To determine the level of agreement between the American (Chilean) and British food composition tables in estimating intakes of macronutrients and antioxidants.

Design, setting and subjects: Information based on a food-frequency questionnaire with emphasis on antioxidants was collected from 95 Chileans aged 24–28 years. Nutritional composition was analysed using the British table of food composition and the American table of food composition modified by Chilean food items. Mean differences and limits of agreement (LOAs) of estimated intake were assessed.

Mean differences between the two tables of food composition ranged from 5.3% to 8.9% higher estimates when using the American (Chilean) table for macronutrients. For micronutrients, a bias towards a higher mean was observed for vitamin E, iron and magnesium when the American (Chilean) table was used, but the opposite was observed for vitamin A and selenium. The intra-class correlation coefficient (ICC) ranged from 0.86 (95% confidence interval (CI) 0.81–0.91) to 0.998 (95% CI 0.995–1.00), indicating high to excellent agreement. LOAs for macronutrients and vitamins A and C were satisfactory, as they were sufficiently narrow. There was more uncertainty for other micronutrients.

The American table gives relative overestimates of macronutrients in comparison to the British table, but the relative biases for micronutrients are inconsistent. Estimates of agreement between the two food composition tables provide reassurance that results are interchangeable for the majority of nutrients.

To examine associations of the frequency of eating at fast-food restaurants with demographic, behavioural and psychosocial factors and dietary intake in African American adults.

Self-reported data from a population-based cross-sectional survey of 658 African Americans, aged 20–70 years, in North Carolina. An 11-page questionnaire assessed eating at fast-food restaurants, demographic, behavioural and diet-related psychosocial factors, and dietary intake (fruit, vegetable, total fat and saturated fat intakes, and fat-related dietary behaviours).

The participants were aged 43.9±11.6 years (mean±standard deviation), 41% were male, 37% were college graduates and 75% were overweight or obese. Seventy-six per cent reported eating at fast-food restaurants during the previous 3 months: 4% usually, 22% often and 50% sometimes. Frequency of eating at fast-food restaurants was positively associated with total fat and saturated fat intakes and fat-related dietary behaviours (P < 0.0001) and inversely associated with vegetable intake (P < 0.05). For example, mean daily fat intake was 39.0 g for usually/often respondents and 28.3 g for those reporting rare/never eating at fast-food restaurants. Participants who reported usual/often eating at fast-food restaurants were younger, never married, obese, physically inactive and multivitamin non-users (all P < 0.01). Frequency of eating at fast-food restaurants was positively associated with fair/poor self-rated health, weak belief in a diet–cancer relationship, low self-efficacy for healthy eating, weight dissatisfaction, and perceived difficulties of preparing healthy meals and ordering healthy foods in restaurants (all P < 0.05). Frequency of eating at fast-food restaurants did not differ significantly by sex, education, smoking, ability to purchase healthy foods or knowledge of the Food Guide Pyramid.

Eating at fast-food restaurants is associated with higher fat and lower vegetable intakes in African Americans. Interventions to reduce fast-food consumption and obesity in African Americans should consider demographic and behavioural characteristics and address attitudes about diet–disease relationships and convenience barriers to healthy eating.

To determine the relative quantities of two hepatotoxic pyrrolizidine alkaloids, symphytine and echimidine, in teas prepared from comfrey leaves (Symphytum officinale), and to determine the potential contribution of the N-oxide forms of these alkaloids to levels of the parent alkaloids.

Comfrey leaves were purchased from three commercial sources and used to prepare tea in a manner consistent with the methods used by consumers. An extraction scheme was devised for extraction of the alkaloids, and a gas chromatographic method was developed to quantify the two major alkaloids, symphytine and echimidine. Recognising that the N-oxide derivatives of these alkaloids have also been identified in comfrey preparations, chemical reduction was applied to determine the total quantities of the alkaloids as free bases and as N-oxide derivatives.

The concentration of symphytine and echimidine varied considerably between teas prepared from leaves purchased from the different vendors of plant material. Moreover, a much higher concentration of symphytine was found in the tea when steps were included to reduce N-oxides prior to analysis. The treatment of pure symphytine with hot water did not generate the N-oxide derivative de novo.

Since the pyrrolizidine alkaloids are known to be hepatotoxic, consumption of herbal teas made from comfrey leaves may be ill-advised. The concentration of pyrrolizidine alkaloids in such teas may be underestimated substantially unless the concentration of N-oxides is taken into consideration.

To investigate the initiation of breast-feeding and exclusive breast-feeding within the first week after delivery for women in rural Vietnam.

An interviewer-administered survey was conducted on a sample of rural women who gave birth during August-October 2002.

Quang Xuong District, Thanh Hoa Province of Vietnam.

