Farm production diversity and women's dietary diversity: Evidence from central Tunisia.

In the context of studies on the effects of agricultural production diversity, there are debates in the scientific community as to the level of diversification appropriate for improving dietary diversity. In Tunisia, agriculture is a strategic sector for the economy and a critical pillar of its food sovereignty. Using instrumental variable methods to account for endogeneity, we have estimated the association between agricultural production diversity and women's dietary diversity among smallholder farming households in the Sidi Bouzid governorate (central Tunisia). Although we found a low level of agricultural production diversity and a fairly diversified diet among women, we observed a systematic weak positive association between five different indicators of agricultural production diversity and women's dietary diversity. We observed a stronger positive association between women's dietary diversity and women being more educated and households being wealthier. Neither diversity of food supplies in food markets nor market distance were associated with women's dietary diversity, whereas we observed a higher level of consumption of some products (dairy) when they were produced on the farm.

Recent Trends in Dietary Habits of the Italian Population: Potential Impact on Health and the Environment.

Population growth, globalization, urbanization, and economic pressures are causing changes in food consumption all over the world. The study's aims are (1) to evaluate trends in food habits in Italy to highlight deviations from the traditional Mediterranean diet, (2) to analyze the features of the present Italian diet that should be modified to meet evidence-based global scientific targets for a healthy and sustainable diet proposed by the EAT-Lancet Commission. Trends in food availability for human consumption during the period 2000-2017 were assessed using the food balance sheets (FBSs). Greenhouse gas (GHG) emission was estimated according to life cycle assessment (LCA) analyses. During the study period, the availability of animal fat and beef meat greatly declined (-58% and -32%, respectively), followed by fruit, potatoes, vegetables, milk, and non-tropical oils (-20%, -15%, -13%, -14%, and -11%, respectively). A substantial increase has occurred for tropical oils, fish, and nuts (+156, +26%, and +21%, respectively). In order to meet the targets of consumption proposed by the EAT-Lancet Commission, the consumption of legumes and nuts should be almost doubled, whereas the consumption of meat, eggs, dairy products, animal fat, tropical oils, and sugars should be reduced by proportions ranging from 60% to 90%. If implemented, these changes would reduce the diet-related greenhouse gas emission by nearly 50%. In conclusion, these data call for nutritional education programs and interventions on the food system aimed at promoting a healthier and more environmentally sustainable diet. To this end, the availability and affordability of products with a better impact on human health and the environment should be promoted.

FEEDING PRACTICES IN THE FIRST YEAR OF LIFE: CHALLENGES TO FOOD AND NUTRITION POLICIES.

OBJECTIVE: To evaluate the feeding practices for infants under one year of age, according to food and nutrition policies. METHODS: This is a descriptive cross-sectional study based on secondary data from the Chamada Neonatal project (research on prenatal, childbirth, and infant care) in the state of Rio Grande do Norte. The sample analyzed comprised 837 mother/child (under one year of age) pairs. We found a prevalence of data on exclusive breastfeeding (EBF) in the first hour of life - partial and total -, as well as on food consumed by children 24 hours prior to the interview. We estimated the probability of consumption according to the child's age in days using the probit analysis. RESULTS: Among the interviewed mothers, 64.8% (95%CI 62.4-70.8) declared breastfeeding in the first hour of life, and 60% (95%CI 56.41-63.07) of the children were still breastfed at the end of their first year of life. The median duration of EBF was 63 days (95%CI 60-67). Water or tea, dairy products, fruits, and vegetables were introduced early, with medians lower than 180 days. The probit analysis revealed that the consumption of breast milk tended to decrease and food intake to increase as the child gets older, with exponential growth in the "unhealthy food" group. CONCLUSIONS: Although most children were breastfed up to one year of life, few did so exclusively. Foods were introduced early, with increased consumption of unhealthy ones, resulting in inadequate dietary quality according to recommendations from food and nutrition public policies.

Written Nutrition Guidelines, Client Choice Distribution, and Adequate Refrigerator Storage Are Positively Associated with Increased Offerings of Feeding America's Detailed Foods to Encourage (F2E) in a Large Sample of Arkansas Food Pantries.

