The present study aimed to compare two situations of endemic malnutrition among <5-year-old African children and to estimate the incidence, the duration and the case fatality of severe wasting episodes.

Secondary analysis of longitudinal studies, conducted several years ago, which allowed incidence and duration to be calculated from transition rates. The first site was Niakhar in Senegal, an area under demographic surveillance, where we followed a cohort of children in 1983–5. The second site was Bwamanda in the Democratic Republic of Congo, where we followed a cohort of children in 1989–92. Both studies enrolled about 5000 children, who were followed by routine visits and systematic anthropometric assessment, every 6 months in the first case and every 3 months in the second case.

Niakhar had less stunting, more wasting and higher death rates than Bwamanda. Differences in cause-specific mortality included more diarrhoeal diseases, more marasmus, but less malaria and severe anaemia in Niakhar. Severe wasting had a higher incidence, a higher prevalence and a more marked age profile in Niakhar. However, despite the differences, the estimated mean durations of episodes of severe wasting, calculated by multi-state life table, were similar in the two studies (7·5 months). Noteworthy were the differences in the prevalence and incidence of severe wasting depending on the anthropometric indicator (weight-for-height Z-score ≤–3.0 or mid upper-arm circumference <110 mm) and the reference system (National Center for Health Statistics 1977, Centers for Disease Control and Prevention 2000 or Multicentre Growth Reference Study 2006).

Severe wasting appeared as one of the leading cause of death among under-fives: it had a high incidence (about 2 % per child-semester), long duration of episodes and high case fatality rates (6 to 12 %).

To better understand the enabling and challenging factors impacting on infant feeding practices in communities with a high HIV prevalence.

Qualitative study, with data collected through in-depth interviews and observations of mothers, in addition to discussions with health-service providers.

Urban settlement in the province of KwaZulu-Natal, South Africa.

Mothers recruited from an HIV clinic and from within the community.

Emerging from discussions with mothers on the acceptability of alternative feeding methods were the challenges they encountered in feeding their infants. Mothers readily identified feeding in the context of HIV infection as an issue of great concern, encompassing three central themes: (i) stigma and disclosure of HIV; (ii) confusion and coercion; and (iii) diarrhoea, sickness and free formula. It became evident that mothers rarely received quality infant feeding counselling and consequently mixed feeding, a widespread practice but one that is highly risky for HIV transmission, remained a common feeding practice. Exclusive breast-feeding (EBF) was best practised with support, following disclosure of HIV status. Availability of free formula did not guarantee exclusive formula feeding but instead led to inappropriate feeding practices.

In addition to providing accurate information, health-care workers must be empowered to counsel mothers effectively, addressing issues of disclosure and thereby facilitating mobilization of maternal support networks. These findings illustrate the challenges that exist in policy translation within the context of quality of training for health-care workers on optimizing maternal infant feeding practices, particularly in HIV-prevalent, resource-poor settings.

The aims of the present paper were to assess the nutritional status of children under 5 years old using the 2006 WHO Child Growth Standards (‘the WHO standards’) and to compare the results with those obtained using the National Center for Health Statistics/WHO international growth reference (‘the NCHS reference’).

This was a community-based cross-sectional survey. The WHO standards were used to calculate Z-scores of height-for-age (HAZ), weight-for-age (WAZ), weight-for-height (WHZ) and BMI-for-age (BMIZ).

Fifty counties of thirteen mid-western provinces, China.

A total 8041 children aged <5 years were measured during a 2-month period from August to October 2006.

The prevalence of stunting, underweight and wasting were 30·2 %, 10·2 % and 2·9 %, respectively. The prevalence of overweight and the possible risk of overweight were as high as 4·1 % and 16·8 %. Further analysis among the children with possible risk of overweight found that the percentage of stunting (HAZ < −2) was 57·6 %, the percentage with −2 ≤ HAZ ≤ 2 was 41·0 % and the percentage with HAZ > 2 was only 1·4 %. The prevalence of stunting was 21·9 % and of underweight was 12·7 % by the NCHS reference.

