To explore the relationship between family average income (FAI; an index of socio-economic status) and body mass index (BMI; a widely used, inexpensive indicator of weight status) above the healthy weight range in a region of Mainland China.

Population-based cross-sectional study, conducted between October 1999 and March 2000 on a sample of regular local residents aged 35 years or older who were selected by random cluster sampling.

Forty-five administrative villages selected from three urban districts and two rural counties of Nanjing municipality, Mainland China, with a regional population of 5.6 million.

In total, 29 340 subjects participated; 67.7% from urban and 32.3% from rural areas; 49.8% male and 50.2% female. The response rate among eligible participants was 90.1%.

The proportion of participants classified as overweight was 30.5%, while 7.8% were identified as obese. After adjusting for possible confounding variables (age, gender, area of residence, educational level, occupational and leisure-time physical activity, daily vegetable consumption and frequency of red meat intake), urban participants were more likely to be overweight or obese relative to their rural counterparts, more women than men were obese, and participants in the lowest FAI tertile were the least likely to be above the healthy weight range.

The proportion of adults with BMI above the healthy weight range was positively related to having a higher socio-economic status (indexed by FAI) in a regional Chinese population.

To evaluate the efficacy of a community-based dietary intervention to reduce risk of micronutrient inadequacies in high-phytate maize-based Malawian diets.

Quasi-experimental post-test design with a non-equivalent control group.

Four villages in Mangochi District, Southern Malawi.

Households with children aged 3–7 years in two intervention (n = 200) and two control (n = 81) villages participated in a 6-month intervention employing dietary diversification, changes in food selection patterns, and modifications to food processing to reduce the phytate content of maize-based diets. Baseline comparability between the groups was confirmed via assessment of sociodemographic characteristics, anthropometry, knowledge and practices, morbidity, haemoglobin and hair zinc. After 12 months, knowledge and practices and dietary intakes were assessed by interactive 24-hour recalls, one during the food plenty and a second during the food shortage season. Nutrient adequacy for the two groups was compared via dietary quality indicators and predicted prevalence of inadequate intakes using the probability approach.

Intervention children had diets that were significantly more diverse and of a higher quality than those of controls. Median daily intakes of protein, calcium, zinc (total and available), haem iron, vitamin B12 and animal foods (grams; % of total energy) were higher (P<0.05) whereas phytate intakes, phytate/zinc and phytate/iron molar ratios were lower (P<0.01) in the intervention group; some spread of knowledge and practices to controls occurred.

Our community-based dietary strategies reduced the predicted prevalence of inadequate intakes of protein, calcium, zinc and vitamin B12, but not iron, in children from Malawian households with very limited resources.

To develop a food-frequency questionnaire (FFQ) useful for ranking of nutrient intakes.

Subjects consuming their regular diet completed 7 days of weighed intake registry (7-WIR). Foods for the FFQ were selected by stepwise multiple regression. The FFQ was then completed for each subject using data on individual food consumption from the 7-WIR. The correlation and agreement between the extrapolated FFQ and the 7-WIR data were assessed using Spearman's rank correlation coefficients (rS) and Bland and Altman's limits of agreement (LOA).

Bucaramanga, Colombia.

We studied 97 randomly selected 20–40-year-old subjects.

Sixty foods were selected for the FFQ. The 7-WIR and the extrapolated FFQ intake estimates correlated well. rS was 0.58 for energy, 0.53 for carbohydrate, 0.50 for total fat, and 0.48 for protein. For micronutrients, rS varied from 0.46 (manganese) to 0.71 (vitamin B12). FFQ average intake estimates were 83%, 80%, 86.2% and 86.4% of 7-WIR estimates for energy, carbohydrate, total fat and protein, respectively. LOA for these nutrients ranged between 45% and 165%. FFQ micronutrient intakes were on average 96% (median) of those from the 7-WIR, and the median lower and upper LOA were 50% and 203%. However, there was no indication that the degree of agreement varied with the level of intake.

According to our simulated validation, this FFQ may be useful to rank subjects by nutrient intake. Its validity against standard independent measurements and its applicability to other subsets of the Colombian population should be carefully considered.

To examine and analyse consumption changes over time of 24 food items between Sardinia and Malta.

The data were collected in 2001 in Sardinia and 2002 in Malta.

