Obesity and associated lifestyle behaviours in Iran: findings from the First National Non-communicable Disease Risk Factor Surveillance Survey

OBJECTIVE: To assess the national prevalence of overweight and obesity, as well as some associated lifestyle behaviours, for the first time in Iran. DESIGN AND SETTINGS: This population-based study was performed in early 2005 as part of the World Health Organization (WHO) STEPwise approach to non-communicable diseases' risk factor surveillance. Dietary and physical activity habits were assessed by WHO questionnaires. SUBJECTS: The study population comprised 89,532 subjects aged over 15 years living in the 28 provinces of Iran. RESULTS: Overall, 50.4% (n = 45,113) of the participants were male and 64.6% (n = 57 866) were from the urban areas. The national estimates of overweight, obesity and morbid obesity were 28.6%, 10.8% and 3.4%, respectively. Body mass index (BMI) > or = 25 kg m-2 in men, women, urban residents and rural residents were found in 37%, 48%, 46.7% and 35.5%, respectively. Abdominal obesity was present in 43.4% of women, 9.7% of men, 28.5% of the urban residents and 23% of the rural residents. Overweight as well as generalised and abdominal obesity were more prevalent in the 45-64-year age group. Although there was no significant difference in frequency of consumption of the food groups in subjects with different BMI categories, various kinds of physical activities showed a steady decline with increasing BMI. CONCLUSIONS: The findings of the present study provide alarming evidence for health professionals and policy makers about the very high prevalence of generalised and abdominal obesity in Iran. The unhealthy lifestyle habits, notably sedentary lifestyles in our community, are the major contributing factors for this emerging public health problem.     

Diabetes and hypertension increases in a society with abdominal obesity: results of the Mexican National Health Survey 2000

OBJECTIVES: To determine the prevalences of overweight, obesity, type 2 diabetes mellitus (DM) and hypertension (HT) in the Mexican population and compare them with those of a previous Mexican urban survey and an American survey. DESIGN: A structured, randomised, nationally representative Mexican sample was compared with a 1993 Mexican urban survey and the US Third National Health and Nutrition Examination Survey (NHANES III) of non-Hispanic Whites. SETTING: The Mexican National Health Survey 2000.Subjects: Subjects were 12,856 men and 28,332 women, aged 20-69 years, who had their body weight, height, waist circumference (WC), blood pressure and fasting capillary blood glucose measured. RESULTS: Mexican adult men and women had a high prevalence of overweight (41.3 and 36.3%, respectively) and obesity (19.4 and 29.0%, respectively), similar to those in the USA in 1988-1992 and exceeding those of the 1993 Mexican survey. The prevalence of HT was 33.3% in men and 25.6% in women, with inferred DM rates of 5.6 and 9.7%, respectively. Abdominal obesity affected 46.3% of men (WC>or=94 cm) and 81.4% of women (WC>or=80 cm). There was a high prevalence of abdominal obesity in normal-weight women, with co-morbidities relating better to WC than to body mass index (BMI) in both sexes. Rates of DM and HT exceeded US rates on a comparable BMI or WC basis in adults aged <50 years. CONCLUSION: The high prevalence of obesity and abdominal obesity in Mexicans is associated with markedly increased prevalences of DM and HT to levels comparable with, or even higher than, those in NHANES III of non-Hispanic Whites.     

Anthropometry of women of childbearing age in Morocco: body composition and prevalence of overweight and obesity

