The Nutritional Support for Africans Starting Antiretroviral Therapy (NUSTART) trial was designed to determine whether nutritional support for malnourished HIV-infected adults starting antiretroviral therapy (ART) can improve early survival. Appetite is related to health outcomes in this population, but the optimal appetite metric for field use is uncertain. We evaluated two measures of appetite with the goal of improving understanding and treatment of malnutrition in HIV-infected adults.

Longitudinal cohort study embedded in a clinical trial of vitamin and mineral-fortified, v. unfortified, lipid-based nutritional supplements.

HIV clinics in Mwanza, Tanzania and Lusaka, Zambia.

Malnourished (BMI<18·5 kg/m2) HIV-infected adults starting ART.

Appetite measurements, by short questionnaire and by weight of maize porridge consumed in a standardized test, were compared across time and correlated with changes in weight. Appetite questionnaire scores, from polychoric correlation, and porridge test results were normally distributed for Tanzanians (n 187) but clustered and unreliable for Zambians (n 297). Among Tanzanian patients, the appetite score increased rapidly from referral for ART, plateaued at the start of ART and then increased slowly during the 12-week follow-up. Change in appetite questionnaire score, but not porridge test, correlated with weight change in the corresponding two-week intervals (P=0·002) or over the whole study (P=0·05) but a point estimate of hunger did not predict weight change (P=0·4).

In Tanzania change in appetite score correlated with weight change, but single point measurements did not. Appetite increases several weeks after the start of ART, which may be an appropriate time for nutritional interventions for malnourished HIV-infected adults.

Although emerging evidence indicates an association between vitamin D and serum lipids, the data are still inconsistent. The purpose of the present study was to investigate whether 25-hydroxycholecalciferol (25-hydroxyvitamin D3; 25(OH)D3) or intact parathyroid hormone (iPTH) was independently related to serum lipids in elderly women and men.

Cross-sectional study. Fasting serum levels of 25(OH)D3, iPTH, TAG, total cholesterol (TC), HDL cholesterol (HDL-C) and LDL cholesterol (LDL-C) were assessed. Body composition was measured by bioelectrical impedance analysis. Lifestyle factors, such as nutrient intake, time spent outdoors, physical activity, smoking, supplement intake and medication, were assessed by questionnaires. Multiple regression analyses were performed to examine associations of 25(OH)D3 and iPTH with serum lipids.

Giessen, Germany.

One hundred and ninety-three well-functioning German elderly aged 66–96 years.

After adjusting for age, body fat, physical activity, smoking, alcohol intake, lipid-modifying drugs and either iPTH or 25(OH)D3, 25(OH)D3 was a predictor of TAG (standardised coefficient beta (β)=–0·180), HDL-C (β=0·197), LDL-C:HDL-C (β=−0·298) and TC:HDL-C (β=−0·302) in women, whereas iPTH was a predictor of HDL-C (β=−0·297) in men. In sub-analysis, associations between 25(OH)D3 and TC (β=−0·252), HDL-C (β=0·230), LDL-C (β=−0·324), LDL-C:HDL-C (β=−0·412) and TC:HDL-C (β=−0·380) were found in women with 25(OH)D3 concentrations above or equal the median vitamin D status (62·3 nmol/l), but not in women with lower 25(OH)D3 concentrations.

In the elderly, associations of 25(OH)D3 and iPTH with serum lipids may differ by sex and may require a vitamin D status above 62 nmol/l.

Assessing the level of adherence and its determinants is important in appraising the overall effectiveness of trials. The present study aimed to evaluate the extent of adherence and its determinants in a pragmatic randomized controlled trial of Fe prophylaxis during pregnancy in Maputo, Mozambique.

A pragmatic randomized controlled trial.

Two health centres (1o de Maio and Machava) in Maputo, Mozambique.

Pregnant women (≥12 weeks’ gestation, ≥18 years old, non-high-risk pregnancy; n 4326) attending prenatal care consultations at two health centres were randomized to receive routine Fe (n 2184; 60 mg ferrous sulfate plus 400 μg folic acid daily throughout pregnancy) or selective Fe (n 2142; screening and treatment for anaemia and daily intake of 1 mg folic acid).

The level of adherence was 79 % for having two or more visits, 53 % for adequate prenatal care and 67 % for complete intake of Fe/folic acid tablets during the trial. The correlation between the adherence measures ranged between 0·151 and 0·739. Adherence did not differ by trial arm, but there were centre differences in adequate prenatal visits and intake of tablets. Older women (>20 years) and those with a history of abortion were more likely to achieve greater adherence, whereas an increased number of previous births decreased the likelihood of adherence. HIV positivity decreased the likelihood of adherence in one trial centre and increased it in the other.

The variation in adherence by trial centre, women’s characteristics and outcome measures suggests that adherence in trials fully depends on participants’ behaviour and can be increased by paying attention to contextual factors.

