We prospectively investigated relationships between blood markers of Fe, vitamin B12, folate, vitamin C and vitamin D status and subsequent all-cause mortality in 208 men and 191 women aged 75 years or over living in the community in Aberdeen, Scotland. The participants had been recruited for a cross-sectional study in 1999–2000 when they completed health and lifestyle questionnaires and had blood samples taken for analysis of serum ferritin, serum vitamin B12, erythrocyte folate, plasma vitamin C and serum 25-hydroxycholecalciferol. Mortality was ascertained on national databases up to December 2005, with a median time of follow up of 69·2 (range 1·0–79·9) months. Participants were divided into sex-specific quintiles of baseline levels for each nutrient, and hazard ratios were estimated with Cox proportional hazard models adjusted for age and sex with the significance of linear trends in the associations assessed by logistic regression. There was no significant association between blood markers of Fe, vitamin B12 or folate status at baseline and mortality, but vitamin D status at baseline was inversely related to mortality (P for trend < 0·001). For vitamin C there was no evidence of a linear trend but participants in the lowest quintile of plasma levels had a significantly higher risk of death than those in the highest quintile. Randomized controlled trials of lifestyle changes which improve vitamin status are needed to assess whether these associations could be causal.

Lactic acid bacteria (LAB) are present in many foods such as yoghurt and are frequently used as probiotics to favour some biological functions in the host. Many investigators have evaluated the therapeutic effects of yoghurt and LAB commonly used in yoghurt production against diseases such as cancer, infection, and gastrointestinal disorders. The increase of immune cell activity in the prevention of cancer by LAB consumption has also been described. Another possible explanation for the preventive effect of probiotics on carcinogenesis is their effect on other bacteria in the intestine. Probiotics may suppress the growth of bacteria that convert procarcinogens into carcinogens, thereby reducing the amount of carcinogens in the intestine. The present review is focused on two types of cancer in which milk fermented by LAB may show a beneficial effect: colon cancer and breast cancer

Since the vegetarian diet lacks the substrate for pancreatic elastase-1 as an enzyme, a decreased secretion of this enzyme could be expected. We aimed therefore to assess the changes of exocrine pancreatic secretion in a prospective way in a group of healthy omnivores who modified their diet by abstaining from meat for 1 month. Twenty healthy omnivores (fourteen females and six males) were used in the study. The nutrient intake was assessed for 7 d before commencing the study (omnivore diet) and after 1 month of dietary modification (modified diet; meat excluded). Similarly, the faecal output of pancreatic enzymes (elastase-1, chymotrypsin and lipase) was assessed before and 1 month after the period of dietary modification. Statistical differences between two points of the assessment (paired data) were calculated with the use of the Wilcoxon rank test. The relationship between the changes of faecal enzyme output and the changes in nutrient intake was assessed using multiple regression analysis. The dietary changes resulted in statistically significant decrease of faecal elastase-1 output (P < 0·05), whereas for chymotrypsin and lipase no changes were observed. No significant change in stool weight was recorded. No statistically significant correlation between changes in energy and nutrient consumption and changes in faecal output of pancreatic enzymes has been found. It was concluded that the exclusion of meat from the diet for a 1-month period results in significant changes in pancreatic secretion with a selective decrease of elastase-1 output. However, the underlying factor remains unclear.

The role of flavonoids in CVD is still unclear. In this cross-sectional study we assessed the relation between the intakes of twenty-six flavonoids from five subclasses: flavonols, flavones, flavanones, flavan-3-ols and anthocyanidins, and the mean common carotid artery intima-media thickness (CCA-IMT). The study population consisted of 1380 middle-aged eastern Finnish men for whom the mean CCA-IMT examinations were carried out as a part of the prospective population-based Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD). The mean intake of flavonoids was 128·5 (sd 206·7) mg/d and the mean CCA-IMT was 0·78 (sd 0·17) mm. In the lowest quartile of total flavonoid intake the non-adjusted mean CCA-IMT was 0·79 (sd 0·19) mm, while the mean CCA-IMT was 0·76 (sd 0·15) in the highest quartile (P < 0·001). After adjustment for age, variables related to CCA-IMT measurement, history of atherosclerosis, smoking, BMI, diabetes, systolic blood pressure, serum HDL- and LDL-cholesterol, VO2 max, and intakes of alcohol, SFA, folate, vitamins C and E, the total flavonoid intake was inversely associated with the mean CCA-IMT (P = 0·018). Out of different flavonoid subclasses, flavan-3-ols were inversely associated with CCA-IMT (P = 0·025) after statistical adjustment. There was a trend for an inverse association between intake of flavonols and mean CCA-IMT (P = 0·055). We conclude that high intake of flavonoids is associated with decreased carotid atherosclerosis in middle-aged Finnish men.

