Adequate fruit and vegetable intake has been suggested to protect against colorectal cancer. However, several recent prospective studies have reported no association. We therefore examined the association between fruit and vegetable intakes and the risk of colorectal cancer in a prospective cohort study in Japan.

Between June and August 1990, 47 605 Japanese men and women completed a self-administered questionnaire, including a food-frequency questionnaire. We divided the subjects into quartiles based on their self-reported fruit and vegetable consumption. There were 165 colon cancer and 110 rectal cancer incidences identified during 7 years of follow-up, to the end of December 1997. We used Cox proportional hazards models to estimate the relative risk (RR) of developing colorectal cancer according to the level of fruit and vegetable consumption, applying adjustments for potential confounders.

No statistically significant association was observed between fruit and vegetable consumption and the risk of colorectal cancer. The multivariate RR of colon cancer in the highest quartile of fruit and vegetable intake compared with the lowest was 1.13 (95% confidence interval (CI) 0.73–1.75), the RR for vegetables alone was 1.24 (95% CI 0.79–1.95) and that for fruit alone was 1.45 (95% CI 0.85–2.47). The corresponding multivariate RRs for rectal cancer were 1.12 (95% CI 0.67–1.89), 1.14 (95% CI 0.67–1.93) and 1.41 (95% CI 0.73–2.73).

We found no association between the consumption of fruit and vegetables and the risk of colorectal cancer among the Japanese population.

To investigate the gap between consumer perception and scientific evidence related to health benefits and safety risks from fish consumption.

Consumer perceptions from a cross-sectional survey in March 2003 in Belgium were compared with scientific evidence based on a literature review.

A quota sampling procedure was used with age as quota control variable. Subjects completed a self-administered questionnaire including health benefit beliefs from fish, fish content and effect beliefs for nutrients and harmful substances.

Adults (n=429), who were the main person responsible for food purchasing in the household (284 women; 145 men), aged 18–83 years, from different regional, education, family size and income groups.

Fish is predominantly perceived as a healthy food that reduces risk for coronary heart disease, which corroborates scientific evidence. This perception is stronger among women than among men. In contrast with scientific evidence, 46% of the consumers believe that fish contains dietary fibre, whereas less than one-third is aware that fish contains omega-3 fatty acids and that this nutrient has a positive impact on human health. The gap between perception and evidence is larger among consumers with lower education. In general, consumers are better aware of the content and effect of harmful substances than of nutrients in fish.

Despite conclusive evidence about the content and positive effect of omega-3 fatty acids in fish, related consumer awareness and beliefs are poor and often wrong. This study exemplifies the need for nutrition education and more effective communication about the health benefits of fish consumption.

To promote the new field of ‘public nutrition’ as a means to address, in a more efficient, sustainable and ethical manner, the world-wide epidemic of malnutrition – undernutrition and specific nutrient deficiencies, and also obesity and other nutrition-related chronic diseases.

Grounded in the health promotion model, public nutrition applies the population health strategy to the resolution of nutrition problems. It encompasses ‘public health nutrition’, ‘community nutrition’ and ‘international nutrition’ and extends beyond them. It fits within the conceptual framework of ‘the new nutrition science’ and is an expression of this reformulated science in practice. Its fundamental goal is to fulfil the human right to adequate food and nutrition. It is in the interest of the public, it involves the participation of the public and it calls for partnerships with other relevant sectors beyond health. Public nutrition takes a broader view of nutritional health, addressing the three interrelated determinant categories of food systems and food security; food and health practices; and health systems. It assesses and analyses how these influence the immediate determinants that are dietary intake and health status so as to direct action towards effective progress. To further enhance the relevance and effectiveness of action, public nutrition advocates improved linkages between policies and programmes, research and training. A renewed breed of professionals for dietetics and nutrition, trained along those lines, is suggested.

There is a critical need to develop new knowledge, approaches and skills to meet the pressing nutrition challenges of our times.

