To discuss factors which have underpinned the nutrition transition in the countries of East Africa, including Kenya, Uganda and Tanzania, from early colonisation to the current, oppressive political–economic structure.

Colonisation and neocolonisation in accordance with the desires of the New World Order have ensured the systematic extirpation of indigenous and traditional food habits in East Africa. These indigenous and traditional food habits, associated with myriad health benefits, have been progressively replaced by the globalised food system of the multinational corporations, a system inherently associated with the creation of non-communicable disease (NCD) epidemics throughout this region and globally. While the simplification of the East African food culture may be most apparent today, the nutrition transition has actually occurred over the past 400 years, since the onset of colonial occupation.

It is imperative that greater efforts be directed towards exposing the colonial and neocolonial forces which have undermined food security and health status in East Africa. Heightened awareness of these forces is essential for proposing genuine solutions to the nutrition transition and related NCD epidemics throughout this region and, indeed, worldwide.

To estimate and compare dietary energy intake (DEI) and total energy expenditure (TEE) among adults, using questionnaires.

Comparative, cross-sectional study.

Community-based, at the demographic surveillance site (DSS) in Butajira District of Ethiopia.

A total of 619 adults, 18–64 years of age, were randomly selected from among the urban and rural population of Butajira using the DSS sampling frame. Habitual dietary intake and physical activity were assessed using questionnaires. BMR was estimated using a regression equation, and TEE was calculated from BMR and the metabolic energy equivalent task (MET) and duration of reported activities. Physical activity level (PAL) was calculated as TEE/BMR, while food intake level (FIL) was calculated as DEI/BMR. The mean DEI:TEE ratio was used to evaluate reported DEI at the population level, while individual misreporters were identified by applying the Goldberg cut-off points at three levels of PAL.

Based on the Goldberg method, 57 % of the study participants were identified as acceptable reporters of DEI, among whom mean TEE was 8·21 (95 % CI 8·01, 8·42) MJ (1963 (95 % CI 1914, 2012) kcal), mean DEI was 8·13 (95 % CI 7·93, 8·34) MJ (1944 (95 % CI 1895, 1993) kcal) and mean DEI:TEE was 1·01 (95 % CI 0·99, 1·04).

The dietary history and physical activity questionnaires provide comparable estimates of mean energy intake and expenditure at a population level. Acceptable reporters have to be identified in order to obtain better estimates. Questionnaire-based estimates of energy intake should not be interpreted without an inherent system of comparison or validation.

The objective of the present study was to assess the construct validity, criterion-related validity and internal consistency of the Radimer/Cornell food insecurity measure for use in rural Tanzania.

A cross-sectional community-based survey was conducted from March to May 2005. Key adaptations to the nine-item Radimer/Cornell items included translation to Swahili, replacing the term ‘balanced diet’ with ‘full meal’ and constructing the items as questions rather than statements. Factor analysis and Cronbach’s alpha were used to assess validity and reliability, respectively.

Rural Kilimanjaro, Tanzania.

Analysis was restricted to data from 530 women aged 15–44 years who had children under 5 years old.

Principal component factor analysis revealed a two-factor solution: (1) altered eating pattern at household level and (2) altered eating pattern at child level. The two factors accounted for 66·2 % of the total variance. The subscales developed had good reliability. Internal consistency of the scales was 0·853 and 0·784 for food insecurity at household level and food insecurity at child level, respectively. Only 14·0 % of the women reported to be food-secure and 86·0 % reported some kind of food insecurity. The Radimer/Cornell food insecurity measure showed significant associations with selected sociodemographic factors in the expected directions. There was also an association with the NHANES III (Third National Health and Nutrition Examination Survey) and CCHIP (Community Childhood Hunger Identification Project) indicators.

Our findings suggest that the adapted Radimer/Cornell measure may have some utility in assessing food insecurity in settings like rural Tanzania.

To determine the prevalence of iodine deficiency, its causes and its association with intelligence quotient (IQ) in Mexican schoolchildren.

Cross-sectional analytical study, in which determinations of thyroid gland size, urinary iodine excretion, IQ, iron nutritional status, physical anthropometry, family consumption of goitrogenic foods, type/origin and iodine saturation of salt consumed at home and coliform organisms in drinking water were performed, and the association of each variable with IQ scores was evaluated by multiple regression analyses.

Municipality of Cuauhtémoc, in Colima, Mexico (altitude: 600–2700 m above sea level). Sea salt is extracted manually nearby and often used for human consumption. Goitre remains present in the region despite over half a century of mandatory salt iodination in the country.

Three hundred and three children, similar proportions of boys and girls, mean age 9·3 years, randomly selected from 19 public elementary schools.

