To examine UK country and ethnic variations in infant feeding practices.

Cohort study.

Infants enrolled in the Millennium Cohort Study, born between September 2000 and January 2002.

A total of 18 150 natural mothers (11 286 (8207 white) living in England) of singleton infants.

Breast-feeding initiation, breast-feeding discontinuation and introduction of solid foods before 4 months.

Maternal ethnic group, education and social class.

Seventy per cent of UK mothers started to breast-feed, of whom 62% stopped before 4 months. Median age at discontinuing breast-feeding was 14, 13, 10 and 6 weeks in Scotland, England, Wales and Northern Ireland, respectively. Thirty-six per cent of UK mothers (34% in England) introduced solids before 4 months. White mothers were more likely to discontinue breast-feeding (62%) and introduce solids early (37%) than most other ethnic minority groups; those stopping before 4 months were more likely to introduce solids early compared with those continuing to breast-feed beyond this age (adjusted rate ratio (95% confidence interval): 1.3 (1.1–1.2)). Educated mothers were less likely to stop breast-feeding before 4 months (white mothers, 0.8 (0.8–0.9); non-white mothers, 0.9 (0.8–1.0)) than those with no/minimal qualifications but, among ethnic minorities, were more likely to introduce solids early (1.3 (1.0–1.6)). Socio-economic status was positively associated with breast-feeding continuation among white women, and with age at introduction of solids among non-white women.

We have identified important geographic, ethnic and social inequalities in breast-feeding continuation and introduction of solids within the UK, many of which have not been reported previously. The factors mediating these associations are complex and merit further study to ensure that interventions proposed to promote maternal adherence to current infant feeding recommendations are appropriate and effective.

There is some evidence that plasma insulin levels might influence ovarian cancer risk. Glyacemic index (GI) and glycaemic load (GL) are measures that allow the carbohydrate content of individual foods to be classified according to their postprandial glycaemic effects and hence their effects on circulating insulin levels. Therefore, we examined ovarian cancer risk in association with GI and GL, and intake of dietary carbohydrate and sugar.

The study was conducted in a prospective cohort of 49 613 Canadian women enrolled in the National Breast Screening Study (NBSS) who completed a self-administered food-frequency questionnaire (FFQ) between 1980 and 1985. Linkages to national mortality and cancer databases yielded data on deaths and cancer incidence, with follow-up ending between 1998 and 2000. Data from the FFQ were used to estimate overall GI and GL, and Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between energy-adjusted quartile levels of GL, overall GI, total carbohydrates, total sugar and ovarian cancer risk.

During a mean 16.4 years of follow-up, we observed 264 incident ovarian cancer cases. GI and total carbohydrate and sugar intakes were not associated with ovarian cancer risk in the total cohort. GL was positively associated with a 72% increase in risk of ovarian cancer (HR = 1.72, 95% CI = 1.13–2.62, Ptrend = 0.01) and the magnitude of the association was slightly greater among postmenopausal (HR = 1.89, 95% CI = 0.98–3.65, Ptrend = 0.03) than among premenopausal women (HR = 1.64, 95% CI = 0.95–2.88, Ptrend = 0.07).

Our data suggest that consumption of diets with high GL values may be associated with increased risk of ovarian cancer.

Higher levels of insulin-like growth factor-I (IGF-I) and lower levels of IGF binding protein-3 (IGFBP-3) have been associated with an increased risk of prostate cancer. Nutrition is known to partially regulate IGF levels and it is possible that nutritional factors mediate the impact of IGF levels on prostate cancer risk.

A cross-sectional analysis of the impact of nutritional factors measured by a dietary questionnaire on plasma levels of IGF-I, IGFBP-3 and their molar ratio. Multiple linear regression analysis was used to test for effects of nutrients on IGF levels.

Prostate cancer screening at the Hollings Cancer Center in Charleston, South Carolina.

Ninety-five African American and 138 white males aged 33–83 years attending the screening.

In whites, intakes of total, saturated and monounsaturated fats were positively associated with an increase in the molar ratio, while there was no association in African Americans. In African Americans, we found that increasing intake of calcium and dairy servings was positively associated with IGF-I levels. Increased vegetable intake was positively associated with IGFBP-3 in African Americans, while there was no effect in whites. A higher percentage of alcohol in the total diet was significantly associated with a decrease in the molar ratio and an increase in IGFBP-3 in both groups.