BACKGROUND: Millions of food-insecure households in the United States obtain food from food pantries each year. These foods are often of insufficient nutritional quality. OBJECTIVE: Our aim was to describe the frequency with which Arkansas food pantries offer foods included in Feeding America's Detailed Foods to Encourage (F2E) framework, and examine food pantry characteristics associated with increased frequency of offering F2E and other foods. DESIGN: This was a 27-item cross-sectional online survey that assessed food pantries' characteristics (eg, storage capacities, number of clients served) and typical food offerings. PARTICIPANTS/SETTING: Partnering with five of Arkansas's six food banks, 764 e-mail invitations were sent to food agency managers across the state. A final sample of 357 food pantries was included in the analyses. MAIN OUTCOME MEASURES: The primary outcomes of interest were the frequencies of offering specific F2E and F2E in general. The F2E framework was developed by Feeding America to more accurately assess food banks' inventories, and its categories (Fruits and Vegetables; Protein; Dairy; and Grains) are generally consistent with MyPlate. STATISTICAL ANALYSES PERFORMED: Descriptive statistics were computed for all food pantry characteristics and frequency of foods offered. Associations between food pantry characteristics and the frequency of offering F2E were examined via multiple linear regression and path analysis. RESULTS: Only 18.5% of food pantries had written nutrition guidelines, and only 19.3% offered client choice distribution. The F2E most commonly offered were meat/poultry/seafood without breading and not fried (59.6%) and peanut butter (58.2%). The least commonly offered F2E were nuts/seeds with nothing added (3.8%) and low-fat/1%/skim cheese (8.2%). Written nutrition guidelines (P<0.001), client choice distribution (P=0.003), and adequate refrigerator storage (P=0.010) were associated with more frequently offering F2E. CONCLUSIONS: This study fills a gap in knowledge by documenting food pantry characteristics that are associated with the frequencies of offering specific types of healthy foods.

Feeding practices in the first year of life: challenges to food and nutrition policies / Práticas alimentares no primeiro ano de vida: desafios para as políticas de alimentação e nutrição

ABSTRACT Objective: To evaluate the feeding practices for infants under one year of age, according to food and nutrition policies. Methods: This is a descriptive cross-sectional study based on secondary data from the Chamada Neonatal project (research on prenatal, childbirth, and infant care) in the state of Rio Grande do Norte. The sample analyzed comprised 837 mother/child (under one year of age) pairs. We found a prevalence of data on exclusive breastfeeding (EBF) in the first hour of life - partial and total -, as well as on food consumed by children 24 hours prior to the interview. We estimated the probability of consumption according to the child's age in days using the probit analysis. Results: Among the interviewed mothers, 64.8% (95%CI 62.4-70.8) declared breastfeeding in the first hour of life, and 60% (95%CI 56.41-63.07) of the children were still breastfed at the end of their first year of life. The median duration of EBF was 63 days (95%CI 60-67). Water or tea, dairy products, fruits, and vegetables were introduced early, with medians lower than 180 days. The probit analysis revealed that the consumption of breast milk tended to decrease and food intake to increase as the child gets older, with exponential growth in the "unhealthy food" group. Conclusions: Although most children were breastfed up to one year of life, few did so exclusively. Foods were introduced early, with increased consumption of unhealthy ones, resulting in inadequate dietary quality according to recommendations from food and nutrition public policies.