OBJECTIVE: To determine the prevalence of obesity and body fat distribution of Moroccan women of childbearing age, using a panel of anthropometric measurements. DESIGN AND SETTING: A cross-sectional survey conducted in 1995 in an agricultural community, El Jadida province of Morocco. Weight, height, waist and hip circumferences and triceps, biceps, subscapular and supra-iliac skinfold thicknesses were measured. Body mass index (BMI), waist/hip ratio (WHR), sum of all and sum of trunk skinfold thicknesses were determined. SUBJECTS: In total, 1269 women aged 15-49 years from urban and rural areas were surveyed. RESULTS: The means of all anthropometric measurements including body fat were higher in urban than in rural women and increased with age. Trunk fat contributed 50% of total fat. Globally, 4.7% of women were underweight (BMI<18.5 kg m(-2)), 35.2% were overweight or obese (BMI> or =25 kg m(-2)), 10.1% were obese (BMI> or =30 kg m(-2)) and 16.8% had central obesity (WHR>0.85). The prevalence of overweight and obesity was higher in the urban than in the rural area. Underweight prevalence decreased with age, whereas that of overweight and obesity increased. All anthropometric parameters adjusted for age increased with the increase of BMI and WHR. CONCLUSIONS: Although undernutrition is still prevalent, there is an alarming prevalence of overweight and obesity in Moroccan women of childbearing age. The results indicate a shift in this country from the problem of dietary deficiency to the problem of dietary excess, and alert one to the necessity of establishing an intervention to prevent obesity-related diseases. It is necessary to address which of the anthropometric variables studied here is the best predictor of obesity-related diseases in this population.     

Alcohol intake in relation to body mass index and waist-to-hip ratio: the importance of type of alcoholic beverage

OBJECTIVE: 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. DESIGN: Cross-sectional. SETTING: Participants were free-living healthy volunteers of the SU.VI.MAX study (an intervention study on the effects of antioxidant supplementation on chronic diseases). SUBJECTS: 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. RESULTS: 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 beta=0.21, 95% confidence interval (CI): 0.09-0.34 and beta=0.22, 95% CI: 0.06-0.39 for men and women, respectively) and WHR (beta=0.003, 95% CI: 0.001-0.005 and beta=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. CONCLUSION: If confirmed in longitudinal studies, our results indicate that consumption of alcoholic beverages may be a risk factor for obesity.     

Generalised and abdominal obesity and risk of diabetes, hypertension and hypertension-diabetes co-morbidity in England

OBJECTIVES: To look at trends in generalised (body mass index (BMI) >or=30 kg m(-2)) and abdominal (waist circumference (WC) >102 cm in men, >88 cm in women) obesity among adults between 1993 and 2003, and to evaluate their association with diabetes, hypertension and hypertension-diabetes co-morbidity (HDC) in England. DESIGN: Analyses of nationally representative cross-sectional population surveys, the Health Survey for England (HSE). SUBJECTS: Non-institutionalised men and women aged >or=35 years. MEASUREMENTS: Interviewer-administered questionnaire (sociodemographic information, risk factors, doctor-diagnosed diabetes), measurements of height and weight to calculate BMI. WC and blood pressure measurements were taken by trained nurses. RESULTS: Generalised obesity increased among men from 15.8% in 1993 to 26.3% in 2003, and among women from 19.3% to 25.8%. Abdominal obesity also increased in both sexes (men: 26.2% in 1993 to 39.0% in 2003; women: 32.4% to 47.0%). In 1994, 1998 and 2003, generalised and abdominal obesity were independently associated with risk of hypertension, diabetes and HDC. The odds of diabetes associated with generalised obesity in 1994, 1998 and 2003 were 1.62, 2.26 and 2.62, respectively, in women and 1.24, 1.82 and 2.10, respectively, in men. Similar differences were observed for hypertension and HDC. Men and women with abdominal obesity also showed a higher risk for diabetes, hypertension and HDC than those with a normal WC. CONCLUSIONS: If current trends in obesity continue then the risk of related morbidities may also increase. This will impact on cardiovascular disease morbidity and mortality, with cost implications for the health service. Therefore there is an urgent need to control the epidemic of obesity.     

Dietary and socio-economic factors associated with overweight and obesity in a southern French population

