At issue is whether weight loss in HIV infection is a cachectic process, characterised by loss of lean body mass with conservation of fat, or a process of starvation. We present data on body composition from 516 persons at different stages of HIV infection as determined by CD4 counts.

Cross-sectional analyses of body composition in relation to CD4 count.

The baseline data from a prospective cohort study of outcomes in HIV/AIDS in relation to nutritional status in Boston, Massachusetts, USA.

The first 516 subjects with HIV/AIDS to enrol in the study.

Differences in weight in relation to CD4 counts were present only at CD4 counts of 600 or less (slope below CD4=600: 1.9 kg per 100 CD4 cells, P<0.0001). On average, 68% of the difference in weight over CD4 counts was fat (slope: 1.3 kg fat per 100 CD4 cells, P<0.0001).

This cross-sectional analysis suggests that weight loss consists principally of fat loss in those persons with adequate fat stores. This observation will need to be confirmed in longitudinal analyses.

To report on the haemoglobin concentrations and prevalence of anaemia in schoolchildren in eight countries in Africa and Asia.

Blood samples were collected during surveys of the health of schoolchildren as a part of programmes to develop school-based health services.

Rural schools in Ghana, Indonesia, Kenya, Malawi, Mali, Mozambique, Tanzania and Vietnam.

Nearly 14 000 children enrolled in basic education in three age ranges (7–11 years, 12–14 years and Ä15 years) which reflect the new UNICEF/WHO thresholds to define anaemia.

Anaemia was found to be a severe public health problem (defined as >40% anaemic) in five African countries for children aged 7–11 years and in four of the same countries for children aged 12–14 years. Anaemia was not a public health problem in the children studied in the two Asian countries. More boys than girls were anaemic, and children who enrolled late in school were more likely to be anaemic than children who enrolled closer to the correct age. The implications of the four new thresholds defining anaemia for school-age children are examined.

Anaemia is a significant problem in schoolchildren in sub-Saharan Africa. School-based health services which provide treatments for simple conditions that cause blood loss, such as worms, followed by multiple micronutrient supplements including iron, have the potential to provide relief from a large burden of anaemia.

To identify the season with the highest prevalence of underweight among young children and to examine geographical variation in seasonality of underweight.

This analysis is based on monthly data from a clinic-based growth monitoring programme that forms part of the National Health Information System. A regression-based technique is used to identify seasonal patterns in both underweight prevalence and attendance nationally and in 60 different districts.

The analysis covers the period 1988–1995 and is based in Zimbabwe.

The analysis is based on weight-for-age measurements of Zimbabwean children less than 5 years old, who attended health centres as part of a growth monitoring programme.

Nationally, a small but significant increase in levels of underweight takes place during January–March. Participation in growth monitoring also varies seasonally and could account for the increase observed. No evidence of seasonal variation in underweight prevalence is found in the majority of districts studied, although 11 of the districts showed a similar pattern to the national data set. This peak in the incidence of poor nutritional status also coincides with the period of food scarcity before harvest, which is also associated with higher prevalence of diarrhoea and malaria. No differences in seasonality of under-nutrition were found between districts with predominantly subsistence agriculture and those with more commercial forms of agriculture.

Seasonal variation in child weight-for-age exists in some parts of Zimbabwe, but its effects on cross-sectional prevalence studies are likely to be small. There are no readily discernible differences between areas that show evidence of seasonality in levels of underweight and those that do not.

The prevalence of chronic diseases is increasing in West Africa, the Caribbean and its migrants to Britain. This trend may be due to the transition in the habitual diet, with increasing (saturated) fat and decreasing fruit and vegetable intakes, both within and between countries.

We have tested this hypothesis by comparing habitual diet in four African-origin populations with a similar genetic background at different stages in this transition.

The study populations included subjects from rural Cameroon (n=743), urban Cameroon (n=1042), Jamaica (n=857) and African–Caribbeans in Manchester, UK (n=243), all aged 25–74 years. Habitual diet was assessed by a food-frequency questionnaire, specifically developed for each country separately.

Total energy intake was greatest in rural Cameroon and lowest in Manchester for all age/sex groups. A tendency towards the same pattern was seen for carbohydrates, protein and total fat intake. Saturated and polyunsaturated fat intake and alcohol intake were highest in rural Cameroon, and lowest in Jamaica, with the intakes in the UK lower than those in urban Cameroon. The percentage of energy from total fat was higher in rural and urban Cameroon than in Jamaica and the UK for all age/sex groups. The opposite was seen for percentage of energy from carbohydrate intake, the intake being highest in Jamaica and lowest in rural Cameroon. The percentage of energy from protein increased gradually from rural Cameroon to the UK.

