mostly lived in smaller households, and the overweight/obese post-menarcheal girls were most inactive on both weekdays and weekends, and more overweight with increasing age.

Smaller households, inactivity and increasing age for girls were found to be determinants that influence the development of overweight/obesity, while female gender and age post-menarche were identified as determinants of higher body fat content. For overweight/obesity prevention, the focus should be on pre-menarcheal girls, aged 10–13 years, using these determinants to identify overweight/obesity risk. Preventive programmes should aim to increase the physical activity of children to improve their current and future weight status.

Cross-sectional studies have suggested an association between glycaemic index (GI) or glycaemic load (GL) and serum lipids. However, no prospective studies have been performed.

To examine whether GI or GL was associated with subsequent changes in serum lipids.

Prospective study with 6 years of follow-up. Overall dietary GI and GL of each participant were assessed from diet history interviews.

Population-based study.

Three hundred and thirty-five healthy men and women aged 35–65 years selected randomly from a larger sample of Danish adults.

In men GI was directly related to changes in total cholesterol (ΔTC), regression coefficient (β) = 0.0044 (95% confidence interval (CI): 0.0008–0.0081) and GL was positively related to changes in low-density lipoprotein cholesterol (ΔLDL), β = 0.1554 (95% CI: 0.0127–0.2982). Furthermore, the relationship between GL and ΔTC was modified by age, being particularly strong for the younger men (P = 0.02). In women the relationship between GI and ΔLDL was modified by age and was stronger for younger rather than older women (P = 0.01). A tendency for a similar interaction was seen for GI and ΔTC (P = 0.09). Associations between GL and ΔLDL and GL and ΔTC were inverse for women with body mass index ≥ 30 kg m−2 (P = 0.03 and 0.04, respectively).

This is the first study to demonstrate that dietary GI and GL are related to 6-year changes in serum lipid levels. However, associations were weak and generally confined to subgroups.

The association of alcohol and fibre intake with breast cancer may be mediated by circulating sex hormone levels, which are predictors of breast cancer risk.

To evaluate the relationship of alcohol and dietary fibre intake with circulating sex hormone levels among premenopausal women.

A total of 205 premenopausal women completed a validated food-frequency questionnaire at baseline and after 2 years; blood samples taken at the same time were analysed for circulating sex hormone concentrations, including oestrone (E1), oestradiol (E2), free E2, progesterone, androstenedione and sex hormone-binding globulin, by radioimmunoassay. We used mixed models to estimate least-square means of sex hormone concentrations for alcohol intake categories and quartiles of dietary intake.

After adjustment for covariates, alcohol consumption was moderately associated with higher circulating oestrogen levels; those who consumed more than one drink per day had 20% higher E2 (Ptrend = 0.07) levels than non-drinkers. In contrast, higher dietary fibre intake was associated with lower serum levels of androstenedione (−8% between the lowest and highest quartiles of intake, Ptrend = 0.06), but not oestrogens. Similarly, consumption of fruits (−12%, Ptrend = 0.03), vegetables (−9%, Ptrend = 0.15) and whole grains (−7%, Ptrend = 0.07) showed inverse associations with androstenedione levels.

The consistency of the observed differences in sex hormone levels associated with alcohol and fibre-rich foods indicates that these nutritional factors may affect sex hormone concentrations and play a role in breast cancer aetiology and prevention.

Several environmental factors influence adolescents' food habits and television (TV) viewing is thought to be one of these factors. The purpose of the present study was to describe sociodemographic differences in TV viewing and to examine associations of TV viewing with the consumption of sweets, soft drinks, fruit and vegetables in different countries.

Data were collected from 162 305 young people completing the 2001/02 Health Behaviour in School-Aged Children survey, a World Health Organization cross-national study on health and health behaviours among 11–, 13– and 15–year-old school pupils. Analyses of variance were used to examine sociodemographic differences in TV viewing and logistic regression analyses to examine associations between TV viewing and food habits.

