In anticipation of the revision of the 1985 Food and Agricultural Organization/World Health Organization/United Nations University (FAO/ WHO/UNU) Expert Consultation Report on ‘Energy and Protein Requirements’, recent scientific knowledge on the principles underlying the estimation of energy requirement is reviewed.

This paper carries out a historical review of the scientific rationale adopted by previous FAO/WHO technical reports on energy requirement, discusses the concepts used in assessing basal metabolic rate (BMR), energy expenditure, physical activity level (PAL), and examines current controversial areas. Recommendations and areas of future research are presented.

The database of the BMR predictive equations developed by the 1985 FAO/WHO/UNU Expert Consultation Report on Energy and Protein Requirements needs updating and expansion, applying strict and transparent selection criteria. The existence of an ethnic/tropical factor capable of affecting BMR is not supported by the available evidence. The factorial approach for the calculation of energy requirement, as set out in the 1985 report, should be retained. The estimate should have a normative rather than a prescriptive nature, except for the allowance provided for extra physical activity for sedentary populations, and for the prevention of non-communicable chronic diseases. The estimate of energy requirement of children below the age of 10 years should be made on the basis of energy expenditure rather than energy intake. The evidence of the existence of an ethnic/tropical factor is conflicting and no plausible mechanism has as yet been put forward.

To evaluate the effect of iron supplementation on mental and motor development in children through a systematic review of randomised controlled trials (RCTs).

Electronic databases, personal files, hand search of reviews, bibliographies of books, abstracts and proceedings of international conferences.

RCTs with interventions that included oral or parenteral iron supplementation, fortified formula milk or cereals were evaluated. The outcomes studied were mental and motor development scores and various individual development tests employed, including Bayley mental and psychomotor development indices and intelligence quotient.

The pooled estimate (random effects model) of mental development score standardised mean difference (SMD) was 0.30 (95% confidence interval (CI) 0.15 to 0.46, P < 0.001; P < 0.001 for heterogeneity). Initial anaemia and iron-deficiency anaemia were significant explanatory variables for heterogeneity. The pooled estimate of Bayley Mental Development Index (weighted mean difference) in younger children (<27 months old) was 0.95 (95% CI −0.56 to 2.46, P = 0.22; P = 0.016 for heterogeneity). For intelligence quotient scores (≥8 years age), the pooled SMD was 0.41 (95% CI 0.20 to 0.62, P < 0.001; P = 0.07 for heterogeneity). There was no effect of iron supplementation on motor development score (SMD 0.09, 95% CI -0.08 to 0.26, P = 0.28; P = 0.028 for heterogeneity).

Iron supplementation improves mental development score modestly. This effect is particularly apparent for intelligence tests above 7 years of age and in initially anaemic or iron-deficient anaemic subjects. There is no convincing evidence that iron treatment has an effect on mental development in children below 27 months of age or on motor development.

To investigate trends in child malnutrition in six countries in southern Africa, in relation to the HIV epidemic and drought in crop years 2001/2 and 2002/3.

Epidemiological analysis of sub-national and national surveys with related data.

Data from Lesotho, Malawi, Mozambique, Swaziland, Zambia and Zimbabwe, compiled and analysed under UNICEF auspices.

Secondary data: children 0–5 years for weight-for-age; HIV prevalence data from various sources especially antenatal clinic surveillance.

Child nutritional status as measured by prevalence of underweight deteriorated from 2001 onwards in all countries except Lesotho, with very substantial increases in some provinces/districts (e.g. from 5 to 20% in Maputo (Mozambique, 1997–2002), 17 to 32% in Copperbelt (Zambia, 1999–2001/2) and 11 to 26% in Midlands province (Zimbabwe, 1999–2002)). Greater deterioration in underweight occurred in better-off areas. Areas with higher HIV/AIDS prevalences had (so far) lower malnutrition rates (and infant mortality rates), presumably because more modern areas – with greater reliance on trade and wage employment – have more HIV/AIDS. Areas with higher HIV/AIDS showed more deterioration in child nutrition. A significant area-level interaction was found of HIV/AIDS with the drought period, associated with particularly rapid deterioration in nutritional status.

