A Knowledge, Attitudes and Practices (KAP) study was conducted in three villages of Bekily District in southern Madagascar prior to the implementation of a health education programme with children. The participatory learning concept of the Child-to-Child approach was followed to involve the children in the planning and implementation of the programme, which was covered by the German Agency for Technical Cooperation.

To this effect, qualitative research methods such as Participatory Learning and Action techniques (focus group discussions, mapping and matrix ranking, etc.) were applied.

The survey was conducted between August and December 1999. It involved a total of 55 school-aged children (6–14 years) along with 21 mothers and 34 fathers, representing different ethnic groups and educational backgrounds.

The results show that children's KAP related to health and nutrition strongly reflect those of adults. They are not aware of a possible link between bad hygiene and the occurrence of diseases. According to them, diarrhoea or malaria is caused by consuming too large amounts of certain foods. Even if they know about certain elementary hygiene behaviours, they do not practise this in their everyday life.

A major objective of the health education programme for children should be to tackle the discrepancy between hygiene-related knowledge and behaviour. Through the participatory study approach the children revealed their ability to contribute to the programme development. In using appropriate communication channels, the Child-to-Child health education programme is expected to influence the health behaviours of both adults and children. The health education programme should be combined with a literacy programme to address the children's desire to learn reading and writing.

To explore published and unpublished research into consumer understanding and use of nutrition labelling which is culturally applicable in Europe.

A systematic review undertaken between July 2002 and February 2003.

One hundred and three papers were identified that reported on consumer understanding or use of nutrition labelling, most originating from North America or northern Europe. Only a few studies (9%) were judged to be of high or medium–high quality. We found that reported use of nutrition labels is high but more objective measures suggest that actual use of nutrition labelling during food purchase may be much lower. Whether or not consumers can understand and use nutrition labelling depends on the purpose of the task. Available evidence suggests that consumers who do look at nutrition labels can understand some of the terms used but are confused by other types of information. Most appear able to retrieve simple information and make simple calculations and comparisons between products using numerical information, but their ability to interpret the nutrition label accurately reduces as the complexity of the task increases. The addition of interpretational aids like verbal descriptors and recommended reference values helps in product comparison and in putting products into a total diet context.

Improvements in nutrition labelling could make a small but important contribution towards making the existing point-of-purchase environment more conducive to the selection of healthy choices. In particular, interpretational aids can help consumers assess the nutrient contribution of specific foods to the overall diet.

To analyse the temporal distribution of the intake of cereal and dairy products in the Republic of Ireland.

The North/South Ireland Food Consumption Survey established a database of habitual food and drink consumption using a 7-day food diary. The database also recorded the time and day of food consumption. Mean intakes of cereal and dairy products were calculated for time of the day and day of the week.

At the weekend, the percentage of consumers decreased for nearly all cereal and dairy products. White bread, total cereals, full-fat milk and total dairy intakes were significantly lower at the weekend (P<0.01) compared with weekdays. Intakes of cereal and dairy products over time of the day showed clear mealtime or snacking patterns when the number of consumers was controlled for. White bread, wholemeal bread, total cereals, full-fat milk, reduced-fat milk and total dairy intakes showed mealtime peaks for morning, afternoon and evening. When examined by tertile of intake, tertile of percentage energy from fat and tertile of fibre intake, intakes of cereal and dairy products over time of the day and day of the week were similar to trends described above, regardless of the tertile.

Temporal analysis of the intakes of cereal and dairy products did not reveal any unusual trends in this population. However, the significant methodological issues raised in this paper will be of benefit to other aspects of research in this area.

To evaluate the effectiveness of a vitamin-fortified maize meal to improve the nutritional status of 1–3-year-old malnourished African children.

A randomised parallel intervention study was used in which 21 experimental children and their families received maize meal fortified with vitamin A, thiamine, riboflavin and pyridoxine, while 23 control children and their families received unfortified maize meal. The maize meal was provided for 12 months to replace the maize meal habitually consumed by these households.