A structured qualitative questionnaire, articulated around four main themes: food supply, transformation, preparation and consumption habits, was administered by face-to-face interviews with the help of a local person. It encompassed mainly open-ended questions, which allowed us to measure factors contributing to change.

Thirty mother–daughter pairs were interviewed in each insular territory.

Despite a common trend revealing a shift away from cereals, pulses and potatoes to the benefit of meat products, fats and sugar, our results showed contrasting evolutions in food consumption between both insular societies. Fruit and vegetables, olive oil and fish, which are part of the main features of the Mediterranean diet, were among the top foods for which consumption frequency has increased in Sardinia. In Malta, besides an increase in olive oil and vegetable consumption, cheeses and desserts showed the highest increase. Along with modernity and improved living conditions, enhanced commercial availability and increased diversity of food preparation were also identified as factors contributing to food consumption changes.

Although the Sardo-Mediterranean model is evolving under the impact of modernisation, it is not disappearing. In Malta, however, modernity has led to a more sudden shift from a state of food shortage to one of affluence, but in a cultural context where the identity is no longer Mediterranean but Anglo-Saxon.

To assess the dietary habits of Balearic Islands' consumers who are successful in meeting current nutritional recommendations, to find clues for the development of future food-based dietary guidelines (FBDG) that would be relevant to this population.

Cross-sectional nutritional survey carried out in the Balearic Islands between 1999 and 2000.

Dietary habits were assessed by means of 24-hour recall (two non-consecutive days: warm and cold season) and a food-frequency questionnaire in a random sample (n = 1200, aged 16–65 years) living in private households. Differences in percentage of compliers with the intermediate nutritional objectives for the Spanish population and differences in food consumption patterns between genders and between high (above the upper quartile of intake) and low (below the lower quartile of intake) consumers of fat, saturated fatty acids (SFA), fibre, and fruit and vegetables were analysed.

Gender differences were observed in nutrient and energy intakes, as well as in attainment of the recommendations. Less than 25% of the population reached the intermediate nutritional recommendations for iodine, fruit, carbohydrates, SFA, fibre and vegetables. Low fat/SFA and high fruit and vegetables/fibre consumers kept a diet in line with the traditional Balearic diet and prevailing dietary pyramids, which ensured better compliance with the nutritional goals.

The intermediate nutritional objectives for the Spanish population could be achieved through maintenance of the traditional Balearic diet, a Mediterranean-type diet in the Balearic population. Therefore, this dietary model could be used to develop FBDG relevant to this population.

Agriculture designed to make best use of landscape and to be maximally sustainable would also provide food of the highest nutritional and gastronomic standards, and would inevitably employ a great many people. Thus it would solve the world's food problems, and its principal social problem, at a stroke. But agriculture in practice is designed for a quite different purpose – to generate wealth, in the cause of ‘economic growth’. The pressing need is not for more science and technology, but to recognise the true cause of the problems and to re-think priorities.

We could all be well fed. Indeed, everyone in the world who is ever likely to be born could be fed to the highest standards of gastronomy as well as of nutrition until humanity itself comes to an end. We already have most of the necessary technique – perhaps all that is needed. We could always do with more excellent science but we need not depend, as we are often told from on high, on the next technological fix. The methods that can provide excellent food would also create a beautiful environment, with plenty of scope for other creatures, and agreeable and stable agrarian economies with satisfying jobs for all.

In reality, in absolute contrast, we have created a world in which almost a billion are chronically undernourished; another billion are horribly overnourished, so that obesity and diabetes are epidemic, and rising; a billion live on less than two dollars a day; and a billion live in urban slums – a figure set to increase and probably at least to double over the next half century; while other species are disappearing so fast that biologists speak of mass extinction.

To determine the prevalence of stunting, wasting and overweight and their determinants in 3-year-old children in the Central Region of Limpopo Province, South Africa.

Prospective cohort study.

Rural villages in the Central Region of the Limpopo Province, South Africa.

One hundred and sixty-two children who were followed from birth were included in the study. Anthropometric measurements and sociodemographic characteristics of the children were recorded.