First, the most vulnerable may be households in more modern areas, nearer towns, to whom resources need to be directed. Second, the causes of this vulnerability need to be investigated. Third, HIV/AIDS amplifies the effect of drought on nutrition, so rapid and effective response will be crucial if drought strikes again. Fourth, expanded nutritional surveillance is now needed to monitor and respond to deteriorating trends. Finally, with or without drought, new means are needed of bringing help, comfort and assistance to the child population.

To identify challenges in translating scientific evidence of a nutrient and health relationship into mandatory food fortification policy.

A case study approach was used in which available evidence associated with the folate–neural tube defect relationship was reviewed against the Australia New Zealand Food Regulation Ministerial Council's Policy Guideline for mandatory food fortification.

Three particular challenges were identified. The first is knowing when and how to act in the face of scientific uncertainty. The second is knowing how to address the special needs of at-risk individuals without compromising the health and safety of the population as a whole. The third is to ensure that a policy is sufficiently monitored and evaluated.

Despite the availability of compelling evidence of a relationship between a particular nutrient and a health outcome, a definitive policy response may not be apparent. Judgement and interpretation inevitably play significant roles in influencing whether and how authorities translate scientific evidence into mandatory food fortification policy. In relation to the case study, it would be prudent to undertake a risk–benefit analysis of policy alternatives and to implement nutrition education activities to promote folic acid supplement use among the target group. Should mandatory folate fortification be implemented, comprehensive monitoring and evaluation of this policy will be essential to know that it is implemented as planned and does more good than harm. In relation to mandatory food fortification policy-making around the world, ongoing national nutrition surveys are required to complement national policy guidelines.

To investigate the prevalence of anaemia and iron deficiency and vitamin A status among school-aged children in rural Kazakhstan and identify factors associated with anaemia in this population.

A cross-sectional design.

School-aged children in rural Kazakhstan.

Socio-economic and anthropometric information was collected from 159 school-aged children living in the Kzyl-Orda region of Kazakhstan. Blood samples were collected and the concentrations of haemoglobin (Hb), serum iron, serum ferritin (SF), erythrocyte protoporphyrin (EP), serum retinol and β-carotene, total iron binding capacity (TIBC), transferrin saturation (TS) and other haematological indices were measured.

Among the 159 children, the prevalence of anaemia and iron deficiency defined by the multiple criteria model (SF, TS and EP) was 27% and 13%, respectively. Nine per cent had iron-deficiency anaemia and 21% had serum retinol value <1.05 μmol l−1. Mean SF and serum iron concentrations and TS were significantly lower in anaemic children than in their non-anaemic peers, while TIBC and EP were significantly higher in children with anaemia. Hb was significantly correlated with serum iron and retinol concentrations. Serum retinol and SF concentrations and mean corpuscular volume were significantly correlated with Hb by multiple regression analysis.

Anaemia among school-aged children in rural Kazakhstan appears to be related to iron indices and vitamin A status.

To examine the role of foreign direct investment (FDI) in the nutrition transition, focusing on highly processed foods.

Data on FDI were identified from reports/databases and then compiled and analysed. A review of published literature on FDI into the food sector was conducted.

The nutrition transition is a public health concern owing to its connection with the rising burden of obesity and diet-related chronic diseases in developing countries. Global health leaders are calling for action to address the threat. Highly processed foods often have considerable fat, sugar and salt content, and warrant closer examination.

FDI into food processing, service and retail has risen rapidly since the 1980s, mainly from transnational food companies (TFCs) in developed countries. As FDI has risen, so has the proportion invested in highly processed foods for sale in the host market. FDI has proved more effective than trade in generating sales of highly processed foods, and enables TFCs to cut costs, gain market power and obtain efficiencies in distribution and marketing. The amount of FDI targeted at developing countries is increasing; while a disproportionate share enters the larger developing economies, foreign affiliates of TFCs are among the largest companies in low- and low- to middle-income countries. The effect of FDI is to make more highly processed foods available to more people. FDI has made it possible to lower prices, open up new purchasing channels, optimise the effectiveness of marketing and advertising, and increase sales.

