Exploration of the Principal Component Analysis (PCA) Approach in Synthesizing the Diet Quality of the Malaysian Population.

(1) Background: One of the most main dietary assessments is through a posteriori application. Although extensive research has incorporated dietary assessment of a population through a posteriori application, this study is the first to examine the Malaysian population and use an a posteriori method and principal component analysis (PCA) to assess the dietary patterns of the Malaysian population. The correlation between all dietary patterns derived via PCA and selected nutrient intake were determined in this sample of study; (2) Methods: A total of 3063 respondents (18 to 59 years old) covering Peninsular Malaysia, Sabah, and Sarawak, participated in this study. PCA was applied on the food frequency questionnaire collected from the respondents, and descriptive statistics and PCA were performed using SPSS version 21; (3) Results: Six patterns were identified: "traditional", " prudent", " modern", "western", "Chinese", and "combination" diets. All together, these six patterns were able to explain 45.9% of the total variability. Few components derived from the factor loadings showed positive association with several nutrient markers. The traditional dietary pattern showed a moderate, positive correlation with total protein and total sugar intake, there was a significant moderate correlation between the prudent dietary pattern and dietary fibre, and there was a moderate positive association between the Chinese dietary pattern and total energy; and (4) Conclusions: The exploration of the PCA approach above may provide justification for assessment of dietary patterns rather than reliance on single nutrients or foods to identify potential connections to overall nutritional wellbeing as well as to explore the diet-disease relationship. However, study of pattern analysis must be conducted among the Malaysian population to produce validity and reproducibility for this dietary approach in light of the numerous methodological issues that arise when performing PCA.

Vegetarian diet in mild hypertension: effects of fat and fiber.

Recently, a relatively small reduction in systolic blood pressure (approximately 5 mm Hg) was estimated to substantially reduce the numbers of major coronary events. The blood pressure reduction is about the same as the difference seen between typical ovolactovegetarians and omnivores. This paper reviews the evidence for the blood pressure-lowering effects of a vegetarian diet on those with elevated blood pressure. It also reviews whether the effect on blood pressure of a vegetarian diet can be attributed either to elevation of the dietary P:S ratio or to fiber intake alone.

Vegetarian diet and blood pressure levels: incidental or causal association?

Evidence that nutrients other than the major cations may influence blood pressure levels stems from studies of acculturated vegetarians and from randomized controlled dietary trials. Earlier studies of vegetarians focused on religious groups and on vegans, making it difficult to know whether their lower blood pressures were due to diet per se or to other aspects of lifestyle. Seventh-day Adventist vegetarians showed significantly less hypertension and lower blood pressures compared with Mormon omnivores, effects which were independent of differences in obesity and not due to altered sodium intake. Subsequently, controlled dietary intervention studies in healthy normotensive omnivores provided more direct evidence for a blood pressure-lowering effect of a lactoovovegetarian diet with reversible changes of 5-6 mm Hg systolic and 2-3 mm Hg diastolic occurring over 6-wk periods. Similar dietary effects in mild hypertensive subjects provides impetus for identifying the responsible nutrients.

Dietary-induced changes in the fatty acid composition of human cheek cell phospholipids: correlation with changes in the dietary polyunsaturated/saturated fat ratio.

Healthy normotensive volunteers aged 20 to 59 yr were randomly allocated either to a control group or to one of two experimental groups. The control group ate a low P/S ratio diet for 12 wk while the first experimental group ate a high P/S ratio diet for 6 wk followed by a low P/S ratio diet for the next 6 wk. The second experimental group ate a low P/S ratio diet in the first 6 wk followed by a high P/S ratio diet for the next 6 wk. Dietary P/S ratio, plasma linoleic acid (18:2), and cheek cell phospholipid 18:2 levels were compared in each dietary group at the end of the 1st and 2nd 6 wk. On change from a low to a high P/S ratio diet, there was a 36% increase in the proportion of 18:2 in the cheek cell phospholipids in comparison with the proportion existing before the change. This was associated with an increase in the proportion of 18:2 in the plasma lipids of this group. No reduction in the proportion of 18:2 in the cheek cell phospholipids was apparent in the control group or the group which changed from a high to a low P/S ratio diet, although in the latter group there was a reduction in the proportion of 18:2 in the plasma lipids. As the phospholipid fatty acid composition of human cheek cells reflects dietary lipid status under certain conditions, this observation may be useful in dietary and nutritional studies, particularly as human cheek cells can be obtained in a noninvasive manner.