Four hundred and sixty-three women participated in the study, of whom 181 delivered at the district hospital (39.1%), 229 at a commune health centre (49.5%) and 53 at home attended by a traditional birth attendant (11.4%).

Although the initiation and exclusive breast-feeding rates were relatively high at 98.3% and 83.6% respectively, the premature introduction of complementary food was a great concern. Logistic regression analysis showed that, together with socio-cultural determinants such as feeding preferences of the husband and maternal grandmother, feeding practices of friends, factors relating to delivery methods, delivery locations and health problems could influence the initiation rate and breast-feeding patterns.

To promote breast-feeding practices of rural mothers, health education on breast-feeding should take into account local socio-cultural features in addition to improving the counselling skills of health workers.

To assess the reliability of newly developed questionnaires measuring theoretical constructs believed to predict fruit and vegetable consumption among 6th–grade pupils.

Participating pupils and parents completed questionnaires twice, 14 days apart.

One hundred and twenty–nine pupils from 6th–grade classes (average age: 11.9 years) at two schools in Norway and their parents were invited to participate.

The test–retest reliability was found to be good or very good for scales reported both by the pupils and their parents. All scales showed acceptable to strong correlations between time 1 and time 2, and only one scale had significant different mean values at the two times. The internal consistency reliability of the scales was acceptable to good.

Sixth graders and their parents are able to provide reliable reports on theoretical determinants of the pupilapos;s fruit and vegetable consumption.

(1) To identify the major sources of nutrition information, and the perceived credibility thereof, among urban black South African women; and (2) to determine the level of knowledge regarding nutrition, particularly regarding the topic of obesity.

A cross–sectional descriptive study that was both qualitative (focus groups) and quantitative (individual questionnaires). Three hundred and ninety–four black women aged 17–49 years were conveniently sampled from the Western Cape and Gauteng provinces in South Africa.

Four focus groups were held with 39 women to identify common themes relating to nutrition knowledge. Based on these data, a questionnaire instrument was developed and administered to 394 women by trained fieldworkers.

The most frequently encountered source of nutrition information was the media, particularly the radio and TV (73.4% and 72.1% of subjects, respectively, obtained information from this source in the past year), followed by family/friends (64.6%). Despite only 48.5% of subjects having received nutrition information from a health professional, this was the most highly credible information source. Factors being most influential in choice of foods were taste, preferences of the rest of the family, and price. A lack of knowledge on certain aspects of nutrition was identified, as well as misconceptions regarding diet and obesity.

To improve nutrition knowledge and the effectiveness of nutrition education activities in South Africa, it is recommended that health and nutrition educators become more actively involved with the training of health professionals, particularly those engaged in delivery of services at primary care level, and in turn encourage health professionals to engage more with media sources. Nutrition messages delivered from health professionals via the media will enable public exposure to nutrition information which is not only easily accessible but also perceived to be highly credible.

We describe the methods used to develop and score a 17-item ‘screener’ designed to estimate intake of fruit and vegetables, percentage energy from fat and fibre. The ability of this screener and a food-frequency questionnaire (FFQ) to measure these exposures is evaluated.

Using US national food consumption data, stepwise multiple regression was used to identify the foods to be included on the instrument; multiple regression analysis was used to develop scoring algorithms. The performance of the screener was evaluated in three different studies. Estimates of intakes measured by the screener and the FFQ were compared with true usual intake based on a measurement error model.

US adult population.

For development of instrument, n = 9323 adults. For testing of instrument, adult men and women in three studies completing multiple 24-hour dietary recalls, FFQ and screeners, n = 484, 462 and 416, respectively.

Median recalled intakes for examined exposures were generally estimated closely by the screener. In the various validation studies, the correlations between screener estimates and estimated true intake were 0.5–0.8. In general, the performances of the screener and the full FFQ were similar; estimates of attenuation were lower for screeners than for full FFQs.

When coupled with appropriate reference data, the screener approach described may yield useful estimates of intake, for both surveillance and epidemiological purposes.

There is a paucity of data on the micronutrient status of low-income, lactating South African women and their infants under 6 months of age. The aim of this study was to elucidate the level of anaemia and vitamin A deficiency (VAD) in peri-urban breast-feeding women and their young infants.

Cross-sectional study including anthropometric, biochemical and infant feeding data.

Peri-urban settlement in Cape Town, South Africa.

Breast-feeding women (n = 113) and their infants (aged 1–6 months) attending a peri-urban clinic.