Stunting was the most serious problem that was impeding child growth and development. The high rate of ‘overweight’ was a false impression, the truth being ‘stunting overweight’, and the way to solve it should be to increase protein and other nutrients in the diet at an early age.

To evaluate the diet of 7-year-old children by comparison with food-based dietary guidelines (FBDG) and reference values for nutrient intake.

Food and nutrient intake was assessed by 3 d weighed dietary records of 7-year-olds in six randomly chosen schools in Reykjavik, Iceland. Height and weight were measured. The diet of 165 children (62 % of sample) was evaluated by the Icelandic FBDG and the Nordic reference values (NRV) for nutrient intake.

Six randomly chosen schools in Reykjavik, Iceland.

The FBDG on fruits and vegetables was reached by less than 20 % of the children. A total of 52 % reached the FBDG to eat fish twice a week and 41 % to use vitamin D supplement. The FBDG on dairy was reached by 66 % of the children. Mean intake of SFA gave 13·9 % of the total energy intake (E%), which is higher than the NRV, 9·3E% of MUFA and 3·8E% of PUFA, both lower than the NRV (for all differences P < 0·001). Added sugar gave 12·1E%, which exceeds the upper level (P < 0·001). Fibre intake was 2·1 g/MJ and lower than the NRV (P < 0·001). Mean intake of micronutrients was above the recommended intake (RI), except for iodine, 109·0 μg/d, and vitamin D, 6·1 μg/d, which was lower than the RI (P = 0·006 and P < 0·001, respectively).

Fruit, vegetable, fish and dairy, as well as vitamin D supplement, need to be increased in the diet of 7-year-old children to reach the FBDG and the reference values for nutrient intake. Dietary changes to increase the quality of fat and carbohydrate are needed as well.

To assess the overall diet quality of a sample of adolescents living in Alberta, Canada, and evaluate whether diet quality, nutrient intakes, meal behaviours (i.e. meal skipping and consuming meals away from home) and physical activity are related.

A cross-sectional study design. Students completed the self-administered Web-Survey of Physical Activity and Nutrition (Web-SPAN). Students were classified as having poor, average or superior diet quality based on Canada’s Food Guide to Healthy Eating (CFGHE).

One hundred and thirty-six schools (37 %) within forty-four public and private school boards (75 %) in Alberta, Canada.

Grade 7 to 10 Alberta students (n 4936) participated in the school-based research.

On average, students met macronutrient requirements; however, micronutrient and fibre intakes were suboptimal. Median CFGHE food group intakes were below recommendations. Those with poor diet quality (42 %) had lower intakes of protein, fibre and low-calorie beverages; higher intakes of carbohydrates, fat and Other Foods (e.g. foods containing mostly sugar, high-salt/fat foods, high-calorie beverages, low-calorie beverages and high-sugar/fat foods); a lower frequency of consuming breakfast and a higher frequency of consuming meals away from home; and a lower level of physical activity when compared with students with either average or superior diet quality.

Alberta adolescents were not meeting minimum CFGHE recommendations, and thus had suboptimal intakes and poor diet quality. Suboptimal nutritional intakes, meal behaviours and physical inactivity were all related to poor diet quality and reflect the need to target these health behaviours in order to improve diet quality and overall health and wellness.

To investigate the associations of BMI and overweight in adulthood with consumption of sweets and sugar-sweetened soft drinks in childhood and with the change in consumption between childhood and adulthood.

Longitudinal 21-year follow-up study of Finnish children and adolescents from childhood to adulthood.

The Cardiovascular Risk in Young Finns Study, comprising participants from both eastern and western Finland.

Boys (n 967) and girls (n 1172) aged 3–18 years at baseline in 1980.

The increase in consumption of sugar-sweetened soft drinks from childhood to adulthood was directly associated with BMI in adulthood in women (b = 0·45, P = 0·0001) but not in men. In women, BMI increased by 0·45 kg/m2 for every 10-unit increase per month. Consumption of sweets and sugar-sweetened soft drinks in childhood and adolescence was not associated with BMI in adulthood. The change in consumption of sweets was not associated with BMI in adulthood. The increase in the consumption of sugar-sweetened soft drinks from childhood to adulthood was associated with being overweight (OR = 1·90, 95 % CI 1·38, 2·61) in women, but not in men. No association was found between overweight (BMI ≥ 25 kg/m2) in adulthood and consumption of sweets in childhood or the change in consumption from childhood to adulthood.

