To examine the relationship between non-milk extrinsic sugars (NMES) concentration and micronutrient intakes and status in free-living older people.

The National Diet and Nutrition Survey of people aged 65 years and over; a cross-sectional study in Britain in 1994/5.

Eight hundred and six men and women living in private households who were not on medication for nutritional disorders. Subjects were classified into four groups (Q1 to Q4), using cut-off points corresponding to quartiles of energy from NMES. Relationships were examined between dietary NMES concentration and intakes of calcium, iron, riboflavin, folate, vitamin C and vitamin D. Status indices were also assessed in each group.

Overall, a small proportion of men and women had intakes below the Lower Reference Nutrient Intake (LRNI) for calcium, iron, folate, riboflavin or vitamin C, while vitamin D intakes were universally low. Intakes of micronutrients tended to be highest at moderate levels of NMES in the diet (Q2 and Q3, equivalent to 8–15% of energy from NMES). Micronutrient status was low for riboflavin in 38% of the sample, while 15% had low vitamin C status and more than 10% were anaemic. There was little evidence that poorer nutrient status was associated with higher levels of dietary NMES. Although some indices of folate status were lower in Q4, this is most likely to reflect confounding by smoking. Energy intake accounted for 20–40% of the variance in micronutrient intakes, compared with less than 5% for NMES concentration.

A diet moderately high in NMES (up to around 15% of energy) is unlikely to have a detrimental impact on micronutrient intake or status in this age group. Energy intake is the major determinant of micronutrient adequacy.

An interviewer-administered quantitative food-frequency questionnaire (FFQ) was developed to determine the energy and nutrient intakes of adult Jamaicans of African origin as part of a study of the epidemiology of diabetes and hypertension.

Reproducibility of the questionnaire was investigated in 123 participants aged 25–74 years. The relative validity of the FFQ was assessed against twelve 24-hour recalls administered over 12 months in 73 of the participants. In addition, energy intakes (EI) were compared with estimated basal metabolic rates (BMR).

Reproducibility correlation coefficients (Pearson and intraclass) varied between 0.42 for retinol and 0.71 for carbohydrate, with most values falling between 0.50 and 0.60. When compared with repeated 24-hour recalls, the FFQ estimated slightly higher energy (mean 6%) and macronutrient intakes (mean 2–14%), and was within 5% when expressed as a percentage of energy intake. Micronutrients were higher by 1.19 (calcium) to 1.61 times (vitamin C). Unadjusted correlations between the FFQ and the reference method ranged from 0.20 for beta-carotene to 0.86 for alcohol. Cross-classification of nutrients into quartiles showed that 46–48% of participants in the lowest and highest quartiles were jointly classified by both methods. Misclassifications were low for most nutrients with one or two persons misclassified at the extreme quartiles. EI/BMR ratios suggested light to moderate activity levels appropriate for an urban population in a developing country.

The FFQ showed reasonable reproducibility and validity and is suitable for estimating the habitual intakes of energy and macronutrients, but was poor for some micronutrients (retinol and beta-carotene).

To describe macronutrient intakes and food sources of the adult population in the Republic of Ireland and Northern Ireland and to assess adherence of this population to current dietary recommendations.

A cross-sectional food consumption survey collected food intake data using a 7-day food diary.

Northern Ireland and the Republic of Ireland between October 1997 and October 1999.

One thousand three hundred and seventy-nine adults aged 18–64 years (662 males and 717 females).

Mean daily energy intakes in men were 11 MJ per day, 15.5% was derived from protein, 34.8% from fat, 43.5% from carbohydrate and 5.9% from alcohol. Corresponding figures for women were 7.6 MJ per day, 15.6%, 35.6%, 45.1% and 3.5%. When alcohol energy was excluded the contribution of fat and carbohydrate to energy did not differ between men and women. When compared with existing dietary recommendations, 93% of men and 86% of women had protein intakes above the Population Reference Intake. Two approaches were used to assess adherence to the fat and carbohydrate dietary recommendations: (1) the proportion of individuals in the population attaining these dietary targets and (2) the proportion of the population that was included in a 'compliers' group which had a group mean equal to these dietary targets. Thirty-three per cent of men and 34% of women met the target of 35% of food energy from fat and 78% of men and 80% of women comprised the ‘compliers’ group having a group mean of 35% of food energy from fat. Twentythree per cent of men and 27% of women met the target of 50% of food energy from carbohydrate and 56% of men and 62% of women made up the 'compliers' group. Meat and meat products were the main source of fat (23%) and protein (37%), and bread and rolls (25%) were the main source of carbohydrate.