Mean (standard deviation (SD)) haemoglobin (Hb) of the lactating mothers was 12.4 (1.3) gdl−1, with 32% found to be anaemic (Hb < 12 g dl−1). Maternal serum retinol was 49.8 (SD 13.3) μg dl−1, with 4.5% VAD. Using breast milk, mean (SD) retinol concentration was found to be 70.6 (24.6) μg dl−1 and 15.7 (8.3) μg/g milk fat, with 13% below the cut-off level of <8μg/g fat. There was no correlation found between breast milk retinol and infant serum retinol. Z-scores (SD) of height-for-age, weight-for-age and weight-for-height were –0.69 (0.81), 0.89 (1.01) and 1.78 (0.83), respectively. Mean (SD) infant Hb was 10.9 (1.1) g dl−1, with the prevalence of anaemia being 50%, 33% and 12% using Hb cut-offs below 11 g dl−1, 10.5 g dl−1 and 9.5 g dl−1, respectively. Mean (SD) infant serum retinol was 26.9 (7.2) μg dl−1, with 10% being VAD. None of the infants was exclusively breast-fed, 22% were predominantly breast-fed and 787percnt; received complementary (mixed) breast-feeding. Thirty-two per cent of infants received weaning foods at an exceptionally young age (≤1 month old).

A high rate of anaemia is present in lactating women residing in resource-poor settings. Moreover, their seemingly healthy infants under 6 months of age are at an elevated risk of developing early-onset anaemia and at lower risk of VAD.

To evaluate dietary habits in Spanish children and adolescents based on a Mediterranean Diet Quality Index tool, which considers certain principles sustaining and challenging traditional healthy Mediterranean dietary patterns.

Observational population-based cross-sectional study. A 16-item Mediterranean Diet Quality Index was included in data gathered for the EnKid study (in which two 24-hour recalls, a quantitative 169-item food-frequency questionnaire and a general questionnaire about socio-economic, demographic and lifestyle items were administered).

Spain.

In total, 3850 children and youths aged 2–24 years residing in Spain.

Of the sample, 4.2% showed very low KIDMED index results, 49.4% had intermediate values and 46.4% had high index results. Important geographical differences were seen, with subjects from the Northeast showing the most favourable outcomes (52% with elevated scores vs. 37.5% of those from the North). Lower percentages of high diet quality were observed in low socio-economic groups, compared with middle and upper income cohorts (42.8%, 47.6% and 54.9%, respectively). Large cities had more positive results and only slight variations were seen for gender and age.

The KIDMED index, the first to evaluate the adequacy of Mediterranean dietary patterns in children and youth, confirms that this collective is undergoing important changes, which makes them a priority target for nutrition interventions. Results challenge certain commonly perceived notions tied to income level, population size and diet quality.

To assess, particularly in longitudinal studies, how close or far the food intakes of population groups are from a reference dietary pattern.

Computation of an index, called the Mediterranean Adequacy Index (MAI), by dividing the sum of the percentage of total energy from typical Mediterranean food groups by the sum of the percentage of total energy from non-typical Mediterranean food groups. The reference Italian–Mediterranean diet utilised was that of subjects from Nicotera in 1960.

Different areas in Italy.

Men aged 45–65 years at the start of the study from rural areas of Italy in the Seven Countries Study followed for 26 years (Crevalcore and Montegiorgio), elderly men and women from Perugia followed for 11 years, men and women from Pollica (Salerno) followed for 32 years, and families from Rofrano (Salerno) followed for 41 years.

The median value of MAI among 40–59-year-old men from Nicotera in 1960 was 7.2; in Crevalcore it was 2.9 in 1965 and 2.2 in 1991; and in Montegiorgio, 5.6 in 1965 and 3.9 in 1991. In Pollica, the values in men ranged from 5.6 to 6.3 in 1967 and from 2.4 to 4.5 in 1999; for women, the corresponding ranges were 4.2–7.2 and 2.7–4.1. In elderly men of Perugia, median MAI value was 4.9 in 1976 and 3.2 in 1987; for women, the corresponding values were 3.1 and 2.6.

The diet of these Italian population groups has changed over the last four decades, progressively abandoning the nutritional characteristics of the reference Italian–Mediterranean diet. The MAI proposed is simple to compute; it has satisfactory discriminating power particularly for longitudinal dietary data with only a few limitations.

To review the evidence that the traditional Mediterranean diet is associated with longevity.

Elderly persons of both genders in Greece, Spain, Denmark and Australia studied by different groups of investigators.

Adherence to the principles of the Mediterranean diet was operationalised through a score devised a priori, and study participants were followed up until death or the end of the study. Proportional hazard models were used.

Closer adherence to the Mediterranean diet was associated with a significant decrease in general mortality among the elderly persons studied.

The Mediterranean diet is positively associated with longevity among the elderly. If the assumption holds that there is no interaction between age and diet with respect to general mortality, it can be inferred that the traditional Mediterranean diet represents a healthy nutritional pattern.

To assess whether the Mediterranean diet contributes to overall mortality differences and trends between Mediterranean and non-Mediterranean European Union (EU) countries.

Routinely recorded adjusted overall mortality and food availability data in Mediterranean and non-Mediterranean EU countries. A Mediterranean diet score designed a priori was used as instrument.

