To describe physical activity of participants in the European Prospective Investigation into Cancer and Nutrition (EPIC).

A cross-sectional analysis of baseline data of a European prospective cohort study.

This analysis was restricted to participants in the age group 50–64 years, which was represented in all EPIC centres. It involved 236 386 participants from 25 centres in nine countries. In each EPIC centre, physical activity was assessed by standardised and validated questions. Frequency distribution of type of professional activity and participation in non-professional activities, and age-adjusted means, medians and percentiles of time dedicated to non-professional activities are presented for men and women from each centre.

Professional activity was most frequently classified as sedentary or standing in all centres. There was a wide variation regarding participation in different types of non-professional activities and time dedicated to these activities across EPIC centres. Over 80% of all EPIC participants engaged in walking, while less than 50% of the subjects participated in sport. Total time dedicated to recreational activities was highest among the Dutch participants and lowest among men from Malmö (Sweden) and women from Naples (Italy). In all centres, total time dedicated to recreational activity in the summer was higher than in the winter. Women from southern Europe spent the most time on housekeeping.

There is a considerable variation of physical activity across EPIC centres. This variation was especially evident for recreational activities in both men and women.

Investigation of relative bias in diet history measurement during dietary intervention trials.

Retrospective analysis of human dietary data from two randomised controlled trials examining modified fat diets in the prevention and treatment of type II diabetes mellitus.

Wollongong, Australia.

Thirty-five overweight, otherwise healthy subjects in trial 1 and 56 subjects with diabetes in trial 2.

Diet history interviews and three-day weighed food records administered at one-month intervals in trial 1 and three-month intervals in trial 2.

In a cross-sectional bias analysis, graphs of the association between bias and mean dietary intake showed that bias decreased in higher carbohydrate consumers in trial 1 ( r = −0.344, P<0.05 ). No other significant associations were found. In a longitudinal analysis, bias did not change over time in either trial. There were no significant differences in bias magnitudes between the trials, with the exception of monounsaturated fat measurement where bias was significantly greater and more positive in trial 2, indicating overestimation of monounsaturated fat intake with the diet history. Subjects in control and intervention groups underestimated energy, fat, saturated fat and alcohol intakes with the diet history in both trials. Overweight and obese individuals appeared to make the greatest contribution to the overall underestimation of saturated fat intake by the diet history regardless of whether they were in the control or intervention group and whether they were healthy or had diabetes.

Bias in diet history measurement appears to be macronutrient-specific, with energy, fat and saturated fat consistently underreported in the interview by subjects with and without diabetes and in both intervention and control groups in a dietary intervention trial. Relative bias analysis appears to be an informative tool in quality control for dietary intervention trials when biochemical markers are unavailable.

To identify child hunger and examine its association with family factors, receipt of benefits, housing conditions and social support among recently arrived refugee families with young children.

Structured and semi-structured questionnaire administered to a service-based, purposive sample of caregivers.

East London, United Kingdom.

Thirty households with children <5 years old, resident in the UK for <2 years.

All households sampled were food-insecure, and 60% of index children were experiencing hunger as defined on the Radimer/Cornell scale. Child hunger was significantly associated with recent arrival, marginally significantly associated with receipt of fewer benefits and younger parenthood, and not associated with maternal education or self-efficacy score, household size or composition, or measures of social support.

A community-based, participatory approach for rapid assessment of the prevalence, extent and causes of child hunger among newly arrived asylum seekers recently arrived in Britain is feasible, and preliminary results suggest a programmatic need for a broader, population-based assessment of food insecurity in this rapidly growing population group.

To determine the effects of birth weight and early childhood stunting on body mass index (BMI), body fat and fat distribution at ages 7 and 11 years, and the change from 7 to 11 years.

Prospective cohort study.

Kingston, Jamaica.

