To determine the nutritional status of a cohort of 11–12 year olds and ascertain social and demographic factors associated with under- and overweight in early adolescence.

Cross-sectional.

Subgroup (n=1698) of the birth cohort (September–October 1986) of the Jamaican Perinatal Survey enrolled in schools in the Kingston Metropolitan area. One thousand and sixty-three parents or caregivers provided social and demographic information.

Undernutrition and overnutrition are of public health significance among adolescent Jamaican children. Ten per cent of 11–12 year olds had body mass index (BMI) values below the 5th percentile (boys, 10.6%; girls, 7.1%) but this prevalence is relatively low compared with other developing countries. The prevalence of stunting was low (3%). The prevalence of overweight (BMI≥85th percentile) (19.3%) was approaching prevalence rates found in the USA. Similar social and demographic variables were associated with thinness and fatness in males. Birth weight predicted overweight in girls.

Under- and overnutrition in early adolescence are important problems in Jamaica. There is a need to address both under- and overnutrition in adolescence in preventive and rehabilitative intervention programmes.

To identify groups within Dhaka slums that report similar patterns of livelihood, and to explore nutritional and health status.

A random sample of households participated in a longitudinal study in 1995–1997. Socio-economic and morbidity data were collected monthly by questionnaire and nutritional status was assessed. Cluster analysis was used to aggregate households into livelihood groups.

Dhaka slums, Bangladesh.

Five-hundred and fifty-nine households.

Main outcome measures: Socio-economic and demographic variables, nutritional status, morbidity.

Four livelihood groups were identified. Cluster 1 (n = 178) was the richest cluster with land, animals, business assets and savings. Loans as well as income were higher, which shows that this group was credit-worthy. The group was mainly selfemployed and worked more days per month than the other clusters. The cluster had the second highest body mass index (BMI) score, and the highest children's nutrition status. Cluster 2 (n = 190) was a poor cluster and was mainly dependent selfemployed. Savings and loans were lower. Cluster 3 (n = 124) was the most vulnerable cluster. Members of this group were mainly casual unskilled, and 40% were femaleheaded households. Total income and expenditure were lowest amongst the clusters. BMI and children's nutritional status were lowest in the slum. Cluster 4 (n = 67) was the second richest cluster. This group comprised skilled workers. BMI was the highest in this cluster and children's nutritional status was second highest.

Cluster analysis has identified four groups that differed in terms of socioeconomic, demographic and nutritional status and morbidity. The technique could be a practically useful tool of relevance to the development, monitoring and targeting of vulnerable households by public policy in Bangladesh.

To determine the nutritional importance of non-home prepared foods for men, women and schoolchildren living in two low-income residential areas of Nairobi, and the sources of these non-home prepared foods.

Design, setting and subjects: A survey was conducted in Korogocho, a slum area, and Dandora, a low–middle-income residential area. Some 241 men, 254 women and 146 children aged 9 to 14 years were included in the study. Food intake was measured using three 24-hour recalls per individual, with special attention on the sources of all foods consumed.

The median proportion of daily energy intake of consumers provided by non-home prepared foods ranged from 13% for schoolchildren in Korogocho to 36% for men in Dandora. The median contribution to fat intake was higher than to energy, but the contributions to iron and vitamin A intakes were lower than to energy intake. Men consumed more non-home prepared foods on weekdays than at the weekend. Intakes of energy and most nutrients were below Kenyan Recommended Daily Intakes in all groups, but similar for consumers and non-consumers. In Korogocho, street foods were the main source of non-home prepared foods. In Dandora, both kiosks and street foods were major sources.

Non-home prepared foods are an important source of energy and nutients for men, women and schoolchildren in Nairobi. In Korogocho, street foods, and in Dandora, both kiosks and street foods are the main sources of non-home prepared foods. The adequacy of energy and nutrient intakes does not differ between consumers and non-consumers of non-home prepared foods.

