A Mediterranean diet quality index (MDQI) was devised to give an overall assessment of dietary habits and to identify groups at risk.

The MDQI was based on scores given for selected levels of consumption of selected nutrients and foods.

Mediterranean southern France.

The sample included 473 men and 491 women in three age classes recruited at random.

Only 9.5% of men, 9.0% of women, 4.7% of 20–34 year old subjects, 6.6% of 35–54 year old subjects and 14.0% of 55–76 year old subjects were shown to have a healthy diet. However, 10.1% of men, 8.6% of women, 19.4% of 20–34 year old subjects, 10.2% of 35–54 year old subjects and 4.6% of 55–76 year old subjects were shown to have a poor diet. There were significantly fewer smokers among subjects with a good diet but the distribution of moderate wine drinkers was comparable between those with a good diet and those with a poor diet. Correspondence analysis associated a healthy diet with 55–76 year old men and women living in rural areas, who had received primary schooling only and who were manual workers. Both men and women with a poor MDQI score tended to be young and smokers. In addition, women with a poor MDQI tended to be heavy drinkers and obese.

This study showed that the Mediterranean model, which is generally recognized as a healthy diet, appears restricted to older people and to rural areas, whereas urbanized young people depart from it. A nutritional prevention policy targeted at young adults is required to encourage them to adhere to the Mediterranean model. Smoking and drinking showed different distribution patterns in the sample under study.

To investigate the accuracy of self-reported weight of overweight and obese women and characterisation of under-, correct- and over-reporters based on a number of related variables.

Weight was self-reported before entering the study. At baseline, actual weight was recorded, and demographic, health, nutritional, psychological and physical activity questionnaires were completed.

A hospital outpatient department.

Participants were 131 women aged 18–64 years with a body mass index (BMI)≥ 28 attending a Comprehensive Weight Management Programme.

The accuracy of self-reported weight was investigated for the total group, and the subjects were then categorised into three groups according to accuracy of self-reported weight (under-, correct- and over-reporters). The relationship between these accuracy groups and demographic, health, nutritional, and psychological variables and physical activity was examined, to characterise the under-, correct- and over-reporters.

Although not statistically significantly different, the total group of women tended to underestimate their weight by 0.8 (±3.6) kg. Categorisation according to the accuracy groups revealed that 29% underestimated their weight by 2 kg or more, 19% overestimated their weight by 2 kg or more, and only 52% correctly estimated their weight within 2 kg. Some trends and statistically significant differences between the accuracy groups concerning certain variables, e.g. height, age, income, education, contraceptive pill usage, smoking and food choices were evident.

Self-reported weight of a group of overweight/obese individuals may be a valid and reliable indicator of actual weight, but self-reported weight of an overweight/obese individual can not be interpreted similarly. Further research is necessary to ensure reliable characterisation of under-, over- and correct reporters.

To describe scales that measure motivations for changing dietary behaviour, and to examine associations of these scales with current diet and dietary change.

A secondary analysis of a randomised trial of a self-help intervention to promote lower fat and higher fruit and vegetable consumption.

Participants and setting: Participants were 1205 adults selected at random from enrolees of a large Health Maintenance Organization. At baseline, data were collected on motives for changing diet, fruit and vegetable intake, fat-related dietary habits, and demographic characteristics. Participants were then randomised to receive the intervention or to receive no materials. A follow-up survey was administered at 12 months.

A majority of participants reported that it was very important to make dietary changes to feel better (72%) and to control an existing medical problem (57%), but very few (4%) were motivated by pressure from others. Factor analysis of the diet motivation items yielded two intrinsic (‘self-image’ and ‘personal health’) and one extrinsic (‘social pressure’) scales with fair internal consistency reliabilities (Cronbach's α = 0.59 to 0.68). Motivation scales were statistically significantly associated with demographic characteristics and baseline diet. For example, desire for a better self-image was a stronger motivator for changing diet among females, while personal health was more important to older persons and men (P < 0.001). Social pressure to change diet was statistically significantly associated with higher fat intake (r = 0.11) and self-image was associated with lower fat intake (r = −0.14, both P < 0.001). Motivation by social pressure and self-image were both significantly associated with greater fat reduction at 12 months post-intervention (P < 0.05).

