To investigate and compare feeding practices among infants of less than 7 months of age in a rural and an urban area in Tanzania.

Cross-sectional, questionnaire-based interview of mothers and focus group discussions with extension workers and community leaders.

Eleven villages in a rural district and 10 wards in an urban district in the Morogoro region, Tanzania, west of Dar es Salaam.

Probability samples of mothers with infants of less than 7 months of age (n = 320 from each area).

Exclusive breast-feeding was rarely practised in either the rural or urban areas investigated. However, the urban mothers initiated breast-feeding earlier, discarded colostrum less frequently, breast-fed exclusively for a longer period, gave breast milk as the first feed more often and delayed the introduction of solid foods for longer than their rural counterparts. The rural mothers, on the other hand, breast-fed their previous infants slightly longer than the urban mothers.

The better performance of urban mothers could be partly due to sustained breast-feeding support in hospital settings and other campaigns which may not have reached the rural areas. In both the rural and urban areas more efforts are needed to encourage exclusive breast-feeding, to avoid premature complementation and, in the case of the urban areas, to protect extended breast-feeding.

To assess the dietary intake and the nutritional status of homeless men.

A night emergency shelter in Paris, France.

Dietary survey (48-h) including alcohol intake and a questionnaire on age, duration of homelessness, smoking habits. Subjects were also weighed and measured.

Ninety-seven men aged 18–72 years (mean 43.3), of whom 54% were homeless for more than 18 months, 82% were smokers and 53% were regular and/or excessive drinkers.

The BMI distribution was shifted towards low values, the percentage of wasted persons being four times higher than in the reference population. The mean total energy intake was 2376 kcal (SD = 879) and included a high and highly variable percentage of energy derived from alcohol (12.0% (SD = 18.1)). Among drinkers, the mean ethanol intake was 90 g (SD = 102) and there was a significant negative correlation between ethanol and non-alcoholic energy intakes. The median intakes of potassium, calcium, zinc, vitamins B1, B2, and niacin were lower than European Population Reference Intakes but only the mean intake of vitamin B1 was significantly lower. Eighty percent of non-alcoholic energy was provided by charitable organisations. For most nutrients, the nutritional density of the shelter ration was not significantly different from the density of the foods purchased by the homeless.

These data suggest that the content of some nutrients should be increased in existing food assistance programs for homeless people in France.

To review studies on the morbidity, mortality and nutrition of migrant populations in France.

A systematic search of the bibliographic database Medline, and direct contact with associations and institutions concerned with migrants' health.

In France, as in other host countries, migrants belong to the lowest socio-economic strata. They have on average better health and lower mortality than the local-born population. Health benefits are particularly noticeable in Mediterranean men, especially for affluence-related diseases such as cancer and cardiovascular diseases. North African men smoke as heavily as the local-born of the same occupational categories, and yet their mortality rates from lung cancer are notably lower. Such a paradox may be the result of a synergy between different phenomena such as the selection of the fittest applicants for immigration and the maintenance of healthy lifestyles from the countries of origin. In contrast, migrant women do not enjoy the same health advantages, possibly because they are less likely to be selected on the basis of their health and because they are often non-working. Adult migrants from southern Europe and North Africa report dietary practices consistent with the typical Mediterranean diet, which is renowned for its positive effects on health.

The diet of Mediterranean adults living in France may partly explain the low rates of chronic diseases and high adult life expectancy observed in migrant men from northern Africa. Information about their diets might provide clues for the design of nutritional education campaigns aimed at low-income people.

A Mediterranean diet quality index (MDQI) was devised to give an overall assessment of dietary habits and to identify groups at risk.

The MDQI was based on scores given for selected levels of consumption of selected nutrients and foods.

Mediterranean southern France.

The sample included 473 men and 491 women in three age classes recruited at random.

Only 9.5% of men, 9.0% of women, 4.7% of 20–34 year old subjects, 6.6% of 35–54 year old subjects and 14.0% of 55–76 year old subjects were shown to have a healthy diet. However, 10.1% of men, 8.6% of women, 19.4% of 20–34 year old subjects, 10.2% of 35–54 year old subjects and 4.6% of 55–76 year old subjects were shown to have a poor diet. There were significantly fewer smokers among subjects with a good diet but the distribution of moderate wine drinkers was comparable between those with a good diet and those with a poor diet. Correspondence analysis associated a healthy diet with 55–76 year old men and women living in rural areas, who had received primary schooling only and who were manual workers. Both men and women with a poor MDQI score tended to be young and smokers. In addition, women with a poor MDQI tended to be heavy drinkers and obese.

This study showed that the Mediterranean model, which is generally recognized as a healthy diet, appears restricted to older people and to rural areas, whereas urbanized young people depart from it. A nutritional prevention policy targeted at young adults is required to encourage them to adhere to the Mediterranean model. Smoking and drinking showed different distribution patterns in the sample under study.

