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Potential error sources in nutrient estimation with the FFQ include inaccurate or biased recall and overestimation or underestimation of intake due to too many or too few items on the FFQ, respectively. Here we report the refinement of an FFQ that overestimated nutrient intake and its validation against multiple 24 h recalls.
Data on 2527 participants in south India (Trivandrum) were available for the original FFQ (OFFQ) that overestimated nutrient intake (132 food items). After excluding participants with implausible energy intake estimates (<2·72 MJ/d (<650 kcal/d), >15·69 MJ/d (>3750 kcal/d)) we ran stepwise regression analyses with selected nutrients as the outcomes and food intake (servings/d) as predictor variables (n 1867). From these results and expert consultation we refined the FFQ (RFFQ), and validated it by comparing intakes obtained with it and the mean of two 24 h recalls among 100 participants.
The OFFQ overestimated usual daily nutrient intake before and after exclusions [for energy: 13·39 (sd 5·46) MJ (3201 (sd 1305) kcal) and 10·96 (sd 2·65) MJ (2619 (sd 634) kcal), respectively]. In stepwise analyses, fifty-seven food items explained 90 % of the variance in nutrients; we retained thirteen food items because participants consumed them at least twice monthly and twelve food items that local nutritionists recommended. Mean energy intake estimated from the RFFQ (eighty-two food items) was 7·94 (sd 2·05) MJ (1897 (sd 489) kcal). The de-attenuated correlations between mean 24 h recall and RFFQ intakes ranged from 0·25 (vitamin A) to 0·82 (fat).
We refined an FFQ that overestimated nutrient intake by shortening and redesigning, and validated it by comparisons with 24 h dietary recall data.
Several aspects of the diet characteristic of the Mediterranean countries are considered favourable not only on cardiovascular disease, but also on cancer risk. We considered some aspects of the Mediterranean diet (including, in particular, the consumption of olive oil and carbohydrates) on cancer risk.
Design, Setting and Subjects
Data were derived from a series of case-control studies, conducted in Italy since the early 1990s, on over 10 000 cases of thirteen cancer sites and over 17 000 controls.
Olive oil, and other mono- and unsaturated fats, appear to be favourable indicators of breast, ovarian, colorectal, but mostly of upper aero-digestive tract cancers. Whole grain foods are also related to reduced risk of upper aero-digestive tract and various other cancers. In contrast, refined grain intake and, consequently, glycaemic index and glycaemic load were associated to increased risk for several cancer sites. Fish, and hence a diet rich in n-3 polyunsaturated fatty acids, tended to be another favourable diet indicator, while frequent red meat intake was directly related to some common neoplasms. An a priori defined Mediterranean diet score was inversely related to upper digestive and respiratory tract cancers.
These data provide additional evidence that major characteristics of the Mediterranean diet favourably affect cancer risk.
The present paper aims at describing the current status of nutrition policy
in the WHO European Region and to discuss the implications for public
health. The stages of policy development in the Region are illustrated and
achievements in specific aspects of food and nutrition policy are
The analysis is based on a WHO survey on nutrition policies in the WHO
European Region in 2005 with information from forty-eight out of fifty-three
countries in the Region. Based on the findings, countries were categorized
according to their stage in policy development. Additionally, fifty policy
documents related to nutrition and published by a national body were
analysed according to certain criteria of food and nutrition policy.
Most Member States (n 46) have available a
policy document related to nutrition and forty have a mechanism to implement
it. Collaboration between sectors is taking place in thirty-one countries.
Implementation tools, such as food-based dietary guidelines and monitoring
and surveillance systems, are in place in twenty-seven countries. The
analysis of policy documents revealed that actions addressing the individual
with information or education are well developed. Actions addressing
environmental determinants, such as food availability, affordability and
accessibility, are indicated in only a few policies.
Food and nutrition policies appear to have developed successfully in the past
decade. However, implementation of the policies seems to be a major
challenge due to lack of funds, political commitment and coordination. More
support should be given to the implementation and evaluation of policies and
a shift towards stronger environmental approaches is needed.