To assess the accuracy of self-reported waist and hip circumferences and the waist-to-hip ratio (WHR) by comparison with measured waist and hip circumferences and WHR in a sample of middle-aged men and women.

Analysis of measured and self-reported waist and hip data from participants in the Oxford cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC–Oxford).

Four thousand four hundred and ninety-two British men and women aged 35–76 years.

Spearman's rank correlation coefficients between measured and self-reported waist, hip and WHR were 0.80, 0.74 and 0.44, respectively, for men and 0.83, 0.86 and 0.62 for women. Waist was underestimated, on average, by 3.1 (standard deviation (SD) 5.6) cm in men and 1.9 (SD 5.4) cm in women. The extent of underestimation was greater in participants with larger waists, older participants and women with greater body mass index (BMI). Hip was underestimated by a mean of 1.8 (SD 4.9) cm in men and 1.2 (SD 4.5) cm in women; the extent of underestimation was greater in participants with larger hip circumference and older participants. On average, WHR was underestimated by less than 2% by men and women; the extent of underestimation was greater among those with larger WHR, older people and those with greater BMI. Using self-reported values, the proportion of classification to the correct tertile was over 65% for waist and hip measurements. For WHR this proportion was 50% among men and 60% among women.

Self-reported waist and hip measurements in EPIC–Oxford are sufficiently accurate for identifying relationships in epidemiological studies.

High consumption of energy-dense foods has been linked to high energy intakes and excess weight gain. This study tested the hypothesis that high energy density of the total diet is associated with lower diet costs.

Dietary intakes of 837 French adults, aged 18–76 years, were assessed using a dietary history method. Dietary energy density (MJ kg−1) was calculated by dividing total energy by the edible weight of foods consumed. Daily diet cost (€day−1) was estimated using mean national food prices for 57 food items. The relationship between dietary energy density and diet cost at each level of energy intake was examined in a regression model, adjusted for gender and age.

The more energy-dense refined grains, sweets and fats provided energy at a lower cost than did lean meats, vegetables and fruit. Within each quintile of energy intake, diets of lower energy density (MJ kg−1) were associated with higher diet costs (€day−1).

In this observational study, energy-dense diets cost less whereas energy-dilute diets cost more, adjusting for energy intakes. The finding that energy-dilute diets are associated with higher diet costs has implications for dietary guidelines and current strategies for dietary change.

To determine the correlates of a high-fat diet in urban, suburban and rural areas of Quebec, Canada.

A secondary analysis of data collected as part of a 5-year multi-factorial, multi-setting, community-intervention project.

Urban, suburban and rural settings of the province of Quebec, 1997.

Data were analysed from a sample of 5214 participants (2227 males, 2987 females). A food-frequency questionnaire was completed and a global index of food quality was calculated. Logistic regression was used to identify correlates of a diet high in total fats, saturated fat and cholesterol.

In both genders, lower level of education, smoking status, French and English languages compared with other languages spoken at home, and a rural environment were associated with poor diet quality. Having no intention to eat low-fat dairy products more often was associated with a high-fat diet. In men, obesity (body mass index >30 kg m−2) and absence of reported health problems were correlates of a high-fat diet, while, in women, lower physical activity was a correlate.

Future health interventions in Quebec should target people with low education, smokers and those living in a rural environment. Obese men and sedentary women should have access to specific dietetic resources.

To investigate pregnant women's views on infant feeding options recommended for HIV-infected women.

A structured interview survey complemented with focus group discussions.

Antenatal clinics in Moshi urban and rural districts of Tanzania.

Five hundred pregnant women participated in the interview survey and 46 pregnant women participated in six focus group discussions.

Participating women reported that they would change to an alternative infant feeding method if they were found to be HIV-infected and were advised to do so. Cow's milk was regarded as the most feasible infant feeding method for local HIV-infected mothers. Infant feeding formula was regarded as too costly, but if recommended by health workers and distributed free of charge, the majority of the women (82%) were confident that they would then choose this option. In the focus group discussions, women were less optimistic and expressed great concern for the social consequences of not breast-feeding. The safety of exclusive breast-feeding was questioned. Less common infant feeding methods, such as expressed heat-treated breast milk and wet-nursing, were not regarded as viable options. Several social barriers to replacement feeding were identified in the focus group discussions, including possible lack of support from partner and potential negative reactions from the community.

