We hypothesized that young adults would commonly have vitamin D deficiency and that a questionnaire could help identify subjects with the condition.

Between January and May 2004, we administered a questionnaire to a convenience sample of young adults. We measured each participant’s serum level of 25-hydroxyvitamin D (25(OH)D) using a chemiluminescent assay and defined deficiency as serum 25(OH)D < 16 ng/ml.

We recruited young adults living in Madison, Wisconsin without pre-existing conditions affecting vitamin D and/or Ca metabolism.

One hundred and eighty-four adults (mean age 24 years, 53 % women, 90 % Caucasian) participated in the study. Nearly three in four adults (71 %) had 25(OH)D level <30 ng/ml and 26 % were vitamin D-deficient. In multivariate analysis, persons reporting a suntan (OR = 0·24, 95 % CI 0·09, 0·63, P = 0·004), tanning booth use (OR = 0·09, 95 % CI 0·02, 0·43, P = 0·002) and daily ingestion of two or more servings of milk (OR = 0·21, 95 % CI 0·09, 0·48, P < 0·001) were less likely to be deficient. These three questions provided a sensitivity and specificity of 79 % and 78 %, respectively, for the presence of deficiency.

The questionnaire is moderately useful to identify young adults likely to be vitamin D-deficient. Additional revisions of the questionnaire may improve its ability to predict vitamin D deficiency.

Environmental strategies at worksites may help consumers change dietary behaviour towards a more healthy diet. The present study aimed to evaluate the availability of healthy meal options at Danish worksite canteens and to identify predictors of worksite canteens providing healthy meals.

A self-administered questionnaire was randomly mailed to 1967 worksite canteen managers. Besides information and characteristics about the canteen and the worksite, the canteen managers specified the menus available. Two different health groups (Healthy and Less Healthy) were defined in three different meal categories (Sandwiches, Hot meals and Salads) as well as a combined category (Combined) combining all the three meal categories. The characteristics of the worksites were compared with regard to the different health groups.

Randomly selected Danish worksite canteens.

553 Danish worksite canteen managers replied, resulting in a response rate of 29 %.

Only 12 % of the canteens applied to the Healthy group combining all the three meal categories. In particular, worksites with more than 75 % female employees served healthy menus on a frequent basis. The size of the worksite was positively correlated with more healthy meal options. Furthermore, the present study suggests a positive relationship between corporate financial support and the availability of healthy meal options.

Among the selected variables studied, workforce gender, company size and corporate financial support were significant predictors of the availability of healthy meal options in worksite canteens. More research is needed on the role that variance in organisation environment plays for the potential of worksite intervention, to make a difference in terms of healthy eating.

To determine the impact of BMI on post-operative outcomes and resource utilization following elective total hip arthroplasty (THA).

A retrospective cohort analysis on all primary elective THA patients between 1996 and 2004. Primary outcomes investigated using regression analyses included length of stay (LOS) and costs (US dollars).

Mayo Clinic Rochester, a tertiary care centre.

Patients were stratified by pre-operative BMI as normal (18·5–24·9 kg/m2), overweight (25·0–29·9 kg/m2), obese (30·0–34·9 kg/m2) and morbidly obese (≥35·0 kg/m2). Of 5642 patients, 1362 (24·1 %) patients had a normal BMI, 2146 (38·0 %) were overweight, 1342 (23·8 %) were obese and 792 (14·0 %) were morbidly obese.