To examine cross-sectional relationships between plasma vitamin D and cardiometabolic risk factors in young adults.

Data were collected from interviews, physical examinations and biomarker measurements. Total plasma 25-hydroxyvitamin D (25(OH)D) was measured using LC–tandem MS. Associations between 25(OH)D and cardiometabolic risk factors were modelled using weighted linear regression with robust estimates of standard errors.

Individuals born in Jerusalem during 1974–1976.

Participants of the Jerusalem Perinatal Study (n 1204) interviewed and examined at age 32 years. Participants were oversampled for low and high birth weight and for maternal pre-pregnancy obesity.

Mean total 25(OH)D concentration among participants was 21·7 (sd 8·9) ng/ml. Among males, 25(OH)D was associated with homeostatic model assessment of insulin resistance (natural log-transformed, β=−0·011, P=0·004) after adjustment for BMI. However, these associations were not present among females (P for sex interaction=0·005).

We found evidence for inverse associations of 25(OH)D with markers of insulin resistance among males, but not females, in a healthy, young adult Caucasian population. Prospective studies and studies conducted on other populations investigating sex-specific effects of vitamin D on cardiometabolic risk factors are warranted.

In life-cycle assessment, the functional unit defines the unit for calculation of environmental indicators. The objective of the present study was to assess the influence of two functional units, 100 g and 100 kcal (420 kJ), on the associations between three dimensions for identifying sustainable foods, namely environmental impact (via greenhouse gas emissions (GHGE)), nutritional quality (using two distinct nutrient profiling systems) and price.

GHGE and price data were collected for individual foods, and were each expressed per 100 g and per 100 kcal. Two nutrient profiling models, SAIN,LIM and UK Ofcom, were used to assess foods’ nutritional quality. Spearman correlations were used to assess associations between variables. Sustainable foods were identified as those having more favourable values for all three dimensions.

The French Individual and National Dietary Survey (INCA2), 2006–2007.

Three hundred and seventy-three foods highly consumed in INCA2, covering 65 % of total energy intake of adult participants.

When GHGE and price were expressed per 100 g, low-GHGE foods had a lower price and higher SAIN,LIM and Ofcom scores (r=0·59, −0·34 and −0·43, respectively), suggesting a compatibility between the three dimensions; 101 and 100 sustainable foods were identified with SAIN,LIM and Ofcom, respectively. When GHGE and price were expressed per 100 kcal, low-GHGE foods had a lower price but also lower SAIN,LIM and Ofcom scores (r=0·67, 0·51 and 0·47, respectively), suggesting that more environment-friendly foods were less expensive but also less healthy; thirty-four sustainable foods were identified with both SAIN,LIM and Ofcom.

The choice of functional unit strongly influenced the compatibility between the sustainability dimensions and the identification of sustainable foods.

To explore the perceptions of educators from the Western Cape Province about the feasibility of implementing South African food-based dietary guidelines (FBDG) in the national curriculum of primary schools.

Combined quantitative and qualitative methods. We report on the quantitative component.

Twelve public primary schools of different socio-economic status in three education districts of the Western Cape: Metro Central, Metro East and Cape Winelands.

Educators (n 256) participated in the self-completed questionnaire survey.

Educators assessed that FBDG were appropriate to South African schoolchildren (94%), could be used as an education tool (97%) and fill gaps in the current curriculum about healthy dietary habits (91%). Besides Life Orientation, FBDG could be taught in other learning areas from grades 3 to 7 (9–13 years old). Important barriers to implementing FBDG in the curriculum were educators’ workload (61%), insufficient time (46%), learners’ disadvantaged background (43%) and educators’ lack of knowledge (33%). Other approaches to teach children about FBDG included linking these to the National School Nutrition Programme (82%), school tuck shops (79%), parent meetings (75%), school nutrition policy (73%) and school assembly (57%). Educators in high-income schools perceived that learners’ lifestyle was significantly worse (P < 0·001) and that tuck shops and the school assembly were the best means to teach pupils about FBDG (P < 0·001 and P < 0·05).

Implementing FBDG in the national school curriculum is seen as important together with optimizing the school physical environment. Key factors required for successful implementation in the curriculum are sufficient educational materials, adequate time allocation and appropriate educator training.

Folate and vitamin B12 are two vital regulators in the metabolic process of homocysteine, which is a risk factor of atherothrombotic events. Low folate intake or low plasma folate concentration is associated with increased stroke risk. Previous randomized controlled trials presented discordant findings in the effect of folic acid supplementation-based homocysteine lowering on stroke risk. The aim of the present review was to perform a meta-analysis of relevant randomized controlled trials to check the how different folate fortification status might affect the effects of folic acid supplementation in lowering homocysteine and reducing stroke risk.

Relevant randomized controlled trials were identified through formal literature search. Homocysteine reduction was compared in subgroups stratified by folate fortification status. Relative risks with 95 % confidence intervals were used as a measure to assess the association between folic acid supplementation and stroke risk.