Large differences were found between countries in reported daily TV viewing time, from an average of 2.0 h in Switzerland to 3.7 h in Ukraine. The results indicate that those most likely to watch TV are boys, 13-year-olds and pupils of lower socio-economic status. Those who watched more TV were more likely to consume sweets and soft drinks on a daily basis and less likely to consume fruit and vegetables daily, although the latter associations were not so apparent among Central and Eastern European countries.

Given the high TV viewing rates among adolescents and the association with less healthy food options, many young people are at increased risk of overweight or obesity. Interventions to modify TV viewing behaviour are needed. The findings underscore the importance of tackling socio-economic differences.

The relation between several measures of body iron and atherosclerotic disease, particularly acute myocardial infarction (AMI), is debated. This is of specific interest since iron is frequently included in supplementation and fortification of foods. We assessed the relation between dietary iron intake and the risk of non-fatal AMI.

Case–control study. The information was collected by interviewers using a food-frequency questionnaire tested for validity and reproducibility. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were obtained by multiple unconditional logistic regression models, including terms for energy and alcohol intakea, as well as for sociodemographic factors, tobacco and other major recognised risk factors for AMI.

Milan, Italy, between 1995 and 1999.

Cases were 507 patients, below age 79 years, with a first episode of non-fatal AMI, and controls were 478 patients admitted to hospital for a wide spectrum of acute conditions unrelated to known or potential AMI risk factors.

Compared with patients in the lowest tertile of total iron intake, the OR was 0.48 (95% CI 0.29–0.82) for those in the highest tertile. The corresponding value for haem iron was 0.71 (95% CI 0.48–1.06), for non-haem, non-alcohol iron was 0.80 (95% CI 0.51–1.24) and for iron derived from alcoholic beverages was 0.60 (95% CI 0.40–0.90). Sex-specific OR for total iron intake were not heterogeneous.

In this Italian population dietary iron intake was inversely related to AMI risk. This inverse association may depend on other nutrients present in the major sources of iron in the Italian diet.

The aim of the present paper is to describe the development of the National Plan of Action for Food and Nutrition (NPAFN) for Turkey.

Access to a safe and healthy variety of food, a fundamental human right, was stressed by the International Conference on Nutrition and by the World Food Summit. In the International Conference on Nutrition in December 1992, one major commitment was the preparation of NPAFN. The NPAFN for Turkey was designed according to this commitment.

Turkey.

To this end, under the coordination of the State Planning Organization, a Working Committee Report for National Food and Nutrition Strategy of Turkey was prepared and published, with the participation of different sectors. The goal of the prepared National Food and Nutrition Strategy for Turkey is to protect and promote health through and healthy nutrition and reduce the burden of diseases, while contributing to socio-economic development and a sustainable food security.

In Turkey the NPAFN was developed and implementation has initiated. Nearly for all the actions, related projects are being developed.

In recent decades, the prevalence of non-communicable diseases (NCDs), such as obesity, diabetes and cardiovascular disorders has increased worldwide; the objective here is to describe the situation in southern Mediterranean countries.

Data derived from surveys in the region countries showed that in 2002 more than 60% of all deaths in the southern Mediterranean region are attributed to NCDs. Cardiovascular diseases (CVD) caused from about 34.3 to 52% of all deaths, making it the major killer among NCDs. In almost all of the southern Mediterranean countries, CVD risk factors increased with age, affected more women and urban area and were significantly associated with obesity. The Mediterranean dietary pattern, generally recognised, as a healthy diet is still the model for southern Mediterranean population; however, following the rapid process of urbanisation, southern Mediterranean populations have changed their lifestyle and food habits and tend to shift from traditional food habit. Indeed, intake trends illustrate the fall in whole-grain intake with a rise in animal sources and vegetable oils. Dietary energy has been steadily increasing by approximately 1000 kcal per capita per day between 1965 and 2000, exceeding per caput energy requirements. Protein and carbohydrate contribution to the energy intake show only small deviations and fat contribution to the energy intake is low, whereas fibre intake is generally low and that of SFA is high. Also, sedentarity appears to play a critical role in the development of body fat and may be a risk indicator for features of metabolic syndrome.