Adjusted LOS was similar among normal (4·99 d), overweight (5·00 d), obese (5·02 d) and morbidly obese (5·17 d) patients (P = 0·20). Adjusted overall episode costs were no different (P = 0·23) between the groups of normal ($17 211), overweight ($17 462), obese ($17 195) and morbidly obese ($17 655) patients. Overall operative and anaesthesia costs were higher in the morbidly obese group ($5688) than in normal ($5553), overweight ($5549) and obese ($5593) patients (P = 0·03). Operating room costs were higher in morbidly obese patients ($3418) than in normal ($3276), overweight ($3291) and obese ($3340) patients (P < 0·001). Post-operative costs were no different (P = 0·30). Blood bank costs differed (P = 0·002) and were lower in the morbidly obese group ($180) compared with the other patient groups (P < 0·05). Other differences in costs were not significant. Morbidly obese patients were more likely to be transferred to a nursing home (24·1 %) than normal (18·4 %), overweight (17·9 %) or obese (16·0 %) patients (P = 0·001 each). There were no differences in the composite endpoint of 30 d mortality, re-admissions, re-operations or intensive care unit utilization.

BMI in patients undergoing primary elective THA did not impact LOS or overall institutional acute care costs, despite higher operative costs in morbidly obese patients. Obesity does not increase resource utilization for elective THA.

Signal detection analysis, a form of recursive partitioning, was used to identify combinations of sociodemographic and acculturation factors that predict trying to lose weight in a community-based sample of 957 overweight and obese Mexican-American adults (ages 18–69 years).

Data were pooled from the 2004 and 2006 Behavioral Risk Factor Surveillance System conducted in a low-income, semi-rural community in California.

Overall, 59 % of the population reported trying to lose weight. The proportion of adults who were trying to lose weight was highly variable across the seven mutually exclusive groups identified by signal detection (range 30–79 %). Significant predictors of trying to lose weight included BMI, gender, age and income. Women who were very overweight (BMI > 28·5 kg/m2) were most likely to be trying to lose weight (79 %), followed by very overweight higher-income men and moderately overweight (BMI = 25·0–28·5 kg/m2) higher-income women (72 % and 70 %, respectively). Moderately overweight men, aged 28–69 years, were the least likely to be trying to lose weight (30 %), followed by moderately overweight lower-income women (47 %) and very overweight lower-income men (49 %). The latter group is of particular concern since they have characteristics associated with medical complications of obesity (low education and poor access to medical care).

Our findings highlight opportunities and challenges for public health professionals working with overweight Mexican-American adults – particularly lower-income adults who were born in Mexico – who are not trying to lose weight and are therefore at high risk for obesity-related co-morbidities.

To evaluate the performance of a short dietary questionnaire, using weights to estimate nutrient intake.

Using dietary data collected in 1993–1995 from a large cohort of French women, stepwise regression analysis was used to identify the food groups that best predicted nutrient intakes, resulting in a short list of twenty-three foods. This list was used to design a twenty-three-item dietary questionnaire. Nutrient intake was estimated from the answers to the twenty-three questions, applying weights to each response. Weights were calculated from the large database as regression coefficients of the nutrient intake against the twenty-three food groups. In 2005–2006, 103 women responded (at a 1-year interval) to both the short questionnaire and a previously validated dietary history questionnaire. Intakes of twenty nutrients and energy estimated from these two questionnaires were compared.

French adult female population.

For developing the instrument, 73 034 women aged 41–72 years; for testing, 103 women aged 55–80 years in 2005.

Mean nutrient intakes generally differed by less than 10 % between the two methods. Correlation coefficients of nutrient intakes ranged from 0·23 for vitamin D to >0·65 for Mg, vitamin B3 and alcohol. For most nutrients, at least 70 % of subjects fell into the same or an adjacent quintile when classified by either of the two questionnaires.

In light of both its strengths and limitations, this short questionnaire could be used in French adult women to obtain some general nutritional information, notably for adjustment purposes when response to an extensive questionnaire cannot be obtained.

The aim of this qualitative study was to test the comprehensibility of the preliminary food-based dietary guidelines (FBDG) for healthy South African children aged 1–7 years. Objectives included assessing exposure to FBDG, comprehension of the proposed paediatric FBDG (PFBDG) and whether the guidelines can be used in meal planning.

Focus group discussions were used to collect data. Discussions were facilitated by the investigator in either English or Afrikaans, according to a predetermined discussion schedule. Focus groups were formed on the basis of language and socio-economic status (SES).