One hundred and sixteen stunted children (height-for-age below two standard deviations (<-2SD) of the National Center for Health Statistics (NCHS) references) and 190 non-stunted children (height-for-age > -1SD), identified at age 9–24 months. The stunted group was divided into a previously stunted group (height-for-age at 11 years ≥ -1SD) and a chronically stunted group (height-for-age <-1SD).

Birth weight was positively related to the children's BMI but not to measures of body fat. Birth weight was negatively associated with the subscapular/triceps skinfold (SSF/TSF) ratio at age 11 years, and to the change between 7 and 11 years. Controlling for birth weight, the chronically stunted group remained significantly smaller than the non-stunted children at both ages and increased less from 7 to 11 years in all measures except the SSF/TSF ratio, which was significantly greater at age 7 years. The previously stunted group had significantly lower BMI and percentage body fat at age 7 years than the non-stunted group. Change from 7 to 11 years was not significantly different from that of the non-stunted group except for a smaller increase in TSF. At age 11 years they had significantly lower TSF and percentage body fat1.

Children stunted in early childhood had less fat and lower BMI than non-stunted children but had a more central fat distribution that was partially explained by their lower birth weights. The association between birth weight and central fat distribution developed between 7 and 11 years.

To compare the mortality of British vegetarians and non-vegetarians.

Analysis of original data from two prospective studies each including a large proportion of vegetarians – the Oxford Vegetarian Study and the Health Food Shoppers Study. Standardised mortality ratios (SMRs) compared with the population of England and Wales were calculated from deaths before age 90 for vegetarians and non-vegetarians in each study. Death rate ratios (DRRs) for vegetarians compared with non-vegetarians within each study were calculated for each of 14 major causes of death.

UK.

Twenty-one thousand men and women aged 16–89 years at recruitment, including more than 8000 vegetarians.

SMRs for all causes of death were significantly below the reference level of 100 in both studies: 52 (95% confidence interval (CI) 49–56) based on 1131 deaths in the Oxford Vegetarian Study and 59 (57–61) based on 2346 deaths in the Health Food Shoppers Study. For all causes of death, the DRR for vegetarians compared with non-vegetarians was close to one in both studies: 1.01 (95% CI 0.89–1.14) in the Oxford Vegetarian Study, 1.03 (0.95–1.13) in the Health Food Shoppers Study.

British vegetarians have low mortality compared with the general population. Their death rates are similar to those of comparable non-vegetarians, suggesting that much of this benefit may be attributed to non-dietary lifestyle factors such as a low prevalence of smoking and a generally high socio-economic status, or to aspects of the diet other than the avoidance of meat and fish.

To summarise the applications and appropriate use of Dietary Reference Intakes (DRIs) as guidance for nutrition and health research professionals in the dietary assessment of groups and individuals.

Key points from the Institute of Medicine report, Dietary Reference Intakes: Applications in Dietary Assessment, are summarised in this paper. The different approaches for using DRIs to evaluate the intakes of groups vs. the intakes of individuals are highlighted.

Each of the new DRIs is defined and its role in the dietary assessment of groups and individuals is described. Two methods of group assessment and a new method for quantitative assessment of individuals are described. Illustrations are provided on appropriate use of the Estimated Average Requirement (EAR), the Adequate Intake (AI) and the Tolerable Upper Intake Level (UL) in dietary assessment.

Dietary assessment of groups or individuals must be based on estimates of usual (long-term) intake. The EAR is the appropriate DRI to use in assessing groups and individuals. The AI is of limited value in assessing nutrient adequacy, and cannot be used to assess the prevalence of inadequacy. The UL is the appropriate DRI to use in assessing the proportion of a group at risk of adverse health effects. It is inappropriate to use the Recommended Dietary Allowance (RDA) or a group mean intake to assess the nutrient adequacy of groups.

Food insecurity has become an important issue in many countries of the former Soviet Union following the transition to a market economy. This study examined three aspects of food security in the Baltic Republics: reasons for choosing foods; level of dependence on home-grown or raised foods; and use of home-grown vegetables.

