To provide current global and regional estimates of anaemia prevalence and number of persons affected in the total population and by population subgroup.

We used anaemia prevalence data from the WHO Vitamin and Mineral Nutrition Information System for 1993–2005 to generate anaemia prevalence estimates for countries with data representative at the national level or at the first administrative level that is below the national level. For countries without eligible data, we employed regression-based estimates, which used the UN Human Development Index (HDI) and other health indicators. We combined country estimates, weighted by their population, to estimate anaemia prevalence at the global level, by UN Regions and by category of human development.

Survey data covered 48·8 % of the global population, 76·1 % of preschool-aged children, 69·0 % of pregnant women and 73·5 % of non-pregnant women. The estimated global anaemia prevalence is 24·8 % (95 % CI 22·9, 26·7 %), affecting 1·62 billion people (95 % CI 1·50, 1·74 billion). Estimated anaemia prevalence is 47·4 % (95 % CI 45·7, 49·1 %) in preschool-aged children, 41·8 % (95 % CI 39·9, 43·8 %) in pregnant women and 30·2 % (95 % CI 28·7, 31·6 %) in non-pregnant women. In numbers, 293 million (95 % CI 282, 303 million) preschool-aged children, 56 million (95 % CI 54, 59 million) pregnant women and 468 million (95 % CI 446, 491 million) non-pregnant women are affected.

Anaemia affects one-quarter of the world’s population and is concentrated in preschool-aged children and women, making it a global public health problem. Data on relative contributions of causal factors are lacking, however, which makes it difficult to effectively address the problem.

To quantify the health and economic outcomes associated with changes in folic acid consumption following the fortification of enriched grain products in the USA.

Cost-effectiveness analysis.

Annual burden of disease, quality-adjusted life years (QALY) and costs were projected for four steady-state strategies: no fortification, or fortifying with 140, 350 or 700 μg folic acid per 100 g enriched grain. The analysis considered four health outcomes: neural tube defects (NTD), myocardial infarctions (MI), colon cancers and B12 deficiency maskings.

The US adult population subgroups defined by age, gender and race/ethnicity, with folate intake distributions from the National Health and Nutrition Examination Surveys (1988–1992 and 1999–2000), and reference sources for disease incidence, utility and economic estimates.

The greatest benefits from fortification were predicted in MI prevention, with 16 862 and 88 172 cases averted per year in steady state for the 140 and 700 μg fortification levels, respectively. These projections were between 6261 and 38 805 for colon cancer and 182 and 1423 for NTD, while 15–820 additional B12 cases were predicted. Compared with no fortification, all post-fortification strategies provided QALY gains and cost savings for all subgroups, with predicted population benefits of 266 649 QALY gained and $3·6 billion saved in the long run by changing the fortification level from 140 μg/100 g enriched grain to 700 μg/100 g.

The present study indicates that the health and economic gains of folic acid fortification far outweigh the losses for the US population, and that increasing the level of fortification deserves further consideration to maximise net gains.

We aimed to investigate the factors associated with a positive intake of folic acid (FA) during the periconceptional period among Korean women.

In a cross-sectional study of demographic, obstetric and socio-economic data, history of periconceptional intake of FA and awareness of the benefits of FA supplementation in pregnancy were obtained and analysed using the χ2 test, followed by multiple logistic regression analysis.

The Maternity School, Cheil General Hospital and Women’s Healthcare Center, Seoul, South Korea, between October 2005 and March 2006.

In total 1313 pregnant women participating in a two-day training course available every month.

After excluding subjects with incomplete or inconsistent data, there were 1277 women included in the analysis. Participants were aged 29·4 (sd 2·9) years and had a mean gestational age of 27·9 (sd 7·1) weeks. Only 131 (10·3 %) women took FA during the periconceptional period. According to multiple logistic regression analyses, the adjusted OR for FA supplementation was 1·79 (95 % CI 1·10, 2·91) in women who had previous spontaneous abortions, 4·10 (95 % CI 2·43, 6·78) in women who planned their pregnancy and 6·63 (95 % CI 2·08, 21·12) in those who were aware of the protective effects of FA.

