To investigate item non-response in a postal food-frequency questionnaire (FFQ), and to assess the effect of substituting/imputing missing values on dietary intake levels in the Norwegian Women and Cancer study (NOWAC). We have adapted and probably for the first time applied k nearest neighbours (KNN) imputation to FFQ data.

Data from a recent reproducibility study were used. The FFQ was mailed twice (test–retest) about 3 months apart to the same subjects. Missing responses in the test FFQ were imputed using the null value (frequencies = null, amount = smallest), the sample mode, the sample median, KNN, and retest values.

A methodological substudy of NOWAC, a national population-based cohort.

A random sample of 2000 women aged 46–75 years was drawn from the cohort in 2002 (response 75%). The imputation methods were compared for 1430 women who completed at least 50% of the test FFQ.

We imputed 16% missing values in the overall test data matrix. Compared to null value imputation, the largest differences in estimated dietary intake were seen for KNN, and for food items with a high proportion of missing. Imputation with retest values increased total energy intake, indicating that not all missing values are caused by respondents failing to specify no consumption, and that null value imputation may lead to underestimation and misclassification.

Missing values in FFQs present a methodological challenge. We encourage the application and evaluation of newer imputation methods, including KNN, which may reduce imputation errors and give more accurate intake estimates.

To explore the nature, role and utility of mentoring in the development of competence in advanced-level Australian public health nutritionists.

Qualitative study using in-depth interviews.

Eighteen advanced-level public health nutritionists working in academic and practice settings in Australia.

The attributes and career pathways of the subjects were consistent with previous findings. Dissatisfaction with clinical practice was a key reason for choosing a career in public health. Experiential learning, postgraduate education and mentoring from both peers and senior colleagues were the most significant contributors to competency development. The subjects supported mentoring as an important strategy for public health nutrition workforce development and articulated the characteristics and models important for mentoring relationships in public health nutrition.

The present study suggests mentoring was an important part of competency development for advanced-level public health and community nutritionists in Australia. Mentoring programmes based on experiential learning may assist in developing public health nutrition workforce competence.

To validate food photographs for food portion size estimation of frequently consumed dishes, to be used in a 24-hour recall food consumption study of pregnant women in a rural environment in Burkina Faso. This food intake study is part of an intervention evaluating the efficacy of prenatal micronutrient supplementation on birth outcomes.

Women of childbearing age (15–45 years).

A food photograph album containing four photographs of food portions per food item was compiled for eight selected food items. Subjects were presented two food items each in the morning and two in the afternoon. These foods were weighed to the exact weight of a food depicted in one of the photographs and were in the same receptacles. The next day another fieldworker presented the food photographs to the subjects to test their ability to choose the correct photograph.

The correct photograph out of the four proposed was chosen in 55% of 1028 estimations. For each food, proportions of underestimating and overestimating participants were balanced, except for rice and couscous. On a group level, mean differences between served and estimated portion sizes were between −8.4% and 6.3%. Subjects who attended school were almost twice as likely to choose the correct photograph. The portion size served (small vs. largest sizes) had a significant influence on the portion estimation ability.

The results from this study indicate that in a West African rural setting, food photographs can be a valuable tool for the quantification of food portion size on group level.

To assess the national prevalence of overweight and obesity, as well as some associated lifestyle behaviours, for the first time in Iran.

This population-based study was performed in early 2005 as part of the World Health Organization (WHO) STEPwise approach to non-communicable diseases’ risk factor surveillance. Dietary and physical activity habits were assessed by WHO questionnaires.

The study population comprised 89 532 subjects aged over 15 years living in the 28 provinces of Iran.

Overall, 50.4% (n = 45 113) of the participants were male and 64.6% (n = 57 866) were from the urban areas. The national estimates of overweight, obesity and morbid obesity were 28.6%, 10.8% and 3.4%, respectively. Body mass index (BMI) ≥ 25 kg m−2 in men, women, urban residents and rural residents were found in 37%, 48%, 46.7% and 35.5%, respectively. Abdominal obesity was present in 43.4% of women, 9.7% of men, 28.5% of the urban residents and 23% of the rural residents. Overweight as well as generalised and abdominal obesity were more prevalent in the 45–64-year age group. Although there was no significant difference in frequency of consumption of the food groups in subjects with different BMI categories, various kinds of physical activities showed a steady decline with increasing BMI.