Overall goitre rate was 21·4 %; low urinary iodine excretion was found in 19·5 % of the children, high urinary iodine excretion in 32·0 %. IQ scores were transformed into percentile values, with the following categorisation: ≤P5 (low IQ), 48·5 %; >P5 to ≤P25 (below average), 24·2 %; >P25 to <P75 (average), 18·8 %; ≥P75 to <P95 (above average), 3·6 %; ≥P95 (high IQ), 4·9 %. Ninety-two per cent of the population used iodinated salt, but deficient iodine saturation (<50 ppm) was found in 86·8 % of salt samples. The main goitrogenic foods consumed were peanuts (by 31·5 % of the sample), cabbage (30·1 %), broccoli (27·7 %) and cauliflower (25·7 %). Median counts of coliform organisms (colony-forming units/100 ml of drinking water) were: 207·5 (well water), 151 (cisterns), 52 (private homes), 25 (elementary schools) and 12 (kindergartens). Moderate iodine deficiency was associated (P < 0·05) with a 4·26 times higher risk of low IQ.

There is a perturbing negative impact of these findings on human capital acquisition for the region and the country. More attention is needed to ensure effective salt iodination processes, particularly in regions where goitrogens may contribute to the negative effects of iodine deficiency on the intellectual development of children.

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.

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.

To assess the proportion of children being stunted and underweight-for-age at 3, 9 and 15 months in Lambaréné, Gabon, using the WHO child growth standards released in 2006 as compared with the Centers for Disease Control and Prevention (CDC) 2000 and the National Center for Health Statistics (NCHS) 1978 child growth charts/references.

Prospective birth cohort in Lambaréné, Gabon.

Two hundred and eighty-nine children from birth to 15 months of age.

Weight and length were recorded at 3, 9 and 15 months. Corresponding Z scores for stunting and underweight-for-age were calculated for the three different standards/references. Children with a height-for-age or weight-for-age below –2 sd of the corresponding reference median (Z score ≤−2) were classified as stunted or underweight-for-age, respectively.

With the new WHO 2006 standards a higher proportion (4·0 %) of 3-month-old infants were underweight compared with the CDC (1·0 %) or the NCHS (0·7 %) child growth charts/references. In contrast to the NCHS references or the CDC charts, this proportion did not increase from 3 to 9 months or from 9 to 15 months. The proportion of children being stunted was highest (above 20 %) with the WHO 2006 standards at all three ages. Again, in contrast to the old standards, this proportion did not increase from 3 to 9 months or from 9 to 15 months.

The present results show considerably different growth faltering patterns for Gabonese children depending on the growth charts used to assess the prevalence of stunting and underweight. Shifting to the new WHO child growth standards may have important implications for child health programmes.

To assess changes in the Fe and vitamin A status of the population of Nangweshi refugee camp associated with the introduction of maize meal fortification.

Pre- and post-intervention study using a longitudinal cohort.

Nangweshi refugee camp, Zambia.

Two hundred and twelve adolescents (10–19 years), 157 children (6–59 months) and 118 women (20–49 years) were selected at random by household survey in July 2003 and followed up after 12 months.

Maize grain was milled and fortified in two custom-designed mills installed at a central location in the camp and a daily ration of 400 g per person was distributed twice monthly to households as part of the routine food aid ration. During the intervention period mean Hb increased in children (0·87 g/dl; P < 0·001) and adolescents (0·24 g/dl; P = 0·043) but did not increase in women. Anaemia decreased in children by 23·4 % (P < 0·001) but there was no significant change in adolescents or women. Serum transferrin receptor (log10-transformed) decreased by −0·082 μg/ml (P = 0·036) indicating an improvement in the Fe status of adolescents but there was no significant decrease in the prevalence of deficiency (−8·5 %; P = 0·079). In adolescents, serum retinol increased by 0·16 μmol/l (P < 0·001) and vitamin A deficiency decreased by 26·1 % (P < 0·001).

The introduction of fortified maize meal led to a decrease in anaemia in children and a decrease in vitamin A deficiency in adolescents. Centralised, camp-level milling and fortification of maize meal is a feasible and pertinent intervention in food aid operations.

To identify aetiological factors in anaemia and to explore knowledge, perceptions and attitudes towards anaemia.

Two cross-sectional surveys and sixteen focus group discussions.

The two regions with the highest prevalence of anaemia in Tunisia, Greater Tunis (GT) and the South West (SW).

Two representative samples of 687 (GT) and 729 (SW) women of reproductive age; 108 women were included in focus group discussions.

