The objectives of the present study were to (i) develop and validate a norm-referenced performance-rating scale to interpret a nutrition knowledge test developed for urban adolescents and (ii) develop a prototype for other researchers to follow when developing nutrition knowledge tests.

For norm development the nutrition knowledge test (questionnaire) was administered to a sample representative of the questionnaire target group, referred to as the norm group. These included 512 adolescents in grades 8 (n 158), 10 (n 149) and 12 (n 205) at three randomly selected schools in Soweto and Johannesburg. The performance scores (in percentages) obtained by the norm group were transformed to Z-scores which were categorised into stanines using established Z-score cut-off points. For validation purposes the questionnaire was completed by 148 volunteers: sixty university dietetics students, nineteen non-nutrition university students and sixty-nine primary-school teachers.

As required of an ideal norm group, the Z-scores formed a normal distribution (a bell-shaped curve). To facilitate interpretation of the results, the Z-score cut-off points for these categories were transformed back to performance scores (percentages) so that the performance of a testee could be interpreted directly from his/her performance in percentage. As is recommended, the nine stanine categories were reduced to five: very poor, fair/below average, good/average, very good/above average and excellent. The discriminatory validity of the norms was substantiated by showing that groups with known nutrition knowledge levels were rated appropriately and that the performance ratings of these groups differed significantly, with university dietetics students scoring 98·3 %, primary-school teachers 20·3 % and non-nutrition university students 31·6 %.

The norm-referenced performance-rating scale can be used with confidence to interpret the performance score achieved by a testee on the nutrition knowledge test developed for urban adolescents in South Africa. The methodology used in the study serves as a prototype for other researchers who are developing knowledge tests.

Glycaemic index (GI) reflects the postprandial glucose response of carbohydrate-containing foods. A diet with lower GI may improve glycaemic control in people with diabetes. The purpose of the present study was to evaluate the change in outcomes following a behavioural intervention which promoted lower-GI foods among adults with diabetes.

A pre-test–post-test control group design was used with participants randomly assigned to an immediate (experimental) or delayed (control) treatment group. The intervention included a 9-week, group-based intervention about carbohydrate and the glycaemic index. Dietary, anthropometric and metabolic measures were obtained pre/post-intervention in both groups and at 18-week follow-up for the immediate group.

The study was conducted in a rural community in the north-eastern USA.

Adults having type 2 diabetes mellitus for ≥1 year, aged 40–70 years and not requiring insulin therapy (n 109) were recruited.

Following the intervention, mean dietary GI (P < 0·001), percentage of energy from total fat (P < 0·01) and total dietary fibre (P < 0·01) improved in the immediate compared with the delayed group. Mean BMI (P < 0·0001), fasting plasma glucose (P = 0·03), postprandial glucose (P = 0·02), fructosamine (P = 0·02) and insulin sensitivity factor (P = 0·04) also improved in the immediate group compared with the delayed group. Mean waist circumference among males (P < 0·01) and body weight among males and females (P < 0·01) were significantly different between treatment groups.

Educating clients about carbohydrate and the glycaemic index can improve dietary intake and health outcomes among adults with type 2 diabetes.

The present study examined the associations between adult food insecurity (FI) and percentage body fat (%BF) and BMI, stratified by height (HT).

%BF, HT and BMI of 2117 men and 1909 women in the National Health and Nutrition Examination Survey 1999–2002 were analysed in relation to adult food security status using multiple regression procedures.

Compared with the fully food-secure, men’s %BF, BMI and HT were lower as FI intensified. Marginal food security among women was associated with 1·3 cm shorter HT, P = 0·016. Marginal food security among women who were below median HT was associated with about 2·0 kg/m2 higher BMI, P = 0·042. %BF was not associated with FI among women.

FI is associated with shorter HT and lower %BF and BMI in men. Women’s HT should be considered in the reported associations between FI and higher BMI.

To investigate the association between Helicobacter pylori infection and anaemia.

