Abnormal haemostasis, and specifically a pre-thrombotic state characterized by hypercoagulability, increased platelet aggregation and impaired fibrinolysis, is associated with increased atheroma and thrombosis. The recent literature clearlyindicates that diet may prevent or be used to treat some abnormal haemostatic stats. There are reports on effects of energy intake and expenditure, alcohol consumption, intakes of total fat, different fatty acids, fish oil, NSP and vitamins on markers of coagulation, platelet function and fibrinolysis. Some of the confusion and controversy in this field has arisen because the wrong markers of haemostasis have been measured in dietary trials. Moreover, many of the studies have lacked good dietary control. It is suggested that more sensitive, functional markers of the balance between the different facets of the haemostatic system should be measured. It is also important to test hypotheses developed from known observations and to propose mechanisms of action of the various dietary factors, based on our improved understanding of the haemostatic system.

The aim of the present study was to examine whether the composition of the diet among patients with psoriasis differed from a regular Norwegian diet and to relate nutrient intake to the clinical status of the patients' disease. Patients were recruited from all five university Departments of Dermatology in Norway. The participants filled in a quantitative food-frequency questionnaire before attending a clinical trial. Dietary data were available from ninety-three men and forty-three women, aged 17-73 years, witb stable plaque psoriasis involving more than 8% of the body surface. The dietary intake of the patients was compared with the diet of a reference group randomly selected from the Norwegian population, and related to a dermatological score of the psoriatics. The patients' intakes of energy and nutrients were fairly similar to those found in the reference group, except for a lower content of carbohydrates and sugar in the diet of female patients. None of the nutrients gave statistically significant contributions to explain the clinical score values when analysed by correlations.

Twenty-two apparently healthy Nigerian adolescent girls aged 11–17 years residing in a hostel, were studied over five consecutive days in order to assess their energy intake (EI), energy cost of specific activities and body composition (BC). The mean characteristics of the group were: height 1·58 (SD 0·1, range 1·42–1·68) m, body weight 49·1 (SD 7·9, range 34·0–61·0) kg and BMI 19·5 (SD 2·0, range 16·0-23·0) kg/m2. The food intake of each subject was assessed by direct weighing and its energy value was determined by means of a ballistic bomb calorimeter. BMR values were calculated according to Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU) (1985) equations. Percentage body fat (BF %) values were derived from three skinfold thickness measurements, using population-specific equations. The adolescents' mean daily EI was found to be 6510 (SD 855) kJ/d (138·3 (SD 27·8) kJ/kg body weight per d) which is lower than the FAO/WHO/UNU (1985) calculated energy requirement of 8800 kJ/d for adolescent girls aged 12–14 years. The contributions of specific nutrients and individual meals to the total EI were: carbohydrate, protein and fat, 59·2, 12·5 and 28·3 % of energy respectively and breakfast, lunch and supper, 21·5, 41·0 and 37·4 % respectively. However, the mean BMR was 5627kJ/d, which is comparable with that given by FAO/WHO/UNU (1985) for adolescent girls aged 13–14 years. The mean BF % was found to be 21·7. The comparatively low EI of the participants in the present study may be indicative of energy deficiency in their meals. This assumption is also reflected in their BC values. Nevertheless, further studies of this kind on adolescents in Nigeria are needed to confirm these observations.

Skinfold thicknesses represent a comparatively simple and reasonably accurate assessment of body fatness which is an important part of the estimation of nutritional state. However, much emphasis is placed on the necessity to be very precise in the exact position of the skinfold being measured and there is frequently concern, also, about the variability of the measurement by different observers using different types of caliper. Fifty-three women and forty-five men had four skinfolds (biceps, triceps, supra-iliac and subscapular) measured first at the standard sites (Tanner, 1953; Edwards et al. 1955), and then at deliberately chosen sites about 20 mm distant from the ‘correct’ ones. The effect on the estimation of body fatness by this manoeuvre resulted in a difference of usually less then 1% and, at a maximum, 3%. In the light of the uncertainty of the basic assumptions which are made in extrapolating from skinfolds (or indeed densitometry, total body water, total body K, and others) to body fatness, these technical errors assume comparatively little importance.

