To demonstrate the effectiveness of the commercial introduction of red palm oil (RPO) as a source of vitamin A (VA) for mothers and children in a non-consuming area, as a dietary diversification strategy.

A pre–post intervention design (no control area) was used to assess changes in VA intake and status over a 24-month pilot project.

The pilot project involved RPO promotion in 10 villages and an urban area in east-central Burkina Faso, targeting approximately 10?000 women and children aged < 5 years. A random sample of 210 mother–child (12–36-months-old) pairs was selected in seven out of the 11 pilot sites for the evaluation.

After 24 months, RPO was reportedly consumed by nearly 45% of mothers and children in the previous week. VA intake increased from 235 ± 23 μg retinol activity equivalents (RAE) to 655 ± 144 μg RAE in mothers (41 to 120% of safe intake level), and from 164 ± 14 μg RAE to 514 ± 77 μg RAE in children (36 to 97%). Rates of serum retinol < 0.70 μmoll−1 decreased from 61.8 ± 8.0% to 28.2 ± 11.0% in mothers, and from 84.5 ± 6.4% to 66.9 ± 11.2% in children. Those with a lower initial concentration of serum retinol showed a higher serum retinol response adjusted for VA intake.

Commercial distribution of RPO was effective in reducing VA deficiency in the pilot sites. While it is promising as part of a national strategy, additional public health and food-based measures are needed to control VA malnutrition, which remained high in the RPO project area

To study risk factors associated with overweight and obesity among adolescents enrolled in private high schools in the city of Pelotas, southern Brazil.

This was a case–control study. The subjects were 264 overweight (body mass index (BMI) ≥85th percentile of the National Center for Health Statistics (NCHS) reference population) and 264 non-overweight (BMI > 5th and <85th NCHS percentiles) adolescents identified by means of an anthropometric survey which included 1608 students. The adolescents were weighed, measured and interviewed about food habits and physical activity at school. Parents provided their own weights and heights when contacted by telephone, and parental BMI was calculated.

Hierarchical multiple conditional logistic regression showed that overweight and obesity were positively associated with mother's (odds ratio (OR) 2.86, 95% confidence interval (Cl) 1.43–5.74) and father's (OR 2.43, 95% Cl 1.37–4.30) BMI ≥ 30 kg m−2, being overweight before 10 years of age (OR 2.26, 95% Cl 1.30–3.90) and the habit of dieting (OR 3.53, 95% Cl 1.76–7.22). Having more than three meals per day was found to be a protective factor against overweight and obesity (OR 0.54, 95% Cl 0.29–1.00).

The present study showed that a family history of obesity, overweight during childhood and the habit of dieting for weight-loss purposes are factors associated with obesity during adolescence. The habit of having more than three daily meals turned out to be a protective factor against overweight. These results suggest the necessity for early intervention at the family and general community levels aimed at the prevention of obesity through actions directed towards the modification of established behaviours.

To determine the sociodemographic associations of obesity in Ghana.

A cross-sectional descriptive study was conducted on a sample of 6300 adults aged 25 years and over who were selected by random cluster sampling.

Two urban (high-class and low-class suburbs) and a rural community in Accra, Ghana.

In total, 4731 (1857 males, 2874 females) subjects participated. Demographic data were obtained by a questionnaire and height and weight were determined with subjects in light clothing and without shoes.

The overall crude prevalence of overweight and obesity was 23.4 and 14.1%, respectively. The rates of overweight (27.1 vs. 17.5%) and obesity (20.2 vs. 4.6%) were higher in females than males. Obesity increased with age up to 64 years. There were more overweight and obesity in the urban high-class residents compared with the low-class residents and in urban than rural subjects. Overweight and obesity were highest among the Akan and Ga tribes and relatively low among Ewes. Subjects with tertiary education had the highest prevalence of obesity (18.8%) compared with less literate and illiterate subjects (12.5–13.8%). Subjects whose jobs were of a sedentary nature had higher levels of obesity (15%) than subjects whose jobs involved heavy physical activity (10%). Subjects who did not engage in leisure-time physical activity were more obese than those who had three or more sessions of leisure-time physical activity per week (15.3 vs. 13.5%).

Overweight and obesity are common among residents in the Accra area. Older age, female gender, urban, high-class residence, sedentary occupation and tertiary education were associated with higher levels of obesity. Policies and programmes that promote healthy lifestyles may prove beneficial.

To investigate underlying causes for food and nutrition insecurity in black South African households and to gain understanding of the factors contributing to better nutrition security, with emphasis on household organisation, gender and intra-household dynamics and social networks.

