How do we improve adolescent diet and physical activity in India and sub-Saharan Africa? Findings from the Transforming Adolescent Lives through Nutrition (TALENT) consortium.

OBJECTIVE: Adolescent diet, physical activity and nutritional status are generally known to be sub-optimal. This is an introduction to a special issue of papers devoted to exploring factors affecting diet and physical activity in adolescents, including food insecure and vulnerable groups. SETTING: Eight settings including urban, peri-urban and rural across sites from five different low- and middle-income countries. DESIGN: Focus groups with adolescents and caregivers carried out by trained researchers. RESULTS: Our results show that adolescents, even in poor settings, know about healthy diet and lifestyles. They want to have energy, feel happy, look good and live longer, but their desire for autonomy, a need to 'belong' in their peer group, plus vulnerability to marketing exploiting their aspirations, leads them to make unhealthy choices. They describe significant gender, culture and context-specific barriers. For example, urban adolescents had easy access to energy dense, unhealthy foods bought outside the home, whereas junk foods were only beginning to permeate rural sites. Among adolescents in Indian sites, pressure to excel in exams meant that academic studies were squeezing out physical activity time. CONCLUSIONS: Interventions to improve adolescents' diets and physical activity levels must therefore address structural and environmental issues and influences in their homes and schools, since it is clear that their food and activity choices are the product of an interacting complex of factors. In the next phase of work, the Transforming Adolescent Lives through Nutrition consortium will employ groups of adolescents, caregivers and local stakeholders in each site to develop interventions to improve adolescent nutritional status.

Addressing embodied inequities in health: how do we enable improvement in women's diet in pregnancy?

OBJECTIVE: To disrupt cycles of health inequity, traceable to dietary inequities in the earliest stages of life, public health interventions should target improving nutritional wellbeing in preconception/pregnancy environments. This requires a deep engagement with pregnant/postpartum people (PPP) and their communities (including their health and social care providers, HSCP). We sought to understand the factors that influence diet during pregnancy from the perspectives of PPP and HSCP, and to outline intervention priorities. DESIGN: We carried out thematic network analyses of transcripts from ten focus group discussions (FGD) and one stakeholder engagement meeting with PPP and HSCP in a Canadian city. Identified themes were developed into conceptual maps, highlighting local priorities for pregnancy nutrition and intervention development. SETTING: FGD and the stakeholder meeting were run in predominantly lower socioeconomic position (SEP) neighbourhoods in the sociodemographically diverse city of Hamilton, Canada. PARTICIPANTS: All local, comprising twenty-two lower SEP PPP and forty-three HSCP. RESULTS: Salient themes were resilience, resources, relationships and the embodied experience of pregnancy. Both PPP and HSCP underscored that socioeconomic-political forces operating at multiple levels largely determined the availability of individual and relational resources constraining diet during pregnancy. Intervention proposals focused on cultivating individual and community resilience to improve early-life nutritional environments. Participants called for better-integrated services, greater income supports and strengthened support programmes. CONCLUSIONS: Hamilton stakeholders foregrounded social determinants of inequity as main factors influencing pregnancy diet. They further indicated a need to develop interventions that build resilience and redistribute resources at multiple levels, from the household to the state.

Dietary patterns of university students in the UK: a cross-sectional study.