The major goal to prevent CVD should begin by preventing obesity through physical exercise and healthy nutrition. The nutritional prevention policy required should encourage population to adhere to the Mediterranean model.

Our objective in this paper is to assess diets in the European Union (EU) in relation to the recommendations of the recent World Health Organization/Food and Agriculture Organization expert consultation and to show how diets have changed between 1961 and 2001.

Computations make use of FAOSTAT data on food availability at country level linked to a food composition database to convert foods to nutrients. We further explore the growing similarity of diets in the EU by making use of a consumption similarity index. The index provides a single number measure of dietary overlap between countries.

The data confirm the excessive consumption by almost all countries of saturated fats, cholesterol and sugars, and the convergence of nutrient intakes across the EU. Whereas in 1961 diets in several European countries were more similar to US diets than to those of other European countries, this is no longer the case; moreover, while EU diets have become more homogeneous, the EU as a whole and the USA have become less similar over time.

Although the dominant cause of greater similarity in EU diets over the period studied is increased intakes in Mediterranean countries of saturated fats, cholesterol and sugar, also important are reductions in saturated fat and sugar in some Northern European countries. This suggests that healthy eating messages are finally having an impact on diets; a distinctly European diet may also be emerging.

Breast cancer mortality and incidence rates in the Canary Islands, and particularly in Gran Canaria, are higher than those in the rest of Spain.

A case–control study was designed to assess the role of differential fatty acid intakes and olive oil consumption on breast cancer risk in the Canary Islands. The study was conducted between 1999 and 2001, including a total of 755 women: 291 incident cases with confirmed breast cancer and 464 controls randomly selected from the Canary Island Nutrition Survey (ENCA). A semi-quantitative food-frequency questionnaire was completed and potential confounders were adjusted using unconditional logistic regression.

Compared to the first quintile of intake, the highest quintile of monounsaturated fat intake was significantly related to a lower risk of breast cancer (odds ratio = 0.52; 95% CI 0.30–0.92). Regarding olive oil, the odds ratio for women in the three upper quintiles of consumption (≥8.8 g/day) was 0.27 (95% CI 0.17–0.42).

Our results support the protective role of olive oil consumption on breast cancer among Canaries women.

Analyse the importance of components of Mediterranean diet in functional feeding.

We have based the study in a bibliographic review.

Many of the characteristic components of the traditional Mediterranean diet (MD) are known to have positive effects on health, capacity and well-being, and can be used to design functional foods. Vegetables, fruits and nuts are all rich in phenols, flavonoids, isoflavonoids, phytosterols and phytic acid—essential bioactive compounds providing health benefits. The polyunsaturated fatty acids found in fish effectively regulate haemostatic factors, protect against cardiac arrhythmias, cancer and hypertension, and play a vital role in the maintenance of neural functions and the prevention of certain psychiatric disorders. Accumulating evidence suggests that olive oil, an integral component of the MD, may have health benefits, including the reduction of the risk of coronary heart disease, the prevention of several types of cancer and the modification of the immune and inflammatory responses. Olive oil is known for its high levels of monounsaturated fatty acids and is a good source of phytochemicals, such as polyphenolic compounds, squalene and α-tocopherol.

In the context of the MD, the benefits associated with the consumption of several functional components may be intensified by certain forms of food preparation. In addition, the practice of more physical activity (once common among Mediterranean populations) and the following of other healthy lifestyle habits may have additive effects.

The identification of the active constituents of the MD is crucial in the formulation of appropriate dietary guidelines. Research into the pharmacological properties of the minor components of this diet (vitamins, sterols, polyphenols, etc.) is very active and could lead to the formulation of functional foods and nutraceuticals.

The mechanisms underlying the association of insulin-like growth factor-I (IGF-I) and leg length (a marker of prepubertal growth) with cancer risk are uncertain. One hypothesis is that diet in early childhood might provide the link. The aim of the present study was to examine the association between early diet – in particular, the intakes of cows' milk and dairy products – and height, leg length and IGF-I levels at age 7–8 years.

