To describe the case of Congo as an example of the assessment and appropriateness of donor operational and sectoral strategies in a complex emergency.

The paper reports the findings of an external evaluation of operations financed by the European Commission Humanitarian Office in the Democratic Republic of Congo (DRC).

The Congolese health system is suffering from severe deterioration. What is functioning in the public health context is donor-dependent with high costs and limited coverage. Despite a relatively favourable agro-climatic situation, food shortage and famine severely affect the nutritional status of large population groups. In this context, humanitarian programmes have generally improved access to health care and the nutritional status of beneficiaries. The reduction of malnutrition in project areas is often demonstrated even though the context did not permit consolidation of these results. Malnutrition continues to claim a massive cost of lives owing to the effect of widespread food insecurity that follows a circular cause-and-effect pattern of very low food production and extreme poverty.

The current context in DRC does not correspond yet to ‘post-crisis’: neither at population level with regard to indicators of poverty, malnutrition, disease and death, nor at institutional level, with regard to state support to institutions. In these situations, the international community is often called upon to replace the state as service provider. Integrated humanitarian actions should be the future of relief projects in DRC. Health, nutrition and food security components should be considered a standard public health intervention strategy representing the most sensible approach to address the needs of the affected population.

To explore the nutritional quality of supplementary foods and additional energy consumption by the recipients in a pilot nutrition initiative of BRAC.

In-depth interviews, observations during feeding at feeding centres, and laboratory analyses of supplementary foods for nutrient contents performed at the Institute of Nutrition and Food Science, University of Dhaka, Bangladesh.

Muktagacha thana (sub-district) in Mymensingh district, a rural area of Bangladesh.

Pregnant and lactating mothers and children below 2 years of age.

Analysis revealed that supplementary food, if taken completely, could provide daily energy equivalent to 752 kcal to a mother and 212 kcal to a child below 2 years of age. Mothers consumed about 75% of the food provided (∼ 564 kcal day−1). The food was shared mostly with young children and husbands. In-depth interview with mothers also suggested that they usually skipped breakfast if the food was given in the morning. The children liked the taste of food, and unless the child was sick or had some food before coming to the centre, she/he ate all the food provided. Although the main purpose of the project was to provide nutrition education, it was observed that activities at feeding centres were limited to food distribution with little time devoted to the communication of nutritional messages.

Training should be given to service providers to communicate nutritional messages effectively as part of understanding the goal of the initiative. It is important to explore whether the regular diets of the recipients are replaced by the food supplementation or not.

To describe the infant feeding practices and attitudes of women who used prevention of mother-to-child transmission of HIV (PMTCT) services in rural Zimbabwe.

A cross-sectional study including structured interviews and focus group discussions was conducted between June 2003 and February 2004.

The study took place in Murambinda Mission Hospital (Buhera District, Manicaland Province), the first site offering PMTCT services in rural Zimbabwe.

The interviews targeted HIV-infected and HIV-negative women who received prenatal HIV counselling and testing and minimal infant feeding counselling, and who delivered between 15 August 2001 and 15 February 2003. The focus groups were conducted among young and elderly men and women.

Overall, 71 HIV-infected and 93 HIV-negative mothers were interviewed in clinics or at home. Most infants (97%) had ever been breast-fed. HIV-negative mothers introduced fluids/foods other than breast milk significantly sooner than HIV-infected mothers (median 4.0 vs. 6.0 months, P = 0.005). Infants born to HIV-negative mothers were weaned significantly later than HIV-exposed infants (median 19.0 vs. 6.0 months, P = 10−5). More than 90% of mothers reported that breast-feeding their infant was a personal decision, a third of whom also mentioned having taken into account health workers' messages.

The HIV-infected mothers interviewed were gradually implementing infant feeding practices recommended in the context of HIV. Increased infant feeding support capacity in resource-limited rural populations is required, i.e. training of counselling staff, decentralised follow-up and weaning support.

We investigated whether experienced food insecurity was associated with weight control behaviour of adolescents.

A national survey of 16-year-old students with the six-item food security scale, questions concerning intentions of trying to change weight, physical activity patterns, and measurement of height and weight.

Representative sample of 29 schools in Trinidad, West Indies.

Data analysed for 1903 subjects including 1484 who were food-secure and 419 who were food-insecure.