Periconceptional intake of FA was more likely among Korean women with a history of previous spontaneous abortion, who planned their pregnancy or who were aware of the protective effects of FA during pregnancy. However, the proportion of women who took FA in the periconceptional period was low.

To examine the effect of Seventh-day Adventist (SDA) membership on ‘immunity’ to the secular effects of changes in BMI.

Three independent, cross-sectional, screening surveys conducted by Sydney Adventist Hospital in 1976, 1986 and 1988 and a survey conducted among residents of Melbourne in 2006.

Two hundred and fifty-two SDA and 464 non-SDA in 1976; 166 SDA and 291 non-SDA in 1986; 120 SDA and 300-non SDA in 1988; and 251 SDA and 294 non-SDA in 2006.

Height and weight measured by hospital staff in 1976, 1986 and 1988; self-reported by respondents in 2006.

The mean BMI of non-SDA men increased between 1986 and 2006 (P < 0·001) but did not change for SDA men or non-SDA women. Despite small increases in SDA women’s mean BMI (P = 0·030) between 1988 and 2006, this was no different to that of SDA men and non-SDA women in 2006. The diet and eating patterns of SDA men and women were more ‘prudent’ than those of non-SDA men and women, including more fruit, vegetables, grains, nuts and legumes, and less alcohol, meat, sweetened drinks and coffee. Many of these factors were found to be predictors of lower BMI.

The ‘prudent’ dietary and lifestyle prescriptions of SDA men appear to have ‘immunised’ them to the secular effects of changes that occurred among non-SDA men’s BMI. The dietary and lifestyle trends of SDA women did not reflect the increase in their BMI observed in 2006.

To determine the prevalence and sociodemographic factors related to vegetarians according to different definitions in Finland and to compare the consumption of selected foodstuffs and nutritional intakes among vegetarians and omnivores.

Information about subjects’ identification as vegetarians in a survey was used as a basis for self-defined vegetarianism. Foodstuffs consumed and their frequencies of consumption were obtained, and the reported consumption frequencies of meat, fish, milk and eggs or food portions containing these foodstuffs were used as a basis for an operationalized definition of different types of vegetarianism. Reported consumption was used to estimate foodstuff and nutritional intakes.

Three large nationwide surveys in Finland.

In total, 24 393 participants aged between 18 and 79 years were included.

The proportion of self-identified vegetarians was 3·3 % of the total population in Finland. According to responses to questions on consumption frequency, 1·4 % of the population were pesco-lacto-ovo-vegetarians, 0·43 % were vegans, lacto-vegetarians or lacto-ovo-vegetarians, and 0·18 % were vegans or lacto-vegetarians. Eighty per cent of the self-identified vegetarians did not follow a vegetarian diet according to the operationalized definition, but they consumed fewer meat products (P < 0·01).

Some self-defined vegetarians do consume red meat, poultry or fish, but they follow a healthier diet than self-defined omnivores. In the same sample self-identification indicated more than double the incidence of vegetarianism than the operationalized definition. Therefore self-identification is not a good method for observing the prevalence of vegetarianism.

The objective of the present study was to assess whether weight status, nutrient intake and dietary adequacy were associated with breakfast consumption patterns.

A representative sample of the US population was used in a secondary analysis of nutrient intake/diet quality and weight status by breakfast consumption patterns.

The 1999–2002 National Health and Nutrition Examination Survey (NHANES).

The study sample included African-American (AA) children aged 1–12 years (n 1389).

