To develop and map indices to illustrate variation in the cost and availability of healthy food.

Two contiguous wards in London were selected by virtue of their high Carstairs deprivation scores. A 2-km area was defined around a randomly chosen central point. All retail outlets selling food within the area were visited and their location recorded. A list of foods, acceptable to the local ethnically diverse population, which met current dietary guidelines, was devised. Data on the availability and price of 71 food items were collected. Indices were developed using SPSS and mapped using Geographic Information System (GIS) software.

Information on availability and prices were collected from 199 outlets. The mean price index shows how expensive a shop is relative to other shops in the area. The least cost index shows the relative expense of a shop using the cheapest ways of buying their range of foods. Shorthand indices were tested, using data on 19 of the 71 prices. Availability indices are also discussed, including a green availability index and a fresh green availability index. Illustrative maps of the shop locations and the mean price index and fresh green availability index are shown.

Data can be collected and indices developed which indicate geographic variation in shop ‘expensiveness’, and in the price and availability of healthy food. GIS software can be used to map these indices, to identify areas with high food prices or low availability.

To explore the utility of cluster analysis in defining complex dietary exposures, separately with two types of variables.

A modified diet history method, combining a 7-day menu book and a 168-item questionnaire, assessed dietary habits. A standardized questionnaire collected information on sociodemographics, lifestyle and health history. Anthropometric information was obtained through direct measurements. The dietary information was collapsed into 43 generic food groups, and converted into variables indicating the per cent contribution of specific food groups to total energy intake. Food patterns were identified by the QUICK CLUSTER procedure in SPSS, in two separate analytical steps using unstandardized and standardized (Z-scores) clustering variables.

The Malmö Diet and Cancer (MDC) Study, a prospective study in the third largest city of Sweden, with baseline examinations from March 1991 to October 1996.

A random sample of 2206 men and 3151 women from the MDC cohort (n=28098).

Both variable types produced conceptually well separated clusters, confirmed with discriminant analysis. ‘Healthy’ and ‘less healthy’ food patterns were also identified with both types of variables. However, nutrient intake differences across clusters were greater, and the distribution of the number of individuals more even, with the unstandardized variables. Logistic regression indicated higher risks of past food habit change, underreporting of energy and higher body mass index (BMI) for individuals falling into ‘healthy’ food pattern clusters.

The utility in discriminating dietary exposures appears greater for unstandardized food group variables. Future studies on diet and cancer need to recognize the confounding factors associated with ‘healthy’ food patterns.

To investigate the effects of currency devaluation on dietary change and nutritional vulnerability of poor households in two African capital cities.

A qualitative study based on 120 semistructured individual interviews and four focus group discussions in each city.

Dakar, Senegal (western Africa) and Brazzaville, Congo (central Africa).

All of the subjects were randomly selected women from modest or poor households, who spoke the local common language and were responsible for household meal preparation. Only those likely to restrict the dynamic of focus group discussions (because of language, age or education) were excluded.

Changes were found in meal preparation characteristics (frequency, sharing pattern) and meal composition. There was frequent depletion of fat and vegetable contents in meals, frequent elimination of desserts and even the elimination of one daily meal. These changes specifically affected economically disadvantaged and socially isolated households, and those headed by women. Other changes were the reduction in the size of consumption units and the development of neighbourhood-specific street food – which has been a growing trend in Brazzaville since the outset of the economic crisis but is more recent in Dakar.

If lasting, these changes pose a dual health risk, i.e. reducing dietary diversity and altering the bacteriological quality of prepared meals. In addition, attempts to reduce the consumption units were found to upset community ties that bind these societies.

To evaluate the impact of nutrition education promoting lower dietary fat on the overall diet quality in children using a multidimensional index that measures nutrient and food intakes in relation to US dietary recommendations.

Prospective cohort study with two intervention and two control groups. Children with elevated low density lipoprotein (LDL) cholesterol were randomized to one of two intervention groups or an at-risk control group. The intervention children received either the parent–child autotutorial (PCAT) programme, a 10-week home-based self-instruction nutrition education programme, or nutrition counselling from a registered dietitian. Children with non-elevated plasma cholesterol formed the not-at-risk control group. Dietary and blood data were collected at baseline and at 3 months.

Paediatric practices in suburbs north of Philadelphia, PA.

