To study the association between alcohol consumption and risk of benign proliferative epithelial disorders (BPED) of the breast (conditions which are thought to have premalignant potential).

Case–cohort study.

The study was undertaken within the 56, 537 women in the Canadian National Breast Screening Study (NBSS) who completed self-administered dietary questionnaires. (The NBSS is a randomized controlled trial of screening for breast cancer in women aged 40–59 years at recruitment.)

The study subjects were the 657 women in the dietary cohort who were diagnosed with biopsy-confirmed incident BPED. For comparative purposes, a subcohort consisting of a random sample of 5681 women was selected from the full dietary cohort. After exclusions for various reasons, the analyses were based on 557 cases and 5028 non-cases.

When compared to non-drinkers, rate ratios (95%CI) for those consuming >0 and ≤10 g of ethanol day−1,>10 and≤20 g day−1, >20 and ≤30 g day1 and >30 g day1 were 0.35(0.27–0.45), 0.26(0.18–0.39), 0.29(0.18–0.48), and 0.23(0.13–0.40), respectively (the associated P value for the trend was 0.089). Similar findings were obtained from analyses conducted separately in the screened and control arms of the NBSS, in premenopausal and postmenopausal women, and for non-atypical and atypical forms of BPED, and there was little difference between the results for screen-detected and interval-detected BPED.

Alcohol consumption was associated with a non-dose-dependent reduction in risk of BPED

To propose a policy framework for the regulation of functional foods and health claims within a public health context.

This article reviews the empirical evidence and public health principles associated with functional foods and health claims to analyse the issues, challenge the assumptions that have emerged and explore options for moving forward.

Functional foods and health claims are among the more controversial and complex issues being debated by food regulators internationally. Proponents of functional foods and health claims state that functional foods may reduce health care expenditure and health claims are a legitimate nutrition education tool that will help them inform consumers of the health benefits of certain food products. Conversely, opponents of these developments respond that it is the total diet that is important for health, not so-called ‘magic bullets’. Moreover, they argue that health claims will enable manufacturers to indulge in marketing hyperbole and essentially blur the distinction between food and drugs. This topic provides a valuable case study of public policy in relation to food and health.

The need to maintain a general prohibition on health claims while accommodating specific exemptions supported by scientific substantiation is recommended. Nutrition education and monitoring and evaluation are integral to the proposed regulatory framework. The intention of this policy position is to encourage research and development of innovative food products while avoiding an inappropriate medicalization of the general food supply.

To determine the role of fruit and vegetable consumption and dietary intake of folic acid and related nutrients such as methionine, cysteine and alcohol in the aetiology of breast cancer.

Population based case-control study.

Part of the European Community Multicentre Study on Antioxidants, Myocardial Infarction, and Cancer of the Breast (EURAMIC) in Berlin, Germany.

As part of the EURAMIC study, dietary intake data were collected in 43 postmenopausal women diagnosed with breast cancer between 191 and 1992 in Berlin, Germany, and compared to 106 population-based controls.

Odds ratios (ORs) adjusted for major risk factors of breast cancer but not for total energy intake showed a non-significant inverse association between a high intake of vegetables (OR=0.76, 95% CI=0.48–1.20) and fruits (OR=0.74, 95% CI=0.48–1.15) and breast cancer. Once results were adjusted for total energy intake the associations became much weaker (vegetables: OR=0.86, 95% CI=0.51–1.46; fruits: OR=0.82, 95% CI=0.51–1.32). For all nutrients, the effect of energy adjustment was more profound and the inverse associations disappeared when results were adjusted for energy intake (total folate—not energy adjusted: OR=0.79, 95% CI=O.51–1.21; energy adjusted: OR=1.14, 95% CI=0.73–1.79; folate equivalents-not energy adjusted: OR=0.81, 95% CI= 0.53–1.23; energy adjusted: OR=1.16, 95% CI=0.78–1.74; methionine—not energy adjusted: OR=0.60, 95% CI=0.35–1.03; energy adjusted: OR=1.29, 95% CI=0.76–2.19; cysteine—not energy adjusted: OR=0.52, 95% CI=0.29–0.94; energy adjusted: OR=1.22, 95% CI=0.75–1.97). Alcohol intake was inversely associated with breast cancer in a non-significant way, possibly due to the relatively low alcohol intake of the study population.