In the whole sample, food security status did not vary by body mass index (BMI) category. ‘Trying to gain weight’ and ‘spending most free time in activities involving little physical effort’ were each associated with lower BMI. ‘Trying to gain weight’ was more frequent in food-insecure subjects (135, 32%) than in food-secure subjects (369, 25%, P=0.012). After adjustment for BMI, age, sex, ethnicity and socio-economic variables, the adjusted odds ratio (OR) of ‘trying to gain weight’ for food-insecure subjects was 1.39 (95% confidence interval (CI) 1.07–1.82, P = 0.014). Food-insecure subjects (197, 47%) were more likely than food-secure subjects (575, 39%) to report that most of their free time was spent doing things that involved little physical effort (P = 0.003). This association was not explained by adjustment for BMI, age, sex and ethnicity (OR = 1.41, 95% CI 1.13–1.76, P = 0.002) or additional socio-economic variables (OR = 1.27, 95% CI 1.02–1.57, P = 0.033).

Adolescents who experience food insecurity are more likely to intend to gain weight but engage in less physical activity than food-secure subjects with the same BMI.

To estimate the burden of disease attributable to low fruit and vegetable intake in the 15 countries that were members of the European Union (EU) before May 2004 (EU-15) and the 10 countries that then joined it (EU-10).

Data on fruit and vegetable intake, target levels of intake and estimates of relative risks, deaths and disability were combined to obtain the burden of ischaemic heart disease, ischaemic stroke and four types of cancer (lung/bronchus/trachea, stomach, oesophagus, and colon/rectum) attributable to low fruit and vegetable consumption.

EU-15 and EU-10 Member States.

The number of lives potentially saved annually from the selected outcomes if fruit and vegetable intake increased to 600 g person−1 day−1 reached 892 000 and 423 000 in the EU-15 and EU-10, respectively; total disease burden could decrease by 1.9% and 3.6%, respectively. The burden of ischaemic heart disease and stroke could be reduced by up to 17% and 10%, respectively, in the EU-15 and by 24% and 15%, respectively, in the EU-10; potential reductions for the selected cancers varied from 1% to 12% in the EU-15 and from 2% to 17% in the EU-10.

The potential health gain of increased fruit and vegetable intake is particularly large in the new Member States, and particularly high for cardiovascular diseases, a main cause of health divide in Europe. This stresses the need for better nutrition programmes and policies that take account of economic, social and cultural specificities.

Our objective in this paper is to assess diets in the European Union (EU) in relation to the recommendations of the recent World Health Organization/Food and Agriculture Organization expert consultation and to show how diets have changed between 1961 and 2001.

Computations make use of FAOSTAT data on food availability at country level linked to a food composition database to convert foods to nutrients. We further explore the growing similarity of diets in the EU by making use of a consumption similarity index. The index provides a single number measure of dietary overlap between countries.

The data confirm the excessive consumption by almost all countries of saturated fats, cholesterol and sugars, and the convergence of nutrient intakes across the EU. Whereas in 1961 diets in several European countries were more similar to US diets than to those of other European countries, this is no longer the case; moreover, while EU diets have become more homogeneous, the EU as a whole and the USA have become less similar over time.

Although the dominant cause of greater similarity in EU diets over the period studied is increased intakes in Mediterranean countries of saturated fats, cholesterol and sugar, also important are reductions in saturated fat and sugar in some Northern European countries. This suggests that healthy eating messages are finally having an impact on diets; a distinctly European diet may also be emerging.

To conduct a policy review of the regulations related to food advertising on television aimed at children.

The study consisted of documentary analysis of relevant legislation and policy documents related to children's advertising from both industry and non-governmental organisations at a global level and in 20 countries. This was supported with semi-structured telephone interviews with individuals from 11 countries.

The initial findings resulted in a listing of regulatory impacts from which we developed a taxonomy of regulatory schemes. There was a tension between the development of legislation to cover this area and the use of voluntary agreements and codes. This tension represents a food industry/civic society split. The food and advertising industries are still engaged in a process of denying the impact of advertising on food choice and children as well as commissioning their own research. Outright bans are unusual, with most countries addressing the situation through voluntary agreements and self-regulation. We found a deep division over the way forward and the role and place of legislation. Policy-makers expressed concerns that national legislation was increasingly less relevant in dealing with broadcast media transmitted from outside national boundaries and therefore not subject to the receiving countries' laws but to the laws of the country from which they were transmitted.