OBJECTIVE: To investigate the socio-economic and dietary factors associated with overweight and obesity, respectively, in southern France. DESIGN: Cross-sectional analysis of socio-economic, lifestyle and nutritional characteristics of a representative population sample. A questionnaire elicited information on anthropometric measurements, socio-economic factors, physical activity, tobacco use, and alcohol and food intakes. Non-parametric tests, multiple linear regression models and correspondence factorial analysis (CFA) were used to estimate the association of the various factors with overweight and obesity. SETTING: French Southwest and Mediterranean areas. SUBJECTS: In total, 1169 subjects (578 women and 552 men), aged 30-77 years, were recruited at random. RESULTS: Overweight and obesity were associated with age and education in both genders, reproductive factors in women and tobacco use in men. A few dietary factors were identified (high energy intake and low intake of carbohydrates), but all these variables explained little of the variation (18.5% in women and 14.6% in men). The CFA further investigated the association of lifestyle and nutritional factors, giving more weight to nutritional behaviour for overweight men and women. Factors for obesity differed from those for overweight by being different in men and women, possibly related to psychological behaviour, and there were fewer of them, suggesting an insufficient coverage by the usual questionnaires. CONCLUSIONS: Overweight and obesity appear as two different entities. Energy imbalance induced by various lifestyle factors plays a major role in the development of overweight, whereas obesity represents a more complex entity where psychological and genetic factors that are difficult to assess may be more important. General nutritional guidelines appear more adapted to the prevention of overweight than to that of obesity, and individual counselling to the prevention of obesity.     

Prevalence of overweight and obesity among school-aged children in urban, rural and mountain areas of the Veneto Region, Italy

OBJECTIVE: To define the prevalence of overweight and obesity among school-aged children resident in mountain areas, rural areas and urban areas.Design, setting and subjectsThe sample (n = 12 832; 50.7% boys) included 9- and 11-year-old children of the Veneto Region of north-east Italy. Overweight and obesity status were determined using the International Obesity Task Force cut-off points for body mass index. The prevalence of overweight and obese subjects was calculated with a confidence interval of 95%. The Mantel-Haenszel method was used to compare the combined prevalence of overweight and obesity among children resident in mountain areas, rural areas and urban areas. RESULTS: Among boys the prevalence of overweight was 21.06%, while obesity prevalence was 5.92%; among girls overweight prevalence was 21.30%, while obesity prevalence was 5.15%. The prevalence was higher among 11-year-old boys (odds ratio (OR) = 1.19; 95% confidence interval (CI): 1.06-1.33) and 9-year-old girls (OR = 1.13; 95% CI: 1.01-1.26). Children resident in rural areas presented a higher risk of overweight and obesity compared with children resident in mountain areas (Mantel-Haenszel OR = 1.27; 95% CI: 1.13-1.42; chi2 = 17.55; P < 0.0001) and in urban areas (Mantel-Haenszel OR = 1.18; 95% CI: 1.07-1.31; chi2 = 10.39; P < 0.001). CONCLUSIONS: A relevant prevalence of overweight and obesity was found; the excess weight concerns one child in four. There are differences linked to different geographical areas that must be further investigated.     

Are dietary diversity scores related to the socio-economic and anthropometric status of women living in an urban area in Burkina Faso?

OBJECTIVES: To study dietary diversity and its relationship with socio-economic and nutritional characteristics of women in an urban Sahelian context. DESIGN: A qualitative dietary recall was performed over a 24-h period. Dietary diversity scores (DDS = number of food groups consumed) were calculated from a list of nine food groups (DDS-9) or from a list of 22 food groups (DDS-22) which detailed both micronutrient- and energy-dense foods more extensively. Body mass index (BMI), mid upper-arm circumference and body fat percentage were used to assess the nutritional status of the women. SETTING AND SUBJECTS: Five hundred and fifty-seven women randomly selected in two districts of Ouagadougou, the capital of Burkina Faso. RESULTS: The mean DDS-9 and DDS-22 were 4.9 +/- 1.0 and 6.5 +/- 1.8 food groups, respectively. In the high tertile of DDS-22, more women consumed fatty and sweetened foods, fresh fish, non-fatty meat and vitamin-A-rich fruits and vegetables. The DDS-9 was not associated with the women's socio-economic characteristics whereas the DDS-22 was higher when the women were younger, richer and had received at least a minimum education. Mean BMI of the women was 24.2 +/- 4.9 kg m-2 and 37% of them were overweight or obese (BMI > or = 25 kg m-2). Neither the DDS-9 nor the DDS-22 was associated with the women's anthropometric status, even though there was a trend towards fewer overweight women in the lowest tertile of DDS-22. CONCLUSION: In this urban area, the qualitative measurement of dietary diversity is not sufficient to identify women at risk of under- or overweight.     