Interactions between growth and nutrient status in school-age children of urban Bangladesh.

The relationship between biochemical, anthropometric, and sociodemographic indexes was investigated in 242 children aged 5-12 y from five schools in Dhaka City, Bangladesh. As height-for-age increased so too did the mean serum concentrations of hemoglobin, protein, vitamin A, and zinc; serum copper concentrations were highest in the shortest group. Serum copper concentrations were highest in those with the lowest serum vitamin A concentrations. By multiple regression analysis, family income, age, weight-for-age, hemoglobin, and serum copper were strongly related to serum vitamin A. For every unit change in serum vitamin A there was a 4.92 unit change in hemoglobin, when all the other factors were taken into account. This study shows that there is a complex interaction between concentrations of biochemical indexes of nutritional status and other anthropometric, biochemical, and sociodemographic variables.

PIP: Between February and March 1990, health workers interviewed and took anthropometric measurements and blood samples from 242 children 5-12 years old, attending 3 primary schools in affluent areas and 2 primary schools in poorer areas around a university campus in Dhaka, Bangladesh. Researchers wanted to study the interaction between anthropometric and biochemical measures of nutritional status in seemingly healthy school children. As the height-for-age increased, so did the mean serum levels of protein, hemoglobin, and vitamin A (p = 0.001 for protein and 0.01 for hemoglobin and vitamin A). The rising trends were strongest for hemoglobin and vitamin A. Children in the group with the highest serum vitamin A level ( 1.05 mcmol/L) had significantly higher hemoglobin levels than did those with lower vitamin A levels (adjusted, 138.9 g/L vs. 133.8 g/L for 0.7-1.07 mcmol/L and 132.8 g/L for 0.7 mcmol/L; p = 0.002). For every unit change in vitamin A, a 4.92 unit change in hemoglobin existed. Children who had the lowest serum vitamin A levels had the highest serum copper levels (22.8 mcmol/L vs. 22.3 mcmol/L middle vitamin A group and 19.8 mcmol/L highest vitamin A group; p = 0.05). Multiple regression analysis showed that family income, age, weight-for-age, and hemoglobin and serum copper levels were significantly associated with serum vitamin A levels. These findings reveal that short children who were light for their age had lower serum vitamin A and hemoglobin levels and higher serum copper levels than their taller and heavier counterparts. They demonstrate a complex interaction between serum levels of biochemical indexes of nutritional status and other anthropometric, biochemical, and sociodemographic variables.

Nutrient intake, blood pressure, serum and urinary prostaglandins and serum thromboxane B2 in a controlled trial with a lacto-ovo-vegetarian diet.

Fifty-nine healthy omnivores volunteered for a randomized crossover trial with a lacto-ovo-vegetarian (L-O-V) diet. Twenty-one 1-day diet records were kept throughout the project as a means of assessing food and nutrient intakes, and samples of serum and urine were assayed to evaluate change in prostanoid metabolism. While on the L-O-V diet subjects ate more vegetable protein, wholegrain cereals, polyunsaturated oils, fruits and vegetables, and avoided eating meat, fish or poultry. The L-O-V diet contained significantly more polyunsaturated fatty acids, fibre, vitamin C, vitamin E, magnesium, calcium and potassium, and less total protein, saturated fat, monounsaturated fat and vitamin B12 than the control omnivore diet. Changes in nutrient intakes were subjected to principal components analysis to identify dimensions of change in nutrient intakes. Three Factors accounted for 83% of the total variation in dietary intake. Blood pressure changes were significantly and negatively (F = 17.4, P less than 0.001 for systolic; F = 6.09, P = 0.02 for diastolic pressure) related to individual scores for only one Factor--that representing an increase in intake of polyunsaturated fat, fibre, vitamin C, vitamin E, calcium and magnesium, and a fall in intake of protein and vitamin B12. Blood pressure changes were unrelated to change in body weight or sodium intake. Serum and urinary prostanoids were not affected by eating the L-O-V diet.