BACKGROUND: University represents a key transition into adulthood for many adolescents but there are associated concerns about health and behaviours. One important aspect relates to diet and there is emerging evidence that university students may consume poor quality diets, with potential implications for body weight and long-term health. This research aimed to characterise dietary patterns of university students in the UK and their sociodemographic and lifestyle antecedents. METHODS: An online, cross-sectional survey was undertaken with a convenience sample of 1448 university students from five UK universities (King's College London, Universities of St Andrews, Southampton and Sheffield, and Ulster University). The survey comprised a validated food frequency questionnaire alongside lifestyle and sociodemographic questions. Dietary patterns were generated from food frequency intake data using principal components analysis. Nutrient intakes were estimated to characterise the nutrient profile of each dietary pattern. Associations with sociodemographic variables were assessed through general linear modelling. RESULTS: Dietary analyses revealed four major dietary patterns: 'vegetarian'; 'snacking'; 'health-conscious'; and 'convenience, red meat & alcohol'. The 'health-conscious' pattern had the most favourable micronutrient profile. Students' gender, age, year of study, geographical location and cooking ability were associated with differences in pattern behaviour. Female students favoured the 'vegetarian' pattern, whilst male students preferred the 'convenience, red meat & alcohol' pattern. Less healthful dietary patterns were positively associated with lifestyle risk factors such as smoking, low physical activity and take-away consumption. The health-conscious pattern had greatest nutrient density. The 'convenience, red meat & alcohol' pattern was associated with higher weekly food spending; this pattern was also identified most consistently across universities. Students reporting greater cooking ability tended towards the 'vegetarian' and 'health-conscious' patterns. CONCLUSIONS: Food intake varied amongst university students. A substantial proportion of students followed health-promoting diets, which had good nutrient profiles obviating a need for dietary intervention. However, some students consumed poor diets, incurred greater food costs and practised unfavourable lifestyle behaviours, which may have long-term health effects. University policy to improve students' diets should incorporate efforts to promote student engagement in cooking and food preparation, and increased availability of low cost healthier food items.

A Comparison of Food Portion Size Estimation by Older Adults, Young Adults and Nutritionists.

OBJECTIVES: To investigate the ability of older adults, younger adults and nutritionists to assess portion size using traditional methods versus a computer-based method. This was to inform the development of a novel dietary assessment method for older adults "The NANA system". DESIGN: Older and younger adults assessed the portion size of self-served portions of foods from a buffet style set up using traditional and computerised portion size assessment aids. Nutritionists assessed the portion size of foods from digital photographs using computerised portion size aids. These estimates were compared to known weights of foods using univariate analyses of covariance (ANCOVA). SETTING: The University of Sheffield, United Kingdom. SUBJECTS: Forty older adults (aged 65 years and over), 41 younger adults (aged between 18 and 40 years) and 25 nutritionists. RESULTS: There was little difference in the abilities of older and younger adults to assess portion size using both assessment aids with the exception of small pieces morphology. Even though the methods were not directly comparable among the test groups, there was less variability in portion size estimates made by the nutritionists. CONCLUSION: Older adults and younger adults are similar in their ability to assess food portion size and demonstrate wide variability of estimation compared to the ability of nutritionists to estimate portion size from photographs. The results suggest that the use of photographs of meals consumed for portion size assessment by a nutritionist may improve the accuracy of dietary assessment. Improved portion size assessment aids are required for all age groups.

Nutritional strategies of high level natural bodybuilders during competition preparation.

BACKGROUND: Competitive bodybuilders employ a combination of resistance training, cardiovascular exercise, calorie reduction, supplementation regimes and peaking strategies in order to lose fat mass and maintain fat free mass. Although recommendations exist for contest preparation, applied research is limited and data on the contest preparation regimes of bodybuilders are restricted to case studies or small cohorts. Moreover, the influence of different nutritional strategies on competitive outcome is unknown. METHODS: Fifty-one competitors (35 male and 16 female) volunteered to take part in this project. The British Natural Bodybuilding Federation (BNBF) runs an annual national competition for high level bodybuilders; competitors must qualify by winning at a qualifying events or may be invited at the judge's discretion. Competitors are subject to stringent drug testing and have to undergo a polygraph test. Study of this cohort provides an opportunity to examine the dietary practices of high level natural bodybuilders. We report the results of a cross-sectional study of bodybuilders competing at the BNBF finals. Volunteers completed a 34-item questionnaire assessing diet at three time points. At each time point participants recorded food intake over a 24-h period in grams and/or portions. Competitors were categorised according to contest placing. A "placed" competitor finished in the top 5, and a "Non-placed" (DNP) competitor finished outside the top 5. Nutrient analysis was performed using Nutritics software. Repeated measures ANOVA and effect sizes (Cohen's d) were used to test if nutrient intake changed over time and if placing was associated with intake. RESULTS: Mean preparation time for a competitor was 22 ± 9 weeks. Nutrient intake of bodybuilders reflected a high-protein, high-carbohydrate, low-fat diet. Total carbohydrate, protein and fat intakes decreased over time in both male and female cohorts (P < 0.05). Placed male competitors had a greater carbohydrate intake at the start of contest preparation (5.1 vs 3.7 g/kg BW) than DNP competitors (d = 1.02, 95% CI [0.22, 1.80]). CONCLUSIONS: Greater carbohydrate intake in the placed competitors could theoretically have contributed towards greater maintenance of muscle mass during competition preparation compared to DNP competitors. These findings require corroboration, but will likely be of interest to bodybuilders and coaches.