Cross-sectional surveys.

Data from surveys conducted in Estonia, Latvia and Lithuania in the summer of 1997 were used to describe the three aspects of food security and their socio-economic correlates (using descriptive statistics and logistic regression).

Representative samples of adults were selected in each country (Estonia, n = 2018; Latvia, n = 2308; Lithuania, n = 2153).

Cost was the most commonly reported reason for choosing foods, particularly in Lithuania (67%) and Latvia (60%) (Estonia 41%), and especially among people with lower income levels. In each country, large proportions of respondents depended partially or entirely on home-grown or raised foods (Latvia 47%, Lithuania 42%, Estonia 32%) or used home-grown vegetables frequently (Lithuania 66%, Latvia 53%, Estonia 29%); this was particularly the case in rural areas.

The issue of food security needs to be examined further in the Baltic Republics and other transitional economies as increased access to safe, healthy foods for all could help improve dietary intake and reduce the high mortality from non-communicable diseases. Access to affordable, high-quality fresh foods by different social groups should be monitored and the potential contribution of home-grown and raised foods to reduce food poverty should be explored further1.

The purpose of this paper is to present longitudinal data on nutrient intakes of youth with emphases on differences by sex and race/ethnicity. Nutrients selected for examination are those implicated in chronic disease.

24-hour dietary recalls were collected from a cohort of third, fifth and eighth graders (n=1874).

The sample is drawn from the Child and Adolescent Trial for Cardiovascular Health and includes students from California, Louisiana, Minnesota and Texas.

Across the total sample, nutrient intakes met recommended levels except that total fat, saturated fat and sodium consistently exceeded recommendations and calcium and iron intake of girls consistently fell short of recommended levels. Nutrient consumption between third and eighth grade differed by sex and race/ethnicity for a number of nutrients. In particular, females' intake of energy from total fat, calcium, iron, folic acid, vitamin A and vitamin D decreased over time relative to males' intakes, controlling for overall energy intake. Compared with the other ethnic/racial groups, African-American students increased their intake of energy from total fat and saturated fat over time.

Our results suggest that the diets of youth change over time, and negative trends are more common in females than in males and in African-American and Hispanics compared with Caucasian students. Nutrition education and intervention are needed throughout childhood and adolescence with an emphasis on choosing healthful foods. In addition, greater attention to differential opportunities and reinforcements for females and males, and Caucasian, Hispanic and African-American students is warranted.

To analyse the nutritional transition in Morocco.

Examination of Moroccan national survey data.

Morocco is undergoing a demographic, epidemiological and social transition. The urban population increased from 29% in 1960 to 53% in 1997. Per capita gross domestic product increased steadily from 1972 to 1999. Life expectancy at birth increased to 70 years in 1999 from 47 years in 1962. Both infant and juvenile mortalities have decreased, from 92/1000 and 69/1000 in 1982–87 to 46/1000 and 37/1000 in 1992–97, respectively. In parallel, the diet changed considerably: the intake of animal products increased while that of cereals and sugar remained relatively high, reflecting the specificity of Moroccan dietary habits. The rise in the consumption of meats and vegetables was accompanied by a steady consumption of bread, used to eat the sauce in which the meat and vegetables are cooked. Sugar is mainly used in tea, the very sweet, national drink consumed throughout the day. Under-nourishment persists among children under five (23% stunting and 10% underweight in 1997) while overweight is rising (9% in 1997 compared with 3% in 1987 for children under three). Among adults, overweight (body mass index (BMI) > 25 kgm−2) increased from 26% in 1984 to 36% in 1998. It is higher among women (32% in 1984 and 45% in 1998) than among males (19% in 1984 and 25% in 1998). It is also higher among urban populations (30% in 1984 and 40% in 1998) than rural populations (20% in 1984 and 29% in 1998). Obesity (BMI > 30 kgm−2) increased from 4% in 1984 to 10% in 1998. Overweight seems to be positively associated with economic status but negatively with education level.