Fifteen EU countries in the 1960s and the 1990s.

The general population in the 15 EU countries.

The difference between Mediterranean and non-Mediterranean EU countries in a 7-point Mediterranean diet score was reduced from 2.9 in the 1960s to 1.6 in the 1990s. This reduction may underlie the reduction in the difference in general mortality between these countries, from about 100 deaths per 100 000 person-years in the early 1970s to about 50 deaths per 100 000 person-years in the 1990s.

The decline in overall mortality in the 15 EU countries over the last 25 years is probably unrelated to diet. However, the gradual loss of the survival advantage of Mediterranean EU citizens, compared with other EU citizens, may be linked to the gradual abandonment by the former of their dietary traditions.

To investigate the possible role of diet in age-related cognitive decline (ARCD) and cognitive impairment of both degenerative (Alzheimer's disease, AD) and vascular (vascular dementia, VaD) origin.

Literature review.

In an elderly population of southern Italy with a typical Mediterranean diet, high energy intake of monounsaturated fatty acids (MUFA) appeared to be associated with a high level of protection against ARCD. In addition, dietary fat and energy in the elderly seem to be risk factors, while fish consumption and cereals are found to reduce the prevalence of AD in European and North American countries. Finally, the relative risk of dementia (AD and VaD) was lower in the subjects of a French cohort who drank three or four glasses of red wine each day compared with total abstainers.

Essential components of the Mediterranean diet – MUFA, cereals and wine – seem to be protective against cognitive decline. As such, dietary antioxidants and supplements, specific macronutrients of the Mediterranean diet, oestrogens and anti-inflammatory drugs may act synergistically with other protective factors, opening up new therapeutic interventions for cognitive decline.

To analyse the role of various aspects of the Mediterranean diet in several common epithelial cancers, including digestive and selected non-digestive tract neoplasms.

Systematic analysis of data from a series of case-control studies.

Northern Italy, between 1983 and 1998.

Over 12 000 cases of 20 cancer sites and 10 000 controls.

For most epithelial cancers, the risk decreased with increasing vegetable and fruit consumption, with relative risk (RR) between 0.3 and 0.7 for the highest versus the lowest tertile. For digestive tract cancers, population-attributable risks for low intake of vegetables and fruit ranged between 15 and 40%. A protective effect was observed also for breast, female genital tract, urinary tract and a few other epithelial neoplasms. A number of antioxidants and other micronutrients showed an inverse relationship with cancer risk, but the main components responsible for the favourable effect of a diet rich in vegetables and fruit remain undefined. Fish tended to be another favourable diet indicator. In contrast, subjects reporting frequent red meat intake showed RRs above unity for several common neoplasms. Intake of whole-grain foods was related to a reduced risk of several types of cancer, particularly of the upper digestive tract. This may be due to a favourable role of fibre, but the issue is still open to discussion. In contrast, refined grain intake and, consequently, glycaemic load and glycaemic index were associated with increased risk of different types of cancer including, among others, breast and colorectal.

A low-risk diet for cancer in the Mediterranean would imply increasing the consumption of fruit and vegetables, as well as avoiding increasing the intakes of meat and refined carbohydrates. Further, olive oil and other unsaturated fats, which are also typical aspects of the Mediterranean diet, should be preferred to saturated ones.

During the past few decades there has been a gradual abandoning of the traditional Mediterranean diet by the population of Crete and especially among the younger generations. Since this is related to the rapidly increasing morbidity and mortality rates from chronic diseases, the need for educating young people on the principles of good nutrition becomes increasingly important. It is also acknowledged that the epidemiological field needs to focus on studying the implementation process, since this will allow for a deeper understanding of the outcomes.

The aims of the present study were to explore the process of implementing an innovation in Cretan primary schools and to identify best teaching practices and principles.

In three state primary schools on the island of Crete, 107 children took part in a 30-h nutrition and media education programme. Classroom observations were used to define attitudes towards the programme and teaching methods. Besides baseline and post evaluation, the pupils were also interviewed about 11 months after the end of the programme.

During observation of the teaching process, emerging issues were the teacher's motivation and interest in the course, his/her preparation before each class, teaching ability and communication skills, the respect and discipline he/she kept and the innovative teaching methods used. In some cases researcher intervention in the classroom could not be avoided.

Overall, individual teacher willingness and teaching skills were mainly responsible for the quality of teaching, the variety of educational methods used in classrooms and pupils' interest in the course. Changes in pupils' knowledge and recall of the course were related to teacher enthusiasm but also to researcher intervention. Exploring the teaching and learning process allowed a deeper understanding of the data. It is concluded that attempts to introduce the principles of a Mediterranean diet to children through nutrition education require innovative, enthusiastic and highly motivated teachers.