The results of this study do not provide firm evidence that a high intake of fruits and vegetables, folic acid, methionine or cysteine reduces the risk of getting breast cancer.

To investigate the dietary pattern and nutritional status of adolescent girls attending schools in Dhaka city and to examine the association with various social factors.

Cross-sectional study.

Girls high schools in Dhaka city.

A total of 384 girls, aged from 10 to 16 years, who were students of classes VI to IX of 12 girls high schools in Dhaka city were selected by systematic random sampling. Nutrient intake was assessed using the 24-h recall method and the usual pattern of food intake was examined using a 7-day food frequency questionnaire.

The prevalence of undernutrition among the participants assessed as stunting was 10% overall with younger girls being less stunted (2%) than older girls (16%), whereas 16% were thin with relatively more of the younger girls (21%) being thin than of the older girls (12%). Based on the usual pattern of food intake, a substantial proportion of the girls did not consume eggs (26%), milk (35%) or dark green leafy vegetables (20%). By comparison, larger proportions consumed meat (50%) and fish (65%) at least four times a week. For the intake of energy and protein, only 9 and 17% of the girls, respectively, met the recommended daily allowance (RDA). For nearly 77% of the girls, the intake of fat was less than the recommendation. Intakes less than the RDA were found for iron (77% of the girls), calcium (79%), vitamin A (62%), vitamin C (67%), and riboflavin (96%). Based on the food consumption data, cereals were the major source of energy (57%), thiamin (67%), niacin (63%) and iron (37%). Animal sources supplied 50% of dietary protein. Cooking fats were the principal source of fat (67%) in the diet. Milk was the major contributor for riboflavin and preformed vitamin A (retinol). Leafy vegetables and fruits were the main sources of provitamin A (carotenes). The girls from families with less educated parents were more likely to be thin and short for their age. Those girls from families with lower incomes and less educated parents had a dietary pattern which tended to be poor with regard to egg, milk, meat and fruit, with lower intakes of protein, fat and riboflavin.

The findings indicate that the diets of these girls tended to be inadequate both for macronutrients and micronutrients, with significant health implications. There was also a relationship between the family income and the education of the parents with the nutritional status of the girls.

To examine the relationships between alcohol consumption and a range of nutrient intakes and blood status indices in older people.

National Diet and Nutrition Survey: cross-sectional survey of nationally representative sample of people aged 65 years or over.

Mainland Britain during 1994/5.

1198 people (623 males, 575 females) aged 65 years or over, of whom 925 were living in private households and 273 were living in institutions.

Intermediate alcohol consumption (particularly 0.1–14 units week−1; 1 unit = 8g) derived from a 4-day diet diary or a 12-month recall questionnaire, was associated with higher intakes of vitamins C, E, B1, iron, calcium, energy from food, carbohydrate and non-starch polysaccharides than heavy alcohol consumption (28 + units week−1) or abstinence, after adjustment for a number of factors (age, sex, domicile, social class, cigarette smoking, self-reported health, grip strength and total energy intake). Intermediate alcohol consumption was also associated with higher blood concentrations (independent of intake) of vitamin C, β-cryptoxanthin, lutein and calcium, with the lowest concentrations being found in heavy alcohol users. The lowest concentrations of serum ferritin were found in light drinkers and the highest levels in heavier alcohol drinkers. Alcohol consumption ranging from 0.1 to > 28 units week−1 was directly correlated with intakes of B vitamins, total energy and fat, with blood concentrations (independent of intake) of lycopene. high density lipoprotein (HDL)-cholesterol, plasma pyridoxal phosphate and retinol, and with blood pressure and grip strength.

Compared with abstinence and heavy drinking, light to moderate alcohol consumption in older people is associated with higher intakes of certain nutrients, and higher blood concentrations (independent of intake) of some micronutrient status indices, including antioxidants. The explanation for the latter associations remains unclear and further investigation is recommended. Heavier alcohol consumption is associated with both beneficial and adverse effects with respect to nutrient intakes and health status.