Overweight and obesity constitute major health problems in Morocco.

To compare the prevalence of self-reported hypertension and mean systolic and diastolic blood pressures in four diet groups (meat eaters, fish eaters, vegetarians and vegans) and to investigate dietary and other lifestyle factors that might account for any differences observed between the groups.

Analysis of cross-sectional data from participants in the Oxford cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC–Oxford).

United Kingdom.

Eleven thousand and four British men and women aged 20–78 years at blood pressure measurement.

The age-adjusted prevalence of self-reported hypertension was significantly different between the four diet groups, ranging from 15.0% in male meat eaters to 5.8% in male vegans, and from 12.1% in female meat eaters to 7.7% in female vegans, with fish eaters and vegetarians having similar and intermediate prevalences. Mean systolic and diastolic blood pressures were significantly different between the four diet groups, with meat eaters having the highest values and vegans the lowest values. The differences in age-adjusted mean blood pressure between meat eaters and vegans among participants with no self-reported hypertension were 4.2 and 2.6 mmHg systolic and 2.8 and 1.7 mmHg diastolic for men and women, respectively. Much of the variation was attributable to differences in body mass index between the diet groups.

Non-meat eaters, especially vegans, have a lower prevalence of hypertension and lower systolic and diastolic blood pressures than meat eaters, largely because of differences in body mass index.

The aim of the study was to estimate the prevalence of diarrhoea in children less than two years old and study the relationship between diarrhoeal episodes and action taken for these episodes by their mothers.

The prevalence of diarrhoeal episodes among children and its associations with sociodemographic information and anthropometric measurements of the subjects was examined. Predictive factors for morbidity-associated diarrhoeal disease and actions taken for this were explored.

Primary health care centres (PHCCs) in Riyadh, Kingdom of Saudi Arabia.

Children less than two years of age.

Nearly a quarter of the children contracted diarrhoea during the two weeks preceding the data collection point, giving about six episodes of diarrhoea per child per year. Diarrhoea was more common in children over 6 months of age, in children who had no vaccination or follow-up cards, and in those who were taken care of by friends and neighbours if their mothers were working outside the home. The mothers of the affected children were young, married before 25 years of age with 2–6 years of formal schooling. During diarrhoeal episodes, about 25% of mothers stopped or decreased breast-feeding, 11.3% reduced the volume of fluids given to their children, and 22.7% of children were fed less solid/semi-solid foods. Mothers used oral rehydration salt in more than 40% of diarrhoeal episodes and unprescribed antibiotics were used in 17% of cases. The mothers who were not taking appropriate action included young mothers with low education level and those working outside the home.

Diarrhoea is common in children less than two years old in Riyadh City, and intervention based in PHCCs needs to be undertaken to correct the faulty practices of mothers during diarrhoeal episodes in their children. Health education messages should emphasise feeding during diarrhoeal episodes.

The overall aim of this study was to examine a variety of belief and demographic factors that are associated with the perception that meat is intrinsically unhealthy.

State-wide survey (written questionnaire) that included questions on meat and nutrition beliefs, perceived barriers and benefits of vegetarian diets, personal values, number of vegetarian friends and family members, and use and trust of health/nutrition/food information sources.

South Australia.

Six hundred and one randomly selected South Australians and 106 non-randomly selected vegetarians and semi-vegetarians.

For all respondents considered as a group, the most important predictors of the belief that meat is intrinsically unhealthy were the perceived benefits of vegetarian diets (all positive predictors). These included: (1) the perceived links between vegetarianism, peace and increased contentment; (2) animal welfare and environmental benefits; and (3) health benefits. There were differences between different dietary groups however. For non-vegetarians, social concerns about vegetarianism (positive) were most important, followed by health and non-health benefits (positive) of vegetarianism. Red meat appreciation was the strongest (positive) predictor for vegetarians, with health benefits of vegetarianism (positive) and education (negative predictor) also important.