The protein requirements of the elderly were investigated with [13C]leucine balance studies of metabolic demand, the efficiency of postprandial protein utilization (PPU) and the consequent apparent protein requirement. Ten elderly subjects aged 68–91 years (five men and five women) and ten young adult subjects aged 21–31 years (five men and five women) were infused with L-[1-13C]leucine for 9h commencing in the postabsorptive state (0–3h), continuing during the half-hourly feeding of low-protein meals (LP; protein 3% energy, 3–6 h), and during similar feeding of isoenergetic higher protein meals (HP; protein 15% energy, 6–9h). Leucine oxidation and balance were determined from plasma [l-13C]-α-ketoisocaproate enrichment and expired 13CO2 excretion measured during the 3rd hour of each 3h period. The protein intake during the HP phase was similar to the habitual intake estimated in the subjects from 24h urinary N excretion. Metabolic demand was defined as equal to twice the body-protein equivalent of measured postabsorptive leucine oxidation. The efficiency of PPU was calculated from the increased leucine oxidation observed during feeding, and the apparent protein requirement was defined as metabolic demand/PPU and calculated in relation to both body weight (BW) and fat-free mass (FFM) determined by densitometry or bioimpedance. Metabolic demand in the young adults was 0·83g protein/kg per d; in both elderly groups it was 36% lower when expressed per kg BW and 30% lower when expressed per kg FFM. The apparent protein requirement calculated from metabolic demand and PPU was 0·99g protein/kg per d in the young adults and this was also lower in the elderly, although this was only significant in the men (0·66g per kg BW, P=0·013; 0·79g per kg FFM, P=0·02). The results show that in this group of healthy elderly adults protein requirements as assessed from leucine balance studies were either similar to or less than those of younger adults.

Urea kinetics were measured in normal women aged 22-34 years at weeks 16, 24 and 32 on either their habitual protein intake (HABIT.) or a controlled intake of 60 g protein/d (CONTROL), using primed-intermittent oral doses of [15N15N]urea and measurement of plateau enrichment in urinary urea over 18 h (ID) or a single oral dose of [15N15N]urea and measurement of enrichment of urea in urine over the following 48 h (SD). The intake of protein during HABIT-ID (80 g/d) was greater than that on HABIT-SD (71 g/d); urea production as a percentage of intake was significantly greater at week 16 for HABIT-ID than HABIT-SD, whereas urea hydrolysis at week 16 was greater for HABIT-SD than HABIT-ID and urea excretion at week 32 was greater for HABIT-ID than HABIT SD. The combined results for HABIT-ID and HABIT-SD showed a significant reduction in urea production at week 32 compared with week 24. Urea excretion decreased significantly from week 16 to week 24 with no further decrease to week 32 and urea hydrolysis was significantly greater at week 24 than either week 16 or week 32. Compared with HABIT, on CONTROL there was a decrease in urea production at week 16, and urea excretion was significantly reduced at week 16. For all time periods urea production was closely related to the sum of intake plus hydrolysis. Hydrolysis was greatest at week 24 and closely related to urea production. There was a significant inverse linear relationship overall for hydrolysis as a proportion of production and excretion as a proportion of intake. The results show that on HABIT N is more effectively conserved in mid-pregnancy through an increase in urea hydrolysis and salvage, and during late pregnancy through a reduction in urea formation. Lowering protein intake at any stage of pregnancy increased the hydrolysis and salvage of urea. The staging of these changes was later than that in pregnancy in Jamaica.

It is commonly stated that ‘snack’ foods provide ‘empty calories’ and, therefore elevate energy intake whist providing insignificant quantities of other nutrients. The data presented in the present review suggest that foods which contribute to the pattern of ‘snacking’ contribute significantly to the nutrient quality of the diet. Those who ‘snack’ frequently tend to eat more food in general. Part of the difficulty in identifying the nutritional implications of ‘snacking’ is related to the definitions of ‘meals’ and ‘snacks’ and subsequent categorization of individual patterns. The physiological definitions typically relating to energy content or the time of eating do not necessarily coincide with colloquial, cultural or individual perceptions of what constitutes a ‘meal’ or ‘snack’. Clearly, a more consistent approach would facilitate interpretation of the literature and enable more effective health education messages about ‘snacking’ to be delivered.