To validate energy intake (EI) estimated from pre-coded food diaries against energy expenditure (EE) measured with a validated position-and-movement monitor (ActiReg®) in groups of 13-year-old Norwegian schoolchildren.

Two studies were conducted. In study 1 the monitoring period was 4 days; participants recorded their food intake for four consecutive weekdays using food diaries and wore the ActiReg® during the same period. In study 2 the monitoring period was 7 days; participants recorded their food intake for four consecutive days but wore the ActiReg® for a whole week.

Participants were recruited from grade 8 in a school in and one outside Oslo (Norway).

Forty-one and 31 participants from study 1 and 2, respectively, completed the study.

The group average EI was 34% lower than the measured EE in study 1 and 24% lower in study 2. The width of the 95% confidence limits of agreement in a Bland–Altman plot for EI and EE varied from -0.2 MJ to 8.2 MJ in study 1 and from -2.3 MJ to 6.9 MJ in study 2. The Pearson correlation coefficients between reported energy intake and expenditure were 0.47 (P = 0.002) in study 1 and 0.74 (P < 0.001) in study 2.

The data showed that there was substantial variability in the accuracy of the food diary at the individual level. Furthermore, the diary underestimated the average energy intake. The ability of the food diary to rank individuals according to energy intake was found to be good in one of the studies and moderate in the other.

This study examines parental report of household food availability, parent dietary intake and associations with adolescent intakes of fruits, vegetables and dairy foods.

Cross-sectional study. Adolescents completed the Project EAT survey and the Youth Adolescent Food Frequency Questionnaire at school. Parents of adolescents were interviewed by telephone about the home food environment, eating habits and weight-related behaviours. General linear modelling was used to compare dietary intakes of adolescents across different levels of household food availability and parental intakes.

The study sample included 902 adolescents and their parent or guardian.

Many parents were not consuming the minimum number of daily recommended fruit (44.5%), vegetable (69.9%) or dairy (46.9%) servings. While most parents reported that fruits and vegetables were available at home (90.3%) and vegetables were usually served at dinner (87.0%), fewer parents reported milk was served at meals (66.6%). Soft drinks were usually available at home (56.8%). Among girls, household availability was positively associated with fruit and vegetable intake (ttrend = 2.70, P < 0.01) and soft drink availability was inversely associated with dairy intake (ttrend = 2.08, P = 0.04). Among boys, serving milk at meals was positively associated with dairy intake (ttrend = 3.65, P < 0.01). Parental intakes were positively associated with dairy intake for boys (ttrend = 2.04, P = 0.04), and with dairy (ttrend = 2.43, P = 0.01), vegetable (ttrend = 3.72, P < 0.01) and fruit (ttrend = 3.17, P < 0.01) intakes for girls.

Interventions designed to help adolescents improve consumption of fruits, vegetables and dairy foods may be enhanced by including a parental component aimed at increasing household availability and parents' intake of healthful food choices.

This background paper was prepared in response to a request to review the concepts related to measurement of body composition, to discuss laboratory and field methods of assessing body composition and to discuss the practical applications of the methods – how they might be used singly or in combination to provide data for a selected population.

The common laboratory and field methods are described and discussed, with particular attention to the assumptions involved and the applicability of the methods to the different population groups. Most measurements of body composition are made in the field, at the bedside or clinic as opposed to in the laboratory. The laboratory methods have a role to play in their own right, in research into new concepts, models and methods. However, they are particularly important in establishing the accuracy of the field methods.

Field, bedside and laboratory studies.

Children, adults, the elderly, ethnic groups.

Laboratory estimates of body compositions are best performed by multi-component methods or by 2-component methods adjusted for to the populations under investigation. There is a scarcity of data for most of the populations in the world.

Energy requirements based on body weight are an approximation since they do not take into account differences in body composition, which will better determine the true requirements. The measurement of body composition occurs in many branches of biology and medicine. It is used in the assessment of nutritional and growth status and in disease states and their treatment. Energy stores, skeletal muscle and protein content can be determined and changes monitored. In human energetics, body composition is widely used for the standardisation of other variables, such as basal metabolic rate (BMR), in the assessments of ethnic and environmental differences and of variability and adaptation to different levels of nutrition. Choosing a method is very problematic. Users want simple, inexpensive, rapid, safe accurate methods to measure body composition but speed and simplicity come at the expense of accuracy. Recommendations are made for age, sex, and in some cases, fatness and ethnic specific methods.

