To indicate why the world's most powerful nation state and one powerful sector of the food and drink production and manufacturing industry are determined to demolish the 2004 WHO (World Health Organization) global strategy on diet, physical activity and health, and to disassociate it from the 2003 WHO/FAO (Food and Agriculture Organization) expert report on diet, nutrition and the prevention of chronic diseases, which with its background papers is the immediate scientific basis for the strategy. To encourage representatives of nation states at the 2004 WHO World Health Assembly to support the strategy together with the report, so that the strategy is explicit and quantified, and responds to the need expressed by member states at the 2002 World Health Assembly. This is for an effective global strategy to prevent and control chronic diseases whose prevalence is increased by nutrient-poor food low in vegetables and fruits and high in energy-dense fatty, sugary and/or salty foods and drinks and also by physical inactivity. Of these diseases, obesity, diabetes, cardiovascular diseases and cancers of several sites are now the chief causes of morbidity and mortality in most countries in the world.

A summary of the global strategy and its roots in scientific knowledge accumulated over the last half-century. Reasons why the global strategy and the expert report are opposed by the current US government and the world sugar industry, with some reference to modern historical context. A summary of the trajectory of the global strategy since its first draft made in early 2003, and a further summary of its weaknesses, strengths and potential.

The 2004 WHO global strategy and the 2003 WHO/FAO expert report are perceived by the current US administration as an impediment to US trade and international policy, within a general context of current US government hostility to the UN (United Nations) system as a brake on the exercise of its power as the world's dominant nation. Policy-makers throughout the world should be aware of the contexts of current pressures put on them by powerful nation states and sectors of industry whose ideologies and commercial interests are challenged by international initiatives designed to improve public health and to leave a better legacy for future generations.

The British Nutrition Foundation was recently commissioned by the Food Standards Agency to conduct a review of the government's research programme on Antioxidants in Food. Part of this work involved an independent review of the scientific literature on the role of antioxidants in chronic disease prevention, which is presented in this paper.

There is consistent evidence that diets rich in fruit and vegetables and other plant foods are associated with moderately lower overall mortality rates and lower death rates from cardiovascular disease and some types of cancer. The ‘antioxidant hypothesis’ proposes that vitamin C, vitamin E, carotenoids and other antioxidant nutrients afford protection against chronic diseases by decreasing oxidative damage.

Although scientific rationale and observational studies have been convincing, randomised primary and secondary intervention trials have failed to show any consistent benefit from the use of antioxidant supplements on cardiovascular disease or cancer risk, with some trials even suggesting possible harm in certain subgroups. These trials have usually involved the administration of single antioxidant nutrients given at relatively high doses. The results of trials investigating the effect of a balanced combination of antioxidants at levels achievable by diet are awaited.

The suggestion that antioxidant supplements can prevent chronic diseases has not been proved or consistently supported by the findings of published intervention trials. Further evidence regarding the efficacy, safety and appropriate dosage of antioxidants in relation to chronic disease is needed. The most prudent public health advice remains to increase the consumption of plant foods, as such dietary patterns are associated with reduced risk of chronic disease.

Many factors need to be considered in a food-based intervention. Vitamin A deficiency and chronic diseases, such as diabetes, heart disease and cancer, have become serious problems in the Federated States of Micronesia (FSM) following the decreased production and consumption of locally grown foods. However, agricultural and social conditions are still favourable for local food production.

To identify key factors to consider in a Micronesian food-based intervention focusing on increased production and consumption of four major Micronesian staple foods: banana, breadfruit, giant swamp taro and pandanus.

Ethnographic methods including key informant interviews and a literature review.

Pacific and Micronesian values, concepts of food and disease, and food classifications differ sharply from Western concepts. There are few FSM professionals with nutrition expertise. Traditional foods and food cultivars vary in nutrient content, consumption level, cost, availability, status, convenience in growing, storing and cooking, and organoleptic factors.

A systematic consideration of the factors that relate to a food-based intervention is critical to its success. The evaluation of which food and cultivar of that food that might be most effectively promoted is also critical. Regional differences, for example FSM inter-island differences between the staple foods and cultivars, must be considered carefully. The evaluation framework presented here may be relevant to Pacific Island and other countries with similar foods where food-based interventions are being planned. An ethnographic approach was found to be essential in understanding the cultural context and in data collection and analysis.

This study investigated young women's perceptions of the feasibility of physical activity and healthy eating behaviours, and how these vary by socio-economic status, domestic characteristics and weight status.

This population-based study used a mailed questionnaire to investigate perceptions of the feasibility of commonly recommended healthy eating and physical activity behaviours among a sample of young women. The feasibility of 29 physical activity behaviours (e.g. relating to frequency, intensity, duration, domain/setting) and 15 healthy eating behaviours (e.g. relating to location/setting, fruit and vegetable intake, fat/sugar intake) was assessed. Height, weight and sociodemographic details were also obtained.

Nation-wide community-based survey.

A total of 445 women aged 18–32 years selected randomly from the Australian electoral roll.

Most women reported that they either were already engaged in many of the healthy eating behaviours or saw these as highly feasible. Many physical activity behaviours, on the other hand, were perceived as less feasible, particularly among women with children and women who were overweight.

