This study aimed to assess mother's/caregiver's understanding, practical application and cultural acceptability of a preliminary set of South African food-based dietary guidelines (FBDGs) for children aged 6–12 months living in the Little Karoo area of the Western Cape Province.

An observational, descriptive and cross-sectional study design was followed. Focus group interviews, recorded on videotape, were analysed for qualitative data. Quantitative questionnaires measured knowledge and comprehension of guidelines, perceived constraints to compliance with and importance of guidelines as well as socio demographic data prior to the focus group interviews.

Afrikaans-, English- and Xhosa-speaking communities of the Little Karoo area of the Western Cape Province of South Africa, including the urban areas of Oudtshoorn, Bongulethu, Bridgton, Toekomsrus and the adjacent rural areas of Dysselsdorp, Calitzdorp, Uniondale, Ladismith and Zoar.

Sixty-four mothers or caregivers to infants 6–12 months of age were included in the sample.

Information obtained through the questionnaires supported what was said during discussions. Although perceived as important by the majority of respondents, some of the guidelines were not well understood without prior explanation. Such guidelines were those pertaining to meal frequency and cup feeding, while application of the guideline to prolonged breast-feeding seemed the most problematic.

The FBDGs for this age group will have to be supported by extensive and appropriate educational material to be effective when introduced to the public. The fact that the applicability of the guideline to prolonged breast-feeding seemed to be the most problematic is a cause for concern.

To evaluate the association between overweight and wheezing in pre-school children in 14 small Brazilian communities.

Cross-sectional epidemiological study, conducted between 2001 and 2002. A sample of 3453 children under 5 years of age was taken from nine communities in the state of Bahia and five in the state of São Paulo. Data on housing, family and children were obtained by applying structured questionnaires in loco. Weight and height for each child were also measured. The association between wheezing and overweight was assessed by unconditional logistic multivariate regression models.

Overweight children had a greater frequency of wheezing and an odds ratio of 2.57 (95% confidence interval 1.51–4.37) was estimated after controlling for several potential confounding variables. The magnitude of the risk was not affected by several different model specifications.

Excess weight is associated with increased risk for wheezing in this population of children below 5 years of age.

Obesity is defined as an excess of total body fat and may be assessed by different methods. The objective of the present study was to establish the discriminatory power of anthropometric data in determining obesity.

The subjects comprised 685 individuals, aged 20–79 years, sampled from a population-based survey. The following indicators were used: body mass index (BMI), waist circumference (WC) and total body fat percentage estimated with both Siri's equation (%BF Siri) and foot-to-foot bioelectrical impedance analysis (%BF BIA). Sensitivity and specificity of different cut-off points for each method were determined using %BF BIA as reference.

Of 685 participants, 57.6% were aged ≥ 40 years, 69.9% were women and 72.6% self-referred themselves as non-white. To classify obesity based on sex and age among women aged < 40 years, the cut-off points were BMI of 26.0 kg m− 2, WC of 84.0 cm and %BF Siri of 34.0%; in those aged ≥ 40 years, the cut-off points were 28.0 kg m− 2, 90.0 cm and 37.4%, respectively. The cut-off points among men aged < 40 years were BMI of 26.3 kg m− 2, WC of 86.0 cm and %BF Siri of 22.5%, and in those aged ≥ 40 years, 26.3 kg m− 2, 89.0 cm and 24.5%, respectively. BMI was the method with the largest area under the curve (AUC) independent of sex and sex/age, yet no differences were observed in AUC between BMI and WC (P>0.05). Classifying according to skin colour did not change cut-off points in any indicator.

BMI and WC better discriminate obesity among women and men aged ≥ 40 years from a mixed-race population.

To examine the relationship of maternal employment characteristics, day care arrangements and the type of maternity leave pay to breast-feeding for at least 4 months.

Cohort study.

Babies aged 9 months in the Millennium Cohort Study, born between September 2000 and January 2002.

A total of 6917 British/Irish white employed mothers with singleton babies.