RESUMO Objetivo: Avaliar as práticas alimentares em menores de um ano de idade, de acordo com as políticas de alimentação e nutrição. Métodos: Estudo transversal descritivo, com dados secundários da Chamada Neonatal no Estado do Rio Grande do Norte. A amostra analisada foi de 837 pares mãe/filho menor de um ano de idade, e observou-se a prevalência de dados do Aleitamento Materno Exclusivo (AME), na primeira hora de vida, parcial e total, assim como dos alimentos ingeridos pelas crianças nas últimas 24 horas anteriores à entrevista. Por meio da análise de probitos, estimaram-se as probabilidades de consumo dos alimentos por idade da criança, em dias. Resultados: A prática de aleitamento na primeira hora de vida foi relatada por 64,8% (IC95% 62,4-70,8) das mães entrevistadas e, ao final do primeiro ano de vida, 60% (IC95% 56,41-63,07) das crianças ainda estavam sendo amamentadas. A mediana de aleitamento exclusivo foi de 63 dias (IC95% 60-67). Água ou chá, alimentos lácteos, frutas, legumes e verduras foram introduzidos precocemente, com medianas menores que 180 dias. Observou-se por análise de probitos que o consumo de leite materno tendeu a diminuir e o de alimentos a aumentar, de acordo com a idade da criança, com aumento exponencial do grupo "alimentos não saudáveis". Conclusões: Apesar de a maioria das crianças ser amamentada até um ano de vida, poucas estavam em aleitamento exclusivo. Alimentos foram introduzidos precocemente, com aumento do consumo dos não saudáveis, resultando em inadequação da qualidade alimentar frente ao preconizado pelas políticas públicas de alimentação e nutrição.

Lactose-Free Dairy Products: Market Developments, Production, Nutrition and Health Benefits.

Lactose-free dairy is able to provide the essential nutrients present in regular dairy products, like calcium and vitamins, to those that are not able to digest lactose. This product category currently has a wide and growing health appeal to consumers. In recent years, the quality and product variety in the lactose-free dairy segment has been increasing significantly, giving consumers more tempting products to decide from. As a result, lactose-free dairy is now the fastest growing market in the dairy industry. This review discusses the market developments and production possibilities and issues related to the wide variation of lactose-free dairy products that are currently available. Additionally, the health benefits that lactose-free dairy may offer compared to dairy avoidance are illustrated.

How do Brazilian citizens perceive animal welfare conditions in poultry, beef, and dairy supply chains?

The aim of this study was to understand the perceptions of Brazilian citizens about the general conditions of animal welfare in the poultry, beef, and dairy supply chains. To reach this aim, an online survey was conducted. The analysis was based on descriptive statistics and three logistic regression models. Results of descriptive statistics showed that citizens in Brazil had mostly negative perceptions about the conditions of animal welfare in the poultry, beef, and dairy supply chains. Results of the logistic regression models showed that citizens with a background in agricultural/veterinary sciences, and citizens who reported a higher level of knowledge about poultry and dairy supply chains were more likely to perceive the general conditions of animal welfare in these two supply chains as being bad. Citizens who reported previous contact with poultry farms were also more likely to perceive the general conditions of animal welfare in the poultry supply chain as being bad. In addition, the perception that farmers are mainly focused on the economic aspect of farming and less on animal welfare, the perception that animals do not have a good quality of life while housed on farms, and the perception that animals are not adequately transported and slaughtered, negatively impact on perceptions about the general conditions of animal welfare in the poultry, beef, and dairy supply chains.

Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study.