Sixty undernourished African children with height-for-age or weight-for-age below the 5th percentile of the National Center for Health Statistics' criteria and aged 1–3 years were randomly assigned to an experimental or control group. Baseline measurements included demographic, socio-economic and dietary data, as well as height, weight, haemoglobin, haematocrit, serum retinol and retinol-binding protein (RBP). Anthropometric, blood and serum variables were measured again after 12 months of intervention. Complete baseline measurements were available for 44 children and end data for only 36. Changes in these variables from baseline to end within and between groups were assessed for significance with paired t-tests, t-tests and analysis of variances using the SPSS program, controlling for expected weight gain in this age group over 12 months. Relationships between changes in variables were examined by calculating correlation coefficients.

The children in the experimental group had a significantly (P≤0.05) higher increase in body weight than control children (4.6 kg vs. 2.0 kg) and both groups had significant (P≤0.05) but similar increases in height. The children in the experimental group showed non-significant increases in haemoglobin and serum retinol, while the control children had a significant (P = 0.007) decrease in RBP. The change in serum retinol showed a significant correlation with baseline retinol (P = 0.014), RBP (P = 0.007) and weight (P = 0.029), as well as with changes in haemoglobin (P = 0.029).

Despite a small sample size, this study showed positive effects of a vitamin-fortified maize meal on weight gain and some variables of vitamin A status in 1–3-year-old African children. The study confirmed the relationship between vitamin A and iron status. The results suggest that fortification of maize meal would be an effective strategy to address micronutrient deficiencies in small children in South Africa.

This study was undertaken to establish the prevalence and severity of nutritional problems among low-income children of elementary school age in the Los Angeles Unified School District (LAUSD) in order to collect baseline data to inform policy-makers.

A cross-sectional survey of children in 14 elementary schools was conducted from January to June, 1998. Nine hundred and nineteen children were measured and interviewed. The planning, design and data analysis were carried out in collaboration with key LAUSD policy-makers.

More than 35% of the sample was classified as being at risk for overweight or overweight according to body mass index.

There is a high prevalence of children who are at risk for overweight or who are overweight in Los Angeles. This finding has triggered the development of multiple school-based intervention programmes.

Combating iron deficiency in toddlers with iron-fortified food has proved difficult in countries with phytate-rich diets. For this purpose, a new haem iron preparation was developed. The study compared changes in iron status after administration of refried beans with beans fortified with a haem iron preparation or ferrous sulphate (FeSO4).

In a masked, stratified-randomised intervention trial, children received five 156-g cans of refried black beans per week for 10 consecutive weeks. The beans-only (control), FeSO4 and haem iron groups were offered a cumulative dose of 155 mg, 1625 mg and 1700 mg of iron from the bean intervention, respectively. Haemoglobin (Hb) and ferritin concentrations were determined at baseline and after 5 and 10 weeks. Compliance was examined weekly.

A low-income community in Guatemala City.

One hundred and ten children aged 12–36 months with initial Hb values between 100 and 115 g l−1.

The cumulative intake of beans was approximately 80% of that offered, signifying an additional ~1300 mg of either haem or inorganic iron in the corresponding treatment groups over 10 weeks. Hb concentrations increased by the order of 7.3–11.4 g l-1 during the intervention, but without significant differences across treatments. Average ferritin concentrations were unaffected by treatment assignment. However, post hoc analysis by subgroups of initial high ferritin and initial low ferritin found the Hb increments after 10 weeks in the haem iron group (13.1±7.7 g l−1) to be significantly greater than the respective increases (6.8±11.2 and 6.4±8.5 g l−1) in the inorganic iron and beans-only groups.

Canned refried beans are a candidate vehicle for fortificant iron. Given the improved colour and organoleptic properties imparted by haem iron added to refried beans, its additional potential for benefiting the iron status of consumers with iron deficiency may recommend it over FeSO4.