FDI has been a key mechanism in shaping the global market for highly processed foods. Notwithstanding the role of demand-side factors, it has played a role in the nutrition transition by enabling and promoting the consumption of these foods in developing countries. Empirical data on consumption patterns of highly processed foods in developing countries are critically needed, but since FDI is a long-term investment vehicle, it is reasonable to assume that availability and consumption of highly processed foods will continue to increase. FDI can, however, bring considerable benefits as well as risks. Through its position ‘upstream’, FDI would therefore be an appropriate entry-point to implement a range of public health policies to ‘redirect’ the nutrition transition.

Although many school-based diet and physical activity interventions have been designed and evaluated, relatively few have been tested for the after-school setting. After-school day-care programmes at either elementary schools or private locations provide a ready-made opportunity for health programmes that may be difficult to incorporate into an already-full school day. The purpose of this paper is to report on a pilot study of an after-school adaptation of the CATCH (Coordinated Approach To Child Health) elementary school programme called the CATCH Kids Club (CKC).

The CKC was pilot-tested and formatively evaluated in 16 Texas after-school programmes: eight in El Paso and eight in Austin (four intervention and four reference sites each). Evaluation consisted of direct observation of moderate to vigorous physical activity during play time, self-reported food intake and physical activity, and focus group interviews with after-school programme staff.

Students responded well to the physical activity and snack components and were less interested in the five-module education component. Routine staff training was a key variable in achieving proper implementation; the ideal would be a full day with repeated follow-up model teaching visits. Staff turnover was a logistic issue, as was programme leader readiness and interest in conducting the programme. Strong and significant effects were observed for the physical activity but not for the education component. The results of the physical education component suggest it is feasible, effective and ready for larger-scale evaluation or dissemination.

To estimate the intakes of cereal and dairy products and their contribution to nutrient intakes in men and women from the Republic of Ireland with a view to formulating food-based dietary guidelines.

The North/South Ireland Food Consumption Survey established a database of habitual food and drink consumption using a 7-day food diary. From this database all cereal and dairy products from recipes and identifiable sources were identified and a new database was generated from which analysis of the role of cereal and dairy products in the diet was carried out.

Almost 100% of the population consumed cereal and dairy products over the course of the survey week. In general, men consumed significantly more cereal and dairy products than did women (P<0.05). Cereal products made an important contribution to the mean daily intakes of energy (26%), protein (21%), fat (13%), carbohydrate (41%), fibre (45%), iron (43%) and folate (27%). Dairy products also contributed largely to the mean daily intakes of energy (11%), protein (14%), fat (17%), calcium (48%), phosphorus (24%) and vitamin A (27%). Analysis of nutrient intakes across tertiles of cereal and dairy consumption showed that high consumers of wholemeal bread, breakfast cereals, reduced-fat milk and yoghurt had lower fat and higher carbohydrate, fibre and micronutrient intakes than low consumers of these foods.

Findings from the present study could be used to develop effective health strategies to implement changes in cereal and dairy consumption that could alter fat, fibre and micronutrient intakes in the diet.

To set out a policy analysis of food taxes as a way of influencing food consumption and behaviour.

The study draws on examples of food taxes from the developed world imposed at national and local levels. Studies were identified from a systemised search in six databases with criteria designed to identity articles of policy relevance.

The dominant approach identified from the literature was the imposition of food taxes on food to raise general revenue, such as Value Added Tax in the European Union. Food taxes can be applied in various ways, ranging from attempts to directly influence behaviour to those which collect taxes for identified campaigns on healthy eating through to those applied within closed settings such as schools. There is a case for combining taxes of unhealthy foods with subsidies of healthy foods. The evidence from the literature concerning the use and impact of food taxes on food behaviour is not clear and those cases identified are mainly retrospective descriptions of the process. Many food taxes have been withdrawn after short periods of time due to industry lobbying.

Small taxes with the clear purpose of promoting the health of key groups, e.g. children, are more likely to receive public support. The focus of many tax initiatives is unclear; although they are generally aimed at consumers, another focus could be food manufacturers, using taxes and subsidies to encourage the production of healthier foods, which could have an effect at a population level. Further consideration needs to be given to this aspect of food taxes. Taxing food (and subsidies) can influence food behaviour within closed systems such as schools and the workplace.

