Challenges for public health nutrition in the 1990s

Usual diet in Bubis, a rural immigrant population of African origin in Madrid

OBJECTIVE

To assess the usual diet of an immigrant Bubis population living in Madrid, the main ethnic group from the Island of Bioco, Equatorial Guinea, and explore how different it is from the predominant diet in West Africa and from the adult population of Madrid.

DESIGN

Cross-sectional study. We randomly selected a sample of 213 Bubis aged 18-84 years, 83 men and 130 women, who were born in Bioco, emigrated and now live in the Madrid area. Participants were interviewed about their usual diet with the use of a food frequency questionnaire. Height and weight were also measured during interviews and prevalence of obesity was estimated as a body mass index (kg m(-2)).

SETTING

The urban area of Madrid in 2001.

RESULTS

The diet of the Bubis living in the metropolitan area of Madrid resembles more the urban diet observed among Spanish people than the traditional rural diet observed among people of West Africa. The percentage of calories from fat, protein and carbohydrates was 33.9, 18.3 and 47.7%, respectively. The Bubi diet presented a much higher protein intake and much lower fat intake than the usual diet in Cameroon. The usual Bubi diet also contained more protein and less fat and alcohol than the predominant diet of adult population living in the Madrid area. Women presented higher prevalence of obesity (23.2%) than men (11.0%), and even higher than that observed among Spanish women.

CONCLUSIONS

The first immigrant generation of Bubis in Madrid showed food and nutrient intakes closer to the prevalent diet in Madrid than to the diet of their native land. The impact of this westernization of the diet of this and other immigrant populations in Spain needs to be monitored in the future.

Nutrient intakes of an adult Pakistani, European and African-Caribbean community in inner city Britain

OBJECTIVES

To report nutrient intakes for three different ethnic groups living in inner city Manchester and explore under-reporting in each group.

DESIGN

Cross-sectional survey. All participants completed one of three food frequency questionnaires, specifically developed for each ethnic group, and took part in a larger international survey of risk factors for diabetes and hypertension.

SETTING

Participants were drawn randomly from seven GP registers in inner city Manchester, UK.

PARTICIPANTS

Men and women aged 25-79 years, 86 European, 246 African-Caribbean origin and 84 Pakistani origin participants were included in the analysis.

RESULTS

Body mass index was highest in the Pakistani women, 30.2 kg m-2. European participants had the highest reported energy intakes (EIs) for men and women (10.9 and 9.6 MJ, respectively). Pakistani men and women had the highest percentage of energy from fat (36.7 and 36.6%, respectively). Iron intakes were low in the African-Caribbean group and calcium intakes were low in the Pakistani group. Under-reporting [assessed as EI : basal metabolic rate (BMR) ratio <1.2] appeared to be high and occurred across all ethnic groups, with those apparently under-reporting having higher BMIs in all groups.

CONCLUSION

The data provide nutrient intake estimates in three different ethnic groups using a similar method. Limitations include under-reporting across all ethnic groups in a similar pattern with under-reporters having higher BMIs in all groups, as found elsewhere.

