Objective: The purpose of this study was to analyse the associations between the food variety score (FVS), dietary diversity score (DDS) and nutritional status of children, and to assess the associations between FVS, DDS and socioeconomic status (SES) on a household level. The study also assessed urban and rural differences in FVS and DDS.

Design: Cross-sectional studies in 1994/95, including a simplified food frequency questionnaire on food items used in the household the previous day. A socioeconomic score was generated, based on possessions in the households. Weight and height were measured for all children aged 6–59 months in the households, and anthropometric indices were generated.

Subjects and setting: Three hundred and twenty-nine urban and 488 rural households with 526 urban and 1789 rural children aged 6–59 months in Koutiala County, Sikasso Region, Mali.

Results: Children from urban households with a low FVS or DDS had a doubled risk (OR>2) for being stunted and underweight. Those relations were not found in the rural area. There was an association between SES and both FVS and DDS on the household level in both areas. The FVS and DDS in urban households with the lowest SES were higher than the FVS and DDS among the rural households with the highest SES.

Conclusions: Food variety and dietary diversity seem to be associated with nutritional status (weight/age and height/age) of children in heterogeneous communities, as our data from urban areas showed. In rural areas, however, this association could not be shown. Socioeconomic factors seem to be important determinants for FVS and DDS both in urban and rural areas. FVS and DDS are useful variables in assessing the nutritional situation of households, particular in urban areas.

To examine the influences of nutritional information and consumer characteristics on meal quality expectations, food selection and subsequent macronutrient intakes of consumers offered a reduced-fat option in a restaurant.

A target, full-fat (FF) main restaurant meal option was developed in a version substantially reduced in fat and energy (RF). Restaurant patrons were randomly placed into one of four treatment groups varying in provision of menu information about the target dish, and the actual version of that dish served (if ordered). A full-fat blind (FFB) control group was given no nutritional information in the menu and was served the FF version. The other three groups were all served the modified RF version: (i) reduced-fat blind (RFB), who were given no nutritional information; (ii) reduced-fat informed (RFI), who were given nutritional information; and (iii) reduced-fat informed with details (RFID), who were given the same nutritional information plus recipe modification details. Subjects rated their expected and actual liking, the pleasantness of taste, texture and appearance of the dish, how well the dish matched their expectations, and the likelihood of purchase again. Additional measures included the other dish selections, sociodemographic and attitudinal information.

A silver service (training) restaurant.

Members of the public (n = 279) consuming meals in the restaurant.

The presence of nutritional information on the menu did not significantly increase subsequent intakes of energy and fat from the rest of the meal, and did not significantly influence sensory expectations or post-meal acceptance measures (which also did not differ between the FF and RF versions). Consumer characteristics relating to fat reduction attitudes and behaviours were significantly related to the selection of different dishes.

Provision of RF alternatives in a restaurant can have significant positive dietary benefits. Menu nutritional information did not affect measures of meal acceptance. Further studies should identify which types of information formats might be most effective in enhancing the selection of ‘healthy’ options.

Although the fatty acid fractions provide similar metabolizable energy, the type of dietary fat consumed could be relevant to the development of obesity.

To investigate the relationship between body mass index (BMI), obesity and the consumption of different types of fat and olive oil in a Mediterranean country with high prevalence of obesity, and high intake of monounsaturated fatty acids (MUFA) and olive oil.

The study was carried out in Spain among 23 289 women and 14 374 men, aged 29–69 years, who were participants of a large European prospective cohort.

Information on usual food intake was collected by interviewers by means of a dietary history questionnaire. The association between obesity (BMI ≥ 30 kg m2), dietary fat, other dietary patterns and other non-dietary factors were tested using multilinear regression analysis. The ratio of reported energy intake to energy requirement was used as an estimation of dietary underreporting.

The association between fatty acid fractions intake (saturated fatty acids (SFA) in women, and MUFA and polyunsaturated fatty acids (PUFA) in both sexes) and BMI was very weak, accounting for less than 1% of variance. All dietary and non-dietary variables accounted for 21% of variance in the measurement of BMI in women and only 6.7% of variance in men. Estimated underreporting of energy intake was 17.5% in obese women and 5.5% in obese men.