The intrinsic and extrinsic motivation scales were weakly associated with current diet and predicted response to dietary intervention. More research is needed to better characterise and measure motives for dietary change, and to test whether tailoring interventions based on individuals' motives for dietary change would improve intervention effectiveness.

To evaluate over two years the effectiveness of multiple interventions targeted at lunches in secondary schools with the aim of increasing the consumption of healthier foods by children during the school day.

Controlled comparison study of two intervention schools targeted with multiple interventions to increase both the availability and the number of pupils consuming healthier foods, and one control school with no interventions but with the same observations over a two-year period.

Three secondary schools in Peterborough, England.

Secondary school children in the three schools taking school lunches between 1996 and 1998.

School Food Groups (SFGs) were set up in both intervention schools. All catering interventions were actioned via the SFGs. Of the food availability targets, only the target to increase the availability of high-fibre bread in both intervention schools was met. The availability of food items at the control school remained stable. The proportion of pupils consuming fruit and vegetables/salad was very low in all schools at baseline. There were positive changes for consumption of fruit and nonfried potato in one intervention school, and for high-fibre bread and non-cream cakes at the other in the short term, but only that for high-fibre bread was close to being sustained at the end of the two years. The dietary consumption target for vegetables/salad was achieved by the final monitoring period in one school.

Overall there were no significant changes in school-based eating at the end of the study. Some positive changes were made, with some of the dietary targets being achieved at an early stage but not sustained. Ultimately this study has shown how difficult it is to achieve sustained dietary changes in the eating habits of secondary school children, even with considerable input.

To document the consumption during pregnancy of pulque, a traditional central Mexican alcoholic beverage, and its relationship to subsequent infant size, physical growth and performance on the Bayley Scales of Infant Development.

Prospective cohort study.

Six villages in rural, central Mexico in 1984–1985.

Seventy mother–infant pairs.

Most women (72.9%) consumed pulque during pregnancy, and 28.6% consumed more than 150 g ethanol week−1 from the beverage. Individuals who consumed pulque showed no compensating decrease in energy obtained from other foods. Pulque consumption possessed curvilinear relationships with both infant length (at 1 and 6 months) and Bayley mental performance (at 6 months). Heavy pulque intakes were associated with smaller infant size and poorer mental performance. In modest quantities, pulque consumption may have been beneficial due to its micronutrient content.

Intakes of alcohol from pulque were common among pregnant women in these rural, central Mexican villages. Given current scientific knowledge of the adverse effects of ethanol on foetal development, public health interventions are needed to reduce heavy pulque consumption during pregnancy in some areas of rural Mexico.

To identify the season with the highest prevalence of underweight among young children and to examine geographical variation in seasonality of underweight.

This analysis is based on monthly data from a clinic-based growth monitoring programme that forms part of the National Health Information System. A regression-based technique is used to identify seasonal patterns in both underweight prevalence and attendance nationally and in 60 different districts.

The analysis covers the period 1988–1995 and is based in Zimbabwe.

The analysis is based on weight-for-age measurements of Zimbabwean children less than 5 years old, who attended health centres as part of a growth monitoring programme.

Nationally, a small but significant increase in levels of underweight takes place during January–March. Participation in growth monitoring also varies seasonally and could account for the increase observed. No evidence of seasonal variation in underweight prevalence is found in the majority of districts studied, although 11 of the districts showed a similar pattern to the national data set. This peak in the incidence of poor nutritional status also coincides with the period of food scarcity before harvest, which is also associated with higher prevalence of diarrhoea and malaria. No differences in seasonality of under-nutrition were found between districts with predominantly subsistence agriculture and those with more commercial forms of agriculture.

Seasonal variation in child weight-for-age exists in some parts of Zimbabwe, but its effects on cross-sectional prevalence studies are likely to be small. There are no readily discernible differences between areas that show evidence of seasonality in levels of underweight and those that do not.