Forty-five per cent of children aged 1–5 years and 38 % of those aged 6–12 years consumed ready-to-eat cereal (RTEC) at breakfast; while 7·4 % and 16·9 % in those age groups skipped breakfast, respectively. The lowest mean BMI (P ≤ 0·05) and mean waist circumference (P ≤ 0·05) was found in children 1–12 years of age who consumed RTEC at breakfast compared with other consumption groups. RTEC breakfast consumers had the highest mean intakes of vitamins A, B6 and B12, thiamine, riboflavin, niacin, folate, Ca, Fe and Zn (P ≤ 0·05) and the highest Mean Adequacy Ratio (P ≤ 0·05). RTEC breakfast consumers also had the highest intake of carbohydrates and total sugars, and the lowest intakes of total fat (P ≤ 0·05).

Consuming RTEC at breakfast was associated with improved weight and nutrient adequacy in AA children. AA children in all breakfast categories still had mean intakes of most nutrients below recommended levels. The implications are that consuming a breakfast meal should be encouraged in these children, and that RTEC at breakfast provides important nutrients and may help promote a healthy weight.

To assess whether overweight Asians, assessed on the basis of WHO criteria, are at greater mortality risk than overweight Caucasians, and to determine whether alternative cut-off points (BMI = 23·0–24·9 kg/m2 for overweight and BMI ≥ 25·0 kg/m2 for obesity) suggested by the WHO Western Pacific Regional Office are appropriate.

The cohort was followed prospectively until the end of 2001. All-cause and CVD mortality risks of the overweight and obese group, relative to the reference group (BMI = 18·5–24·9 or 18·5–22·9 kg/m2), were assessed using Cox regression analysis, adjusting for age, smoking and gender. Excess deaths were estimated with a method proposed by the US Centers for Disease Control and Prevention.

National Health Interview Survey (NHIS 2001) and a middle-aged perspective cohort in Taiwan.

Subjects comprised 36 386 civil servants and school teachers, aged 40 years and older, who underwent a medical examination during 1989–1992.

In the WHO-defined overweight group, Asians showed a significant increase in all-cause mortality risk compared with Caucasians. Asians showed risks equivalent to Caucasians’ at lower BMI (around 5 units). Every unit of BMI increase, at 25·0 kg/m2 or above, was associated with a 9 % increase in relative mortality risk from all causes. Applying a cut-off point of 25·0 kg/m2 for obesity would result a prevalence of 27·1 %, while the traditional WHO cut-off point of 30·0 kg/m2 yielded obesity prevalence of 4·1 %. Excess deaths due to obesity accounted for 8·6 % of all deaths and 21·1 % of CVD deaths, based on the alternative cut-offs.

In this Asian population, significant mortality risks started at BMI ≥ 25·0 kg/m2, rather than at BMI ≥ 30·0 kg/m2. The study supports the use of BMI ≥ 25·0 kg/m2 as a new cut-off point for obesity and BMI = 23·0–24·9 kg/m2 for overweight. The magnitude of obesity-attributable deaths has been hitherto under-appreciated among Asians.

To investigate the Asian enigma, the phenomenon of relatively high levels of undernutrition among children and adult women in South Asia, despite more favourable records with respect to infant mortality, women’s education, food availability or other aspects of living conditions in comparison with, for example, sub-Saharan Africa.

Literature has been explored to identify countries outside South Asia that are home to sizeable population segments from different ethnic backgrounds, including people of South Asian and African descent, and to compare prevalence rates of undernutrition in combination with indicators of standard of living between these various population segments.

Data on adult undernutrition prevalence rates among population groups of different ethnic descent living in the same country (South Africa, Fiji and the USA) generally reveal the highest prevalence rates of low BMI among adults, males and females, from South Asian background. The relatively high rates of low BMI among adults from South Asian background cannot be explained by less favourable socio-economic characteristics, such as lower income or less access to food.