Six cross-sectional studies. H. pylori infection was assessed by the [13C]urea breath test using MS or IR analysis. Hb was measured for all countries. Ferritin and transferrin receptors were measured for Argentina, Bolivia, Mexico, and Venezuela.

Health services in Argentina, Brazil and Mexico or public schools in Bolivia, Cuba and Venezuela.

In Argentina, 307 children aged 4–17 years referred to a gastroenterology unit; in Bolivia, 424 randomly selected schoolchildren aged 5–8 years; in Brazil, 1007 adults (157 men, 850 women) aged 18–45 years attending thirty-one primary health-care units; in Cuba, 996 randomly selected schoolchildren aged 6–14 years; in Mexico, seventy-one pregnant women in their first trimester attending public health clinics; in Venezuela, 418 children aged 4–13 years attending public schools.

The lowest prevalence of H. pylori found was among children in Argentina (25·1 %) and the highest in Bolivia (74·0 %). In Bolivia, Cuba and Venezuela children showed similar prevalence of H. pylori infection as in Brazilian and Mexican adults (range 47·5 % to 81·8 %). Overall anaemia prevalence was 11·3 % in Argentina, 15·4 % in Bolivia, 20·6 % in Brazil, 10·5 % in Cuba and 8·9 % in Venezuela. Adjusted analyses allowing for confounding variables showed no association between H. pylori colonization and anaemia in any study. Hb, ferritin and transferrin receptor levels were also not associated with H. pylori infection in any country.

The present study showed no evidence to support the hypothesis that H. pylori contributes to anaemia in children, adolescents, adults or pregnant women in six Latin American countries.

To investigate the comparative effect of social, economic, health and environmental characteristics on the nutritional status of children aged <3 years in Central Asia.

Cross-sectional analysis using data from Demographic and Health Surveys.

Uzbekistan, Kyrgyzstan and Kazakhstan.

Information on demographic health was gathered by Macro International Inc., Uzbekistan, Kyrgyzstan and Kazakhstan governments from a random sample of 14 067 households in the three countries. Anthropometric measurements were performed using standardized procedures on all children <3 years of age (n 2358). Only children with plausible Z-scores (n 1989) were selected for subsequent analyses.

The main results indicated that country of residence, number of people in household, household wealth, birth weight, age of child, knowledge of oral rehydration therapy, maternal education, number of children <5 years of age and source of drinking water were strong predictors of child nutritional status in these countries. Furthermore, chronic malnutrition was most prevalent in all three countries but at varied levels. An unexpected finding was that fully vaccinated children were more likely to be malnourished than children who were partially vaccinated. A further unexpected finding was that breast-feeding especially in children >6 months old had a strong negative association with stunting and underweight.

In summary, the results from both the descriptive and binary logistic regression analysis are similar in terms of the explanatory variables and the statistical significance in the models.

The present study aimed to estimate the lutein concentration in human milk during early lactation and its relationship with dietary lutein intake measured through the administration of a short FFQ.

A cross-sectional study in which an FFQ was administered twice: on day 3 (T0) and day 30 (T1) postpartum; meanwhile two breast milk samples were collected. Maternal plasma samples were obtained at T0. The comparison of dietary lutein intakes and likewise lutein concentrations in breast milk at T0 and T1 were analysed with Student’s t test. Pearson’s correlation coefficient was used to determine the association between dietary lutein intake and lutein concentration in milk and plasma, respectively, as well as the correlation between breast milk and plasma lutein concentrations at T0.

Pavia, northern Italy.

Twenty-one pregnant women, age range 24–42 years, were recruited during their last trimester on a voluntary basis.

Both breast milk and plasma lutein concentrations were significantly correlated with dietary lutein intake (r = 0·86, P = 0·0001 and r = 0·94, P = 0·0001, respectively). There was a clear significant correlation between milk and plasma lutein concentrations (r = 0·87, P = 0·0001). Mature milk lutein concentration, although significantly reduced at T1 (P < 0·01), maintained a fairly high correlation with dietary lutein intake (r = 0·82, P = 0·0001).