Nutrient sources in the English diet: quantitative data from three English towns.

Diet records from 2402 middle-aged men and women in three English towns have been used to derive food lists which indicate the percentage contribution each food, or group of foods, makes to the intake of specific nutrients. Comparison of these food lists with those based on the American diet show differences in sources of nutrients; for example, brussels sprouts provide 5% of the vitamin C intake in our English towns, whereas in the US they provide only 0.3%. It would not be appropriate, therefore, to use American food lists in English populations, since important sources of the nutrient may be omitted or non-important sources included. These food lists can be used for English populations as a basis for food frequency questionnaires.

Comparison of a food frequency questionnaire with a 10-day weighed record in cigarette smokers.

The aim of the study was to compare nutrient intakes estimated by a self-administered food frequency questionnaire and a 10-day weighed record in 122 men and 179 women cigarette smokers aged 40-59 years. Comparison of nutrient intake by means, per cent mean differences and ability to rank individuals correctly between the methods showed good agreement for most nutrients. Spearman rank correlations were statistically significant for all nutrients except vitamin A intake in men; adjusting for energy intake increased the strength of the associations found. Bland-Altman plots showed differences in agreement over the range of intakes for energy in men and ascorbic acid in women. Food frequency questionnaires may be used to assess the dietary habits of smokers, but some caution is required and the method should be assessed in the study sample before being applied to the whole sample.

Comparison of a food frequency questionnaire with a diet record.

The associations between levels of nutrients derived from a 24-hour diet record and a food frequency questionnaire were assessed in a sample of 433 men and women. The food frequency questionnaire was administered three years after the completion of the diet record. Spearman correlations were all statistically significant; they varied from 0.36 for energy to 0.15 for vitamin A. Comparison of distributions into fifths showed few people grossly misclassified. A model was developed to assess the correlations which would be expected under various conditions of within and between subject variance for each nutrient, errors in measurements and drift in intake over time. The best possible correlation that could be obtained using the within and between subject variations in intake previously published, and with no measurement error or drift over time, was 0.60 for energy and 0.34 for vitamin A. Using a realistic measure of measurement error (standard deviation on log scale of 0.12 for diet record method, 0.06 for drift over time and 0.18 for food frequency method) the correlations obtained in the modelling were very similar to that observed. This study shows that it may be appropriate to use a food frequency questionnaire instead of a diet record to estimate intakes in population based epidemiological studies.

The relation of maternal weight to the blood pressures of Gambian children.

The objective of the study was to relate blood pressure levels in children to their mother's weight in pregnancy. The blood pressures of 675 children aged from one to nine years in three villages in rural Gambia were measured. They were matched to antenatal clinic data which had been collected from all pregnant women in the three villages since 1980. Among children under eight years of age those born in the dry season had the highest blood pressures and were heavier. Their blood pressures were positively related to body weight and to mothers' weight at six months of pregnancy. These relationships were independent of mothers' age and parity, birthweight, gestational age, and placental weight. Among older children, aged eight and nine years, those born in the rainy season had the highest blood pressures. Their blood pressures were not related to their mothers' weight at six months of pregnancy. Rather they were inversely related to mothers' weight gain in the last trimester. An interpretation of these findings is that among young children differences in blood pressure are largely determined by rates of maturation. However, the long-term effects of adverse intra-uterine influences which elevate blood pressure become apparent in older children.