This article reviews information on the rapid changes in diet, activity and body composition that lower- and middle-income countries are undergoing and then examines some of the potential health implications of this transition.

Data came from numerous countries and also from national food balance (FAOSTAT) and World Bank sources. Nationally representative and nationwide surveys are used. The nationally representative Russian Longitudinal Monitoring Surveys from 1992–96 and the nationwide China Health and Nutrition Survey from 1989–93 are examined in detail.

Rapid changes in the structure of diet, in particular associated with urbanization, are documented. In addition, large changes in occupation types are documented. These are linked with rapid increases in adult obesity in Latin America and Asia. Some of the potential implications for adult health are noted.

The rapid changes in diet, activity and obesity that are facing billions of residents of lower- and middle-income countries are cause for great concern. Linked with these changes will be a rapid increase in chronic diseases. Little to date has been done at the national level to address these problems.

To assess iron status in a sample of clinically well, Caucasian children and explore the complex factors which contribute to iron deficiency during infancy.

Infants recruited at birth and followed longitudinally at 1, 2, 3, 4, 5, 6, 9, 12, 24 and 36 months; feeding practices and socioeconomic data recorded. Iron status assessed using venous blood at 12, 24 and 36 months.

Baseline data recorded in the maternity unit. Follow-up visits took place in the infants' homes and blood sampling in a paediatric hospital.

Subjects comprised a mixed socioeconomic group of healthy children (n=121). Blood samples taken from 85, 72 and 67% at 12, 24 and 36 months, respectively.

Prevalence of anaemia (Hb < 110 gl−1) in the longitudinal sample (n=76) increased from 2.6% at age 12 months to 9.2% at 24 months, and at age 36 months (n=70) was 8%. The most significant finding was that at age 12 months, cows' milk consumption was negatively associated with iron status. Other variables also had an influence. At both 24 and 36 months the most significant predictor of iron status was earlier iron status.

Infants born to anaemic mothers or mothers who smoke and infants who consume cows' milk during infancy are at increased risk of developing anaemia. Breast milk is the ideal, but for the infant who is not breast fed an iron fortified formula should be used. Advice to mothers should focus on the importance of introducing nutrient dense complementary foods, such as meat, which contains readily absorbable iron.

To describe the distribution of plasma fibrinogen and relationships with other risk factors for coronary heart disease (CHD) and stroke in the black population of the Cape Peninsula.

A cross-sectional survey of a stratified proportional sample of randomly selected black men and women.

Households in Gugulethu, Langa, Nyanga, New Crossroads, KTC, Old Crossroads and Khayelitsha in the Cape Peninsula, South Africa.

One subject per household (352 men and 447 women), aged 15–64 years, voluntarily participated. Visitors, pregnant, lactating, ill, mentally retarded and intoxicated subjects were excluded.

Mean fibrinogen (thrombin time coagulation method) of men and women were higher than published data for Europeans but slightly lower than values of black Americans. Women aged 45–54 years had the highest level (3.13 ± 0.89g1−1) and men aged 15–24 years had the lowest (2.13 ± 0.88g1−1). Fifteen per cent of the men and 12% of the women had a level greater than 1 standard deviation of the mean for their age group. Univariate and multivariate analyses revealed significant (P< 0.05) positive correlations of fibrinogen with smoking habit, age, body mass index (BMI), total and low-density lipoprotein (LDL) cholesterol, triglycerides, blood pressure and white blood cell count, and significant negative correlations with high-density lipoprotein (HDL) cholesterol, gamma glutamyl transferase (GGT), serum iron and ferritin. The correlations with BMI, serum lipoproteins, iron, ferritin, and GGT suggest that nutritional status and therefore diet influences plasma fibrinogen.

Relatively high fibrinogen levels, tending to cluster with other, including diet-related, risk factors for CHD and stroke, were observed in black South Africans. It is suggested that fibrinogen may contribute to the high stroke incidence of this population group.

The aim of the study was to examine the daily variations in sales data for individual food items in a supermarket and to assess the usefulness of the computerized sales data of supermarkets for reliable monitoring and evaluation of shopping behaviour.

Longitudinal observational study.