A 5-year nationwide mass media campaign aimed at prevention of overweight was organised from 2002 onwards. The present study evaluates the first campaign, which was aimed primarily at increasing awareness of weight gain.

Data were collected by telephone interview in four independent cross-sectional surveys among non-obese Dutch adults aged 25–35 years (total n = 1949) for statistical analyses. Awareness of personal body-weight status, overweight-related risk perceptions, attitudes towards weight-gain prevention, motivation to prevent weight gain and self-reported body mass index (BMI) were measured in each survey. Campaign exposure was assessed in the post-intervention surveys. To identify intervention effects over time multiple linear and logistic regression analyses were used, adjusted for secular time effects and age.

After the campaign about 65% of the respondents knew about the campaign. The campaign was associated with more positive attitudes towards the prevention of weight gain (β = 0.16; P ≤ 0.01) and higher self-reported BMI (β = 0.14; P ≤ 0.01).

The results suggest that the first campaign reached a large proportion of the population and initiated some positive change in attitudes, but did not achieve significant improvements in other determinants of weight-gain prevention among non-obese young adults.

Adequate zinc nutriture is critically important for human health, but the development of programmes to control zinc deficiency is limited by the lack of reliable information on population zinc status. The present analyses were conducted to: (1) estimate the absorbable zinc content of national food supplies; (2) compare this information with theoretical population requirements for zinc; and (3) use these results to predict national risks of inadequate zinc intake.

Setting and design: National food balance data were obtained for 176 countries from the Food and Agriculture Organization of the United Nations. The amount of absorbable zinc in these foods was estimated from food composition data, and zinc absorption was predicted using a model developed by the International Zinc Nutrition Consultative Group (IZiNCG). Demographic data were obtained from United Nations estimates, and age- and sex-specific physiological requirements for absorbable zinc were estimated using IZiNCG recommendations.

Results and conclusions: The mean per capita absorbable zinc content of national food supplies ranged from 2.98–3.01 mg day−1 in Western Europe and USA & Canada to 2.09 mg day−1 in Southeast Asia. The estimated percentage of individuals at risk of inadequate zinc intake ranged from 9.3–9.5% in the regions of North Africa & Eastern Mediterranean and USA & Canada to 33.1% in Southeast Asia. Overall, approximately 20.5% of the world's population is estimated to be at risk of inadequate zinc intake. Data on the absorbable zinc content of national food supplies can be used to determine whether further assessments of population zinc status and development of intervention programmes are warranted.

To specify the principles, definition and dimensions of the new nutrition science.

To identify nutrition, with its application in food and nutrition policy, as a science with great width and breadth of vision and scope, in order that it can fully contribute to the preservation, maintenance, development and sustenance of life on Earth.

A brief overview shows that current conventional nutrition is defined as a biological science, although its governing and guiding principles are implicit only, and no generally agreed definition is evident. Following are agreements on the principles, definition and dimensions of the new nutrition science, made by the authors as participants at a workshop on this theme held on 5–8 April 2005 at the Schloss Rauischholzhausen, Justus-Liebig University, Giessen, Germany.

Nutrition science as here specified will retain its current [classical] identity as a biological science, within a broader and integrated conceptual framework, and will also be confirmed as a social and environmental science. As such it will be concerned with personal and population health, and with planetary health – the welfare and future of the whole physical and living world of which humans are a part.

The aim of the study was to investigate the relative importance of personal and social environmental predictors of the consumption of fruit, high-fat snacks and breakfast.

A school-based cross-sectional survey. Data were collected through written questionnaires.

Students from eight schools in the southern part of The Netherlands.

Six hundred and one students from preparatory secondary vocational education schools.