The study aimed to assess the relationship of various types of kindergarten differing in length of care and food availability with the development of overweight in pre-school children.

A cross-sectional study was carried out in 2002 in Stuttgart, Germany, as part of the school entrance examination. Height and weight of 2140 children (participation 70.2%) were measured and information on type of kindergarten and other potential determinants of overweight was collected by a parental questionnaire. Change in relative body mass index (BMI) position between the ages of 4 and 6 years was assessed using medical records.

The prevalence of overweight or change in relative BMI position did not differ according to the type of kindergarten. For the prevalence of overweight in German children, adjusted odds ratios (OR) comparing institutions that open only in the morning with those opening in the morning and afternoon or for the full day were 0.86 (95% confidence interval (CI) 0.40, 1.83) and 0.63 (95% CI 0.25, 1.58), respectively. Parental BMI and duration of television watching were positively associated, and maternal educational status and duration of breast-feeding were negatively associated, with overweight and/or change in relative BMI position. The prevalence of overweight was substantially higher among non-German than among German children (adjusted OR 2.17 (95% CI 1.53, 3.07)).

These data show no association between different types of kindergarten and the development of overweight in early childhood. Duration of television watching and breast-feeding, as well as the relatively high prevalence of overweight in ethnic minorities, deserve further attention.

Longitudinal research has shown that eating fruit and vegetables during childhood has a positive impact on long-term health outcome from heart disease and asthma. However, recommendations for fruit and vegetable intakes in pre-school children are not as explicit as those for adults and few data exist on actual intakes of fruit and vegetables in this particular age group.

To describe fruit and vegetable intakes in the daily diets of a sample of pre-school children in Bradford, West Yorkshire, and to compare the findings with existing national UK data.

Pre-school children aged 3 and 4 years (n = 207). All subjects attended nurseries in the Airedale and Bradford South and West regions at the time of the study.

Dietary data were collected using the pre-validated CADET (Child and Diet Evaluation Tool) diary. All children were also seen individually in order to assess their awareness and preference for a range of fruit and vegetables.

Intakes of fruit and vegetables in this sample of pre-school children were below recommended levels. Only 16% of children in this sample were successfully eating fruit and vegetables on five occasions a day and conversely 14% ate no fruit and vegetables at all. Vegetable intakes were far lower than fruit intakes with 39% of the sample consuming no vegetables. There were statistically significant differences in median fruit and vegetable intakes between children with different demographic and lifestyle variables, such as which nursery they attended and what the highest educational qualification in the household was. Children's awareness of and preferences for different fruit and vegetables significantly affected their median intakes of fruit and vegetables.

Fruit and vegetable intakes in this sample of pre-school children were far lower than the recommended levels of 5 portions a day. A greater diversity of intakes should be encouraged and these data suggest that this may be attained by increasing children's awareness by exposing them to a wider range of fruit and vegetables.

Household budget survey (HBS) data are used regularly for nutritional epidemiological purposes. The validity of HBS data, however, is not well established. The aim of this project was to compare HBS and individual nutrition survey (INS) data in a nationally representative sample of Polish households.

Estimates of food consumption and nutrient intake were compared between household food acquisition data collected over 1 month and a single 24-hour recall collected from every household member in a nationally representative sample of Polish households surveyed between September and November 2000. To facilitate the comparison, INS food consumption data excluded food eaten away from home and were modified using a computer program to estimate food ‘as purchased’ (including disaggregation of recipe data) and to allow for wastage.

Poland.

Participants were 3716 individuals in 1215 households (representing co-operation rates of 86.2% and 89.2%, respectively).