Preparing and sharing food: a quantitative analysis of a primary school-based food intervention.

Background: Primary schools are increasingly used as arenas for public health initiatives. The aim of this study was to assess a primary school-based food intervention. Methods: The intervention comprised timetabled kitchen classroom sessions (90 min, fortnightly). Pupils prepared and cooked food, which they then ate together. Children's relationship with food, including food enjoyment, experience and food neophobia, were addressed at the intervention school (baseline n = 154; follow-up n = 164) and at a matched control school (baseline n = 171; follow-up n = 174). Results: Pupils at the intervention school scored significantly higher (M = 3.90, SD = 1.81) for scores on Kitchen Equipment, compared to the control school (M = 3.06, SD = 2.12); and again scored significantly higher (M = 9.34, SD = 3.79) for the overall Cooking Experience Score compared to the control school (M = 7.98, SD = 4.57). Shifts accompanying the intervention in three outcome measures for pupils (taste description, liking for cooking and helping with cooking at home) were also revealed. No main intervention effect for food neophobia and fussiness was found; a close to significant time by intervention interaction (P = 0.053) was evident. Conclusions: The study indicates limited but encouraging changes, and contributes to the growing literature regarding school-based food initiatives.

Adolescents' beverage choice at school and the impact on sugar intake.

BACKGROUND/OBJECTIVES: To examine students' beverage choice in school, with reference to its contribution to students' intake of non-milk extrinsic (NME) sugars. SUBJECTS/METHODS: Beverage and food selection data for students aged 11-18 years (n=2461) were collected from two large secondary schools in England, for a continuous period of 145 (school A) and 125 (school B) school days. Descriptive analysis followed by cluster analysis of the beverage data were performed separately for each school. RESULTS: More than a third of all items selected by students were beverages, and juice-based beverages were students' most popular choice (school A, 38.6%; school B, 35.2%). Mean NME sugars derived from beverages alone was high (school A, 16.7 g/student-day; school B, 12.9 g/student-day). Based on beverage purchases, six clusters of students were identified at each school (school A: 'juice-based', 'assorted', 'water', 'cartoned flavoured milk', 'bottled flavoured milk', 'high volume juice-based'; school B: 'assorted', 'water with juice-based', 'sparkling juice/juice-based', 'water', 'high volume water', 'high volume juice-based'). Both schools included 'high volume juice-based' clusters with the highest NME sugar means from beverages (school A, 28.6 g/student-day; school B, 24.4 g/student-day), and 'water' clusters with the lowest. A hierarchy in NME sugars was found according to cluster; students in the 'high volume juice-based' cluster returned significantly higher levels of NME sugars than students in other clusters. CONCLUSIONS: This study reveals the contribution that school beverages combined with students' beverage choice behaviour is making to students' NME sugar intake. These findings inform school food initiatives, and more generally public health policy around adolescents' dietary intake.

A qualitative study of a food intervention in a primary school: Pupils as agents of change.