Risk factors for overweight among Brazilian adolescents of low-income families: a case-control study

OBJECTIVE: To study risk factors for overweight among Brazilian adolescents of low-income families. DESIGN: Case-control study of obese and non-obese adolescents. SETTING: Anthropometric survey including 1420 students (aged 14-19 years) attending a public high school in S?o Paulo, Brazil. METHODS: Selection of 83 overweight (body mass index (BMI) >85th percentile) and 89 non-overweight (BMI >5th percentile and <85th percentile) subjects, frequency-matched by age, gender, pubertal development and socio-economic status. Among the nutritional, familial and behavioural data available, five covariates (parents' obesity, adolescents' past obesity, to have a best friend, dietary restriction and habit of napping) were included in the fitted hierarchical conditional logistic regression models. MEASUREMENTS: Parents or guardians and adolescents were weighed, measured and answered a pre-tested questionnaire applied by trained nutritionists and paediatricians. RESULTS: The prevalence of overweight was 15.2%. As previous risks, obese parents and obesity during infancy presented odds ratios (OR) and 95% confidence intervals (CI) of 2.23 (1.15-4.35) and 3.60 (1.47-8.80), respectively. As concurrent factors, the habit of napping, to have a best friend and reported dietary restriction presented OR (95% CI) of 3.43 (1.32-8.92), 5.15 (1.76-15.07) and 7.26 (2.95-17.88), respectively. Dietary patterns, frequency of obesogenic foods and other physical activity indicators presented no statistical significance. CONCLUSION: In case-control studies, OR may overestimate the true risks. Parents' obesity and previous childhood obesity were identified as risk factors; therefore these factors should be the target for preventive programmes and policies in order to prevent the burden of obesity in the near future.     

Assessment of obesity and fear of fatness among inner-city Dublin schoolchildren in a one-year follow-up study

BACKGROUND: Positive secular trends in adolescent obesity and an increased prevalence of fear of fatness, particularly among girls, have been documented world-wide. There is a lack of consensus about assessment criteria for childhood obesity and no standard exists for assessing Irish children. In 1990, the Irish National Nutrition Survey used body mass index (BMI) > or =26 kg m(-2) to describe the prevalence of overweight among Irish adolescents. OBJECTIVES: (1) To examine the range in classification of Dublin schoolchildren as overweight according to four standard assessment methods; (2) to assess changes in weight status, prevalence of fear of fatness and accompanying slimming practices in a one-year follow-up; and (3) to compare the prevalence of overweight with that documented in 1990 among adolescents of similar age. DESIGN: A one-year follow-up study of 199 healthy schoolchildren (90 boys and 109 girls; mean age of 11 years at baseline) attending seven fee-paying (six single- and one mixed-sex) and eight non-fee-paying (four single- and four mixed-sex) primary schools in Dublin city centre. MEASUREMENTS: Weight, height, waist circumference and triceps skinfold were measured and used in five definitions of overweight, including published cut-off points of BMI-for-age (Centers for Disease Control and Prevention BMI-for-age charts for boys and girls; BMI reference curves for the UK 1990; International Obesity Task Force age- and sex-specific BMI cut-offs), actual relative weight and BM > or =26 kg m(-2). Assessment of body image perceptions and satisfaction (using figure line drawings) was reported in a questionnaire specifically designed for this study. RESULTS: The prevalence of overweight within the total group differed between the four standard definitions of weight status, by 9% at baseline and 8% at follow-up. Accordingly, increasing trends over the year ranged from zero to 3%. Using the criterion BMI > or =26 kg m(-2), 6% of Dublin schoolchildren were overweight, compared with 1.9% of schoolchildren in 1990. Significantly more girls than boys were affected by fear of fatness and were trying to lose weight. CONCLUSION: A standard method for assessment of weight status is urgently needed for the evaluation of obesity prevention initiatives among Irish schoolchildren. Such initiatives need to be sensitive to the pervasiveness of fear of fatness among adolescent girls.     

