The aim was to contribute to the nutritional well-being of young children living in Duncan Village by investigating factors that influence clinic attendance of mothers and to formulate recommendations for optimisation of accessibility of primary health care (PHC) clinics in the area.

PHC clinic accessibility was evaluated by assessing the experiences of mothers who attended clinics in the area as well as the experiences of health care workers (HCWs) in these clinics of service delivery and its recipients (mothers/children), using the focus group technique. The ATLAS/ti program was used to analyse the data in the following steps: preparation and importing of the data, getting to know and coding the data, retrieval and examination of codes and quotations, creation of families and creation of networks.

Duncan Village, a low socio-economic urban settlement in East London, South Africa.

Focus group discussions (four to seven participants per group) were conducted with four groups of mothers who do not attend PHC clinics, six with mothers who do attend the clinics (including pregnant women) and four groups of HCWs.

Four networks that provide a summary of all the major trends in the data were created. The results clearly indicate that mothers in Duncan Village perceive and/or experience serious problems that make it difficult for them to attend clinic and even prevent them from doing so. These problems include both the way they are treated at the clinics (especially the problem of verbal abuse) as well as the actual services delivered (no medicines, no help, disorganised, long waiting periods, being turned away). The main problem experienced by the HCWs with service delivery seems to be a heavy workload, as well as the fact that many mothers do not come for follow-up visits.

Efforts to increase the accessibility of PHC clinics in Duncan Village should focus on improving the relationship between mothers and HCWs and the heavy workload experienced by these workers.

To examine dietary change that has occurred over 5 to 6 years.

A cohort of Scottish women (n=898) with a mean age of 47.5 years (range 45–54 years) at baseline.

Dietary intake was assessed by validated food-frequency questionnaire (FFQ) and analysed using the UK Composition of Foods database.

Since the first dietary assessment, mean daily energy intake had decreased from 8.2±2.3 to 7.9±2.2 MJ. The degree of low energy reporting (defined as ratio of energy intake to basal metabolic rate >1.1) had increased from 18.7% at baseline to 25.6% at follow-up. Low energy reporters were significantly heavier than ‘normal’ energy reporters (mean weight at follow-up, 68.9±12.6 vs. 66.8±11.3 kg) and could be deliberately restricting intake rather than underreporting. Overall there were decreases in intakes of red meat, processed meat and cheese, but increases in poultry and non-oily fish consumption. Consumption of bread, biscuits and cakes had gone down and there was an increase in cereal and rice/pasta consumption. Intake of potatoes had decreased whereas fruit intake had increased. There were small but statistically significant differences in intakes for most nutrients (>8% change). Nutrient intakes at both visits were similar across menopausal status and usage groups of hormone replacement therapy. Modifications to the computer version of the McCance and Widdowson nutrient database, which differed from the published version, were noted. These changes altered the original baseline values for our study.

The menopause per se is not a period of marked change in nutrient intake. Caution is advised when using computer databases of food compositions for longitudinal studies.

The role played by lay knowledge in understanding health inequalities has received increased interest recently. Very little is known, however, about how lay knowledge of food and health varies across social class. The present exploratory study compared and contrasted ways in which people from different social backgrounds draw on and use different forms of lay knowledge about food and health.

Parents from 40 families were recruited from two socio-economically different suburbs (20 families from each suburb). In-depth interviews were conducted with the mother and father in each family to examine lay knowledge about food and health. All interviews were transcribed and coded for specific themes. Responses from each suburb were compared and contrasted.

Different forms of lay knowledge about food and health were noted, especially concerning children's eating habits. Parents in the high-income suburb were more likely to discuss food and health in technical terms informed by contemporary nutritional or medical priorities. Parents in the low-income suburb did not share this discourse, but instead were more likely to discuss food in terms related to children's outward appearance or functional capacity.

The research highlights differences in lay knowledge about food and health across social class. It emphasises the need for public health nutrition policy-makers and practitioners to pay attention to lay knowledge on its own terms, rather than attempting to educate from predetermined assumptions, principles and standards.

To explore the terms on which nutrition should engage with the global challenges ahead.

Analysis of current orientation of nutrition and policy.