Children participating in the Avon Longitudinal Study of Parents and Children.

Diet was assessed using a 3-day unweighed food record. Anthropometry, IGF-I and insulin-like growth factor-binding protein-3 (IGFBP-3) were measured by standard methods.

Data on both diet and height were available for 744 children (404 boys) and on diet and IGF for 538 (295 boys). After adjusting for energy, both cows' milk and dairy product intakes were positively associated with IGF-I (P=0.040 and 0.027, respectively) and IGFBP-3 levels (P=0.082 and 0.067, respectively). These associations persisted on adjustment for potential confounders, but were abolished on controlling for protein intake. In energy-adjusted models there was only weak evidence of associations of milk and dairy product intakes with anthropometry. In boys only, dairy product intake was positively associated with leg length (equivalent to a 0.058 (0.002, 0.114) standard deviation score increase in leg length per 100 g increase in daily intake).

These data provide some evidence that variation in childhood milk and dairy product intakes underlies associations of leg length, IGF-I and cancer risk. The association appears to be due to the protein content of milk.

To examine the association between fish consumption and stroke risk.

Prospective population cohort study.

Norfolk, UK cohort of the European Prospective Investigation into Cancer (EPIC–Norfolk).

Subjects were 24 312 men and women aged 40–79 years who had no previous history of stroke at baseline.

Fish consumption was assessed using a food-frequency questionnaire at baseline in 1993–1997 and stroke incidence ascertained to 2004.

A total of 421 incident strokes were identified (mean follow-up=8.5 years, total person-years=209 238). There were no significant relationships between total fish, shellfish or fish roe consumption and risk of stroke in men and women after adjusting for age, systolic blood pressure, body mass index, smoking, cholesterol, diabetes, physical activity, alcohol consumption, fish oil supplement use and total energy intake using Cox regression analyses. Oily fish consumption was significantly lower in women who subsequently had a stroke (odds ratio (OR) for consumers vs. non-consumers=0.69, 95% confidence interval (CI) 0.51–0.94, P=0.02). The trend in men was similar but not significant (OR for consumers vs. non-consumers=0.88, 95% CI 0.65–1.19, P=0.41).

There was no consistent relationship between fish consumption and stroke in this British population. Inconsistencies in the observed health effects of fish consumption in different populations may reflect different patterns and type of fish consumed and preparation methods.

To examine the influence of individual- and area-level socio-economic characteristics on food choice behaviour and dietary intake.

The city of Eindhoven in the south-east Netherlands.

A total of 1339 men and women aged 25–79 years were sampled from 85 areas (mean number of participants per area = 18.4, range 2–49). Information on socio-economic position (SEP) and diet was collected by structured face-to-face interviews (response rate 80.9%). Individual-level SEP was measured by education and household income, and area-level deprivation was measured using a composite index that included residents' education, occupation and employment status. Diet was measured on the basis of (1) a grocery food index that captured compliance with dietary guidelines, (2) breakfast consumption and (3) intakes of fruit, total fat and saturated fat. Multilevel analyses were performed to examine the independent effects of individual- and area-level socio-economic characteristics on the dietary outcome variables.

After adjusting for individual-level SEP, few trends or significant effects of area deprivation were found for the dietary outcomes. Significant associations were found between individual-level SEP and food choice, breakfast consumption and fruit intake, with participants from disadvantaged backgrounds being less likely to report food behaviours or nutrient intakes consistent with dietary recommendations.

The findings suggest that an individual's socio-economic characteristics play a more important role in shaping diet than the socio-economic characteristics of the area in which they live. In this Dutch study, no independent influence of area-level socio-economic characteristics on diet was detected, which contrasts with findings from the USA, the UK and Finland.

To investigate the relationships of two main physical activity domains (during leisure and at work) with cardiovascular risk factors and eating habits.

Cross-sectional study.

Preventive medicine centre.