About a quarter of the variation in actual behaviours and intentions to change the behaviours could be explained. Stepwise multiple regression analysis revealed that, for all three behaviours, higher intention to change was especially associated with a more positive attitude and subjective norm, and higher intentions to increase fruit intake with more positive self-efficacy expectations. With regard to actual consumption, a more positive attitude towards eating fruit was the only significant correlate of a higher consumption of fruit. A more positive attitude towards eating high-fat snacks, perceived lower intake of the mother, and higher food availability and accessibility were associated with consumption of high-fat snacks, and a more positive attitude to breakfast more frequently was associated with more frequent breakfast consumption.

The results indicate that adolescents’ attitudes are the most important determinants of different health-related eating behaviours and intentions to change. Interventions promoting a healthy diet for adolescents should include creative strategies to achieve positive associations with healthy dietary changes.

To develop a nutrition screening tool for use in older South Africans.

A cross-sectional validation study in 283 free-living and institutionalised black South Africans (60+ years).

Trained fieldworkers administered a 24-hour recall and the Mini Nutritional Assessment (MNA) screening tool, and performed anthropometric measurements and physical function tests. Cognitive function was assessed using a validated version of the Six-Item Cognitive Impairment Test. Biochemical indicators assessed included serum albumin, haemoglobin, ferritin, vitamin B12, red-blood-cell folate, cholesterol and vitamin C. The MNA was used as the gold standard against which a novel screening tool was developed using a six-step systematic approach, namely: correspondence analysis; identification of key questions; determination of internal consistency; correlational analyses with objective measures; determination of reference cut-off values for categories of nutritional risk; and determination of sensitivity and specificity.

The new screening tool includes nine separate concepts, comprising a total of 14 questions, as well as measurement of mid-upper arm circumference. The new tool score was positively associated with level of independence in either basic activities of daily living (r = 0.472) or the more complex instrumental activities of daily living (r = 0.233). A three-category scoring system of nutritional risk was developed and shown to significantly characterise subjects according to physical function tests, level of independence and cognitive function. The new tool has good sensitivity (87.5%) and specificity (95.0%) compared with the MNA scoring system. It has a very high negative predictive value (99.5%), which means that the tool is unlikely to falsely classify subjects as well nourished/at risk when they are in fact malnourished.

A novel screening tool has been shown to have content-, construct- and criterion-related validity, and the individual items have been shown to have good internal consistency. Further validation of the tool in a new population of elderly Africans is warranted.

To determine the nutrient composition of complementary foods consumed by 6–12-month-old South African infants.

Nutrient intake was determined for infants who were recruited to participate in a randomised controlled trial using a single 24-hour dietary recall.

Infants aged 6–12 months (n = 475) residing in The Valley of a Thousand Hills, a rural area in KwaZulu-Natal, South Africa.

Energy and protein intakes from complementary foods were adequate. Infants who consumed infant products (commercially available fortified infant cereals/ready-to-eat canned baby foods/formula milk powder) had significantly higher intakes of calcium, iron, zinc, vitamin A, thiamine, riboflavin, niacin, vitamin B6, vitamin B12 and vitamin C than infants who did not consume any infant products. For infants who consumed infant cereals (n = 142), these cereals provided 51% of total iron intake. Infant cereals provided more than 25% of total intake for magnesium, thiamine, niacin and vitamin B12. For infants consuming ready-to-eat canned baby foods (n = 77), these products contributed less than 15% of total intake for all the micronutrients. The nutrient density of the complementary diet was less than half the desired density for calcium, iron and zinc. Animal products were consumed by 17% of infants, 26% consumed dairy products and 18% consumed vitamin-A-rich fruit and vegetables during the 24-hour recall period.

The nutrient composition of complementary foods among rural South African infants was inadequate, especially for iron, zinc and calcium. Strategies should be developed to improve the nutritional quality of their diets.

To determine the serum levels of three lipid-soluble antioxidants (retinol, β-carotene and α-tocopherol) in pregnant women attending an antenatal clinic (ANC) in Gondar, Ethiopia.