Height-for-age Z-scores were low, with a high prevalence of stunting (48%). The children also exhibited a high prevalence of overweight (22%) and obesity (24%). Thirty-one (19%) children were both stunted and overweight. Gaining more weight within the first year of life increased the risk of being overweight at 3 years by 2.39 times (95% confidence interval (CI) 1.96–4.18) while having a greater length at 1 year was protective against stunting (odds ratio (OR) 0.41; 95% CI 0.17–0.97). Having a mother as a student increased the risk for stunting at 3 years by 18.21 times (95% CI 9.46–34.74) while having a working mother increased the risk for overweight by 17.87 times (95% CI 8.24–38.78). All these factors also appeared as risks or as being protective in children who were both overweight and stunted, as did living in a household having nine or more persons (OR 5.72; 95% CI 2.7–12.10).

The results of this study highlight the importance of evaluating anthropometric status in terms of both stunting and overweight. Furthermore, it is important to realise the importance of normal length and weight being attained at 1 year of age, since these in turn predict nutritional status at 3 years of age.

To estimate the burden of disease due to selected nutrition-related risk factors (high total blood cholesterol, high systolic blood pressure, high body mass index (BMI) and inadequate vegetable and fruit intake) in 1997, as well as the burden that could potentially be avoided in 2011 if small, favourable changes in the current risk factor distribution were to occur.

Data on risk factor levels, disease burden and risk associations were combined using comparative risk assessment methodology, a systematic approach to estimating both attributable and avoidable burden of disease. Disease outcomes assessed varied according to risk factor and included ischaemic heart disease, stroke, type 2 diabetes mellitus and selected cancers.

New Zealand.

Approximately 4500 deaths (17% of all deaths) in 1997 were attributable to high cholesterol, 3500 (13%) to high blood pressure, 3000 (11%) to high BMI and 1500 (6%) to inadequate vegetable and fruit intake. Taking prevalence overlap into account, these risk factors were estimated jointly to contribute to approximately 11 000 (40%) deaths annually in New Zealand. Approximately 300 deaths due to each risk factor could potentially be avoided in 2011 if modest changes were made to each risk factor distribution.

High cholesterol, blood pressure and BMI, as well as inadequate vegetable and fruit intake, are major modifiable causes of death in New Zealand. Small changes in the population distribution of these risk factors could have a major impact on population health within a decade.

The aims of the study were to provide information that will contribute to conceptualising what is called ‘dietary Westernisation’, and to provide an example of measuring it on an individual level.

Food consumption frequency and demographic data on adults in Mauritius were examined in 1988, 1992 and 1998. In 1992, a 24-hour recall was also included. The cross-sectional samples consisted of 1115 (age 25–74 years) Mauritians in 1987/88, 1917 (age 30–74 years) in 1992 and 2239 (age 20–74 years) in 1998. Principal components analysis was carried out on daily consumption frequencies of 10 indicator foods (white rice, white bakery bread, pulses, processed meat, poultry, fresh/frozen fish, butter, margarine, whole milk and skimmed/low-fat milk). Correlations between dietary patterns and selected food consumption frequencies were examined in each survey year.

Four dietary patterns were identified as being related to dietary Westernisation. The Traditional dietary pattern was characterised by higher consumption frequencies of Indian breads, salted/smoked fish and sugar-sweetened tea. The Western dietary pattern was characterised by higher consumption frequencies of cakes/pastries, meat and many Western fast foods like burgers, but, surprisingly, also by brown bread, breakfast cereals and salad. The Bread/butter dietary pattern predominantly described more frequent consumption of bread compared with rice. The Margarine/milk dietary pattern was inconsistently related with staple foods. Younger, educated and wealthier Mauritians appeared to adopt Western dietary patterns earlier.

This study suggests that relatively few indicator foods are needed for measuring dietary Westernisation. Dietary Westernisation in a non-Western country may also include shifts towards voluntary consumption of healthier foods.

To determine the prevalences of overweight, obesity, type 2 diabetes mellitus (DM) and hypertension (HT) in the Mexican population and compare them with those of a previous Mexican urban survey and an American survey.

A structured, randomised, nationally representative Mexican sample was compared with a 1993 Mexican urban survey and the US Third National Health and Nutrition Examination Survey (NHANES III) of non-Hispanic Whites.

The Mexican National Health Survey 2000.