The implications of the findings for health and other issues are discussed. Judgements about the healthiness of meat are likely to be related to moral and environmental beliefs and, for non-vegetarians, to social concerns about vegetarianism, in addition to health beliefs. These need to be considered if any attempts are made to influence meat consumption.

To assess breast-feeding promotion in maternity hospitals and breast-feeding prevalences during the first year of life in mother–infant pairs in Germany.

Cross-sectional assessment of breast-feeding practices in a random sample of German maternity hospitals by use of a postal questionnaire. Follow-up of mother–infant pairs recruited in the participating hospitals to assess breast-feeding prevalences and infant feeding practices by use of a telephone interview 14 days after birth and food-frequency questionnaires mailed at the end of the 2nd, 4th, 6th, 9th and 12th month of life. Use of indicators for breast-feeding proposed by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF).

Nation-wide survey.

One hundred and seventy-seven maternity hospitals, 1717 mother–infant pairs.

There were wide variations in breast-feeding promotion in hospitals as evaluated by the practice of the '10 Steps to Successful Breastfeeding' given by WHO and UNICEF for certification as a ‘Babyfriendly Hospital’. Some steps (3, 4, 8) were practised in about 90% of the hospitals, others (steps 7, 9) in only 10%. Prevalences for exclusive (total) breast-feeding as defined by WHO were: 73% (86%) at discharge, 60% (85%) at 14 days, 42% (70%) at 2 months, 33% (59%) at 4 months, 10% (48%) at 6 months, <1% (26%) at 9 months and 0 (13%) at 12 months.

By use of indicators proposed by WHO and UNICEF, a differentiated insight into the breast-feeding situation in Germany has become possible. Moderate levels of breast-feeding promotion in hospitals resulted in almost satisfactory early breast-feeding prevalences but were not effective for long-term breast-feeding success in most mothers.

To describe and compare the consumption of the main groups and sub-groups of vegetables and fruits (V&F) in men and women from the centres participating in the European Prospective Investigation into Cancer and Nutrition (EPIC).

Cross-sectional analysis. Dietary intake was assessed by means of a 24-hour dietary recall using computerised interview software and standardised procedures. Crude and adjusted means were computed for the main groups and sub-groups of V&F by centre, separately for men and women. Adjusted means by season, day of the week and age were estimated using weights and covariance analysis.

Twenty-seven centres in 10 European countries participating in the EPIC project.

In total, 35 955 subjects (13 031 men and 22 924 women), aged 35–74 years, randomly selected from each EPIC cohort.

The centres from southern countries had the highest consumption of V&F, while the lowest intake was seen in The Netherlands and Scandinavia for both genders. These differences were more evident for fruits, particularly citrus. However, slightly different patterns arose for some sub-groups of vegetables, such as root vegetables and cabbage. Adjustment for body mass index, physical activity, smoking habits and education did not substantially modify the mean intakes of vegetables and fruits.

Total vegetable and fruit intake follows a south–north gradient in both genders, whereas for several sub-groups of vegetables a different geographic distribution exists. Differences in mean intake of V&F by centre were not explained by lifestyle factors associated with V&F intake.

To study the effect of advice to increase dietary soluble fibre, including fruit and vegetables, on plasma folate and homocysteine in men with angina.

Data were collected on a subset of subjects from the Diet and Angina Randomised Trial (DART II). In a randomised (2 × 2) factorial design, subjects received advice on either, neither or both interventions to: (1) increase soluble fibre intake to 8.0 g day−1 (fruit, vegetables and oats); (2) increase oily fish intake to 2 portions week−1. Those who received soluble fibre advice were compared with those who did not. Subjects were genotyped for C677T variant 5,10-methylenetetrahydrofolate reductase (MTHFR).