Trends in overweight by socio-economic status in Vietnam: 1992 to 2002

OBJECTIVE: To explore socio-economic factors associated with rising rates of overweight among Vietnamese adults. DESIGN: The study was based on three national surveys of socio-economic factors and health conducted over a 10-year period. The studies were: the Vietnamese Living Standard Survey 1992-1993 (11 982 participants); the Vietnamese Living Standard Survey 1997-1998 (15 975 participants); and the Vietnamese National Health Survey 2001-2002 (94 656 participants). SUBJECTS: Male and female adults >18 years old were stratified by gender, age group, area of residence, occupation, education and relative food expenditures. Overweight was defined using body mass index (BMI) > or = 25 kg m(-2). RESULTS: Overweight rates in Vietnam more than doubled between 1992 and 2002 (from 2.0 to 5.7%). Significant increases were observed for men and women, in urban and rural areas, and for all age groups. In univariate analyses, both age and higher socio-economic status were associated with higher rates of overweight. Using the most recent survey, urban populations were more likely to be overweight than rural ones (odds ratio (OR) = 1.79), white-collar workers were more likely to be overweight than manual labourers (OR = 1.95) and persons in the top level of food expenditures were more likely to be overweight than persons in the bottom level (OR = 4.96) after adjustment for other factors. Education was inversely associated with overweight after adjusting for covariates. CONCLUSION: Economic growth and improved standard of living are associated with higher rates of overweight in nations in early stages of economic development. In Vietnam, higher rates of overweight were observed among the higher income and occupation groups.     

The effects of socio-economic status on BMI, waist:hip ratio and waist circumference in a group of Iranian women

OBJECTIVE: To assess the effects of socio-economic status (SES) on BMI, waist:hip ratio (WHR) and waist circumference (WC) in a group of Iranian women. METHODS: A cross-sectional study was conducted on 888 women in Sistan and Baluchestan Province. SES was measured using level of education. In addition, parity, marital status and physical activity were assessed. Standardized measurements were taken, BMI and WHR were calculated. RESULTS: Low education level was a strong determinant of overweight and obesity among Iranian women. After controlling for age, women with higher education level had significantly lower BMI, WC and parity. Multiple linear regression analysis found a significant negative association of BMI and WC with education level and a significant positive association of BMI and WC with parity. Significant factors associated with obesity by a logistic regression model were education level (OR for university graduates v. illiterate or low literacy levels: 1.00 v. 3.70; P = 0.01), living with spouse (OR for married v. single subjects: 1.00 v. 0.15; P = 0.05), parity (OR for more than five v. less than two pregnancies: 1.00 v. 0.34; P = 0.03) and WC (OR for < 0.88 cm v. > or = 0.88 cm: 1.00 v. 11.20; P = 0.001). CONCLUSION: The present study revealed that educational level, multiple pregnancies, marital status and lack of exercise are some possible explanations for the obesity among Sistan and Baluchestan women.     

The association between consumption of breakfast cereals and BMI in schoolchildren aged 12-17 years: the VYRONAS study

OBJECTIVE: To evaluate whether consumption of breakfast cereals is associated with BMI in a sample of Greek adolescents. DESIGN: A cross-sectional health and nutrition survey.Setting and subjectsDuring 200417 years were selected from twelve schools located in Vyronas region (Athens metropolitan area). Height and weight were measured and BMI was calculated. A semi-quantitative FFQ was applied and multiple logistic regression analysis was used. RESULTS: Overall, 47 % of girls were obese, whereas 192 % of girls were overweight. Only 205 % of girls reported that they consume cereals as a first choice for breakfast. Consumption of breakfast cereals was associated with lower BMI in boys (P = 0019), irrespective of age and physical activity status. More prominent results were observed for daily cereal consumption or for more than two daily servings of cereals consumed for breakfast. Consumption of pre-sweetened breakfast cereals was associated with lower BMI compared with non-pre-sweetened or no intake of cereals, in both genders (P < 0.001). Consumption of breakfast cereals was associated with 33 % (95 % CI 14 %, 48 %) lower likelihood of overweight/obesity, irrespective of age, sex and physical activity status. CONCLUSIONS: Consumption of breakfast cereals was associated with lower BMI levels and a lower likelihood of overweight/obesity in both genders; thus a solid basis for public health professionals could be built when issuing advice on weight management.     