The association between consumption of specific types of dietary fat, olive oil and obesity in Spain is not very important. However, because of the cross-sectional design and some level of underreporting of energy intake observed in overweight subjects and overreporting in underweight subjects, systematic bias cannot be completely discarded.

Feverfew (Tanacetum parthenium L.) is a popular herbal remedy often advocated for the prevention of migraine. The aims of this systematic review are to update the evidence from rigorous clinical trials for or against the efficacy of feverfew for migraine prevention and to provide a safety profile of this herbal remedy.

Literature searches were performed using the following databases: Medline, Embase, Biosis, CISCOM and the Cochrane Library (all from their inception to December 1999). Only randomized, placebo-controlled, double-blind trials of feverfew mono-preparations for the prevention of migraine in human subjects were included. All articles were read by two independent reviewers. Data were extracted in a pre-defined, standardized fashion. The methodological quality of the trials was evaluated by the Jadad score. For the assessment of safety issues, major reference texts were also consulted.

Six trials met the inclusion/exclusion criteria. The majority favour feverfew over placebo. Yet important caveats exist. The data also suggest that feverfew is associated with only mild and transient adverse effects and few other safety concerns.

Feverfew is likely to be effective in the prevention of migraine. There are no major safety problems.

To document the type and volume of drinks given to infants and investigate whether giving supplementary drinks leads to reduced milk consumption.

Carers were asked to record all drinks consumed by the infants in a 24-hour period at two ages, detailing the types and volume taken.

The Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC).

A randomly chosen population sample of over 1000 infants at 4 and 8 months of age.

The different types of milk feed were used to group infants, compare volumes consumed and look at the use of non-milk drinks. The average volume of drinks consumed over 24 hours at 4 months was 861 ml and at 8 months was 662 ml. At 4 months 69.7% consumed infant formula and 43.0% breast milk. The mean volume of milk consumed by those having only formula was 802 ml and for those having only breast milk was estimated at 850 ml. The volumes of milks consumed were slightly lower in the groups who also had supplementary drinks. A quarter of infants were given fruit drinks and 14.6% herbal drinks. Supplementary drinks and solids were more likely to be given to formula-fed than breast-fed infants. At 8 months, formula milk was consumed by 71.4% and breast milk use had decreased (22.9%) but fruit drink use had increased (squash/cordial: 55.8%, fruit juice: 14.9%), with 13.9% of infants having no infant milk at all. More infants were fed formula milk and less were fed cows' milk compared with a nationally representative British study conducted 5 years earlier.

Many infants were given supplementary drinks by 4 months; there is some evidence that this led to a small reduction in milk intake. A minority were not being given infant milks at all by 8 months, contrary to British infant feeding recommendations.

To assess the cross-sectional association of dietary and supplemental antioxidant (carotenoids, vitamins C and E) intake with cognitive function in 12 187 individuals, aged 48–67 years, participating in the Atherosclerosis Risk in Communities (ARIC) Study.

Dietary intake of antioxidant vitamins, as assessed by a food frequency questionnaire, and use of supplements were analysed in relation to the results of three cognitive tests, the delayed word recall test, the Wechsler adult intelligence scale, revised (WAIS-R) digit symbol subtest and the word fluency test.

After adjustment for covariates previously found to be associated with cognition in this sample, we found no consistent associations between dietary antioxidant vitamin intake or supplement use and any of the cognitive tests.

This study suggests little, if any, association between antioxidant vitamin intake and better cognitive function in middle-aged adults.

Stature is a powerful indicator of poor nutrition early in life in nations where undernutrition is a public health problem. Hypertension in adults has been associated with factors present early in life such as low birth weight. We tested the hypothesis that short stature is associated with hypertension among adults.

A household survey of representative adults in Rio de Janeiro city, Brazil was carried out in 1996.

Blood pressure and anthropometric measures were collected from 2802 adults in their own households. Prevalence estimates and modelling incorporated the sample design and weights.