It is hypothesized that there exists among adults of South Asian descent an ethnic predisposition for a low BMI. Other factors that may contribute to high levels of undernutrition in South Asia are discrimination of women and a poor dietary quality of poor households’ food composition pattern. The question needs to be addressed whether the commonly used cut-off point for adult underweight (BMI < 18·5 kg/m2) is universally applicable or whether ethnic differences should be taken into account.

The current paper aims to describe the characteristics of mothers failing to initiate breast-feeding, provide information on the factors contributing to longer duration of breast-feeding and identify the association of maternal obesity with both initiation and duration of breast-feeding in the Greek population.

Data from the cross-sectional GENESIS (Growth, Exercise and Nutrition Epidemiological Study In preSchoolers) study were used. Mothers were categorized by their pre-pregnancy BMI and their gestational weight gain according to guidelines from the Institute of Medicine.

Preschool children aged 1–5 years in five counties in Greece.

Preschoolers (n 2374) with full maternal anthropometric data before and during pregnancy and breast-feeding data.

A higher percentage of mothers with increased pre-pregnancy BMI or high gestational weight gain failed to initiate breast-feeding compared with their normal-weight counterparts. Obese mothers were 2·86 times more likely to fail in initiating breast-feeding in a multiple logistic regression model. Multiple linear regression analysis showed that among women initiating breast-feeding, those who were either underweight before pregnancy or smoked at the third trimester of pregnancy breast-fed their children for about 1·5 weeks less than their normal-weight or non-smoking counterparts, respectively. Similarly, multiparous women breast-fed their children for about 7 weeks less than uniparous women. In women who initiated breast-feeding, no significant differences in breast-feeding duration were found between women of different gestational weight gains.

Mothers with high pre-pregnancy BMI are less likely to initiate breast-feeding while high gestational weight gain has no effect on either the initiation or duration of breast-feeding in Greece.

Transition from a low-fat vegetable-rich rural diet to a high-fat Westernised diet is considered a factor in the escalating occurrence of vascular-related diseases and type 2 diabetes in urban black South Africans. Consumption of morogo is a distinguishing feature of rural African diets.

To determine fatty acid profiles and folate contents of three widely consumed, wild-growing, African dark green leafy vegetables (morogo).

GC–MS was applied for analysis of fatty acid composition and a validated microbiological assay conducted to determine folic acid contents of wild-growing morogo sampled from deep rural villages in three different geographical regions of South Africa.

Measured fatty acids ranged from 1610·2 to 2941·6 mg/100 g dry mass, with PUFA concentrations 1·4 to 2·8 times those of SFA. Calculated from the relative percentages of linoleic acid (18:2n-6) and linolenic acid (18:3n-3), the ratio of 18:2n-6 to 18:3n-3 PUFA was 1·0:3·4 to 1·0:8·9. The only MUFA was palmitoleic acid (16:1), measured at 34·7 (sd 0·3) to 79·0 (sd 9·3) mg/100 g dry mass, and the predominant SFA was palmitic acid (16:0), measured at 420·6 (sd 83·3) to 662·0 (sd 21·2) mg/100 g dry mass. Folic acid concentration varied from 72 to 217 μg/100 g fresh sample.

Morogo is low-fat food item high in folate and with 18:3n-3 in excess of 18:2n-6, the proposed anti-inflammatory effects of which may lower risks of vascular-related chronic diseases and type 2 diabetes.

To examine correlates of home usage of commercially available cooking fats in Bogotá, Colombia and to determine their fatty acid composition.

Cross-sectional survey.

Bogotá, Colombia.

A representative sample of low- and middle-income families (n 2408).

The types of fat primarily used for cooking at home were mixed vegetable oils (66 %), sunflower oil (21 %) and other oils/fats including margarine (13 %). In multivariate analysis, usage of sunflower oil as the primary cooking fat was positively related to home ownership, age of the father and health as a reason for choosing the main cooking fat, and inversely associated with the number of people per room and an index of household food insecurity. The trans fat content of sunflower oil was unexpectedly higher (mean 4·2 %, range 2·2–8·6) than that of the vegetable mixture oils (mean 3·1 %, range 1·1–6·5).