This study explored the impact of a school-based kitchen project at a large inner London school. Timetabled kitchen classroom sessions (90 min every fortnight) were held with all 7-9 year old pupils. Semi-structured focus group discussions (with 76 pupils, 16 parents) and interviews (with headteachers, catering managers and specialist staff) were conducted at the intervention school and a matched control school. Categories and concepts were derived using a grounded theory approach. Data analysis provided three main categories each with their related concepts: Pupil factors (enthusiasm and enjoyment of cooking, trying new foods, food knowledge and awareness, producing something tangible); School factors (learning and curriculum links, resource implications and external pressures) and Home factors (take home effects, confidence in cooking and self-esteem, parents' difficulties cooking at home with children). Children's engagement and the opportunity to cook supported increased food awareness, skills and food confidence. In the grounded theory that emerged, take home effects beyond the school gate dominate, as children act as agents of change and influence cooking and food choice at home. These short term outcomes have the potential to lead to longer term outcomes including changing eating behaviour and diet.

Food choice and nutrient intake amongst homeless people.

BACKGROUND: Homeless people in the UK and elsewhere have typically been found to consume a nutritionally inadequate diet. There is need for contemporary research to update our understanding within this field. The present study aimed to provide an insight into the nutrient intake and food choice of a sample of homeless adults. METHODS: In this mixed-methods study, 24 homeless individuals accessing two charitable meal services in Sheffield, UK, participated in up to four 24-h dietary recalls between April and August 2012. Twelve individuals took part in a semi-structured interview focusing on food choice. RESULTS: Energy intake was significantly lower than the estimated average requirement. Median intakes of vitamin A, zinc, magnesium, potassium and selenium were significantly lower than reference nutrient intakes. Contributions of saturated fat and nonmilk extrinsic sugars to total energy intake were significantly higher, whereas dietary fibre was significantly lower, than population average intakes. Charitable meals made an important contribution to intakes of energy and most micronutrients. Thematic analysis of interview transcripts revealed three major themes: food aspirations; constraints over food choice; and food representing survival. CONCLUSIONS: The present study reveals risk of dietary inadequacies amongst homeless people alongside a lack of control over food choices. Charitable meal services are suggested as a vehicle for improving the dietary intake and nutritional health of homeless people.

Nutrition claims in British women's magazines from 1940 to 1955.

BACKGROUND: The present study examined dietary messages conveyed in articles and advertising in two popular British women's magazines, Woman and Home and Woman's Own, between 1940 and 1954. METHODS: A qualitative analysis of written content was performed, focusing on regularities evident in content, and addressing the construction of the role of women in relation to food provision, as well as assertions for nutritional health. The setting comprised a desk-based study. The study sample encompassed 37 magazines, and yielded a corpus of 569 articles concerned with food or dietary supplements, of which 80.1% were advertisements. RESULTS: Ministry of Food dietary advice featured prominently up to 1945 and advocated food consumption according to a simple nutrient classification. Advertising and article content also used this classification; advocating consumption of food and supplements on the grounds of energy, growth and protection of health was customary. Providing food to meet nutritional needs was depicted as fundamental to women's war effort and their role as dutiful housewives. Advertising in 1950s magazines also focused on nutritional claims, with a particular emphasis on energy provision. CONCLUSIONS: These claims reflected the prevailing food policy and scientific understanding of nutritional health. This analysis of food messages in women's magazines provides lessons for contemporary nutrition policy.

Food, nutrition and slimming messages in British women's magazines, 1950-1998.