A reduction in dietary fat intake remains an important public health issue in the Republic of Ireland and Northern Ireland. An increase in carbohydrate intake and attention to the rise in alcohol intake is also warranted.

Irish participation in the EU-supported DAta Food NEtworking (DAFNE) project required compliance with the overall aims and objectives. The Irish Household Budget Survey (HBS) expenditure data had to be transformed into a format compatible with the collaborative effort, by converting them into quantities of foodstuffs available per person per day.

The Irish 1987 HBS expenditure data on all commodities for 7705 households in the Republic of Ireland, collected using a 14-day diary kept by all members of the household aged 15 years and over.

Following identification of 188 food items in the HBS dataset, retail prices per unit weight were sought for each food. Adjustment of prices, collected from a number of different sources, was made to those of 1987 using the Consumer Price Index. Simple models were used to estimate household food availability through application of the adjusted retail prices per unit weight to the expenditure data. The household level data were converted to food availability per person per day. An internal validation of quantities estimated using the retail prices was made using the 12 foodstuffs for which the Irish HBS collects expenses and quantities.

The comparison of quantities published by the Irish Central Statistics Office for 12 foodstuffs in the Irish 1987 Household Budget Survey with the quantities estimated using equivalent expenditure data and corresponding retail prices showed agreement, with less than a 10% margin of error for 10 of the foods.

In spite some difficulty in converting HBS food expenditure data into food availability per person per day, the DAFNE approach is potentially useful for Irish nutrition surveillance purposes and for facilitating comparisons of the Irish HBS food data with those of other European countries.

To present disparities in consumption of vegetables and fruits in Europe and to discuss how educational level, region and level of consumption influence the variation.

A review of selected studies from 1985 to 1997.

33 studies (13 dietary surveys, nine household budget surveys and 11 health behaviour surveys) representing 15 European countries were selected based on criteria developed as part of the study. Association between educational level and consumption of vegetables and fruits was registered for each study and common conclusions were identified.

In the majority of the studies, with the exception of a few in southern and eastern Europe, consumption of vegetables and fruits was more common among those with higher education. The results suggest that in regions where consumption of vegetables and fruits is more common, the lower social classes tend to consume more of these than the higher social classes.

The differences in the patterns of disparities in vegetable and fruit consumption between regions, as well as within populations, need to be considered when efforts to improve nutrition and health are planned.

Intake of soybean protein was associated with a reduced risk of breast cancer in a case–control study. It has also been demonstrated to increase menstrual cycle length in an experimental setting.

To ascertain whether the association of soybean protein intakes with menstrual cycle length persists in an uncontrolled community setting.

Cross-sectional food frequency dietary survey, menstrual cycle survey and prospective collection of menstrual cycle data.

A hospital clinic and a nursing college.

Two hundred menstruating women.

An association (P=0.034) of higher intakes of soybean protein with increased menstrual cycle length, as recorded by self report and by prospectively recording three consecutive cycles, was observed. The risk of menstrual cycle length being greater than the median, when comparing the upper quartile (8.7–35.2 g day−1) of soybean intake and the lowest quartile (0.1–3.3 g day−1) was double, and this approached statistical significance (OR=2.02, 95% CI=0.88−4.64 and OR=1.93, 95% CI=0.82−4.56 for self-reported cycle length and cycle length as recorded by diary, respectively). In terms of the absolute association with cycle length, subjects in the upper quartile of soybean intake demonstrated a cycle length 1–2 days longer than did subjects in the lowest quartile.

It is likely that the association between dietary intake of soybean protein and length of menstrual cycle prevails in the community setting. This is shown using both self-reported cycle length and cycle length as recorded in a prospective diary.

To assess the relative ability of principal components analysis (PCA)-derived dietary patterns to correctly identify cases and controls compared with other methods of characterising food intake.