Age-adjusted prevalence of hypertension for both sexes was lower in the third quartile of stature distribution. In women, but not in men, the odds ratio comparing the first quartile of stature with the fourth quartile was statistically significant with an odds ratio of 1.68 (95% CI 1.02–2.76). Adjusting for known risk factors for hypertension such as age, income, smoking, sodium and alcohol intake and race, the association among women, comparing the first with the fourth quartile for stature, was 1.84 (95% CI 1.03–3.30). With further adjustment for residual of weight on height the ratio reduced to 1.76 (95% CI 0.97–3.19, P value of trend = 0.03). Systolic blood pressure showed a U-shaped association with quartiles of stature, mainly among women, with a β-coefficient significantly lower at the third quartile.

This association of stature with hypertension supports the theory of an important ontogenetic dependence of adult blood pressure, at least among women.

To pilot test theory-based questionnaires to measure socioenvironmental influences on children's fruit, juice and vegetable (FJV) consumption as reported by parents.

Cross-sectional.

Parents of fourth to sixth grade students completed socioenvironmental questionnaires. The students completed food records (FRs) for 2 days in the classroom.

Interviews were completed by 109 parents (17% African-American, 32% Hispanic-American and 51 Euro-American).

Student mean daily FJV intake was 2.1 servings. Principal components analyses revealed subscales measuring positive and negative parenting practices; self-efficacy for modelling and planning/encouraging FJV consumption, and making FJV available; encouraging, consequences and discouraging food socialization practices; negative home, cost and canned/frozen food barriers; meal planning; child shopping; mother food preparation; and child lunch and dinner FJV preparation practices. Internal consistencies were adequate to high. Negative parent practices and negative home FJV barriers were significantly negatively correlated with child FJV consumption variables. Planning/encouraging self-efficacy was positively associated with fruit consumption, and child dinner FJV preparation was significantly negatively correlated with child juice consumption.

These questionnaires may provide important insights about the relationship between parent-reported socioenvironmental influences and children's FJV consumption. Future work should test these questionnaires with larger groups of parents and youths, with more reliable estimates of usual FJV intake, e.g. 7-day food records, to obtain a detailed understanding of how parents influence what children eat. Tests of models of relationships among these variables are warranted, but should control for possible confounding variables, e.g. socioeconomic status, gender of the child, etc

To identify the most important motivations for food choice from the point of view of the consumer in the Irish population, and to characterize those subjects who do and do not regard nutrition as a significant consideration in food choice.

As part of a pan-European Union (EU) survey on consumer attitudes to food, nutrition and health, a quota-controlled, nationally representative sample of Irish adults (n = 1009) aged 15 years upwards, completed an interview-assisted, close-ended questionnaire. Subjects selected three factors, from a list of 15, which they believed had the greatest influence on their food choice.

The interviews for the survey were conducted in subjects' homes.

‘Quality/freshness of food’ was the most frequently selected food choice factor (51%) followed by ’taste‘ (43%) and ‘trying to eat a healthy diet’ (36%). Female gender, increasing age and higher levels of education were found to be independent sociodemographic factors affecting the selection of ‘trying to eat a healthy diet’ as an important factor in food choice.

Although included in the top five most frequently selected factors affecting food choice, nutrition/healthy eating does not appear to have top priority for the majority of Irish adults. There are differences between the various sociodemographic groups within the population; males and younger subjects appear to require specific nutrition promotion messages.

To explore the relationships between biochemical indicators of vitamin A and iron status and the intestinal helminths Ascaris lumbricoides and hookworm in primary school children.

Two rural governmental schools in northwestern Bangladesh.

Cross-sectional study.

The sample consisted of 164 children in grades 3–5.

Serum retinol and β-carotene (by high-performance liquid chromatography, HPLC), haemoglobin (HemoCue), ferritin (enzyme-linked immunoadsorbent assay, ELIZA) and height and weight were measured. Dietary intake of vitamin A was assessed using a food frequency questionnaire and faecal analyses were done using Stoll's egg-count technique.

