To evaluate the feasibility of diet mediterranisation, in a food-at-work context, and its consequence on metabolic syndrome in a mid-age unselected healthy male population group.

One-year longitudinal intervention study. Physical exercise was not modified.

All workers of the Santiago division of ‘Maestranza Diesel’, a metal-mechanic company servicing the mining industry, were invited to participate.

Initially, 145 workers of a total of 171, of average age 39 years, accepted to participate (sixteen women and 129 men). A subgroup of ninety-six men fully completed the controls programmed for the intervention study. Losses from the original group correspond to missing one control (sixteen), leaving the company (eleven) or blood sampling discomfort (six). The women and sixteen male workers, hired post study initiation, did participate but were excluded from this 12-month analysis.

Diet mediterranisation was successful, reflected in the daily food consumption at the canteen and the evolution of the Mediterranean diet score (MDS) from 4·8 ± 1·4 to 7·4 ± 1·5 (limits 0–14). Some metabolic syndrome components showed statistically significant improvement and also statistically significant correlation with the MDS: waist circumference, HDL-cholesterol, systolic and diastolic blood pressure. After 12 months, the reversion rate for metabolic syndrome was 48 % (12/23) with an incidence rate of 4·1 % for new cases (3/73). In total, metabolic syndrome decreased from 24·0 % to 15·6 % (23/96 to 15/96) (P = 0·029).

Diet mediterranisation is feasible in a food-at-work intervention, affecting lunch consumption at the workers canteen and overall consumption evaluated with MDS, together with a significant reduction in metabolic syndrome.

To investigate nutritional status and related living conditions among drug addicts in Oslo.

A cross-sectional study of nutritional status evaluated by anthropometric and biochemical measurements; a structured interview concerning education, living conditions, income source, drug history and sex practice; and biochemical testing of sexually transmitted infections.

The present study was conducted between November 2001 and April 2003 in locations where the drug addicts reside in Oslo.

A total of 123 male and seventy-two female addicts using drugs by injections regularly.

We found that 20 % of the women were moderately underweight (BMI in kg/m2) (16·5 < BMI < 18·5), 7 % were severely underweight (BMI ≤ 16·5) and 3 % of the men were moderately underweight (16·5 < BMI < 18·5). BMI was positively correlated with days institutionalised and number of eating events per day. Respondents sleeping rough had significantly reduced BMI compared to those in hostels and shelters. The concentrations of Hb, serum ferritin and albumin supported a higher prevalence of malnutrition among the women. Hepatitis C was found in 85 %, active hepatitis B in 6 % and less than 2 % were HIV positive. Also, 84 % received public financial support, 38 % of the women had prostitution as a significant income source, while burglary was most prevalent among the men; 20 % were pushing drugs.

Malnutrition among the drug addicts varied from 5 % to 30 %, independent of drug history, education and income. Moderate and severe underweight was most prevalent among the women. Being previously institutionalised and having increased number of eating events increased BMI. Sleeping rough correlated with reduced body weight. Hepatitis C infection was common; hepatitis B and HIV were rare.

To determine the effectiveness of a redesigned Fe supplementation delivery system (ISDS) in improving Hb concentrations and compliance among pregnant women.

A controlled before and after study design was used. Interviews and Hb measurements of randomly selected pregnant women in both treatment areas were conducted at baseline and after 6 months. The redesigned ISDS, reached by consensus based on the surveys and focus group discussions, involved the health workers in spot mapping and clustering; Fe tablets’ distribution, monitoring and promotion; and counselling of pregnant women.

Negros Occidental and Negros Oriental, Philippines.

In total, 1180 pregnant women given Fe/folic acid tablets daily through the redesigned ISDS in the experimental areas and the existing ISDS in the control areas.

There were significantly more anaemic pregnant women in the experimental than in the control area at baseline (50·7 v. 37·3 %; P = 0·001). However, at endline, the anaemia prevalence rate in the experimental area was comparable to that of the control (35·6 v. 33·1 %; P = 0·530). Also, the mean Hb concentration increased significantly in the experimental area by 0·5 g/dl (P = 0·002). An increase in the actual number of prenatal visits/trimester in the experimental area was observed (from 0·99 to 1·66; P < 0·0001). Pregnant women in the experimental area were four times more likely to take Fe tablets (OR = 3·79; P < 0·001) and sixteen times more likely to being monitored for Fe intake (OR = 16·86; P < 0·001) compared to the control.