PIP: Recent findings show that the intrauterine environment has a major effect on blood pressure and hypertension. This article reports on a study of the blood pressure of 675 Gambian children 1-9 years old and the relationship to mother's weight in pregnancy and seasonality. The children were born in the rural Keneba, Manduar, and Kanton Kunda in The Gambia after January 1980. Since 1979, clinic data was available on child's birth weight, growth, and morbidity data within the 1st 18 months, and after 18 months, clinic visit data on weight, height, diagnosis, and treatment. Mother's anthropometry and blood pressure (BP) were used at within 15 days of 6 months and 30 days of birth; mother's BP is not comparable between younger and older children. Periodic census data on households was also accessible. A study survey was also administered in 1989. Children's height was measured with a Harpenden infantometer for those 900 mm, and with a Raven Maximeter for those 900 mm. A SECA medal 727 (5 g gradations) was used for lower weights and a SOEHNLE digital scale for mother's and for heavier children. DINAMAP (model 18465 X) was used for 2 BP readings. A BP pretest with 2 observers revealed a mean difference in readings of .27 and a standard error of 1.36. Seasonality was set at rainy (Aug-Nov), cool (Apr-Jly), and hot and dry (Dec-Mar). The results were that systolic and diastolic pressures rose with children's age; i.e., from 89.3 mm Hg in 1 year olds to 102.7 mm Hg in 9 year olds. It increased with body weight and decreased with the time since the last meal. Ambient temperature was unrelated. Cole's LMS method for calculating centile curves was used to adjust the data for age, body weight, and time since eating. In the age groups 1-4, 5-7, mean BP was lowest during the rainy season and among 8-9 year olds, BP was highest during rainy seasons and variation was statistically significant. Mother's weight gain was lowest in the rainy season and among 8-9 year olds, BP was highest during rainy seasons and variation was statistically significant. Mother's weight gain was lowest in the rainy season and BP increased with age. Every 10mm Hg rise in mother's systolic BP was related to a 1 mm Hg rise in children's (1-7 years) adjusted systolic BP (p=.008). Mother's weight at 7.5 months was positively related to the child's (1-7 years) adjusted systolic BP (p=.003). There was no trend for children 8-9 years. Among the younger children BP was not related to mother's weight gain. Birthweight was unrelated to adjust systolic pressure at any age, but strongly positively related to mother's height, mother's weight at 7.5 months, and weight gain in the last trimester. Future followup is planned to examine whether the 6-7 year olds a year later begin to show the effects of maternal weight gain in pregnancy.

Applying the stages-of-change model to dietary change.

The transtheoretical model of behavior change ("Stages of Change") was first proposed by Prochaska and DiClemente 14 years ago. It was originally developed by observing smokers who were planning or attempting to give up smoking. It has since been applied to behaviors other than smoking, and several recently published papers have examined its application in the area of dietary change. The complexity of dietary change, however, has made it more difficult to apply the model in this area. Studies applying the model to diet have differed in terms of the aspect of diet being examined, as well as the staging algorithms and dietary assessment methodology used. Such differences in methodology have led to variable results and have made it difficult to interpret results obtained. This review summarizes the studies in this area and makes recommendations for future research.

Relationship between diet and smoking--is the diet of smokers different?

STUDY OBJECTIVE: The aim was to compare nutrient intakes of smokers, past smokers, and non-smokers. DESIGN: The study was cross sectional and compared nutrient intake by smoking status using data obtained from a concurrent study of diet. SETTING: The study took place in three towns in England: Ipswich, Wakefield, and Stoke on Trent. PARTICIPANTS: Food records were obtained from 1115 men and 1225 women aged 35 to 54 years, representing response rates of 84-86% in the three towns. MEASUREMENTS AND MAIN RESULTS: Diet was assessed using a 24h food record in household measures. For both men and women vitamin C, total fibre, beta carotene, and vitamin E intakes were lowest in the current smokers and highest in the non-smokers with past smokers having intermediate values. Polyunsaturated/saturated fat ratio was lowest in the current smokers. Men who smoked had higher energy intakes than those who did not. The lower fat intakes of beta carotene, vitamin C, fibre, and polyunsaturated fat in the smokers was due to fewer smokers eating a whole range of foods including fruit, wholemeal bread, cereals, and polyunsaturated margarine. Current smokers had a lower body mass index than non-smokers or past smokers despite their higher energy intakes. CONCLUSIONS: Smokers have different nutrient and food intakes compared with past smokers or non-smokers.