To describe the relationship between specific levels of nitrite intake from cured meat consumption during pregnancy and the relative risk of paediatric brain tumours in the offspring.

Exposure data were previously collected for a population-based case–control study of paediatric brain tumours; data on nitrite content were obtained by a comprehensive literature review of surveys of residual nitrite content in cured meats published in the USA and Canada. The level of nitrite intake for each mother was predicted by year of pregnancy based on survey results. Dose–response was evaluated both categorically and continuously using polynomial and quadratic spline regression.

The US west coast: Los Angeles County, the San Francisco–Oakland Bay Area and the Seattle–Puget Sound area.

There were 540 cases diagnosed between 1984 and 1990 at ages varying from 0 to 19 years, and 801 controls frequency-matched by geographic area, age and birth year.

In general, survey results suggest a trend of decreasing nitrite levels in cured meats over time. We observed a moderate increase in brain tumour risk in the offspring of mothers with relatively low levels of nitrite consumption from cured meats during pregnancy, and a two- to three-fold risk increase in offspring of mothers who consumed 3 mg day−1 nitrite from cured meats (about 125 g day−1 of cured meat consumption throughout the pregnancy).

A substantial risk of paediatric brain tumour appears to be associated with relatively high levels of maternal cured meat consumption during pregnancy. A more scientifically valid approach than a literature review to estimate nitrite intake from cured meats and data from a large group of highly exposed subjects would be useful in determining potentially harmful levels.

Intake of soybean protein was associated with a reduced risk of breast cancer in a case–control study. It has also been demonstrated to increase menstrual cycle length in an experimental setting.

To ascertain whether the association of soybean protein intakes with menstrual cycle length persists in an uncontrolled community setting.

Cross-sectional food frequency dietary survey, menstrual cycle survey and prospective collection of menstrual cycle data.

A hospital clinic and a nursing college.

Two hundred menstruating women.

An association (P=0.034) of higher intakes of soybean protein with increased menstrual cycle length, as recorded by self report and by prospectively recording three consecutive cycles, was observed. The risk of menstrual cycle length being greater than the median, when comparing the upper quartile (8.7–35.2 g day−1) of soybean intake and the lowest quartile (0.1–3.3 g day−1) was double, and this approached statistical significance (OR=2.02, 95% CI=0.88−4.64 and OR=1.93, 95% CI=0.82−4.56 for self-reported cycle length and cycle length as recorded by diary, respectively). In terms of the absolute association with cycle length, subjects in the upper quartile of soybean intake demonstrated a cycle length 1–2 days longer than did subjects in the lowest quartile.

It is likely that the association between dietary intake of soybean protein and length of menstrual cycle prevails in the community setting. This is shown using both self-reported cycle length and cycle length as recorded in a prospective diary.

To investigate the role of blood loss and diet in the aetiology of mild iron deficiency (MID) in premenopausal New Zealand women. Mild iron deficiency was defined as low, but not necessarily exhausted, iron stores (i.e. serum ferritin <20 μg/L) in the absence of anaemia (i.e. haemoglobin ≥120 g/L).

Cross-sectional study of a volunteer sample of premenopausal adult women. Information on habitual dietary intakes (using a specially designed and validated computerised iron food frequency questionnaire), health and demographic status, sources of blood loss (including menstrual blood loss estimated using a validated menstrual recall method), contraceptive use, height and weight, haemoglobin, serum ferritin and C-reactive protein were collected.

Dunedin, New Zealand during 1996/1997.

Three hundred and eighty-four women aged 18–40 years.

The characteristics that were associated with an increased risk of MID were: low meat/fish/poultry intake, high menstrual blood loss, recent blood donation, nose bleeds, and low body mass index. The protective factors included shorter duration of menstrual bleeding, and multivitamin–mineral supplement use in the past year.

There are a number of potentially modifiable factors that appear to influence risk of MID. Women with low menstrual blood loss may be able to decrease their risk of MID by increasing their meat/fish/poultry intake, while those with a higher menstrual blood loss may be able to decrease their risk by decreasing their menstrual blood loss, perhaps by changing their method of contraception. Women should be encouraged to maintain a healthy body weight, and those who choose to donate blood, or who experience nose bleeds, should have their iron stores monitored.

To identify the major perceived influences on food choice, to examine the use of and trust in information sources concerning healthy eating, and to assess attitudes towards and barriers to adopting healthy eating practices in a post-USSR country (Ukraine).

A survey of an urban adult population. The questions were adopted from the Pan-European Union (EU) Survey of Consumer Attitudes to Food, Nutrition and Health (1995–1996).

Lviv city, Ukraine.