BACKGROUND: The present study examined temporality in the representation of food in two popular British women's magazines between 1950 and 1998. METHODS: A quantitative content analysis of (i) prevalence of cooking, slimming, nutrition advice in articles; (ii) prevalence of food advertising by food type; and (iii) likelihood of various nutrition and consumer messages in advertising was performed on a sample comprising 200 magazines, with 3045 advertisements and 88 articles. RESULTS: The prevalence of food advertisements decreased (P < 0.001), whereas food articles increased, across decades (P < 0.001). Cooking tips dominated 1950s food writing (100%), contrasting with miniscule coverage in the 1990s (5%). Slimming advice was not represented in 1950s articles and was most common in 1970s articles (55% of articles). Food advertising for all food types decreased in the 1990s decade. There were greater bread and cereals (P < 0.001), protein foods (P = 0.001) and dairy (P < 0.001) advertising in later decades; advertising for sugar- and fat-rich foods (P < 0.001), condiments and baking ingredients (P < 0.001) and beverages (P < 0.001) was greater in earlier decades. Odds of advertising claims for energy, easy digestion, nourishment, general health, economy, good for family (all P < 0.01), pleased others (P = 0.017) and convenience (P = 0.031) were greater in the 1950s and decreased thereafter. Claims around taste and quality were highest in the 1960s (all P < 0.01). Mineral, additive-free, and protein claims were most likely to be invoked in 1970s advertising (all P < 0.01). Low-fat, low-calorie and fibre claims peaked in the 1980s (all P < 0.01), whereas the odds of specific fat claims was greatest in the 1990s (P = 0.015). CONCLUSIONS: Representation of food resonated with prevailing food culture but was not always congruent with nutrition policy.

Development of a 20-item food frequency questionnaire to assess a 'prudent' dietary pattern among young women in Southampton.

OBJECTIVE: To develop a short food frequency questionnaire (FFQ) that can be used among young women in Southampton to assess compliance with a prudent dietary pattern characterized by high consumption of wholemeal bread, fruit and vegetables, and low consumption of sugar, white bread, and red and processed meat. METHODS: Diet was assessed using a 100-item interviewer-administered FFQ in 6129 non-pregnant women aged 20-34 years. In total, 94 of these women were re-interviewed 2 years later using the same FFQ. Subsequently, diet was assessed in 378 women attending SureStart Children's Centres in the Nutrition and Well-being Study (NWS) using a 20-item FFQ. The 20 foods included were those that characterized the prudent dietary pattern. RESULTS: The 20-item prudent diet score was highly correlated with the full 100-item score (r=0.94) in the Southampton Women's Survey (SWS). Both scores were correlated with red blood cell folate (r=0.28 for the 100-item score and r=0.25 for the 20-item score). Among the women re-interviewed after 2 years, the change in prudent diet score was correlated with change in red cell folate for both the 20-item (r(S)=0.31) and 100-item scores (r(S)=0.32). In the NWS a strong association between the 20-item prudent diet score and educational attainment (r=0.41) was observed, similar to that seen in the SWS (r=0.47). CONCLUSIONS: The prudent diet pattern describes a robust axis of variation in diet. A 20-item FFQ based on the foods that characterize the prudent diet pattern has clear advantages in terms of time and resources, and is a helpful tool to characterize the diets of young women in Southampton.

Clinical trial: a multistrain probiotic preparation significantly reduces symptoms of irritable bowel syndrome in a double-blind placebo-controlled study.

BACKGROUND: The efficacy of probiotics in alleviating the symptoms of irritable bowel syndrome (IBS) appears to be both strain- and dose-related. AIM: To investigate the effect of LAB4, a multistrain probiotic preparation on symptoms of IBS. This probiotic preparation has not previously been assessed in IBS. METHODS: Fifty-two participants with IBS, as defined by the Rome II criteria, participated in this double blind, randomized, placebo-controlled study. Participants were randomized to receive either a probiotic preparation comprising two strains of Lactobacillus acidophilus CUL60 (NCIMB 30157) and CUL21 (NCIMB 30156), Bifidobacterium lactis CUL34 (NCIMB 30172) and Bifidobacterium bifidum CUL20 (NCIMB 30153) at a total of 2.5 × 10(10) cfu/capsule or a placebo for 8 weeks. Participants reported their IBS symptoms using a questionnaire fortnightly during the intervention and at 2 weeks post-intervention. RESULTS: A significantly greater improvement in the Symptom Severity Score of IBS and in scores for quality of life, days with pain and satisfaction with bowel habit was observed over the 8-week intervention period in the volunteers receiving the probiotic preparation than in the placebo group. CONCLUSION: LAB4 multistrain probiotic supplement may benefit subjects with IBS.