Even though milk lutein concentration decreased during early lactation, it remained significantly correlated with daily lutein intake. Therefore, while awaiting further research, dietary recommendations advising intake of fresh fruit and vegetables rich in lutein, throughout the whole duration of pregnancy and lactation, are extremely useful.

Foods can contain natural phosphorus (NP) and phosphate-containing food additives (AP). The main objective of the present study was to investigate whether NP and AP of habitual diets differ in their effects on markers of Ca metabolism. We also investigated the impact of total habitual dietary P intake on markers of Ca metabolism.

Cross-sectional study. Fasting blood samples were collected and participants kept a 4 d food record, from which dietary intake of total P and the consumption of NP (milk and cheese, excluding processed cheese) and AP (processed cheese) sources were calculated. Participants were divided into groups according to their NP- and AP-containing food consumption and into quartiles according to their total P intake.

Southern Finland.

One hundred and forty-seven healthy premenopausal women aged 31–43 years.

Relative to the lowest total dietary P quartile, mean serum parathyroid hormone (S-PTH) concentration was higher (P = 0·048, analysis of covariance (ANCOVA)) and the mean serum ionized Ca concentration lower (P = 0·016, ANCOVA) in the highest P intake quartile. Mean S-PTH concentrations were higher among participants who consumed processed cheese (P = 0·027, ANCOVA) and less milk and other cheese than processed cheese (P = 0·030, ANCOVA).

High total habitual dietary P intake affected S-PTH unfavourably. Furthermore, phosphate additives may have more harmful effects on bone than other P sources, as indicated by higher mean S-PTH concentration among participants who consumed AP-containing foods. Because of the high dietary P intake and current upward trend in consumption of processed foods in Western countries, these findings may have important public health implications.

To estimate the prevalence of and risk factors for vitamin D deficiency in young urban children in Auckland, New Zealand, where there is no routine vitamin D supplementation.

A random sample of urban children. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D <27·5 nmol/l (<11 ng/ml). Logistic regression analysis was used to calculate odds ratios and, from these, relative risks (RR) and 95 % confidence intervals were estimated.

Auckland, New Zealand (36°52′S), where the daily vitamin D production by solar irradiation varies between summer and winter at least 10-fold.

Children aged 6 to 23 months enrolled from 1999 to 2002.

Vitamin D deficiency was present in forty-six of 353 (10 %; 95 % CI 7, 13 %). In a multivariate model there was an increased risk of vitamin D deficiency associated with measurement in winter or spring (RR = 7·24, 95 % CI 1·55, 23·58), Pacific ethnicity (RR = 7·60, 95 % CI 1·80, 20·11), not receiving any infant or follow-on formula (RR = 5·69, 95 % CI 2·66, 10·16), not currently receiving vitamin supplements (RR = 5·32, 95 % CI 2·04, 11·85) and living in a more crowded household (RR = 2·36, 95 % CI 1·04, 4·88).

Vitamin D deficiency is prevalent in early childhood in New Zealand. Prevalence varies with season and ethnicity. Dietary factors are important determinants of vitamin D status in this age group. Vitamin D supplementation should be considered as part of New Zealand’s child health policy.

Wild edible plants (WEP) play the dual role of securing food diversity and promoting health in traditional societies. Current simplified dietary habits contribute to increasing population health risks. Since WEP are integral to the diet of traditional communities, identifying their significance as foods to people provides further evidence to conserve them and promote their consumption. Six species of WEP were identified as integral to the diet of rural Lebanese communities. We investigated their patterns of consumption and knowledge regarding their health and medicinal properties.

An ethnobotanical survey, employing a qualitative questionnaire, was conducted among thirty informants. The identified species were Cichorium intybus, Eryngium creticum, Foeniculum vulgare, Malva sylvestris, Thymus syriacus and Gundelia tournifortii.

