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.     

Efficacy and safety of food fortification with calcium among adults in Finland

OBJECTIVE: To examine the efficacy and safety of foods fortified with calcium in the adult population in Finland. DESIGN: A simulation study based on the FINDIET 2002 Survey, which estimated habitual food consumption, dietary supplement use and nutrient intakes using 48-hour recall and two 3-day food records, and an Internet survey of the consumption of fortified foods and dietary supplements. SETTING/PARTICIPANTS: Participants of FINDIET 2002 were 25-64 years old from five areas (n = 2007). Participants of the Internet-based survey (n = 1537) were over 15 years of age from all over the country. RESULTS: If all potentially fortifiable foods were to be fortified with calcium, the proportion of participants with calcium intake below the recommended level (< 800 mg day(-1)) would decrease from 20.3% to 3.0% in men and from 27.8% to 5.6% in women compared with the situation where no foods were fortified. At the same time, the proportion of participants with calcium intake above the tolerable upper intake level (UL, > 2500 mg day(-1)) would increase from 0.6% to 12.7% in men and from 0.1% to 3.8% in women. However, in a probability-based model (11% of all fortifiable foods to be fortified with calcium) the proportion of participants with calcium intake below the recommended level would be 15.7% in men and 23.2% in women. The proportion with intake above the UL in this model would be 1.2% in men and 0.7% in women. CONCLUSIONS: Food fortification would be a relatively effective and safe way to increase the calcium intake of the Finnish adult population.     

Determinants of adolescents' soft drink consumption

OBJECTIVE: To identify determinants of adolescents' consumption of carbonated soft drinks (regular and diet), both of total consumption and of consumption at school. DESIGN/SETTING/SUBJECTS: Regular and diet soft drink consumption was measured by food frequency questions that were dichotomised. Several potential environmental and personal determinants of consumption were measured. A total of 2870 (participation rate: 85%) 9th and 10th graders, within 33 Norwegian schools, participated in the study. Multilevel logistic regression analyses were preformed for total soft drink consumption (twice a week or more vs. less) and for consumption at school (once a week or more vs. less). RESULTS: A total of 63% and 27% of the participants reported to drink respectively regular and diet soft drinks twice a week or more, and 24% and 8%, respectively, reported to drink soft drinks once a week or more at school. Preferences, accessibility, modelling and attitudes were the strongest determinants of both regular and diet soft drink consumption. In addition, gender, educational plans and dieting were related to both total soft drink consumption and consumption at school. Pupils with longer distance from school to shop and those in schools with rules concerning soft drink consumption tended to have lower odds of drinking both regular and diet soft drinks at school. CONCLUSION: This study shows that gender, educational plans, dieting, accessibility, modelling, attitudes and preferences all seem to be strong determinants of adolescents' soft drink consumption. Parents and the home environment appear as great potential intervention targets.     

Food consumption patterns in an adult urban population in Beirut, Lebanon

OBJECTIVES: To investigate, measure and assess the food consumption pattern of the adult population living in Beirut, Lebanon, and to identify inadequate or excessive intake of food groups particularly linked to non-communicable diseases. DESIGN: A cross-sectional food consumption survey was conducted in 2001. Dietary habits were assessed by means of a quantitative food-frequency questionnaire. SETTING: Dietary survey of the urban population (Beirut). SUBJECTS: Random sample of 444 adult subjects (aged 25-54 years) in Beirut. RESULTS: The mean consumption of food by the study population was estimated to be 3,030 g day(-1), providing an energy intake of 2,523.57 kcal day(-1). Fat contributed 38.9% to the average daily energy intake, protein 13.4% and carbohydrates 47.2%. Mean consumption of fruits and vegetables was approximately 367 g day(-1) and 45.3% of subjects consumed less than the recommended 400 g daily. Cereals contributed 324.5 g day(-1), providing 35.0% of daily energy intake, with bread being the most highly consumed (146.2 g day(-1)) in this food group. The mean intake of meat and poultry products was 91.7 g day(-1) and provided 8.8% of daily energy intake, with consumption of butchery products especially beef being the highest (47.6 g day(-1)) followed by poultry (36.1 g day(-1)). A low consumption of fish was noted (19.7 g day(-1)), with 73.6% of subjects consuming less than the recommended 2 servings of fish per week. Dairy products contributed 243.1 g day(-1) or 10.9% of daily energy intake, and milk was the least consumed dairy product (56.8% of consumers). The intake of added fats and oils, excluding those in cooked recipes, was 20.4 g day(-1); olive oil was not used in cooking but was added solely at the table and its mean intake was 5 g day(-1). The consumption of butter was low (0.86 g day(-1)) and vegetable oil was the type of fat mostly used in cooking. The average intake of alcoholic beverages was low (33.6 g day(-1)), accounting for 0.7% of total energy intake. Women had significantly higher intakes of milk, dairy products, vegetables and coffee than men (P < 0.05). The percentage of women who reported the use of low-fat items was significantly higher than that of men. Younger people (25-34 years) ate significantly more meat, sugar, alcoholic beverages and soft drinks, and consumed significantly less cooked vegetables and legumes, than older ones (P < 0.05). CONCLUSIONS: The rather high contribution of fat to daily energy intake, the low intake of fish and the relatively high percentage of people consuming less than the recommended amount of fruits and vegetables observed in this study suggest that the adult Lebanese population is at increased risk of cardiovascular diseases, obesity and other non-communicable diseases, which provides the basis for recommending increased intakes of fish, particularly fatty fish, and fruits and vegetables.     