The study was carried out in one supermarket in Mikkeli, Finland. Seventy-nine packed food items from food groups important for salt and fat intake were monitored. In all food groups both ‘healthier’ and ‘reference’ products were included for assessment of both direct sales and proportional sales. The sales data were collected daily for 2 months in May and September 1996 by reading the European Article Numbering (EAN) codes of the packed foods.

The proportional sales turned out to be a more stable and useful measure than the direct sales data and the variation remained the same when the monitoring time was increased from 1 week to 1 month.

Proportional sales data are proposed as a tool for measuring the effect of nutrition interventions and also as a possible indirect assessment for population salt and fat intake.

To review current information on under- and over-malnutrition and the consequences of socioeconomic disparities on global nutrition and health.

Malnutrition, both under and over, can no longer be addressed without considering global food insecurity, socioeconomic disparity, both globally and nationally, and global cultural, social and epidemiological transitions.

The economic gap between the more and less affluent nations is growing. At the same time income disparity is growing within most countries, both developed and developing. Concurrently, epidemiological, demographic and nutrition transitions are taking place in many countries.

Fully one-third of young children in the world's low-income countries are stunted because of malnutrition. One-half of all deaths among young children are, in part, a consequence of malnutrition. Forty per cent of women in the developing world suffer from iron deficiency anaemia, a major cause of maternal mortality and low birth weight infants. Despite such worrying trends, there have been significant increases in life expectancy in nearly all countries of the world, and continuing improvements in infant mortality rates. The proportion of children malnourished has generally decreased, although actual numbers have not in sub-Saharan Africa and south Asia. Inequalities are increasing between the richest developed countries and the poorest developing countries. Social inequality is an important factor in differential mortality in both developed and developing countries. Many countries have significant pockets of malnutrition and increased mortality of children, while obesity and non-communicable disease (NCDs) prevalences are increasing. Not infrequently it is the poor and relatively disadvantaged sectors of the population who are suffering both. In the industrialized countries. cardiovascular disease incidence has declined, but less so in the poorer socioeconomic strata.

The apparent contradicitions found represent a particular point in time (population responses generally lag behind social and environmental transitions). They do also show encouraging evidence that interventions can have a positive impact, sometimes despite disadvantageous circumstances. However, it seems increasingly unlikely that food production will continue to keep up with population growth. It is also unlikely present goals for reducing protein-energy malnutrition prevalence will be reached. The coexistence of diseases of undernutrition and NCDs will have an impact on allocation of resources. Action needs to be continued and maintained at the international, national and individual level.

To compare the mortality rates of vegetarians and non-vegetarians.

Collaborative analysis using original data from five prospective studies. Death rate ratios for vegetarians compared to non-vegetarians were calculated for ischaemic heart disease, cerebrovascular disease, cancers of the stomach, large bowel, lung, breast and prostate, and for all causes of death. All results were adjusted for age, sex and smoking. A random effects model was used to calculate pooled estimates of effect for all studies combined.

USA, UK and Germany.

76, 172 men and women aged 16–89 years at recruitment. Vegetarians were those who did not eat any meat or fish (n = 27,808). Non-vegetarians were from a similar background to the vegetarians within each study.

After a mean of 10.6 years of follow-up there were 8330 deaths before the age of 90 years, including 2264 deaths from ischaemic heart disease. In comparison with non-vegetarians, vegetarians had a 24% reduction in mortality from ischaemic heart disease (death rate ratio 0.76, 95% CI 0.62–0.94). The reduction in mortality among vegetarians varied significantly with age at death: rate ratios for vegetarians compared to non-vegetarians were 0.55 (95% CI 0.35—0.85), 0.69 (95% CI 0.53–0.90) and 0.92 (95% CI 0.73–1.16) for deaths from ischaemic heart disease at ages <65, 65–79 and 80–89 years, respectively. When the non-vegetarians were divided into regular meat eaters (who ate meat at least once a week) and semi-vegetarians (who ate fish only or ate meat less than once a week), the ischaemic heart disease death rate ratios compared to regular meat eaters were 0.78 (95% CI 0.68–0.89) in semi-vegetarians and 0.66 (95% CI 0.53–0.83) in vegetarians (test for trend P<0.001). There were no significant differences between vegetarians and non-vegetarians in mortality from the other causes of death examined.