Our results confirm previous findings of nutritional determinants of IGF levels. Additionally, we found the impact of several nutrients on IGF levels to be different in whites and African Americans, which warrants further investigation.

To evaluate the feasibility of undertaking a food skills intervention study in areas of social deprivation aimed at altering cooking confidence, food preparation methods and dietary choices.

A standardised skills programme was implemented in community-based settings. Pre- (T1) and post-intervention (T2) and 6-month follow-up (T3) measures (7-day diaries and self-administered questionnaires) were undertaken in intervention and comparison groups.

Eight urban communities in Scotland.

One hundred and thirteen adults living in areas of social deprivation.

It was clear that many subjects led fragmented lives and found commitment to intervention classes problematic. Sixty-three subjects completed the final (T3) assessments. The response to each component varied due to inability to attend sessions, illness, study requirements, employment, moving out of the area, change in circumstances, loss of interest and loss of postal questionnaires. At baseline, reported consumption of fruit and vegetables was low (mean frequency 8.1 ± 4.78 times per week). Fruit intake increased significantly (P < 0.05) between T1 and T2 in the intervention group (1.7 ± 2.36 to 2.7 ± 3.28 times per week) only. Between T1 and T3, there was a significant increase (P < 0.05) in intervention subjects who reported confidence in following a recipe (67–90%,).

This exploratory trial shows that a food skills intervention is likely to have a small but positive effect on food choice and confidence in food preparation. A full-scale randomised controlled trial in this hard-to-reach group would require a range of flexible approaches rather than a fully defined intervention, and presents challenges for trial design.

To assess the validity of the adapted Radimer/Cornell questionnaire to measure food insecurity in low-income urban households in Tehran, the capital of Iran.

The Radimer/Cornell questionnaire was modified and used to assess the applicability, validity and reliability of such a measure in a culturally different context of urban households in Tehran. Factor analysis and Cronbach's α were used to assess validity and reliability, respectively. Socio-economic characteristics and food consumption frequency of the household were used to assess the criterion validity of the questionnaire.

District 20 of Tehran.

A sample of 250 Iranian nuclear households with at least one child aged 1–18 years and a non-pregnant, non-lactating woman of reproductive age, selected through a multistage random sampling method.

Three scales, labelled as household, individual and child hunger, were extracted through factor analysis using varimax rotation. Internal consistency of the scales was 0.897, 0.820 and 0.796, respectively. Individual insecurity and child hunger were inversely correlated with monthly per capita income, father's education, mother's education and father's occupational status, and positively correlated with household size, as expected. However, household insecurity did not follow the same pattern. Consumption frequency of fruits, vegetables, dairy, red meat and rice declined as food insecurity status worsened, while bread and potato consumption increased.

The results show that a modified version of the Radimer/Cornell questionnaire is a valid and reliable instrument to measure household food insecurity in a culturally different context. However, further modifications seem necessary to measure food insecurity at household level. Results lend support to the utility and applicability of experience-based measures in varying cultural communities.

To determine the differences in macronutrient and food group contribution to total food and energy intakes between Estonian and Swedish under-, normal- and overweight schoolchildren, and to estimate the association between diet and body mass index (BMI).

Cross-sectional comparison between Estonian and Swedish children and adolescents of different BMI groups.

Twenty-five schools from one region in Estonia and 42 in two regions of central Sweden.

In total 2308 participants (1176 from Estonia and 1132 from Sweden), including 1141 children with a mean age of 9.6 ± 0.5 years and 1167 adolescents with a mean age of 15.5 ± 0.6 years.

Overweight was more prevalent among younger girls in Sweden (17.0 vs. 8.9%) and underweight among girls of both age groups in Estonia (7.9 vs. 3.5% in younger and 10.5 vs. 5.1% in older age group of girls). Compared with that of normal- and underweight peers, the diet of overweight Estonian children contained more energy as fat (36.8 vs. 31.7%) but less as carbohydrates, and they consumed more milk and meat products. Absolute BMI of Estonian participants was associated positively with energy consumption from eggs and negatively with energy consumption from sweets and sugar. Swedish overweight adolescents tended to consume more energy from protein and milk products. Risk of being overweight was positively associated with total energy intake and energy from fish or meat products. In both countries the association of overweight and biological factors (pubertal maturation, parental BMI) was stronger than with diet.