BACKGROUND: Dietary guidelines recommend minimising consumption of whole-fat dairy products, as they are a source of saturated fats and presumed to adversely affect blood lipids and increase cardiovascular disease and mortality. Evidence for this contention is sparse and few data for the effects of dairy consumption on health are available from low-income and middle-income countries. Therefore, we aimed to assess the associations between total dairy and specific types of dairy products with mortality and major cardiovascular disease. METHODS: The Prospective Urban Rural Epidemiology (PURE) study is a large multinational cohort study of individuals aged 35-70 years enrolled from 21 countries in five continents. Dietary intakes of dairy products for 136 384 individuals were recorded using country-specific validated food frequency questionnaires. Dairy products comprised milk, yoghurt, and cheese. We further grouped these foods into whole-fat and low-fat dairy. The primary outcome was the composite of mortality or major cardiovascular events (defined as death from cardiovascular causes, non-fatal myocardial infarction, stroke, or heart failure). Hazard ratios (HRs) were calculated using multivariable Cox frailty models with random intercepts to account for clustering of participants by centre. FINDINGS: Between Jan 1, 2003, and July 14, 2018, we recorded 10 567 composite events (deaths [n=6796] or major cardiovascular events [n=5855]) during the 9·1 years of follow-up. Higher intake of total dairy (>2 servings per day compared with no intake) was associated with a lower risk of the composite outcome (HR 0·84, 95% CI 0·75-0·94; ptrend=0·0004), total mortality (0·83, 0·72-0·96; ptrend=0·0052), non-cardiovascular mortality (0·86, 0·72-1·02; ptrend=0·046), cardiovascular mortality (0·77, 0·58-1·01; ptrend=0·029), major cardiovascular disease (0·78, 0·67-0·90; ptrend=0·0001), and stroke (0·66, 0·53-0·82; ptrend=0·0003). No significant association with myocardial infarction was observed (HR 0·89, 95% CI 0·71-1·11; ptrend=0·163). Higher intake (>1 serving vs no intake) of milk (HR 0·90, 95% CI 0·82-0·99; ptrend=0·0529) and yogurt (0·86, 0·75-0·99; ptrend=0·0051) was associated with lower risk of the composite outcome, whereas cheese intake was not significantly associated with the composite outcome (0·88, 0·76-1·02; ptrend=0·1399). Butter intake was low and was not significantly associated with clinical outcomes (HR 1·09, 95% CI 0·90-1·33; ptrend=0·4113). INTERPRETATION: Dairy consumption was associated with lower risk of mortality and major cardiovascular disease events in a diverse multinational cohort. FUNDING: Full funding sources are listed at the end of the paper (see Acknowledgments).

A realist review to explore how low-income pregnant women use food vouchers from the UK's Healthy Start programme.

OBJECTIVES: To explore how low-income pregnant women use Healthy Start food vouchers, the potential impacts of the programme, and which women might experience these impacts and why. DESIGN: A realist review. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Primary or empirical studies (of any design) were included if they contributed relevant evidence or insights about how low-income women use food vouchers from the Healthy Start (UK) or the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) programmes. The assessment of 'relevance' was deliberately broad to ensure that reviewers remained open to new ideas from a variety of sources of evidence. ANALYSIS: A combination of evidence synthesis and realist analysis techniques was used to modify, refine and substantiate programme theories, which were constructed as explanatory 'context-mechanism-outcome'-configurations. RESULTS: 38 primary studies were included in this review: four studies on Healthy Start and 34 studies on WIC. Two main outcome strands were identified: dietary improvements (intended) and financial assistance (unintended). Three evidence-informed programme theories were proposed to explain how aspects of context (and mechanisms) may generate these outcomes: the 'relative value' of healthy eating (prioritisation of resources); retailer discretion (pressure to 'bend the rules'); the influence of other family members (disempowerment). CONCLUSIONS: This realist review suggests that some low-income pregnant women may use Healthy Start vouchers to increase their consumption of fruits and vegetables and plain cow's milk, whereas others may use them to reduce food expenditure and save money for other things.

Tackling inadequate vitamin D intakes within the population: fortification of dairy products with vitamin D may not be enough.

Dietary recommendations for vitamin D are designed by authoritative agencies to prevent vitamin D deficiency in the population, and while individual target intakes around the globe vary, they are generally between 10 and 20 µg/day [400-800 IU/day], depending on age, assuming little or no sunshine exposure. National dietary surveys report usual intakes of vitamin D that are much lower than these targets, at about 3-7 µg/day [120-280 IU/day], depending on usual diet, age, sex, and mandatory or voluntary fortification practices, and there is widespread dietary inadequacy around the globe. While acknowledging the valuable contribution fortified milk makes to vitamin D intakes among consumers, particularly in children, and the continued need for fortification of milk and other dairy products, additional strategic approaches to fortification, including biofortification, of a wider range of foods, have the potential to increase vitamin D intakes in the population and minimize the prevalence of low serum 25(OH)D without increasing the risk of excessive dosing. Careful consideration must be given to the range of products used for fortification and the amount of vitamin D used in each; there is a need for well-designed and sustainable fortification, and biofortification strategies for vitamin D, which use a range of foods to accommodate dietary diversity. Clinical patients may require additional consideration in terms of addressing low vitamin D status.

Persistent and occasional poverty and children's food consumption: evidence from a longitudinal Québec birth cohort.