Alcohol and dietary fibre intakes affect circulating sex hormones among premenopausal women

BACKGROUND: The association of alcohol and fibre intake with breast cancer may be mediated by circulating sex hormone levels, which are predictors of breast cancer risk. OBJECTIVE: To evaluate the relationship of alcohol and dietary fibre intake with circulating sex hormone levels among premenopausal women. METHODS: A total of 205 premenopausal women completed a validated food-frequency questionnaire at baseline and after 2 years; blood samples taken at the same time were analysed for circulating sex hormone concentrations, including oestrone (E1), oestradiol (E2), free E2, progesterone, androstenedione and sex hormone-binding globulin, by radioimmunoassay. We used mixed models to estimate least-square means of sex hormone concentrations for alcohol intake categories and quartiles of dietary intake. RESULTS: After adjustment for covariates, alcohol consumption was moderately associated with higher circulating oestrogen levels; those who consumed more than one drink per day had 20% higher E2 (Ptrend=0.07) levels than non-drinkers. In contrast, higher dietary fibre intake was associated with lower serum levels of androstenedione (-8% between the lowest and highest quartiles of intake, Ptrend=0.06), but not oestrogens. Similarly, consumption of fruits (-12%, Ptrend=0.03), vegetables (-9%, Ptrend=0.15) and whole grains (-7%, Ptrend=0.07) showed inverse associations with androstenedione levels. CONCLUSIONS: The consistency of the observed differences in sex hormone levels associated with alcohol and fibre-rich foods indicates that these nutritional factors may affect sex hormone concentrations and play a role in breast cancer aetiology and prevention.     

The potential effect of iron defortification on iron-deficiency anaemia in the US population

OBJECTIVE: To quantify the potential effect of iron defortification in the USA on iron-deficiency anaemia (IDA). METHODS: Monte Carlo models were built to simulate iron nutrition in the US population. A hypothetical cohort of 15 000 persons from the general population was used in 15-year simulations to compare the prevalence of IDA with and without fortification. RESULTS: With iron fortification, the prevalence of IDA was 2.4% for children aged 3-5 years, 5.4% for women aged 20-49 years, and 0.14% for men aged 20-49 years. The corresponding IDA estimates under iron defortification were 4.5%, 8.2% and 0.46%, respectively. Defortification had little effect on the distribution of iron indicators at or above the 50th percentile within each of these three groups and little effect on the distributions of iron indicators among adult men. CONCLUSION: Iron defortification is likely to increase IDA among children and women of reproductive age, but is not likely to have meaningful effects on the iron status of men or the majority of women and children.     

Impact of disaggregation of composite foods on estimates of intakes of meat and meat products in Irish adults