The risk of many important diseases can be reduced by consuming a diet rich in vegetables and fruit. For this reason the World Health Organization (WHO) recommends a daily intake of more than 400 g person−1. The pattern of both the supply and intake of vegetables and fruit and the potential health gain achieved by increasing intake in the European Union (EU) and three accession countries are presented in this paper.

Patterns of supply and dietary intake were assessed using (1) FAO food balance sheets, which allow comparison between the levels of supply in countries but do not reflect actual intake; and (2) survey data reflecting dietary intake. Using WHO mortality data for coronary heart and cerebrovascular disease and major cancers up to age 65 years, the number of preventable deaths is estimated, assuming vegetable and fruit consumption were levelled up to that of the highest consuming group, and assuming relative risks of 0.5, 0.7 or 0.9.

Vegetable and fruit consumption varies considerably between EU Member States. The populations of about half (seven) of the EU Member States have a mean daily intake of less than 275 g. Using the best current estimates of relative risk, over 26,000 deaths before the age of 65 years would be prevented annually in the EU if intake was levelled up to the highest consumption levels (and about double this number of deaths before the age of 75 years).

Increasing the intake of vegetables and fruit is feasible and could result in considerable improvements in public health within the EU. Priority should be given to developing methods that demonstrate the burden of disease caused by too low intakes of vegetables and fruit. This would enable the appropriate social, cultural and economic policies to be developed within the EU.

To examine energy intakes (El), their ratio to estimated basal metabolic rate (BMRest) and the contribution of food groups to energy intake in the North/South Ireland Food Consumption Survey.

Random sample of adults from the populations of Northern Ireland and the Republic of Ireland. Food intake data were collected using a 7-day food diary. Body weight and height were measured and EI/BMRest was calculated from reported energy intake and estimated basal metabolic rate. Dieting practices were assessed as part of a self-administered questionnaire.

Mean energy intake in men was 11.0 MJ and in women was 7.6 MJ, which is comparable to reported energy intakes in Northern Ireland and the Republic of Ireland over a decade ago. Mean EI/BMRest was 1.38. This increased to 1.42 after the exclusion of dieters and those who were unwell, but still remained less than the established cut-off of 1.53. EI/BMRest was significantly (P < 0.05) higher in men than in women and decreased significantly (P < 0.05) with increasing BMI in both sexes. The four food groups that contributed 50% of energy in men and women were meat and meat products, breads and rolls, potatoes and potato products, and biscuits, cakes, pastries and puddings.

Energy intakes have not changed remarkably in Northern Ireland or the Republic of Ireland in the last 10 years, but the mean EI/BMRest of 1.38 suggests that energy underreporting occurred. EI/BMRest was lower in women and in the overweight/obese. Additional multivariate analysis of the data is needed to identify more clearly subgroups of the population reporting lower than expected energy intakes and to evaluate the effect of low energy reporting on the consumption of various foods and food groups.

To assess the proportion of pre-school children meeting reference nutrient intakes (RNIs) and recommendations for daily intakes of iron, zinc, vitamins C and A, and energy from non-milk extrinsic sugars. To assess whether meeting these five dietary requirements was related to a series of socio-economic variables.

Secondary analysis of data on daily consumption of foods and drinks from the National Diet and Nutrition Survey (NDNS) of children aged 1.5–4.5 years based on 4-day weighed intakes.

One thousand six hundred and seventy-five British pre-school children aged 1.5–4.5 years in 1993.

Only 1% of children met all five RNIs/recommendations examined; 76% met only two or fewer. Very few children met the recommendations for intakes of zinc (aged over four years) and non-milk extrinsic sugars (all ages). The number of RNIs/recommendations met was related to measures of socio-economic class. Children from families in Scotland and the North of England, who had a manual head of household and whose mothers had fewest qualifications, met the least number of RNIs/recommendations.

Very few pre-school children have diets that meet all the RNIs and recommendations for iron, zinc, vitamins C and A, and energy from non-milk extrinsic sugars. Dietary adequacy with respect to these five parameters is related to socio-economic factors. The findings emphasise the need for a range of public health policies that focus upon the social and economic determinants of food choice within families.