Areas within the City of Cape Town representing lower, middle and upper SES groups.

A total of seventy-six English- and Afrikaans-speaking mothers were contacted via randomly selected consenting preschool groups to participate voluntarily.

Most mothers reported that they do not use guidelines. They had a good grasp of the concepts of and need for PFBDG. They suggested slight alterations to wording/phrasing of the guidelines. The most problematic guidelines were those regarding starch, milk and sweet treats/drinks. No substantial differences were found between English and Afrikaans data. Differences were found between SES groups, with the upper SES groups comprehending the guidelines better.

The proposed PFBDG were well received. The target population that would benefit the most from these guidelines would be the less educated, lower SES groups. The present study shows that once the guidelines have been modified, they may be used as a comprehensive guide for nutritional education.

Inadequate energy and nutrient intakes are a major nutritional problem in developing countries. A recent study in Beninese school-aged children in different seasons revealed a high prevalence of stunting and poor iron status that might be related to the food pattern.

To analyse the food pattern and resulting energy and nutrient intakes of rural Beninese school-aged children in relation to season and school attendance.

The study was performed in northern Benin in eighty randomly selected children aged 6–8 years. Dietary intake was assessed using observed weighed records. Food, energy and nutrient intakes were measured in post- and pre-harvest seasons. Complete food consumption data sets were available for seventy-five children.

Food pattern showed seasonal variations. Cereals, roots and tubers were the main staple foods. Contributions of animal products to the diet were very small. The food pattern was not different for either boys v. girls or for children attending v. not attending school. Median daily energy intakes were 5·0 and 5·3 MJ in the post- and pre-harvest season, respectively. Only fat and vitamin C showed seasonal differences (P < 0·05). Energy and nutrient intakes were different for boys and girls but, unexpectedly, not for children attending v. not attending school.

Seasonal variations in food pattern did not result in seasonality in energy and nutrient intakes. Because the children’s diet was low in animal products, protein, fat and vitamin C and high in fibre, the absorption of fat, fat-soluble vitamins, carotenoids, Fe and Zn might be low. Fe and Zn bioavailability from such a diet needs further investigation.

The Mediterranean diet is considered one of the healthiest dietary models. Recent changes in the actual Mediterranean diet include a reduction in energy intake and a higher consumption of foods with low nutrient density (e.g. soft drinks, candy, sweets, etc.). In Spain, in association with cultural and lifestyle changes, there has been a reduction in the intake of antioxidants and vitamins, an increase in the proportion of SFA and a decrease in the consumption of fibre, among other changes. Children and adolescents may be the age groups with the most deteriorated Mediterranean diet. The current paper presents the results of applying the Mediterranean Diet Quality Index for children and adolescents (KIDMED) to a large sample of Spanish schoolchildren.

Data from questionnaires were used to calculate the KIDMED index.

Granada, Southern Spain.

Schoolchildren (n 3190) aged 8–16 years.

Among the 8–10-year-olds, the KIDMED index classification was ‘good’ in 48·6% of the population, ‘average’ in 49·5% and ‘poor’ in 1·6%. Among the 10–16-year-olds, the KIDMED index classification was good in 46·9% of the population, average in 51·1% and poor in 2·0%.

The nutritional behaviour of the present population of schoolchildren is similar to that found in the earlier KIDMED study.

To examine the association between the risk of neural tube defects (NTD) and maternal serum vitamin B12, folate and homocysteine in a high-risk area of China.

A case–control study was carried out in Luliang mountain area of Shanxi Province.

A total of eighty-four NTD pregnancies and 110 matched controls were included in the study; their serum vitamin B12 and folate concentrations were measured by chemiluminescent immunoenzyme assay and total homocysteine concentrations by fluorescent polarisation immunoassay.