OBJECTIVE: To evaluate the impact of the disaggregation of composite foods on intake estimates of meat and individual meat categories and on the contribution of meat to nutrient intakes in Irish adults. DESIGN: Data were analysed from the North/South Ireland Food Consumption Survey, which used a 7-day food diary to estimate food intake. Of 742 food codes that contained meat, 320 were codes for meat consumed as an individual portion and 422 were composite foods and were disaggregated to estimate the meat content. SUBJECTS: A nationally representative sample of 475 men and 483 women (not pregnant or lactating) from the Republic of Ireland aged 18-64 years. RESULTS: The mean intake of meat was 134 g day(-1) in consumers (98.5%) and men (168 g day(-1)) consumed significantly more (P<0.001) than women (102 g day(-1)). Mean intakes of meat were higher in subjects with manual skilled occupations (P<0.01) and lower in those with third-level educational qualifications (P<0.05). Without disaggregating meat from composite foods, meat intake was overestimated by 43% (57 g day(-1)) and varied widely by meat category. Meat disaggregated from composite foods contributed 25% of meat intake. The contribution meat made to nutrient intakes ranged from 29% for protein, vitamin B12, zinc and niacin to 20% for vitamin D, 16% for vitamin B6, 15% for thiamine and 14% for iron. CONCLUSIONS: Failure to disaggregate meat from composite foods substantially overestimates meat intake, with a large variation between meat categories. This has important implications for estimates of meat intakes in nutritional epidemiological studies and for food safety purposes.     

Dietary behaviour of Tehranian adolescents does not accord with their nutritional knowledge

OBJECTIVE: To determine the nutritional behaviour of Tehranian adolescents. SUBJECTS AND METHODS: This study was undertaken on 7669 adolescents (4070 boys and 3599 girls) of 22 junior high schools and high schools as a representative sample of Tehranian adolescents. A validated knowledge, attitudes and practices (KAP) questionnaire and a food-frequency questionnaire (FFQ) were used. Factor analysis was used to determine the key questions. RESULTS: The mean ( +/- standard deviation) age and body mass index of the adolescents was 14 +/- 1 years and 27.2 +/- 11 kg m- 2. Although 82% of girls and 75% of boys had good nutritional knowledge, only 25% of boys and 15% of girls had good nutritional practice. Eighty-five per cent of adolescents knew that drinking too many soft beverages resulted in overweight or obesity, but only 4.5% of them did not drink soft beverages. Although 89% of adolescents knew that crisps and corn balls are not healthy snacks, 45% of them used such snacks during their break time. Thirty-seven per cent of adolescents preferred whole-grain biscuits to creamy wafer ones but only 10% of adolescents used whole-grain biscuits as a snack. The most frequently consumed snacks among Tehranian adolescents were sausage sandwiches, cocoa cola, crisps and corn balls, creamy wafers, cakes, chocolate and toffee. CONCLUSION: A low percentage of Tehranian adolescents have good nutritional behaviour and in most of them their nutritional practice does not accord with their nutritional knowledge. These results indicate the necessity of nutritional intervention in Tehranian adolescents.     

Lead in women's and children's vitamins

A survey was conducted to determine the extent of lead (Pb) contamination in vitamins labeled for use by women and children. The Pb content of 324 multivitamin-mineral products was determined using microwave assisted nitric acid digestion and inductively coupled plasma mass spectrometry. Cryogenic grinding was used to composite soft samples such as oil filled capsules and candy-like products such as gummies and jelly beans. Estimates of Pb exposures from consumption of these products were derived for four population groups: young children (0-6 yrs), older children (7+ yrs), pregnant or lactating women, and adult women. The estimated median and maximum Pb exposures were 0.123 and 2.88 microg/day for young children, 0.356 and 1.78 microg/day for older children, 0.845 and 8.97 microg/day for pregnant and lactating women, and 0.842 and 4.92 microg/day for adult women. The overall median value for Pb exposure was 0.576 microg/day. Five samples would have provided exposures that exceeded 4 microg/day. Estimates of exposures were assessed with respect to safe/tolerable exposure levels that have been developed for the specific age and sex groups. These safe/tolerable levels are referred to as the provisional total tolerable intake levels (PTTI) and are 6, 15, 25, and 75 microg Pb/day for young children, older children, pregnant or lactating women, and adult women, respectively. Estimates of Pb exposures were below the PTTI levels for the four population groups. Median and maximum values were used instead of the mean and standard deviation because of the skewed distribution of results toward lower mass fraction and exposure.     