The Health Education Authority's health and lifestyle survey 1993: who are the low fruit and vegetable consumers?

STUDY OBJECTIVE: Firstly, to determine the demographic and behavioural characteristics of low fruit and vegetable consumers. Secondly, to investigate whether knowledge and attitudes are barriers to consumption of fruit and vegetables. DESIGN: Cross sectional survey: an interviewer administrated questionnaire was used to assess the demographic, knowledge, attitude, and behavioural characteristics of the respondents. SETTING: England. PARTICIPANTS: Random sample of 5553 men and women aged between 16 and 74 years. Response rate 70%. MAIN RESULTS: The main demographic characteristics of the respondents identified as low consumers of fruit and vegetables (less than daily consumption of either fruit or vegetables) were age, sex, and smoking status. The adjusted odds ratios were 2.59 for those aged 16-24 years compared with those aged 45-74 years, 2.17 for men compared with women, and 1.77 for current smokers compared with never smokers. The most important knowledge and attitude statements after adjusting for the demographic variables were disagreeing with the statement "healthy foods are enjoyable" (odds ratio 1.90) and agreeing with the statement "I don't really care what I eat" (odds ratio 1.76). The impact of knowledge seemed less important than attitudes about a healthy diet in characterising a low fruit and vegetable consumer. CONCLUSIONS: These findings are relevant to future strategies for improving intake of fruit and vegetables, but demonstrate the complexity of interventions required, and the dangers inherent in assuming simplistic relations between psychosocial factors and behaviour.

Persistence of lower birth weight in second generation South Asian babies born in the United Kingdom.

OBJECTIVE: To assess differences in birth weight between all first and second generation South Asian babies born in Southampton, and trends since 1957. DESIGN: Retrospective, cohort study. SETTING: Birth records for babies born in Southampton from 1957 to 1996 were searched to identify all babies born of South Asian origin (including from the Indian subcontinent, East Africa, and elsewhere). MAIN OUTCOME MEASURES: All information recorded in the birth record about the mother and baby was extracted. RESULTS: 2395 full term (>37 weeks; mean birth weight 3110; 95%CI 3092 to 3129) singleton births were identified. Detailed analysis was restricted to mothers either born in the Indian subcontinent (India, Pakistan, or Bangladesh (1435)) or United Kingdom (283). Mean birth weight and % low birth weight (<2500 g) were 3133 g (95%CI 3108 to 3157) and 7.5%, for first generation babies and 3046 g (2992 to 3099) and 11.7% for second generation babies. There was no trend over time to increased average birth weight in either first or second generation babies. Adjusting for other factors that were statistically significantly related to birth weight (gender, gestational age, mother's age, maternal weight at 15 weeks, parity, and mother's ethnic group) did not alter the trends. CONCLUSIONS: For that group in the UK who derive from the Indian subcontinent, average birth weight is significantly less than the national average. There has not been any increase in the average birth weight over the past 40 years, and the birth weight of babies of women who were born in the UK are no greater. The persistence of lower than desirable birth weight may result long term in higher than average rates of diabetes and heart disease in these groups.

An epidemiological study of hypertension and its determinants in a population in transition: the THUSA study.