Serum vitamin B12 and folate concentrations were lower in NTD-affected pregnant women than in controls (P < 0·01). Serum total homocysteine was higher in the NTD group than in controls at less than 21 weeks of gestation (P < 0·01). Adjusted odds ratios revealed that women with lower vitamin B12 (adjusted OR=4·96; 95 % CI 1·94, 12·67) and folate (adjusted OR=3·23; 95 % CI 1·33, 7·85) concentrations had a higher risk of NTD compared to controls. Based on dietary analysis, less consumption of meat, egg or milk, fresh vegetables and fruit intake would increase the risk of NTD.

Lower serum concentrations of folate and vitamin B12 are related to the increased risk of NTD in high-risk populations. Both folate and vitamin B12 intake insufficiency could contribute to the increased risk of NTD. A dietary supplement, combining folate and vitamin B12, might be an effective measure to decrease the NTD incidence in these areas.

To find the ideal combination of Fe fortifier and its food vehicle is an essential measure in developing countries. However, its cost also plays an important role. In the present study, the effect on blood parameter values of corn flour-derived products fortified with powdered elemental Fe in the form of H2-reduced Fe was investigated in children and adolescents.

One hundred and sixty-two individuals (eighty-six boys and seventy-six girls) from public educational centres in Londrina, Paraná (southern Brazil) participated in the study. Fe-deficiency anaemia (IDA) was defined when Hb and serum ferritin values fell below 12 g/dl and 20 μg/l, respectively; Fe deficiency (ID) was considered when serum ferritin was below 20 μg/l.

The prevalence of ID and IDA decreased from 18·0 % and 14·9 %, values found at the beginning of the study, to respectively 5·6 % and 1·2 % after 6 months. Changes from altered to normal values occurred more often than normal to altered values with transferrin saturation (14·2 % v. 6·8 %; P < 0·04) and ferritin (12·4 % v. 0 %; P < 0·001). Hb, transferrin saturation and ferritin showed differences between normal and altered parameters after 6 months (P < 0·001).

A pronounced reduction in the prevalence of ID and IDA was observed in children and adolescents following 6 months’ ingestion of corn flour-derived products enriched with elemental Fe.

The present study examined the association between area socio-economic status (SES) and food purchasing behaviour.

Data were collected by mail survey (64·2 % response rate). Area SES was indicated by the proportion of households in each area earning less than $AUS 400 per week, and individual-level socio-economic position was measured using education, occupation and household income. Food purchasing was measured on the basis of compliance with dietary guideline recommendations (for grocery foods) and variety of fruit and vegetable purchase. Multilevel regression analysis examined the association between area SES and food purchase after adjustment for individual-level demographic (age, sex, household composition) and socio-economic factors.

Melbourne city, Australia, 2003.

Residents of 2564 households located in fifty small areas.

Residents of low-SES areas were significantly less likely than their counterparts in advantaged areas to purchase grocery foods that were high in fibre and low in fat, salt and sugar; and they purchased a smaller variety of fruits. There was no evidence of an association between area SES and vegetable variety.

In Melbourne, area SES was associated with some food purchasing behaviours independent of individual-level factors, suggesting that areas in this city may be differentiated on the basis of food availability, accessibility and affordability, making the purchase of some types of foods more difficult in disadvantaged areas.

To examine the opinions of physicians in Bahrain regarding their role in obesity control, and to evaluate their knowledge, attitudes and practices towards obesity prevention and management in primary health care.

A cross-sectional survey of physicians in Bahrain. A single-stage cluster sample was used, which included twelve health centres and 107 physicians. Ninety-seven physicians participated in the study with a 90 % response rate. A self-administered questionnaire was used to measure physicians’ knowledge and practices, their perceived role and potential limitations. Correction for design effect and finite population were considered in the analysis.

The majority of physicians in Bahrain (92 %) were aware of the obesity epidemic and 60 % of them felt capable of assuming a major role in obesity control, regardless of their negative views towards the success rates of weight management. Only 36 % agreed that they had effective weight-management practices. They were knowledgeable about weight-loss goals and showed a reasonable level of obesity identification, especially as part of chronic disease care (71 %). Physicians reported a high rate of utilization of various weight-loss strategies, except for pharmacotherapy and surgery. The major barriers identified in patient care included time constraints (91 %), lack of specialty clinics (81 %), absence of guidelines (78 %) and an inadequate number of dietitians (71 %). Sixty-four per cent reported that training in lifestyle counselling and behaviour modification are important requirements.