The redesigned ISDS was effective in improving the Hb concentration and health-related behaviour of pregnant women.

To determine whether an educational programme aimed at discouraging students from drinking sugar-sweetened beverages could prevent excessive weight gain.

Forty-seven classes in twenty-two schools were randomised as intervention or control.

Participants were 1140, 9–12-year-old fourth graders (435 in the intervention group and 608 in the control group). Sugar-sweetened beverages and juice intake were measured through one 24 h recall at baseline and another at the end of the trial. The main outcome was the change in BMI (BMI = weight (kg)/height (m2)), measured at the beginning and at the end of the school year. Intention-to-treat analysis was performed taking into account the cluster (classes) effect.

A statistically significant decrease in the daily consumption of carbonated drinks in the intervention compared to control (mean difference = −56 ml; 95 % CI −119, −7 ml) was followed by a non-significant overall reduction in BMI, P = 0·33. However, among those students overweight at baseline, the intervention group showed greater BMI reduction (−0·4 kg/m2 compared with −0·2 kg/m2 in the control group (P = 0·11)), and this difference was statistically significant among girls (P = 0·009). Fruit juice consumption was slightly increased in the intervention group (P = 0·08), but not among girls.

Decreasing sugar-sweetened beverages intake significantly reduced BMI among overweight children, and mainly among girls. Efforts to reduce energy intake through liquids need to emphasise overall sweetened beverages and addition of sugar on juices.

Effective nutrition labels are part of a supportive environment that encourages healthier food choices. The present study examined the use, understanding and preferences regarding nutrition labels among ethnically diverse shoppers in New Zealand.

A survey was carried out at twenty-five supermarkets in Auckland, New Zealand, between February and April 2007. Recruitment was stratified by ethnicity. Questions assessed nutrition label use, understanding of the mandatory Nutrition Information Panel (NIP), and preference for and understanding of four nutrition label formats: multiple traffic light (MTL), simple traffic light (STL), NIP and percentage of daily intake (%DI).

In total 1525 shoppers completed the survey: 401 Maori, 347 Pacific, 372 Asian and 395 New Zealand European and Other ethnicities (ten did not state ethnicity).

Reported use of nutrition labels (always, regularly, sometimes) ranged from 66 % to 87 % by ethnicity. There was little difference in ability to obtain information from the NIP according to ethnicity or income. However, there were marked ethnic differences in ability to use the NIP to determine if a food was healthy, with lesser differences by income. Of the four label formats tested, STL and MTL labels were best understood across all ethnic and income groups, and MTL labels were most frequently preferred.

There are clear ethnic and income disparities in ability to use the current mandatory food labels in New Zealand (NIP) to determine if foods are healthy. Conversely, MTL and STL label formats demonstrated high levels of understanding and acceptance across ethnic and income groups.

To assess consumer understanding of fruit and vegetable serving sizes.

The Western Australian Health Department launched the Go for 2&5® campaign to promote fruit and vegetables in March 2002. The Health & Wellbeing Surveillance System surveyed 1108 adults, aged 16 years and over, between September and November 2002 about what constituted a serving of fruit and of vegetables, their usual daily fruit and vegetables intake, and their recall of the campaign.

The study was undertaken as a part of a public health intervention – social marketing campaign in Western Australia, which had a population of 1 927 000 in 2002.

Forty-two per cent of respondents knew that the fruit serving size was one piece and only 14·5 % reported the ½ cup vegetable serving size. The mean fruit intake was 1·8 (95 % CI 1·7, 1·8) servings/d and the mean vegetable intake was 2·8 (95 % CI 2·7, 3·0) servings/d. Vegetable intake was associated with being female (P = 0·006), increasing age (P < 0·0001), awareness of the campaign (P = 0·031) and knowledge of standard serving size (P = 0·006). Fruit consumption was associated with being female (P = 0·007). Fruit and vegetable intakes were not associated with educational attainment or household income.

The Go for 2&5® campaign uses a prescriptive message to promote increased consumption of fruit and vegetables. Respondent’s knowledge of the standard of serving sizes for fruit and vegetables suggests there is value in separating fruit and vegetable recommendations in messages to encourage increased consumption.