Menstrual disorders are common in young women, and heavy menstrual blood losses (MBL) are an important cause of anaemia. Menstrual morbidity normally goes untreated in developing countries where cultural barriers also serve to make the problems. We investigated the prevelance of menstrual morbidity, and measured MBL and its relationship to iron deficiency in a rural adolescent population. The rationale was to assess whether or not reducing heavy MBL could be part of a strategy to reduce iron deficiency anaemia.

Rural village in south-east Nigeria.

Cross-sectional survey.

The studdy included all non-pregnant, unmarried nulliparous girls (< 20 years) who had menstruated, and who lived in K'Dere village.

A field worker allocated to each girl completed a questionnaire, and supervised recovery and collection of soiled pads and ensured blood sampling. MBL was measured using the standard alkaline haematin method. Haemoglobin (HB), serum iron, transferin saturation and protoporphyrin levels (ZPP) were also measured.

307 girls completed MBL measurements; 11.9% refused to participate. 12.1% had menorrhagia (> 80 ml);. median MBL was 33.1 ml. Menorrhagia was more frequent in girls who had menstruated for > 2 years (p = 0.048), and had longer duration of meneses (p < 0.001). Iron status as measured by haematocrit, serum iron, transferrin saturation and ZPP values was inversely related to MBL. Neither height nor body mass index for age was associated with current iron status.

The level of menorrhagia detected (12%) may be an ‘expected’ level for a condition which often has no underlying pathology. Heavy MBL is one of the most important factors contributing to iron deficiency anaemia. Measures are needed to alleviate menstrual disorders and improve iron status. Oral contraceptives can be part of a strategy to reduce anaemia, particularly for adolescents at high risk of unwanted pregnancies.

To show that nutrition science, with its application to food and nutrition policy, now needs a new conceptual framework. This will incorporate nutrition in its current definition as principally a biological science, now including nutritional aspects of genomics. It will also create new governing and guiding principles; specify a new definition; and add social and environmental dimensions and domains.

A narrative review of nutrition science, its successes and achievements, and its dilemmas, paradoxes, shortcomings, dissonances and challenges. Reference is made to 16 associated papers. Equal use is made of continuous text and of boxed texts that extend the review and give salient examples.

Recent and current interrelated electronic and genomic discoveries and linked sequential demographic, nutritional and epidemiological shifts, in the context of associated and interlinked global social, cultural, environmental, economic, political and other developments, altogether amount to a world in revolution, requiring all disciplines including that of nutrition science to make comparably radical responses.

Nutrition in principle and practice should be a biological and also an environmental and social science. This new broad integrated structure brings much recent and current progressive work into the centre of nutrition science, and in some ways is a renewal of the period when nutrition science had its greatest impact. It amounts to a map charting well-known and also new worlds. The new nutrition science is concerned with personal and population health, and also with planetary health – the welfare and future of the whole physical and living world of which humans are a part. In this way the discipline will make a greater contribution to the preservation, maintenance, development and sustenance of life on Earth, appropriate for the twenty-first century.

To estimate the energy requirements of infants from total energy expenditure and energy deposition during growth.

Energy requirements during infancy were estimated from total energy expenditure measured by the doubly labelled water method and energy deposition based on measured protein and fat gains.

Database on the total energy expenditure and energy deposition of infants was compiled from available studies conducted in China, Chile, Gambia, Mexico, Netherlands, UK, and USA.

Healthy, term infants.

Total energy requirements (kJ day−1) increased with age and were higher in boys than girls due to differences in weight. Energy requirements decreased from 473 kJ kg−1 per day for boys and 447 kJ kg−1 per day for girls at 1 month of age to 337 kJ kg−1 per day for boys and 341 kJ kg−1 per day for girls at 6 months of age, and thereafter tended to plateau. Energy deposition as a percentage of total energy requirements decreased from 40% at 1 month to 3% at 12 months of age. These estimates are 10–32% lower than the 1985 FAO/WHO/UNU recommendations which were based on observed energy intakes of infants.

Recommendations for the energy intake of infants should be revised based on new estimates of total energy expenditure and energy deposition.