To evaluate the 137-item Utah Picture-sort Food-frequency Questionnaire (FFQ) in the measurement of usual dietary intake in older adults.

The picture-sort FFQ was administered at baseline and again one year later. Three seasonal 24-hour dietary recall interviews were collected during the year between the two FFQs. Mean nutrient intakes were compared between methods and between administrations of the FFQ.

The FFQ interviews were administered in respondents' homes or care-centres. The 24-hour diet recalls were conducted by telephone interview on random days of the week.

Two-hundred-and-eight men and women aged 55–84 years were recruited by random sample of controls from a case–control study of nutrition and bone health in Utah.

After adjustment for total energy intake, median Spearman rank correlation coefficients between the two picture-sort FFQs were 0.69 for men aged ≤69 years, 0.66 for men aged >69 years; and 0.68 for women aged ≤69 years, 0.67 for women aged >69 years. Median correlation coefficients between methods were 0.50 for men ≤69 years old, 0.52 for men >69 years old; 0.55 for women ≤69 years old, 0.46 for women >69 years old.

We report intake correlations between methods and administrations comparable to those reported in the literature for traditional paper-and-pencil FFQs and one other picture-sort method of FFQ. This dietary assessment method may improve ease and accuracy of response in this and other populations with low literacy levels, poor memory skill, impaired hearing, or poor vision.

The DAta Food NEtworking (DAFNE) initiative was conceived in the 1980s and aims at using data already collected in the context of household budget surveys (HBSs) for the assessment of dietary patterns across Europe.

HBSs are country-representative surveys conducted, with similar methodology, at regular time intervals by the National Statistical Offices of almost all European countries. DAFNE focuses at the designation of comparable, between European countries, categories of food and socio-demographic data, and the estimation of daily per capita food availability. With food and socio-demographic data classified into common categories, comparisons of food habits between European countries become possible.

Fifteen European countries with one or more HBS all undertaken during the period 1981–1999.

Representative population samples in 15 European countries.

DAFNE HBS data are comparable and allow a wide range of dietary analyses. Preliminary data document differences in food habits among European countries and provide insights into the socio-demographic determinants of food preferences.

The DAFNE databank, if properly expanded and exploited, could become a valuable tool for national food and nutrition policy planning across Europe and for the identification of groups at higher risk for developing nutrition-related conditions.

The way in which nutrition knowledge transforms into dietary behaviour and nutrient intake may vary among populations. Therefore, the goal of the study was to examine whether nutrition knowledge is associated with nutritional intake in middle-aged men who are at major risk of cardiovascular disease.

Cross-sectional population study aimed at comparing the response to a nutrition quiz with food habits and nutrient intake determined by a 3-day food record.

Men of the Urban Community of Lille (France) examined at home.

361 men aged 45–64 y, randomly selected from the electoral rolls.

Subjects were separated in a high-score (n = 59) and a low-score (n = 41) group according to their responses to the nutrition quiz. Subjects in the high-score group had better educational and higher income levels than those from the low-score group. Multivariate analysis, adjusting on educational and socio-economic levels and other confounding variables – such as age, body mass index, cigarette smoking, physical activity and energy intake underreporting – showed that subjects in the high-score group were more often consumers of olive oil (36 vs. 12%; p = 0.06), cheese (85 vs. 76%; p<0.01) or cereals (27 vs. 15%; p<0.04) and less often consumers of sunflower oil (51 vs. 68%; p<0.02) or dry vegetables (12 vs. 22%; p<0.05) than those in the low-score group. Subjects in the high-score group had lower intakes of fat (89±24 vs. 104±38 g/d; p = 0.04) and especially of monounsaturated fat of animal origin (23±9 vs. 29±13 g/d; p = 0.01) than individuals in the low-score group.

Nutrition quiz score is associated with specific patterns of food choices and nutrient intake suggesting that nutrition knowledge influences dietary behaviour in middle-aged men from Northern France.

To describe the relationship between specific levels of nitrite intake from cured meat consumption during pregnancy and the relative risk of paediatric brain tumours in the offspring.