The findings of the present study provide alarming evidence for health professionals and policy makers about the very high prevalence of generalised and abdominal obesity in Iran. The unhealthy lifestyle habits, notably sedentary lifestyles in our community, are the major contributing factors for this emerging public health problem.

To determine the extent to which differences in sociodemographic, dietary and lifestyle characteristics exist between users of different types of dietary supplements and supplement non-users.

We analysed cross-sectional data obtained from self-administered questionnaires completed at baseline by participants in The Tomorrow Project; a prospective cohort study in Alberta, Canada. Participants who used at least one type of dietary supplement at least weekly in the year prior to questionnaire completion were defined as supplement users, while the remainder were classified as non-users. Seven discrete user categories were created: multivitamins (+/− minerals) only, specific nutritional supplements only, herbal/other supplements only, and all possible combinations. Differences in sociodemographic, dietary and lifestyle characteristics between different groups of supplement users and non-users were analysed using Rao–Scott χ2 tests and multinomial logistic regression.

Subjects were 5067 men and 7439 women, aged 35–69 years, recruited by random digit dialling throughout Alberta.

Supplement use was extensive in this study population (69·8 %). Users of herbal/other supplements only, and women who used multivitamins only, tended to report dietary and lifestyle characteristics that were not significantly different from non-users. In contrast, those who reported using a combination of multivitamins, specific nutritional and herbal/other supplements were more likely than non-users to report behaviours and characteristics consistent with current health guidelines.

Dichotomizing participants as supplement users or non-users is likely to mask further differences in sociodemographic, dietary and lifestyle characteristics among users of different types of supplements. This may have implications for analysis and interpretation of observational studies.

There is an increasing concern of anaemia in Japanese women, but no national trend data has existed to date. We analysed long-term national trends of anaemia in adult women.

Secondary analyses of 15 consecutive cross-sectional nationwide surveys conducted during the period 1989–2003. Analyses were based on 5-year intervals (1989–1993, 1994–1998, 1999–2003).

Japan.

The subjects included the National Health and Nutrition Survey of Japan (NHNS-J) population. Analyses were based on 50 967 non-pregnant/non-lactating women aged 20 years and over, with complete data sets. We stratified subjects into six age groups (20–29 years, 30–39 years, 40–49 years, 50–59 years, 60–69 years and 70+ years), and three age groups (20–49 years, 50–69 years, 70+ years) for analyses on residential areas (metropolitan, cities and towns).

Decreases in trends of mean haemoglobin values (intravenous) were significant in all age groups. Changes in the prevalence of anaemia were significant only in women aged 30–39 and 40–49 years. Anaemia (haemoglobin < 12.0 g dl−1) increased from 16.8% to 20.6% in women aged 30–39 years, and from 20.2% to 26.9% in women aged 40–49 years, respectively. Prevalence was highest in women aged 70 years and older in all times, but no significant change was observed.

Haemoglobin values have declined significantly in all ages in the last 15 years. Anaemia was especially significant in women aged 30–39 years and 40–49 years. Our findings suggest that a large number of young women in Japan are at risk of anaemia, so continuous monitoring and controlling efforts of this trend are needed.

To assess the Ca, nutrient and food intake of Greek Orthodox Christian monks during a vegetarian-type fasting week, compared with their normal diet.

Dietary data collection (using 7 d weighed food records), anthropometric and blood pressure measurements, as well as serum glucose and lipid analyses, were performed during Palm Sunday week (fasting) and the week following Pentecost Sunday (non-fasting). Mean daily nutrient and food (g/d) intakes were calculated from the food records.

The study took place in two monasteries in the Municipality of Heraklion, Crete.

The study involved ten healthy monks aged 25–65 years, with BMI > 30 kg/m2, who had been performing fasts for the last 24·4 (sd 10·4) years and lived in monasteries in Crete during April–June 2005.