Two hundred and twenty-seven 4–10-year-old children with elevated LDL cholesterol between the 80th and 98th percentiles, and 76 age- and gender-matched children with non-elevated plasma cholesterol, were studied.

Children who received PCAT or counselling significantly improved their overall diet quality (−0.6 and −0.4 change in diet quality index (DQI) scores) compared with at-risk control children. Children who received either form of nutrition education were more likely to meet the recommendations for three components of the DQI (total fat, saturated fat, sodium) (OR <1.7), but did not improve their intakes of three components of the DQI (vegetables and fruits, complex carbohydrates, calcium) at 3 months.

Nutrition education promoting lower dietary fat improved children's overall diet quality. However, several dietary behaviours important for long-term health remained unchanged.

To assess weight perceptions, weight concerns and weight control behaviours and related beliefs in a representative sample of adults.

Cross-sectional postal survey.

The survey was conducted between October and December 1997 in the state of Victoria, Australia.

A total of 2500 subjects were selected at random from the Australian electoral roll; 900 provided usable responses.

At the time of the survey, 2.7% of respondents were trying to gain weight, 26.6% were trying to avoid gaining weight, 22.9% were trying to lose weight and 47.9% were not doing anything for their weight. Men (47.2%) were less likely than women (55.3%) to be attempting any form of weight control. Watching the type of food eaten (95.6%), reducing dietary fat intake (87.3%) and engaging in physical activity or exercise (84.4%) were the most common weight control strategies used. Potentially harmful strategies, such as self-induced vomiting and smoking, were used by relatively few respondents. Many adults believed that vigorous activity (26.8%) and total omission of fat from the diet (35.3%) are necessary in order to lose weight.

Attempts at weight control are common in the community. However, many men, including men who are already overweight, appear to be unconcerned about their weight. Obesity prevention initiatives should attempt to influence individuals' weight-related beliefs and behaviours, as well as seeking to change policies and environments to better support weight control.

Extracts of St. John's wort have been widely used in the treatment of depression. Our aim was to review information related to the efficacy and safety of St. John's wort as an antidepressant.

Primary and review articles were identified by a search of Medline (1960 to February 2000) and through secondary sources.

All the articles identified from the data sources were evaluated and all relevant information was included in this review. The pharmacokinetics, mechanism of action, efficacy, side effects and drug interactions of St. John's wort have been examined in various studies.

St. John's wort is a promising investigational antidepressant, but the data are not yet sufficient to accept hypericum as a first line antidepressant preparation for treatment of depression. Besides the need for dose standardization and adequate trial lengths, there is a need for studies in severely depressed patients and long-term studies to assess the risk of relapse and recurrence.

The purpose of this study was to measure the reported use of nutrition information on food labels by a population of university students and to determine if label users differed from non-users in terms of gender and specific beliefs related to label information and diet–disease relationships, specifically fat and heart disease and fibre and cancer.

A single-stage cluster sampling technique was used. Data was obtained using a self-administered, validated questionnaire.

The present investigation took place at the University of Saskatchewan, Canada in the autumn of 1997.

A total of 553 students in randomly selected classes in the College of Arts and Science took part in the survey (92% response rate). The sample consisted of roughly equal numbers of males and females, most between the ages of 18 and 24.

There were approximately equal numbers of label users and non-users among males, while label users outnumbered non-users by almost four to one among females. The importance of nutrition information on food labels was the only belief that differed significantly between label users and non-users for both sexes. For females, no other beliefs distinguished label users from non-users. However, for males, significant differences were found between label users and non-users on the beliefs that nutrition information is truthful and that a relationship between fibre and cancer exists.

Females appear to use food labels more often than do males. The only consistently observed difference between label users and non-users (male and female) was that users believed in the importance of nutrition information on food labels while non-users did not.

To assess the relative importance of socioeconomic and maternal/prenatal determinants of the nutritional situation of children < 6 years old in an urban African area after several years of economic crisis.

Cross-sectional cluster sample survey.

Brazzaville, capital city of the Congo.

Information on socioeconomic characteristics was gathered from a random sample of 1368 households by house visits and anthropometric measurements were performed using standardized procedures on preschool children (n=2373) and their mothers (n=1512).