Participants in this study were 232 endometrial cancer cases and 639 controls from the Western New York Diet Study, 1986–1991, frequency-matched to cases on age and county of residence.

Usual intake in the year preceding interview of 190 foods and beverages was collected during a personal interview using a detailed food-frequency questionnaire. Principal components analysis identified two major dietary patterns which we labelled ‘healthy’ and ‘high fat’. Classification on disease status was assessed with separate discriminant analyses (DAs) for four different characterisation schemes: stepwise DA of 168 food items to identify the subset of foods that best discriminated between cases and controls; foods associated with each PCA-derived dietary pattern; fruits and vegetables (47 items); and stepwise DA of USDA-defined food groups (fresh fruit, canned/frozen fruit, raw vegetables, cooked vegetables, red meat, poultry, fish and seafood, processed meats, snacks and sweets, grain products, dairy, and fats).

In general, classification of disease status was somewhat better among cases (54.7% to 67.7%) than controls (54.0% to 63.1%). Correct classification was highest for fruits and vegetables (67.7% and 62.9%, respectively) but comparable to that of the other schemes (49.5% to 66.8%).

Our results suggest that the use of principal components analysis to characterise dietary behaviour may not provide substantial advantages over more commonly used, less sophisticated methods of characterising diet.

Malnutrition and poor nutritional status among children are common problems in the Republic of Maldives, a small island nation in the Indian Ocean. The aim of this study was to determine possible macro- and micronutrient deficiencies in the traditional Maldivian diet.

In five atolls, 333 women with children aged between 1 and 4 years who were no longer breast-fed were interviewed, using a 24-hour recall. Additionally, the weights and heights of both the women and children were measured, and blood samples from 15 women were collected for measurements of vitamins A and E, β-carotene, homocysteine, cholesterol and haemoglobin.

Of the women, 22% had a body mass index (BMI) below 18.5. Of the children, 41% were stunted, 14% were wasted and 51% were underweight. The women's and children's diets were sufficient in protein (14%) and carbohydrates (67%) but deficient in fat, which contributed only 19% to the total energy intake. Consumption of dietary substances that depend on vegetable and fruit intake (e.g. β-carotene, vitamin C, dietary fibre and folic acid) was low. The low intake of β-carotene was underlined by low plasma concentration. The estimated iron intake was low, although blood haemoglobin levels were normal.

Marginal nutritional status and marginal malnutrition are due to low fat intake and selected micronutrient deficiency. Higher intakes of locally available vegetables and fruits and fat (especially for children) on a regular basis might reverse the deficits documented on the atolls.

Mean daily intakes of dietary fibre (DF, Southgate) and non-starch polysaccharide (NSP, Englyst) are estimated in a representative sample of adults aged 18-64 years in Ireland. The contribution of food groups to DF and NSP intake is reported and fibre intakes are compared with dietary recommendations and with intakes in some European countries.

Food consumption was estimated using 7-day food diaries for a representative sample (n = 1379; 662 men, 717 women) of 18–64 year old adults in the Republic of Ireland and Northern Ireland selected from the electoral register. DF and NSP intakes were estimated from tables of food composition.

The mean daily intake of DF in the total sample was 20.2 g (standard deviation (SD) 7.8) [23-2 g (SD 8.5) in men, 17.4 g (SD 5.9) in women] or 2.24 g MJ−1 (SD 0.7) [2.16 g MJ−1 (SD 0.7) in men, 2.33 g MJ−1 (SD 0.7) in women]. Mean daily intake of NSP was 14.8 g (SD 6.2) [16.7 g (SD 6.8) in men, 13.0 g (SD 5.0) in women] or 1.65 g MJ−1 (SD 0.6) [1.56 g MJ−1 (SD 0.6) in men, 1.74 g MJ−1 (SD 0.6) in women]. The main food groups that contributed to mean daily intake of DF (NSP) in the sample were breads 31% (23%), potatoes 19% (23%), and vegetables 17% (19%). Absolute intakes of DF and NSP were higher (P < 0.001) in men than women; however, women overall consumed more (P < 0.001) fibre-dense diets than men. Women aged 18-35 years consumed less (P < 0.01) DF and NSP (g) than women aged 36-64 years. Both men and women aged 18–35 years consumed less (P < 0.01) fibre-dense diets than men and women aged 36–64 years. The NSP intake was below the nutritional goal of 18 g day−1 in 77% of adults and below the minimum of the recommended range (12 g day−1) in 37% of the total sample. Compliance (i.e. the maximum number of individuals whose collective mean daily intake corresponded to the population goal) with the (UK) population goal for an average intake of 18 g day−1 NSP was achieved by a greater proportion of the population (63%) than compliance with the (German) dietary fibre recommendation of 30 g day−1 (27%) or the (Nordic) recommendation of 3 g MJ−1 day−1 (33%).