We conclude that direct associations exist between adulthood overweight and BMI and an increase in consumption of sugar-sweetened soft drinks in women. Thus sugar-sweetened soft drinks consumption may be important when considering weight management in women.

The aim of the present study was to investigate the relationship between out-of-home (OH) eating and overweight and obesity among adults in Brazil.

Data were based on the 2002–2003 Household Budget Survey (48 470 households) conducted by The Brazilian Census Bureau. Foods and drinks purchased for OH eating during a one-week period were recorded by each participant. We considered OH eating as the purchase of at least one food or drink item for OH consumption during this period. We classified items as: soft drinks, deep-fried snacks, fast foods, sweets and sit-down meals.

Urban areas in Brazil.

56 178 participants (26 225 men and 29 953 women), aged 25–65 years.

The weighted prevalence of OH eating was 40·3 %. Overall, OH eating was positively associated with overweight (OR = 1·21; 95 % CI 1·10, 1·33) and obesity (OR = 1·35; 95 % CI 1·16, 1·57) among men, but not among women. Sit-down meals and soft drinks were the most frequently reported food groups. Both were positively associated with overweight (OR = 1·34 for meals; OR = 1·17 for soft drinks, P < 0·05) and obesity (OR = 1·51 for meals; OR = 1·39 for soft drinks, P < 0·05) among men, but negatively associated with overweight and obesity among women.

OH eating was associated with overweight and obesity only among men, whereas, among women, eating sit-down meals out of home was protective for obesity, suggesting that women make healthier food choices when they eat out of home.

Neighbourhood differences in access to fresh fruit and vegetables may explain social inequalities in diet. Investigations have focused on variations in cost and availability as barriers to the purchase and consumption of fresh produce; investigations of quality have been neglected. Here we investigate whether produce quality systematically varies by food store type, rural–urban location and neighbourhood deprivation in a selection of communities across Scotland.

Cross-sectional survey of twelve fresh fruit and vegetable items in 288 food stores in ten communities across Scotland. Communities were selected to reflect a range of urban–rural settings and a food retail census was conducted in each location. The quality of twelve fruit and vegetable items within each food store was evaluated. Data from the Scottish Executive were used to characterise each small area by deprivation and urban–rural classification.

Scotland.

Quality of fruit and vegetables within the surveyed stores was high. Medium-sized stores, stores in small town and rural areas, and stores in more affluent areas tended to have the highest-quality fresh fruit and vegetables. Stores where food is secondary, stores in urban settings and stores in more deprived areas tended have the lowest-quality fresh produce. Although differences in quality were not always statistically significant, patterns were consistent for the majority of fruit and vegetable items.

The study provides evidence that variations in food quality may plausibly be a micro-environmental mediating variable in food purchase and consumption and help partially explain neighbourhood differences in food consumption patterns.

The present study explores the spatial distribution and in-store availability of fresh fruits and vegetables from a socio-environmental perspective in terms of the type of food store, level of deprivation and the setting (urban/rural) where the food outlets are located.

Seven types of fresh fruit and vegetable stores (FVS) were identified then visited in six districts (urban setting) and seven communities (rural setting). The quantity and diversity of fresh fruits and vegetables (F&V) were also assessed.

Québec City, Canada.

The FVS spatial distribution showed differences between the two settings, with accessibility to supermarkets being more limited in rural settings. The quantity and diversity of fresh F&V in-store availability were associated with the type of FVS, but not with setting or its level of deprivation. Greengrocers and supermarkets offered a greater quantity and diversity of fresh F&V than the other FVS.

The results suggest that inequalities in physical access to fresh F&V across the region could have an impact on public health planning considering that supermarkets, which are one of the excellent sources of F&V, are less prevalent in rural settings.

While corner store-based nutrition interventions have emerged as a potential strategy to increase healthy food availability in low-income communities, few evaluation studies exist. We present the results of a trial in Baltimore City to increase the availability and sales of healthier food options in local stores.

