To determine risk factors for anaemia in preschool children.

A cross-sectional study.

Tigray province, northern Ethiopia.

2080 of 2373 children aged 6–60 months provided blood to assess anaemia.

Anaemia was highly prevalent (42%) and constituted an important nutritional problem in the region. In a sub-sample of 230 anaemic children, 56% had a low red blood cell (RBC) count, and 43% had a serum ferritin of less than 12 μg l−1 indicating that the anaemia was largely due to iron deficiency. Unlike other regions in developing countries, hookworm (0.4%) and malaria (0.0%) were rare and contributed little to the anaemia. Even though their diet lacked variety, the amount of iron consumed through cereal-based staple foods was adequate. However, the iron in these foods was not readily available and their diets were probably high in iron absorption inhibitors and low in enhancers. Dietary factors associated with anaemia included frequent consumption of inhibitors, such as fenugreek and coffee, and poor health in the child such as diarrhoea and stunting.

Underlying causes of anaemia were lack of safe water and inadequate human waste management, maternal illiteracy and mother being ill, and having no food reserves. The root cause of these factors was poverty. The optimal control strategy for iron deficiency anaemia should have a holistic approach which includes the alleviation of poverty, the empowerment of women and the provision of a safe environment.

To compare the effect of advice to reduce both dietary fat and sugar with advice to reduce fat alone on subsequent dietary intake in Scottish men.

A parallel design intervention study was employed to measure compliance to the two types of dietary advice. Subjects were randomly assigned to Group 1 (advice to reduce fat and non-milk extrinsic (NME) sugar), Group 2 (advice to reduce fat only, ad libitum sugar) or a control Group 0 (no advice). Compliance was assessed by two 4-day food diaries over 6 months.

The study was conducted in the Strathclyde area of Scotland.

Subjects were normal to moderately overweight Scottish men. The men recruited were non-dieting and volunteered for a ‘healthy eating’ study with the aim to improve the ‘healthiness’ of their diet.

Groups 1 and 2 achieved the dietary target for fat, reducing their mean intake to below 35% energy. Group 1 achieved a statistically significant reduction in percentage energy from NME sugar in the short term (6 weeks), decreasing their mean intake from 9.9% to 7.2% energy. This initial decrease appeared to slip back towards baseline levels at 6 months (8.1% energy from NME sugar) and was no longer significantly different from baseline. At 6 months Group 1 reported a significantly lower mean energy intake than at baseline, whereas Group 2 adjusted for an initial decrease in energy intake and by 6 months energy intakes were not significantly different from baseline intakes. Group 2 appeared to compensate for the absolute reduction in dietary fat with a slight increase in total sugars and the maintenance of NME sugar intakes.

Subjects in Group 1 complied with advice to reduce both fat and sugar over 6 weeks but to a lesser extent over 6 months. The 1.8% reduction in percentage energy from NME sugars in Group 1 at 6 months may not have reached significance due to the small sample size. Alternatively it may be that free-living populations find it hard to maintain concurrent reductions in fat and sugar owing to the well-documented inverse relationship between intakes of these macronutrients when expressed as a proportion of energy.

To explore the factors that influence attitudes and beliefs about the effects of body weight and physical activity on health.

Cross-sectional survey using a face-to-face interview-assisted questionnaire.

The survey was conducted between March and April 1997 in the 15 member states of the EU.

Approximately 1000 adults aged 15 years plus from each country were selected by quota-controlled sampling; the total sample was of 15 239 persons (7162 males and 8077 females). Data were weighted by population size for each country and by age, gender and regional distribution within countries.

Overall 27% of men and 35% of women reported not engaging in any form of recreational activity; rates were highest in those with a primary-level education (37% men, 43% women) compared with tertiary-level education (20% men, 25% women). Recreational activity levels declined with age and tended to be lowest in those who were more physically active at work. Eighteen per cent of respondents believed that physical activity was one of the two greatest influences on health; 13% mentioned body weight, 38% mentioned food, 41% mentioned smoking and 33% mentioned stress. Logistic regression was used to assess for the effects of gender, age, educational level, body mass index (BMI), smoking status, activity level and country on beliefs that body weight and physical activity influenced health. Primary-educated, overweight, ex- and non-smoking women were most likely to mention body weight as an influence; young tertiary-educated, thinner, non-smoking and active males were most likely to mention physical activity. There was wide variation across Europe in reported behaviour and beliefs, which persisted after taking account of all of the other factors in the regression model.