Overweight and obesity in a Swiss city: 10-year trends

BACKGROUND: Increased rates of overweight/obesity have been reported in recent years in developed countries. This population study of healthy subjects evaluated the changes in overweight/obesity prevalence in 2003, compared with 1993, and determined the association of age, sex and leisure-time activity with body mass index (BMI), fat-free mass index (FFMI) and fat mass index (FMI). DESIGN: Two transversal samples of convenience. PARTICIPANTS: Healthy volunteers (1993, n = 802; 2003, n = 1631). METHODS: Fat-free mass was determined using the bioelectrical impedance multiple regression equation. Multivariable linear regression, including confounding variables (age, sex, leisure-time activity), was used to model the body composition evolution between the 1993 and the 2003 subjects. RESULTS: BMI and FMI were higher in 2003 than in 1993, P < 0.001. FFMI was not higher in 2003 than in 1993, P = 0.38. More subjects were overweight/obese in 2003 than in 1993 (27.5 versus 17.2%, chi-square P < 0.001), and had a high FFMI (30.2 versus 21.8%, chi-square P < 0.001) and high FMI (28.0 versus 20.3%, chi-square P < 0.001). Multivariate linear regressions showed that leisure-time activity was negatively, and sex, age and inclusion year were positively associated with BMI, FFMI and FMI (the exception was a negative association with sex) (P < 0.001). CONCLUSION: Overweight prevalence increased between 1993 and 2003 in a Swiss city, and was associated with a higher fat mass. This observation remained statistically significant after adjustment for age, sex and leisure-time activity.     

Body mass index, waist circumference and waist-to-hip ratio cut-off points for categorisation of obesity among Omani Arabs

BACKGROUND: There are no data on optimal cut-off points to classify obesity among Omani Arabs. The existing cut-off points were obtained from studies of European populations. OBJECTIVE: To determine gender-specific optimal cut-off points for body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) associated with elevated prevalent cardiovascular disease (CVD) risk among Omani Arabs. DESIGN: A community-based cross-sectional study. SETTING: The survey was conducted in the city of Nizwa in Oman in 2001. SUBJECTS AND METHODS: The study contained a probabilistic random sample of 1421 adults aged > or =20 years. Prevalent CVD risk was defined as the presence of at least two of the following three risk factors: hyperglycaemia, hypertension and dyslipidaemia. Logistic regression and receiver-operating characteristic (ROC) curve analyses were used to determine optimal cut-off points for BMI, WC and WHR in relation to the area under the curve (AUC), sensitivity and specificity. RESULTS: Over 87% of Omanis had at least one CVD risk factor (38% had hyperglycaemia, 19% hypertension and 34.5% had high total cholesterol). All three indices including BMI (AUC = 0.766), WC (AUC = 0.772) and WHR (AUC = 0.767) predicted prevalent CVD risk factors equally well. The optimal cut-off points for men and women respectively were 23.2 and 26.8 kg m-2 for BMI, 80.0 and 84.5 cm for WC, and 0.91 and 0.91 for WHR. CONCLUSIONS: To identify Omani subjects of Arab ethnicity at high risk of CVD, cut-off points lower than currently recommended for BMI, WC and WHR are needed for men while higher cut-off points are suggested for women.     

Trends in food intakes in Swedish adults 1986-1999: findings from the Northern Sweden MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease) Study

OBJECTIVE: To determine changes in reported food frequency in adults between 1986 and 1999. DESIGN: Four consecutive cross-sectional surveys. SETTING: Counties of Norrbotten and V?sterbotten, Northern Sweden. SUBJECTS: 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. RESULTS: 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). CONCLUSIONS: 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.     

Dietary intake of heterocyclic amines in relation to socio-economic, lifestyle and other dietary factors: estimates in a Swedish population