Growth in utero and blood pressure levels in the next generation.

OBJECTIVE: To determine whether blood pressure levels in adult life are related to the mother's fetal growth and size at birth. DESIGN: A follow-up study of men and women whose mothers' or fathers' size at birth was recorded in Preston, Lancashire, UK. SUBJECTS: Two hundred and twenty-eight men and women born in Preston, Lancashire, UK, and still living in Lancashire. MAIN OUTCOME MEASURES: Blood pressure at 18-40 years of age. RESULTS: Systolic and diastolic pressures fell with increasing mother's birthweight and head circumference. Systolic pressure fell by 2.4 mmHg (95% confidence interval (CI) 0.1-4.7) for each pound increase in mother's birthweight and by 4.0 mmHg (95% CI 0.2-7.8) for each one inch increase in head circumference. These associations were little changed by adjusting for length of gestation or for the subject's age, sex, body mass index or alcohol consumption. They were independent of the mother's blood pressure. As expected, mothers' birthweights were strongly related to their children's birthweights (P= 0.009), but the association between mother's birthweight and offspring's blood pressure was largely independent of this. Father's size at birth was not related to the offspring's blood pressure. CONCLUSIONS: If the growth of a female fetus is constrained by lack of nutrients, there are persisting changes in her physiology and metabolism which lead to reduced fetal growth and raised blood pressure in the next generation. Public health policies to improve fetal growth in one generation may therefore benefit succeeding generations as well.

Evaluation of the Dinamap 8100 and Omron M1 blood pressure monitors for use in children.

The aim of this study was to evaluate the Dinamap 8100 and the Omron M1 (the test devices) against standard criteria for use in children in a fieldwork setting. Device calibration and validation were carried out in accordance with the British Hypertension Society protocol for special groups such as children. A total of 102 children, recruited from infant and junior schools in Southampton, had six sequential measurements made of their blood pressure-four measurements with a mercury sphygmomanometer and two with one of two test devices, 55 children with the Dinamap 8100 and 47 with the Omron M1. Systolic and diastolic readings with the Dinamap 8100 were on average 11 mmHg higher (95% confidence interval [CI] +9, +12 mmHg) and 3 mmHg lower (95% CI -5, -1 mmHg), respectively, than measurements with the mercury sphygmomanometer, overestimating systolic pressures and underestimating diastolic pressures across the whole range observed. The Omron M1 gave readings lower by 1 mmHg on average for systolic pressures and 2 mmHg for diastolic pressures compared with the sphygmomanometer (95% CIs -4, +1 mmHg and -5, +1 mmHg respectively), specifically overestimating higher pressures and underestimating lower pressures. According to the criteria of the British Hypertension Society, neither the Dinamap 8100 nor the Omron M1 can be recommended for use in children in clinical situations in which accuracy of the absolute measurement is required. In epidemiological surveys, in which differences in blood pressure between groups of people are more important than absolute levels, it may be more appropriate to use these devices. Of the two, its more consistent performance supports the Dinamap 8100 as the instrument of choice in such studies of children.

Zinc supplementation and bone growth in pubertal girls.

We supplemented the diets of 47 peripubertal girls with zinc (15 mg/day) or placebo for 6 weeks. Zinc supplementation increased serum zinc. Insulin-like growth factor I and biochemical markers of bone turnover did not change, albeit dietary zinc was below the reference level (in 94% of individuals).

How are consumers of low-fat and high-fat diets perceived by those with lower and higher fat intake?