Mothers employed part-time or self-employed were more likely to breast-feed for at least 4 months than those employed full-time (adjusted rate ratio (aRR) and 95% confidence interval (CI) 1.30 (1.17–1.44) and 1.74 (1.46–2.07), respectively). The longer a mother delayed her return to work postpartum, the more likely she was to breast-feed for at least 4 months (P for trend < 0.001). Mothers were less likely to breast-feed for at least 4 months if they returned to work for financial reasons (aRR 0.86, 95% CI 0.80–0.93) or used informal day care arrangements rather than care by themselves or their partner (aRR 0.81, 95% CI 0.71–0.91). Mothers were more likely to breastfeed for at least 4 months if their employer offered family-friendly (aRR 1.14, 95% CI 1.02–1.27) or flexible work arrangements (aRR 1.24, 95% CI 1.00–1.55), or they received Statutory Maternity Pay (SMP) plus additional pay during their maternity leave rather than SMP alone (aRR 1.13, 95% CI 1.02–1.26). These findings were independent of confounding factors, such as socio-economic status and maternal education.

Current policies may encourage mothers to enter or return to employment postpartum, but this may result in widening inequalities in breast-feeding and persistence of low rates. Policies should aim to increase financial support and incentives for employers to offer supportive work arrangements.

To determine the nutritional behaviour of Tehranian adolescents.

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.

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.

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.

A number of individual risk factors for childhood obesity have been identified, but only some of these are amenable to prevention. To assess the amount of cases in a general population attributable to these risk factors, adjusted population-attributable fractions were estimated.

Cross-sectional study.

Obligatory school entry examination in 2001/2002 in six Bavarian communities (Germany).

5472 children at age 5–6 years.

Anthropometric measures were ascertained by public health nurses, and measures concerning sociodemographics, lifestyle and child behaviour such as child's daily meal frequency were obtained with self-administered parental questionnaires. Obesity was defined according to sex- and age-specific body mass index cut-off points proposed by the International Obesity Task Force. Adjusted population-attributable fractions were calculated based on logistic regression.

A combination of the risk factors low meal frequency, decreased physical activity, watching television >1 h day− 1, formula feeding and smoking in pregnancy accounted for 48.2% of obese children. This combination yielded a maximal achievable prevalence reduction of 1.5% for obesity (3.2% observed prevalence).

A modification of five known risk factors for childhood overweight and obesity could reasonably lower obesity prevalences at school entry. These risk factors should be particularly considered in decision making on preventive measures.

To compare therapeutic feeding programme coverage for severely malnourished children achieved by a community-based therapeutic care (CTC) programme and a therapeutic feeding centre (TFC) programme operating in neighbouring districts in Malawi.

Two surveys were implemented simultaneously one in each of the two programme areas. Each survey used a stratified design with strata defined using the centric systematic area sample method. Thirty 100 km2 quadrats were sampled. The community or communities located closest to the centre of each quadrat were sampled using a case-finding approach. Cases were defined as children aged under 5 years with ≤ 70% of the weight-for-height median or bilateral pitting oedema. Receipt of treatment was ascertained by the child's presence in a therapeutic feeding programme or by documentary evidence. Coverage in each quadrat was estimated in two ways, a period estimate that provides an estimation of coverage for the recent period preceding the survey and a point estimate that provides an estimation of coverage at the exact point in time of the survey.

Overall the period coverage was 24.55% (95% confidence interval (CI) = 17.8–31.4%) in the TFC programme and 73.64% (95% CI = 66.0–81.3%) in the CTC programme. The point coverage was 20.04% (95% CI = 13.8–26.3%) in the TFC programme and 59.95% (95% CI = 51.4–68.5%) in the CTC programme.

In this context, CTC gave substantially higher programme coverage than a TFC programme. Given effective treatment, this enabled higher impact of CTC on severe malnutrition in this population.

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).

Two transversal samples of convenience.

Healthy volunteers (1993, n = 802; 2003, n = 1631).

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.

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).

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.

To investigate the association between pregravid weight status and diet quality.