Relatively few people in some countries believed body weight and physical activity were important influences on health. Many people mentioned stress and it might be possible to use this interest to motivate changes in physical activity to relieve stress. It may be important to take a more integrated approach to activity patterns that consider the role of work and recreation. Although social and demographic factors were important, after adjusting for these factors there was still wide between-country variation in reported attitudes, beliefs and behaviour. This will need to be taken into account in any activity promotion campaigns.

The main objectives of this pan-European study were: (1) to identify different types of physical activity and the time devoted to them, (2) to assess physical activity/inactivity at work and in leisure time, and (3) to determine self-reported body weight and height.

In each member state of the EU, approximately 1000 adults, aged 15 years or more, were selected to participate in an interview-assisted face-to-face questionnaire on physical activity and body weight. In each country, sample selection was quota-controlled to ensure national representativeness. Overall, 15 239 subjects in the EU completed the study.

On average in the EU, nearly three-quarters of the population participate in some kind of activity. In general, the highest proportions of participants were found in the Nordic countries and the lowest in the southern ones. At the European level, the five most common activities include walking, gardening, cycling, keep fit and swimming. Higher participation rates were found among men, younger subjects and those with a higher level of education. The majority of Europeans fall within the normal body mass index (BMI) range but more than one-third are overweight (31%) or obese (10%) and 11% have a BMI below 20.

Several risk groups related to physical activity emerge from this survey: women, those with a lower level of education, older subjects, the overweight/obese and the underweight. Programmes to promote physical activity need to be tailored to the different groups identified in each country/region in order to increase adherence of non-participants and for the maintenance of those already engaged in activities.

To examine the relationship between cigarette smoking and a range of nutrient intakes and blood status indices in older people.

National Diet and Nutrition Survey: cross-sectional survey of nationally representative sample of people aged 65 years and over.

Mainland Britain during 1994/95.

1191 people (619 male, 572 female) aged 65 years and over, of whom 920 were living in private households and 271 were living in institutions.

Cigarette smoking was inversely correlated with intakes of antioxidants and other micronutrients after adjustment for age, sex and domicile. Cigarette smoking was also inversely correlated with a number of antioxidant micronutrient status indices including plasma vitamin C and the carotenoids (but not vitamin E status indices), and with other micronutrient status indices, including plasma pyridoxal phosphate, red cell and serum folate, after adjustment for age, sex, domicile and the corresponding nutrient intake. Previous cigarette smoking or cigar/pipe smoking was not generally associated with lower nutrient intakes or status indices, however, both current and previous cigarette smoking was associated with increased concentrations of acute phase indicators. Further adjustment for total energy intake and/or sociodemographic, health and drug usage variables attenuated only a few of the associations observed.

Older people who smoke cigarettes are at increased risk of suboptimal antioxidant and other micronutrient intakes and status, but the lower intakes found in cigarette smokers only partly explain their reduced blood indices.

This report examines how sources of fat and patterns of fat-related dietary habits differed between black, Hispanic and white women participating in a randomized trial of a low-fat diet intervention.

The intervention consisted of group sessions, which met weekly for 6 weeks, biweekly for 6 weeks and monthly for 9 months, and included didactic nutrition education and activities to provide motivation for sustained dietary change. Outcomes included total fat and fat from nine food groups from a food frequency questionnaire (FFQ), and a summary scale and five subscales that measure fat-related dietary habits.

Data are from 1702 post-menopausal women, recruited from clinical centres in Atlanta, Birmingham and Miami, with dietary assessments at baseline and 6 months post-randomization.

Total fat intake was similar across race/ethnic groups at baseline, yet there were many differences in sources of fat and fat-related dietary habits. For example, blacks consumed less fat from dairy foods and more fat from meats than whites. Effects of the intervention on total fat intake or the summary fat-related dietary habits scale did not differ across race/ethnicity groups. There were, however, many differences in how the intervention affected sources of fat and fat-related dietary habits. For example, the intervention effect for added fats (e.g. butter and salad dressings) was −8.9 g for blacks and −12.0 g for whites (P < 0.05). The intervention effect for adopting low-fat meat purchasing and preparation methods was larger for blacks than whites, and the intervention effect for replacing high-fat foods with fruits and vegetables was larger for Hispanics than whites.