The survey included 296 adults (84 males, 212 females) aged 18–55 years; they were primarily college students and subjects with tertiary education – the groups most likely to be both interested in healthy eating and affected by current socioeconomic downturns.

The major factors in food choice were: ‘quality/freshness’ (cited by 80%), ‘price’ (58%) and ‘taste’ (47%); only 34% cited ‘trying to eat healthily’. More older people cited ‘price’ than ‘quality/freshness’, and men were more likely than women to cite ‘taste’. Sources of healthy eating information included: ‘relatives/friends’ (cited by 65%, trusted by 85%) and health professionals (trusted by 92%, but used by only 35%); while advertising was the least trusted source (cited by 28%). Fifty-three per cent of respondents considered their diet to be healthy enough without further changes; 50% thought of the nutritional aspects of the food they ate; fewer women than men considered their diet healthy, and more women than men thought about nutrition. Barriers to healthy eating included: ‘cost’ (cited by 65%), ‘lack of time’ (55%), ‘self-control’ (54%), ‘selection influences’ (41%), ‘lack of knowledge’ (32%), ‘unpleasant foods’ and ‘resistance to change’ (both 30%).

Strategies to encourage healthy eating in this population should involve word-of-mouth nutrition education concerning low-cost healthy alternatives.

As beliefs and knowledge about the possible effects of foods on health can influence food behaviours, this study examined selected dietary beliefs in the Baltic countries and the association of beliefs related to salt intake and to types of fat with food behaviours.

A cross-sectional study.

Data from three surveys conducted in Estonia, Latvia and Lithuania in the summer of 1997 were used to describe the prevalence of dietary beliefs in these countries and to investigate the association between beliefs and behaviours (using logistic regression).

Representative national samples of adults were selected in each country (Estonia, n=2018; Latvia, n=2308; Lithuania, n=2153).

Misunderstood concepts (myths) related to dietary salt, types of fat, meat consumption and bread and potatoes were observed in high proportions of the population. Education level was an important correlate of beliefs related to salt intake and types of fat, people with a higher education level being more likely to be familiar with these issues. Correct beliefs were not consistently associated with healthier behaviours (e.g. less frequent use of salt at the table and use of non-animal fats for cooking), except for salt intake in Estonia.

Several misunderstood dietary concepts (myths) are still prevalent in the Baltic countries. Correct beliefs related to salt intake and types of fat were not consistent predictors of healthier food behaviours. In-depth qualitative investigations are needed to better describe and understand dietary beliefs and attitudes in the Baltic countries, and to identify barriers to the adoption of healthy food habits.

To assess the fat intake and knowledge about the fat content of foods consumed by a sample of self reported users of reduced-fat dairy products.

Cross-sectional study of a population-based sample of women shoppers.

A small, rural town (population approximately 6000) in central Victoria, Australia.

Seventy-eight women aged 25–50 years, who regularly used at least one reduced-fat dairy product.

Mean reported intake of total fat was lower while intake of dairy fat was similar to that of a national sample of women of the same age both in the whole sample and when under-reporters were excluded. The ability to identify major sources of fat in the diet as reported appeared to be limited. Less than half of the subjects were able to correctly estimate the fat content of reduced-fat dairy products relative to regular products and about one quarter of subjects reported replacing one kind of oil or fat with another as a strategy to reduce fat intake. Subjects were generally aware of the need to ‘eat less fat’ but few could articulate specific recommendations. A number of subjects reported using low fat diets to control their weight but few subjects appeared to understand the connection between fat intake and energy intake.

The findings of this study raise important questions about how nutrition advice is understood and implemented by consumers, particularly the message to reduce fat intake and the role of energy balance in weight management. They also highlight the difficulty of interpreting information on food intake, in subjects who have modified their diet by reducing intake of specific foods.

The effect on individual rankings and total intakes of nutrients of correcting total fruit and vegetable frequencies from a long food frequency questionnaire (FFQ) using the responses to two summary questions was examined in a group of women.

The performance of a self-administered FFQ in ranking individual levels of intake and estimating absolute levels of nutrient and energy intake was compared with the performance of the questionnaire when it was corrected for fruit and vegetable intake reported using the Block summary questions.

The study population included 123 women, aged between 18 and 54 years, who were recruited from the Family Planning Association Colposcopy Clinic in Sydney.

Substantial and significant differences (P<0.001) were found in fruit and vegetable intakes between the FFQ and the summary questions. Intake frequency by the FFQ was more than double that by the summary questions. When the FFQ was corrected for fruit and vegetable intakes using the summary questions, the intakes of beta-carotene, vitamins A and C, and dietary fibre were more than 20% lower (P<0.001) than the uncorrected results. However, this had little effect on ranking individuals. This study also examined seasonal differences in vegetable intakes and differences in nutrient intakes when either summer or winter vegetable consumption was substituted for seasonal vegetable intake in the FFQ. Although there were seasonal differences for some foods, the substitution had little effect on intake of nutrients.