Nutrition faces four conceptual problems. The first is that nutrition has fissured into two broad but divergent directions. One is biologically reductionist, now to the genome; the other sees nutrition as located in social processes, now also requiring an understanding of the physical environment. As a result, nutrition means different things to different people. The second problem is a misunderstanding of the relationship between evidence, policy and practice, assuming that policy is informed by evidence, when there is much evidence to the contrary. The third problem is that nutrition is generally blind to the environment despite the geo-spatial crisis over food supply, which will determine who eats what, when and how. How can we ask people to eat fish when fish stocks are collapsing, or to eat wisely if water shortage dominates or climate change weakens food security? The fourth problem is that, in today's consumerist and supermarketised world, excess choice plus information overload may be nutrition's problem, not solution.

Nutrition science needs to re-engage with society and the environment. The alternative is, at best, to produce an individualised approach to public health or, at worst, to produce brilliant science but be policy-irrelevant.

To assess the short- and long-term reproducibility of a short food group questionnaire, and to compare its performance for estimating nutrient intakes in comparison with a 7-day diet diary.

Participants for the reproducibility study completed the food group questionnaire at two time points, up to 2 years apart. Participants for the performance study completed both the food group questionnaire and a 7-day diet diary a few months apart. Reproducibility was assessed by kappa statistics and percentage change between the two questionnaires; performance was assessed by kappa statistics, rank correlations and percentages of participants classified into the same and opposite thirds of intake.

A random sample of participants in the Million Women Study, a population-based prospective study in the UK.

In total, 12 221 women aged 50–64 years.

In the reproducibility study, 75% of the food group items showed at least moderate agreement for all four time-point comparisons. Items showing fair agreement or worse tended to be those where few respondents reported eating them more than once a week, those consumed in small amounts and those relating to types of fat consumed. Compared with the diet diary, the food group questionnaire showed consistently reasonable performance for the nutrients carbohydrate, saturated fat, cholesterol, total sugars, alcohol, fibre, calcium, riboflavin, folate and vitamin C.

The short food group questionnaire used in this study has been shown to be reproducible over time and to perform reasonably well for the assessment of a number of dietary nutrients.

There is a widely held view that the lower weight of drug abusers is attributable to diet. However, many studies on the dietary intake of drug abusers have failed to find energy insufficiency, while non-dietary factors have rarely been examined. The purpose of this study was to examine non-dietary factors that could affect the weight of drug abusers with and without HIV infection.

Participants were recruited into one of three groups: HIV-positive drug abusers (n=85), HIV-negative drug abusers (n=102) and HIV-positive persons who do not use drugs (‘non-drug abusers’, n=98). Non-dietary factors influencing weight included infection with HIV and/or hepatitis, malabsorption, resting energy expenditure and physical activity.

The baseline data from a prospective cohort study of the role of drug abuse in HIV/AIDS weight loss conducted in Boston, USA.

The first 286 participants to enrol in the study.

HIV-positive drug abusers had a body mass index (BMI) that was significantly lower than that of HIV-positive non-drug abusers. The differences in weight were principally differences in fat. In the men, cocaine abuse, either alone or mixed with opiates, was associated with lower BMI, while strict opiate abuse was not. Infection with HIV or hepatitis, intestinal malabsorption, resting energy expenditure and physical activity, as measured in this study, did not explain the observed differences in weight and BMI.

Drug abuse, and especially cocaine abuse, was associated with lower weight in men. However, infection with HIV and/or hepatitis, malabsorption and resting energy expenditure do not explain these findings.

Previous research on the health transition and nutrition security in black South African households revealed the need for further research among farm workers who belong to the poorest population categories. This article gives an overview of the link between nutrition security, livelihoods and HIV/AIDS in South Africa, drawing conclusions for research among farm worker households.

Design and setting: A literature review, observations on farms and interviews with farmers and key informants were carried out in 2003 and 2004. Peer examination was done with South African and German researchers from the natural and social sciences.

Farm workers face poverty and nutrition insecurity and continue to be a tragically underserved population group, also in terms of research. There is furthermore a lack of in-depth research on underlying causes for nutrition security in South Africa and on the link with livelihoods, poverty and HIV/AIDS. Micro-social qualitative research from the household and gender perspective is required, as valid data on households, their internal dynamics and therefore the reflection of social realities are missing. A multidisciplinary research approach based on a new conceptual framework was developed to address the situation of farm worker households.

The outlined research contributes to existing programmes on farms in the North West Province, with the findings being valid also for other parts of southern Africa facing poverty, nutrition insecurity and HIV/AIDS.

Green tea has been widely acknowledged in Japan to induce a pleasurable mental feeling. Recent laboratory studies have suggested positive psychological effects as a result of consuming green tea. The present study examined whether green tea consumption in everyday life in Japan is associated with positive mental health.