The mean serum retinol was 26.8 μg dl−1 and 20% had a level of <20 μg dl−1, the cut-off value for low vitamin A status. There was a strong positive association between serum β-carotene and serum retinol (r = 0.44, P <0.001), suggesting those with higher retinol levels had a higher carotene intake. Thirty-one per cent were anaemic (Hb <11.5 g dl−1), 30% had iron deficiency (serum ferritin <12.0 μg l−1) and 14% were suffering from iron deficiency anaemia. Children with a serum retinol level of 20 μg dl−1 had significantly lower ferritin (14.0 compared to 26.0 μg l−1, P = 0.005) and Hb levels (11.7 compared to 12.4 g dl−1, P = 0.005) than those with higher levels. The proportion of iron deficiency anaemia was significantly greater among children with hookworm. Our data suggest that hookworm exerts its impact on iron status independently of the vitamin A status of the host.

Programmes to improve iron status should consider including both vitamin A prevention programmes and deworming.

To review and discuss the effect of n-3 polyunsaturated fatty acids (PUFA) from fish in the prevention and, primarily, in the treatment of coronary artery disease (CAD).

Overview of the literature.

Denmark.

There is good evidence that fish consumption may reduce the risk of CAD.

Fish can be recommended to reduce the risk of CAD both in healthy subjects and in patients with a high risk of CAD or with documented CAD. The use of fish oil concentrates can not be recommended in general, but may be considered in patients after a myocardial infarction or in patients with hypertriglyceridaemia. An increased intake of n-3 polyunsaturated fatty acids from fish may have substantial implications for public health and health economy by decreasing the risk of coronary events and sudden cardiac death.

The USA and Canada both want to reduce social health inequalities in their population. These two countries have recently begun a process of harmonization of their nutrient recommendations.

To develop a standardized indicator to measure the impact of these recommendations on the health of different social groups in North America. The authors have compared three of the methods currently used for measuring overall diet quality for a population.

The three methods, adjusted to the 1990 Canadian nutrition recommendations, were used to analyse the Québec Nutrition Survey data collected by Santé Québec in 1990.

The authors found that the indicator developed by Kennedy and collaborators works best for analysing the Québec data. Moreover, it allows comparisons with the USA. Some questions, such as whether or not to add calories from alcohol consumption to the model and whether the indicators should be adjusted to the different cultures and specific population groups remain unanswered.

In order to determine the role of nutrition in social health inequalities, it is important to develop standard indicators that are suitable for monitoring the relationship between dietary recommendations and eating habits.

This study examined the relationship between breakfast cereal consumption and non-milk extrinsic sugars (NMES) intake and the possible implications of this for caries in preschool children.

Data from the 1995 UK National Diet and Nutrition Survey (NDNS) of children aged 1.5–4.5 years were reanalysed. Four-day weighed food records and dental examinations were available on 1450 children living in private households in Britain. Children were classified by tertiles (age-adjusted) according to the proportion of energy derived from breakfast cereals, and the amount of NME sugar from cereals. There were no significant differences in social class background between any of the groups.

Children with diets high in breakfast cereals as a proportion of total energy (top third) had lower proportional intakes of NMES, compared with low consumers of cereals (lowest third). Consumption of sweetened cereals was positively associated with NMES intake. However, caries experience was unrelated to breakfast cereal consumption, whether presweetened or not.

Although presweetened cereals are relatively high in NMES, their cariogenic potential is probably minimal in the circumstances in which they are normally consumed.

Assessing how the Italian average food pattern would be affected in terms of consumption structure and expenditure by the adoption of nutritional prescriptions.

A linear programming model with nutritional and food habits constraints was employed to generate a pattern following recommended daily allowances (RDAs) and nutritional guidelines provided for the Italian population.

Food consumption data from ISTAT Household Budget Survey of Italian population.

Italian families investigated by the Family Budget Survey of the National Institute of Statistics.

Compared to actual behaviour, the pattern generated by the model implies an increased consumption of vegetables, pasta, rice and fresh fish, and a decreased consumption of meats, bread, sugars and cakes, and especially fats and oils. At given prices, total expenditure is lower than actual expenditure.

Differences between actual behaviour and the generated pattern are consistent with long-term trends in food consumption. The adoption of RDAs is unlikely to result in an increased food expenditure.

Results of previous studies on diet and gallbladder disease (GBD), defined as having gallstones or having had surgery for gallstones, have been inconsistent. This research examined patterns of food intake in Mexican Americans and their associations with GBD.