Future research on infant feeding options should include the broader cultural context and the psychological stress that HIV-infected women face when choosing infant feeding methods.

To identify and characterise dietary patterns in a middle-aged Irish population sample and study associations between these patterns, sociodemographic and anthropometric variables and major risk factors for cardiovascular disease.

A cross-sectional study.

A group of 1473 men and women were sampled from 17 general practice lists in the South of Ireland. A total of 1018 attended for screening, with a response rate of 69%. Participants completed a detailed health and lifestyle questionnaire and provided a fasting blood sample for glucose, lipids and homocysteine. Dietary intake was assessed using a standard food-frequency questionnaire adapted for use in the Irish population. The food-frequency questionnaire was a modification of that used in the UK arm of the European Prospective Investigation into Cancer study, which was based on that used in the US Nurses' Health Study. Dietary patterns were assessed primarily by K-means cluster analysis, following initial principal components analysis to identify the seeds.

Three dietary patterns were identified. These clusters corresponded to a traditional Irish diet, a prudent diet and a diet characterised by high consumption of alcoholic drinks and convenience foods. Cluster 1 (Traditional Diet) had the highest intakes of saturated fat (SFA), monounsaturated fat (MUFA) and percentage of total energy from fat, and the lowest polyunsaturated fat (PUFA) intake and ratio of polyunsaturated to saturated fat (P:S). Cluster 2 (Prudent Diet) was characterised by significantly higher intakes of fibre, PUFA, P:S ratio and antioxidant vitamins (vitamins C and E), and lower intakes of total fat, MUFA, SFA and cholesterol. Cluster 3 (Alcohol & Convenience Foods) had the highest intakes of alcohol, protein, cholesterol, vitamin B12, vitamin B6, folate, iron, phosphorus, selenium and zinc, and the lowest intakes of PUFA, vitamin A and antioxidant vitamins (vitamins C and E). There were significant differences between clusters in gender distribution, smoking status, physical activity, body mass index, waist circumference and serum homocysteine concentrations.

In this general population sample, cluster analysis methods yielded two major dietary patterns: prudent and traditional. The prudent dietary pattern is associated with other health-seeking behaviours. Study of dietary patterns will help elucidate links between diet and disease and contribute to the development of healthy eating guidelines for health promotion.

To examine the relationship between child-feeding strategies and the stage of change for fruit and vegetable consumption of low-income African American women.

Mothers were asked to think aloud as they shopped for groceries and prepared a meal for their family. Verbalisations were audio-taped and transcribed. Transcripts were coded. Coded segments were sorted according to stage of change of the women who made the verbalisation. Themes were identified and analysed for differences across the stages of change. Child-feeding strategies and factors influencing provision of fruits and vegetables to children were identified through content analysis procedures.

Seventy women, aged 18 to 45 years, were classified by stage of change (10 to 18 per stage) based on self-reported intakes of fruits and vegetables and intention to increase intake. Women on average had two to three children less than 12 years of age and tended to be single heads of households, with about half having some college or technical training.

According to the women's comments, food preferences of children were important considerations for women in all stages regarding their food choice behaviours. Women in the later stages reported using more positive child-feeding strategies to promote the intake of fruit and vegetables, including positive role-modelling and methods related to food purchasing, preparation and meal planning.

Promoting mothers' movement to more advanced stages of change for fruit and vegetable intake may result in the use of more positive child-feeding strategies and therefore contribute to increased fruit and vegetable intake by children.

An unbalanced diet is a main risk factor for several chronic diseases. This paper identifies groups of individuals with an unbalanced diet based on the consumption of nutrients. A characterisation of the groups may help to focus efforts aimed at improving the dietary behaviour of the population.

Using nutritional data of 1763 men and 2267 women participating in the German Nutrition Survey of 1998, we constructed two indices for diet quality that each combines a large amount of nutrients into a single indicator. The impact of sociodemographic and lifestyle characteristics on the diet quality indices was analysed using multiple regression analyses.

The results show a considerable variation of diet quality between different groups of individuals. High diet quality in terms of the consumption of vitamins, minerals and trace elements is positively associated with income, education level, age, energy intake, food diversity, sport activity and vegetarianism. On the other hand, a low diet quality as indicated by high intakes of e.g. fat, sugar, alcohol and sodium can be expected when energy intake is high, for individuals of middle age and for pregnant and breast-feeding women.