BACKGROUND: Childhood poverty is associated with poorer food consumption but longitudinal data are limited. The objective was to assess if food consumption differs depending on age (6, 7, 10 and 12 years) and pattern of poverty. METHODS: Participants were from the 1998-2010 'Quebec Longitudinal Study of Child Development' birth cohort. Poverty was defined as income below the low-income thresholds established by Statistics Canada which adjusts for household size and geographic region. Multiple imputation was used for missing data, and latent class growth analysis identified poverty trajectories. Multivariable ordinal logistic regression assessed the association between poverty and greater consumption of milk, cheese, fruits, vegetables, sweets and sugar-sweetened beverages (SSB). RESULTS: Four poverty trajectories were identified: 1 reference category (stable non-poor) and 3 higher-risk categories (stable poor, increasing and decreasing risk). The probability of more frequent consumption was lower among children from stable poor households compared to children from stable non-poor households for fruit (6, 10 and 12 years), milk and vegetables (6, 7, 10 and 12 years) but was higher for SSB (10 and 12 years). Among children from increasing and decreasing poverty households compared to stable non-poor households, the probability of greater consumption of fruits and vegetables was lower and greater consumption of SSB was higher by the age of 12 years. CONCLUSIONS: While experiencing continual exposure to poverty has detrimental effects on food consumption throughout childhood, the association for milk, fruits and vegetables does not differ across age. Intermittent exposure to poverty may also have long-lasting effects.

Availability of healthy snack foods and beverages in stores near high-income urban, low-income urban, and rural elementary and middle schools in Oregon.

BACKGROUND: Food stores near schools are an important source of snacks for children. However, few studies have assessed availability of healthy snacks in these settings. The aim of this study was to assess availability of healthy snack foods and beverages in stores near schools and examine how availability of healthy items varied by poverty level of the school and rural-urban location. METHODS: Food stores were selected based on their proximity to elementary/middle schools in three categories: high-income urban, low-income urban, and rural. Audits were conducted within the stores to assess the presence or absence of 48 items in single-serving sizes, including healthy beverages, healthy snacks, fresh fruits, and fresh vegetables. RESULTS: Overall, availability of healthy snack foods and beverages was low in all stores. However, there was significant cross-site variability in availability of several snack and fruit items, with stores near high-income urban schools having higher availability, compared to stores near low-income urban and/or rural schools. Stores near rural schools generally had the lowest availability, although several fruits were found more often in rural stores than in urban stores. There were no significant differences in availability of healthy beverages and fresh vegetables across sites. CONCLUSIONS: Availability of healthy snack foods and beverages was limited in stores near schools, but these limitations were more severe in stores proximal to rural and low-income schools. Given that children frequent these stores to purchase snacks, efforts to increase the availability of healthy products, especially in stores near rural and low-income schools, should be a priority.

Access to healthier food retailers - United States, 2011.

According to the Dietary Guidelines for Americans, persons in the United States aged ≥2 years should increase their intake of certain nutrient-rich foods, including fruits and vegetables. Fruits and vegetables contribute important nutrients that are underconsumed in the United States. Higher intake of fruits and vegetables might reduce the risk for many chronic diseases including heart disease, stroke, diabetes, and some types of cancer. In addition, replacing high-calorie foods with fruits and vegetables can aid in weight management. However, most persons in the United States do not consume the recommended amounts of fruits and vegetables and other healthier food groups (e.g., whole grains or fat-free or low-fat dairy foods).

A comprehensive dairy valorization model.

Dairy processors face numerous challenges resulting from both unsteady dairy markets and some specific characteristics of dairy supply chains. To maintain a competitive position on the market, companies must look beyond standard solutions currently used in practice. This paper presents a comprehensive dairy valorization model that serves as a decision support tool for mid-term allocation of raw milk to end products and production planning. The developed model was used to identify the optimal product portfolio composition. The model allocates raw milk to the most profitable dairy products while accounting for important constraints (i.e., recipes, composition variations, dairy production interdependencies, seasonality, demand, supply, capacities, and transportation flows). The inclusion of all relevant constraints and the ease of understanding dairy production dynamics make the model comprehensive. The developed model was tested at the international dairy processor FrieslandCampina (Amersfoort, the Netherlands). The structure of the model and its output were discussed in multiple sessions with and approved by relevant FrieslandCampina employees. The elements included in the model were considered necessary to optimally valorize raw milk. To illustrate the comprehensiveness and functionality of the model, we analyzed the effect of seasonality on milk valorization. A large difference in profit and a shift in the allocation of milk showed that seasonality has a considerable impact on the valorization of raw milk.