The study determined the impact of a community-based nutrition education programme, using trained community nutrition advisors, on the anthropometric nutritional status of mixed-race children aged between 2 and 5 years.

The programme was implemented over two years in four study areas in the Free State and Northern Cape Provinces. Two control areas were included to differentiate between the effect of the education programme and a food aid programme that were implemented simultaneously. Weight-for-age, height-for-age and weight-for-height were summarised using standard deviations from the NCHS reference median. For each of the indicators, the difference in the percentage of children below minus two standard deviations from the reference NCHS median in the initial and follow-up surveys was determined.

Initially 536 children were measured and, after two years of intervention, 815.

Weight-for-age improved in all areas, but only significantly in boys and girls in the urban study area, and in boys in one rural study area. No significant improvement in height-for-age occurred in any area. Weight-for-height improved significantly in the urban study area.

The education programme in combination with food aid succeeded in improving the weight status of children, but was unable to facilitate catch-up growth in stunted children after two years of intervention.

To determine the nutritional and health status of urban infants in two disadvantaged communities in the Western Cape, South Africa with special reference to micronutrient status. The results of this study will serve to plan an intervention study in these communities in the same age group.

Cross-sectional study.

Two disadvantaged urban black and ‘coloured’ communities in the Western Cape, South Africa.

Sixty infants aged 6–12 months from each community.

Dietary intake, anthropometric measurements, micronutrient status and psychomotor development.

Stunting and underweight were more prevalent in coloured infants (18% and 7%, respectively) than in black infants (8% and 2%, respectively). Anaemia (haemoglobin (Hb)<11 g dl−1 ) was prevalent in 64% of coloured and 83% of black infants. Iron-deficiency anaemia ( Hb<11 g dl−1 and ferritin < 10 ng ml−1) was found in 32% of coloured infants and in 46% of black infants. Zinc deficiency was prevalent in 35% and 33% of the coloured and black infants, respectively. Marginal vitamin A deficiency (serum retinol < 20 μg dl−1) was observed in 23% of black infants compared with 2% of coloured infants. Of black infants, 43% and of coloured infants 6% were deficient in two or more micronutrients. Six per cent of coloured infants had C-reactive protein concentrations above 5 mg l−1 compared with 38% of the black infants. The dietary intake of micronutrients was in general lower in black infants than in coloured infants. The overall psychomotor development, assessed by the Denver Developmental Screening Test, was different between the two groups. The coloured infants scored higher in three out of the four categories as well as in their overall score.

This study shows that information on stunting and wasting only in urban disadvantaged infants is not sufficient to make recommendations about specific community intervention programmes. Information on the micronutrient status, independent of wasting and stunting, is necessary to design nutrition programmes for different communities. The study also showed a substantially higher prevalence of micronutrient deficiencies among black infants.

To evaluate acceptability, compliance and attitude towards the use of iron pots compared with aluminium pots, for cooking in a community that traditionaly did not use iron pots.

Randomised trial.

Two rural Malawian villages.

Fifty-two households received iron pots and 61 aluminium pots.

Pot characteristics were assessed by a questionnaire after 3, 6, 11 and 20 weeks of use. Within households using iron pots there was a significant decrease in acceptability score with usage, from an initial value of 13.7 to 11.4 (range 1–20) (P = 0.01). Answers to questions concerning cooking characteristics showed that after 3 weeks' use the aluminium pot scored better, whereas after 20 weeks fewer answers differed between the iron and aluminium pot groups. Almost a third of the households planned to continue using iron pots daily after 20 weeks, although they had ready access to their former aluminium pot. The presence of a group of consistent pot users suggests that if households were convinced about daily use, then they were likely to maintain consistent use. Some householders considered that iron pots required less firewood for cooking than aluminium pots. The main problems related to lower acceptability were rusting and pot weight. About 25% of problems with iron pots were unrelated to their cast iron characteristics. Overall 23.4% of the households indicated they would buy an iron pot.