Seven hundred and fifty-three male angina patients were recruited from general practice.

Plasma homocysteine concentrations were at the upper end of the normal range (median 11.5, 25% 9.4, 75% 14.0 μmol l−1). Baseline intake of fruit and vegetables was positively correlated with plasma folate (rs = 0.29, P < 0.01). Smokers had lower intakes of fruit and vegetables, lower plasma folate and higher homocysteine (all P < 0.01). Homozygotes for variant MTHFR had higher homocysteine concentrations at low plasma folate (P < 0.01). Reported intakes of fruit and vegetables and estimated dietary folate increased in the intervention group (ca. +75 g day−1, P < 0.01 and ca. +20 g day−1, P < 0.05, respectively). However, neither plasma folate (baseline/follow-up 4.5 vs. 4.4 μg l−1, P = 0.40) nor homocysteine (baseline/follow-up 11.7 vs. 11.7 μmol l−1, P = 0.31) changed.

Plasma homocysteine, a cardiovascular risk factor, is influenced by MTHFR genotype, plasma folate and smoking status. Dietary advice successfully led to changes in fruit and vegetable intake, but not to changes in plasma folate or homocysteine, possibly because the fruits and vegetables that were chosen were not those richest in folate.

To validate abbreviated methods that estimate food security level among poor communities in Caracas, Venezuela.

Two independent cross-sectional studies were undertaken to internally and externally validate simple quantitative/qualitative methods. The quantitative measure was constructed from data on household food availability, gathered using the list-recall method. It is a count of the foods that explain 85% or more of household energy availability. The qualitative measure is a score of female-perceived food insecurity level estimated with a modified ‘hunger index’, reflecting food resource constraints and hunger experiences within the home. Socio-economic and food behaviour data that may predict household food security (HFS) levels were gathered. The second study was repeated a year later to measure the impact of an increase in the minimum wage on HFS levels.

Two poor urban communities in Caracas, Venezuela.

All households in both communities that complied with selection criteria (poor and very poor families that share food resources) and were willing to participate. The sample comprised 238 and 155 female household food managers in the two communities.

In 1995, data from females in 238 urban poor households provided evidence for the overall validity of the method. Its application in 1997 to 155 households in the other community gave support to the external validity of the method. Measures were repeated in 1998 on 133 subjects of the above sample, when the minimum wage was increased by 23%. Evidence is presented showing the sensitivity of the method to changes in the determinants of HFS. Data analysed during these three periods suggest that the method can be simplified further by using the food diversity score instead of the quantitative measure since these variables correlate highly with one another (r ≥ 0:854).

This simple method is a valid and precise measure of food security among poor urban households in Caracas. The qualitative/quantitative measures complement each other as they capture different dimensions of HFS.

To evaluate, in terms of function and mobility, the predictive value of commonly adopted anthropometric ‘definitions’ used in the nutritional assessment of older adults, in a cohort of older Australians.

Prospective cohort study – Australian Longitudinal Study of Ageing (ALSA).

Adelaide, South Australia (1992–1994).

Data were analysed from 1272 non-institutionalised (685 males, 587 females) older adults ≥70 years old in South Australia. Seven ‘definitions’ commonly used in the anthropometric assessment of both under- and overnutrition (including four using body mass index (BMI), waist-to-hip ratio, waist circumference and percentage weight change) were evaluated at baseline, for their ability to predict functional and mobility limitation assessed (by self-report questionnaire) at two years follow-up. All questionnaires were administered and anthropometry performed by trained investigators. The associations between the definitions and decline in mobility and physical function were evaluated over two years using multiple logistic regression.

A BMI >85th percentile or >30 kgm−2 or a waist circumference of >102 cm in males and >88 cm in females increased risk of functional and mobility limitations. Over two years, a loss of 10% body weight significantly increased the risk of functional and mobility limitations.