The finding that differences in dietary intake between under-, normal- and overweight schoolchildren are country-specific suggests that local dietary habits should be considered in intervention projects addressing overweight.

To determine missed opportunities and problems relating to implementation of the Vitamin A Supplementation Programme in urban and rural regions of the Western Cape Province of South Africa.

A cross-sectional survey was conducted at primary health-care (PHC) clinics in Cape Metropole, an urban region, and West Coast Winelands, a rural region, of the Western Cape. A purposive sample of clinics where more than 30 children were seen per day was drawn from 10 of the 11 districts in the Cape Metropole region and the two districts of the West Coast Winelands region. The number of children selected from each district was weighted in terms of population size for the two regions. At each clinic visited, the first five to 10 children seen on a day, and meeting the inclusion criteria for vitamin A supplementation (VAS) based on the vitamin A provincial policy guidelines, were selected. These included children with low birth weight (LBW), growth faltering, underweight and severe undernutrition, recurrent diarrhoea and lower respiratory tract infection (LRTI), tuberculosis, measles, HIV/AIDS and eye signs of vitamin A deficiency. Clinic records were reviewed following consultation with the PHC nurse to identify if the child required vitamin A, exit interviews were conducted with mothers/caregivers, and Road to Health Charts (RTHCs) were reviewed. At the end of the study, PHC managers were interviewed to determine if problems could be identified with the Programme.

Forty-three of 123 (35%) and 13 of 40 (33%) of the fixed PHC clinics in the Cape Metropole and West Coast Winelands regions were visited, and a total of 300 children (234 from Cape Metropole, 66 from West Coast Winelands) with a mean (standard deviation) age of 24.3 (16.3) months and who met the inclusion criteria for VAS were selected. Of the total sample of children, 198 (66%) had multiple (i.e. more than one) indication and 102 (34%) had a single indication for VAS. There were a total of 617 indications for VAS in the two regions; 238 (39%) for growth faltering, 119 (19%) for underweight, 98 (16%) for LBW, 70 (11%) for LRTI, 51 (8%) for diarrhoea, 21 (3%) for HIV/AIDS and 20 (3%) for tuberculosis. A total of 102 (34%) of the children in the two regions received vitamin A supplements (Cape Metropole 29%; West Coast Winelands 52%). A record was made on the RTHC of 79 (77%) of the children who received VAS (Cape Metropole 76%; West Coast Winelands 79%). Twenty-four per cent of the mothers knew why their child had been given vitamin A (Cape Metropole 29%; West Coast Winelands 12%). Eleven per cent of the mothers had previously heard about the Vitamin A Supplementation Programme (Cape Metropole 12%; West Coast Winelands 6%). More than 81% of PHC managers indicated that health staff had been trained to implement the Vitamin A Supplementation Programme. The main problems identified by health staff in the two regions were lack of vitamin A capsules, inadequate training and difficulties in implementing the Programme.

Opportunities to administer vitamin A were underutilised in both regions. Recommendations such as improving mothers' awareness of the benefits of vitamin A and training of PHC nurses were made to the provincial Department of Health and are being implemented to improve the effectiveness of the Programme.

To identify associations between dietary glycaemic index (GI) and weight, body mass index and other risk factors for cardiovascular disease (CVD) – waist-to-hip ratio (WHR), lipoprotein fractions, triacylglycerols (TAG) and blood pressure (BP) – in an older British population.

Cross-sectional dietary, anthropometric and biochemical data from the National Diet and Nutritional Survey for adults aged over 65 years were reanalysed using a hierarchical regression model. Associations between body weight, CVD risk factors, and dietary factors including GI and fibre intakes were explored among 1152 healthy older people living in the UK between 1994 and 1995.

In the unadjusted model, GI was significantly and directly associated with TAG (β = 0.008 ± 0.003) and diastolic BP (β = 0.325 ± 0.164) in males. These relationships were attenuated and non-significant after adjustment for potential confounding factors. WHR (β = 0.003 ± 0.001) and TAG (β = 0.005 ± 0.002) were significantly predicted by GI in males and females combined. The association with WHR was attenuated by adjustment for sex, age, region and social class; the relationship with TAG was non-significant after adjustment for other potential dietary confounders.