This study demonstrates that, if properly designed, a single nutrition intervention programme can work well even in groups with culturally diverse dietary patterns.

To investigate the direct and indirect cost differences associated with eating a ‘healthy’ or ‘unhealthy’ diet.

Analysis of data from a baseline postal questionnaire for the UK Women's Cohort Study, including a detailed food frequency questionnaire (FFQ), supplemented by a telephone interview on a sub-sample.

The first 15 191 women who responded to the questionnaire, aged 35–69 years with similar numbers of meat eaters, fish eaters and vegetarians.

A healthy diet indicator (hdi), with values from 0 (lowest) to 8 (highest) was developed based on the WHO dietary recommendations. Direct monetary cost of the diet was calculated using prices from the 1995 National Food Survey and the Tesco home shopping catalogue. Women in the healthy diet group were almost four times as likely to be vegetarian and have a higher educational level. For direct costs, the difference between the most extreme hdi groups was £1.48 day−1 (equivalent to £540 year−1), with fruit and vegetable expenditure being the main items making a healthy diet more expensive. Forty-nine per cent of the food budget was spent on fruit and vegetables in hdi group 8 compared to 29% in hdi group 0. Interestingly, 52% of those questioned in both extreme hdi groups did not think that it was difficult to eat healthily.

To achieve a particularly healthy diet independent predictive factors were spending more money, being a vegetarian, having a higher energy intake, having a lower body mass index (BMI) and being older.

To develop and test a quantitative, interviewer-administered food frequency questionnaire (FFQ) to ascertain nutrient intakes of individuals in northern India.

A 92-item FFQ was developed based on food use and market surveys of the study area. A validation study was conducted consisting of 24-h diet recalls (24HR) administered on 6 randomly selected days over 1 year. Two FFQs were administered, one each at the beginning and end of the 1-year period. FFQ and 24HR-derived nutrient scores were compared using correlation and regression analyses and by computing differences between nutrient intakes estimated by the two methods.

Rural villages in Bhavnagar District, Gujarat, North India.

60 individuals who agreed to provide all necessary data.

Pearson (parametric) correlation coefficients averaged 0.69 in comparing nutrient scores derived from the 24HR with those from the first FFQ and 0.72 in comparing the second FFQ (P < 0.0001). Spearman correlation coefficients were virtually identical to the Pearson correlations, averaging 0.68 and 0.72, respectively. In regression analyses, most coefficients were close to 1.0 (perfect linear association). Nutrient scores were significantly and consistently higher on both FFQs relative to the 24HR.

This FFQ produces results broadly comparable, and superior in some respects, to those commonly used in the West. Higher than average measures of association indicate its suitability for comparing exposures within this study population in reference to health-related endpoints.

To evaluate the association of vegetable and fruit intake with several demographic, anthropometric, lifestyle and dietary factors.

Cross-sectional analysis. Information on habitual diet was collected by means of the diet history method. Association of vegetable and fruit intakes with other factors was assessed separately by means of multiple lineal regression and the cumulative odds model.

39 622 healthy subjects aged 29–69 years from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort in Spain.

Fruit intake increased with age, education and physical activity and decreased with intake of saturated fatty acids and cholesterol; smoking and alcohol consumption were also negatively associated with fruit, with a very low consumption for current smokers and heavy drinkers. Vegetable intake increased with education and physical activity and with intake of unsaturated fatty acids, mainly mono-unsaturated. Former smokers consumed more vegetables than never or current smokers and non-consumers of alcohol ate less vegetables than consumers, among whom no differences were observed. All these estimates were adjusted by energy and body mass index (BMI).

When assessing the association of fruit and vegetables with chronic diseases it is important to take into account confounding factors. Furthermore, it would be useful to study dietary patterns including several interrelated factors.

A national survey was developed in order to assess the difficulties and the potential benefits that the adult Spanish population perceive when they try to eat a healthier diet and also to help nutrition educators to develop relevant and specific strategies to promote healthy eating.

The study survey was carried out according to an established protocol on a representative sample of 1009 Spanish subjects over 15 years of age selected by a multi-stage procedure. This study belongs to a partnership in a pan-European survey about food, nutrition and health. The analysis was focused on the evaluation of the seven most frequently chosen barriers and benefits.