Nutrient and food intake profiles were more favourable during the fasting week, when participants had lower intakes of total and saturated fat and trans-fatty acids, and higher intakes of dietary fibre, Fe, folate, legumes and fish/seafood. Ca intake was lower when participants fasted, whereas consumption of dairy products, meat and eggs increased significantly in the non-fasting week. Systolic blood pressure was significantly higher, whereas blood lipid levels were more favourable during the fasting week.

The periodic vegetarianism recommended by the Greek Orthodox Church contributes to the favourable profiles of several biomarkers of health among this sample of monks. The fasting rituals described are an important component of the traditional diet of Crete and should be emphasised in nutrition education programmes promoting this Mediterranean eating pattern.

There has been surprisingly little research into the effects of food advertising on parents’ perception of commonly consumed children’s food items, although the available research suggests that parents may find nutritional claims in these advertisements confusing. The purpose of the present study was to investigate parents’ perceptions of branded snack foods targeted at children, and the extent to which these perceptions are influenced by advertising messages.

Using an intercept survey, participants were shown either adult-targeted or child-targeted advertisements for the same food products.

Central business district of a major Australian city.

One hundred adults, mean age 40 years.

The study results suggest that: (1) adults’ perceptions of advertised food products and, most importantly, purchase intentions for those products differ according to the version of the advertisement seen (for three of the products, 42–54% would buy the product after seeing the child version compared with 82–84% after seeing the adult version); and (2) adults clearly perceive distinctly different messages in advertisements for the same products which are targeting parents vs. those targeting children (e.g. for three of the products, 74–92% perceived that the adult version of the advertisement suggested the food was nutritionally beneficial compared with 2–14% perceiving this for the child version).

It is clear that the messages conveyed to children about specific foods are quite different to the messages conveyed to adults – and importantly parents – about the same foods.

To assess the validity of nutrient profiling Model WXYfm – developed for the purpose of regulating the promotion of ‘less healthy’ foods to children. The model ranks foods according to their healthiness and categorises foods into ‘healthier’ and ‘less healthy’ foods.

Convergent and discriminant validity was tested by comparing the way Model WXYfm categorises foods with the way the UK’s national food guide – the Balance of Good Health (BGH) – categorises foods. Construct validity was assessed by testing a hypothesis relating the constructs of ‘healthiness’ of foods (as measured by Model WXYfm) and the ‘healthiness’ of diets (measured using the Diet Quality Index) and assessing whether this hypothesis was confirmed or refuted by using data on the dietary patterns of subjects (n = 1117) of the National Diet and Nutrition Survey of adults carried out in Great Britain in 2000–01.

Model WXYfm showed good convergent and discriminant validity: the level of agreement between the way the model categorises foods and the way the BGH categorises foods was good (κ = 0.69). Model WXYfm also showed good construct validity: the energy intake from ‘less healthy’ foods amongst subjects with the least healthy diets was nearly twice the energy intake from ‘less healthy’ foods amongst the subjects with the healthiest diets.

Model WXYfm demonstrated good validity in categorising foods in a way that is related to the healthiness of diets both recommended and achieved. The methods for assessing the validity of a nutrient profile model used in this paper have not, to our knowledge, been used before.

To provide a basis for making recommendations on the potential to improve use of folic acid supplements in the UK, particularly among low-income and young women.

Systematic reviews of relevant research from 1989 to May 2006 in Europe, the USA, Canada, Australia and New Zealand.

Twenty-six systematic reviews and/or meta-analyses were identified from the wider public health literature, and eighteen studies on the effectiveness of preconception interventions were included. Ninety studies were identified which were directly relevant to folic acid supplement intake. There were factors that are particularly associated with lower rates of use of folic acid supplements. One of the most important of these is the link with unintended pregnancy, followed by age, socio-economic and ethnic group. Integrated campaigns can increase the use of folic acid supplements to some extent. Research trials indicated that: (i) printed resources and the mass media used in isolation are not effective in the longer term; and (ii) health-care-based initiatives can be effective and are more likely to be successful if they include making supplements easily available.

Campaigns and interventions have the potential to exacerbate socio-economic inequalities in folic acid use. One way of addressing this is to include elements that specifically target vulnerable women. To achieve and maintain an effect, they need to be based on good health promotion practice and to be sustained over a long period. However, even high-quality campaigns that increase use result in under half of women in the target group taking supplements.