A cross-sectional study involving laboratory determination of serum levels of retinol, α-tocopherol and β-carotene using high-performance liquid chromatography and questionnaire-based assessment of socio-economic status.

ANC of a university teaching hospital.

Three hundred and twenty-two healthy pregnant women in their third trimester, who attended the ANC.

Mean serum levels of retinol, α-tocopherol and β-carotene were found to be 1.23±0.5, 25.5±0.9 and 0.21±0.09 μmol l−1, respectively. The prevalence of vitamin A deficiency (<1.05 μmol l−1) among pregnant women was 38.5%. Women having low retinol (vitamin A) levels were highly likely to live in earth-floored and mud-walled houses, and less likely to own a house and to have a latrine.

The study shows that serum levels of lipid-soluble antioxidants were low among ANC attendees in northern Ethiopia. It also indicates that some socio-economic factors (such as poor housing standard) are associated with vitamin A deficiency.

To describe issues related to energy requirements of free living adults and discuss the importance of basal metabolic rate (BMR) and their relationships to total energy expenditure (TEE ) and physical activity level (PAL, derived as TEE/BMR) and to determine the influence of body weight, height, age and sex.

Based on a review of the literature, this paper examines the variability in BMR due to methodology, ethnicity, migration and adaptation (both metabolic and behavioural) due to changes in nutritional status. Collates and compiles data on measurements of TEE in free living healthy adults, to arrive at limits and to compare TEE of populations with different life-styles.

The constancy of BMR and its validity as a reliable predictor of TEE in adults as well as the validity of PAL as an index of TEE adjusted for BMR and thus its use to categorise the physical activity pattern and lifestyle of an individual was confirmed. The limits of human daily energy expenditure at around 1.2×BMR and 4.5×BMR based on measurements made in free living adults have been reported in the literature. A large and robust database now exists of energy expenditure measurements obtained by the doubly labelled water method in the scientific literature and the data shows that, in general, levels of energy expenditure are similar to the recommendations for energy requirements adopted by FAO/WHO/UNU (1985). The review also confirms that metabolic adaptation to energy restriction is not an important factor that needs to be considered when recommending energy requirements for adults in developing countries.

Adequate zinc nutriture is critically important for human health, but the development of programmes to control zinc deficiency is limited by the lack of reliable information on population zinc status. The present analyses were conducted to: (1) estimate the absorbable zinc content of national food supplies; (2) compare this information with theoretical population requirements for zinc; and (3) use these results to predict national risks of inadequate zinc intake.

Setting and design: National food balance data were obtained for 176 countries from the Food and Agriculture Organization of the United Nations. The amount of absorbable zinc in these foods was estimated from food composition data, and zinc absorption was predicted using a model developed by the International Zinc Nutrition Consultative Group (IZiNCG). Demographic data were obtained from United Nations estimates, and age- and sex-specific physiological requirements for absorbable zinc were estimated using IZiNCG recommendations.

Results and conclusions: The mean per capita absorbable zinc content of national food supplies ranged from 2.98–3.01 mg day−1 in Western Europe and USA & Canada to 2.09 mg day−1 in Southeast Asia. The estimated percentage of individuals at risk of inadequate zinc intake ranged from 9.3–9.5% in the regions of North Africa & Eastern Mediterranean and USA & Canada to 33.1% in Southeast Asia. Overall, approximately 20.5% of the world's population is estimated to be at risk of inadequate zinc intake. Data on the absorbable zinc content of national food supplies can be used to determine whether further assessments of population zinc status and development of intervention programmes are warranted.

To investigate the tracking of sugar-sweetened, carbonated soft drinks intake from age 15 to 33 years and the association between this intake and lifestyle factors and body weight.

A longitudinal study with 18–20 years of follow-up. Data about diet, physical activity, smoking and dieting were collected in 1981/1979, 1991 and 1999. Body weight and height were measured in 1981/1979 and self-reported in 1999.