We examined the relationship between whole grain intake and obesity, insulin resistance, inflammation, diabetes and subclinical CVD using baseline data from the Multi-Ethnic Study of Atherosclerosis. Whole grain intake was measured by a 127-item FFQ in 5496 men and women free of CHD and previously known diabetes. Mean whole grain intake was 0·5 (sd 0·5) servings per d; biochemical measures reflect fasting levels. After adjustment for demographic and health behaviour variables, mean differences for the highest quintile of whole grain intake minus the lowest quintile of intake were 0·6 kg/m2 for BMI, 0·36 mg/l for C-reactive protein, 0·82 μmol/l for homocysteine, 0·15 mU/l*mmol/l for homeostasis model assessment (HOMA), 0·48 mU/l for serum insulin, 2·0 mg/dl for glucose and 5·7 % for prevalence of newly diagnosed impaired fasting glucose (glucose ≥ 100 mg/dl or diabetes medication). These differences represent 11–13 % of a standard deviation of BMI, HOMA, glucose and impaired fasting glucose, but 23 %, 52 % and 80 % of a standard deviation of homocysteine, C-reactive protein and insulin, respectively. An inverse association between whole grains and urine albumin excretion was suggested but retained statistical significance after adjustment only in Chinese and Hispanic participants. No associations were observed between whole grain intake and two subclinical disease measures: carotid intima-media thickness and coronary artery calcification. Concordant with previous research, whole grain intake was inversely associated with obesity, insulin resistance, inflammation and elevated fasting glucose or newly diagnosed diabetes. Counter to hypothesis, however, whole grain intake was unrelated to subclinical CVD.

An investigation was carried out to determine whether there were significant changes in the intake of haem and non-haem Fe of adult men and women in the UK from 1982 (aged 36 years) to 1999 (aged 53 years). The 1253 subjects studied were members of the Medical Research Council National Survey of Health and Development; a longitudinal study of a nationally representative cohort of births in 1946. Food intake was recorded in a 5-d diary at age 36 years in 1982, 43 years in 1989 and 53 years in 1999. Outcome measures were mean intakes of total Fe, haem and non-haem Fe, by year, gender and food source. There were significant changes in total Fe, haem Fe and non-haem Fe intake over the three time points. Total Fe intake was significantly higher in 1989 than in 1982 or 1999 for both men and women but haem Fe was significantly lower in 1999 mainly due to a 40 % fall in haem Fe from beef during this period. Haem Fe from processed meats fell by more than 50 % between 1989 and 1999 but that from poultry rose by more than 50 %. Cereal foods remained the most important source of non-haem Fe and the contribution from breakfast cereals rose relative to that of bread over the 17 years. Several factors could be responsible for these changes, particularly the importance of the epidemic of BSE from 1990. The possible advantages of a lower haem Fe intake in older subjects are discussed.

Olive oil decreases the risk of CVD. This effect may be due to the fatty acid profile of the oil, but it may also be due to its antioxidant content which differs depending on the type of olive oil. In this study, the concentrations of oleic acid and antioxidants (phenolic compounds and vitamin E) in plasma and LDL were compared after consumption of three similar olive oils, but with differences in their phenolic content. Thirty healthy volunteers participated in a placebo-controlled, double-blind, crossover, randomized supplementation trial. Virgin, common, and refined olive oils were administered during three periods of 3 weeks separated by a 2-week washout period. Participants were requested to ingest a daily dose of 25 ml raw olive oil, distributed over the three meals of the day, during intervention periods. All three olive oils caused an increase in plasma and LDL oleic acid (P < 0·05) content. Olive oils rich in phenolic compounds led to an increase in phenolic compounds in LDL (P < 0·005). The concentration of phenolic compounds in LDL was directly correlated with the phenolic concentration in the olive oils. The increase in the phenolic content of LDL could account for the increase of the resistance of LDL to oxidation, and the decrease of the in vivo oxidized LDL, observed in the frame of this trial. Our results support the hypothesis that a daily intake of virgin olive oil promotes protective LDL changes ahead of its oxidation.