After controlling for potential confounders, no clear links were detected between GI and body weight or other CVD risk factors. This study provides little evidence for advising the consumption of a low-GI diet in the elderly to prevent weight gain or improve other CVD risk factors.

To determine whether maternal anthropometry predicted birth weight, and if so, to identify which cut-offs provided the best prediction of low birth weight (LBW) in a field situation.

Community-based longitudinal study.

A rural union of Bhaluka Upazila, Mymensingh, located 110 km north-west of Dhaka, the capital of Bangladesh.

A total of 1104 normotensive, non-smoking pregnant women who attended community nutrition centres were studied from first presentation at the centre until delivery of their child.

Most of the pregnant mothers were between 20 and 34 years of age. Over one-third of the women were nulliparous, while 12.8% were multiparous (parity ≥ 4). Most (93%) mothers registered between the 3rd and 5th month of pregnancy. The frequency of LBW ( < 2500 g) was 17%. Polynomial regression analyses showed that the best predictors of birth weight (based on adjusted R2 values) were in general weight at registration and weight at month 9, with adjusted R2 ranging from 2.5% to nearly 20%. Sequential regression analyses with height and weight showed that there was a significant effect of height after removing the weight variables, and adjusted R2 increased in all analyses. Weight and height at registration month continued to be the best predictors of LBW. Sensitivity and specificity curves were drawn for each registration month, body mass index and different weight gain groups, and using different weight and height combinations. The results showed that, for registration month 3–5, a combination of weight ( ≤ 45 kg) and height ( ≤ 150 cm) gave the highest sensitivity, which was 50%. However, maternal weight ≤ 43 kg in pregnancy month 3–5 alone gave the highest sensitivity of 80%.

The best predictor of birth weight as a continuous variable was maternal weight at registration, each 1 kg increase in weight at registration being associated with an increase in birth weight of about 260 g. Maternal weight ≤ 43 kg in pregnancy month 3–5 alone gave the highest sensitivity of 80%. A combination of initial weight and height of the mother was not as good a predictor of LBW as weight alone.

To study the relationship between exercise by the mother and breast-feeding initiation and duration, and its effect on infant growth.

A cohort study of mothers and infants, recruited at birth. Infant feeding methods were recorded in detail and breast-feeding was categorised as ‘any’ or ‘full’. Exercise levels were categorised using the metabolic equivalent tasks approach based on details of physical activity recorded in questionnaires.

Perth, Western Australia.

A total of 587 mothers were interviewed on seven occasions over a period of 12 months.

There was no difference in the means of infant weight and length changes, indicating that exercise appeared to have no significant influence on infant growth up to 52 weeks after birth (P = 0.236 and 0.974, respectively). The mother's level of exercise was not significantly associated with breast-feeding to 6 or 12 months. This applied to ‘full’ and ‘any’ categories of breast-feeding.

Exercise does not affect breast-feeding outcomes at the usual levels of activity undertaken by mothers. Breast-feeding and exercise are important for maintaining and promoting health, and this study provides reassurance to health professionals wishing to encourage mothers to continue both behaviours.

To compare diet measures from a food-frequency questionnaire (FFQ) with measures from 24-hour dietary recalls (24HDRs).

The participants answered an FFQ after completing four, repeated 24HDRs during a year.

Norway, nationwide.

Of 500 women randomly selected from The Norwegian Women and Cancer Study (the Norwegian arm of the European Prospective Investigation into Cancer and Nutrition), 286 agreed to participate and 238 completed the study.

On the group level, the FFQ overestimated absolute intake in seven and underestimated intake in six of 21 food groups. Intakes of energy, fat, added sugar and alcohol were lower in the FFQ than in the 24HDRs, whereas intake of fibre was higher. Spearman's rank correlation coefficient ranged from 0.13 (desserts) to 0.82 (coffee) for foods, and from 0.25 (β-carotene) to 0.67 (alcohol) for nutrients. Three per cent of the observations on nutrient intake fell in the opposite quintile when classified according to the FFQ as compared with the 24HDR. The median calibration coefficient, calculated by regression of the 24HDR data on the FFQ data, was 0.57 for foods and 0.38 for nutrients.

The FFQ's ability to rank subjects was good for foods eaten frequently and fairly good for macronutrients in terms of energy percentages. Weaker ranking abilities were seen for foods eaten infrequently and for some micronutrients. The results underline the necessity of performing measurement error corrections.