There was a trend to select as the main barriers: ‘irregular work hours’ (29.7%), ‘willpower’ (29.7%) and ‘unappealing food’ (21.3%), while ‘prevent disease’ (73.6%) was the most frequently selected benefit to healthy eating. About 20% of the subjects said they did not have any difficulty eating healthier and most people believed that healthy eating was associated with at least one benefit.

In Spain, nutrition educators should be aware that an irregular and busy lifestyle, willpower and food-related factors (such as price and unappealing foods) are the main perceived barriers to healthy eating. Conversely, the prevention and health promotion aspects are the main perceived benefits.

To examine the distribution of the stages of change towards physical activity across Europe and the influence of sociodemographic variables on this distribution.

A cross-sectional study in which quota-controlled, nationally representative samples of approximately 1000 adults from each country completed a face-to-face interview-assisted questionnaire.

The survey was conducted in the 15 member states of the European Union between March and April 1997.

The questionnaire was completed by 15 239 subjects (aged 15 years upwards). Data were weighted by population size for each country and by sex, age and regional distribution within each member state.

Twenty-nine per cent of subjects were in the precontemplation stage, while a similar proportion (30%) were in the maintenance stage. Ten per cent had been physically active but had relapsed recently. Considerable intercountry variation existed with Scandinavian countries tending to be lower in the precontemplation stage and southern countries tending to be higher (particularly Greece and Portugal). Men and younger subjects with a higher education level were more likely to be in the maintenance stage. Overweight and obese subjects were more likely to be in the precontemplation stage than normal-weight subjects. In terms of barriers to participating in physical activity ‘not being the sporty type’ was more important for those in precontemplation stages, while ‘work/study commitments’ was more important for those people in the maintenance stage.

The model of the stages of behavioural change towards physical activity was able to distinguish people according to their level and attitude to physical activity. The considerable intercountry and sociodemographic variation in the distribution of stages of change suggest that targeted programmes aimed at specific subgroups in the population identified using the model may be more effective in promoting physical activity.

To investigate links between taste responses, self-reported food preferences and selected dietary outcomes in young women.

Subjects were 159 women, with a mean age of 27.0 years. Taste responses were measured using aqueous solutions of 6−n-propylthiouracil (PROP) and sucrose. All subjects completed a 171-item food preference checklist, using nine-point category scales. Food preference data were reduced using principal components factor analyses, with the internal consistency of factor-based subscales established using Cronbach's alpha. Dietary intakes, available for a subset of 87 women, were based on 3 days of food records. Estimated intakes of carbohydrate, fibre and β-carotene were the key dietary outcome variables.

Genetically-mediated sensitivity to the bitter taste of PROP was associated with reduced preferences for Brussels sprouts, cabbage, spinach and coffee beverages. Higher preferences for sucrose in water were associated with increased preferences for sweet desserts. Food preferences, in turn, were associated with measures of current diet. Reduced acceptability of vegetables and fruits was associated with lower estimated intakes of carbohydrate, fibre and β-carotene.

Taste responses to sucrose and PROP were predictive of some food preferences. Food preferences, in turn, were associated with food consumption patterns. Given that taste responsiveness to PROP is an inherited trait, there may be further links between genetic taste markers, eating habits and the selection of healthful diets.

To examine the association between self-reported consumption of foods and plasma vitamin C levels.

A cross-sectional analysis of dietary data and plasma vitamin C levels. Subjects placed the following foods into frequency categories: fresh fruit, leafy greens, other vegetables, fatty fish, other fish, chicken, meat, meat products, eggs, cheese and brown bread. The six frequency categories ranged from ‘never’ to ‘at least daily’. Plasma vitamin C was measured by fluorometric assay.

A population-based cohort study in Norfolk, UK.

598 men and 566 women aged 45–74 years not taking vitamin supplements.

Plasma vitamin C was positively correlated with intake of fresh fruit (r = 0.29 in men and r = 0.25 in women, P < 0.001), leafy greens (r = 0.20 in men P < 0.001, r = 0.13 in women P < 0.01), other vegetables (r = 0.20 in men P < 0.001, r = 0.14 in women P < 0.01) and brown bread (r = 0.28 in men, r = 0.17 in women, P < 0.001) and negatively associated with intake of meat products (r = −0.13 in men P = 0.02, r = −0.10 in women P < 0.01). The difference in plasma vitamin C between never and daily eaters of brown bread was 13.6 μmol l−1 in men and 9.9 μmol l−1 in women, P < 0.001

These data suggest that plasma vitamin C is not only a marker of foods rich in vitamin C but of certain patterns of food consumption. Such patterns are likely to be population specific and might explain inconsistencies in biomarker–disease associations.