To assess the association of indicators of general and abdominal obesity with the prevalence of type 2 diabetes (T2DM) and intermediate hyperglycaemia (IHG) in the Chinese population.

We used data of 50 905 adults aged 18–79 years in the 2002 China National Nutrition and Health Survey. Recommended Chinese cut-off values were used for BMI (24 kg/m2) and waist circumference (WC; 85 cm in men, 80 cm in women). Optimal cut-offs for waist:height ratio (WHtR) were determined from analyses of receiver-operating characteristic (ROC) curves.

The prevalence of T2DM and IHG was 2·6 % and 1·9 % respectively. ROC curve analyses indicated 0·5 as the optimal cut-off value for WHtR in both sexes. High BMI, WC and WHtR were all associated with the prevalence of glucose tolerance abnormalities, with the highest prevalence ratio (PR) for high WHtR (men: PR = 2·85, 95 % CI 2·54, 3·21; women: PR = 3·10, 95 % CI 2·74, 3·51). When combining BMI and WHtR, in men either a high BMI or a high WHtR alone was associated with increased risk. Among women, a high BMI without a concomitant high WHtR was not associated with increased glucose tolerance abnormalities risk, whereas a high WHtR was associated with risk irrespective of BMI.

Among the Chinese adult population measures of central obesity are better predictors of glucose tolerance abnormalities prevalence than BMI. A WHtR cut-off point of 0·5 for both men and women can be considered as optimum for predicting (pre-) diabetes and may be a useful tool for screening and health education.

To investigate the relative efficacy of four popular weight-loss programmes on plasma lipids and lipoproteins as measures of CVD risk.

A multi-centred, randomised, controlled trial of four diets – Dr Atkins’ New Diet Revolution, The Slim-Fast Plan, Weight Watchers Pure Points programme and Rosemary Conley’s ‘Eat yourself Slim’ Diet and Fitness Plan – against a control diet, in parallel for 6 months.

The trial was conducted at five universities across the UK (Surrey, Nottingham, Ulster (Coleraine), Bristol and Edinburgh (Queen Margaret University College)) and involved the participation of 300 overweight and obese males and females aged 21–60 years in a community setting.

Significant weight loss was achieved by all dieting groups (5–9 kg at 6 months) but no significant difference was observed between diets at 6 months. The Weight Watchers and Rosemary Conley (low-fat) diets were followed by significant reductions in plasma LDL cholesterol (both −12·2 % after 6 months, P < 0·01), whereas the Atkins (low-carbohydrate) and Weight Watchers diets were followed by marked reductions in plasma TAG (–38·2 % and –22·6 % at 6 months respectively, P < 0·01). These latter two diets were associated with an increase in LDL particle size, a change that has been linked to reduced CVD risk.

Overall, these results demonstrate the favourable effects of weight loss on lipid-mediated CVD risk factors that can be achieved through commercially available weight-loss programmes. No detrimental effects on lipid-based CVD risk factors were observed in participants consuming a low-carbohydrate diet.

To assess whether overweight Asians, assessed on the basis of WHO criteria, are at greater mortality risk than overweight Caucasians, and to determine whether alternative cut-off points (BMI = 23·0–24·9 kg/m2 for overweight and BMI ≥ 25·0 kg/m2 for obesity) suggested by the WHO Western Pacific Regional Office are appropriate.

The cohort was followed prospectively until the end of 2001. All-cause and CVD mortality risks of the overweight and obese group, relative to the reference group (BMI = 18·5–24·9 or 18·5–22·9 kg/m2), were assessed using Cox regression analysis, adjusting for age, smoking and gender. Excess deaths were estimated with a method proposed by the US Centers for Disease Control and Prevention.

National Health Interview Survey (NHIS 2001) and a middle-aged perspective cohort in Taiwan.

Subjects comprised 36 386 civil servants and school teachers, aged 40 years and older, who underwent a medical examination during 1989–1992.

In the WHO-defined overweight group, Asians showed a significant increase in all-cause mortality risk compared with Caucasians. Asians showed risks equivalent to Caucasians’ at lower BMI (around 5 units). Every unit of BMI increase, at 25·0 kg/m2 or above, was associated with a 9 % increase in relative mortality risk from all causes. Applying a cut-off point of 25·0 kg/m2 for obesity would result a prevalence of 27·1 %, while the traditional WHO cut-off point of 30·0 kg/m2 yielded obesity prevalence of 4·1 %. Excess deaths due to obesity accounted for 8·6 % of all deaths and 21·1 % of CVD deaths, based on the alternative cut-offs.