A cross-sectional study was performed in February–March 2002.

The subjects of the study consisted of a general population of 600 Japanese aged 20–69 years. Responses of 380 subjects, obtained by home-visit interview, were analysed. The questionnaire inquired about consumption of brewed green tea and other beverages, perceived mental health status, lifestyle and others. The 12-item General Health Questionnaire (GHQ 12) was used for the assessment of mental ill-health (GHQ score ≥4).

After adjustments for age, area, perceived mental stress, lifestyle and daily caffeine intake, the consumption of brewed green tea was not statistically associated with any decrease in risk of mental ill-health among either males or females (odds ratio (OR) = 0.78, 95% confidence interval (CI) = 0.47–1.29 for males; OR = 0.77, 95% CI = 0.51–1.14 for females). Daily caffeine intake (100 mg) inclusive of green tea, black tea, coffee and other caffeine-containing beverages was associated with a higher risk of mental ill-health among females (OR = 1.26, 95% CI = 1.01–1.56).

The results provide population-based evidence on the consumption of brewed green tea in everyday life and mental health, together with information on consumption patterns of various beverages and lifestyles.

To determine changes in reported food frequency in adults between 1986 and 1999.

Four consecutive cross-sectional surveys.

Counties of Norrbotten and Västerbotten, Northern Sweden.

The Northern Sweden MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease) population, four independent cross-sectional surveys in 1986, 1990, 1994 and 1999. Randomly selected age-stratified samples of the population aged 25–64 years. Analysis is based on 2982 males and 3087 females who completed an 84-item food-frequency questionnaire.

Between 1986 and 1999, average reported consumption of 3%-fat milk decreased from 42 to 7 intakes month-1 in men and from 28 to 4 intakes month-1 in women. Reported use of 1.5%-fat milk increased from 6 to 27 intakes month-1 in men and from 6 to 24 in women. Monthly intakes of potatoes and root vegetables decreased from 38 to 27 in men and from 39 to 32 in women. Consumption of pasta increased from 4 to 7 intakes month-1 in both sexes. Intakes of solid fats with 80% fat content dropped from 92 to 62 per month in men and from 78 to 52 per month in women, whereas use of 40%-fat spread increased from 12 to 22 intakes month-1 in men and from 5 to 26 in women. Monthly intakes of vegetable oil increased from 3 to 12 in men and from 3 to 15 in women. The percentage of overweight or obese individuals (body mass index >25 kg m-2) increased from 52 to 65% in men and from 41 to 52% in women (P for linear trend in all these changes, <0.001).

Our data indicate reduced consumption of foods with a high content of saturated fats. In spite of that, there is an unbroken trend towards increased obesity.

To evaluate the reliability and validity of a six-item food security scale when self-administered by adolescents.

Cross-sectional questionnaire survey including the six-item food security measure, socio-economic variables and a food-frequency questionnaire.

Representative sample of 29 schools in Trinidad.

In total 1903 students aged approximately 16 years.

Item affirmatives ranged from 514 (27%) for the ‘balanced meal’ item to 128 (7%) for the ‘skipped or cut meals often’ item and 141 (7%) for the ‘hungry’ item. Item-score correlations ranged from 0.444 to 0.580. Cronbach's α was 0.77. Relative item severities from the Rasch model ranged from −1.622 (standard error 0.043) for the ‘balanced meal’ item to 1.103 (0.068) for the ‘skipped or cut meals often’ item and 0.944 (0.062) for the ‘hungry’ item. The ‘hungry’ item gave a slightly lower relative severity in boys than girls. Food insecurity was associated with household overcrowding (adjusted odds ratio comparing highest and lowest quartiles 2.61, 95% confidence interval 1.75 to 3.91), lack of pipe-borne water in the home, low paternal education or paternal unemployment. After adjusting for socio-economic variables, food insecurity was associated with less frequent consumption of fruit (0.75, 0.60 to 0.94) or fish (0.72, 0.58 to 0.88) but more frequent consumption of biscuits or cakes (1.47, 1.02 to 2.11).

The food security scale provides a valid, reliable measure in adolescents, although young people report being hungry but not eating relatively more frequently than adults. Food-insecure adolescents have low socio-economic position and may eat less healthy diets.

To explain how the philosophy of nutrition is part of the philosophy of health. To show that this link allows practical solutions for equity and sustainability.

An analysis of the historical philosophies concerned with nutrition and health. A comparison of the definitions in the history of mind from antiquity to the beginning of the twenty-first century.