These results indicate that important differences in intakes are observed when two methods, which appear to yield the same results, are used. Further work is needed to determine which, if either, of the two methods yields intakes that can be compared quantitatively with national references for assessing the adequacy of population intakes.

To determine whether a short set of questions about foods in the household can provide information about the fat-related dietary behaviour of individual household members in less-acculturated Chinese populations.

Cross-sectional survey.

The study population included 244 adult females of Chinese ethnicity in Seattle, WA, and Vancouver, BC, Canada.

Bilingual interviewers collected information on the presence of 14 high-fat foods and seven reduced-fat foods in the household. Respondents were also asked about the consumption of foods and behaviour reflective of adoption of Western dietary practices, fat-related dietary behaviour, changes in consumption of high-fat foods since immigration, and sociodemographic characteristics.

Although this was a less-acculturated sample, many households had Western foods such as butter (58%), lunchmeats (36%), snack chips (43%), and 1% or skim milk (48%). Households with respondents who were younger, married, employed outside the home, and lived with young children had significantly more high-fat foods, while high education and longer percentage of life in North America were significantly associated with having more reduced-fat foods (P ≤ = 0.05). Participants living in households with more high-fat foods had higher-fat dietary behaviour than those with fewer high-fat foods (fat-related dietary behaviour score, 1.54 versus 1.28; P < 0.001). Women in households with more reduced-fat foods had a significantly decreased consumption of high-fat foods since immigration compared with those in households with fewer reduced-fat foods (P < 0.001). Western dietary acculturation was higher among women in households both with more high-fat foods and more reduced-fat food counterparts (P ≤ 0.05).

Our inventory of household foods was strongly associated with current dietary behaviour, changes in food consumption, and westernization of dietary patterns. This simple, practical measure may be a useful alternative dietary assessment tool in less-acculturated Chinese populations.

Diet is an important determinant of health outcomes, but physicians have few ways to identify persons with suboptimal diets. The purposes of this study were to examine the reproducibility of a short dietary assessment questionnaire (PrimeScreen) and to compare its results with those of a longer food frequency questionnaire and with plasma levels of selected nutrients.

Each subject completed two PrimeScreen questionnaires at an interval of 2 weeks and one full length, 131-item, semiquantitative food frequency questionnaire (SFFQ), and had a sample of blood drawn. We compared the PrimeScreen with two reference standards, the SFFQ and plasma levels of selected nutrients.

A large managed care organization in New England.

A total of 160 men and women, aged 19–65 years, participated.

For foods and food groups, the mean correlation coefficient (r) was 0.70 for reproducibility and 0.61 for comparability with the SFFQ. For nutrients, the mean r was 0.74 for reproducibility and 0.60 for comparability with the SFFQ. No substantial differences were evident by sex, race, body mass index, occupation or education. Correlation coefficients for the comparison of vitamin E, β-carotene and lutein/zeaxanthin intakes from the PrimeScreen with plasma levels were 0.33, 0.43 and 0.43, respectively. These values were similar to those comparing the SFFQ with plasma levels. The median time to complete PrimeScreen was 5 min; 87% of participants required fewer than 10 min.

A quick way to assess quality of diet among adults, PrimeScreen has adequate reproducibility and its results compare well with a longer food frequency questionnaire and biomarkers.

To compare intra- and inter-method reliability of a semi-quantitative food frequency questionnaire (FFQ) designed specifically to measure beta carotene (BC) and retinol intake, using two methods – the limits of agreement (LOA) and the correlation coefficient.

A cross-sectional study of dietary intake.

A randomized trial of vitamin A supplements in 2769 subjects with past asbestos exposure.

Data from 57 men and 26 women, aged 28–72 years, living in Western Australia.

The FFQ was administered at baseline (FFQ1) and repeated 1 year later (FFQ2). Four 1-week diet records (DRs) were completed during the year.

Mean agreement between FFQ2 and FFQ1 was 120% for BC and 98% for retinol. LOA were 47–306% and 21–459%, respectively. Mean agreement between FFQ2 and the DR was 149% for BC and 63% for retinol; LOA were 50–447% and 11–349%, respectively. Mean agreement and LOA varied across energy intakes. Between the DR and FFQ2, correlation coefficients were 0.36 for BC and 0.51 for retinol. These varied considerably across age, gender and energy intakes and were not in accordance with limits of agreement findings.

Although correlation coefficients were positive and significant, there was less than ideal intra-method and inter-method reliability shown by the limits of agreement method. Bias was uneven across the range of intakes, the LOA were wide and, compared with the DR, the FFQ significantly over-estimated BC and under-estimated retinol. This shows the limitations of calculating correlation coefficients alone, for assessing reliability and validity.