These results do not support our hypothesis that carbohydrate intake increased, while (saturated) fat intake decreased, from rural Cameroon to the UK.

Malnutrition and poor nutritional status among children are common problems in the Republic of Maldives, a small island nation in the Indian Ocean. The aim of this study was to determine possible macro- and micronutrient deficiencies in the traditional Maldivian diet.

In five atolls, 333 women with children aged between 1 and 4 years who were no longer breast-fed were interviewed, using a 24-hour recall. Additionally, the weights and heights of both the women and children were measured, and blood samples from 15 women were collected for measurements of vitamins A and E, β-carotene, homocysteine, cholesterol and haemoglobin.

Of the women, 22% had a body mass index (BMI) below 18.5. Of the children, 41% were stunted, 14% were wasted and 51% were underweight. The women's and children's diets were sufficient in protein (14%) and carbohydrates (67%) but deficient in fat, which contributed only 19% to the total energy intake. Consumption of dietary substances that depend on vegetable and fruit intake (e.g. β-carotene, vitamin C, dietary fibre and folic acid) was low. The low intake of β-carotene was underlined by low plasma concentration. The estimated iron intake was low, although blood haemoglobin levels were normal.

Marginal nutritional status and marginal malnutrition are due to low fat intake and selected micronutrient deficiency. Higher intakes of locally available vegetables and fruits and fat (especially for children) on a regular basis might reverse the deficits documented on the atolls.

This study examined dietary intakes and nutritional status of marijuana users and non-current marijuana users in US adults aged 20 to 59 years.

We used data from the Third National Health and Nutrition Examination Survey (NHANES III), 1988–1994. Information on self-reported drug use, including marijuana, was obtained as part of the NHANES III physical examination component. Nutritional status was assessed using height and weight, and blood biochemistries. Dietary intake was assessed using a 24-hour recall and a food-frequency questionnaire.

Among adults 20–59 years of age, 45% reported ever having used marijuana in their lifetime. A total of 8.7% reported using marijuana in the past month. Current marijuana users had higher intakes of energy and nutrients than non-current marijuana users; however, body mass index (BMI) was slightly lower. We found higher cigarette-smoking rates and higher consumption of sodas and alcohol, specifically beer, among marijuana users than among non-current marijuana users. Marijuana users also consumed more sodium, fewer fruits, and more pork, cheese, and salty snacks. Nutritional status, using indicators of serum nutrients, serum albumin, haematocrit and haemoglobin, was similar between marijuana users and non-current marijuana users. Serum carotenoid levels were lower among marijuana users, independent of cigarette smoking.

Dietary intake was different among marijuana users than among non-current marijuana users. Although overall nutritional status was similar, serum carotenoid levels were lower in marijuana users. The long-term health effects of these differences in marijuana users deserve careful consideration in future research.

Using a national representative sample to identify groups within the UK male and female population over 65 years who report similar patterns of diet.

National representative dietary survey, using 4-day weighed dietary records of men and women aged over 65 years old and living in private households in Great Britain in 1994–1995. Cluster analysis was used to aggregate individuals into diet groups.

United Kingdom.

558 women and 539 men.

Consumption of predefined food groups, nutrient intakes, socio-economic, demographic and behavioural characteristics.

Three large clusters comprising 86% of the male population and three large clusters comprising 83% of the female population were identified. Among men, the most prevalent cluster was a ‘mixed diet’ with elements from a traditional diet and some elements from a healthy diet (48% of the male population); the second was a ‘healthy diet’ (21% of the male population); and the third was a ‘traditional diet high in alcohol’ (17% of the male population). Among women, the most prevalent diet was a ‘sweet traditional diet’ (33% of the female population); the second was a ‘healthy diet’ (32% of the female population); and the last was a ‘mixed diet’ with elements of the traditional diet and the healthy diet (18% of the female population). There were important differences in average nutrient intakes, socio-demographic and behavioural characteristics across these diet clusters.

Cluster analysis identified three diet groups among men and three among women. These differed not only in terms of reported dietary intake, but also with respect to their nutrient content, social and behavioural profile. The groups identified could provide a useful basis for health promotion based upon the diet clusters.

To assess how the dental status of older people affected their stated ability to eat common foods, their nutrient intake and some nutrition-related blood analytes.

Cross-sectional survey part of nation-wide British National Diet and Nutrition Survey: people aged 65 years and older. Data from a questionnaire were linked to clinical data and data from four-day weighed dietary records. Two separate representative samples: a free-living and an institutional sample. Seven-hundred-and-fifty-three free-living and 196 institution subjects had a dental exam and interview.