To evaluate the impact and appropriateness of programmes for the management and treatment of severe malnutrition in emergency situations.

A central unified database was set up with all data and statistics provided by nutritional centres (NC) active in Burundi.

The paper describes the case of Burundi as an example of the response of the humanitarian community to nutritional crisis.

Since 1999, more than one million (1 054 210) severely malnourished patients were treated in NC established in Burundi.

Peaks of beneficiaries were registered in 2000 and 2001; the admission rate started to decrease in 2002. In 2004, twenty therapeutic feeding centres (TFC) and 224 supplementary feeding centres (SFC) were active for the treatment of 127 420 beneficiaries. Nutritional programmes were present in every province with a coverage rate of 55 %. The most convincing impact of the nutritional programme in Burundi was the reduction of mortality rate in children under 5 years of age; an impact on the prevalence of acute malnutrition could not be demonstrated. Children under 5 years old accounted for 62 % of beneficiaries in TFC and 76 % in SFC. TFC performance indicators fulfilled the minimum standards in disaster response; the performance of SFC was not so optimal with a low recovery rate (69 % v. >80 %) and a high non-respondent rate (16 % v. <5 %). With the combination of coverage and cure rate, the programme met 44 % of the assessed needs in 2004.

In Burundi the stabilisation of security conditions permitted a combination of humanitarian responses ranging from emergency activities to strengthening of community-based initiatives that could correct the coverage and impact limitations.

To explore the relationship between infant feeding and maternal mental well-being among women of Bangladeshi and Pakistani ethnicity; and to explore the sources of advice, information and support available to women before and after childbirth.

A cross-sectional survey of infant feeding and maternal well-being via structured interviews conducted in the home.

Home visits within two inner-city wards of Newcastle upon Tyne.

Eighty-six women of South Asian ethnicity.

Enjoyment of everyday activities was higher among women who breast-fed only (P = 0.028); whereas feeling sad or crying during pregnancy was lower among breast-feeding women (P = 0.005), as was not sleeping well (P = 0.003) and feeling that everything was too much (P = 0.039), compared with women who used formula or mixed feeding. Women who breast-fed only had better mean mood scores than those who formula-fed or those who both breast-fed and formula-fed (P < 0.001). Mean mood responses were also significantly associated with the mother’s level of understanding of English and number of years in education (P = 0.005 and P = 0.003, respectively). The association between method of feeding and maternal mood remained strong after controlling for the effects of English language and maternal education.

The study suggests that breast-feeding may be an important mediator of maternal mental well-being after childbirth. Community-based programmes tailored to the needs of Bangladeshi and Pakistani women which support breast-feeding and encourage exclusive breast-feeding may be of benefit.

The aim of the present study was to investigate blood pressure (BP) levels and their relationship with different indices of body fat in a group of adolescents, in order to evaluate the prevalence of hypertension and plan preventive and corrective strategies.

Cross-sectional study in primary care.

All high schools in the Aosta Valley region, northern Italy.

Five hundred and thirty-two adolescents of both sexes, aged 15·4 (standard deviation 0·7) years. The following parameters were measured: body weight, body height, body mass index (BMI), four skinfold thicknesses, body fat mass, waist and hip circumferences and BP.

BMI data indicated a high prevalence of overweight subjects in both sexes, but higher in males, while the prevalence rate of obese adolescents was lower. Of the total, 11·8 % of subjects suffered from systolic hypertension, while 6·9 % suffered from diastolic hypertension. In linear correlation analysis, BMI and all adiposity indices, except waist:hip ratio, were found to be significantly associated (P ranging between 0·05 and 0·001) with both systolic BP and diastolic BP in both sexes, with r ranging between 0·152 and 0·359. Multiple regression analysis with the stepwise method showed BMI and body fat mass to have the strongest association (P < 0·001) with BP, with r ranging between 0·275 and 0·359.

Unless reversed, these conditions are worrying and predict the possible development of cardiovascular disease in adulthood. There is a pressing need to develop a comprehensive medical and nutrition plan, together with preventive and corrective strategies, in school programmes.