High dietary intakes of tomato products are often associated with a reduced risk of CVD, but the atheroprotective mechanisms have not been established. This study was conducted to investigate the effects of increased dietary intake of tomato products on plasma lipids and LDL oxidation. The diet intervention included a baseline period, a 3-week low tomato diet (no tomato products allowed) and a 3-week high tomato diet (400 ml tomato juice and 30 mg tomato ketchup daily). Twenty-one healthy study subjects participated in the study. Total cholesterol concentration was reduced by 5·9 (sd 10) % (P = 0·002) and LDL cholesterol concentration by 12·9 (sd 17·0) % (P = 0·0002) with the high tomato diet compared to the low tomato diet. The changes in total and LDL cholesterol concentrations correlated significantly with the changes in serum lycopene (r 0·56, P = 0·009; r 0·60, P = 0·004, total and LDL, respectively), β-carotene (r 0·58, P = 0·005; r 0·70, P < 0·001) and γ-carotene concentrations (r 0·64, P = 0·002; r 0·64, P = 0·002). The level of circulating LDL to resist formation of oxidized phospholipids increased 13 % (P = 0·02) in response to the high tomato diet. In conclusion, a high dietary intake of tomato products had atheroprotective effects, it significantly reduced LDL cholesterol levels, and increased LDL resistance to oxidation in healthy normocholesterolaemic adults. These atheroprotective features associated with changes in serum lycopene, β-carotene and γ-carotene levels.

It is not known what constitutes an optimal diet in infancy. There are relatively few studies of weaning practice in the UK, and there is a need for prospective data on the effects of infant diet and nutrition on health in later life. We describe the dietary patterns, defined using principal components analysis of FFQ data, of 1434 infants aged 6 and 12 months, born between 1999 and 2003. The two most important dietary patterns identified at 6 and 12 months were very similar. The first pattern was characterised by high consumption of fruit, vegetables and home-prepared foods (‘infant guidelines’ pattern). The second pattern was characterised by high consumption of bread, savoury snacks, biscuits and chips (‘adult foods’ pattern). Dietary pattern scores were correlated at 6 and 12 months (r 0·46 ‘infant guidelines’; r 0·45 ‘adult foods’). These patterns, which reflect wide variations in weaning practice, are associated with maternal and family characteristics. A key influence on the infant diet is the quality of the maternal diet. Women who comply with dietary recommendations, and who have high intakes of fruit and vegetables, wholemeal bread and rice and pasta, are more likely to have infants who have comparable diets – with high ‘infant guidelines’ pattern scores. Conversely, women whose own diets are characterised by high intakes of chips, white bread, crisps and sweets are more likely to have infants who have high ‘adult foods’ pattern scores. The effects of these patterns on growth and development, and on long-term outcomes need to be investigated.

Increasing evidence suggests that light to moderate amounts of polyphenol-rich alcoholic beverages like wine or beer could have health benefits. Scientists have long debated the effects of alcohol on immune function, showing on the one hand, that high doses of alcohol consumption can directly suppress a wide range of immune responses, and that alcohol abuse is associated with an increased incidence of a number of infectious diseases. On the other hand, moderate alcohol consumption seems to have a beneficial impact on the immune system compared to alcohol abuse or abstinence. Therefore, the link between alcohol consumption, immune response, as well as infectious and inflammatory processes remains not completely understood. With this in mind, it is important to realise that other factors, unrelated or indirectly related to immune function, like drinking patterns, beverage type, amount of alcohol, or gender differences, will affect the influence that alcohol consumption may have on the immune system. This review summarises published data describing the effects that light to moderate amounts of polyphenol-rich beverages like wine or beer seem to have on immunity in healthy adults.