Oslo, Norway.

Four hundred and twenty-two men and women.

Tracking of soft drinks intake from adolescence into early adulthood (age 25 years) and from early adulthood into later adulthood (33 years) was moderate to high, while tracking from adolescence into later adulthood was low. Comparing those reporting a high intake of soft drinks in both 1991 and 1999 with those reporting a low intake at both times, male long-term high consumers were more likely to smoke (48 vs. 21%, P = 0.002) and reported higher intakes of energy (12.2 vs. 10.2 MJ day−1, P = 0.005) and sugar (142 vs. 50 g day−1, P < 0.001) in 1999 than did long-term low consumers. Women high consumers were less likely to be physically active (14 vs. 42%, P = 0.03) and had higher sugar intake (87 vs. 41 g day−1, P < 0.001) in 1999 than did women low consumers. There were no differences in body mass index, overweight or obesity in 1999 between long-term high and low consumers.

In this study, stability of soft drinks intake from age 15 to 25 years and from age 25 to 33 years was moderate to high, while from age 15 to 33 years it was low. Soft drinks intake from age 25 to 33 years was associated with smoking and physical inactivity, but not with body weight.

To examine the temporal pattern of the number of eating occasions that occurred at home, at work and outside the home, and to examine the contribution of fat to energy and the contribution of 26 food groups to fat at home and outside the home.

Food intake data were collected using a 7-day food diary from a random sample of 18–64-year-old adults from the Republic of Ireland (n = 958). Respondents recorded the day, time and location of every eating occasion.

The number of eating occasions was constant across the days of the week for meals consumed at home, whereas the number of eating occasions increased at weekends for meals outside the home. The contribution of fat to energy approximated the 35% recommendation at home from Monday to Friday, but increased above this on Saturday and Sunday. The contribution of fat to energy outside the home was always above the recommendation. The food groups that contributed most to fat were similar at home and outside the home. These included butter and full-fat spreads, fresh meat, meat products, meat dishes, biscuits, cakes and pastries, whole milk, and chips and processed potatoes.

The contribution of fat to energy was above the recommendations when eating outside the home, regardless of day of the week. A number of food groups have been identified that contributed most to fat intake outside the home and these might be targeted in developing public health nutrition strategies to reduce fat intake.

In areas where vitamin A deficiency (VAD) is prevalent, vitamin A repletion reduces child mortality by 23% on average.

To estimate the potential child survival benefits of policies and programmes aimed at controlling VAD in Mozambique, and to make policy and programme recommendations.

The potential contribution of VAD to child mortality in Mozambique was estimated by combining the observed VAD prevalence in the under-5s (71.2%), the measured child mortality effects of VAD (risk of death in children with VAD = 1.75 times higher than in children without VAD) and the observed under-5 mortality rate in the country (210 per 1000 live births).

In Mozambique, an estimated 2.3 million children below the age of 5 years are vitamin-A-deficient. In the absence of appropriate policy and programme action, VAD will be the attributable cause of over 30 000 deaths annually in the under-5s. This represents 34.8% of all-cause mortality in this age group.

Vitamin A supplementation (VAS) has been adopted as a short- to medium-term strategy to control VAD in children, and is integrated into routine child health services. However, the last VAS coverage survey showed that only 46% of children received a vitamin A supplement in the 6 months preceding the survey. If VAS coverage is to increase significantly in the foreseeable future, four areas appear to be of paramount importance: (1) reduce missed opportunities for VAS such as visits of sick children to child health services and community outreach activities; (2) take advantage of all potential opportunities for accelerating VAS coverage, such as additional vaccination campaigns and emergency response activities; (3) strengthen health workers’ training, supervision and monitoring skills; and (4) increase community demand for VAS of children. Biannual VAS, as the primary component of an integrated strategy for VAD control in children, has the promise to be among the most cost-effective/high-impact child survival interventions in Mozambique.