Milk utilisation patterns in the low-input production systems in South Africa.

Understanding the utilisation patterns of milk assists in designing appropriate dairy development schemes in rural communities. The objective of the study was to determine milk utilisation patterns in different smallholder farming systems in the Eastern Cape Province of South Africa. Data were collected through the administration of recording sheets to 130 randomly selected households in Alice, Fort Beaufort and Queenstown districts. Amounts of milk produced per household ranged from 9 to 21 l per household per day. Milk consumption/household/day was similar among the three districts. Milk consumption in the early lactation doubled the amount consumed in late lactation (P < 0.05). Milk in the communal areas was largely utilised as fresh or sour milk. Fresh milk was mostly used in tea/coffee or to make porridge for children. Sour milk was consumed with thick boiled maize meal. Fort Beaufort (10.2 +/- 1.37 l/day) had the highest sour milk sales whilst Queenstown had the highest fresh milk sales (9.7 +/- 5.57 l/day). It was concluded that quantities of milk consumed or sold as fresh or sour were generally low and varied across smallholder farming systems.

Short-term temporal stability in observed retail food characteristics.

OBJECTIVE: Use of direct observation to characterize neighborhood retail food environments is increasing, but to date most studies have relied on a single observation. If food availability, prices, and quality vary over short time periods, repeated measures may be needed to portray these food characteristics. This study evaluated short-term (2-week), within-season temporal stability in retail food availability, prices, and quality. DESIGN: In-person observations of retail food stores at 2 time points, 2 weeks apart. SETTING: Southwest Chicago, IL. SAMPLE: 157 food stores. MAIN OUTCOME MEASURES: Availability and prices of food items selected from the following food groups: fruit, vegetables, grains, meats and beans, and dairy, as well as fresh produce quality. ANALYSIS: Temporal stability was tested for availability using a McNemar test and for price and quality using a Wilcoxon signed-rank test. RESULTS: Measures of food availability and prices as well as fresh produce quality at stores were generally stable at the 2 time points. CONCLUSIONS AND IMPLICATIONS: This study suggests that a single observation may be sufficient to accurately characterize within-season food availability, food prices, and fresh produce quality.

Healthy food availability in small urban food stores: a comparison of four US cities.

OBJECTIVE: Given that small food stores may be important retail food sources in low-income urban communities, our objective was to examine cross-city comparative data documenting healthy food availability within such facilities, particularly those located in low-income areas and nearby schools. DESIGN: Food stores in Baltimore, Maryland; Minneapolis/St. Paul, Minnesota; Oakland, California; and Philadelphia, Pennsylvania were selected for assessment based on proximity to low-income schools. Stores were defined as: (i) single-aisle (n 45); (ii) small (2-5 aisles; n 52); and (iii) large (> or = 6 aisles; n 8). Staff conducted in-store audits to assess the presence/absence of twenty-eight healthy items, organized within five categories: (i) fresh fruits/vegetables, (ii) processed fruits/vegetables, (iii) healthy beverages/low-fat dairy, (iv) healthy snacks and (v) other healthy staple foods. RESULTS: The availability of healthy food items was low, particularly in single-aisle and small stores, and there was significant cross-site variability in the availability of healthy snacks (P < 0.0001) and other healthy staple foods (P < 0.0001). No cross-site differences existed for fruits/vegetables or healthy beverages/low-fat dairy availability. Healthy food availability scores increased significantly with store size for nearly all food/beverage categories (P < 0.01). CONCLUSIONS: Overall, healthy food availability in these venues was limited. Region-specific factors may be important to consider in understanding factors influencing healthy food availability in small urban markets. Data suggest that efforts to promote healthy diets in low-income communities may be compromised by a lack of available healthy foods. Interventions targeting small stores need to be developed and tailored for use in urban areas across the USA.