Childhood malnutrition is known to be associated with visible lightening of hair colour (hypochromotrichia). Nevertheless, no systematic investigations have been carried out to determine the biochemical basis of this change. We used an HPLC method to measure melanins in the scalp hair of thirteen Jamaican children, diagnosed as having primary malnutrition, during various stages of their treatment and after recovery. During treatment for malnutrition, a progressive decrease in total melanin content along the hair shaft from tip to root (root:tip ratio: 0·62 (sd 0·31)) was observed. This ratio was significantly different (P = 0·003) from the ratio observed among children sampled several months after discharge from hospital (0·93 (sd 0·23)) and among normal control children (0·97 (sd 0·12)). Thus, it appears that a decrease in melanin content is associated with periods of malnutrition. The low root:tip ratio during malnutrition presumably arises because the tips reflect prior hair growth during ‘normal’ nutrition and the roots reflect hair growth during malnutrition; a return of the root:tip ratio to that seen among controls reflects ‘recovery’ from malnutrition. It is possible that reduced intake or availability of tyrosine, a key substrate in melanin synthesis, may play a role in the reduction of hair melanin content during periods of malnutrition. The precise mechanisms by which melanin content is reduced, and the role of aromatic amino acid availability in hair colour change and other features of childhood malnutrition remain to be explored.

Dietary habits play an important role in healthy ageing. We have investigated the role of dietary patterns on overall mortality in a large series of Italian elderly, recruited in five EPIC cohorts in Northern (Varese and Turin), Central (Florence) and Southern Italy (Naples and Ragusa).A total of 5611 subjects (72·6 % women) aged 60 years or older, enrolled in 1993–1998, were prospectively followed (median 6·2 years), with 152 deaths (98 women). Four major dietary patterns were identified by using an exploratory factor analysis based on dietary information collected at enrolment. The associations between these dietary patterns and overall mortality were evaluated by Cox models adjusted for potential confounders. The ‘Olive Oil & Salad’ pattern, characterised by a high consumption of olive oil, raw vegetables, soups and poultry, emerged as being inversely associated with overall mortality in both crude and adjusted models. After adjustment for gender, age and caloric intake, overall mortality was reduced by approximately 50 % in the highest quartile and a significant trend emerged (P = 0·008). This association persisted after adjusting for several additional confounders (hazard ratio (HR) 0·50; 95 % CI 0·29, 0·86; P for trend =  0·02). An association of the ‘Pasta & Meat’ pattern (characterised by pasta, tomato sauce, red meat, processed meat, added animal fat, white bread and wine) with increased overall mortality was also suggested, but only for the highest quartile in a multivariate model. Dietary recommendations aimed at the Italian elderly population should support a dietary pattern characterised by a high consumption of olive oil, raw vegetables and poultry.

The objective of this cross-sectional study was to investigate energy and nutrient intakes in pre-school children in Flanders-Belgium, using multistage clustered sampling. Diets of 661 children (338 boys; 323 girls) between 2·5 and 6·5 years old were assessed, with parentally reported 3 d estimated diet records. Usual energy and nutrient intakes were compared with national and international recommendations. Statistical modelling was used to account for within-individual variation. Mean daily energy intakes (boys, 6543 kJ; girls, 5757 kJ) approached the estimated energy requirements (EER) (boys, 6040 kJ; girls, 5798 kJ) for children < 4 years old. For children at least 4 years old, mean energy intakes (boys, 6408 kJ; girls, 5914 kJ) were below the EER of 6995 and 6740 kJ/d, respectively. Mean energy percentage (en%) derived from saturated fatty acids (SFA) (13–14 en%) was above the acceptable macronutrient distribution range (AMDR) upper level of 12 en%. Mean percentages derived from MUFA (10–11 en%) and PUFA (4–5 en%) were below the AMDR lower levels of 12 and 8 en%, respectively. For fibre, iron and vitamin D intakes, < 15 % of the children reached the recommended dietary allowances. Everybody exceeded the tolerable upper intake levels for sodium. Although diets in Belgian children were adequate in most nutrients, the implications of low iron, vitamin D and fibre intakes should be investigated. Furthermore, this affluent diet, characterised by SFA, MUFA and PUFA intakes differing from the recommendations and excessive sodium intakes, might increase the risk for CVD in later life.