In 5478 adults (32% women, aged 20–80 years) who consecutively underwent a standardised health examination, leisure-time physical activity (LTPA; i.e. non-sport leisure and sport activities), occupational physical activity (OPA) and eating habits were assessed by self-administered questionnaires. We analysed sex-specific relationships of LTPA and OPA (in quartiles) with (1) various cardiovascular risk factors and (2) eating habits using analysis of variance and logistic regression, respectively.

In both genders, with and without adjustment for education in addition to age, LTPA was associated negatively with body mass index, body fat, waist circumference, resting heart rate, diastolic blood pressure and triglycerides, and positively associated with high-density lipoprotein cholesterol (all P ≤ 0.005). OPA adjusted for age only was positively associated with most cardiovascular risk factors but these associations were not significant after further adjustment on education (except for waist circumference in women). Age- and education-adjusted LTPA was associated with increased frequency of consumption of fruits (odds ratio (OR) = 2.05, 95% confidence interval (CI) 1.68–2.52 in men; OR = 1.90, 95% CI 1.41–2.05 in women) and vegetables (OR = 1.81, 95% CI 1.48–2.21 in men; OR = 2.22, 95% CI 1.66–2.97 in women).

The data emphasise the favourable associations of LTPA, a modifiable behaviour, with various cardiovascular risk factors and healthy eating habits. The results also suggest that the relationships of OPA with cardiovascular risk factors depend, at least in part, on socio-economic status as reflected by educational level.

To conduct a policy review of the regulations related to food advertising on television aimed at children.

The study consisted of documentary analysis of relevant legislation and policy documents related to children's advertising from both industry and non-governmental organisations at a global level and in 20 countries. This was supported with semi-structured telephone interviews with individuals from 11 countries.

The initial findings resulted in a listing of regulatory impacts from which we developed a taxonomy of regulatory schemes. There was a tension between the development of legislation to cover this area and the use of voluntary agreements and codes. This tension represents a food industry/civic society split. The food and advertising industries are still engaged in a process of denying the impact of advertising on food choice and children as well as commissioning their own research. Outright bans are unusual, with most countries addressing the situation through voluntary agreements and self-regulation. We found a deep division over the way forward and the role and place of legislation. Policy-makers expressed concerns that national legislation was increasingly less relevant in dealing with broadcast media transmitted from outside national boundaries and therefore not subject to the receiving countries' laws but to the laws of the country from which they were transmitted.

The options for the regulation of advertising targeted at children range from (1) a complete ban on advertising as in the case of Sweden, through (2) partial restrictions on advertising by type of food, target group or limits on the amount of advertisements or times shown, to (3) continuation of self-regulation by the advertising and food industries. There is a global dimension to regulation that needs to be built in, as national frontiers are no barriers to broadcast media and public health nutrition needs to ensure that its concerns are heard and addressed.

To understand the role of women's input into household decisions as a possible factor contributing to women's undernutrition in settings where HIV/AIDS and drought have constrained household resources.

Three cross-sectional surveys of non-pregnant women in partnerships without a birth in the last 3 months were analysed. Factors associated with chronic energy deficiency (CED), defined as body mass index of < 18.5 kg m−2, were assessed among 1920 women in Zimbabwe, 2870 women in Zambia and 6219 women in Malawi.

Prevalence of CED was 4.2% in Zimbabwe, 13.5% in Zambia and 6.7% in Malawi. In Malawi, women with less input into decisions were more likely to have CED. After multivariable adjustment, each additional decision made by the partner increased the odds of CED in Malawi by 1.08 (95% confidence interval (CI) 1.02–1.15); each additional decision made by the woman decreased the odds of CED by 0.90 (95% CI 0.88–0.97). Malawian women with all the final say or with partners with no final say had significantly more CED than expected (odds ratio (OR) = 2.88, 95% CI 1.42–5.83 and OR = 1.64, 95% CI 1.06–2.52, respectively), and removing these points increased the magnitude and significance of the linear trends. In Zambia, the relationship was found for urban women only and no associations were found in Zimbabwe.

Input into household decisions may be a key factor in the cycle of drought and CED. Women with both low input and CED may lose productive capacity, putting them at greater risk of food insecurity and potentially HIV/AIDS in high prevalence settings.