Alcohol and stroke: a community case-control study in Asturias, Spain

The relationship between alcohol consumption and stroke is uncertain. Heavy alcohol consumption has been associated with an increased risk of stroke, while light drinking appears to be protective. However, the evidence is not uniform. We sought to examine the relationship between alcohol consumption and stroke, according to stroke type. We performed a population-based case-control study from September 1990 to December 1991. The study comprised 467 incident cases of stroke and 477 controls aged between 40 and 85. Case was defined following WHO criteria and control was randomly selected from the study base population. Alcohol exposure was obtained by medical interview. We found that consumption of less than 30 g/day of alcohol was protective against all stroke types combined, the multivariated adjusted odds ratio (OR) was 0.58 (95% confidence interval [CI], 0.41-0.83). Moderate alcohol drinking is also protective against all cerebral infarction combined (OR = 0.53; 95% CI, 0.35-0.80) and cortical infarction (OR = 0.40; 95% CI, 0.18-0.86). Drinking up to 30 g/day of alcohol has a borderline protective effect on deep cerebral infarction (OR = 0.40; 95% CI, 0.16-1.02) and has no effect on intracerebral hemorrhage (OR = 0.88; 95% CI, 0.44-1.74). Heavy alcohol drinking, over 140 g/day, is a risk factor for all stroke types combined (OR = 3.2; 95% CI, 1.1-9.7), all cerebral infarction combined (OR = 5.0; 95% CI, 1.5-16.3), small deep cerebral infarction (OR = 9.7; 95% CI, 2.6-36.7), intracerebral hemorrhage (OR = 6.2; 95% CI, 1.3-24.0), and is marginally associated with superficial cerebral infarction (OR = 4.6; 95% CI, 1.0-20.6). The relationship between alcohol and stroke depends on the alcohol dose and the pathology of the disease. Atherosclerosis of the large and medium cerebral arteries is found mainly in superficial cerebral infarction, and this type of stroke shows a J-shaped relationship with alcohol similar to that found in coronary heart disease, suggesting that they are similar diseases. On the other hand, arteriosclerosis of the penetrating arteries has been found in deep cerebral infarction and intracerebral hemorrhage, while atherosclerosis is not prominent. This may explain why alcohol does not have a protective effect on cerebral hemorrhage whereas heavy drinking is a strong risk factor in these two types of stroke.

Promoting the selection of low-fat milk in elementary school cafeterias in an inner-city Latino community: evaluation of an intervention

OBJECTIVES

This study examined the effects of a school-based intervention designed to promote the consumption of low-fat white milk at lunchtime in 6 elementary schools in an inner-city, primarily Latino neighborhood.

METHODS

A multifaceted intervention based on social marketing techniques was delivered at 3 randomly selected schools. The school was the unit of assignment and analysis; 6902 children were involved in the study. Milk selection and consumption were measured by sampling discarded milk and/or tallying milk carton disappearance at baseline, immediately postintervention, and at 3 to 4 months follow-up.

RESULTS

Immediately postintervention, the mean proportion of sampled milk cartons that contained low-fat milk increased in the intervention schools, from 25% to 57%, but remained constant at 28% in the control schools. Differences between intervention and control schools remained significant at 3 to 4 months follow-up. The intervention was not associated with a decrease in overall milk consumption.

CONCLUSIONS

A school-based intervention can lead to significant increases in student consumption of low-fat milk.

[Social inequities and food: an ecological study of the food sales of a supermarket chain]

With the aim of finding out the pattern of food consumption in different socioeconomic areas of the city of Valencia and examining if the sales data from the supermarkets make up an information source which is capable of detecting inequalities and revealing trends, the sales figures of a chain of supermarkets, referring to 10 food products during 1989 and 1990 were studied. Foods were considered as "healthier" (fruit, vegetables, skimmed milk, fresh fish and chicken), "less healthy" (pork, butter and cakes) and foods indicative of a "new style of eating" (pre-cooked frozen foods and frozen food products). The ratio of between "healthier" food sales and sales of "less healthy" foods is directly related to the socio-economic level of the population. The higher the socioeconomic level, the higher, the ratio of proportions of "healthier" and less healthy" food. This pattern was similar for 1989 (2.78 in lower level districts and 3.32 in higher level districts, and in 1990 (2.92 and 4.09 respectively) (p < 0.01). From these results, we deduce the need for developing different activities for the promotion of healthy foods according to social groups.

5-A-DAY: dietary behavior and the fruit and vegetable intake of Latino children

OBJECTIVES

The purpose of the study was to examine children's intake of fruits and vegetables in relation to the recent national "5-A-DAY" campaign.

METHODS

Four 24-hour dietary recalls per child collected from 205 mothers of 4- to 5-year-old urban Latino children were used to analyze average 5-A-DAY fruit and vegetable consumption and examine associations between 5-A-DAY consumption, nutrient intakes, and eating patterns.

RESULTS

The reported mean servings per day of fruits and vegetables, as defined by 5-A-DAY criteria, were 1.8 and 1.0, respectively, with only 6.8% (n = 14) of the children averaging five or more servings per day. Fruit juice accounted for 36% of 5-A-DAY servings. There were significant linear trends in intake of vitamins A and C, potassium, iron, cholesterol, protein, and fiber across quintiles of 5-A-DAY intake. There were no differences among quintiles in intake of saturated or total fat or in servings from most non-5-A-DAY food groups.