We are not individually healthy, but we are so in togetherness, even with animals and plants. Comprehensive nutrition science has physical, social and environmental attributes. It follows that nutrition is good for the enhancement of good company with human beings as well as with the connatural world. We recognise that we owe to others what we are and this constitutes the equity of being.

To determine whether weight problems in children (overweight, obesity and overweight or obesity) were related to deprivation indices when attributed only according to electoral ward of the school attended. To determine whether children with weight problems were more likely to be found in some wards rather than others, and to compare the distribution for boys and girls.

Retrospective, cross-sectional, observational study.

One hundred and six primary schools from all parts of Liverpool city.

Five cohorts of 9–10-year-old children between 1998 and 2003.

Body mass index (BMI) for each child to estimate proportions overweight, obese and overweight or obese according to international criteria.

Between January 1998 and March 2003, the heights and weights of 7902 boys and 7514 girls were measured and BMI calculated. The prevalence of boys and girls categorised as overweight or obese was very high (1620, 20.6% and 1909, 25.7%, respectively). Prevalence was not related to deprivation and varied between wards only for the girls; some wards had very different prevalence rates for boys and girls (Picton: 59 boys, 23.4%; 106 girls, 36.6%). The most deprived ward did not have a remarkable prevalence of overweight or obesity (Speke: 32 boys, 15.3%; 40 girls, 19.8%).

Obesity is a major problem and requires urgent action but targeting intervention on the basis of administrative areas may be very wasteful. Different factors seem to lead to obesity in boys and girls, and attention should be paid to the role of the physical environment.

To examine the utility of using external estimates of within-person variation to adjust usual nutrient intake distributions.

Analyses of the prevalence of inadequate intake of an example nutrient by the Estimated Average Requirement (EAR) cut-point method using three different methods of statistical adjustment of the usual intake distribution of a single 24-hour recall in Russian children in 1996, using the Iowa State University method for adjustment of the distribution. First, adjusting the usual intake distribution with day 2 recalls from the same 1996 sample (the correct method) second, adjusting the distribution using external variance estimates derived from US children in 1996; and third, adjusting the distribution using external estimates derived from Russian children of the same age in 2000. We also present prevalence estimates based on naïve statistical analysis of the unadjusted distribution of intakes.

Children drawn from the Russia Longitudinal Monitoring Survey in 1996 and 2000 and from the 1996 Continuing Survey of Food Intakes by Individuals.

When the EAR cut-point method is applied to a single recall, the resulting prevalence estimate in this study is inflated by 100–1300%. When the intake distribution is adjusted using an external variance estimate, the prevalence estimate is much less biased, suggesting that any adjustment may give less biased estimates than no adjustment.

In moderately large samples, adjusting distributions with external estimates of variances results in more reliable prevalence estimates than using 1–day data.

To assess breast-feeding initiation and rates of exclusive breast-feeding for the first 6 months after birth, and to examine social class differences in breast-feeding rates.

First sweep of a longitudinal population-based survey, the Millennium Cohort Study.

Four countries of the UK.

Subjects were 18 125 singletons born over a 12-month period spanning 2000–01. Data were collected by parental interview on the initiation of breast-feeding and exclusivity at 1, 4 and 6 months after birth.

Overall breast-feeding was initiated for 71% of babies, and by 1, 4 and 6 months of age the proportions being exclusively breast-fed were 34%, 3% and 0.3%, respectively. There were clear social class differences and mothers with routine jobs with the least favourable working conditions were more than four times less likely (odds ratio (OR) 0.22, 95% confidence interval (CI) 0.18–0.29) to initiate breast-feeding compared with women in higher managerial and professional occupations. Women in routine jobs were less likely to exclusively breast-feed their infants at 1 month (OR 0.42, 95% CI 0.36–0.50) and 4 months (OR 0.5, 95% CI 0.31–0.77) compared with women in higher managerial and professional occupations.

Clear social class differences in breast-feeding initiation and exclusivity for the first 4 months were apparent in this large UK sample. By 6 months, less than 1% of babies were being exclusively breast-fed. A co-ordinated multi-faceted strategy is required to promote breast-feeding, particularly among lower-income women.

The aim of the National Food Consumption Survey (NFCS) in South Africa was to determine the nutrient intakes and anthropometric status of children (1–9 years old), as well as factors that influence their dietary intake.

This was a cross-sectional survey of a nationally representative sample of all children aged 1–9 years in South Africa. A nationally representative sample with provincial representation was selected using 1996 Census information.