DF (NSP) intakes were lower than dietary recommendations in a substantial proportion of the population. This is likely to contribute to impaired bowel function and constipation, which in turn may contribute to increased risk of chronic gastrointestinal disease.

To review the psycho-social research with respect to relevance for the development of nutritional education strategies.

The eating behaviour of the newborn baby is controlled by innate preferences and dislikes, and by biological self-regulation. These innate control-systems are modified by learning processes, most importantly by the mere exposure to unknown food, by social influences, and by associating the physiological consequences of food intake with taste cues. The last decades have witnessed a change of the social meaning of food and eating, and the social context of eating is subject to dramatic changes. While on the one hand, prevalence of overweight and obesity is increasing, even young children deliberately practise weight control measures ranging from selective food choice to self-induced vomiting thus including behaviours which are clearly symptomatic of eating disorders. Such behaviour is motivated by unrealistic conceptions of a healthy body weight and shape. Children are interested in a range of nutrition topics. However, these topics have to be related to direct perceivable benefits from nutrition.

Educational strategies should: firstly, focus on providing a variety of foods, including a range of nutrient-dense ‘healthy’ food and encouraging children to taste it; secondly, provide a stable and predictive pattern of social eating occasions to promote the social meaning and importance of eating and to enable social learning of food preferences; and finally, encourage a positive body image by providing advice and reassurance regarding the range of healthy and acceptable body weights and shapes.

To assess relationships between TV viewing and body composition, energy expenditure, physical activity, fitness and nutrition habits in prepubertal children.

Cross-sectional study.

Sixty prepubertal children (mean body mass index: 20.8 kg m−2, age: 5–11 years, overweight: n=52, normal weight: n=8).

TV consumption, socio-economic status (SES) and nutrition habits were estimated by questionnaires. Fat mass and fat-free mass were assessed by anthropometrics and bioelectrical impedance analysis, and resting energy expenditure by indirect calorimetry. Total energy expenditure was measured by a combination of indirect calorimetry and individually calibrated 24-hour heart rate (HR) monitoring. Activity-related energy expenditure and physical activity level were calculated. Aerobic fitness (VO2 submax) was determined by ergometry, muscle strength (musculus quadriceps, musculus ischiocruralis) was measured by computer tensiometry. Children were stratified according to their daily TV consumption: <=1 h of TV per day (group I) and >1 h of TV per day (group II).

When compared with children of group I, children of group II had increased body weight, body mass index, skinfolds, fat mass and prevalence of overweight (P<0.05 and <0.01, respectively). By contrast, fat-free mass, energy expenditure, measures of physical activity and muscle strength were similar. Children of group II had normal absolute VO2 submax but reduced adjusted VO2 submax (P<0.05). They also had parents with a lower educational level (P<0.05). Similar nutritional habits were observed in both groups. There were no significant differences in the observed parameters between children with high (1–3 h day−1) and very high (>3 h day−1) TV viewing.

There is a positive relationship between TV viewing and fatness. Increased TV viewing does not reflect reduced 24-hour energy expenditure as assessed by 24-hour HR monitoring, submaximal VO2, muscle strength or poor dietary intake. Increased TV consumption is associated with a low SES.

To apply structural equation modelling (SEM) and estimation of variance components to the relative validation data obtained from the quantitative food frequency questionnaire (QFFQ) used in the Transition, Health and Urbanisation in South Africa (THUSA) study.

A cross-sectional study.

A community-based field study in an African population conducted during 1996.

Residents of the North West Province, South Africa, aged between 15 and 65 years.