In view of the paucity of data on energy costs, the present study aimed to estimate these for typical daily activities performed by women in rural India.

A cross-sectional study covering 26 different activities was done by indirect calorimetry using the Oxylog™ instrument (Morgan).

Villages about 30–40 km from Pune city, Maharashtra, India.

Energy costs were measured on 22 rural Indian women aged 18–45 years.

Irrespective of whether an activity was domestic or farming, energy cost was lower when performed in sitting position (cleaning grains 5.24 kJ min−1, plucking leafy vegetables 5.76 kJ min−1) and increased considerably with the extent of muscular movement (carrying two water containers 14.77 kJ min−1, chopping firewood 14.5 kJ min−1), indicating the importance of the postural details of the activity. Physical activity ratio computed using the Food and Agriculture Organization/World Health Organization/United Nations University equation (PARw) was lower for all activities compared with that (PARm) based on measured basal metabolic rate, indicating the need for a population-specific equation. Furthermore, PARw identified more activities as belonging to the ‘very light’ category (nine out of 26 activities), in contrast to the perception of rural women which was supported with empirical evidence. Estimated daily energy expenditure of the women was 7.69 ± 0.63 MJ (1837 ± 150 kcal) and identified their daily activity pattern as ‘moderate’ based on PALw (1.65 ± 0.16) while PALm (2.04 ± 0.18) identified it as ‘heavy’.

Our results highlight the importance of qualitative descriptions of the various activities. The energy costs for several daily activities reported in this study could potentially be used for estimating daily energy expenditure of women from similar rural settings.

To identify determinants of adolescents’ consumption of carbonatedsoft drinks (regular and diet), both of total consumption and of consumptionat school.

Regular and diet soft drink consumption was measured by food frequencyquestions that were dichotomised. Several potential environmental andpersonal determinants of consumption were measured. A total of 2870(participation rate: 85%) 9th and 10th graders, within 33 Norwegian schools,participated in the study. Multilevel logistic regression analyses werepreformed for total soft drink consumption (twice a week or more vs. less)and for consumption at school (once a week or more vs. less).

A total of 63% and 27% of the participants reported to drink respectivelyregular and diet soft drinks twice a week or more, and 24% and 8%,respectively, reported to drink soft drinks once a week or more at school.Preferences, accessibility, modelling and attitudes were the strongestdeterminants of both regular and diet soft drink consumption. In addition,gender, educational plans and dieting were related to both total soft drinkconsumption and consumption at school. Pupils with longer distance fromschool to shop and those in schools with rules concerning soft drinkconsumption tended to have lower odds of drinking both regular and diet softdrinks at school.

This study shows that gender, educational plans, dieting, accessibility,modelling, attitudes and preferences all seem to be strong determinants ofadolescents’ soft drink consumption. Parents and the homeenvironment appear as great potential intervention targets.

To measure the occurrence and correlates of hunger and to evaluate the association between hunger and three health indicators among undocumented Mexican immigrants.

Non-probability cross-sectional sample.

Neighbourhoods within New York City.

Four hundred and thirty-one undocumented Mexican immigrants living in the USA.

Hunger was indicated by approximately 28% of respondents. In a multivariate model, working as a day labourer was associated with hunger (odds ratio (OR) 3.33, 95% confidence interval (CI) 1.83–6.06) while receiving public assistance protected against hunger (OR 0.23, 95% CI 0.06–0.88). In multivariate models, respondents who reported experiencing hunger also reported poorer overall health (OR 1.69, 95% CI 0.95–3.02) and more days of poor mental (P = 0.045) and physical health (P < 0.0001). Greater amount of time lived in the USA was also associated with worse overall health (P = 0.054) and more days of poor mental and physical health (P < 0.01).

The present study shows that food insecurity and hunger may be problems among undocumented migrants living in the USA. Uncertain and unpredictable work schedules and limited access to public assistance may contribute to high levels of hunger, which in turn may also negatively affect mental and physical health. Increasing amount of time lived in the USA is also associated with poorer health indicators. Programmes that provide undocumented migrants with emergency access to resources may reduce food insecurity and lead to improved health outcomes among this vulnerable population.