Habitual fish consumption and risk of incident stroke: the European Prospective Investigation into Cancer (EPIC)-Norfolk prospective population study

OBJECTIVES: To examine the association between fish consumption and stroke risk. DESIGN: Prospective population cohort study.Setting: Norfolk, UK cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk). SUBJECTS: Subjects were 24 312 men and women aged 40-79 years who had no previous history of stroke at baseline.Methods: Fish consumption was assessed using a food-frequency questionnaire at baseline in 1993-1997 and stroke incidence ascertained to 2004. RESULTS: A total of 421 incident strokes were identified (mean follow-up=8.5 years, total person-years=209 238). There were no significant relationships between total fish, shellfish or fish roe consumption and risk of stroke in men and women after adjusting for age, systolic blood pressure, body mass index, smoking, cholesterol, diabetes, physical activity, alcohol consumption, fish oil supplement use and total energy intake using Cox regression analyses. Oily fish consumption was significantly lower in women who subsequently had a stroke (odds ratio (OR) for consumers vs. non-consumers=0.69, 95% confidence interval (CI) 0.51-0.94, P=0.02). The trend in men was similar but not significant (OR for consumers vs. non-consumers=0.88, 95% CI 0.65-1.19, P=0.41). CONCLUSIONS: There was no consistent relationship between fish consumption and stroke in this British population. Inconsistencies in the observed health effects of fish consumption in different populations may reflect different patterns and type of fish consumed and preparation methods.     

Analysis of the temporal intake of cereal and dairy products in Irish adults: implications for developing food-based dietary guidelines

OBJECTIVES: To analyse the temporal distribution of the intake of cereal and dairy products in the Republic of Ireland. DESIGN: The North/South Ireland Food Consumption Survey established a database of habitual food and drink consumption using a 7-day food diary. The database also recorded the time and day of food consumption. Mean intakes of cereal and dairy products were calculated for time of the day and day of the week. RESULTS: At the weekend, the percentage of consumers decreased for nearly all cereal and dairy products. White bread, total cereals, full-fat milk and total dairy intakes were significantly lower at the weekend (P<0.01) compared with weekdays. Intakes of cereal and dairy products over time of the day showed clear mealtime or snacking patterns when the number of consumers was controlled for. White bread, wholemeal bread, total cereals, full-fat milk, reduced-fat milk and total dairy intakes showed mealtime peaks for morning, afternoon and evening. When examined by tertile of intake, tertile of percentage energy from fat and tertile of fibre intake, intakes of cereal and dairy products over time of the day and day of the week were similar to trends described above, regardless of the tertile. CONCLUSIONS: Temporal analysis of the intakes of cereal and dairy products did not reveal any unusual trends in this population. However, the significant methodological issues raised in this paper will be of benefit to other aspects of research in this area.     

The relationship between education and food consumption in the 1995 Australian National Nutrition Survey

OBJECTIVE: To assess the relationship between education and the intake of a variety of individual foods, as well as groups of foods, for Australian men and women in different age groups. DESIGN: Cross-sectional national survey of free-living men and women. SUBJECTS: A sample of 2501 men and 2739 women aged 18 years and over who completed the National Nutrition Survey (NNS) 1995. METHODS: Information about the frequency of consumption of 88 food items was obtained using a food-frequency questionnaire in a nation-wide nutrition survey. Irregular and regular consumers of foods were identified according to whether they consumed individual foods less than or more than once per month. The relationship between single foods and an index of education (no post-school qualifications, vocational, university) was analysed via contingency table chi-square statistics for men and women. Food group variety scores were derived by assigning individual foods to conventional food group taxonomies, and then summing the dichotomised intake scores for individual foods within each food group. Two-way analyses of variance (education by age groups) were performed on food variety scores for men and women, separately. RESULTS: While university-educated men and women consumed many individual foods more regularly than less-educated people, they were less likely to be regular consumers of several meat products. The relationship between education and food consumption was less apparent when individual food scores were aggregated into food group scores. University-educated men and women exhibited higher scores on total food group variety than the other educational groups. CONCLUSIONS: Higher education is associated with the regular consumption of a wider variety of foods. Aggregation of individual food consumption indices into food variety scores may mask the apparent effects of educational background on food consumption.     

The influence of cereal and dairy consumption on the Irish diet: implications for developing food-based dietary guidelines

OBJECTIVES: To estimate the intakes of cereal and dairy products and their contribution to nutrient intakes in men and women from the Republic of Ireland with a view to formulating food-based dietary guidelines. DESIGN: The North/South Ireland Food Consumption Survey established a database of habitual food and drink consumption using a 7-day food diary. From this database all cereal and dairy products from recipes and identifiable sources were identified and a new database was generated from which analysis of the role of cereal and dairy products in the diet was carried out. RESULTS: Almost 100% of the population consumed cereal and dairy products over the course of the survey week. In general, men consumed significantly more cereal and dairy products than did women (P<0.05). Cereal products made an important contribution to the mean daily intakes of energy (26%), protein (21%), fat (13%), carbohydrate (41%), fibre (45%), iron (43%) and folate (27%). Dairy products also contributed largely to the mean daily intakes of energy (11%), protein (14%), fat (17%), calcium (48%), phosphorus (24%) and vitamin A (27%). Analysis of nutrient intakes across tertiles of cereal and dairy consumption showed that high consumers of wholemeal bread, breakfast cereals, reduced-fat milk and yoghurt had lower fat and higher carbohydrate, fibre and micronutrient intakes than low consumers of these foods. CONCLUSIONS: Findings from the present study could be used to develop effective health strategies to implement changes in cereal and dairy consumption that could alter fat, fibre and micronutrient intakes in the diet.     

