Food consumption in rural and urban Tanzania.

Food consumption of 177 rural and 94 urban subjects (98 aged 12 years, 105 aged 35-44 years, and 68 aged 65-74 years) was studied in rural and urban Ilala district, Dar-es-Salaam, Tanzania, to characterize rural-urban differences in the meal and snack patterns and intakes of energy and nutrients. Food consumption of each subject was studied using 24 h dietary recall once during the rainy season and once during the dry season. Micro Nutrica PC database, expanded with East African food composition tables, was used in the nutrient intake analyses. All urban and 92% of rural subjects had three daily meals, and snacks were as commonly eaten in both areas of the survey. Foods of animal origin, e.g. meat and milk, were seldom used by the rural subjects. The WHO/FAO recommended minimal daily allowances of energy and protein were not reached by 26 and 15% of the rural subjects, respectively (10 and 4% of the urban subjects). Mean intake of folic acid by rural subjects was clearly below that of the urban subjects. Intakes of sucrose, mono- and disaccharides combined, polysaccharides, fibre and cholesterol differed markedly in all age groups in rural and urban circumstances (P < 0.05). Intake of fat and saturated fat was extremely low in all age groups, particularly in the rural subjects. The data suggest that (sub)clinical protein-energy malnutrition is prevelant in Tanzania, and that the high intakes of sucrose and cholesterol and the low intake of fibre by the urban subjects may increase the prevalence of dental caries and cardiovascular diseases in that population.

Group vs. individual weight reduction programmes in the treatment of severe obesity--a five year follow-up study.

The aim of the study was to compare group and individual weight reduction programmes in the treatment of severe obesity. The study population included 40 women and 20 men, mean age 41 years. The mean body mass index was 43.5 kg/m2 in women and 42.2 kg/m2 in men. The subjects were randomly divided into two groups, one with group counselling (GC group) and the other with individual counselling (IC group). The treatment programme of the GC group consisted of a two-week weight reduction period in a rehabilitation centre followed by group sessions for two years. The programme of the IC group consisted of individual counselling and follow-up by a physician. The adherence rate of the follow-up examinations was 97% at two years and 88% at five years. In the GC group the mean weight reduction in women at three months and at one, two and five years was 15.6, 15.7, 5.4 and 2.1 kg and in men 14.9, 13.1, 1.8 and 3.0 kg, respectively. In the IC group the corresponding values for women were 8.4, 11.9, 10.4 and 3.4 kg and for men 17.0, 26.2, 15.6 and 12.9 kg. Self-reported and measured weights at the five-year follow-up were closely correlated (r = 0.99). Weight loss during the first three months predicted a good result at two and five years. The results showed that group counselling starting with an in-patient period led to rapid weight reduction, but a better and more sustained effect was achieved by individual counselling, especially in men.

A seven-year follow-up of a weight reduction programme in Finnish primary health care.

The study was carried out to assess the short- and long-term effects of a Finnish Social Insurance Institution (SII) weight reduction programme in overweight primary health care clients and the suitability of the programme for use in health centres. The treatment group consisted of 22 men and 71 women, mean body mass index (BMI) 34.3, divided into 8 subgroups. These subjects participated in a 6-week weight reduction course led by public health nurses. Afterwards, there were six follow-up sessions and weight measurements at about 2-month intervals. A control group of 20 men and 76 women, mean BMI 33.5, received no weight reduction instruction during the 1 year that they served as controls. The weights, serum and high-density lipoprotein (HDL) cholesterol levels as well as blood pressures of the subjects in both groups were measured at entry to the study and at the end of the 1-year period. At that time the treatment group showed a weight reduction of 10.9 kg in men and 5.4 kg in women. The control group showed a mean weight gain of 0.9 kg in men and 0.2 kg in women. HDL cholesterol increased in the treatment group. The blood pressure decreased significantly in the category of subjects with a weight loss exceeding 4 kg weight. At the end of the 7-year follow-up period the mean weight reduction in the treatment group was 8.7 kg in men and 3.5 kg in women. Of men 53% and of women 21% still weighed over 10 kg less than at baseline. Both the clients and public health nurses found the weight reduction programme useful and applicable to health centres, preferably with extended time. The programme has now been adopted nationwide in the Finnish primary health care system.

Validity of the estimated food diary: comparison of 2-day recorded and observed food and nutrient intakes.

We assessed the validity of the estimated food diary by comparing recorded and observed food and nutrient intakes for 121 subjects (71 men and 50 women) aged 15 to 65 years. We obtained observed intake by unobtrusively recording the amounts of foods, preweighed or measured when served, at the four meals on each of the two study days. At the same time, subjects kept an estimated food diary. In general, the mean food intake recorded in the food diaries deviated from the observed intake by 15% at most. The deviation exceeded 20% for only a few food items. With the exception of calcium (-11%), starch (+10%) and thiamin (+8%), there was no difference or only a few percent difference in the means for energy and the 16 nutrients calculated. The validity of the food diary was equally high for men and women in the 15 to 34, 35 to 44, and 45 to 65 age groups. Product-moment correlation coefficients ranged from 0.68 to 0.97 for food intake and from 0.75 to 0.92 for nutrient intake. We conclude that validity is very satisfactory on the group level and is probably acceptable on the individual level.

Long-term nopharmacological treatment for mild to moderate hypertension.