Exposure data were previously collected for a population-based case–control study of paediatric brain tumours; data on nitrite content were obtained by a comprehensive literature review of surveys of residual nitrite content in cured meats published in the USA and Canada. The level of nitrite intake for each mother was predicted by year of pregnancy based on survey results. Dose–response was evaluated both categorically and continuously using polynomial and quadratic spline regression.

The US west coast: Los Angeles County, the San Francisco–Oakland Bay Area and the Seattle–Puget Sound area.

There were 540 cases diagnosed between 1984 and 1990 at ages varying from 0 to 19 years, and 801 controls frequency-matched by geographic area, age and birth year.

In general, survey results suggest a trend of decreasing nitrite levels in cured meats over time. We observed a moderate increase in brain tumour risk in the offspring of mothers with relatively low levels of nitrite consumption from cured meats during pregnancy, and a two- to three-fold risk increase in offspring of mothers who consumed 3 mg day−1 nitrite from cured meats (about 125 g day−1 of cured meat consumption throughout the pregnancy).

A substantial risk of paediatric brain tumour appears to be associated with relatively high levels of maternal cured meat consumption during pregnancy. A more scientifically valid approach than a literature review to estimate nitrite intake from cured meats and data from a large group of highly exposed subjects would be useful in determining potentially harmful levels.

1.1 A new Nutrition Committee for the European Union, should be created to give independent scientific and policy advice on nutrition, diets and physical activity to the Commission. This should be supported by a strengthened Nutritional Unit within the Commission.

2.1 There needs to be a comprehensive and coherent nutritional policy for the EU

2.2 The development of European dietary goals should continue after the completion of the Eurodiet Project.

2.3 The European Commission should revise its Recommended Daily Allowances for vitamins and minerals using a systematic, evidence-based approach. Recommended Daily Allowances should be set at a level which would prevent deficiencies and lower the risk of disease.

2.4 The European Commission should produce, preferably every four years, a report on the state of nutrition, diet and physical activity in the EU. This report should contain proposals for action

To review and analyse criteria for vitamin supplementation and fortification in Spain.

Systematic review of scientific literature and simulation analysis of food fortification.

A simulation analysis using a fortified beverage was performed in a random sample of 2855 children aged 2 to 24 years in Spain.

High-risk groups for vitamin supplementation and fortification in Spain are highlighted, and target vitamins considered have been: folic acid, vitamin A, vitamin E, vitamin D and vitamin B12 (particularly in the elderly). A beverage fortified with vitamins C, A, B1 and B6 may contribute to improving the intake of all of these vitamins with the exception of vitamin A, since the Recommended Nutrient Intake is already covered with current consumption.

A detailed knowledge of nutritional status helps to ensure the rationale and follow up of nutrient supplementation and fortification.

The prevalence of chronic diseases is increasing in West Africa, the Caribbean and its migrants to Britain. This trend may be due to the transition in the habitual diet, with increasing (saturated) fat and decreasing fruit and vegetable intakes, both within and between countries.

We have tested this hypothesis by comparing habitual diet in four African-origin populations with a similar genetic background at different stages in this transition.

The study populations included subjects from rural Cameroon (n=743), urban Cameroon (n=1042), Jamaica (n=857) and African–Caribbeans in Manchester, UK (n=243), all aged 25–74 years. Habitual diet was assessed by a food-frequency questionnaire, specifically developed for each country separately.

Total energy intake was greatest in rural Cameroon and lowest in Manchester for all age/sex groups. A tendency towards the same pattern was seen for carbohydrates, protein and total fat intake. Saturated and polyunsaturated fat intake and alcohol intake were highest in rural Cameroon, and lowest in Jamaica, with the intakes in the UK lower than those in urban Cameroon. The percentage of energy from total fat was higher in rural and urban Cameroon than in Jamaica and the UK for all age/sex groups. The opposite was seen for percentage of energy from carbohydrate intake, the intake being highest in Jamaica and lowest in rural Cameroon. The percentage of energy from protein increased gradually from rural Cameroon to the UK.

These results do not support our hypothesis that carbohydrate intake increased, while (saturated) fat intake decreased, from rural Cameroon to the UK.