In this Asian population, significant mortality risks started at BMI ≥ 25·0 kg/m2, rather than at BMI ≥ 30·0 kg/m2. The study supports the use of BMI ≥ 25·0 kg/m2 as a new cut-off point for obesity and BMI = 23·0–24·9 kg/m2 for overweight. The magnitude of obesity-attributable deaths has been hitherto under-appreciated among Asians.

Chewing betel-nuts (Areca catechu) is carcinogenic but the risk for hepatocellular carcinoma (HCC) and liver cirrhosis (LC) is little considered. Worldwide 600 million people chew betel, including emigrants from palm-growing countries.

We aimed to assess the relationships and dose–response effects of betel chewing on LC and HCC risks, since habit cessation could reduce the increased risks of HCC and LC found in such communities.

Screening 60 326 subjects aged 30–79 years in a population-based study in Taiwan identified LC in 588 and HCC in 131 subjects. Demographic features, hepatitis B/C infections, other risk factors and betel chewing were noted. Multiple Cox regression models were used to assess independent relationships, interactions and synergisms between age, betel chewing and hepatitis B/C.

Betel chewing increased LC and HCC risk 4·25-fold (95 % CI 2·9, 6·2) in current chewers and 1·89-fold (95 % CI 1·13, 3·16) in ex-chewers v. never-chewers, with dose effects for quantity, duration and cumulative exposure in chewers. Subjects without hepatitis B/C infections had 5·0-fold (95 % CI 2·87, 9·03) increased risk of LC/HCC v. never-chewers, and betel chewing had an additive synergistic effect on hepatitis B/C-related risks. Risk reduction with betel habit cessation could exceed that expected from immunization programmes for hepatitis B and C.

Increased risks of cirrhosis and hepatocellular cancer were found in betel chewers free of hepatitis B/C infection, and these risks were synergistically additive to those of hepatitis B/C infections. Estimated risk reduction from effective anti-betel chewing programmes would be sizeable.

To assess the folate and vitamin B12 status of a group of Vietnamese women of reproductive age and to estimate the rate of neural tube defects (NTD) based on red blood cell (RBC) folate concentrations.

A representative sample of non-pregnant women (15–49 years) living in Hanoi City (n 244) and Hai Duong Province (n 245).

RBC folate, plasma vitamin B12 and plasma holo-transcobalamin (holoTC), a sensitive indicator of vitamin B12 status.

Mean (95 % CI) concentrations of RBC folate, plasma B12 and plasma holoTC were 856 (837, 876) nmol/l, 494 (475, 513) pmol/l and 78 (74, 82) pmol/l, respectively. Only 3 % and 4 % of women had plasma B12 and holoTC concentrations indicative of deficiency. No woman had an RBC folate concentration indicative of deficiency (<317 nmol/l). Only 47 % of women had an RBC folate concentration ≥905 nmol/l. Accordingly, we predict the NTD rate in these regions of Vietnam to be 14·7 (14·2, 15·1) per 10 000 pregnancies.

There was no evidence of folate and vitamin B12 deficiency among this population of Vietnamese women. However, suboptimal folate status may be placing three out of five women at increased risk of NTD. Reductions in NTD rates are still possible and women would benefit from additional folic acid during the periconceptional period from either supplements or fortified foods.

To examine the association between overweight and health problems of the lower extremities, i.e. osteoarthritis (OA), pain and disability.

Cross-sectional data from the Dutch population-based Musculoskeletal Conditions & Consequences Cohort (DMC3), comprising a random sample from the Dutch population aged >25 years (n 3664), were analysed using multivariate logistic regression. Overweight was defined as BMI ≥ 25·0 kg/m2, moderate overweight as 25·0 kg/m2 ≤ BMI < 30·0 kg/m2 and obesity as BMI ≥ 30·0 kg/m2. Health problems of the lower extremities were: (i) self-reported OA of the hip or knee as told by a doctor; (ii) presence of self-reported chronic pain (>3 months) of the lower extremities; and (iii) disabilities in mobility as measured by the Euroqol questionnaire (EQ-5D).