Most informants consumed the six plants as a regular part of their diet. Seasonal variability in consumption was evident. C. intybus was renowned for its digestive and blood strengthening properties. F. vulgare was used as a digestive stimulant. M. sylvestris was distinguished for its anti-inflammatory qualities. T. syriacus was popular for its digestive and anti-poisonous properties. E. creticum was attributed less pronounced health benefits. G. tournifortii was considered a nutritious food.

All six species were popular for their edible uses as well as their health and/or medicinal benefits. These properties are supported by scientific evidence. Our results highlight the importance of these plants for local people and support efforts for their conservation. However, we noticed a decline in indigenous knowledge. We encourage efforts to record it for other plants and in other communities.

To compare the food consumption and nutrient intakes of German children and adolescents in the 1980s with present dietary habits.

Two cross-sectional representative surveys, the German National Food Consumption Study (Nationale Verzehrsstudie, NVS) from 1985–8 and the nutrition module ‘EsKiMo’ of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) from 2006, were analysed for differences in food and nutrient intakes stratified by age and sex groups.

Secondary analyses of data from representative observational studies.

Children and adolescents aged 6–17 years living in Germany in the 1980s (n 2265) and in 2006 (n 2506).

Food consumption was characterised by higher amounts of vegetables/pulses, fruits/nuts and beverages and less meat products/sausages, butter, fats/oils, potatoes/potato products and bread/pastries in 2006 than in 1985–8. The overall changes in food intake were reflected in improvements of macronutrient composition, increased water intake and lower energy density of the diet. Intake of most vitamins and minerals increased in relation to energy intake, but the nutrient density of the diet for vitamins B12 and D decreased. The most critical nutrients observed in NVS and EsKiMo were folate, vitamin D, vitamin A, vitamin E, Ca and Fe. In addition, dietary fibre intake was relatively low and fatty acid and carbohydrate compositions were not favourable.

Further efforts will be necessary to improve dietary habits among children and adolescents.

The dietary diversity score (DDS) is a good indicator of diet quality as well as of diet–disease relationships; therefore, the present study was undertaken to reveal the effect of a lifestyle intervention on this index.

A baseline and three evaluation studies were conducted in two intervention districts (Isfahan and Najaf-Abad) and a reference area (Arak), all located in central Iran. The Isfahan Healthy Hearth Programme (IHHP) targeted the entire population of nearly 2 million in urban and rural areas of the intervention communities. One of the main strategies of the lifestyle intervention phase in the IHHP was healthy nutrition. Usual dietary intake was assessed using a forty-nine-item FFQ. A diversity score for each food group was calculated and the DDS was considered the sum of the diversity scores of the food groups.

There were significant increases in DDS in both intervention areas (P = 0·0001) after controlling for confounding factors. There was a significant interaction between area and evaluation stage with regard to DDS (P = 0·0001). The effect of the intervention on the diversity scores of all food groups was also significant (P = 0·0001 for all) after adjusting for socio-economic status.

The community-based lifestyle intervention in the IHHP was successful in improving DDS which might be related to an increase of diet quality of the population that in turn might decrease the risks of chronic diseases.

To explore the relationship between industry sponsorship of Ca supplementation studies in healthy children and study outcomes.

An electronic search for published randomized controlled trials (RCT) was conducted. We collected data on study design features aimed at reducing bias, statistical significance of results, authors’ conclusions and financial sponsorship of study. We used Fischer’s exact test to examine associations between sponsorship and study results and conclusions.

Healthy children between the ages of 9 and 18 years.

Nineteen trials met our inclusion criteria. Seventeen out of nineteen studies reported a statistically significant improvement of supplementation on bone mineral density. Subjects in eight of the seventeen studies had a baseline daily Ca intake of 800–1300 mg. There was no significant association between study design features and the results or conclusions of the studies. Three studies received government funding, two of which (66·7 %) concluded in favour of additional supplementation. Sixteen studies were either industry-funded or had mixed industry funding, thirteen (81·3 %) of which had a conclusion supporting Ca supplementation in children. There was no significant association between study sponsorship and authors’ conclusions.