Of the 3120 children who were originally sampled data were obtained from 2894, a response rate of 93%.

The sociodemographic status of each household was assessed by a questionnaire. Dietary intake was assessed by means of a 24-hour recall and a food-frequency questionnaire from the caregivers of the children. Food purchasing practices were determined by means of a food procurement questionnaire. Hunger was assessed by a modified hunger scale questionnaire. Nutritional status was determined by means of anthropometric measurements: height, weight, head circumference and arm circumference.

At the national level, stunting (height-for-age below minus two standard deviations (< -2SD) from the reference median) was by far the most common nutritional disorder, affecting nearly one in five children. The children least affected (17%) were those living in urban areas. Even with regard to the latter, however, children living in informal urban areas were more severely affected (20%) compared with those living in formal urban areas (16%). A similar pattern emerged for the prevalence of underweight (weight-for-age < -2SD), with one in 10 children being affected at the national level. Furthermore, one in 10 (13%) and one in four (26%) children aged 1–3 years had an energy intake less than half and less than two-thirds of their daily energy needs, respectively. For South African children as a whole, the intakes of energy, calcium, iron, zinc, selenium, vitamins A, D, C and E, riboflavin, niacin, vitamin B6 and folic acid were below two-thirds of the Recommended Dietary Allowances. At the national level, data from the 24-hour recalls indicated that the most commonly consumed food items were maize, sugar, tea, whole milk and brown bread. For South African children overall, one in two households (52%) experienced hunger, one in four (23%) were at risk of hunger and only one in four households (25%) appeared food-secure.

The NFCS indicated that a large majority of households were food-insecure and that energy deficit and micronutrient deficiencies were common, resulting in a high prevalence of stunting. These results were used as motivation for the introduction of mandatory fortification in South Africa.

To evaluate responses to self-administered brief questions regarding consumption of vegetables and fruit by comparison with blood levels of serum carotenoids and red-cell folate.

A cross-sectional study in which participants reported their usual intake of fruit and vegetables in servings per day, and serum levels of five carotenoids (α-carotene, β-carotene, β-cryptoxanthin, lutein/zeaxanthin and lycopene) and red-cell folate were measured. Serum carotenoid levels were determined by high-performance liquid chromatography, and red-cell folate by an automated immunoassay system.

Between October and December 2000, a sample of 1598 adults aged 25 years and over, from six randomly selected urban centres in Queensland, Australia, were examined as part of a national study conducted to determine the prevalence of diabetes and associated cardiovascular risk factors.

Statistically significant (P<0.01) associations with vegetable and fruit intake (categorised into groups: ≤1 serving, 2–3 servings and ≥4 servings per day) were observed for α-carotene, β-carotene, β-cryptoxanthin, lutein/zeaxanthin and red-cell folate. The mean level of these carotenoids and of red-cell folate increased with increasing frequency of reported servings of vegetables and fruit, both before and after adjusting for potential confounding factors. A significant association with lycopene was observed only for vegetable intake before adjusting for confounders.

These data indicate that brief questions may be a simple and valuable tool for monitoring vegetable and fruit intake in this population.

To provide a concise summary of field and laboratory methods for the measurement of dietary intake with particular reference to the assessment of energy and protein intake and to the pitfalls and difficulties that may be encountered in practice when implementing the methods both in the field and under laboratory conditions.

We aimed at examining the association between dietary constituents and risk of cutaneous melanoma.

In an area of northern Italy we recruited 59 newly diagnosed melanoma patients and 59 age- and sex-matched population controls, to whom we administered a validated semi-quantitative food-frequency questionnaire.

We found an excess risk of melanoma in subjects with a higher energy-adjusted intake of total polyunsaturated fatty acids and, in particular, of linoleic acid (relative risk = 2.16 for intake in the highest tertile compared with the lowest tertile, P for linear trend = 0.061). Conversely, disease risk was inversely associated with the consumption of soluble carbohydrates (relative risk = 0.34 for intake in the upper vs. the lowest tertile adjusting for total energy intake, P for linear trend = 0.046). No other dietary factors, including alcohol, vitamins and trace elements, correlated with melanoma risk. The association of melanoma risk with linoleic acid and soluble carbohydrates intakes was further strengthened in multivariate analysis, and when analysis was limited to females.

Overall, these results indicate that an excess energy-adjusted intake of linoleic acid and a lower consumption of soluble carbohydrates may increase melanoma risk.