Dietary social stereotypes may hinder dietary change. The aim of this study was to measure stereotypes attributed to consumers of low-fat and high-fat diets, and to investigate if stereotype attribution differed with subjects' fat intake. A sample of 100 subjects completed a 24-h dietary recall for the estimation of macronutrient intake, and then completed a questionnaire which assessed the stereotypes associated with a low-fat and a high-fat diet. The low-fat diet was associated with a "healthy", "slim", "fit" and "sporty" person, who was "intelligent", "middle class" and "female". Conversely, the high-fat diet was associated with an "unhealthy", "overweight", "unfit" and "inactive" person, who was "unintelligent", "working class", "smoking" and "male". Followers of the low-fat diet were seen as "serious" and "highly strung", while followers of the high-fat diet were seen as "fun-loving" and "happy". However, positive stereotypes were the predominant descriptors of consumers of the low-fat diet, while negative stereotypes were the predominant descriptors of consumers of the high-fat diet by both men and women. Older people were more likely to choose negative descriptors for a follower of the low-fat diet. Subjects were grouped according to their own fat intake. A high-fat (>33% fat energy) group selected more positive and negative stereotypes to describe high- and low-fat diet consumers, respectively, than did their low-fat counterparts (<33% fat energy). Choice of "happy" to describe a follower of a high-fat diet had four-fold higher odds for the high-fat group. The social meaning and values associated with food choices require further investigation. Health education may need to redress some of these stereotypes.

A longitudinal study of bone gain in pubertal girls: anthropometric and biochemical correlates.

The aim of this longitudinal study was to investigate the factors associated with bone mineral acquisition in pubertal girls. Subjects were 37 healthy, Caucasian girls aged 12.1 years (SD 0.3). Measurements were made at 6-month intervals over a period of 18 months and included total body bone mineral content (TBBMC), total body bone mineral density (TBBMD), lean mass, and fat mass by dual-energy X-ray absorptiometry, anthropometry, lifestyle factors, four biochemical markers of bone turnover, hormonal status, and fractional calcium absorption. In multiple regression analysis, correlates of relative gain in TBBMC were gain in lean mass (p < 0.001) and estradiol (p = 0.008). For TBBMD, correlates were gain in lean (p < 0.001) and fat mass (p = 0.003), estradiol (p < 0.001), dietary energy intake (p = 0.003), and parathyroid hormone (p = 0.023). Statural growth and gain in bone mass were unrelated; both height velocity and bone turnover peaked approximately 20 months prior to menarche, whereas gain in bone mass peaked at menarche. Bone turnover markers correlated with height velocity (0.40 < r < 0.62), but not with bone gain. Estradiol was independently and negatively associated with all markers of bone turnover (-0.67 < r < -0.80). We conclude that estradiol is an important determinant of bone mineral gain in pubertal girls and is probably responsible for the reduction in bone turnover in late puberty; lean mass was the body composition parameter most closely associated with bone gain; height gain and bone gain are dissociated during the period of rapid growth at puberty; and bone turnover markers are modestly related to height gain, but are not predictive of bone gain.

Attitudes towards meat-eating in vegetarian and non-vegetarian teenage girls in England--an ethnographic approach.

This study compared vegetarian and non-vegetarian teenage English girls' attitudes towards meat. A convenience sample of 15 vegetarian (mean age 17.2 years) and 15 non-vegetarian (mean age 17.3 years) girls was recruited from a teenage health clinic. Attitudes towards meat were assessed in a single, tape-recorded, semi-structured interview. Eight themes of the cultural meaning of meat were identified; five were common to both groups: Animal (66% of vegetarians, 33% of non-vegetarians); Taste/Texture/Smell (66%, 60%); Flesh and Blood (86%, 26%); Colour (33%, 20%); Miscellaneous (60%, 46%). The theme Eating Well was unique to the non-vegetarian group (40%). The themes Life/Death and Health-related were unique to the vegetarian group (66 and 20%, respectively). The vegetarians generally abhorred killing animals for food, meat's sensory characteristics and ingesting blood. A meat-free diet was not particularly associated with health in either group. The non-vegetarians tended to characterize meat positively, both liking meat's sensory characteristics and associating meat with luxury and special occasions. We speculate on possible reasons for the current popularity of vegetarianism in teenage girls.