The influence of socioeconomic factors on the nutritional status of children, taking into account adjustment variables such as mother's age and child's age and sex was assessed. For stunting, as well as for the mean height-for-age index among children, the main determinants were economic level of the household (P=0.048 and P=0.004, respectively), schooling of the mother (P=0.004 and P < 10−3) and living in the peripheral district (P=0.005 and P < 10−3). The influence of socioeconomic determinants on weight-for-age and wasting was less straightforward. When adjusting, in addition, for maternal and prenatal factors (mother's height and body mass index (BMI) and birth weight), most of the effects of the socioeconomic determinants on the nutritional status of children persisted somewhat, but the effect of the economic level on the stunting became not significant (P=0.11). The mean BMI of mothers appeared to be related to the economic level of the household (P < 10−4), to the marital status (P=0.01) and to the occupation of the mother (P < 10−4).

Among the socioeconomic determinants of malnutrition in children, some, such as economic level of the household or schooling of the mother, seem to act mainly through prenatal factors, whereas others, mainly dwelling district characteristics, seem to influence more directly the children's nutritional status.

To determine the nutritional status and household resources of preschool children.

A cross-sectional survey.

Two informal settlement areas, Joe Slovo (JS) and JB Mafora (JBM) in Mangaung, near Bloemfontein, South Africa.

Preschool children (<72 months) of a randomly selected sample of households in JS (experimental) (n = 162) and JBM (control) (n = 186) were included. Standard methods were used to obtain household and care-giver particulars, weight and height measurements, blood and stool samples, and 24-hour dietary recalls.

Breast-feeding and dietary intake in the two areas were nearly similar; breast-feeding was continued for 12 months and longer. Although the children's total protein intake was sufficient, their energy intake was low. A low median intake of micronutrients prevailed, including iron, zinc, calcium, niacin, riboflavin, thiamine and vitamins C, B6, A and D. The prevalence of being underweight (JS = 19.8%; JBM = 18.8%), stunted (JS = 29%; JBM = 21.5%) and wasted (JS = 6.5%; JBM = 3.7%) were fairly similar in both areas, as well as the prevalence of marginal vitamin A deficiency, anaemia, iron deficiency and parasite infestations. No significant associations could be found between household and nutritional status indicators, probably due to the small number of well-nourished children and the generally poor household situation of the participants.

The generally poor nutritional status and environmental conditions emphasize the urgency of intervention for these children.

To evaluate the errors incurred by young adults using single portion size colour food photographs to quantify foods and nutrients consumed at six meals on two non-consecutive days.

Breakfast menus remained the same for the 2 days; but lunch and dinner menus varied. The amounts of food eaten by individuals were determined by weighing individual serving dishes pre- and post-consumption. The day after eating, all foods consumed were quantified in terms of fractions or multiples of the amounts shown in the food photographs.

Thirty adult volunteers (15 male, 15 female), aged 18–36 years, completed the protocol for day one; 27 (90%) completed day two.

Some foods were more difficult to quantify accurately than others. The largest error range was −38.9% to +284.6% (cheese), whereas the smallest errors were incurred for juice (−21.5% to +34.6%, day one). All subjects who consumed muesli (day one) overestimated (+3.7% to +113.7%). No other foods were consistently over-or underestimated. For foods consumed at breakfast by the same subjects on both days, individual estimation errors were inconsistent in magnitude and/or direction. At the group level, most nutrients were estimated to within ±10% of intake; exceptions were thiamin (+10.5%, day one) and vitamin E (−10.1%, day one; −15.3%, day two). Between 63% and 80% of subjects were correctly classified into tertiles on the basis of estimated intakes.

Despite some large food quantification errors, single portion size food photographs were effective when used to estimate nutrient intakes at the group level. It remains to be established whether, under the conditions used in this study, more photographs per food would improve estimates of nutrient intake at the individual level.

To study energy and macronutrient intake in relation to dental caries incidence among urban black South African children at the ages of 1 and 5 years.

Food frequency questionnaires and WHO caries diagnostic criteria were used. The study sample of 1639 urban black children with nutrition and dental information from the 1991 and/or 1995 Birth-to-Ten (BTT) Study interceptions comprised true longitudinal (n = 259) and cross-sectional (n = 1216 for 1991 and n = 164 for 1995) subjects. For the longitudinal group true dmfs (decayed, missing, filled surfaces) incidence and average intakes of energy and macronutrients between 1991 and 1995 were calculated.

South Africa.