About one in five dentate (with natural teeth) free-living people had difficulty eating raw carrots, apples, well-done steak or nuts. Foods such as nuts, apples and raw carrots could not be eaten easily by over half edentate (without natural teeth but with dentures) people in institutions. In free-living, intakes of most nutrients and fruit and vegetables were significantly lower in edentate than dentate. Perceived chewing ability increased with increasing number of teeth. Daily intake of non-starch polysaccharides, protein, calcium, non-haem iron, niacin, vitamin C and intrinsic and milk sugars were significantly lower in edentate. Plasma ascorbate and retinol were significantly lower in the edentate than dentate. Plasma ascorbate was significantly related to the number of teeth and posterior contacting pairs of teeth.

The presence, number and distribution of natural teeth are related to the ability to eat certain foods, affecting nutrient intakes and two biochemical measures of nutritional status.

To assess the association between nutrition and health in an adult urban homeless population.

Cross-sectional – nutritional state (body mass index (BMI), triceps skinfold (TSF), upper arm circumference), dietary habits (food frequency), socio-demographic data and self-stated diseases were assessed.

Four sites for homeless people in Kiel and Hamburg, Germany.

Sample of 75 homeless people (60 males, 15 females) aged 19–62 years.

A lack of food was not found in the majority of the homeless. Seventy-six per cent of the study population showed a normal dietary pattern. Critical food groups were fresh fruit and vegetables, rice and noodles. However, 52 or 29% of the homeless were malnourished (i.e. they were below the 25th or 5th percentile of arm muscle area). In addition, 22.7% of the homeless were obese (i.e. BMI>30 kg m−2 and/or TSF>90th percentile). Almost two-thirds of the population suffered from at least one chronic disease (prevalence of nutrition-related disorders 33.3%, gastrointestinal disorders 32.0%, dental diseases 22.7%, psychiatric disorders 18.7%, wasting diseases 6.7%). Smoking (prevalence rate 82%), drinking alcohol (51%) and drug abuse (20%) were frequent among homeless people. Food intake was not related to nutritional state, the prevalence of chronic diseases or addiction habits. By contrast, a poor nutritional state was associated with drug abuse and the prevalence of wasting diseases.

Prevention of nutritional problems should be directed to health-related problems such as the prevention or treatment of chronic diseases and addiction habits.

The aim of this research was to describe the variation in bread consumption within social classes and to link this consumption to health-related lifestyles in Finland from 1978 until 1998.

A cross-sectional survey on health-related behaviour and socio-demographic factors has been conducted annually since 1978.

Mailed questionnaire.

A random sample of 5000 Finns aged 15–64 years has been drawn annually. The response rate has varied from 84% to 68%.

The consumption of rye bread decreased, but among the female population a slight increase appeared in the 1990s. The consumption of rye bread was associated with a low educational level and a rural place of residence. White bread was consumed less than was rye bread. White bread was consumed more frequently by the less educated in urban areas. Contrary to white bread, the consumption of rye bread was not associated with smoking, exercise or alcohol consumption.

The traditional place of rye bread in the Finnish dietary pattern has remained rather constant. White bread consumption has been associated with an unhealthy lifestyle. As a result, those Finns who are concerned about their health avoid white bread but seem not to associate rye bread with a healthier lifestyle. In Finland, rye bread has a different image to the image of whole-grain or dark brown bread in many other western European countries.

Laboratory data suggest that several different vitamins may inhibit the growth of mammary cancers, however epidemiologic data on the relationship between vitamin supplement use and breast cancer are inconsistent. We examined the association between self-reported vitamin supplement use and breast cancer among black women and white women.

The data came from a population-based, case–control study conducted in North Carolina between 1993 and 1996. Logistic regression models were used to calculate adjusted odds ratios (ORs) for breast cancer associated with the use of multivitamins or individual vitamin supplements.

Eligible cases were aged 20 to 74, and approximately 40% of the study population were black women. The analyses included 861 cases and 790 controls.

Among all women, there was little evidence for an association between any vitamin supplement and breast cancer. Modest inverse associations were observed among white women for use of multivitamins (OR = 0.81, 95% confidence interval (CI): 0.59–1.12), vitamin C (OR = 0.78, 95% CI: 0.54–1.14) and vitamin E (OR = 0.75, 95% CI: 0.49–1.13). There was no evidence that vitamin supplements reduced the risk of breast cancer among black women.

This study provided very limited support for the hypothesis that vitamin supplements may reduce the risk of breast cancer. Although dietary factors are likely an important influence in breast cancer aetiology, reductions in risk are most likely to be achieved through dietary modification rather than through vitamin supplementation.

To investigate the usefulness of serum carotenoids as biomarkers of fruit and vegetable consumption.

Reproducibility study on three repeat measurements of serum carotenoids. Correlation analysis of carotenoids and dietary food intake, and regression analysis of potential predictive parameters for serum carotenoid levels.

New York, USA.