The options for the regulation of advertising targeted at children range from (1) a complete ban on advertising as in the case of Sweden, through (2) partial restrictions on advertising by type of food, target group or limits on the amount of advertisements or times shown, to (3) continuation of self-regulation by the advertising and food industries. There is a global dimension to regulation that needs to be built in, as national frontiers are no barriers to broadcast media and public health nutrition needs to ensure that its concerns are heard and addressed.

To explore how time spent watching television (TV) is associated with the dietary behaviours of New Zealand children and young adolescents.

Secondary data analysis of a nationally representative, cross-sectional survey.

In homes or schools of New Zealand school students.

In total, 3275 children aged 5 to 14 years.

The odds of being overweight or obese increased with duration of TV viewing for children and adolescents when controlling for age, sex, ethnicity, socio-economic status and physical activity. Children and adolescents who watched the most TV were significantly more likely to be higher consumers of foods most commonly advertised on TV: soft drinks and fruit drinks, some sweets and snacks, and some fast foods. Both children and adolescents watching two or more hours of TV a day were more than twice as likely to drink soft drinks five times a week or more (P = 0.03 and P = 0.04, respectively), eat hamburgers at least once a week (both P = 0.02), and eat French fries at least once a week (both P < 0.01).

These findings suggest that longer duration of TV watching (thus, more frequent exposure to advertising) influences the frequency of consumption of soft drinks, some sweets and snacks, and some fast foods among children and young adolescents. Efforts to curtail the amount of time children spend watching TV may result in better dietary habits and weight control for children and adolescents. Future studies examining the impact of advertising on children's diets through interventions and international comparisons of legislation would provide more definitive evidence of the role of advertising in child and adolescent obesity.

Nutrient profiling systems aim at positioning foodstuffs relative to each other according to their contribution to a balanced diet. The accuracy and performance of methodologies are still debated. We present here a critical analysis of the structure and efficiency of the current schemes.

The literature survey detected only four systems addressing the issue on an ‘across the board’ approach and with enough detail to enable analysis. The building principles of these systems were compared and their performance was estimated via their classification of a series of 125 foodstuffs on the basis of nutritional composition. These classifications were compared with one another and with an empirical classification by expert nutritionists.

All systems gave a similar overview, with fruits and vegetables ranked as the most favourable foods and fatty and sugary foods as the least favourable ones, but numerous discrepancies existed in every system, mainly related to their choice of nutrients and thresholds. The FSA scoring system seemed the most consistent approach, although it still generated some questionable rankings. Expert classification did not clearly validate any scheme, and cannot be considered as a true reference.

Nutrient profiling systems are confirmed to be powerful tools to translate nutritional information related to the whole diet into the level of individual foods. However, the performance of the existing schemes remains moderate. Alternative approaches, such as considering food categories or introducing more stringent validation steps by a panel of expert nutritionists, could be ways to reach more efficient and consensual tools.

This study employed a multilevel design to test the contribution of individual, social and environmental factors to mediating socio-economic status (SES) inequalities in fruit and vegetable consumption among women.

A cross-sectional survey was linked with objective environmental data.

A community sample involving 45 neighbourhoods.

In total, 1347 women from 45 neighbourhoods provided survey data on their SES (highest education level), nutrition knowledge, health considerations related to food purchasing, and social support for healthy eating. These data were linked with objective environmental data on the density of supermarkets and fruit and vegetable outlets in local neighbourhoods.

Multilevel modelling showed that individual and social factors partly mediated, but did not completely explain, SES variations in fruit and vegetable consumption. Store density did not mediate the relationship of SES with fruit or vegetable consumption.

Nutrition promotion interventions should focus on enhancing nutrition knowledge and health considerations underlying food purchasing in order to promote healthy eating, particularly among those who are socio-economically disadvantaged. Further investigation is required to identify additional potential mediators of SES–diet relationships, particularly at the environmental level.

Kiribati, a remote atoll island country of the Pacific, has serious problems of vitamin A deficiency (VAD). Thus, it is important to identify locally grown acceptable foods that might be promoted to alleviate this problem. Pandanus fruit (Pandanus tectorius) is a well-liked indigenous Kiribati food with many cultivars that have orange/yellow flesh, indicative of carotenoid content. Few have been previously analysed.

This study was conducted to identify cultivars of pandanus and other foods that could be promoted to alleviate VAD in Kiribati.