Good agreement was shown between median estimates of foods such as potatoes, vegetables (including processed), meat, meat products and poultry, and animal fats (excluding butter), but agreement was poor for bread and rolls, fruit, vegetable fats and oils, eggs and six other food groups. Estimates of energy and nutrient intake were within ±10% with the exceptions of polyunsaturated fats, potassium and vitamin C.

Possible reasons for differences in findings between the two surveys include survey bias (e.g. social approval bias leading to overreporting of fruit), seasonal variations (e.g. high potato purchases between September and November) and aspects of the methodology (e.g. HBS data were based on records collected over 1 month, whereas 24-hour recall data were based on recalls collected from all household respondents on only 1 day and averaged for each household type). HBSs provide useful data for epidemiological research, but findings need to be interpreted in the light of other data regarding consumption, and numerous factors that may affect consumption need to be taken into account.

To describe the consequences of systematic reporting bias by the obese for diet–disease relationships.

The present report used 24-hour urinary nitrogen and estimates of 24-hour energy expenditure to assess error in diet reporting, and examined the consequence of accounting for this error for associations between dietary fat intake and serum low-density lipoprotein (LDL)-cholesterol.

Sub-study to the Danish MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) project, carried out in 1987–1988.

A random sub-sample of the adult Danish male population (n = 152).

Correcting dietary fat for underreporting error weakened, rather than strengthened, the association between dietary fat intake and LDL-cholesterol by reducing the slope of the regression from β = 3.4, P = 0.02 to β = 2.7, P = 0.04.

This example illustrates that systematic underreporting of dietary fat by high-risk groups such as the obese may produce an overestimated association. These results imply that previous epidemiological studies showing a positive association between percentage of energy from fat and other health outcomes, e.g. cancer and heart disease, may have overestimated the negative effects of a high-fat diet. If we were able to correctly assess dietary fat intake in general populations, recommendations for fat intake may be more liberal than the 30% suggested today. Improved assessment of fat intake in epidemiological studies is necessary for future development of evidence-based recommendations for diet and health.

To describe food sources of nutrient intake for white and African American adults in the Lower Mississippi Delta (LMD), and their use in the development of a regional food-frequency questionnaire (FFQ) based on an earlier version of the National Cancer Institute's Health Habits and History Questionnaire.

We ranked food sources of energy, macronutrients, vitamins and minerals, and examined portion size distributions for 842 white and 857 African American residents aged 19 years and older, using 24-hour dietary intake recall data from a telephone survey of 36 LMD counties. These values were used to develop a regional FFQ, which was then field-tested with 100 subjects and revised to improve interpretability.

The LMD region of the USA.

White and African American adult residents of the LMD.

LMD African Americans obtained more of their energy and nutrient intakes from poultry, processed meat, salty snacks, fruit drinks, pork and cornbread; and less from milk, alcohol, legumes, salad dressing, butter/margarine and sweetened tea than did white residents. Regional foods not on nationally used FFQs included grits, turnip greens, okra, ham hocks, chitterlings, crawfish, catfish, cracklings, jambalaya, potato logs, chicken and dumplings, and sweet potato pie. Based on responses during field-testing, the questionnaire was also designed to add four portion sizes for each food item, presented as questions, rather than in grid format.

Regional food use patterns differ from national patterns and furthermore differ between African American and white adults in the LMD. The resulting Delta NIRI FFQ for Adults should contribute to improved assessment of usual intake for use in studies of diet and health in this region.

Alcohol consumption may play a role in the development of obesity but the relationship between alcohol and weight is still unclear. The aim of our study was to assess the cross-sectional association of intakes of total alcohol and of specific alcoholic beverages (wine, beer and spirits) with waist-to-hip ratio (WHR) and body mass index (BMI) in a large sample of adults from all over France.

Cross-sectional.

Participants were free-living healthy volunteers of the SU.VI.MAX study (an intervention study on the effects of antioxidant supplementation on chronic diseases).

For 1481 women aged 35–60 years and 1210 men aged 45–60 years, intakes of total alcohol and specific alcoholic beverages were assessed by six 24-hour dietary records. BMI and WHR were measured during a clinical examination the year after.