Vegetable oils are the primary home cooking fats in Bogotá, Colombia. Higher socio-economic status is associated with usage of sunflower oil. Paradoxically, oblivious to the higher trans content of sunflower oil and the negligible amount of n-3 fatty acids, families commonly reported ‘health’ as a reason to choose sunflower over other oils.

To identify the best anthropometric index that predicts cardiometabolic risk factors.

Cross-sectional study in Turkey, in 2003.

Turkish men and women aged 18 years and over (n 1692) were examined. Body weight, height, waist and hip circumferences, blood pressure, total cholesterol, HDL cholesterol, TAG, glucose and insulin were measured. Metabolic syndrome score was calculated as the sum of modified National Cholesterol Education Program Adult Treatment Panel III criteria, excluding waist circumference. Insulin resistance was estimated by homeostasis model assessment (HOMA-IR).

BMI, waist:hip ratio (WHpR), waist:height ratio (WHtR), waist circumference (WC) and hip circumference (HC) were significantly correlated with each other. Partial correlation coefficients between systolic blood pressure, HDL cholesterol, TAG levels or HOMA-IR and BMI, WC or WHtR were similar and higher than correlation coefficients of WHpR and HC. The association of anthropometric indices with metabolic syndrome score and Framingham risk score was highest for WHtR. Areas under the receiver-operating characteristic curves showed that WHtR was the best anthropometric index that discriminated between the presence and absence of hypertension, diabetes and metabolic syndrome, whereas WHpR was better for dyslipidaemia.

WHtR was the best anthropometric index for predicting most cardiometabolic risk factors. WC and BMI ranked second for their predictive capability of cardiometabolic risk, followed by WHpR and HC.

To evaluate the performance of a short dietary questionnaire, using weights to estimate nutrient intake.

Using dietary data collected in 1993–1995 from a large cohort of French women, stepwise regression analysis was used to identify the food groups that best predicted nutrient intakes, resulting in a short list of twenty-three foods. This list was used to design a twenty-three-item dietary questionnaire. Nutrient intake was estimated from the answers to the twenty-three questions, applying weights to each response. Weights were calculated from the large database as regression coefficients of the nutrient intake against the twenty-three food groups. In 2005–2006, 103 women responded (at a 1-year interval) to both the short questionnaire and a previously validated dietary history questionnaire. Intakes of twenty nutrients and energy estimated from these two questionnaires were compared.

French adult female population.

For developing the instrument, 73 034 women aged 41–72 years; for testing, 103 women aged 55–80 years in 2005.

Mean nutrient intakes generally differed by less than 10 % between the two methods. Correlation coefficients of nutrient intakes ranged from 0·23 for vitamin D to >0·65 for Mg, vitamin B3 and alcohol. For most nutrients, at least 70 % of subjects fell into the same or an adjacent quintile when classified by either of the two questionnaires.

In light of both its strengths and limitations, this short questionnaire could be used in French adult women to obtain some general nutritional information, notably for adjustment purposes when response to an extensive questionnaire cannot be obtained.

To detect the association of diet and lifestyle with blood pressure in the Guangxi Hei Yi Zhuang and Han populations.

A cross-sectional study of hypertension.

Both populations were from seven to nine villages in Napo County, Guangxi Zhuang Autonomous Region, China.

A total of 1068 subjects of Hei Yi Zhuang and 933 participants of Han Chinese aged 20–89 years were surveyed by a stratified randomised cluster sampling.