Vegetarians have a lower risk of dying from ischaemic heart disease than non-vegetarians.

To examine the hypothesis that there is sufficient agreement between percentage of households purchasing selected foods using household budget surveys and percentage of individuals consuming these foods as determined in individual-based surveys to allow the former to act as a surrogate for the latter when estimating food chemical intakes using household budget data.

Database study.

Databases from Sweden, The Netherlands, Ireland and the UK.

319 foods (Sweden n=60, The Netherlands n=80, Ireland n=90, UK n=89).

Pearson correlations demonstrated a high degree of linear association between % households purchasing and % consumers (r=0.86). Regression analysis defined a close positive relationship between the two datasets (slope 0.95, intercept +2.74). Across countries, using the regression equation, the % households predicted % consumers to within 5% of the true value for between 33 and 48% of foods and to within 10% for between 53 and 78% of foods.

Values for % households can be used as a crude surrogate for % consumers and can thus play a role in improving estimates of food additive intake.

We examined whether or not the effect of elevated blood lead levels on children's psychomotor development was modified by their nutritional status.

Anthropometry, developmental quotients (DQs), blood lead levels and haemoglobin were measured in lead exposed and unexposed children with different levels of nutritional status. Social background and maternal height and verbal intelligence were also measured. Testers, anthropometrists and interviewers established reliabilities with a trainer before the study began.

Children were from two suburban areas in Kingston, Jamaica. All measurements on the children were carried out at a research unit. Social background and maternal measurements were carried out at the children's homes.

The exposed group comprised 58 children (3–6 years) attending the same preschool which was situated in a lead contaminated environment. The unexposed group comprised 53 children attending a nearby preschool without lead contamination.

The exposed children had significantly higher blood lead levels and lower DQs, and their homes had poorer facilities than the unexposed children. The deficit in DQ was greater (10.6 points) among children with weight for height less than –1 SD (National Center for Health Statistics references) than among better nourished Children (2 points).

Undernourished children exposed to lead may have more serious developmental deficits than better nourished children.

To compare the effects on serum lipoproteins of three isocaloric diets with reduced total fat and saturated fatty acid (SFA) contents but with different proportions of monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA).

A low-fat diet (LF) provided 20 en% fat, 7.9% SFA, 7.8% MUFA, 3.0% PUFA; a high-PUFA diet (HP) 26 en% fat, 7.5% SFA, 8.2% MUFA, 8.1% PUFA; and a high-MUFA diet (HM) 26 en% fat, 7.3% SFA, 14.1% MUFA, 3.2% PUFA. Diets were consumed for 8 weeks in a parallel design, after 2 weeks on a habitual diet with 33–34 en% fat, 13–14% SFA, 12% MUFA, 6% PUFA, and followed by an 8-week period on habitual diet. Compliance to diet was monitored by repeated food records and weekly visits to a nutritionist.

45 free-living, middle-aged couples who were randomly allocated into the three diet groups; 43 men and 44 women completed the study.

During the diet periods, a small but significant reduction in body weight of 0.4–1.0kg was observed in all groups. Similar and significantreductions of mean weight-adjusted serum total cholesterol (4–8%), low-density lipoprotein (LDL) cholesterol (7–11%), and high-densitylipoprotein (HDL) cholesterol (8–11%) were observed during the diets. HDL2-cholesterol and apoprotein (apo) A-I levels were reduced whereas HDL3-cholesterol and apoA-II increased. ApoB was significantly decreased during the HM diet only. Serum triglycerides increased significantly during diets LF (25%, P< 0.01) and HP (19%, P< 0.05) but not during diet HM (5%, NS).

Reduction in the intake of total fat and saturated fatty acids reduced serum LDL-cholesterol and HDL2-cholesterol concentrations irrespective of the relative proportions of MUFA and PUFA in the diets. The results suggest that there might be some advantage in increasing the proportion of MUFA in low-fat diets, since the HM diet rich in MUFA reduced apoB and slightly attenuated the increase in serum triglycerides that is commonly associated with dietary fat reduction.