Availability of more healthful food alternatives in traditional, convenience, and nontraditional types of food stores in two rural Texas counties.

Limited research has focused on the availability of more healthful food alternatives in traditional food stores (supermarkets and grocery stores) in rural areas. Current market trends suggest that food items may be available for purchase in stores other than traditional food stores. An observational survey was developed and used on-site to document the availability and variety of fruit and vegetables (fresh, canned, and frozen), meats (meat, poultry, fish, and eggs), dairy (milk, yogurt, and cheese), and grains (whole grains and refined grains) in all traditional food stores, convenience stores, and nontraditional food stores (dollar stores and mass merchandisers) in two rural Texas counties. Descriptive statistics and t tests identified that although the widest selection of more healthful food items was available in supermarkets, not all supermarkets carried all items. Grocery stores carried less variety of fresh fruits (8+/-0.7 vs 4.7+/-0.3; P<0.01) and vegetables (10.7+/-0.2 vs 6+/-0; P<0.001) than supermarkets. Fresh fruits and vegetables were not readily available in convenience or nontraditional food stores. Among convenience and nontraditional food stores, "dollar" stores offered the best variety of more healthful canned fruits and vegetables, whole-wheat bread, and whole-grain cereal. Mass merchandisers and dollar stores offered a greater variety of more healthful types of canned tuna and poultry, reduced-fat and skim milk, and low-fat tortillas. In these rural counties, traditional food stores offered greater availability of more healthful food choices across food groups. More healthful food choices in canned fruits and vegetables, canned meat and fish, milk, and grains were also available in dollar stores, mass merchandisers, and convenience stores. Results suggest that a complete understanding of the food environment, especially in rural areas, requires knowledge of the availability and variety of healthful food in all types of stores that are accessible to families.

Protein supply and nutritional status in nineteenth century Bavaria, Prussia and France.

What determined regional height differences in the 19th century? We compare anthropometric evidence with production estimates of different food products and other economic variables. To this end, we concentrate on 179 rural regions and 29 towns in Bavaria (Southeast Germany). This regionally disaggregated level of analysis enables us to study the influence of the local supply of different food products on the nutritional status of the population, among which milk turned out particularly important. This result is tested and confirmed with regional data from Prussia and France.

Worldwide trends in dairy production and consumption and calcium intake: is promoting consumption of dairy products a sustainable solution for inadequate calcium intake?

BACKGROUND: Adequate calcium intake is critical for good health. Inadequate calcium intake is a worldwide problem and is more serious in countries where consumption of dairy products is low. OBJECTIVE: To analyze worldwide trends in production and consumption of dairy products and in calcium intake. METHODS: Data were taken from Food and Agriculture Organization food balance sheets, from published studies, and from surveys of four countries with large populations and large dairy production (China, India, the United States, and Russia). Linear regression models were fitted to estimate average annual changes and to project future trends. RESULTS: Overall global dairy production and supply (total and per capita) have increased since 1980, especially in developing countries. There are large between-region and between-country differences in the levels of production, supply, and consumption and in the trends. In 1997 India surpassed the United States to become the largest dairy producer. Consumption of dairy products in China has more than tripled since 1982 and has increased sevenfold among urban residents. The increase has been more dramatic during recent years. In spite of increases in dairy production and consumption in China and India, calcium intake has decreased in these countries. The average daily per capita consumption of dairy products was more than 200 g in the United States in 1999-2004 but less than 27g in China in 2002; the average daily per capita intake of calcium was 962 mg in US men and 756 mg in US women in 1999-2004, but less than 400 mg in China in 2002. CONCLUSIONS: Global production and supply of dairy products have been increasing since 1980, which has an impact on the environment. Dairy consumption and calcium intake remain low in most countries examined as compared with recommended amounts of dairy products and calcium. Promotion of consumption of dairy products does not necessarily increase total calcium intake.