Rural areas of the Eastern Cape (EC) Province, South Africa have a high incidence of squamous cell oesophageal cancer (OC) and exposure to mycotoxin fumonisin has been associated with increased OC risk. However, to assess exposure to fumonisin in Xhosas—having maize as a staple food—it is necessary to determine the amount of maize consumed per day. A maize-specific food frequency questionnaire (M-FFQ) has recently been developed. This study developed a food photograph (FP) series to improve portion size estimation of maize dishes. Two sets of photographs were developed to be used alongside the validated M-FFQ. The photographs were designed to assist quantification of intakes (portion size photographs) and to facilitate estimation of maize amounts in various combined dishes (ratio photographs) using data from 24 h recalls (n = 159), dishing-up sessions (n = 35), focus group discussions (FGD) (n = 56) and published literature. Five villages in two rural isiXhosa-speaking areas of the EC Province, known to have a high incidence of OC, were randomly selected. Women between the ages of 18–55 years were recruited by snowball sampling and invited to participate. The FP series comprised three portion size photographs (S, M, L) of 21 maize dishes and three ratio photographs of nine combined maize-based dishes. A culturally specific FP series was designed to improve portion size estimation when reporting dietary intake using a newly developed M-FFQ. Full article

Misreporting of energy intake (EI) is a common problem in national surveys. The aim of this study was to identify misreporters using a variety of criteria, examine the impact of misreporting on the association between EI and weight status, and to define the characteristics of misreporters in the 2007 Australian Children’s Survey. Data from the 2007 Australian Children’s Survey which included 4800 children aged 2–16 years were used to examine the extent of misreporting based on EI, physical activity level (PAL), age, gender, height and weight status. Three options for identifying misreporters using the Goldberg cut-offs were explored as was direct comparison of EI to energy expenditure (TEE) in a subset of children. Linear regression was used to determine the impact of misreporting on the association between EI and weight status. The prevalence of under-reporting among all children varied from 5.0% to 6.7%, and over-reporting from 1.6% to 3.0% depending on the option used. Direct comparison of EI to TEE revealed similar results. Regression analysis showed that excluding misreporters provided the best model to examine cross-sectional associations between EI and BMI. Characteristics associated with under-reporting included older age, female, higher BMI, higher PAL, living in an urban location, lower parental education level and feeling unwell on the survey day. Over-reporting was more common among children with a lower BMI and lower PAL. In conclusion, misreporting of EI is present among various subgroups of the 2007 Australian Children’s Survey. The impact of misreporting on the association between EI and body weight should be recognised by users of this survey. Full article

Serum fatty acids are increasingly used in cross-sectional surveys and cohort studies as biomarkers of dietary fat intake; however, it is currently difficult to judge whether an individual has low or high fatty acid status, or whether the distribution of fatty acids of a group of people is low or high due to a lack of appropriate reference values. In the absence of interpretive criteria, the distribution of serum fatty acids from a suitable reference population can be used as an alternative. We describe the distribution of the fatty acid composition of the three most commonly reported lipid classes in serum; cholesterol ester, phospholipid and triacylgycerol. Results for each serum lipid class are presented as means (SD) and percentiles (5, 10, 25, 50, 75, 90, and 95) of serum fatty acids in non-fasting blood samples collected from a population based cross-sectional survey of New Zealand adults (n = 2793). These serum fatty acid reference ranges are applicable and relevant to Australia, United Kingdom, and United States as well as other countries where fat intakes are similar to New Zealand. Full article

Optimal dietary quality, indicated by higher diet quality index scores, reflects greater adherence to National dietary recommendations and is also associated with lower morbidity and mortality from chronic disease. Whether this is reflected in lower health care cost over time has rarely been examined. The aim of this study was to examine whether higher diet quality, as measured by the Australian Recommended Food Score (ARFS), was associated with lower health care costs within the mid-aged cohort of the Australian Longitudinal Study on Women’s Health. We found that there was a statistically significant association between five year cumulative costs and ARFS, but in the opposite direction to that predicted, with those in the highest quintiles of ARFS having higher health care costs. However the number of Medicare claims over the six year period (2002–2007) was lower for those in the highest compared with the lowest quintile, p = 0.002. There is a need to monitor both costs and claims over time to examine health care usage in the longer term in order to determine whether savings are eventually obtained for those with the dietary patterns that adhere more closely to National recommendations. Full article