Health promotion messages and strategies aimed at increasing physical activity and healthy eating are unlikely to succeed unless they take into account perceptions that these behaviours are not feasible. For young women, this may involve promoting more time-effective, flexible ways of achieving recommended physical activity. Messages specifically targeted to women with children, and women who are overweight, are required.

To investigate the proportion of middle-aged Australian women meeting national dietary recommendations and its variation according to selected sociodemographic and behavioural characteristics.

This cross-sectional population-based study used a food-frequency questionnaire to investigate dietary patterns and compliance with 13 commonly promoted dietary guidelines among a cohort of middle-aged women participating in the Australian Longitudinal Study on Women's Health.

Nation-wide community-based survey.

A total of 10 561 women aged 50–55 years at the time of the survey in 2001.

Only about one-third of women complied with more than half of the guidelines, and only two women in the entire sample met all 13 guidelines examined. While guidelines for meat/fish/poultry/eggs/nuts/legumes and ‘extra’ foods (e.g. ice cream, chocolate, cakes, potatoes, pizza, hamburgers and wine) were met well, large percentages of women (68–88%) did not meet guidelines relating to the consumption of breads, cereal-based foods and dairy products, and intakes of total and saturated fat and iron. Women working in lower socio-economic status occupations, and women living alone or with people other than a partner and/or children, were at significantly increased risk of not meeting guidelines.

The present results indicate that a large proportion of middle-aged Australian women are not meeting dietary guidelines. Without substantial changes in their diets, and help in making these changes, current national guidelines appear unachievable for many women.

To examine to what extent the obesity epidemic is a general phenomenon in adults by assessing the secular change, by birth cohort and age, in the prevalence of obesity and median body mass index (BMI) in Danish men and women measured between 1964 and 1994.

Multiple cross-sectional population surveys.

The greater Copenhagen area of Denmark.

The study included 17 065 men (30 336 observations) and 13 417 women (24 065 observations), aged 20–84 years.

Trends in median BMI and prevalence of obesity estimated from measured height and weight in 10-year age groups.

In general the prevalence of obesity was increasing, although in an irregular way: among men in two phases, during the 1970s and 1990s and among women only during the 1990s. Great heterogeneity was observed between birth cohorts and age groups. There was only little indication of an increasing trend in obesity prevalence for women, except for the 55–64-year-olds. In men, the prevalence of obesity was increasing in all age groups except in the youngest ones, and it was statistically significant only for men aged 35–74 years. There was no significant linear change in median BMI in any group, except for an increasing trend among men aged 50 years and above.

Although the overall Danish trend for obesity prevalence, similar to trends world-wide, showed a marked increase, the trend was very heterogeneous and generally neither uniform nor significantly positive; the changes were irregular, different among men and women, and different in the different age and birth cohorts. The obesity problem in middle-aged and older men of certain birth cohorts poses a specific public health challenge. Future studies of determinants behind the heterogeneity in the development of the obesity epidemic may provide clues to its causes.

To determine the prevalence of overweight and obesity in British young people (4–18 years) in 1997.

Cross-sectional analysis of the National Diet and Nutrition Survey of young people.

Great Britain.

Nationally representative sample of 1836 young people (age 4–18 years).

The prevalence of obesity based on body mass index (weight/height2) and the International Obesity Task Force cut–offs was 4.0%, with a further 15.4% identified as overweight. Asians were almost four times as likely to be obese as white subjects (13.6 vs. 3.5%, P < 0.001). Among white subjects there was no significant difference in the prevalence of obesity between girls and boys, or with age. The risk of obesity was significantly higher in subjects from social classes IV and V than from social classes I–III (6.5 vs. 2.7%, P = 0.003). Subjects living in Scotland and Wales were significantly more likely to be obese than those in England (7.6 and 6.5 vs. 2.9%, respectively, P < 0.01). Multiple logistic regression showed that, among white subjects, those in social classes IV and V living in Wales and Scotland were three times more likely to be obese than the other children in the survey (odds ratio 3.3, 95% confidence interval 1.1–9.8).

These data provide information on the national prevalence of overweight and obesity in Great Britain and baseline data from which to monitor future trends. This analysis provides important demographic information on those most at risk of obesity, which may be used to inform public health strategies to prevent obesity in young people.

The study aimed to evaluate the homocysteine and cobalamin status of German vegans and determine whether the intake of very small amounts of foods of animal origin can improve this status.

Cross-sectional study, Germany.

The dietary and nutritional intakes of 131 vegans (73 women, 58 men; a range: 20.2–82.1 years) were evaluated using a general questionnaire and two food–frequency questionnaires.

The prevalence of inadequate cobalamin status in volunteers of the German Vegan Study was 28.2%, and that of hyperhomocysteinaemia, 38.1%. Moderate vegans were affected to a lesser extent than were strict vegans. Duration of veganism and cobalamin concentration were inversely correlated (Spearman's r = -0.175, P = 0.047). Folate concentration and erythrocyte aspartic acid aminotransferase activity were not correlated with plasma homocysteine concentration, but duration of veganism correlated positively with homocysteine concentration (Spearman's r = 0.319, P < 0.001). Cobalamin and homocysteine concentrations were inversely correlated (when controlling for duration of veganism; r = -0.602, P < 0.001).

Cobalamin status needs to be improved in order to minimise the risk of hyperhomocysteinaemia.