The levels of systolic blood pressure and pulse pressure were higher in Hei Yi Zhuang than in Han (125·20 (sd 18·62) v. 121·88 (sd 15·99) mmHg and 48·64 (sd 14·75) v. 44·98 (sd 11·12 ) mmHg, P < 0·001 for each, respectively). The prevalence of hypertension and isolated systolic hypertension was also higher in Hei Yi Zhuang than in Han (25·19 % v. 17·26 % and 12·45 % v. 3·86 %, P < 0·001 for each, respectively). Mean arterial pressure was positively correlated with gender, age, physical activity, TAG, alcohol consumption, cigarette smoking, total energy, total fat and salt intakes, and negatively associated with education level and total dietary fibre intake in Hei Yi Zhuang (P < 0·05–0·001), whereas it was positively associated with gender, age, physical activity, BMI, waist circumference, total cholesterol, alcohol consumption, cigarette smoking, total energy, total fat and salt intakes, and negatively associated with education level and total dietary fibre intake in Han (P < 0·05–0·001).

The differences in blood pressure levels and the prevalence of hypertension between the Hei Yi Zhuang and Han populations were associated with different dietary habits, lifestyle choices, education level, as well as geographical surroundings.

To evaluate pregnant women’s knowledge regarding the importance of long-chain omega-3 polyunsaturated fatty acids (LC n-3 PUFA) consumption during pregnancy and assess their views on current information availability.

A 27-item demographic and food safety/behaviour questionnaire was administered to pregnant women during their antenatal clinic visits. χ2 tests were performed using SPSS.

Antenatal clinics at two regional hospitals in New South Wales, Australia.

One hundred and ninety (n 190) pregnant women.

Three quarters of the women had not received information regarding LC n-3 PUFA. Approximately half of the women were aware of issues relating to LC n-3 PUFA; however, their knowledge was limited, with most obtaining their knowledge from books and magazines. Women generally had low (30 %, 29 %) to moderate (28 %, 24 %) levels of concern about LC n-3 PUFA and mercury, respectively.

Pregnant women lack knowledge of LC n-3 PUFA and health-care services do not provide pregnant women with adequate information on the importance of eating foods high in LC n-3 PUFA during pregnancy.

To evaluate the effect on decrease in blood pressure of modifying risk factors for stroke, such as blood lipid profiles, diet habits and indices of body weight, through a family-based nutrition health education programme among hypertensive patients and pre-hypertensive subjects without taking any antihypertensive drugs.

This was a community-based prospective study. The study population was randomly selected from communities in Taipei; potential subjects were invited by telephone to participate.

After excluding subjects whose blood pressure was normal and those using antihypertensive drugs, there were 390 participants included in the study. Subjects in the intervention group (n 293) received nutrition health education on blood pressure control and stroke-related risk factor modification at each visit. Non-intervention subjects (n 97) only acquired a general education sheet available in clinics. The blood pressure of study subjects was measured at baseline and 6-month follow-up to evaluate the intervention’s effect on decrease in blood pressure.

Significant decreases of 2·0 mmHg and 5·9 mmHg in systolic blood pressure were observed both in pre-hypertensive and hypertensive subjects in the intervention group. Additionally, intervention subjects with improvement of total cholesterol and LDL cholesterol, decrease in indices of body weight and increase in consumption of fruit and vegetables also had significant lowering of blood pressure.

The present study provided evidence that the blood pressure of pre-hypertensive and hypertensive subjects could decrease significantly, without taking antihypertensive drugs, after modifying blood lipid profiles and waist by dietary habits changed through a family-based nutrition heath education programme, resulting in a significant effect on stroke risk reduction.

Vitamin D is essential for Ca absorption, prevention of falls and fracture, and maintenance of muscle strength and balance. Lack of awareness of the importance of vitamin D in bone health is common in Asia.

To define key statements, objectives and actions for improving osteoporosis management and vitamin D inadequacy in Asia.

This declaration was jointly produced by specialists at the Asia Metaforum on the Role of Vitamin D and the Management of Osteoporosis, held in September 2006 in Hong Kong, to define actions to prevent vitamin D insufficiency in Asia. Although developed specifically for Asia, some or all of these statements may be applicable to other regions of the world.