Healthy food baskets have been used around the world for a variety of purposes, including: examining the difference in cost between healthy and unhealthy food; mapping the availability of healthy foods in different locations; calculating the minimum cost of an adequate diet for social policy planning; developing educational material on low cost eating and examining trends on food costs over time. In Australia, the Illawarra Healthy Food Basket was developed in 2000 to monitor trends in the affordability of healthy food compared to average weekly wages and social welfare benefits for the unemployed. It consists of 57 items selected to meet the nutritional requirements of a reference family of five. Bi-annual costing from 2000–2009 has shown that the basket costs have increased by 38.4% in the 10-year period, but that affordability has remained relatively constant at around 30% of average household incomes. Full article

The objective of this narrative review is to examine the nutrition transition and its consequences when populations in Africa modernize as a result of socio-economic development, urbanization, and acculturation. The focus is on the changes in dietary patterns and nutrient intakes during the nutrition transition, the determinants and consequences of these changes as well as possible new approaches in public health nutrition policies, interventions and research needed to steer the nutrition transition into a more positive direction in Africa. The review indicates that non-communicable, nutrition-related diseases have emerged in sub-Saharan Africa at a faster rate and at a lower economic level than in industrialized countries, before the battle against under-nutrition has been won. There is a putative epigenetic link between under- and over-nutrition, explaining the double burden of nutrition-related diseases in Africa. It is concluded that it is possible to steer the nutrition transition into a more positive direction, provided that some basic principles in planning public health promotion strategies, policies and interventions are followed. It is suggested that sub-Saharan African countries join forces to study the nutrition transition and implemented interventions on epidemiological, clinical and molecular (genetic) level for better prevention of both under- and over-nutrition. Full article

Iodine is an integral part of the thyroid hormones, thyroxine (T₄) and tri-iodothyronine (T₃), necessary for normal growth and development. An adequate supply of cerebral T₃, generated in the fetal brain from maternal free T₄ (fT₄), is needed by the fetus for thyroid hormone dependent neurodevelopment, which begins in the second half of the first trimester of pregnancy. Around the beginning of the second trimester the fetal thyroid also begins to produce hormones but the reserves of the fetal gland are low, thus maternal thyroid hormones contribute to total fetal thyroid hormone concentrations until birth. In order for pregnant women to produce enough thyroid hormones to meet both her own and her baby’s requirements, a 50% increase in iodine intake is recommended. A lack of iodine in the diet may result in the mother becoming iodine deficient, and subsequently the fetus. In iodine deficiency, hypothyroxinemia (i.e., low maternal fT₄) results in damage to the developing brain, which is further aggravated by hypothyroidism in the fetus. The most serious consequence of iodine deficiency is cretinism, characterised by profound mental retardation. There is unequivocal evidence that severe iodine deficiency in pregnancy impairs brain development in the child. However, only two intervention trials have assessed neurodevelopment in children of moderately iodine deficient mothers finding improved neurodevelopment in children of mothers supplemented earlier rather than later in pregnancy; both studies were not randomised and were uncontrolled. Thus, there is a need for well-designed trials to determine the effect of iodine supplementation in moderate to mildly iodine deficient pregnant women on neurodevelopment in the child. Full article

The approach used by food regulation agencies to examine the literature and forecast the impact of possible food regulations has many similar features to the approach used in nutritional epidemiological research. We outline the Risk Analysis Framework described by FAO/WHO, in which there is formal progression from identification of the nutrient or food chemical of interest, through to describing its effect on health and then assessing whether there is a risk to the population based on dietary exposure estimates. We then discuss some important considerations for the dietary modeling component of the Framework, including several methodological issues that also exist in research nutritional epidemiology. Finally, we give several case studies that illustrate how the different methodological components are used together to inform decisions about how to manage the regulatory problem. Full article