Physicians in Bahrain showed a reasonable level of interest in participating in obesity prevention and management. It seems that there would be a good opportunity for better practice if physicians were supported with appropriate training and the constraints of their working environment were adequately addressed.

The aim of the present study was to evaluate the urinary I excretion of pregnant women in Malatya Province, eastern Turkey.

A cross-sectional study was performed on pregnant women in urban and rural settlements of Malatya Province.

Urinary I excretion was measured for 824 pregnant women who were randomly selected using a probability-proportional-to-size sampling methodology.

Median urinary I concentration (UIC) of pregnant women was 77·4 μg/l. The percentage of pregnant women with UIC below 100 μg/l was 83·3.

These results indicate that I deficiency disorders (IDD) is still a problem in Malatya Province and most certainly in other parts of the country. Proper monitoring of I content of the salt sold or used in the area, in order to strengthen the IDD intervention programme, is suggested.

To examine the relationship between psychological distress (PD) and plasma n-3 long-chain (LC) PUFA, i.e. EPA, docosapentaenoic acid (DPAn-3) and DHA.

Population-based, cross-sectional Santé-Québec Health Survey (1991). Participants were categorized as high-level PD if they scored over the 80th percentile of the PD Index in the Santé-Québec Survey; non-distressed subjects were those who scored less than this cut-off. Associations between tertiles of n-3 fatty acids (FA) and the risk of high-level PD were expressed as odds ratios, with the lowest tertile as the reference group.

Québec, Canada.

Data were analysed from a representative sample of 852 James Bay Cree Indian adults aged 18 years and over.

Proportions of n-3 FA were statistically significantly lower in the PD than in the non-distressed group. After adjustment for confounders, EPA was the only individual n-3 FA significantly associated with the risk of high-level PD. Combinations of EPA + DHA or EPA + DPAn-3 + DHA or the sum of n-3 were also associated with the risk of high-level PD. Compared with the lowest tertile of EPA + DHA, the OR for high-level PD was 0·89 (95 % CI 0·59, 1·36) for the second and 0·56 (95 % CI 0·32, 0·98) for the third tertile, after controlling for confounders.

In the present retrospective, cross-sectional study, we found that proportions of n-3 LC PUFA in plasma phospholipids, markers of n-3 LC PUFA consumption from fish, were inversely associated with PD.

In New Zealand (NZ), Fe deficiency (ID) is present in 14 % of children aged <2 years. Prevalence varies with ethnicity (NZ European 7 %, Pacific 17 %, Maori 20 %). We describe dietary Fe intake, how this varies with ethnicity and whether intake predicts Fe status.

A random sample of children aged 6–23 months. Usual Fe intake and dietary sources were estimated from 2 d weighed food records. Associations were determined between adequacy of Fe intake, as measured by the Estimated Average Requirement (EAR), and ID.

Sampling was stratified by ethnicity. Dietary and blood analysis data were available for 247 children.

The median daily Fe intake was 8·3 mg (age 6–11 months) and 6·3 mg (age 12–23 months). Breast milk and milk formulas (median 58 %; age 6–11 months), and cereals (41 %) and fruit and vegetables (17 %; age 12–23 months), were the predominant dietary sources of Fe. Fe intake was below the EAR for 25 % of the children. Not meeting the EAR increased the risk of ID for children aged 6–11 months (relative risk = 18·45, 95 % CI 3·24, 100·00) and 12–23 months (relative risk = 4·95, 95 % CI 1·59, 15·41). In comparison with NZ European, Pacific children had a greater daily Fe intake (P = 0·04) and obtained a larger proportion of Fe from meat and meat dishes (P = 0·02).