Quasi-experimental study.

Corner stores owned by Korean-Americans and supermarkets located in East and West Baltimore.

Seven corner stores and two supermarkets in East Baltimore received a 10-month intervention and six corner stores and two supermarkets in West Baltimore served as comparison.

During and post-intervention, stocking of healthy foods and weekly reported sales of some promoted foods increased significantly in intervention stores compared with comparison stores. Also, intervention storeowners showed significantly higher self-efficacy for stocking some healthy foods in comparison to West Baltimore storeowners.

Findings of the study demonstrated that increases in the stocking and promotion of healthy foods can result in increased sales. Working in small corner stores may be a feasible means of improving the availability of healthy foods and their sales in a low-income urban community.

Environmental strategies at worksites may help consumers change dietary behaviour towards a more healthy diet. The present study aimed to evaluate the availability of healthy meal options at Danish worksite canteens and to identify predictors of worksite canteens providing healthy meals.

A self-administered questionnaire was randomly mailed to 1967 worksite canteen managers. Besides information and characteristics about the canteen and the worksite, the canteen managers specified the menus available. Two different health groups (Healthy and Less Healthy) were defined in three different meal categories (Sandwiches, Hot meals and Salads) as well as a combined category (Combined) combining all the three meal categories. The characteristics of the worksites were compared with regard to the different health groups.

Randomly selected Danish worksite canteens.

553 Danish worksite canteen managers replied, resulting in a response rate of 29 %.

Only 12 % of the canteens applied to the Healthy group combining all the three meal categories. In particular, worksites with more than 75 % female employees served healthy menus on a frequent basis. The size of the worksite was positively correlated with more healthy meal options. Furthermore, the present study suggests a positive relationship between corporate financial support and the availability of healthy meal options.

Among the selected variables studied, workforce gender, company size and corporate financial support were significant predictors of the availability of healthy meal options in worksite canteens. More research is needed on the role that variance in organisation environment plays for the potential of worksite intervention, to make a difference in terms of healthy eating.

The present study examined the association between area socio-economic status (SES) and food purchasing behaviour.

Data were collected by mail survey (64·2 % response rate). Area SES was indicated by the proportion of households in each area earning less than $AUS 400 per week, and individual-level socio-economic position was measured using education, occupation and household income. Food purchasing was measured on the basis of compliance with dietary guideline recommendations (for grocery foods) and variety of fruit and vegetable purchase. Multilevel regression analysis examined the association between area SES and food purchase after adjustment for individual-level demographic (age, sex, household composition) and socio-economic factors.

Melbourne city, Australia, 2003.

Residents of 2564 households located in fifty small areas.

Residents of low-SES areas were significantly less likely than their counterparts in advantaged areas to purchase grocery foods that were high in fibre and low in fat, salt and sugar; and they purchased a smaller variety of fruits. There was no evidence of an association between area SES and vegetable variety.

In Melbourne, area SES was associated with some food purchasing behaviours independent of individual-level factors, suggesting that areas in this city may be differentiated on the basis of food availability, accessibility and affordability, making the purchase of some types of foods more difficult in disadvantaged areas.

To study the role of energy derived from sugar (both table sugar and sugar added to processed foods) in the total energy content of food purchases in Brazil.

Food purchase data were collected during a national household budget survey carried out between June 2002 and July 2003 on a probabilistic sample representative of all households in the country. The amount of food purchased in this 12-month period was transformed into energy and energy from sugar using food composition tables. Multiple linear regression models were used to study the association between amount of energy from sugar and total energy content of food purchases, controlling for sociodemographic variables and potential interactions between these variables and sugar purchases.

There was a positive and significant association between energy from sugar and total household energy purchases. A 1 kJ increase in sugar purchase corresponded to a 3·637 kJ increase in total energy. In the absence of expenditure on meals outside the home, i.e. when household food purchases tend to approximate actual food consumption by household members, sugar purchase of 1926·35 kJ/d (the 90th percentile of the distribution of sugar purchases in Brazil) was associated, depending on income strata, with total energy purchase over 40–60 % of the recommended daily value for energy intake in Brazil.