Subjects were 12856 men and 28332 women, aged 20–69 years, who had their body weight, height, waist circumference (WC), blood pressure and fasting capillary blood glucose measured.

Mexican adult men and women had a high prevalence of overweight (41.3 and 36.3%, respectively) and obesity (19.4 and 29.0%, respectively), similar to those in the USA in 1988–1992 and exceeding those of the 1993 Mexican survey. The prevalence of HT was 33.3% in men and 25.6% in women, with inferred DM rates of 5.6 and 9.7%, respectively. Abdominal obesity affected 46.3% of men (WC ≥ 94 cm) and 81.4% of women (WC ≥ 80 cm). There was a high prevalence of abdominal obesity in normal-weight women, with co-morbidities relating better to WC than to body mass index (BMI) in both sexes. Rates of DM and HT exceeded US rates on a comparable BMI or WC basis in adults aged <50 years.

The high prevalence of obesity and abdominal obesity in Mexicans is associated with markedly increased prevalences of DM and HT to levels comparable with, or even higher than, those in NHANES III of non-Hispanic Whites.

To evaluate the current status of dietary intakes in early pubertal girls with a special focus on milk products.

Cross-sectional data using 3-day food records.

Eight hundred and sixty girls, aged 10–12 years, at Tanner maturation stage I-III.

The mean consumption of milk products (620 g day−1) was similar to that of a Finnish study in the 1980s, while the consumption of non-milk drinks (403 gday−1) had increased. Twelve per cent of the girls had a dairy-restricted diet and consumed significantly less milk products than girls with a non-restricted diet (465 vs. 644 g day−1, P<0.001). Girls with low milk product consumption had the highest non-milk drinks consumption (P<0.001). The mean energy intake was 7.1 MJ day−1. No major changes were found in the sources of nutrients. The shares of energy for nutrients were close to recommendations except for saturated fat (13.9 vs. 10% of energy) and carbohydrates (51.5 vs. 55–60% of energy). The mean calcium intake (1117 mg day−1) was above the recommendation, while the vitamin D intake (3.1 μg day−1) of 88% of the girls was below the recommendation.

The diet quality of early pubertal girls is close to the recommendations and has improved with respect to fat compared with the 1980s. Consumption of milk products is high although the consumption of non-milk drinks has increased. We found a subgroup of girls who compensate their low milk product consumption with a higher consumption of non-milk drinks. Following a dairy-restricted diet is the main reason for low consumption of milk products.

To focus on factors that play a major role in our rapid, global nutritional changes.

A range of studies are summarised: these show how an understanding of social, economic and technological change at the global, national and community levels affects diet, activity, and body composition patterns and trends. These studies are used to demonstrate the value of the key global, national, community, household and individual factors that should define the field of nutrition.

The focus is global.

Large shifts have occurred in diet and in physical activity patterns – particularly in the last one or two decades of the twentieth century. These changes are reflected in nutritional outcomes such as changes in average stature, body composition and morbidity. Understanding the rapidity of these changes and the underlying factors at the global, national and community levels is critical for creating a science of nutrition that can prevent disease and sustain the health and integrity of humans.

The vision of the nutrition field is one where scholars who work on many levels will intersect; equal weight in the nutrition profession will be provided to all dimensions as they are welcomed into the field of nutrition – particularly those that will directly or indirectly affect dietary patterns, physical activity patterns, and energetics. This vision of the nutrition field is one where scholars from a range of disciplines and perspectives meet to work together with the goal being a focus on improving nutritional status and the human condition.

To investigate the internal consistency of the scales and the test–retest reliability and predictive validity of behaviour theory-based constructs measuring personal, social and environmental correlates of fruit and vegetable intake in 10–11-year-old children.

Test–retest with one-week interval.

Five European countries: Norway, Spain, Denmark, Portugal, Belgium.

Three hundred and twenty-six children completed the questionnaire during class hours.