Institute of Medicine body mass index (BMI) cut-off points of < 19.8 kg m− 2 for underweight, 19.8–26.0 kg m− 2 for normal weight, >26.0–29.0 kg m− 2 for overweight and >29 kg m− 2 for obese were used to categorise women's weight status. Dietary information was obtained by self-report at 26–28 weeks' gestation using a modified Block food-frequency questionnaire. The Diet Quality Index for Pregnancy (DQI-P) included: servings of grains, vegetables and fruits, folate, iron and calcium intake, percentage calories from fat, and meal pattern score. Multinomial logistic regression models were used to estimate the association between weight status and tertiles of DQI-P controlling for potential individual confounders.

A clinical-based population recruited through four prenatal clinics in central North Carolina.

A total of 2394 women from the Pregnancy, Infection and Nutrition study were included in this analysis.

Evidence of a dose–response relationship was found between BMI and inadequate servings of grains and vegetables, and iron and folate intake. Pregravid obesity was associated with 76% increased odds of falling into the lowest diet quality tertile compared with underweight women after controlling for potential confounders.

A modest association was found between pregravid weight status and diet quality. If corroborated, these findings suggest that overweight pregnant women should be targeted for nutrition counselling interventions aimed to improve diet quality.

To assess overweight and related risk factors among urban low socio-economic status (SES) African-American adolescents in an attempt to study the underlying causes of ethnicity and gender disparities in overweight.

Cross-sectional data collected on anthropometric measures, diet, physical activity and family characteristics from 498 students in grades 5–7 in four Chicago public schools were analysed to study the risk factors for overweight using stepwise regression analysis.

Only 37.2% of the students lived with two parents. Nearly 90% had a television (TV) in their bedroom, and had cable TV and a video game system at home. Overall. 21.8% (17.7% boys versus 25.1% girls) were overweight (body mass index (BMI) ≥ 95th percentile); and 39.8% had a BMI ≥ 85th percentile. Compared with national recommendations, they had inadequate physical activity and less than desirable eating patterns. Only 66.1% reported having at least 20 min vigorous exercise or 30 min of light exercise in ≥ 5 days over the past 7 days; 62.1% spent >3 h days− 1 watching TV/playing video games/computer, while 33.1% spent ≥ 5 h days− 1. Their vegetable and fruit consumption was low, and they consumed too many fried foods and soft drinks: 55.1% consumed fried food twice or more daily and 19.5% four times or more daily; 70.3% consumed soft drinks twice or more daily and 22.0% four times or more daily on average. Gender, physical activity and pocket money were significant predictors of overweight (P < 0.05).

Several factors in the students' behaviours, school and family environments may increase overweight risk among this population. There is a great need for health promotion programmes with a focus on healthy weight and lifestyle, and targeting urban low-SES minority communities.

To measure the effects of two school-based interventions on children's intake of fruit and vegetables (F&V).

A total of six primary schools were randomly assigned to (1) a free F&V distribution programme, or (2) a multicomponent programme, consisting of a classroom curriculum and parental involvement. The two interventions were evaluated on their effects and compared with six control schools in a pre-test–post-test design. Two methods were used for dietary assessment: a pre-structured food recall and a food-frequency questionnaire including only F&V.

A total of 939 parents of children aged 4–12 years filled out the questionnaire at both pre-test and post-test. The response rate was 54%.

Multilevel analyses showed that both programmes were equally effective in increasing children's fruit consumption by 0.2 portions per day. The free F&V distribution increased vegetable intake among non-native children and the oldest age group, and the multicomponent programme among the oldest children and girls. The distribution also caused an increased 24 h fruit, juice and vegetable intake among the youngest and the oldest age groups, and the multicomponent programme among all children.

The results of this study indicate that both interventions were shown to be effective for different subgroups regarding age, gender and ethnicity. When comparing both interventions, the distribution programme was shown to be more effective, especially in increasing vegetable consumption. An important next step will be to investigate which intervention has the greatest potential to be implemented in primary schools.

To demonstrate how dietary data collected from 24-hour dietary recalls were incorporated into the development of a quantitative food-frequency questionnaire (QFFQ) for the Apache in Arizona.

A cross-sectional study was first conducted using 24-hour dietary recalls to identify foods for inclusion on a QFFQ that would be used to evaluate a nutrition intervention.

The White Mountain and San Carlos Apache reservations in East-central Arizona.