The meta-analysis included fourteen randomized controlled trials,

A total of 39 420 patients.

Homocysteine reductions were 26·99 (sd 1·91) %, 18·38 (sd 3·82) % and 21·30 (sd 1·98) %, respectively, in the subgroups without folate fortification, with folate fortification and with partial folate fortification. Significant difference was observed between the subgroups with folate fortification and without folate fortification (P=0·05). The relative risk of stroke was 0·88 (95 % CI 0·77, 1·00, P=0·05) in the subgroup without folate fortification, 0·94 (95 % CI 0·58, 1·54, P=0·82) in the subgroup with folate fortification and 0·91 (95 % CI 0·82, 1·01, P=0·09) in the subgroup with partial folate fortification.

Folic acid supplementation might have a modest benefit on stroke prevention in regions without folate fortification.

To explore (i) the prevalence of thyroid dysfunction in populations with adequate and excessive iodine intakes and (ii) the effect of iodine exposure on the prevalence of thyroid dysfunction.

Cross-sectional study was conducted in Hebei in 2010. The population was classified as having adequate or excessive iodine intake according to the iodine concentration in drinking water. Demographic information was collected by questionnaire. Levels of serum thyroid hormones, thyroid autoantibodies and iodine in drinking water and urine were measured.

Villages with adequate or excessive drinking water iodine in Hebei Province, People’s Republic of China.

A total of 854 men and women aged 20–50 years who had lived in the surveyed areas for over 5 years, including 348 from the adequate iodine area (AIA) and 506 from the excessive iodine area (EIA).

Median urinary iodine concentration was 185 μg/l in AIA and 1152 μg/l in EIA. The prevalence of thyroid dysfunction in AIA was 10·3 %, which included 1·1 % with hypothyroidism and 8·1 % with subclinical hypothyroidism; and 20·6 % in EIA, which included 3·6 % with hypothyroidism and 13·6 % with subclinical hypothyroidism. The positive rates of thyroglobulin antibody were 16·1 % in AIA and 11·9 % in EIA; the positive rates of thyroperoxidase antibody were 20·7 % in AIA and 16·4 % in EIA.

Excessive iodine intake may lead to increased prevalence of biochemical thyroid dysfunction, especially biochemical hypothyroidism. This is not related to an increase in prevalence of thyroid antibodies. Women are more susceptible to iodine excess.

To investigate the differences in acculturation experiences between parent and adolescent refugees from the Horn of Africa in Melbourne, Australia and to explore food beliefs and perceived health risks from an intergenerational perspective.

Qualitative cross-sectional study involving a combination of semi-structured one-on-one interviews and focus group discussions.

North-West suburbs of Melbourne, Australia.

Eritrean, Ethiopian, Somali and Sudanese refugees.

Using a purposeful sampling technique, twelve semi-structured face-to-face interviews (nine adults and three adolescents) and four in-depth focus groups (two with adolescents each containing six participants and two with adults one containing six participants and the other ten participants) were carried out. Thus overall data were obtained on fifteen adolescents and twenty-five parents. Qualitative analysis identified differences between parents and adolescents in relation to lifestyle, diet and physical activity. Views regarding health consequences of their changed diets also differed. Parental feeding practices encompassed a variety of methods and were enforced in an attempt by parents to control their children's dietary behaviours and prevent their drift away from traditional eating habits.

These findings call for more research to contextualise dietary acculturation among refugee youth and the impact of migration on parenting styles and feeding practices in communities from the Horn of Africa. Preventive health programmes with Horn of Africa refugees need to acknowledge the effect of acculturation on diet and physical activity levels and a socio-cultural framework needs to be developed with respect to the importance and influence of the family environment.

To determine key points of intervention in urban food systems to improve the climate resilience, equity and healthfulness of the whole system.

The paper brings together evidence from a 3-year, Australia-based mixed-methods research project focused on climate change adaptation, cities, food systems and health. In an integrated analysis of the three research domains – encompassing the production, distribution and consumption sectors of the food chain – the paper examines the efficacy of various food subsystems (industrial, alternative commercial and civic) in achieving climate resilience and good nutrition.

Greater Western Sydney, Australia.

Primary producers, retailers and consumers in Western Sydney.

This overarching analysis of the tripartite study found that: (i) industrial food production systems can be more environmentally sustainable than alternative systems, indicating the importance of multiple food subsystems for food security; (ii) a variety of food distributors stocking healthy and sustainable items is required to ensure that these items are accessible, affordable and available to all; and (iii) it is not enough that healthy and sustainable foods are produced or sold, consumers must also want to consume them. In summary, a resilient urban food system requires that healthy and sustainable food items are produced, that consumers can attain them and that they actually wish to purchase them.

This capstone paper found that the interconnected nature of the different sectors in the food system means that to improve environmental sustainability, equity and population health outcomes, action should focus on the system as a whole and not just on any one sector.