Within a larger cross-sectional survey that investigated the impact of urbanisation on the health of black South Africans, 166 people, mostly women, were interviewed on household food security. Methods used were structured face-to-face interviews, in-depth interviews, observation, interviews with key informants and a sociodemographic questionnaire. Information was collected from 1998 to 2000 in 15 rural and urban areas of the North West Province, South Africa.

Three-quarters of households in this sample are chronically food-insecure. Families are disrupted, due to migrant work, poverty and increasing societal violence, and half of households are female-headed. Certain categories of female-headed households and households based on partnership relationships, despite more limited resources, achieve a better or an equal economic status and better nutrition security than those households led by men, with the latter often being considered an economic liability. The reliance on and fostering of social ties and networks appear to be of central significance.

Gender and intra-household relations, as well as social networks and income from informal sector activities, are often not uncovered by conventional statistical methods. Qualitative research can reveal the unexpected and furthermore empowers people, as their voices are heard.

The World Health Organization (WHO) recommends a daily intake of at least 400?g of vegetables and fruit. The aim of this paper was to evaluate the public health benefit of meeting this WHO recommendation by applying a statistical method that combines estimated intake distributions and simulated intake changes.

The benefit of an increased consumption of vegetables and fruit was quantified by the preventable proportion of diseases. This proportion was estimated by a general formula derived in the paper that incorporates individual relative risks. Three different strategies of increasing usual intake were simulated and compared. The first strategy assumes that all individuals increase their intake by the same amount, the second assumes a constant increase among low consumers, and the third simulates individual increments necessary to meet the WHO recommendation. Calculations were made for three different scenarios with varying relative risks.

The third simulation strategy turned out to be the most appropriate one to quantify the potential health gain of the current dietary recommendation. Applying this strategy to prevent cancer, the proportion of preventable cases was country-specific. Estimates for France and Sweden were 21.9% and 19.3%, respectively, which are somewhat lower than the non-specific figure published by the World Cancer Research Fund.

To improve estimates of the preventable proportion of diseases, the estimation formula presented here can be applied. Its application requires intake data to estimate the initial intake distribution in the population and to simulate adequate dietary changes.

The aim of this paper is to describe the source and the scope of social inequalities in infant feeding practices. It examines the extent to which different recommendations are followed in different social groups and highlights the main factors influencing the total adherence to three recommendations at the population level.

The study follows a representative sample (n = 2103) of the children born in 1998 in the province of Québec (Canada). Detailed information on breast-feeding and complementary feeding was collected at 5 and 17 months by face-to-face interviews with the mother. The independent variables were mother's age, mother's education level, poverty level, family type, socio-economic status (SES) and living area. Odds ratios (adjusted for baby's rank in the family, birth weight and premature birth) are presented for breast-feeding, and for formula and cows' milk consumption, at different ages. The adherence to a combined indicator cumulating three recommendations (breast-fed at birth, complementary food at 4 months or later and cows' milk at 9 months or later) is also presented.

The analysis indicates that adherence to the recommendations is low in Québec. Breast-feeding initiation, duration and its exclusivity improved with mother's age and education level and SES. Adherence to the different recommendations was interrelated, indicating an accumulation of bad nutritional circumstances for children in low-SES families. The odds of being fed in accordance with the three studied recommendations, when living in a family with the highest SES, was 2.3 times higher than when living in a family with the lowest SES. When living with a highly educated mother, the odds ratio was 2.7 times higher than when living with a low-educated mother. For mother's age, the odds ratio reached 3.7 for children from mothers aged ≥35 years, in comparison with children from mothers ≤24 years old. When SES or mother's education level was combined with mother's age, the children in the best situation were >8 more times likely than the least privileged children to be fed in accordance with these recommendations. Living area was not related with infant feeding during the first year of life

Breast-feeding and nutrition could be related with different health and cognitive outcomes in childhood and later in life. Consequently, social disparities in diet during infancy could play a role in the development of social and health inequalities more broadly observed at the population level. Intervention to improve adherence to breast-feeding and nutrition recommendations in infancy should be prioritised and evaluated for its impact on the reduction on infant diet inequalities over time

This study aimed to clarify the iodine deficiency status in the Semipalatinsk region that has been contaminated by radioactive fallout from nuclear testing during the period of the former USSR.

Based on the Japan–Kazakstan joint project of adult cancer screening around the Semipalatinsk Nuclear Testing Site (SNTS), from May to October 2002 spot urine specimens were collected at random in each village. Separately, children aged 5–15 years from around the SNTS were chosen at random and spot urine specimens were collected from them.