Ninety-one middle-aged men and women with untreated mild hypertension were allocated to a nopharmacological treatment group or to a control group. Members of the treatment group were instructed to reduce daily sodium intake to less than 70 mmol, to reduce the intake of saturated fat, to lose weight if necessary and to perform regular physical exercise and relaxation training. Adherence to and effects of the programme on blood pressure and serum lipids were monitored for 12 months. In the treatment group, daily sodium excretion decreased to and remained at 50% of its original level (P less than 0.001), and there was a significant reduction in saturated fat intake. The average weight reduction was modest. Adherence to physical exercise and relaxation training regimens was poor. The net decreases (difference in changes between treatment and control group) in blood pressure were greatest during the first 3 months: in men the decrease in systolic blood pressure was 11.3 mmHg (P less than 0.001) and in diastolic blood pressure 8.3 mmHg (P less than 0.001); in women the decrease in systolic blood pressure was 10.8 mmHg (P less than 0.01) and in diastolic blood pressure 6.4 mmHg (P less than 0.01). However, this decrease diminished during the last 3 months to approximately one half owing to blood pressure reduction in controls. Low density lipoprotein cholesterol levels decreased significantly in treated men and women.

Weight reduction on lactovegetarian and mixed diets. Changes in weight, nutrient intake, skinfold thicknesses and blood pressure.

The purpose of this study was to investigate whether a weight reduction programme based on a lactovegetarian diet has any beneficial effects on the weight, nutrient intake, blood pressure and skinfold thickness of overweight subjects compared with a programme based on a balanced mixed diet. The subjects consisted of three groups of moderately overweight persons, with a mean age of 38 years and a mean overweight of 38 per cent. Two groups had a weight reduction programme for 1 year; group 1 (n = 31) had a 1200 kcal lactovegetarian diet and group 2 (n = 37) had an isocaloric mixed diet. Group 3 (n = 42) served as a control group which had no intervention. During the 1-year study period, group 1 lost 9.2 kg in weight, group 2 lost 10.4 kg and group 3 gained 1.6 kg in weight. Weight loss in both weight reduction groups was accompanied by a reduction in blood pressure, skinfold thickness and arm circumference. The results were slightly more favourable in the mixed diet group than in the lactovegetarian group. In the lactovegetarian group 7 persons were not able to follow the lactovegetarian diet throughout the whole year but ate some meat, fish and eggs during the latter part of the study year. The intake of fibre, vitamin C and calcium was greater and the intake of fat lower in the lactovegetarian than in the mixed diet group during the 1-year weight reduction period. The intake of most nutrients was above the recommended level in both weight reduction groups. The intake was somewhat below recommendations for niacin in the lactovegetarian group, for calcium in the mixed diet group and for iron for women in both groups. It seems desirable to recommend a low-calorie nutritionally well-balanced mixed diet, based on familiar foods and rich in vegetables, instead of a lactovegetarian diet, for long-term weight reduction of overweight persons. In the long term some nutrients may need to be supplemented in both diets.

Validity of the 24-hour dietary recall.

The validity of the 24-hour recall was studied with a comparison of recalled and observed food and nutrient intake for 140 subjects, 84 males (60%) and 56 females (40%), 15 to 57 years old. The observation was carried out during 1 day by recording the amounts of foods selected by the subjects at four meals. The following day, 24-hour recalls were obtained. The results showed that some food items eaten were omitted in the recall, the extremes being 4% of times eaten for fish and 50% for cooked vegetables. In addition, some food items not actually eaten were added in the recall, the additions ranging from 2% of times recalled for bread to 29% for sugar. The difference between mean recalled and observed nutrient intake was between -6% and 11%, except for sucrose (-20%) and vitamin C (-16%). The product-moment correlation coefficient between observed and recalled nutrient intake was in the range of 0.58 to 0.74. Women achieved somewhat more accurate results than men, and the recall results in the 35 to 44 age group were the most valid. It was concluded that validity is unsatisfactory on the individual level and satisfactory on the group level.

Effects of comprehensive rehabilitation on weight reduction in myocardial infarction patients.

The effect of a comprehensive rehabilitation programme, including diet therapy, was studied in overweight male myocardial infarction (MI) patients randomly assigned to a rehabilitation group (n = 69) and a control group (n = 64). The results show a mean weight decrease of 3.8 kg in the rehabilitation group and a mean weight increase of 1.1 kg in the control group (t = -5.78, p less than 0.001). The proportion of patients reducing their weight more than 5 kg was 33% in the rehabilitation group and 5% in the control group (chi 2 = 15.6, p less than 0.001). Patient characteristics which significantly affected the weight change by univariate analysis were age, level of overweight, smoking habits, employment situation and social problems. Multivariate analyses yielded a two-variable model with moderate explanatory power in the rehabilitation group. The model includes the variables Body Mass Index and cessation of smoking before MI.

Agreement between dietary interviews.

The nutrient intake for 86 male myocardial infarction patients was calculated from data based on the interview methods studied both one and two years after infarction. The dietary history method resulted in systematically higher mean daily intakes than the other methods. The differences in mean intakes calculated from the recall methods were, in general, rather small. The agreement, measured by the intraclass correlation coefficient, varied from 0.42 to 0.69. The pattern of mean differences between methods was consistent one and two years after infarction.

Effects of nutrition education.

A group of 86 male myocardial infarction patients receiving diet therapy in the form of individual counseling and lectures or food-preparation classes and a group of 78 control subjects were studied. The desired changes in food and nutrient intake were greater in the treatment than in the control group. For the lecture and food-preparation groups, the changes in dietary intakes were similar. The reduction in the patients' weights and in the level of serum lipids also indicated the effectiveness of nutrition education in comprehensive rehabilitation.