For the total sample across all countries, the test–retest reliability was good to very good (intra-class correlation coefficient (ICC) >0.60) for 12 out of the 15 fruit constructs and also for 12 out of the 15 vegetable constructs. Acceptable ICCs, ranging between 0.50 and 0.59, were found for the remaining constructs. Test–retest reliability was comparable across countries. Only in Portugal were some significantly lower ICCs found for some constructs (knowledge and barriers related to fruit, general self-efficacy related to fruit and vegetables) compared with the other countries. Cronbach's α values were moderate to high (range 0.52 to 0.89) with the exception of the general self-efficacy scale, which had a value below 0.50 for both fruit (α = 0.42) and vegetables (α = 0.49). Spearman correlations with intake ranged between -0.16 and 0.54 for personal determinants and between 0.05 and 0.38 for environmental determinants. Compared with other studies, predictive validity can be considered moderate to good.

The questionnaire provides a reliable, valid and easy-to-administer tool for assessing personal, social and environmental factors of potential influence on fruit and vegetable intake in 10–11-year-olds.

To investigate the effects on maternal micronutrient status and infant growth of the increased maize prices that resulted from the southern African drought of 2001–2002.

Longitudinal cohort study.

A maternal and child health clinic in Lusaka, Zambia.

Maternal and infant health and nutrition data and maternal plasma were being collected for a study of breast-feeding and postpartum health. Samples and data were analysed according to whether they were collected before (June to December 2001), during (January 2002 to April 2003) or after (May 2003 to January 2004) the period of increased maize price. Season and maternal HIV status were controlled for in analyses.

Maize price increases were associated with decreased maternal plasma vitamin A during pregnancy (P = 0.028) and vitamin E postpartum (P = 0.042), with the lowest values among samples collected after May 2003 (vitamin A: 0.96 μmol l−1, 95% confidence interval (CI) 0.84–1.09, n = 38; vitamin E: 30.8 μmol mmol−1 triglycerides, 95% CI 27.2–34.8, n = 64) compared with before January 2002 (vitamin A: 1.03 μmol l−1, 95% CI 0.93–1.12, n = 104; vitamin E: 38.9 μmol mmol−1 triglycerides, 95% CI 34.5–43.8, n = 47). There were no significant effects of sampling date on maternal weight, haemoglobin or acute-phase proteins and only marginal effects on infant weight. Infant length at 6 and 16 weeks of age decreased progressively throughout the study (P-values for time of data collection were 0.51 at birth, 0.051 at 6 weeks and 0.026 at 16 weeks).

The results show modest effects of the maize price increases on maternal micronutrient status. The most serious consequence of the price increases is likely to be the increased stunting among infants whose mothers experienced high maize prices while pregnant. During periods of food shortages it might be advisable to provide micronutrient supplements even to those who are less food-insecure.

Random errors, from any source, will attenuate epidemiological risk estimates. Before we launched the Shanghai Men's Health Study (SMHS), a large population-based cohort study investigating the diet–cancer association among Chinese men, a dietary calibration study was conducted among 96 men aged 40–75 years (mean age 56.5 years), with biweekly 24-hour dietary recalls (24HDRs) implemented over a 1-year period. Data from this study were analysed to evaluate the nature and magnitude of variances for intake of 26 nutrients among SMHS participants, to compare variance ratios of 26 nutrients among Chinese men and women and individuals in other studies, and to estimate the number of 24HDRs required for future dietary calibration studies in similar populations.

Ninety-six healthy, free-living men in Shanghai were administered biweekly 24HDR interviews 24 times over a 1-year period. To assess between-individual and within-individual contributions to variance, a mixed effects model was fitted and ratios of within-individual to between-individual dietary intake variances were computed.

Shanghai, China.

In agreement with reports from studies conducted in the USA and many other countries, we found that within-individual variances were usually larger than between-individual variances in dietary intake for all nutrients. The sum of all other variation (e.g. weekday and weekend, seasonal, interviewer) accounted for less than 5% of total variation. Ratios of within- to between-individual variances (for log-transformed data) ranged from 1.25 for carbohydrate intake to near 8 for δ-tocopherol intake.

The results of this study suggest that among middle-aged and elderly Chinese men in Shanghai, within- and between-individual variation account for more than 95% of the total variation for 26 nutrients. Further dietary validation studies in the same population could be adequately carried out with only 12 days of dietary recalls, if 100 participants were enrolled.

The insulin-like growth factor (IGF) system is implicated in the pathogenesis of diabetes and cardiovascular disease.

We report the effects of total energy intake on the IGF system in two populations with markedly different dietary macronutrient intake and cardiovascular event rate.