A significant proportion of young NZ children have inadequate dietary Fe intake. This inadequate intake increases the risk of ID. Ethnic differences in Fe intake do not explain the increased risk of ID for Pacific children.

The prevalence of child overweight in the Czech Republic is substantially lower than that in the USA. The objective of the present pilot study was to explore dietary intakes, frequency of dining in fast-food establishments, and the amount and intensity of physical activity between a sample of American and Czech children.

A cross-sectional correlational pilot study.

Four public schools in the USA and four public schools in the Czech Republic.

Ninety-five Czech and forty-four American 4–6th graders from urban public schools participated in the study. Dietary intake and number of fast-food visits were evaluated using two multiple-pass 24 h recalls. Physical activity was measured using the modified Self-Administered Physical Activity Checklist.

American children (mean age 10·8 (se 0·2) years) consumed more energy and fat, less fruits and vegetables, more soft drinks, and visited fast-food establishments more often than Czech children (mean age 11·0 (se 0·1) years). Although no differences were found in vigorous activity by nationality, Czech children spent significantly more time in moderate physical activities than American children.

Despite the influx of some negative Western dietary trends into the country, Czech children had a healthier diet and were more physically active than American children. Further research is warranted to determine whether the same differences in dietary intakes, physical activity and fast-food visits exist between nationally representative samples of American and Czech children.

Breakfast consumption has been associated with better mental health in adulthood, but the relationship between breakfast and mental health in adolescence is less well known. The aims of the present study were to evaluate breakfast quality in a cohort of adolescents and to investigate associations with mental health.

Cross-sectional population-based study. Breakfast quality was assessed by intake of core food groups at breakfast, as determined from 3 d food diaries. Mental health was assessed using the Child Behaviour Checklist (CBCL), with higher scores representing poorer behaviour.

The Western Australian Pregnancy Cohort (Raine) Study, Perth, Western Australia.

Eight hundred and thirty-six males and females aged between 13 and 15 years.

Mean mental health score as assessed by the CBCL was 45·24 (sd 11·29). A high-quality breakfast consisting of at least three food groups was consumed by 11 % of adolescents, while 7 % of adolescents did not consume any items from core food groups on average over the 3 d period. The two most common core food groups consumed at breakfast in this population were dairy products followed by breads and cereals. For every additional food group eaten at breakfast, the associated total mental health score decreased by 1·66 (95 % CI −2·74, −0·59) after adjustment for potential confounding factors, representing an improvement in mental health score.

These findings support the concept that breakfast quality is an important component in the complex interaction between lifestyle factors and mental health in early adolescence.

To evaluate the modification effect of sex in the association between lifestyles and acute myocardial infarction (AMI).

Population-based case–control study. Trained interviewers collected information using a standard structured questionnaire. Associations were estimated using unconditional logistic regression. The effect modification by sex was evaluated in the regression models, testing interaction terms between lifestyles and sex.

Porto, Portugal.

Portuguese Caucasian adults, aged ≥18 years. Cases were patients consecutively admitted with an incident AMI during 1999–2003 (n 918) and controls were a representative sample of non-institutionalized inhabitants of Porto with no evidence of previous clinical or silent infarction (n 2316).

Cigarette smoking was positively associated with AMI in both men and women (smokers >15 cigarettes/d v. never smokers: OR = 9·11, 95 % CI 4·83, 17·20 for women; OR = 3·92, 95 % CI 2·75, 5·58 for men; interaction term P value = 0·001). A significant protective effect of moderate alcohol intake on AMI occurrence was found in women (0·1–15·0 g/d v. non-drinkers: OR = 0·48, 95 % CI 0·31, 0·74), but not in men. Fruit and vegetable intake, vitamin and mineral supplement use and leisure-time physical activity practice were found to decrease AMI risk, with similar effects between sexes.

A strong positive association between smoking and AMI was found in women. Also, a protective effect of moderate alcohol intake was only found among females. Fruit and vegetable intake, vitamin and mineral supplement use and leisure-time physical activity practice were found to decrease AMI risk in both sexes.