Ethnography was used to select foods and assess acceptability factors. Pandanus and other foods were analysed for β- and α-carotene, β-cryptoxanthin, lutein, zeaxanthin, lycopene and total carotenoids using high-performance liquid chromatography.

Of the nine pandanus cultivars investigated there was a great range of provitamin A carotenoid levels (from 62 to 19 086 μg β-carotene/100 g), generally with higher levels in those more deeply coloured. Seven pandanus cultivars, one giant swamp taro (Cyrtosperma chamissonis) cultivar and native fig (Ficus tinctoria) had significant provitamin A carotenoid content, meeting all or half of estimated daily vitamin A requirements within normal consumption patterns. Analyses in different laboratories confirmed high carotenoid levels in pandanus but showed that there are still questions as to how high the levels might be, owing to variation arising from different handling/preparation/analytical techniques.

These carotenoid-rich acceptable foods should be promoted for alleviating VAD in Kiribati and possibly other Pacific contexts where these foods are important. Further research in the Pacific is needed to identify additional indigenous foods with potential health benefits.

To assess whether a food variety score (FVS) and/or a dietary diversity score (DDS) are good indicators of nutrient adequacy of the diet of South African children.

Secondary data analyses were undertaken with nationally representative data of 1–8-year-old children (n = 2200) studied in the National Food Consumption Study in 1999. An average FVS (mean number of different food items consumed from all possible items eaten) and DDS (mean number of food groups out of nine possible groups) were calculated. A nutrient adequacy ratio (NAR) is the ratio of a subject's nutrient intake to the estimated average requirement calculated using the Food and Agriculture Organization/World Health Organization (2002) recommended nutrient intakes for children. The mean adequacy ratio (MAR) was calculated as the sum of NARs for all evaluated nutrients divided by the number of nutrients evaluated, expressed as a percentage. MAR was used as a composite indicator for micronutrient adequacy. Pearson correlation coefficients between FVS, DDS and MAR were calculated and also evaluated for sensitivity and specificity, with MAR taken as the ideal standard of adequate intake. The relationships between MAR and DDS and between anthropometric Z-scores and DDS were also evaluated.

The children had a mean FVS of 5.5 (standard deviation (SD) 2.5) and a mean DDS of 3.6 (SD 1.4). The mean MAR (ideal = 100%) was 50%, and was lowest (45%) in the 7–8-year-old group. The items with the highest frequency of consumption were from the cereal, roots and tuber group (99.6%), followed by the ‘other group’ (87.6%) comprising items such as tea, sugar, jam and sweets. The dairy group was consumed by 55.8%, meat group by 54.1%, fats by 38.9%, other vegetables by 30.8%, vitamin-A-rich by 23.8%, other fruit by 22%, legumes and nuts by 19.7% and eggs by 13.3%. There was a high correlation between MAR and both FVS (r = 0.726; P < 0.0001) and DDS (r = 0.657; P < 0.0001), indicating that either FVS or DDS can be used as an indicator of the micronutrient adequacy of the diet. Furthermore, MAR, DDS and FVS showed significant correlations with height-for-age and weight-for-age Z-scores, indicating a strong relationship between dietary diversity and indicators of child growth. A DDS of 4 and an FVS of 6 were shown to be the best indicators of MAR less than 50%, since they provided the best sensitivity and specificity.

Either FVS or DDS can be used as a simple and quick indicator of the micronutrient adequacy of the diet.

To examine relationships between the ratio of energy intake to basal metabolic rate (EI/BMR) and age and body mass index (BMI) among Japanese adults.

Energy intake was assessed by 4-day semi-weighed diet records in each of four seasons (16 days in total). The EI/BMR ratio was calculated from reported energy intake and estimated basal metabolic rate as an indicator of reporting accuracy.

Residents in three areas in Japan, namely Osaka (urban), Nagano (rural inland) and Tottori (rural coastal).

One hundred and eighty-three healthy Japanese men and women aged ≥30 years.

The oldest age group (≥60 years) had higher EI/BMR values than the youngest age group (30–39 years) in both sexes (1.74 vs. 1.37 for men; 1.65 vs. 1.43 for women). In multiple regression analyses, age correlated positively (partial correlation coefficient, β = 0.012, P < 0.001 for men; β = 0.011, P < 0.001 for women) and BMI correlated negatively (β = −0.031, P < 0.001 for men; β = −0.025, P < 0.01 for women) with EI/BMR.

Age and BMI may influence the relative accuracy of energy intake among Japanese adults.