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.     

Association of key foods and beverages with obesity in Australian schoolchildren

OBJECTIVE: To examine the pattern of intake of key foods and beverages of children aged 4-12 years and the association with weight status. DESIGN AND SETTING: A computer-assisted telephone interview was used to determine the intake of fruit, vegetables, packaged snacks, fast foods and sweetened drinks 'yesterday' and 'usually' as reported by parents/guardians of a representative sample of 2184 children from the Barwon South-Western region of Victoria, Australia. RESULTS: Children who consumed >2-3, >3-4 and >4 servings of fruit juice/drinks 'yesterday' were, respectively, 1.7 (95% confidence interval (CI) 1.2-2.2), 1.7 (95% CI 1.2-2.5) and 2.1 (95% CI 1.5-2.9) times more likely to be overweight/obese compared with those who had no servings of fruit juice/drink 'yesterday', adjusted for age, gender and socio-economic status (SES). Further, children who had > or = 3 servings of soft drink 'yesterday' were 2.2 (95% CI 1.3-3.9) times more likely to be overweight/obese compared with those who had no servings of soft drink 'yesterday', adjusted for age, gender and SES. In addition, children who 'usually' drank fruit juice/drinks twice or more per day were 1.7 (95% CI 1.2-2.4) times more likely to be overweight/obese compared with those who drank these beverages once or less per week, adjusted for age, gender and SES. Although fast foods and packaged snacks were regularly eaten, there were no associations between weight status and consumption of these foods. CONCLUSIONS: Intake of sweetened beverages was associated with overweight and obesity in this population of Australian schoolchildren and should be a target for intervention programmes aimed at preventing unhealthy weight gain in children.     

The association of diet and other lifestyle factors with the onset of overactive bladder: a longitudinal study in men

OBJECTIVE: To investigate associations between diet and non-dietary lifestyle factors and the onset of overactive bladder (OAB) in men. SUBJECTS: Random sample of community-dwelling men aged 40 years plus. DESIGN AND METHODS: Baseline data on urinary symptoms and diet were collected from 5454 men using a postal questionnaire and a food-frequency questionnaire. Follow-up data on urinary symptoms were collected from 4887 men in a postal survey one year later. Logistic regression analysis was used to investigate diet and lifestyle factors associated with onset of OAB in the men without OAB at baseline. RESULTS: There was a highly significant negative association between beer intake at baseline and subsequent OAB onset (P=0.001), with reduced risk at all levels of intake compared with those who seldom/never drank beer. Adjustment for total alcohol intake (g ethanol day(-1)) reduced the significance of the association (P=0.02). None of the food groups studied was associated with OAB onset, with the possible exception of potatoes (P=0.05), which showed an increased risk of onset at the highest level of consumption. Physical activity, smoking and obesity were not significantly associated. CONCLUSIONS: While most diet and lifestyle factors were not associated with OAB onset, the evidence from this prospective longitudinal study suggests that beer may have a protective role in the development of OAB. This could be due to a non-alcoholic ingredient as well as the alcohol content.     

Food consumption and nutrient intakes with a special focus on milk product consumption in early pubertal girls in Central Finland