In this study, the intake of n-6 and n-3 PUFA of pre-school children in Flanders, Belgium, was evaluated, and recommendations to address the very low intake of long-chain PUFA are presented. Food consumption data (based on parentally reported 3 d dietary records obtained from October 2002 to February 2003) of 661 children (338 boys, 323 girls) between 2·5 and 6·5 years of age and the PUFA concentrations obtained from various food composition databases were used. The actual PUFA intake levels were compared to Belgian, European and American recommendations. Only the intake of linoleic acid (LA) fell within the recommended ranges. Margarine, bread, biscuits and chocolate products contributed most to LA intake. The intake of α-linolenic acid (LNA) was low compared to the recommendations and was obtained mostly from the consumption of margarines and fatty sauces. This resulted in a high LA/LNA ratio. The intake of all long-chain PUFA was far below the recommended levels. Meat and meat products were the most important sources of arachidonic acid. Consumption of fish and other seafood was very low, though these were the most important sources of long-chain n-3 PUFA. In conclusion, Flemish pre-school children should consume more n-3-rich products in order to increase their LNA intake and decrease their LA/LNA ratio. Furthermore, the replacement of meat products rich in SFA by poultry would increase the arachidonic acid intake. As well, fatty fish consumption needs to be increased, as it is a rich source of long-chain n-3 PUFA.

The objectives of the present study were to evaluate the effect of normobaric and hyperbaric O2 (HBO) on plasma antioxidants and biomarkers of oxidative stress in plasma and urine and to investigate the effect of a 4-week vitamin C plus E supplementation on HBO-induced oxidative stress. Nineteen healthy men were exposed to HBO (100 % O2; 240 kPa) before and after 4 weeks' supplementation with 500 mg vitamin C plus 165 mg α-tocopherol equivalents. Exposure to 21 % O2 at 100 kPa served as intra-individual controls (control). Samples for the analysis of plasma antioxidants and oxidative stress biomarkers were collected before and immediately after each treatment. The present results showed that when compared with ‘control’, a single exposure to HBO resulted in a decrease of plasma vitamin C (P = 0·027) and an increase of lipid peroxides (P = 0·0008) and urinary 8-oxo-deoxyguanosine (8-oxodG) excretion (P = 0·006). Oxidative stress was not prevented by a 4-week supplementation with vitamins C and E. HBO-induced changes in plasma parameters correlated with basal antioxidant levels. The increase of urinary 8-oxodG after HBO plus supplementation correlated negatively with vitamin E intake (P = 0·023). We concluded that in healthy men HBO caused oxidative stress, which could not be prevented by dietary vitamin C plus E supplementation. The present data support the idea that HBO is a suitable model for oxidative stress in healthy volunteers.

Prevailing dietary patterns and their association with nutritional outcomes are poorly understood, particularly for children in Korea. Our purposes were to identify major dietary patterns and to examine their associations with overweight among young children in Korea. For 1441 preschool children, usual diet was assessed by a FFQ, from which thirty-three food groups were created and entered into a factor analysis. We identified three dietary patterns by relative intake frequency of (1) vegetables, seaweeds, beans, fruits, milk and dairy products (Korean healthy pattern); (2) beef, pork, poultry, fish and fast foods (animal foods pattern); and (3) ice cream, soda, chocolate, cookies and candies (sweets pattern). The Korean healthy pattern was associated with better health status. As compared with the lowest quintile, the multivariate-adjusted OR of the highest quintile for health status inferior or similar to their peers was 0·59 (95 % CI 0·42, 0·84). Likelihood of being overweight was higher among those in the highest quintile (OR 1·77 (95 % CI 1·06, 2·94)) v. the lowest quintile regarding the animal foods pattern. These findings suggest that major dietary patterns are predictors of overweight and health status in Korean preschool children.

Some blood orange juice (BOJ) flavanones may have antioxidant, anti-inflammatory, anti-allergic, hypolipidaemic, vasoprotective and anticarcinogenic properties. The aim of the present study was to evaluate the pharmacokinetics of hesperetin and naringenin in human subjects after BOJ intake. In a cross-over study, seven healthy female volunteers consumed 150 and 300 ml BOJ corresponding to about 51–102 mg hesperetin and to 6–12 mg naringenin, respectively. Plasma samples were collected before, each hour for 8 h and 24 h after BOJ administration and analysed for their content of hesperetin and naringenin by liquid chromatography–MS/MS. The plasma concentrations of these compounds were dose dependent and the peak concentration (Cmax) was reached in 5·1 (sd 0·6) h after BOJ intake. The Cmax of hesperetin was 43·4 (sd 32·4) and 79·8 (sd 60·1) ng/ml after 150 and 300 ml intake, respectively. For naringenin the plasma peak was 16·4 (sd 11·9) and 34·0 (sd 20·6) ng/ml. Moreover, the conjugated forms of these flavanones represent more than 95 % of the plasma concentration. The results indicate that both hesperetin and naringenin are bioavailable after BOJ intake; naringenin seemingly more so than hesperetin.