Median macronutrient intakes were not significantly different between the cross-sectional and longitudinal samples. Dental caries prevalences at age 1 were 1.2% and 1.5% for the cross-sectional and longitudinal samples, respectively. By age 5 these values were 60.4% and 62.2%, respectively. The median dmfs score at age 1 was 0. At 5 years this was 2 for all children and 5 for those with caries. Statistical analysis for trend at age 5 showed a significant increase in caries prevalence with increasing energy, carbohydrate and added sugar in the cross-sectional sample only. The only significant changes in dmfs scores were seen for energy and added sugar for the whole sample. The r values between log(dmfs incidence + 0.3) and the average nutrient log variables were low, and a general linear models analysis showed no statistically significant effects on log(dmfs incidence + 0.3) of any of the log nutrient variables.

For the relationship between macronutrient intake and caries (prevalence and incidence), a cross-sectional and true longitudinal study gave similar results.

This paper examines socioeconomic, demographic, epidemiological and nutrition changes that have occurred in Chile in the last decades using concepts of epidemiological and nutrition transition, and discusses policies related to nutrition.

This is a descriptive, population-based study to analyse changes in the Chilean diet and nutrition situation including some of the main demographic, socioeconomic and epidemiological variables. Data came from the FAO, the National Institute of Statistics, the Ministry of Health and national surveys.

In Chile, the epidemiological and nutrition situation shifted from a pretransition stage with high rates of undernutrition to a post-transition stage with increasing rates of obesity in all groups aged less than 20 years. However, changes were not accompanied by modifications in nutrition policy, which had been successful in reducing undernutrition. Despite changes in diet to a ‘western’ diet and in nutritional status of the population from undernutrition to obesity, food and nutrition programmes have been maintained unaltered. Governmental and university organizations were created in 1994 and 1995 to address the current food and nutrition problems. The accomplishments of these institutions have been the elaboration of dietary guidelines, reformulating the food and nutrition programmes and the promulgation of the Food Sanitary Regulations for Chile.

Education for the prevention of nutrition excess problems should be a main food and nutrition policy in developing countries.

To evaluate the long-term effects of a horticultural and nutrition education intervention in rural Tanzania.

A quasi-experimental post-test design was used.

The research was carried out in 10 villages in Singida region, Tanzania.

Mothers and their children aged 6–71 months (n = 236) from an experimental (Ilongero) and control (Ihanja) area were interviewed regarding knowledge and practices related to vitamin A nutrition. Intake of vitamin A-rich foods by the children during the 7 days prior to the interview was recorded. Stools were examined for helminths and serum samples were analysed for retinol and C-reactive protein (CRP) (n = 146) for the children aged 12–71 months.

Knowledge and practices were more favourable to vitamin A intake in the experimental area than in the control area, and an increased frequency of intake of green leaves was associated with higher serum retinol values. The experimental area had lower mean serum retinol levels (13.7 μg dl−1, n = 75) than the control area (19.3 μg dl−1, n = 71). One likely confounder was the higher helminth infestation in the experimental area (n = 75, 79%) than in the control area (n = 71, 49%) (P > 0.001). Children with helminths (n = 94) had a lower mean serum retinol level than those without (n = 52) (12.3 ± 5 vs. 24 ± 10 μg dl−1; P = 0.001).

Food-based vitamin A programmes can make sustainable improvements in knowledge and dietary practices but these may not necessarily be reflected in increases in serum retinol. Programme implementation and evaluation should take confounders into consideration as, in this case, helminth infestation.

To examine the relationship between sociodemographic factors (sex, age, education, occupation and region of birth) and absolute levels of energy, fat and fibre intake in adults at the national level.

The 1983 National Dietary Survey of Adults (NDSA), covering six Australian capital cities, collected food and nutrient intake data using the 24-hour recall method, from subjects aged 25–64 years (n = 6255).

Interactions of variables occurred, especially for males. The greatest effect on male intake of all three dietary components was a combination of age and education. For females, the main explanatory variable for fat and energy intake was age, but that for fibre was a combination of region of birth and education. Both education (alone or in combination) and region of birth (alone or in combination) had a greater effect than occupation (alone or in combination).

Energy, fat and fibre intakes vary considerably between sociodemographic groups. Such variability must be taken into account in formulating policy and planning decisions and in assessing temporal change.