OBJECTIVE: To evaluate the current status of dietary intakes in early pubertal girls with a special focus on milk products. DESIGN: Cross-sectional data using 3-day food records. SUBJECTS: Eight hundred and sixty girls, aged 10-12 years, at Tanner maturation stage I-III. RESULTS: The mean consumption of milk products (620 g day(-1)) was similar to that of a Finnish study in the 1980s, while the consumption of non-milk drinks (403 g day(-1)) had increased. Twelve per cent of the girls had a dairy-restricted diet and consumed significantly less milk products than girls with a non-restricted diet (465 vs. 644 g day(-1), P<0.001). Girls with low milk product consumption had the highest non-milk drinks consumption (P<0.001). The mean energy intake was 7.1 MJ day(-1). No major changes were found in the sources of nutrients. The shares of energy for nutrients were close to recommendations except for saturated fat (13.9 vs. 10% of energy) and carbohydrates (51.5 vs. 55-60% of energy). The mean calcium intake (1117 mg day(-1)) was above the recommendation, while the vitamin D intake (3.1 microg day(-1)) of 88% of the girls was below the recommendation. CONCLUSIONS: The diet quality of early pubertal girls is close to the recommendations and has improved with respect to fat compared with the 1980s. Consumption of milk products is high although the consumption of non-milk drinks has increased. We found a subgroup of girls who compensate their low milk product consumption with a higher consumption of non-milk drinks. Following a dairy-restricted diet is the main reason for low consumption of milk products.     

Changes in neighbourhood food store environment, food behaviour and body mass index, 1981--1990

OBJECTIVE: This paper examines trends in the neighbourhood food store environment (defined by the number and geographic density of food stores of each type in a neighbourhood), and in food consumption behaviour and overweight risk of 5779 men and women. DESIGN: The study used data gathered by the Stanford Heart Disease Prevention Program in four cross-sectional surveys conducted from 1981 to 1990. SETTING: Four mid-sized cities in agricultural regions of California. SUBJECTS: In total, 3154 women and 2625 men, aged 25-74 years. RESULTS: From 1981 to 1990, there were large increases in the number and density of neighbourhood stores selling sweets, pizza stores, small grocery stores and fast-food restaurants. During this period, the percentage of women and men who adopted healthy food behaviours increased but so did the percentage who adopted less healthy food behaviours. The percentage who were obese increased by 28% in women and 24% in men.ConclusionFindings point to increases in neighbourhood food stores that generally offer mostly unhealthy foods, and also to the importance of examining other food pattern changes that may have a substantial impact on obesity, such as large increases in portion sizes during the 1980s.     

Using epidemiological models to estimate the health effects of diet behaviour change: the example of tailored fruit and vegetable promotion

OBJECTIVE: To explore the use of epidemiological modelling for the estimation of health effects of behaviour change interventions, using the example of computer-tailored nutrition education aimed at fruit and vegetable consumption in The Netherlands. DESIGN: The effects of the intervention on changes in consumption were obtained from an earlier evaluation study. The effect on health outcomes was estimated using an epidemiological multi-state life table model. Input data for the model consisted of relative risk estimates for cardiovascular disease and cancers, data on disease occurrence and mortality, and survey data on the consumption of fruits and vegetables. RESULTS: If the computer-tailored nutrition education reached the entire adult population and the effects were sustained, it could result in a mortality decrease of 0.4 to 0.7% and save 72 to 115 life-years per 100,000 persons aged 25 years or older. Healthy life expectancy is estimated to increase by 32.7 days for men and 25.3 days for women. The true effect is likely to lie between this theoretical maximum and zero effect, depending mostly on durability of behaviour change and reach of the intervention. CONCLUSION: Epidemiological models can be used to estimate the health impact of health promotion interventions.     

Secular and socio-economic trends in compliance with dietary targets in the north Glasgow MONICA population surveys 1986-1995: did social gradients widen?

OBJECTIVE: To compare trends in the consumption of key foods over 10 years in the most deprived and least deprived quarters in north Glasgow, Scotland as defined by the Carstairs deprivation index for their postcode of domicile. DESIGN: Four random, cross-sectional, age- and gender-stratified population surveys carried out in 1986, 1989, 1992 and 1995. After assigning a deprivation score, food-frequency questionnaires from 2883 men and 3127 women were examined for compliance with dietary targets, examining trends by gender and within the most and least deprived quarters of the population. SETTING: North Glasgow, Scotland. SUBJECTS: Over 600 men and 600 women (aged 25-64 years) in each of the four survey years who completed a lifestyle questionnaire including a food frequency section. RESULTS: Increasing trends in the reported consumption of fruit and vegetables and oil-rich fish were observed over the 10-year period. However, the trend to increased fruit and vegetable consumption in the most deprived groups was not significant, and in 1995 only 8% of men and 12% of women in this group claimed consumption of these foods 4 or more times a day. In general, a higher percentage of those in the least deprived group met the targets for the key foods. CONCLUSIONS: Trends to increasing consumption of fruit and vegetables and fish were in the right direction, but the targets for consumption of certain key foods were met by a minority of the population. The progress towards the target for fruit and vegetables showed widening social gradients with time.