The present results corroborate the recommendations of the WHO and the Brazilian Ministry of Health regarding limiting the consumption of sugar.

Previous studies have shown that highly nutritious diets are more costly, but to date there has been no evaluation of the costs associated with failing to meet micronutrient recommendations in a Spanish population.

We examined whether daily food consumption costs (classified in quintiles) were associated with failing to meet at least three daily nutritional recommendations out of twenty (including fibre and nineteen micronutrients) in a cross-sectional analysis of baseline data of a cohort of 17 197 Spanish university graduates. Micronutrients and fibre intake were assessed with a validated 136-item FFQ. Average cost of food was calculated from official Spanish government data.

As participants presented higher dietary energy cost from their diet, their intake of micronutrients increased significantly. Low dietary energy cost was associated with a higher likelihood of failing to meet three or more recommendations (P for trend <0·001 across quintiles of dietary cost), the association being stronger among female than male participants (P for interaction between sex and quintile of dietary energy cost <0·001).

To assess the prevalence and identify possible predictors of food insecurity among college students at the University of Hawai’i at Mānoa.

Cross-sectional survey, including the US Department of Agriculture’s Household Food Security Survey Module, demographic and spending variables.

University of Hawai’i at Mānoa, Honolulu, Hawai’i (USA).

Four hundred and forty-one non-freshmen students from thirty-one randomly selected classes.

Twenty-one per cent of students surveyed were food-insecure, while 24 % were at risk of food insecurity. Students at higher risk of food insecurity included those who reported living on campus and those living off-campus with room mates. Those identifying themselves as Hawaiians and Pacific Islanders, Filipinos and mixed were also at increased risk of food insecurity.

Food insecurity is a significant problem among college students at the University of Hawai’i at Mānoa. Food availability and accessibility should be increased for these students through the establishment of on-campus food banks and student gardens. Future studies should assess the prevalence of food insecurity in other college campuses nationwide.

Millions of US households experienced food insecurity in 2005. Research indicates that low wages and little social support contribute to food insecurity. The present study aimed to examine whether social support moderates the relationship between income and food insecurity.

Using a mail survey, we collected data on social support sources (social network, intimate partner and community) and social support functions from a social network (instrumental, informational and emotional). We used hierarchical logistic regression to examine the potential moderation of various measures of social support on the relationship between income and food insecurity, adjusting for potential confounding variables.

Oregon, USA.

A stratified random sample of Oregonians aged 18–64 years (n 343).

We found no evidence of an association between social support and food insecurity, nor any evidence that social support acts as a moderator between income and food insecurity, regardless of the measure of social support used.

Although previous research suggested that social support could offset the negative impact of low income on food security, our study did not find support for such an effect.

The present study aimed to understand the relationship between need and help-seeking behaviour in older adults by examining the patterns of food insecurity and participation in food assistance programmes (FAP), i.e. the Food Stamp Program and home-delivered meals.

Data from two longitudinal studies were used. The studies were designed to obtain nationally representative information on health, insurance coverage, financial status, family support systems, labour market status and retirement planning, every two years: the Health and Retirement Study (HRS, 1996–2002) and Asset and Health Dynamics Among the Oldest Old (AHEAD, 1995–2002).

USA.

There were 7623 participants for HRS and 3378 for AHEAD.

The older adults appeared to have persistent patterns between food insecurity and participation in FAP, especially in the Food Stamp Program. More persistently food-insecure older adults had higher participation in FAP (P < 0·001). Food-insecure older adults at one time were more likely to shift from non-participation to participation in FAP the next time than food-secure older adults (P < 0·001). Regardless of previous food insecurity status, previous participants in FAP were more likely to participate subsequently.

The relationship between need and help-seeking behaviour in older adults was found to follow a persistent positive pattern, determined by looking at the patterns of food insecurity and participation in FAP. Although food insecurity as a need is a good predictor of participation in FAP, it is not enough to fully predict participation in FAP. Help-seeking behaviour (i.e. previous programme participation) is also important in predicting participation in FAP.