BACKGROUND: Many black persons in South Africa have been subjected to urbanisation and urbanisation has led to a significant increase in diseases of lifestyle. The determinants of hypertension in a population in transition have not been well-defined and there is a pressing need for observational epidemiological studies as well as randomised-controlled trials in populations from Africa. The aim of this study was to investigate the association between blood pressure and factors known to contribute to hypertension. METHODS: The study sample consisted mainly of Setswana speaking people, divided into different levels (strata) of urbanisation, namely stratum 1 (rural) to stratum 5 (urbanized). A total of 1821 black subjects, which included 1040 woman, were recruited and randomly selected from 37 sites from the four geographical quarters of the North West Province of South Africa. The following questionnaires were used: demographic, anthropometric, quantitative food frequency, physical activity and scales to measure psychosocial variables. Biochemical analysis (standardised methods) were done on the serum and plasma of the subjects and the blood pressure was measured with a sphygmomanometer. RESULTS: Of the total sample, 22.8% of the subjects had systolic and 20.7% diastolic blood pressures above 140/90 mm Hg. Males and females from stratum 3 showed the highest rate of hypertension (32.9% systolic and 25.1% diastolic) and stratum 5 the lowest. Blood pressure correlated positively with age, level of urbanisation, WHR (waist:hip ratio) and smoking. In the woman the diastolic blood pressure correlated the best with body mass index (BMI), serum triglycerides, total serum cholesterol, low-density lipoprotein (LDL) cholesterol and s-GGT. Coping strategies, experience of social support, cultural aspects and affect balance are related to blood pressure, especially in the case of women. CONCLUSIONS: It seems that factors associated with urbanisation are related to the manifestation of hypertension in black people of the North West Province, given the highest mean blood pressure in people living in informal settlements, where most newcomers to the urban areas live. Journal of Human Hypertension (2000) 14, 779-787

The determinants of plasma beta-carotene: interaction between smoking and other lifestyle factors.

OBJECTIVE: To assess the effect of cigarette smoking on the relationship between dietary intake and circulating levels of beta-carotene. DESIGN: A secondary analysis of data collected for the Diet and Nutritional Survey of British Adults by The Department of Health and The Ministry of Agriculture, Fisheries and Food; the study was a cross-sectional survey of a representative sample of the British population. SETTING: The study was conducted on a free living adult (16-64 years of age) population resident in Great Britain. SUBJECTS: 1483 subjects completed a seven day weighed inventory and provided a blood sample. RESULTS: Smokers had statistically significantly lower dietary intakes and circulating levels of beta-carotene than non-smokers. At the same level of dietary intake, smokers were more likely to have lower circulating levels than non-smokers. For every 1000 micrograms change in dietary intake, there was a 0.01 mumol/l change in plasma beta-carotene in smokers and a 0.04 mumol/l change in non-smokers. The effect of smoking on circulating levels of beta-carotene persisted after adjusting for other factors. CONCLUSIONS: The results suggest that smoking places extra demands on the host; the higher risk of heart disease for smokers may be due to a combination of an increased inflammatory response, reduced host defences, and increased levels of circulating LDL. Failure to take account of the interaction between risk factors may distort the estimates of the relative importance of each factor when considered in isolation.

Prevalence of risk of undernutrition is associated with poor health status in older people in the UK.

OBJECTIVES: To establish the prevalence of the risk of undernutrition, using criteria similar to those used by the Malnutrition Advisory Group (MAG), in people aged 65 y and over, and to identify relationships between risk of undernutrition and health and demographic characteristics. DESIGN: A cross-sectional nationally representative sample of free-living and institutionalized older people in the UK (65 y of age and over). Secondary analysis of the National Diet and Nutrition Survey based on 1368 people aged 65 y and over. RESULTS: About 14% (21% in those living in institutions) were at medium or high risk of undernutrition based on a composite measure of low body mass index and recent reported weight loss. Having a long-standing illness was associated with a statistically significantly increased risk of undernutrition (odds ratio: men 2.34, 95% CI 1.20-4.58; women 2.98; 1.58-5.62). The risk of undernutrition increased: in women reporting bad or very bad health status; in men living in northern England and Scotland; for those aged 85 y and older; for those hospitalized in the last year, and those living in an institution. Lower consumption of energy, meat products or fruit and vegetables and lower blood measures of zinc, vitamins A, D, E and C were associated with statistically significantly increased risk of undernutrition. CONCLUSIONS: A substantial proportion of the older population of the UK is at risk of undernutrition. High-risk subjects are more likely to have poorer health status. It is unlikely that the individuals at high risk are being detected currently, and therefore effective care is not being provided, either in the community or in institutions.