Moderate overweight was associated with self-reported OA of the hip or knee (OR = 1·7; 95 % CI 1·4, 2·1), chronic pain of the lower extremities at one or more location(s) (OR = 1·6; 95 % CI 1·3, 1·9) and disability in mobility (OR = 1.7; 95 % CI 1·4, 2·0). For obesity these odds were higher: 2·8 (95 % CI 2·1, 3·7), 2·5 (95 % CI 1·9, 3·2) and 3·0 (95 % CI 2·3, 3·9), respectively. Also, among those with OA, moderate overweight and obesity were associated with disability in mobility.

There is a strong association between overweight/obesity and health problems of the lower extremities, i.e. OA, pain and disability. The increasing prevalence of overweight and obesity worldwide urges for public health action not only for diabetes and heart disease, but also OA.

The present paper reports the prevalence of underweight, overweight and obesity by gender, ethnicity and grade, among participants in a 2002 national survey among South African school-going youth that included height and weight measurements.

A stratified two-stage sample was used. Nationally representative rates of underweight, overweight and obesity were calculated using weighted survey data and compared using χ2 analysis.

In all, 9224 grade 8 to grade 11 students, present at school in selected classes within selected South African government-funded schools in all nine provinces, participated in this study. Most of the students were between 13 and 19 years of age.

Higher rates of underweight were observed for males than females as well as for black and ‘coloured’ than white students. Within each gender group, black and ‘coloured’ students had significantly higher rates of underweight than their white counterparts. Higher percentages of females than males were overweight and obese, overall and among black students. Furthermore, white male students had significantly higher rates of overweight than their black and ‘coloured’ counterparts. Among females, black and white students had significantly higher rates than ‘coloured’ students. Students in higher grades showed significantly lower rates of underweight and higher rates of overweight.

These data confirm that South Africa, a developing nation in socio-economic transition, is experiencing both undernutrition and overnutrition. However, these problems are disproportionately distributed by gender, socio-economics and ethnicity. Continued surveillance of nutritional status may be one important component of a national strategy to prevent and control malnutrition.

To examine the association between fruit and vegetable access in the community and change in fruit and vegetable consumption among participants in community-based health promotion programmes.

Fruit and vegetable consumption and perceived access to fresh fruit and vegetables were measured by self-administered questionnaires at programme start, end and 1-year follow-up. Community produce availability was determined by grocery store assessments measuring the display space devoted to fruit and vegetable offerings, as well as price, variety and freshness. A total of nine communities were studied; 130 participants completed the fruit and vegetable portions of the questionnaires and could be linked to grocery store assessments.

Participants made modest but significant increases in fruit and vegetable consumption from programme start to end: the average increase was 2·88 (95 % CI 1·52, 4·25) servings weekly; the average increase from start to follow-up was 2·52 (95 % CI 1·09, 3·95) servings weekly. Greater perceived access to fruits and vegetables was significantly associated with higher increases in fruit and vegetable consumption from programme start to programme end. Greater availability of produce was associated with greater increases in fruit and vegetable servings from programme start to programme end as measured by store assessments.

Environmental factors, such as access to fruits and vegetables, can modify the effects of community interventions. Interventions with the goal of increasing fruit and vegetable consumption should consider focusing on increasing access to fresh fruits and vegetables in target communities. Similarly, researchers may want to study access as an intervention, not just a contextual variable.

To determine the prevalence of anaemia and associated factors among under-fives and their mothers in a rural area of Western Uganda.

A cross-sectional investigation using both qualitative and quantitative methods of data collection. Stratified multistage sampling methods were used to select the study sample. A haemoglobinometer was used to assess Hb levels in the blood.

A rural district in Western Uganda.

Children aged 6–59 months and their mothers aged 15–49 years.

The overall prevalence of Fe-deficiency anaemia among children and their mothers was 26·2 % and 17·9 %, respectively. There was a significant correlation (r = 0·5, P = 0·008) between the Hb levels of the mothers and their children. Place of birth, age of the child, factors related to complementary foods, and formal education and nutrition knowledge of the mother were major factors that were significantly associated (r = 0·05, P = 0·05) with low Hb levels among the children. The most important factors that were associated with low Hb levels of the mothers were their formal education, nutrition knowledge and health status.