The low acceptability of iron pots for cooking could limit their value as an intervention to control iron-deficiency anaemia. Design modifications and better instructions on pot use should improve acceptability. The study highlights the need to assess the acceptability of interventions in order to facilitate their adoption in traditional communities.

To assess the applicability and use of infant nutrition and health indicators during emergencies.

Indicators recommended by international health and nutrition organisations for assessing infant feeding practice were compiled and analysed to evaluate their consistency and applicability for use in surveys of emergency-affected populations. These indicators included measures of breast-feeding status, use of artificial feeding, anthropometric status and morbidity. Health and nutrition surveys performed on the resident or refugee population of Kosovo during the years 1996–1999 were then reviewed and the use of infant feeding and morbidity indicators were compared.

A number of recommended indicators exist for assessing infant and child feeding practice which have been generated by different international organisations. A comparison of these indicators revealed a number of inconsistencies, both in target population and measurement method. Their use during the Kosovo crisis was likewise inconsistent and prevented conclusions being drawn about the effectiveness of the international response in protecting infant health and nutrition.

Standard indicators need to be agreed and promoted for use during surveys of emergency-affected populations. Failure to do so will lead to a continued inability to monitor the health and nutrition of infants at a population level during international relief operations.

To describe time trends in under- and overnutrition in different regional and income strata of the child and adult population of Brazil.

Nation-wide surveys conducted in 1975, 1989 and 1996/7 in probabilistic samples of 1–4-year-old children and adults 20 years and over. Time trends refer to stunting, wasting and overweight prevalences among children and age-adjusted underweight and obesity prevalences among adults (95% confidence intervals included).

Individuals examined by each survey in each age group ranged from 1796 young children in 1996 to 78 031 adults in 1975.

North-eastern and south-eastern regions of Brazil.

Undernutrition indicators declined intensively and continuously among children and adults in all region and income strata. Obesity remained low and relatively stable among children, but increased intensively and continuously in all regions and income strata among adult males. Obesity also increased intensively and continuously among adult women from the less economically developed region of Brazil (the north-eastern region) and among lower-income women from the more developed region (the south-eastern region). Higher-income women from the more developed region had a significant increase in obesity from 1975 to 1989, followed by a significant decline from 1989 to 1997.

Undernutrition in young children is being controlled in Brazil without evidence of increasing obesity. However, obesity is rapidly replacing undernutrition in most gender, region and income strata of the adult population. Adult obesity is already more frequent than adult undernutrition in the more economically developed region, among all higher-income groups, and also among lower-income women living in the more developed region. These lower-income women are significantly more exposed than their higher-income counterparts to both undernutrition and obesity.

To illustrate biomarkers of diet that can be used to validate estimates of dietary intake in the study of gene–environment interactions in complex diseases.

Prospective cohort studies, studies of biomarkers where diet is carefully controlled.

Free–living individuals, volunteers in metabolic suites.

Male and female human volunteers.

Recent studies using biomarkers have demonstrated substantial differences in the extent of measurement error from those derived by comparison with other methods of dietary assessment. The interaction between nutritional and genetic factors has so far largely gone uninvestigated, but can be studied in epidemiological trials that include collections of biological material. Large sample sizes are required to study interactions, and these are made larger in the presence of measurement errors.

Diet is of key importance in affecting the risk of most chronic diseases in man. Nutritional epidemiology provides the only direct approach to the quantification of risks. The introduction of biomarkers to calibrate the measurement error in dietary reports, and as additional measures of exposure, is a significant development in the effort to improve estimates of the magnitude of the contribution of diet in affecting individual disease risk within populations. The extent of measurement error has important implications for correction for regression dilution and for sample size. The collection of biological samples to improve and validate estimates of exposure, enhance the pursuit of scientific hypotheses, and enable gene–nutrient interactions to be studied, should become the routine in nutritional epidemiology.