The rapid increase in obesity rates over recent years suggest that cultural and societal influences are affecting the adjustment in the energy balance equation in addition to other physiopathological or genetic determinants. Therefore, a pan-EU study was carried out to explore the influence of sociodemographic factors as well as some attitudes (smoking and exercise) on the prevalence of obesity in the adult population of all 15 member states of the EU.

Overall, a sample of 15 239 individuals aged 15 years and upwards in the EU completed the questionnaire. Subject selection was quota-controlled to make the sample nationally representative following a multistage stratified cluster sampling. Self-reported height and weight were used to calculate body mass index (BMI).

From the EU average results, it can be seen that only about half of the EU population (48%) is within the normal weight range, while the obesity (BMI > ≥ 30 kg m−2) prevalence was about 10% in the EU and the overweight prevalence was 36.6% and 25.6% among men and women, respectively. UK subjects had the highest prevalence of obesity (12%), while Italians, French and Swedes had the lowest levels of obesity (about 7%). Concerning age and social class interactions, logistic regression analysis showed that high social class and younger individuals in all groups had a lower odds ratio for obesity prevalence. People with a higher level of education are less likely to be obese, while the interaction between educational levels and obesity was different for men and women. A low participation in various leisure-time physical activities, the lack of interest (precontemplation) in being involved in exercise/physical activity and the increasing number of hours sitting down at work appear to be predictors of obesity. Single individuals were less prone to become obese than couples or widowed/divorced people. Finally, smoking status was statistically linked to the prevalence of obesity, since non-smokers or ex-smokers for more than 1 year presented a higher tendency for a BMI > 30.

This survey confirms that a priority area for health intervention aimed at preventing the development of obesity should be to increase levels of physical activity, although the approach will depend on the population, especially with respect to educational and socioeconomic aspects.

To examine intake of fruits and vegetables in smokers and non-smokers.

Secondary analysis using general linear modelling approaches. Food intake measured using a food frequency questionnaire approach.

The community (the population of the province of Ontario, Canada).

Members of the general public (n=38,000).

Smokers ate substantially less fruit and fruit juice then non-smokers with heavy smokers eating the least. Heavy smokers were between four and six times more likely to be eating less fruit than recommended. Similar but less marked differences were noted for vegetable intake. Smokers also obtained a larger part of their total caloric intake from fats.

While smoking cessation remains the primary target for lung cancer prevention, attention should also be given to dietary interventions in smokers in order to improve their nutrition. Such interventions might also be expected to reduce the risk of other cancers (e.g. colon cancer).

To evaluate the accuracy of a simplified inventory procedure for assessing nutrient intake from vitamin and mineral supplements.

Participants brought their supplements to a clinic. An interviewer conducted the supplement inventory procedure, which consisted of recording data on the type of multiple vitamin and single supplements used. For the multiple vitamins, the interviewer recorded the exact dose for a subset of nutrients (vitamin C, calcium, selenium). For other nutrients, we imputed the dose in multiple vitamins. The dose of all single supplements was recorded. Labels of the supplements were photocopied and we transcribed the exact nutrient label data for the criterion measure. Spearman correlation coefficients were used to assess precision of nutrient intakes from the simplified inventory compared to the criterion measure.

Data are from 104 adult vitamin supplement users in Washington state.

Correlation coefficients between nutrient intake estimated from the simplified inventory compared to the criterion measure were high (0.8–1.0) for those nutrients (vitamin C, calcium, selenium) for which the interviewer recorded the exact dose contained in multiple vitamins. However, for nutrients for which imputations were made regarding dose in multiple vitamins, correlation coefficients ranged from good (0.8 for vitamin E) to poor (0.3 for iron).

The simplified inventory is rapid (4–5 min) and practical for large-scale studies. The precision of nutrient estimates using this procedure was variable, although excellent for the subset of nutrients for which the dose was recorded exactly. This study illustrates many of the challenges of collecting high quality supplement data.