Area contaminated by radioactive fallout around the SNTS, Republic of Kazakstan.

A total of 2609 adults aged >40 years from 16 settlements in three regions and one city, and 298 children aged 5–15 years from two regions and one city.

Median urinary iodine concentrations of adults and children in all regions were in the range of 116.0–381.7 and 127.7–183.0 μg l−1, respectively. The highest prevalence of values <50 μg l−1 (14.1%) did not exceed 20%. Distributions within each group, adults and children, showed almost the same pattern, except for one region where more than 50% of adults had urinary iodine concentration >100 μg l−1.

In agreement with our previous studies, the urinary iodine concentration data showed no clear evidence of iodine deficiency around the SNTS. Kazakstan is geographically and nutritionally at moderate risk of iodine deficiency disorders without fortification or iodine replacement by iodised salt. The socio-medical prophylaxis against iodine deficiency has been successfully maintained in East Kazakstan.

(1) To develop a useful tool to measure food, alcohol and tobacco items; (2) to document the availability of these items in Almaty, Kazakstan; (3) to describe the relationship between consumption and availability; and (4) to identify possible relationships between availability and health outcomes in the city and region.

A survey of 648 vendors in Almaty, Kazakstan was conducted over one month from December 1999 to January 2000. Vendors identified which items they sold from a list of 61 food, alcohol and tobacco items.

Vendors were approached in three of the six regions of Almaty, Kazakstan. Regions canvassed included Auzov, one of the three ‘sleeping regions’; Medeo, one of the two downtown regions; and Turksib, a more suburban/rural area of the city.

There was a significant correlation between alcohol and cigarette consumption and availability. The relative availability of items was numerically and spatially consistent throughout the city. Fruits and vegetables occurred infrequently (<20% of sites) and in relative isolation from the rest of the system, while candy and cigarettes occurred with a higher relative frequency (75–80% of sites). Maps of vendors showed clusters around geographical features such as major roads and intersections.

Combining a checklist and mapping tools provides a model of consumer item availability that can help identify priorities for public health and urban planning professionals. The wide availability of cigarettes, alcohol, candy, coffee and tea, and limited availability of fruits, vegetables and whole grains, is likely to support increasing rates of chronic disease in Almaty.

This paper reports on the status of lactose digestion during early and late pregnancy and at 8 weeks postpartum in an African-American population. The hypothesis is that lactose digestion and milk tolerance do not change throughout pregnancy anddo not differ from those of non-pregnant African-American women.

This longitudinal study determined lactose digestion after ingesting 240 ml of 1% fat milk containing 12g of lactose at: (1) early pregnancy, prior to 16 weeks (n = 148); (2) late pregnancy, 30–35 weeks (n = 77); and (3) 8 weeks postpartum (n = 93). One hundred and one comparably matched non-pregnant African-American women served as controls.

Prevalence of lactose digestion, as measured by breath hydrogen, was 80.2% in the control women, 66.2% in early pregnancy, 68.8% in late pregnancy and 75.3% postpartum. The prevalence of women reporting symptoms was approximately 20% regardless of lactose absorption status. However, the control women reported significantly more symptoms than did the pregnant women.

This study indicates that there is no significant change in lactose digestion during pregnancy. The prevalence of lactose intolerance for the pregnant African-American women studied is similar to that for non-pregnant African-American women and similar to previous prevalence reports in adult African-Americans. There was no change in the tolerance of lactose noted during pregnancy in these women. There were, however, fewer symptoms reported by the lactose-maldigesting pregnant women.

To estimate the intake of refined sugar in Australian children and adolescents, aged 2–18 years.

Foods contributing to total sugar intake were identified using data from the National Nutrition Survey 1995 (NNS95), the most recent national dietary survey of the Australian population. The top 100 foods represented means of 85% (range 79–91%) and 82% (range 78–85%) of total sugar intake for boys and girls, respectively. Using published Australian food composition data (NUTTAB95), the proportion of total sugar being refined sugar was estimated for each food. Where published food composition data were not available, calculations from ingredients and manufacturer's information were used.

The NNS95 assessed the dietary intake of a random sample of the Australian population, aged 2–18 years (n = 3007).

Mean daily intakes of refined sugar ranged from 26.9 to 78.3 g for 2–18-year-old girls, representing 6.6–14.8% of total energy intake. Corresponding figures for boys were 27.0 to 81.6 g and 8.0–14.0%, respectively. Of the 10 highest sources of refined sugar for each age group, sweetened beverages, especially cola-type beverages, were the most prominent.