To review the association between major causes of maternal mortality and vitamin A, trying to determine if these associations are causal in nature, and to highlight possible biological pathways that may explain vitamin A effects.

Literature review, observational studies and clinical trials. The strength of association was determined by applying Bradford Hill criteria of causality.

In a vitamin A deficient population, vitamin A is essential for adequate treatment of anaemia. While vitamin A does not seem to be capable of preventing uterine atony, obstetric or surgical trauma, which are important causes of haemorrhage, it might be capable of preventing or decreasing coagulopathy. Possible effects on the placenta as regards implantation, site and size are not clear. As regards pregnancy-related infections, vitamin A supplementation can improve wound healing by decreasing fibrosis and increasing transforming growth factor-β (TFG-β). It can increase resistance to infection by increasing mucosal integrity, increasing surface immunoglobulin A (sIgA) and enhancing adequate neutrophil function. If infection occurs, vitamin A can act as an immune enhancer, increasing the adequacy of natural killer (NK) cells and increasing antibody production. β-carotene in its provitamin form can act as an antioxidant by decreasing endothelial cell damage (the pathognomonic feature of pre-eclampsia) and promote the vasodilator effect of nitric oxide that might bring about a better outcome of toxaemia in pregnancy. It is unlikely that vitamin A or β-carotene has an effect on obstructed labour.

Plausible biomedical pathways can only be constructed for obstetric haemorrhage, anaemia in pregnancy, hypertension in pregnancy and pregnancy-related infections. A 40% reduction in the maternal mortality ratio, as observed in Nepal, is unlikely to be solely explained through the aforementioned pathways.

To examine risk factors for poor iron status in British toddlers.

National Diet and Nutrition Survey (NDNS) of children aged 1.5–4.5 years.

Mainland Britain, 1992/93.

Of the 1859 children whose parents or guardians were interviewed, a weighed dietary intake was provided for 1675, and a blood sample obtained from 1003.

Mean haemoglobin (Hb) and ferritin levels were significantly lower in younger (1.5–2.5 years) than in older (3.5–4.5 years) children, with boys having significantly lower ferritin levels than girls. Poor iron status (Hb>110 g l−1, ferritin >10 μg l−1, or low values for both indices) was associated with lower socioeconomic and employment status. Iron status was directly associated with meat and fruit consumption and inversely with that of milk and milk products, after adjustment for age and gender. The latter association remained significant after further adjustment for sociodemographic variables, energy intake and body weight. Children consuming <400 g day−1 of milk and cream were less likely to consume foods in other groups, with those also consuming little meat, fish, fruit and nuts at greatest risk of poor iron status. Few associations were observed between poor iron status and individual nutrient intakes, and iron status was not associated with either iron intake or with consumption of a vegetarian diet.

Overdependence on milk, where it displaces iron-rich or iron-enhancing foods, may put toddlers at increased risk of poor iron status. However, this becomes non-significant when moderate-to-high amounts of foods known to enhance iron status (e.g. meat and/or fruit) are also consumed. Milk consumption in this age group should ideally be part of a mixed and balanced diet including all food groups, and particularly lean meat (or other iron-rich or fortified foods) and fruit. This is particularly relevant for households of lower socioeconomic and employment status.

To evaluate changes over 1 year in weight and body mass index (BMI) among a population-based sample of non-pregnant women in Indonesia and to identify risk factors for developing under- and overnutrition.

Cross-sectional studies in 1996 and 1997 in the same population.

Purworejo District, central Java, Indonesia.

Non-pregnant women (n = 4132) aged 15–49 years of age who participated in both 1996 and 1997. Based on BMI, women were classified as having chronic energy deficiency (CED), and as being either of normal weight or obese.

The mean height of the women was below the fifth percentile of international standards. In 1996, 16.2% had CED, 72.2% were normal and 11.6% were obese. In 1997, the corresponding figures were 14.4%, 71.2% and 14.3%, respectively, revealing a significant mean increase in weight and BMI. Among women classified as normal in 1996, 3.0% developed CED in 1997. Significant risk factors for developing CED were experiences of child deaths and non-use of contraceptives. Among women classified as normal in 1996, 5.3% developed obesity in 1997. Here, significant risk factors included most indicators of wealth as well as occupation.

The results should be important for future efforts to prevent CED and obesity in the general population; conditions which are both associated with health risks.