Dietary macronutrient intake was measured in a specific Gujarati migrant community in Sandwell, UK (n = 205) compared with people still resident in the same villages of origin in India (n = 246). Fasting IGF-I, IGF-binding protein (IGFBP)-1 and IGFBP-3, insulin and glucose (0 and 2-hour) were measured.

Total energy and total fat intake were higher in UK migrants, as were IGFBP-3 and IGF-I (mean (95% confidence interval): 145.9 (138.1–153.6) vs. 100.9 (94.6–107.3) ng ml-1; F = 76.6, P < 0.001). IGFBP-1 was lower in UK migrants (29.5 (25.9–33.0) vs. 56.5 (50.6–62.5) μg l-1; F = 48.4, P < 0.001). At both sites, IGF-I correlated positively with total energy (Spearman's ρ = 0.45, P < 0.001) and total fat (ρ = 0.44, P < 0.001) as did IGFBP-3 with total energy (ρ = 0.21, P < 0.05) and fat (ρ = 0.26, P < 0.001). Conversely, in Indian Gujaratis, IGFBP-1 fell with increasing total energy (ρ = -0.27, P < 0.001) and fat intake (ρ = -0.26, P < 0.01) but not in UK Gujaratis. Multiple linear regression modelling showed that increasing quartiles of fat intake were associated with higher IGF-I (β = 0.42, P = 0.007) independent of age, body mass index, plasma insulin, fatty acids and 2-hour glucose.

In these genetically similar groups, migration to the UK and adoption of a different diet is associated with marked changes in the IGF system, suggesting that environmental factors profoundly modulate serum concentrations and actions of IGFs.

To estimate the burden of mortality in New Zealand due to higher-than-optimal body mass index (BMI) in 1997, as well as mortality that could be avoided in 2011 with feasible changes in mean population BMI.

New Zealand.

Comparative risk assessment methodology was used to estimate the attributable and avoidable mortality due to high BMI. Outcomes assessed were ischaemic heart disease (IHD), ischaemic stroke, type 2 diabetes mellitus, colorectal cancer and postmenopausal breast cancer.

In 1997, 3154 deaths (11% of all deaths) in New Zealand were due to higher-than-optimal BMI (<21 kg m−2). This amounted to 83% of diabetes deaths, 24% of IHD deaths, 15% of ischaemic stroke deaths and 4% of all cancer deaths. If the projected increase in mean population BMI by 2011 was limited to 1.0 kg m−2 rather than 1.3 kg m−2, approximately 385 deaths could be prevented annually, mainly from diabetes.

These results quantify the importance of higher-than-optimal BMI as a major modifiable cause of premature death in New Zealand. Intervention policies that would have only modest effects on slowing the rate of increase in mean population BMI by 2011 could still prevent hundreds of deaths annually.

We sought to validate questionnaires concerning body image perception, body size dissatisfaction and weight-related beliefs in multi-ethnic South African mothers and their daughters.

Settings and subjects: Girls attending primary school (ages 9–12 years, n = 333) and their mothers (n = 204) were interviewed regarding their demographics and body image. Weight, height and skinfold thicknesses were measured. Body image questions and body mass index (BMI) were compared with silhouettes adapted from the Pathways Study for girls and Stunkard's body image figures for mothers. A Feel–Ideal Difference (FID) index score was created by subtracting the score of the silhouette selected by the participants as ‘Ideal’ from the one selected as most closely representing their current appearance or ‘Feel’. We hypothesised that a higher FID index score would be associated with greater body size dissatisfaction.

BMI percentiles in girls (r = 0.46, P < 0.05) and BMI in mothers (r = 0.68, P < 0.05) were positively correlated with the selected silhouettes based on size. Participants who reported feelings of being ‘fat’ and those who perceived that their family and friends were more dissatisfied with their body size had significantly higher FID index scores. Scores were lower in black than white girls (all P < 0.05). No differences were found in FID index scores between ethnic groups of mothers. Internal reliability of the ‘thin’ and ‘fat’ belief constructs for girls was demonstrated by standardised Cronbach's α values ≥0.7.

Silhouettes, FID index, ‘fat’ and ‘thin’ belief constructs (in girls) are age-appropriate, culturally sensitive and can be used in further intervention studies to understand body image.