The results of this study help to identify groups of individuals with preferable and non-preferable diet quality. For developing public health strategies, in particular the impact of age on diet quality seems to be interesting. The rising diet quality with increasing age could reflect a changing health consciousness. It could thus be a challenge for health policy to promote a healthy way of living focused especially on young individuals.

To assess the epidemiological evidence on diet and cancer and make public health recommendations.

Review of published studies, concentrating on recent systematic reviews, meta-analyses and large prospective studies.

Overweight/obesity increases the risk for cancers of the oesophagus (adenocarcinoma), colorectum, breast (postmenopausal), endometrium and kidney; body weight should be maintained in the body mass index range of 18.5–25?kg/m2, and weight gain in adulthood avoided. Alcohol causes cancers of the oral cavity, pharynx, oesophagus and liver, and a small increase in the risk for breast cancer; if consumed, alcohol intake should not exceed 2?units/d. Aflatoxin in foods causes liver cancer, although its importance in the absence of hepatitis virus infections is not clear; exposure to aflatoxin in foods should be minimised. Chinese-style salted fish increases the risk for nasopharyngeal cancer, particularly if eaten during childhood, and should be eaten only in moderation. Fruits and vegetables probably reduce the risk for cancers of the oral cavity, oesophagus, stomach and colorectum, and diets should include at least 400?g/d of total fruits and vegetables. Preserved meat and red meat probably increase the risk for colorectal cancer; if eaten, consumption of these foods should be moderate. Salt preserved foods and high salt intake probably increase the risk for stomach cancer; overall consumption of salt preserved foods and salt should be moderate. Very hot drinks and foods probably increase the risk for cancers of the oral cavity, pharynx and oesophagus; drinks and foods should not be consumed when they are scalding hot. Physical activity, the main determinant of energy expenditure, reduces the risk for colorectal cancer and probably reduces the risk for breast cancer; regular physical activity should be taken.

Positive secular trends in adolescent obesity and an increased prevalence of fear of fatness, particularly among girls, have been documented world-wide. There is a lack of consensus about assessment criteria for childhood obesity and no standard exists for assessing Irish children. In 1990, the Irish National Nutrition Survey used body mass index (BMI) ≥26kgm−2 to describe the prevalence of overweight among Irish adolescents.

(1) To examine the range in classification of Dublin schoolchildren as overweight according to four standard assessment methods; (2) to assess changes in weight status, prevalence of fear of fatness and accompanying slimming practices in a one-year follow-up; and (3) to compare the prevalence of overweight with that documented in 1990 among adolescents of similar age.

A one-year follow-up study of 199 healthy schoolchildren (90 boys and 109 girls; mean age of 11 years at baseline) attending seven fee-paying (six single- and one mixed-sex) and eight non-fee-paying (four single- and four mixed-sex) primary schools in Dublin city centre.

Weight, height, waist circumference and triceps skinfold were measured and used in five definitions of overweight, including published cut-off points of BMI-for-age (Centers for Disease Control and Prevention BMI-for-age charts for boys and girls; BMI reference curves for the UK 1990; International Obesity Task Force age- and sex-specific BMI cut-offs), actual relative weight and BMI≥26kgm−2. Assessment of body image perceptions and satisfaction (using figure line drawings) was reported in a questionnaire specifically designed for this study.

The prevalence of overweight within the total group differed between the four standard definitions of weight status, by 9% at baseline and 8% at follow-up. Accordingly, increasing trends over the year ranged from zero to 3%. Using the criterion BMI≥26kgm−2, 6% of Dublin schoolchildren were overweight, compared with 1.9% of schoolchildren in 1990. Significantly more girls than boys were affected by fear of fatness and were trying to lose weight.

A standard method for assessment of weight status is urgently needed for the evaluation of obesity prevention initiatives among Irish schoolchildren. Such initiatives need to be sensitive to the pervasiveness of fear of fatness among adolescent girls.

To identify factors potentially associated with weight retention measured 9 months after childbirth.

Prospective study with four follow-up waves in time (0.5, 2, 6 and 9 months postpartum).

Rio de Janeiro, Brazil.

Two hundred and sixty-six Brazilian women of childbearing age. Analysis was based on hierarchical logistic regression. The dependent variable was weight retention and was defined as the difference between weight at 9 months postpartum and pre-pregnancy weight, with a dichotomised cut-off at 7.5 kg. Covariates included demographic and socio-economic data, obstetric history, anthropometric data, and data on the infant. These data were grouped in blocks and ordered according to their influence on the dependent variable.