CONCLUSIONS

Latino children's intake of fruits and vegetables falls far short of current recommendations. Fruit juice accounted for a disproportionate amount of 5-A-DAY intake in this population. Sensible 5-A-DAY interventions should take into consideration the existing eating patterns of the target population.

Weight loss attempts in adults: goals, duration, and rate of weight loss

OBJECTIVES

Although attempted weight loss is common, little is known about the goals and durations of weight loss attempts and the rates of achieved weight loss in the general population.

METHODS

Data were collected by telephone in 1989 from adults aged 18 years and older in 39 states and the District of Columbia. Analyses were carried out separately for the 6758 men and 14,915 women who reported currently trying to lose weight.

RESULTS

Approximately 25% of the men respondents and 40% of the women respondents reported that they were currently trying to lose weight. Among men, a higher percentage of Hispanics (31%) than of Whites (25%) or Blacks (23%) reported trying to lose weight. Among women, however, there were no ethnic differences in prevalence. The average man wanted to lose 30 pounds and to weigh 178 pounds; the average woman wanted to lose 31 pounds and to weigh 133 pounds. Black women wanted to lose an average of 8 pounds more than did White women, but Black women's goal weight was 10 pounds heavier. The average rate of achieved weight loss was 1.4 pounds per week for men and 1.1 pounds per week for women; these averages, however, may reflect only the experience of those most successful at losing weight.

CONCLUSIONS

Attempted weight loss is a common behavior, regardless of age, gender, or ethnicity, and weight loss goals are substantial; however, obesity remains a major public health problem in the United States.

Food sources, dietary behavior, and the saturated fat intake of Latino children

BACKGROUND

Recent recommendations for Americans aged 2 and older call for a reduction in the average saturated fat intake to less than 10% of calories.

METHODS

Using 24-hour dietary recalls collected from mothers of 4- to 7-year-old urban Latino children, we identified foods and dietary behavior patterns that distinguish children with higher and lower mean daily percentages of calories from saturated fat.

RESULTS

Compared with children in the lowest quintile of intake, children in the highest quintile consumed more than twice as much saturated fat per day from high-fat milk products (18.5 g vs 7.8 g), mostly from whole milk. They did not consume different kinds of milk or different amounts of milk per eating occasion, but on average they consumed milk more frequently (2.8 vs 1.6 eating occasions per day). Even children in the lowest quintile, on average, exceeded the 10% of calories from saturated fat currently recommended. If low-fat (1% fat) milk had been substituted without other dietary changes, all but the highest two quintiles would have been within the recommended level.

CONCLUSIONS

The substitution of low-fat for whole milk appears to be a key strategy for preschool children for achieving recommended levels of saturated fat intake.

Glutathione in foods listed in the National Cancer Institute's Health Habits and History Food Frequency Questionnaire

Glutathione (GSH) is an antioxidant and anticarcinogen that is present in plant and animal tissues that form the bulk of the human diet. Recent studies show that GSH is absorbed intact in rat small intestine and that oral GSH increases plasma GSH concentration in humans. To provide a database for epidemiological studies of dietary intake of GSH and risk of diseases in humans, we have measured the content of GSH in the foods listed in the National Cancer Institute's Health Habits and History Questionnaire. Foods were purchased in the Atlanta area and prepared as most commonly consumed in the United States. GSH analyses were performed using a high-performance liquid chromatography technique with a method of additions to correct for losses during sample preparation. A separate set of samples was run after treatment with dithiothreitol to measure the total of GSH and its disulfide forms (GSH). The results show that dairy products, cereals, and breads are generally low in GSH; fruits and vegetables have moderate to high amounts of GSH; and freshly prepared meats are relatively high in GSH. Frozen foods generally had GSH contents similar to fresh foods, whereas other forms of processing and preservation generally resulted in extensive loss of GSH. Thus this database will allow researchers to examine the relationship between dietary GSH and risk of cancers and other diseases.