Observational studies and clinical trials have shown conclusive evidence that periconceptional folic acid supplementation prevents up to 70 % of neural tube defects (NTD). The Honduran government wanted to implement a supplementation programme of folic acid but needed to assess the relative effects of two dosages of folic acid.

To determine the effect of two dosages of folic acid on blood folate levels in Honduran female factory workers aged 18 to 49 years.

This was a randomized, double-blind control supplementation trial conducted in Choloma, Honduras. A total of 140 eligible women were randomly assigned to two dosage groups and followed up for 12 weeks. One group received a daily dosage of 1 mg folic acid and the other a once weekly dosage of 5 mg. Serum folate and red blood cell folate levels were determined by radioassay at baseline, 6 weeks and 12 weeks.

Serum folate levels increased from 6·3 (se 0·2) to 14·9 (se 0·6) ng/ml (P < 0·0001) in women assigned to the 1 mg/d group and from 6·9 (se 0·3) to 10·1 (se 0·4) ng/ml (P < 0·0001) in those assigned to the 5 mg/week group. Red blood cell folate concentrations also increased significantly in both groups, albeit more slowly. Educational level, age and BMI were not associated with the changes in serum and red blood cell folate levels during the supplementation period. However, a differential effect on serum folate levels by dosage group and time was observed.

Although both folate supplementation regimens increased serum and red blood cell folate levels significantly among the women studied, blood folate levels that are considered to be protective of NTD were reached faster with the daily dosage of 1 mg folic acid.

In New Zealand the burden of nutrition-related disease is greatest among Māori, Pacific and low-income peoples. Nutrition labels have the potential to promote healthy food choices and eating behaviours. To date, there has been a noticeable lack of research among indigenous peoples, ethnic minorities and low-income populations regarding their perceptions, use and understanding of nutrition labels. Our aim was to evaluate perceptions of New Zealand nutrition labels by Māori, Pacific and low-income peoples and to explore improvements or alternatives to current labelling systems.

Māori, Samoan and Tongan researchers recruited participants who were regular food shoppers. Six focus groups were conducted which involved 158 people in total: one Māori group, one Samoan, one Tongan, and three low-income groups.

Māori, Pacific and low-income New Zealanders rarely use nutrition labels to assist them with their food purchases for a number of reasons, including lack of time to read labels, lack of understanding, shopping habits and relative absence of simple nutrition labels on the low-cost foods they purchase.

Current New Zealand nutrition labels are not meeting the needs of those who need them most. Possible improvements include targeted social marketing and education campaigns, increasing the number of low-cost foods with voluntary nutrition labels, a reduction in the price of ‘healthy’ food, and consideration of an alternative mandatory nutrition labelling system that uses simple imagery like traffic lights.

Food-insecure populations employ multiple strategies to ensure adequate household food supplies. These strategies may increase the risk of overweight and obesity. However, existing literature reports conflicting associations between these strategies and BMI. The objective of the present study was to examine whether food insecurity and strategies for managing food insecurity are associated with BMI in adults.

In 2005, RTI International and Project Bread conducted a representative survey of 435 adult residents of low-income census tracts in Massachusetts. Food insecurity was assessed using the US Department of Agriculture’s eighteen-item Household Food Security Module.

The prevalence of overweight and obesity was 51 % and 25 %, respectively. After adjusting for age, sex, sociodemographic characteristics and food insecurity, both participation in the Food Stamp Program (FSP) and participation in any federal nutrition programme 12 months prior to the survey were each associated with an approximate 3·0 kg/m2 higher adult BMI. In the subset of current FSP participants (n 77), participation for ≥6 months was associated with an 11·3 kg/m2 lower BMI compared with participation for <6 months. Respondents who consumed fast foods in the previous month had a mean BMI that was 2·4 kg/m2 higher than those who did not. Food insecurity was not associated with BMI after adjustment for sociodemographic characteristics and FSP participation.

Participation in federal nutrition programmes and consumption of fast food were each associated with higher adult BMI independent of food insecurity and other sociodemographic factors. However, prolonged participation in the FSP was associated with lower BMI.