Of the women studied, 19.2% presented weight retention values ≥7.5 kg. According to the logistic regression analysis, the following variables remained associated with weight retention ≥7.5 kg: total family income, difficulty or inability to read a letter, age category ≥30 years, age at first childbirth <23 years, gestational weight gain ≥12 kg, body fat at baseline ≥30% and infant birth weight <3500 g. Infant hospitalisation was only marginally significant.

Determinant factors identified by the analysis highlight the need for nutritional intervention policies during pregnancy and in the first months postpartum as a way of minimising obesity and the diseases resulting from it.

In Turkey, the incidence of neural tube defects (NTDs) is 30.1 per 10 000 births. For this reason it seems an important problem for women of childbearing age. Adequate periconceptional consumption of folic acid could prevent NTDs. Most women are unaware of this recommendation. The objectives of this study were to evaluate women' knowledge and beliefs with regard to folic acid, and to estimate the consumption frequency of vitamin supplements periconceptionally and during the first trimester of pregnancy.

Eight hundred and eighteen married women who had delivered a live-born infant within the previous 12 months completed the questionnaire. Each subject participated in a 20-minute interview, with the questionnaire comprising multiple-choice statements. A random sample of 10 public health centres was drawn from 27 in three districts in Konya where about 50% of the population lives.

Only 22% of subjects had heard or read about folic acid. Thirteen per cent of women indicated knowledge of the direct link between folic acid supplementation and NTD prevention. The knowledge was greatest among 26- to 35-year-olds. Women with a university degree were more likely to have heard about folic acid than were less-educated women.

The results indicate that further government efforts are needed to inform the population and promote the optimal use of folic acid supplements and folate-enriched foods. It is the responsibility of national authorities to increase health education concerning folic acid and the prevention of NTDs in their countries.

To identify the prevalence of breast-feeding at discharge and the determinants of breast-feeding initiation amongst Aboriginal women.

A prospective cohort study using a self-administered baseline questionnaire and telephone-administered follow-up interviews.

Six hospitals with maternity wards in Perth, Western Australia.

Four hundred and twenty-five Aboriginal mothers of newborn infants.

At discharge, 89.4% of Aboriginal mothers were breast-feeding. Breast-feeding at discharge was most positively associated with perceived paternal support of breast-feeding, with an adjusted odds ratio (OR) of 6.65 (95% confidence interval (CI) 2.81–15.74), and with maternal age (OR 1.12, 95% CI 1.03–1.22), but negatively associated with parity and having delivered vaginally.

The factors independently associated with breast-feeding at discharge were similar to those previously identified for a group of non-Aboriginal Perth women, suggesting that separate breast-feeding interventions specially targeted at Aboriginal women are not warranted. The findings do, however, highlight the importance of including the father in the breast-feeding discussions.

To investigate the socio-economic and dietary factors associated with overweight and obesity, respectively, in southern France.

Cross-sectional analysis of socio-economic, lifestyle and nutritional characteristics of a representative population sample. A questionnaire elicited information on anthropometric measurements, socio-economic factors, physical activity, tobacco use, and alcohol and food intakes. Non-parametric tests, multiple linear regression models and correspondence factorial analysis (CFA) were used to estimate the association of the various factors with overweight and obesity.

French Southwest and Mediterranean areas.

In total, 1169 subjects (578 women and 552 men), aged 30–77 years, were recruited at random.

Overweight and obesity were associated with age and education in both genders, reproductive factors in women and tobacco use in men. A few dietary factors were identified (high energy intake and low intake of carbohydrates), but all these variables explained little of the variation (18.5% in women and 14.6% in men). The CFA further investigated the association of lifestyle and nutritional factors, giving more weight to nutritional behaviour for overweight men and women. Factors for obesity differed from those for overweight by being different in men and women, possibly related to psychological behaviour, and there were fewer of them, suggesting an insufficient coverage by the usual questionnaires.

Overweight and obesity appear as two different entities. Energy imbalance induced by various lifestyle factors plays a major role in the development of overweight, whereas obesity represents a more complex entity where psychological and genetic factors that are difficult to assess may be more important. General nutritional guidelines appear more adapted to the prevention of overweight than to that of obesity, and individual counselling to the prevention of obesity.