Women participating in the New York Women's Health Study, a prospective study of sex hormones, diet and breast cancer. Forty-eight women with three repeat blood samples and 302 women having a blood sample and a dietary history questionnaire.

Serum carotenoid concentrations were highly reproducible between one- and two-year repeat samples. Estimated fruit and vegetable consumption was positively correlated with serum carotenoid concentrations but correlation coefficients were low. Consumption of fruit was predictive for serum levels of beta-carotene, alpha-carotene and beta-cryptoxanthin, while vegetable consumption was predictive for serum beta-carotene, lutein, zeaxanthin and lycopene. Serum concentrations of cholesterol and triglycerides were predictive for serum carotenoids but adjustment for their levels had little or no influence on the correlation between fruit and vegetable consumption and serum carotenoid concentrations.

One single serum measurement of alpha-carotene, beta-carotene and lutein can accurately rank subjects according to their usual serum level. Serum concentrations, however, correlate only moderately with estimated dietary intake of fruits or vegetables and should therefore be used with caution as biomarkers of fruit and vegetable intake.

Brassica vegetable consumption (e.g. broccoli) leads to excretion of isothiocyanates (ITC) in urine. We evaluated the consistency of ITC as a biomarker for dietary Brassica vegetable consumption across the types of vegetables and methods of preparation used in Western societies, and across consumption levels.

A single-armed behavioural intervention with duplicate baseline assessment and post-intervention assessment. Urinary ITC excretion and estrogen metabolites were measured from 24-hour urine samples. Dietary intake was measured by a 24-hour recall.

The behavioural intervention facilitated daily Brassica intake among participants by providing peer support, food preparation instruction, guided practice in a teaching kitchen, and other information.

Thirty-four healthy free-living postmenopausal women who recently had a negative screening mammogram at the University of Massachusetts Medical Center.

Urinary ITC excretion and total Brassica intake followed the same pattern over the intervention. The ITC biomarker significantly predicted Brassica intake when Brassica consumption averaged about 100 g day−1, but not when Brassica consumption averaged about 200 g day−1. Urinary ITC levels were somewhat higher when more raw vegetables were consumed as compared to lightly cooked vegetables, while the types of Brassica consumed appeared to have only a small, non-significant effect on urinary ITC levels.

Urinary ITC excretion would be a good exposure biomarker among populations regularly consuming a vegetable serving/day, but may be less accurate among populations with greater intake levels or a wide range of cooking practices.

To describe methods and dietary habits of a large population cohort.

Prospective assessment of diet using diet diaries and food-frequency questionnaires, and biomarkers of diet in 24-h urine collections and blood samples.

Free living individuals aged 45 to 75 years living in Norfolk, UK.

Food and nutrient intake from a food-frequency questionnaire on 23 003 men and women, and from a 7-day diet diary from 2117 men and women. Nitrogen, sodium and potassium excretion was obtained from single 24-h urine samples from 300 individuals in the EPIC cohort. Plasma vitamin C was measured for 20 846 men and women.

The food-frequency questionnaire (FFQ) and the food diary were able to determine differences in foods and nutrients between the sexes and were reliable as judged by repeated administrations of each method. Plasma vitamin C was significantly higher in women than men. There were significant (P<0.001) differences in mean intake of all nutrients measured by the two different methods in women but less so in men. The questionnaire overestimated dairy products and vegetables in both men and women when compared with intakes derived from the diary, but underestimated cereal and meat intake in men. There were some consistent trends with age in food and nutrient intakes assessed by both methods, particularly in men. Correlation coefficients between dietary intake assessed from the diary and excretion of nitrogen and potassium in a single 24-h urine sample ranged from 0.36 to 0.47. Those comparing urine excretion and intake assessed from the FFQ were 0.09 to 0.26. The correlations between plasma vitamin C and dietary intake from the first FFQ, 24-h recall or diary were 0.28, 0.35 and 0.40.

EPIC Norfolk is one of the largest epidemiological studies of nutrition in the UK and the largest on which plasma vitamin C has been obtained. Methods for obtaining food and nutrient intake are described in detail. The results shown here for food and nutrient intakes can be compared with results from other population studies utilising different methods of assessing dietary intake. The utility of different methods used in different settings within the main EPIC cohort is described. The FFQ is to be used particularly in pooled analyses of risk from diet in relation to cancer incidence within the larger European EPIC study, where measurement error is more likely to be overcome by large dietary heterogeneity on an international basis. Findings in the UK, where dietary variation between individuals is smaller and hence the need to use a more accurate individual method greater, will be derived from the 7-day diary information on a nested case–control basis. 24-h recalls can be used in the event that diary information should not be forthcoming from some eventual cases. Combinations of results utilising all dietary methods and biomarkers may also be possible.