Refined sugar is an important contributor to dietary energy in Australian children. Sweetened beverages such as soft drinks and cordials were substantial sources of refined sugar and represent a potential target for campaigns to reduce refined sugar intake. Better access to information on the amounts of sugar added to processed food is essential for appropriate monitoring of this important energy source.

To examine associations between breakfast cereal consumption and the dietary habits, nutrient intakes and nutritional status of young people, considering both nutrient adequacy and safety issues (fortification).

Using archived data from 1688 children in the (British) National Diet and Nutrition Survey of Young People aged 4 to 18 years, nutrient intakes and status were compared across thirds of breakfast cereal consumption (T1 to T3), adjusted for age and energy intake. Cereals provided on average 2%, 6% and 12% of energy in T1, T2 and T3, respectively, for boys; 1%, 4% and 10%, respectively, for girls.

Intakes of iron, B vitamins and vitamin D were around 20–60% higher in T3 compared with T1, with significant linear relationships observed for iron, thiamin, riboflavin and folate (T1 < T2 < T3). After excluding low energy reporters and the unwell, 14% of girls had iron intakes below the Lower Reference Nutrient Intake and this varied fivefold between T1 and T3 (27%, 12% and 5%; P = 0.0001). High consumers of breakfast cereals (T3) had better folate, vitamin B12 and riboflavin status and lower total and low-density lipoprotein cholesterol. There was also an association with thiamin and vitamin B6 status in girls. However, iron status (haemoglobin, ferritin and transferrin saturation) was not significantly different between groups, possibly due to lower meat intakes in T3. Total iron intakes were within tolerable levels (maximum of 32 mg day−1 in one girl taking supplements).

The nutritional benefits of breakfast cereals are demonstrated in status measurements as well as in nutrient intakes in this study. Concerns about excessive iron intakes from fortification appear unjustified.

To assess the reproducibility and validity a 127-item, habitual intake, food-frequency questionnaire (FFQ), developed for low-income and low-literacy Brazilian workers, by comparison with a 24-hour dietary recall (24-HDR).

The FFQ and 24-HDR were interviewer-administered at the local workplace to each subject twice, with a period of 6 months between estimates; and four 24-HDRs were conducted during the 4-month period between the two FFQs (FFQ1 and FFQ2). Reproducibility was tested by comparing mean nutrient intakes from the two FFQs. Validity was determined by comparing the mean nutrient intakes from the FFQs with the corresponding averages of the six 24-HDRs (reference method).

Goiânia City, in Central West Brazil.

The study was based on 104 (62 women and 42 men) subjects, aged 18 to 60 years, who were randomly selected.

Dietary intake from the FFQ was higher than from the 24-HDR. Reproducibility was assessed by Pearson correlation coefficients for nutrients from FFQ1 and FFQ2, and ranged from 0.23 for retinol to 0.69 for total energy (mean 0.52). Intra-class coefficients for nutrients averaged by the 24-HDRs ranged from 0.29 for vitamin C to 0.76 for total energy; retinol was not significant. In the validation study, correlation between the FFQ and the 24-HDR ranged between 0.21 for vitamin C and 0.70 for total energy (mean 0.50). Adjusting for total energy lowered the coefficients, except for calcium, retinol and vitamin C. Coefficients increased with attenuation, ranging from 0.35 for carbohydrate to 0.65 for calcium.

Results indicate that this questionnaire had satisfactory reproducibility and reasonable validity.

To assess factors affecting competency development of the Australian public health nutrition workforce and investigate competency development intentions, barriers and self-reported training needs.

Cross-sectional study using self-administered mail- or email-delivered questionnaire.

Two hundred and forty practitioners working in designated community and public health nutrition positions in the Australian health system.

An 87% questionnaire response rate was achieved. The profile of the sample included female practitioners (95%) within the age range of 26–45 years (67%), from dietetic backgrounds (75%) and employed in state health departments as community dietitians/nutritionists (52%) or public health nutritionists (32%). Only 14% had completed higher degree qualifications but most (80%) reported an intention to do so in the future. Entry-level dietetic education was considered by most respondents (57%) to be inadequate preparation for public health nutrition practice but considered it had utility as a precursor for public health nutrition competency development because of its strong grounding in nutrition knowledge, basic research skills and problem-solving. On-the-job learning was the most prominent competency development influence reported by this workforce. Flexibility in teaching and learning approaches is needed to facilitate workforce participation in further competency development. The main competency development needs focused on analytical and policy process competencies; however, there was a general need expressed for competency development across many competency areas.

These data provide intelligence to inform public health nutrition workforce development, particularly that relating to continued professional development amongst the existing workforce.