Available anthropometric reference values for elderly people do not include specific norms for over-90-year-old subjects despite their increasing number. In the present study, weight, height and a number of anthropometric variables related to body muscle and fat mass were collected from fifty-seven nonagenarian and forty-one centenarian healthy, non-institutionalized subjects living in an Italian area. Recumbent anthropometry was used to avoid errors associated with impaired mobility. Nonagenarians and centenarian men were taller and heavier than women of corresponding age and had a greater amount of muscle and trunk fat, whereas women showed a marked peripheral adipose distribution. Anthropometric values of both age-groups were generally lower than published norms for 70–89-year-old American and European elderly people. However, differences were less marked when comparing Italian nonagenarians and centenarians with French and British people aged 85 years and over than when comparing Italian subjects with American octogenarians and younger European elderly people. Taken together these findings suggest a dramatic loss of muscle and fat mass in over-90-year-old subjects with respect to younger elderly people. However, changes between successive generations and geographical influences cannot be excluded. The need for local and age-specific norms in nutritional assessment of over-90-year-old people is emphasized. It is also suggested that current anthropometric indices may not be reliable when evaluating the oldest elderly subjects.

The aim of the present study was to establish whether the characteristics of members of a large national birth cohort study who submitted diet diaries with implausibly low-energy intake differed from those whose recorded energy intake was more plausible. Survey members (n 1898) recorded their diets in a 7d diary in household measures. Those whose reported energy intake (EI) as 'a fraction of their estimated BMR was less than 1·10, here termed low-energy reporters (LER) but often called under-reporters, constituted 20·6% of the study population. None of the variables describing dietary, smoking or exercise behaviour bore a significant relationship with low EI/BMR (<1·10), neither did those describing region of residence, subjective adequacy of income, current social class, social relations or the social environment of the subjects. Results of logistic regression analysis showed that the only independently significant characteristic for men was higher BMI. In women, in addition to higher BMI, having been overweight or obese as an adult independently, but less significantly, predicted low EI/BMR, while membership as a child of social class III (non-manual), having more children in the household and having a paid job marginally but independently decreased the probability of reporting low EI/BMR. Submission of a diary with EI/BMR < 1·10 7 years earlier in the same survey was an even more powerful predictor of current low EI/BMR than higher BMI in both sexes. The average reported diet-composition of LER was more micronutrient- and protein-rich than that of the others, indicating different dietary, or diet-recording, behaviour in this group of subjects. LER are not a random sample of the survey population, and their characteristics, definable to some extent, put them at risk for lower health status. Although EI/BMR cut-off points can be used to identify LER, the problem of how to use their data is still unresolved.

The main objective of the present study was to evaluate the short-term effects of exercise of different intensities on energy intake. Eleven young men were submitted to three randomly assigned sessions (one control and two exercise sessions) in which they ate, ad libitum, foods from a buffet-type meal. The energy cost of exercise was the same in the two exercise sessions. Results showed that there was no significant change in post-exercise subjective levels of hunger and fullness as well as total energy and macronutrient intakes in comparison with the control session. However, when energy intake relative to expenditure was considered by subtracting the surplus of energy expended during exercise from total energy intake, high-intensity exercise exerted a greater reducing effect on this variable compared with the control and low-intensity exercise sessions. These results suggest that for a given level of energy expenditure, high-intensity exercise favours negative energy balance to a greater extent than low-intensity exercise.

A study was performed in a rural Mexican community and in Mexico City to investigate possible differences in non-starch polysaccharide (NSP) intakes. One hundred and fourteen women (fifty-five rural and fitty-nine urban) and forty-three men (twenty-four rural and nineteen urban) completed 24 h recall questionnaires for three consecutive days with NSP intakes being estimated from a specially prepared set of new food composition tables. Potential underestimation of intakes was assessed by estimating individual BMR and dividing the estimated energy intakes by BMR to give a ratio. Excluding severe underrecording (ratio < 1·01) suggested NSP intakes of 21·8 and 17·3 g/d in rural men and women and 17·7 and 15·6 g/d in urban men and women respectively. NSP sources differed, with a marked fall in intake from pulses in the urban areas but a compensatory increase of tortilla intakes and a rise in NSP-rich fruit consumption. Both soluble- and insoluble-NSP intakes were higher in rural areas. NSP intakes scaled by probable energy intakes of moderately active adults in developing countries suggest that NSP intakes in Mexico are similar to adjusted values in Africa, i.e. 26·9 g/d in Mexico v. 28·5 g/d in Africa in rural men and 22·9 v. 21·0 g/d respectively in rural women. The NSP: energy density ratio (g/MJ) of the rural diet conformed with the World Health Organization (1990) goal. Data available on urban and rural communities for three countries showed that in each case the intake of NSP was lowest in the urban community.