A J-shaped relationship was found between total alcohol consumption and WHR in both sexes and between total alcohol consumption and BMI in men only (P < 0.05). The same relationships were observed with wine (P < 0.05); men and women consuming less than 100 g day−1 had a lower BMI (men only) and WHR than non-drinkers or those consuming more. Spirits consumption was positively associated with BMI (linear regression coefficient β = 0.21, 95% confidence interval (CI): 0.09–0.34 and β = 0.22, 95% CI: 0.06–0.39 for men and women, respectively) and WHR (β = 0.003, 95% CI: 0.001–0.005 and β = 0.003, 95%CI: 0.0002–0.006) in both sexes in a linear fashion. No relationship between beer consumption and BMI or WHR was found.

If confirmed in longitudinal studies, our results indicate that consumption of alcoholic beverages may be a risk factor for obesity.

We investigated whether life-long adherence to a vegetarian diet is associated with adult height, age at menarche, adult body weight and body mass index (BMI), used as indicators of growth, development and obesity, in a large sample of adults.

This was a cross-sectional study. Anthropometric data and information on age, ethnicity, education, age at menarche and age at becoming a vegetarian were obtained through a questionnaire. Self-reported height and weight were calibrated using predictive equations derived from a previous validation study.

United Kingdom.

The study includes 45 962 British men and women aged ≥ 20 years of whom 16 083 were vegetarians (not eating fish or meat).

In men and women, there were no significant differences in height, weight or BMI between life-long vegetarians (n = 125 (men) and n = 265 (women)) and people who became vegetarian at age ≥ 20 years (n = 3122 (men) and n = 8137 (women)). Nor was there a significant difference in age at menarche between life-long vegetarian women and women who became vegetarian at age ≥ 20 years.

This study suggests that, compared with people who become vegetarian when adult, life-long vegetarians do not differ in adult height, weight, BMI or age at menarche in women.

To assess the impact of a school-based nutrition education intervention aimed at increasing the consumption of fruits and vegetables.

The intervention programme increased the provision of fruits and vegetables in schools and provided a range of point-of-purchase marketing materials, newsletters for children and parents, and teacher information. Curriculum materials at age 6–7 and 10–11 years were also developed and utilised. Evaluation was undertaken with groups of younger (aged 6–7 years) and older (aged 10–11 years) children. Methods included 3-day dietary records with interview and cognitive and attitudinal measures at baseline, with follow-up at 9 months, in intervention and control schools.

The work was undertaken in primary schools in Dundee, Scotland.

Subjects comprised 511 children in two intervention schools with a further 464 children from two schools acting as controls.

Children (n = 64) in the intervention schools had an average increase in fruit intake (133±1.9 to 183±17.0 g day-1) that was significantly (P < 0.05) greater than the increase (100±11.7 to 107±14.2 g day-1) estimated in children (n = 65) in control schools. No other changes in food or nutrient intake were detected. Increases in scores for variables relating to knowledge about fruits and vegetables and subjective norms were also greater in the intervention than in the control group, although taste preferences for fruits and vegetables were unchanged.

It is concluded that a whole school approach to increasing intakes of fruits and vegetables has a modest but significant effect on cognitive and attitudinal variables and on fruit intake.

To emphasise the importance of defining a new nutrition science and food policy that includes social and environmental dimensions.

Nutrition science and food policy is put in the context of sustainable development. Examples are presented to show that a number of factors including exploitation of resources, disrespect for land and food insecurity contribute to the decline of a culture. The fate of cultures that lack implemented sustainable development strategies is discussed.

Pressure from low-income and economically challenged countries combined with the efforts of not-for-profit private institutions is proposed. The goal is to produce and provide science-based evidence and guidelines to be used as a tool to encourage institutions and organisations to redefine their policies to deal effectively with global issues.

To illustrate the effect of common mistakes when using 24-hour national dietary survey data to estimate the prevalence of inadequate nutrient intakes.