Relative validity of the QFFQ was tested against 7-day weighed food records, 24-hour urinary nitrogen (UN) excretion and estimated basal metabolic rate (BMR). SEM and estimation of variance components were applied to the log-transformed energy, protein, fat, calcium, iron, vitamin A and vitamin C intakes. UN excretion was used as a biomarker in the application of the SEM to protein and estimated BMR to energy intakes.

Constant bias (αQ) derived by the SEM varied from 0.85 (vitamin C) to 5.8 (energy). There was significant proportional bias for all nutrients except vitamin C. Validation coefficients (ρ(Q, T )) varied from 0.3 (fat, calcium, iron) to 0.7 (vitamin C). The inclusion of estimated BMR in the SEM for energy increased ρ(Q, T ) from 0.38 to 0.42. The estimation of variance components gave slightly lower correlations for the relationship between intakes from the QFFQ and the unknown true intake.

Robust statistical methods were successfully applied in a relative validation study for a QFFQ in an African population. Estimated BMR as a biomarker for energy intake produced more meaningful results than UN excretion as a biomarker for protein intake.

To investigate the role of blood loss and diet in the aetiology of mild iron deficiency (MID) in premenopausal New Zealand women. Mild iron deficiency was defined as low, but not necessarily exhausted, iron stores (i.e. serum ferritin <20 μg/L) in the absence of anaemia (i.e. haemoglobin ≥120 g/L).

Cross-sectional study of a volunteer sample of premenopausal adult women. Information on habitual dietary intakes (using a specially designed and validated computerised iron food frequency questionnaire), health and demographic status, sources of blood loss (including menstrual blood loss estimated using a validated menstrual recall method), contraceptive use, height and weight, haemoglobin, serum ferritin and C-reactive protein were collected.

Dunedin, New Zealand during 1996/1997.

Three hundred and eighty-four women aged 18–40 years.

The characteristics that were associated with an increased risk of MID were: low meat/fish/poultry intake, high menstrual blood loss, recent blood donation, nose bleeds, and low body mass index. The protective factors included shorter duration of menstrual bleeding, and multivitamin–mineral supplement use in the past year.

There are a number of potentially modifiable factors that appear to influence risk of MID. Women with low menstrual blood loss may be able to decrease their risk of MID by increasing their meat/fish/poultry intake, while those with a higher menstrual blood loss may be able to decrease their risk by decreasing their menstrual blood loss, perhaps by changing their method of contraception. Women should be encouraged to maintain a healthy body weight, and those who choose to donate blood, or who experience nose bleeds, should have their iron stores monitored.

To estimate mercury intake due to fish consumption among the individuals from Gipuzkoa participating in the European Prospective Investigation into Cancer (EPIC), and to validate the estimation of mercury exposure through diet, by measuring blood mercury level.

The population for the EPIC Gipuzkoa cohort was recruited from 1992 to 1995. Each individual's diet was assessed regarding habitual intake over the previous year, using the diet history method. Blood samples were taken at the time of the interview. The mercury content of the fish species consumed was supplied by the Food Chemical Surveillance Programme in the Basque Country.

For the estimation, 8417 volunteers, men and women, aged 35–65 years, of the EPIC cohort; for the validation, a random sample of 120 individuals stratified by fish intake was taken.

The validation study confirmed the relationship between fish consumption and mercury intake, as well as between fish consumption and mercury in erythrocytes. 99.9% of individuals have intakes below 75% of the Provisional Tolerable Weekly Intake (PTWI) of mercury established by the World Health Organization. But the limit dosage recommended by the United States Environmental Protection Agency, measured by the average risk index, would be exceeded often.

No individual from the cohort would exceed the PTWI of mercury. Nevertheless, owing to the amount of fish consumed, certain individuals would have mercury intakes approaching the recommended limits. With a view to the future, we believe mercury in fish must continue to be monitored closely in order to assess the risks for the population.

To derive estimates of age–gender specific food availability, based on data collected at household level.

Two alternative modelling approaches are described leading to linear and non-linear optimisation, respectively. The idea of penalised least squares is used for estimation of model parameters. The effect of household characteristics can be incorporated into both modelling approaches.

Household budget survey data from four European countries (Belgium, Greece, Norway and the United Kingdom), circa 1990.