The majority of RCT assessing the effects of Ca supplementation in healthy children are industry-funded and support Ca supplementation. The clinical significance of the outcomes measured in Ca supplementation studies should be considered when examining associations between study design and results. Further non-industry funded research is needed to thoroughly assess the impact of funding on authors’ conclusions in nutrition research.

To assess the association of time spent viewing television, videos and video games with measures of fat mass (BMI) and distribution (triceps and subscapular skinfold thicknesses (TSF, SSF)).

Cross-sectional validated survey, self-administered to students to assess screen time (television, videos and video games) and lifestyle variables. Trained personnel obtained anthropometry. The association of screen time with fat mass and distribution, stratified by sex, was modelled with multivariable linear regression analysis, adjusting for potential confounders and correlation of observations within schools.

State of Morelos, Mexico.

Males (n 3519) and females (n 5613) aged 11 to 18 years attending urban and rural schools in Morelos.

In males, screen time of >5 h/d compared with <2 h/d was significantly associated with a 0·13 (95 % CI 0·04, 0·23) higher BMI Z-score, 0·73 mm (95 % CI 0·24, 1·22) higher SSF and 1·08 mm (95 % CI 0·36, 1·81) higher TSF. The positive association of screen time with SSF was strongest in males aged 11–12 years. Sexual maturity appeared to modify the association in females; a positive association between screen time and SSF was observed in those who had not undergone menarche (P for trend = 0·04) but not among sexually mature females (P for trend = 0·75).

Screen time is associated with fat mass and distribution among adolescent males in Mexico. Maturational tempo appears to affect the relationship of screen time with adiposity in boys and girls. Findings suggest that obesity preventive interventions in the Mexican context should explore strategies to reduce screen time among youths in early adolescence.

As part of a larger study designed to understand how to protect the food and nutrition security of individuals living in a protected area of Gabon, we assessed their nutritional status and its relationship to dietary adequacy and health status.

A 7 d food consumption survey was conducted during each of the two major seasons using a weighing method. Data were also collected on weight, height and health of individuals as well as on sociodemographic characteristics and potential determinants of the nutrition situation.

Four rural communities were intentionally selected to represent both inland and coastal settings and access to food markets.

Approximately 500 individuals representing over 90 % of the population of these communities participated in the survey during each season.

Undernutrition was present in the area, particularly among children <5 years of age and the elderly. Health was generally good and under-fives were most frequently ill. Energy, Fe and vitamin A requirements of individuals were generally not satisfied; the opposite was true for protein. The estimated prevalence of inadequate intakes of energy and vitamin A was very high in most age groups. Global nutrient adequacy was associated with nutritional outcome.

Individuals do not eat enough and breast-feeding practices are poor. Many suffer from undernutrition, particularly young children and the elderly. The results confirm the need to investigate the determinants of this poor nutrition situation to ensure that protection of natural resources will not be associated with harm to the well-being of the population.

The present study aimed to examine associations between availability of outlets where takeaway or fast food could be purchased and consumption of takeaway or fast food among children.

Cross-sectional. Parents completed a questionnaire regarding the frequency per week their child usually ate takeaway or fast foods. The availability of outlets where these foods could be purchased close to home and en route to school was determined with a Geographic Information System (presence of any outlets and density of outlets within 800 m from home and along the route to school, and distance from home to closest outlet).

Greater Melbourne and Geelong, Australia.

Three hundred and fifty-three children aged 5–6 years and 463 children aged 10–12 years.

Overall, 69·4 % of children consumed takeaway or fast foods once weekly or more often. Only one measure of availability of outlets close to home was associated with consumption; each additional outlet within 800 m was associated with 3 % lower odds of consuming takeaway or fast foods at least once weekly (OR = 0·97, 95 % CI 0·95, 1·00). There were no associations between availability en route to school and the likelihood of consuming takeaway or fast food at least once weekly.

Access to outlets where takeaway or fast food could be purchased did not predict frequency of consumption of takeaway or fast food in the expected direction. Such relationships appear to be complex and may not be adequately captured by the measures of access included in the current study.