Cross-sectional.

The study population included 4641 Mexican Americans aged 20–74 years who participated in the 1988–94 third National Health and Nutrition Examination Survey (NHANES III). GBD was diagnosed by ultrasound. Food intake patterns were identified by principal components analysis based on food frequency questionnaire responses. Component scores representing the level of intake of each pattern were categorized into quartiles, and prevalence odds ratios (POR) were estimated relative to the lowest quartile along with 95% confidence intervals (CI).

There were four distinct patterns in women (vegetable, high calorie, traditional, fruit) and three in men (vegetable, high calorie, traditional). After age adjustment, none were associated with GBD in women. However, men in the third (POR = 0.42, 95%CI 0.21–0.85) and fourth (POR = 0.53, 95%CI 0.28–1.01) quartiles of the traditional intake pattern were half as likely to have GBD as those in the lowest quartile.

These findings add to a growing literature suggesting dietary intake patterns can provide potentially useful and relevant information on diet–disease associations. Nevertheless, methods to do so require further development and validation.

This first nationwide survey was undertaken to estimate the prevalence rates and severity of iodine deficiency disorders (IDD) and the proportion of households consuming iodized salt.

The country was stratified into two ecological zones and 30 clusters (primary schools) from each zone, including the required numbers of pupils, were selected randomly. A subsample of pupils provided urine and salt samples for the determination of urinary iodine excretion (UIE) and presence of iodate, respectively.

Yemen.

There were a total of 2984 pupils aged 6–12 years of whom 2003 were boys and 981 girls. The majority (1800) pupils were from the lowland/coastal areas (zone II) and the rest (1184) from the mountainous regions (zone I).

The total goitre rates (TGR) in the whole country, zones II and I were 16.8%, 31.1% and 7.4%, respectively. The TGR in zone I for males was 32.8% and 27.3% for females, while in zone II the corresponding rates were 8.1% and 5.9%, respectively, and the differences were not statistically significant. Only three cases of visible goitres were encountered. The median UIE levels in zones I, II and the whole country were 13.6, 18.9 and 17.3 μg dl−1, respectively. Based on UIE cut-off points recommended by WHO, IDD was severe in 4.7% of pupils in zone I and 2.6% in zone II. Mild and moderate IDD were found in 18.5% and 8.7% of the pupils respectively. Nearly 70% of the surveyed pupils had UIE values of > 10 μg dl−1 (no deficiency). Girls had relatively better iodine nutrition as suggested by higher levels of median UIE. In addition, across all age groups median UIE values were above 10 μg dl−1. Over half of the households consumed iodized salt.

Since the introduction of universal salt iodization in 1996 both the prevalence and severity of IDD in Yemen were reduced markedly and Yemen can now be classified as a country with a mild IDD problem. However, the low level of households consuming iodized salt may hamper the goal of IDD elimination.

We quantified the public health benefit of fruits and vegetables on the prevention of cancer and cardiovascular disease (CVD), using currently available human data.

We reviewed over 250 observational studies on cancer and CVD. Relative risks (RRs) for high versus low intake of fruits and vegetables were obtained. The preventable proportion of chronic diseases, i.e. the per cent of cases attributable to low consumption of fruits and vegetables, was estimated using three scenarios: best guess, optimistic (using stronger RRs) and conservative (using weaker RRs and eliminating the contribution of smoking and/or drinking). The preventable proportion was calculated for increasing average intake from the current 250 g day−1 to the recommended 400 g day among the general Dutch population.

It is estimated that in the Netherlands cancer incidence could be reduced by 19% (12 000 cases annually, best guess), ranging from 6% (conservative) to 28% (optimistic). Cardiovascular deaths could be reduced by 16% (8000 deaths annually, best guess), ranging from 6% to 22%. Evidence is most abundant for gastrointestinal cancers, followed by hormone-related cancers, but limited for other sites and CVD.

Increasing consumption of fruits and vegetables carries a large public health potential. Population trials and biological mechanisms should eventually provide scientific proof of their efficacy. The available evidence is sufficient to justify public health education and promotion aimed at a substantial increase in the consumption of fruits and vegetables.