OBJECTIVES: To estimate the dietary intakes of heterocyclic amines (HCAs), to examine the intakes in relation to socio-economics, lifestyle and other dietary factors and to compare the classification of subjects by intake of HCA versus intake of meat and fish. DESIGN: Cross-sectional analysis within the Malm? Diet and Cancer (MDC) cohort. Data were obtained from a modified diet history, a structured questionnaire on socio-economics and lifestyle, anthropometric measurements and chemical analysis of HCAs. HCA intake was cross-classified against meat and fish intake. The likelihood of being a high consumer of HCAs was estimated by logistic regression analysis. Dietary intakes were examined across quintiles of HCA intake using analysis of variance. SETTING: Baseline examinations conducted in 1991-1994 in Malm?, Sweden. SUBJECTS: A sub-sample of 8599 women and 6575 men of the MDC cohort. RESULTS: The mean daily HCA intake was 583 ng for women and 821 ng for men. Subjects were ranked differently with respect to HCA intake compared with intake of fried and baked meat and fish (kappa = 0.13). High HCA intake was significantly associated with lower age, overweight, sedentary lifestyle and smoking. Intakes of dietary fibre, fruits and fermented milk products were negatively associated with HCA intake, while intakes of selenium, vegetables, potatoes, alcohol (among men) and non-milk-based margarines (among women) were positively associated with HCA intake. CONCLUSIONS: The estimated daily HCA intake of 690 ng is similar to values obtained elsewhere. The present study suggests that lifestyle factors (e.g. smoking, physical activity, fruit and vegetable intakes, and types of milk products and margarines) may confound associations between HCA intake and disease. The poor correlation between HCA intake and intakes of fried meat and fish facilitates an isolation of the health effects of HCAs.     

Dietary intakes and health-related behaviours of Korean American women born in the USA and Korea: the Multiethnic Cohort Study

OBJECTIVE: This study assessed and compared heath-related behaviours and nutrient and food group intakes between US-born and Korea-born Korean American women. DESIGN AND SUBJECTS: Cross-sectional analyses were performed for ethnic Koreans who participated in the Multiethnic Cohort Study in Hawaii and Los Angeles in 1993-1996. The sample included 492 Korean American women aged 45-75 years who were born in the USA (n = 274) or Korea (n = 218). Participants were recruited using driver's license files as a primary sampling source and completed a self-administered questionnaire, including a quantitative food frequency section. RESULTS: The proportion overweight or obese was 31.4% in US-born and 9.4% in Korea-born women. US-born women had higher intakes of total fat and fat as a percentage of energy, and lower intakes of sodium, vitamin C, beta-carotene and carbohydrate as a percentage of energy, than Korea-born women. Comparing intakes of food group servings from the Food Guide Pyramid, US-born women reported more whole grains, red meat and nuts, and less soy products, than did Korea-born women. US-born women also consumed fewer vegetables and fruit than those born in Korea. Few women in either group reported intakes that met the recommendations for dairy foods. Intake of discretionary fat from the Pyramid tip was higher in US-born than in Korea-born women. CONCLUSIONS: These findings indicate that the acculturation of Korean immigrants affects dietary intakes in ways that may alter risks of several chronic diseases. Further studies will be necessary to examine the effects of dietary acculturation on disease patterns.     

Monetary costs of dietary energy reported by young Japanese women: association with food and nutrient intake and body mass index

OBJECTIVE: Little is known about the relationship of monetary diet costs to dietary intake and obesity, particularly in non-Western populations. This study examined monetary cost of dietary energy in relation to diet quality and body mass index (BMI) among young Japanese women. DESIGN: Dietary intake was assessed by a validated, self-administered, diet history questionnaire. Diet costs were estimated using retail food prices. Monetary cost of dietary energy (Japanese yen 1000 kcal-1) was then calculated. BMI was computed from self-reported body weight and height. SUBJECTS: A total of 3931 female Japanese dietetic students aged 18-20 years. RESULTS: Monetary cost of dietary energy was positively associated with intakes of fruits, vegetables, fish and shellfish, and pulses; however, higher monetary cost of dietary energy was also associated with higher consumption of fat and oil, meat and energy-containing beverages, and lower consumption of cereals (rice, bread and noodles) (all P for trend <0.01). At the nutrient level, monetary cost of dietary energy was positively associated with intakes of dietary fibre and key vitamins and minerals, but also associated positively with intakes of fat, saturated fatty acids, cholesterol and sodium, and negatively with carbohydrate intake (all P for trend <0.0001). After adjustment for possible confounders, monetary cost of dietary energy was quite weakly but significantly negatively associated with BMI (P for trend = 0.0197). CONCLUSIONS: Increasing monetary cost of dietary energy was associated with both favourable and unfavourable dietary intake patterns and a quite small decrease in BMI in young Japanese women.