Maintaining weight within older adults, irrespective of initial body weight, may be important in preventing functional and mobility limitations. Excessive weight is associated with an increased risk of limitation in function and mobility, both key components of health-related quality of life.

To propose an approach for investigation of the relationship between the frequency of carbohydrates intake and dental caries in real-life conditions.

The frequency of separate eating events (with the exclusion of lunch and dinner) and their sugars and starch content were assessed on the basis of diaries collected for seven consecutive days. The total number of decayed, missing and filled teeth (DMFT) was assessed through clinical examination. The interrelation between DMFT and frequency of eating events was analysed through Pearson correlation coefficient and stepwise forward linear regression analysis.

Italy.

One hundred and ninety-three students (males and females, mean age 16 years) of a secondary school.

Individual DMFT varied between 0 (24% of subjects) and 12, with a mean of 3. Once lunch and dinner were excluded, the mean number of separate eating events was 2.9. A statistically significant relationship was found between DMFT and eating frequency thus defined. Correlations were calculated considering only eating events containing a proportion of sugars or starch higher than different cut-off levels. In a stepwise multiple regression model for DMFT, the frequency of ‘high sugars and high starch events’ accounted for 8% of the DMFT variance. Overall frequency of separate eating events defined according to their content of both sugars and starch accounted for 18% of the DMFT variance. A stronger correlation was found among males only.

The precise characterisation of eating events in terms of their sugars and starch content allows us to explain a consistent percentage of the variability in DMFT.

To describe changing food consumption patterns in Egypt over the last several decades, current levels of overweight and obesity, and current data on obesity-related morbidity.

Secondary analysis and synthesis of existing data from national-level food consumption surveys, large recent surveys of hypertension and diabetes, and documentation of historical and policy context.

Arab Republic of Egypt.

As selected and described in primary data sources.

Results and conclusions: The nutrition transition in Egypt has occured in the context of abundant dietary energy availability, urbanisation and moderate fat intakes. The prevalence of obesity in adults is very high, particularly among women. The prevalences of diabetes mellitus and of hypertension parallel that of obesity, and both are very high. Little information is available on physical activity, but it is likely that a large proportion of the population is quite sedentary, particularly in the cities. At the same time, rates of early childhood malnutrition remain stubbornly stable and relatively high. Public awareness of the increasing prevalence of obesity and of diet-related chronic disease is increasing, and attention has turned to documenting the problem(s).

To describe the average consumption of carbohydrate-providing food groups among study centres of the European Prospective Investigation into Cancer and Nutrition (EPIC).

Of the 27 redefined EPIC study centres, 19 contributed subjects of both genders and eight centres female participants only (men, n=13 031; women, n=22924, after exclusion of subjects under 35 and over 74 years of age from the original 36 900 total). Dietary data were obtained using the 24-hour recall methodology using the EPIC-SOFT software. The major sources of dietary carbohydrate were identified, and 16 food groups were examined.

The 10 food groups contributing most carbohydrate were bread; fruit; milk and milk products; sweet buns, cakes and pies; potato; sugar and jam; pasta and rice; vegetables and legumes; crispbread; and fruit and vegetable juices. Consumption of fruits as well as vegetables and legumes was higher in southern compared with northern centres, while soft drinks consumption was higher in the north. Italian centres had high pasta and rice consumption, but breakfast cereal, potato, and sweet buns, cakes and pies were higher in northern centres. In Sweden, lower bread consumption was balanced with a higher consumption of crispbread, and with sweet buns, cakes and pies. Overall, men consumed higher amounts of vegetables and legumes, bread, soft drinks, potatoes, pasta and rice, breakfast cereal and sugar and jam than women, but fruit consumption appeared more frequent in women.

The study supports the established idea that carbohydrate-rich foods chosen in northern Europe are different from those in the Mediterranean region. When comparing and interpreting diet–disease relationships across populations, researchers need to consider all types of foods.