Fe-deficiency anaemia was found to be a major problem in this cohort of children and their mothers. Dietary factors and sociodemographic factors were the major factors associated with high levels of anaemia among the children and their mothers. It is therefore recommended that rural mothers should be sensitized on best practices for prevention of anaemia among both women and children.

We sought to evaluate the relationship between selected lifestyle and socio-economic characteristics and dietary habits of Greek adolescents.

During 2004, 2118 school adolescents were selected from twelve schools in Vyronas region, Athens. Dietary intake was assessed through a semi-quantitative FFQ. Principal components analysis was applied to extract dietary patterns.

Seven components, explaining the 50 % of the total variation in intake, were extracted. Component 1 (‘junk food’ pattern) was heavily loaded by the consumption of ‘sweet’ and ‘salty’ snacks, soft drinks and other ‘fast foods’. Component 2 was characterized as ‘red meat’ consumption pattern. Component 3 was characterized by the consumption of vegetables, fruits and juices. Component 4 was characterized by the intake of dairy products, pasta and wholegrain bread. Component 5 can be described as rice, fish, potatoes and poultry intake. Component 6 was characterized by the consumption of ‘traditional Greek cooked foods’ and legumes, and component 7 was characterized by the consumption of eggs and white bread. Time spent watching television was positively associated with the ‘junk food’ pattern and inversely associated with the ‘vegetarian/healthy’ pattern. Moreover, the ‘junk food’ pattern was positively related to smoking status and the ‘vegetarian/healthy’ pattern was positively correlated with sports activities outside school.

An unhealthy dietary behaviour is associated with an overall unhealthy lifestyle. Taking into account the fact that unhealthy eating habits and sedentary lifestyle have been associated with increased obesity prevalence, school- or community-based programmes should be conducted promoting healthy dietary and lifestyle behaviours.

To examine the association between skipping breakfast, daily energy, macronutrients and food intakes, and BMI in pre-school children.

A cross-sectional study using information on children’s food consumption and measured height and weight. Energy and macronutrient intakes of the children were derived from parent/day-care attendant’s responses to 24 h recall interviews and eating behaviour questionnaires.

Data obtained from a representative sample (n 2103) of children born in Quebec (Canada) in 1998.

One thousand five hundred and forty-nine children, with a mean age of 49 (sd 3·12) months.

Ten per cent of children ate breakfast on fewer than 7 days per week. This behaviour was associated with a lower diet quality and concentrated energy intakes through higher protein intakes at lunch and the consumption of snacks higher in energy and carbohydrate in the afternoon and evening; yet total daily energy intakes were not significantly different from those of pre-school children who ate breakfast every day. Breakfast skippers’ mean BMI increased as intake of energy, carbohydrates or servings of grain products increased; however, this was not the case for breakfast eaters. When Cole’s cut-off for overweight/obesity was used, overweight/obesity in breakfast skippers was related to the dinner-time consumption of approximately 3000 kJ (700 kcal) or more for energy intake, approximately 100 g or more of carbohydrates, or approximately 3 servings or more of grain products.

Eating breakfast every day is associated with having a healthy body weight, likely due to a more even distribution of energy intake across meals throughout the day.

To investigate the Asian enigma, the phenomenon of relatively high levels of undernutrition among children and adult women in South Asia, despite more favourable records with respect to infant mortality, women’s education, food availability or other aspects of living conditions in comparison with, for example, sub-Saharan Africa.

Literature has been explored to identify countries outside South Asia that are home to sizeable population segments from different ethnic backgrounds, including people of South Asian and African descent, and to compare prevalence rates of undernutrition in combination with indicators of standard of living between these various population segments.

Data on adult undernutrition prevalence rates among population groups of different ethnic descent living in the same country (South Africa, Fiji and the USA) generally reveal the highest prevalence rates of low BMI among adults, males and females, from South Asian background. The relatively high rates of low BMI among adults from South Asian background cannot be explained by less favourable socio-economic characteristics, such as lower income or less access to food.

It is hypothesized that there exists among adults of South Asian descent an ethnic predisposition for a low BMI. Other factors that may contribute to high levels of undernutrition in South Asia are discrimination of women and a poor dietary quality of poor households’ food composition pattern. The question needs to be addressed whether the commonly used cut-off point for adult underweight (BMI < 18·5 kg/m2) is universally applicable or whether ethnic differences should be taken into account.