Among anaemic women, 63·4 % in the GT region and 80·2 % in the SW displayed iron deficiency (ID). Genetic haemoglobinopathies accounted for 10·0 % and 3·6 % of the cases of anaemia in the two regions, respectively. After adjustment for confounders, the major factors for iron-deficiency anaemia were low dietary Fe intake (OR = 5·0, 95 % CI 3·0, 8·4), drinking tea after eating (OR = 3·4, 95 % CI 2·0, 5·7) and pica (OR = 2·1, 95 % CI 1·1, 3·9). Most of the women related anaemia to the following causes: malnutrition, lack of hygiene, and their heavy workload and responsibilities in the household. Many women connected anaemia with hypotension. Few established a relationship between ID and anaemia. They had confidence in their doctor for treatment, but many complained they were not given sufficient information. Low dietary Fe intake, inappropriate food practices and inadequate perceptions contribute to the aetiology of anaemia in women.

These results point out to the need for a strategy combining food fortification, Fe supplementation for pregnant women, nutritional education for the general public and at-risk specific target groups, and training of health professionals.

To determine vitamin A (retinol) and fat concentrations in breast milk during early lactation.

Healthy lactating women (n 88) aged between 18 and 35 years were randomly selected for the study from urban, semi-urban, rural and estate (plantation) sectors of Galle District. Their anthropometry was recorded; breast milk samples were collected from the right breast one hour after the last feed. Breast milk retinol was determined by HPLC and fat content by the crematocrit method.

Subjects were in the 2nd to 9th month of lactation. Retinol concentrations of the breast milk samples ranged from 0·10 to 2·46 μmol/l, with a mean of 0·50 μmol/l, and correlated positively with parity (Pearson correlation coefficient, r = 0·307; P = 0·01) and negatively with period of lactation (r = −0·209; P = 0·05). The fat content of breast milk ranged between 5·09 and 56·46 g/l with a mean of 26·95 g/l. A significant difference in either breast milk fat or retinol content and mean birth weight of the babies was not seen between the groups. The ratio of retinol to fat in breast milk was positively correlated with weight (r = 0·274; P = 0·01) and height (r = 0·328; P < 0·001) of the mothers.

In this primary investigation on breast milk quality the fat content was found to be marginal; the majority of lactating mothers (92·0 %) were not providing the minimum daily requirement (1·05 μmol/l) of retinol to their babies.

To evaluate the relative validity of a food frequency questionnaire (FFQ) for assessing nutrient intakes in 6-month-old infants.

The FFQ was developed to assess the diets of infants born to women in the Southampton Women’s Survey (SWS), a population-based survey of young women and their offspring. The energy and nutrient intakes obtained from an interviewer-administered FFQ were compared with those obtained from a 4-day weighed diary.

A sub-sample of 50 infants aged 6 months from the SWS had their diets assessed by both methods. The FFQ recorded the frequencies and amounts of milks, baby foods, regular foods and drinks consumed by the infants over the previous seven days. The diaries recorded the weights of all foods and drinks consumed by the infants on four separate days within 15 days following FFQ completion.

Spearman rank correlation coefficients for intakes of energy, macronutrients and 18 micronutrients, determined by the two methods, ranged from r = 0·39 to 0·86; adjustment for energy intake tended to increase the correlation coefficients, range ra = 0·55 to 0·89. Bland–Altman statistics showed that mean differences between methods were in the range of −12·5 % to +12·5 % except for vitamin B12 (−18·9 %).

Although there were differences in absolute energy and nutrient intakes between methods, Spearman rank correlation coefficients indicated reasonable agreement in the ranking of intakes. The interviewer-administered FFQ is a useful tool for assessing energy and nutrient intakes of healthy infants aged about 6 months.

To assess the effects of socio-economic status (SES) on BMI, waist:hip ratio (WHR) and waist circumference (WC) in a group of Iranian women.

A cross-sectional study was conducted on 888 women in Sistan and Baluchestan Province. SES was measured using level of education. In addition, parity, marital status and physical activity were assessed. Standardized measurements were taken, BMI and WHR were calculated.

Low education level was a strong determinant of overweight and obesity among Iranian women. After controlling for age, women with higher education level had significantly lower BMI, WC and parity. Multiple linear regression analysis found a significant negative association of BMI and WC with education level and a significant positive association of BMI and WC with parity. Significant factors associated with obesity by a logistic regression model were education level (OR for university graduates v. illiterate or low literacy levels: 1·00 v. 3·70; P = 0·01), living with spouse (OR for married v. single subjects: 1·00 v. 0·15; P = 0·05), parity (OR for more than five v. less than two pregnancies: 1·00 v. 0·34; P = 0·03) and WC (OR for <0.88 cm v. ≥0.88 cm: 1·00 v. 11·20; P = 0·001).

The present study revealed that educational level, multiple pregnancies, marital status and lack of exercise are some possible explanations for the obesity among Sistan and Baluchestan women.