Effect of socio-demographic conditions on growth of urban school children of Bangladesh.

The relationship between socio-demographic variables and growth of 242 school children from five schools in Dhaka city, Bangladesh, was investigated. The socio-demographic data were collected by questionnaire and the anthropometric data were collected by visits to each school on a prefixed date. Children from the high-family-income group showed significantly higher body weight, height, MUAC, SFT, wt/age, and ht/age compared with children from the low-family-income group. When the effect of age, sex, father's occupation and family size were adjusted for by means of multiple analysis of variance, the family income still showed a significant contribution to the variation in the anthropometric indices of these children. These findings suggest that family income makes a significant contribution as a determinant of growth of urban school children in Bangladesh.

Definitions of 'healthy' eating: a pan-EU survey of consumer attitudes to food, nutrition and health.

OBJECTIVE: To describe the perceptions of a healthy diet across Europe and to explore the socio-cultural factors that influence these perceptions. DESIGN: A cross-sectional study in which quota-controlled, nationally-representative samples of approximately 1000 adults from each country completed a face-to-face interview-assisted questionnaire. SETTING: The survey was conducted between October 1995 and February 1996 in the 15 member states of the European Union. SUBJECTS: 14331 subjects (aged 15 y upwards) completed the questionnaire. Data were weighted by population size for each country and by sex, age and regional distribution within each member state. RESULTS: Responses were grouped into broad categories; overall 80% (specific country rates varied from 67-91%) of respondents mentioned either more fruit and vegetables or less fat, fatty foods, or a low fat diet, or balance and variety. The effects of age, gender and level of education were also explored: educational level appeared to have the strongest influence on perceptions of a healthy diet. Respondents who mentioned the family as a key influence on food choice, were more likely to mention eating more fruit and vegetables as part of a healthy diet. Respondents who stated that they did not have any source of information about diet were less likely to mention balance and variety or less fat or more vegetables. CONCLUSIONS: The results of the present study suggest that many people defined healthy eating in a way which would suggest that the healthy dietary guidelines are having some impact. The results also show, however, that there may be specific groups who are missed by current national campaigns, and that any European wide campaigns to change attitudes about healthy eating need to consider the baseline perception of healthy eating reported here.

Effect of family size and income on the biochemical indices of urban school children of Bangladesh.

The relationship between family size and income and the biochemical indices of 242 children (aged from 5 to 12 years) from five schools in Dhaka City, Bangladesh, was investigated. Socio-economic data were collected by questionnaire and blood samples were drawn by visiting each school on a prefixed date. Mean levels of all measures, except for serum zinc, fell within the normal range. Older boys, but not girls (10-12 years of age) had statistically significantly higher haemoglobin, serum protein and serum vitamin A levels compared with those of the younger boys (5-9 years of age). The children were divided into three family size groups (small, up to 4 members; medium, 5-7 members; and large, 8 or more) to investigate the effect of family size on the biochemical data. The children from smaller families showed significantly higher levels of haemoglobin and serum vitamin A compared with the children from large families. For serum protein, copper and zinc, there was no statistically significant difference between the children of different family size groups. To analyse the effect of family income, children were divided into three income groups (low, up to taka 2000; medium, taka 2001-4500; and high, 4501 or more). The children from the low family income group had significantly lower serum protein (7.5 g/100 ml) and haemoglobin (13.4 g/100 ml) levels compared with those of the children from the high family income group (for protein, 7.7 g/100 ml and haemoglobin, 14.1 g/100 ml).(ABSTRACT TRUNCATED AT 250 WORDS)