Raw data on nutrient intake from the Australian 1995 National Nutrition Survey were adjusted for within-person variance using standard techniques and corrected for underreporting using the criteria of Goldberg et al. The distributions for six nutrients were compared with current dietary reference values from the UK, USA and Australia.

A national sample of the Australian population with a 61.4% response rate.

Adjusting for within-person variance reduced the range of nutrient intakes to 66–80% of the raw data range and the proportion with intakes below the estimated average requirement (EAR) by up to 20%. Excluding underreporters further reduced the proportion below the EAR by up to 10%. Using the dietary reference values from different countries also resulted in some markedly different estimates. For example, the prevalence of low folate intakes ranged from <1 to 92% for adult women depending on the reference used. Except for vitamin A and protein, the prevalence of low intakes was invariably higher for women than for men.

Estimates of the prevalence of low nutrient intakes based on raw 24-hour survey data are invariably misleading. However, even after adjustment for within-person variance and underreporting, estimates of the prevalence of low nutrient intakes may still be misleading unless interpreted in the light of the reference criteria used and supported by relevant biochemical and physiological measures of nutritional status.

To describe the selection and modification of an appropriate diet score to assess diet quality in early old age.

Cross-sectional analyses of the Boyd Orr cohort – a long-term follow-up of men and women whose families took part in a survey of diet and health in pre-war Britain. Dietary data were obtained from a 113-item food-frequency questionnaire. A nine-item Healthy Diet Indicator (HDI) developed by Huijbregts and colleagues was identified from the literature and modified because some dietary variables were unavailable and to accord more closely with recommendations of the UK Committee on Medical Aspects of Food Policy.

In total, 1475 traced, surviving cohort members aged 60 years and over.

Modification resulted in a 12-item Healthy Diet Score (HDS). We found that about half the variation in the HDS was explained by variation in the HDI (r = 0.71). There was, however, little misclassification of subjects (<10%) into extreme thirds of the distribution by the HDS compared with the HDI. Items of the score most strongly correlated with overall score were saturated fat (r = −0.57), red meat (r = −0.46), dietary fibre (r = 0.58), fruit and vegetables (r = 0.54) and percentage energy from carbohydrates (r = 0.51). Modifying existing items had greater impact on agreement between HDI and HDS than the addition of new items.

The selection and modification of diet scores is more complicated than often assumed. Furthermore, modest changes to an existing score can produce a score that is different from the original, and although it was not possible to test this issue, it may no longer predict subsequent health experience.

To validate a fat intake questionnaire (FIQ) developed to assess habitual dietary intake while focusing on the assessment of detailed fatty acid intake including total trans unsaturated fatty acids (TUFA).

An 88 food item/food group FIQ was developed using a meal pattern technique. Validation was achieved by comparison with dietary intake assessed by a modified diet history (DH) in a cross-over design. Eighty-four individuals supplied adipose tissue biopsies for linoleic acid and total TUFA analysis as an independent validation of the FIQ and DH.

Medical Centre, Dublin Airport, Republic of Ireland.

One hundred and five healthy volunteers (43 females and 62 males aged 23–63 years).

Significant correlations (P < 0.0005) were achieved for intakes of energy (0.78), total fat (0.77), saturated fat (0.77), monounsaturated fat (0.63), polyunsaturated fat (0.73), TUFA (0.67) and linoleic acid (0.71) assessed by the FIQ compared with the DH. Linoleic acid intake assessed by the FIQ and the DH was significantly correlated with adipose tissue concentrations (r = 0.58 and 0.49, respectively; P<0.005); however, total TUFA intake was poorly correlated with adipose tissue concentrations (r = 0.17 and 0.10 for FIQ and DH, respectively).

The FIQ compared favourably with the DH in assessing habitual diet, in particular fatty acid intake. In addition, the FIQ was successfully validated against the linoleic acid composition of adipose tissue, an independent biomarker of relative fatty acid status. The FIQ could therefore be used as an alternative to the DH as it is a shorter, less labour-intensive method.