To evaluate the role of central adiposity, as evaluated by the measurement of waist circumference (WC), as an independent risk factor for hypertension and type 2 diabetes mellitus in the setting of a developing country.

Population-based, cross-sectional study.

A medium-sized town in southern Brazil.

One thousand and ninety-five non-pregnant women, 20 to 69 years old, recruited by cluster random sampling between 1999 and 2000. Their mean WC was 85.3 cm (standard deviation 13.9 cm) and 23.3% (n = 255) were obese (body mass index >30 kg m−2). The prevalence of hypertension and diabetes was 25.6% (n = 280) and 6.2% (n = 68), respectively.

The risks of hypertension and diabetes were directly related to WC measurement. Women with WC > 80 cm had increased risk of hypertension (odds ratio (OR) = 6.2, P < 0.001). The association remained significant (OR = 1.04 per cm increase in WC, P = 0.02) after adjusting for confounders. The effect of WC on diabetes was modified by age. The effect was stronger in women younger than 40 years old (OR = 12.7, P = 0.016) than in those over 40 years old (OR = 2.8, P = 0.013). In the multivariate analysis, the odds ratio was 5.7 (P = 0.12) in those under 40 years old and 2.8 (P = 0.008) in older women.

Waist circumference is an independent determinant for hypertension and diabetes in women in this population. The stronger association between WC and diabetes in younger women suggests that the validity of this indicator to assess abdominal adiposity is age-specific. Further studies should validate the usefulness of WC measurement in different age groups.

To examine differences in food habits among Native Americans with and without diabetes.

A cross-sectional epidemiological study in which participants underwent a physical examination and answered an extensive interviewer-administered questionnaire to assess differences in food servings, preparation and eating habits.

Participants aged ≥25 years were randomly selected from three reservations in Minnesota and Wisconsin. There were 990 persons without diabetes, 294 with a prior diagnosis of diabetes, and 80 with fasting glucose >125 mg dl−1 but no prior diabetes diagnosis.

Persons with prior diabetes diagnosis were less likely than those without diabetes to report eating fast-food meals two or more times per week, eat visible fat on meat or the skin on poultry, eat fried chicken or fried fish, to add fat to cooked vegetables and drink whole milk. Persons with previously undiagnosed diabetes were more likely than previously diagnosed persons to report eating fast-food meals two or more times per week, eat visible fat on meat and the skin on poultry, drink whole milk and eat fried fish, but were less likely to drink low-fat milk. Previously undiagnosed persons were more likely than either diagnosed persons or persons without diabetes to consume lard from cooked foods and use it when cooking.

Persons with diagnosed diabetes showed healthier eating patterns than those without diabetes, while undiagnosed persons showed some less favourable patterns. Because virtually all persons with diabetes in these communities receive nutrition education, the results suggest that nutrition education programmes for diabetics may be associated with healthier eating patterns.

It is debated whether the intake of added sugar displaces micronutrient-rich foods and dilutes the nutrient density of the diet, and whether there is a link between sugar and the increased rate of obesity. The objectives of this study were to examine the effect of added sugar on the intakes of energy, micronutrients, fruit and vegetables, and to examine the association between intake of added sugar and age, sex, body mass index, physical activity, inactivity and parents' education.

Participants recorded their food intake in pre-coded food diaries for 4 days and filled in a questionnaire about physical activity, watching television (TV)/using a personal computer (PC) and parents' education.

Three hundred and ninety-one 4-year-olds, 810 students in the 4th grade (9 years old) and 1005 in the 8th grade (13 years old) were included in the study.

The intakes of all nutrients, except α-tocopherol among 4-year-olds and vitamin C among 4-year-olds and 4th graders, decreased with increasing content of added sugar in the diet. Moreover, high consumers of added sugar had a 30–40% lower intake of fruit and vegetables than did low consumers. A negative association was observed between consumption of added sugar and body mass index among girls in the 8th grade (P = 0.013), whereas a positive association was observed among 4-year-old boys (P = 0.055). Associations between physical activity, hours spent watching TV/using a PC, parents' education and the energy intake from added sugar varied in the different age groups.

This study showed a negative association between the intake of added sugar and intakes of micronutrients, fruit and vegetables. The negative association between sugar intake and intake of fruit and vegetables is important from a public health perspective, since one of the main health messages today is to increase current intake of fruit and vegetables.