Results of previous studies on fish intake and stroke risk have been inconclusive. Different stroke types have often not been separated. Our aim was to elucidate whether intake of fish, Hg or the sum of proportions of fatty acids EPA (20 : 5n-3) and DHA (22 : 6n-3) influence the risk of haemorrhagic or ischaemic stroke. Within a population-based cohort from a community intervention programme, 369 stroke cases and 738 matched controls were identified and included in the present nested case–control study. Information on fish intake had been recorded at recruitment, i.e. before diagnosis. Hg levels were determined in erythrocyte membranes, also collected at recruitment, and the relative content of fatty acids was measured in erythrocyte membranes or plasma phospholipids. The results showed that in women there was a non-significant decrease in stroke risk with increasing fish intake (OR 0·90 (95 % CI 0·73, 1·11) per meal per week). The risk in women differed significantly (P = 0·03) from that in men, in whom the OR for stroke rose with increasing fish intake (OR 1·24 (95 % CI 1·01, 1·51) per meal per week). The corresponding risk in men for Hg was 0·99 (95 % CI 0·93, 1·06), and for the sum of proportions of EPA and DHA 1·08 (95 % CI 0·92, 1·28). We conclude that the relationship between stroke risk and fish intake seems to be different in men and women. Increased levels of EPA and DHA do not decrease the risk for stroke and there is no association between stroke risk and Hg at these low levels.

Inflammatory processes are involved in the pathogenesis of the most common chronic non-communicable diseases and may also play an important initiating role in their development. Only recently have inflammatory markers been included in epidemiological studies focusing on nutritional status, body composition and physical activity. We are just starting to understand how different lifestyles can determine basal levels of inflammatory biomarkers in early ages. This review aims to summarise what is known about the relationships between lifestyle-related determinants (focusing on overweight, physical activity and dietary habits) and inflammatory markers in apparently healthy young populations. Obesity is the most widely studied determinant. Several large-scale studies have now demonstrated that healthy young subjects with more body fat or higher BMI have moderately higher concentrations of inflammatory markers than their leaner peers, supporting the idea that obesity should be considered as a state of chronic low-grade inflammation. Less data is available to allow us to elucidate how physical activity/fitness or dietary patterns may have a direct effect on inflammation in apparently healthy, disease-free young populations.

Child malnutrition, including wasting, underweight and stunting, is associated with infections, poor nutrient intake, and environmental and socio-demographic factors. Preschool-age children are especially vulnerable due to their high growth requirements. To target interventions for preschool-age children in a community of extreme poverty in Peru, we conducted a household survey between October 2005 and January 2006 to determine the prevalence of malnutrition and its risk factors. Of 252 children < 5 years old, the prevalence of wasting, underweight and stunting was 26·6, 28·6 and 32·1 %, respectively, based on the new WHO Child Growth Standards. Risk factors for wasting were: (1) moderate–high intensity Trichuris infection (OR 2·50; 95 % CI 1·06, 5·93); (2) hookworm infection (OR 6·67; 95 % CI 1·08, 41·05); (3) age (OR6-month 1·27; 95 % CI 1·11, 1·46); (4) maternal education (secondary incomplete) (OR 5·77; 95 % CI 2·38, 13·99); and (5) decreasing maternal BMI (OR1 kg/m2 1·12; 95 % CI 1·02, 1·23). Risk factors for underweight were: (1) moderate–high intensity Trichuris infection (OR 4·74; 95 % CI 1·99, 11·32); (2) age (OR6-month 1·22; 95 % CI 1·07, 1·38); (3) maternal education (secondary incomplete) (OR 2·92; 95 % CI 1·40, 6·12); and (4) decreasing maternal BMI (OR1 kg/m2 1·11; 95 % CI 1·02, 1·21). Risk factors for stunting were: (1) age (OR6-month 1·14; 95 % CI 1·02, 1·27) and (2) decreasing maternal height (OR1 cm 1·12; 95 % CI 1·06, 1·20). Overall, risk factors for malnutrition included both child and maternal determinants. Based on these data, locally appropriate and cost-effective dietary, de-worming and educational programmes should be targeted to mothers and preschool-age children.