The 24-hour dietary recalls were collected from a random sample of 53 adults (34 women and 19 men).

A QFFQ was developed that included all foods reported by two or more respondents, plus traditional and seasonal foods. Portion size was assessed using familiar household units and culturally appropriate food models. The final instrument contains 155 foods. Frequency of consumption is assessed using eight categories ranking from ‘never or less than once a month’ to ‘2 or more times a day’. Nutrient intakes and the five major food sources of energy, fat and sugar are presented.

The QFFQ developed is complete and up-to-date for assessing usual food and nutrient intake for the Apache in Arizona. The instrument will be used to evaluate a food store-based nutrition intervention to reduce risk of chronic diseases.

To examine UK country and ethnic variations in infant feeding practices.

Cohort study.

Infants enrolled in the Millennium Cohort Study, born between September 2000 and January 2002.

A total of 18 150 natural mothers (11 286 (8207 white) living in England) of singleton infants.

Breast-feeding initiation, breast-feeding discontinuation and introduction of solid foods before 4 months.

Maternal ethnic group, education and social class.

Seventy per cent of UK mothers started to breast-feed, of whom 62% stopped before 4 months. Median age at discontinuing breast-feeding was 14, 13, 10 and 6 weeks in Scotland, England, Wales and Northern Ireland, respectively. Thirty-six per cent of UK mothers (34% in England) introduced solids before 4 months. White mothers were more likely to discontinue breast-feeding (62%) and introduce solids early (37%) than most other ethnic minority groups; those stopping before 4 months were more likely to introduce solids early compared with those continuing to breast-feed beyond this age (adjusted rate ratio (95% confidence interval): 1.3 (1.1–1.2)). Educated mothers were less likely to stop breast-feeding before 4 months (white mothers, 0.8 (0.8–0.9); non-white mothers, 0.9 (0.8–1.0)) than those with no/minimal qualifications but, among ethnic minorities, were more likely to introduce solids early (1.3 (1.0–1.6)). Socio-economic status was positively associated with breast-feeding continuation among white women, and with age at introduction of solids among non-white women.

We have identified important geographic, ethnic and social inequalities in breast-feeding continuation and introduction of solids within the UK, many of which have not been reported previously. The factors mediating these associations are complex and merit further study to ensure that interventions proposed to promote maternal adherence to current infant feeding recommendations are appropriate and effective.

To determine whether maternal anthropometry predicted birth weight, and if so, to identify which cut-offs provided the best prediction of low birth weight (LBW) in a field situation.

Community-based longitudinal study.

A rural union of Bhaluka Upazila, Mymensingh, located 110 km north-west of Dhaka, the capital of Bangladesh.

A total of 1104 normotensive, non-smoking pregnant women who attended community nutrition centres were studied from first presentation at the centre until delivery of their child.

Most of the pregnant mothers were between 20 and 34 years of age. Over one-third of the women were nulliparous, while 12.8% were multiparous (parity ≥ 4). Most (93%) mothers registered between the 3rd and 5th month of pregnancy. The frequency of LBW ( < 2500 g) was 17%. Polynomial regression analyses showed that the best predictors of birth weight (based on adjusted R2 values) were in general weight at registration and weight at month 9, with adjusted R2 ranging from 2.5% to nearly 20%. Sequential regression analyses with height and weight showed that there was a significant effect of height after removing the weight variables, and adjusted R2 increased in all analyses. Weight and height at registration month continued to be the best predictors of LBW. Sensitivity and specificity curves were drawn for each registration month, body mass index and different weight gain groups, and using different weight and height combinations. The results showed that, for registration month 3–5, a combination of weight ( ≤ 45 kg) and height ( ≤ 150 cm) gave the highest sensitivity, which was 50%. However, maternal weight ≤ 43 kg in pregnancy month 3–5 alone gave the highest sensitivity of 80%.

The best predictor of birth weight as a continuous variable was maternal weight at registration, each 1 kg increase in weight at registration being associated with an increase in birth weight of about 260 g. Maternal weight ≤ 43 kg in pregnancy month 3–5 alone gave the highest sensitivity of 80%. A combination of initial weight and height of the mother was not as good a predictor of LBW as weight alone.