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Objective: To determine the iodine status of participants in the Aboriginal Birth Cohort Study who resided in the Darwin Health Region (DHR) in the “Top End” of the Northern Territory prior to the introduction of mandatory iodine fortification of bread. Design, setting and participants: Participants in our study had been recruited at birth and were followed up at a mean age of 17.8 years. Spot urine samples were collected and assessed for iodine concentration at a reference laboratory. The median urinary iodine concentration (MUIC) of residents of the DHR was calculated and compared with international criteria for iodine status. Analyses were conducted for subgroups living in urban areas (Darwin–Palmerston) and remote communities (rural with an Aboriginal council). We collected a repeat sample in a subset of participants to explore the impact of within-person variation on the results. Main outcome measure: MUIC for residents of the DHR. Results: Urine specimens were provided by 376 participants in the DHR. Overall MUIC was 58 μg/L when weighted to the 2006 Census population. Urban boys had higher values (MUIC = 77 μg/L) than urban and remote-dwelling non-pregnant girls (MUIC = 55 μg/L), but all these groups were classified as mildly iodine deficient. Remotedwelling boys had the lowest MUIC (47 μg/L, moderate deficiency). Pregnant girls and those with infants aged less than 6 months also had insufficient iodine status. Correction for within-person variation reduced the spread of the population distribution. Conclusions: Previously, iodine deficiency was thought to occur only in the southeastern states of Australia. This is the first report of iodine deficiency occurring in residents of the NT. It is also the first study of iodine status in a defined Indigenous population. Future follow-up will reassess iodine status in this group after the

A survey of nutritional status and dietary problems in adults with learning disabilities aged 20–50 years and living in the general community is reported. The frequency of overweight (BMI 25–30) and obese (BMI >30) women (and in Down Syndrome subjects both men and women) was more than twice that in their community controls. No significant difference in BMI categories was found in the men. Hypertension and hypercholesterolaemia were more frequent in overweight and obese learning disabled women than in their community counterparts. These results indicate a need for specific nutrition education programmes, in concert with proper nutritional assessment and dietary intervention.

Vietnamese-Australian women have infants with lower birth weight than Australian-born women. Traditional humoral food habits, based on ancient Chinese medicine, are more likely to be followed during life changes like pregnancy. These food habits may influence maternal energy intake, weight gain and therefore infant birth weight. This study determined the proportion of pregnant Vietnamese women in southwestern Sydney who practise traditional humoral food habits, and their effect on birth weight. A cohort of 113 pregnant Vietnamese-born women were questioned on smoking status, height, weight, parity, food practices and demographics. Dietary intake was measured in each trimester. Known risk factors and infant birth weights were collected from medical records for participants and nonresponders. Fifty-seven per cent practised the traditional food habits. There were no differences in energy intake or weight gain between the two groups. After adjusting for confounders, birth weight was estimated to be 3257 g (95 per cent confidence interval (CI) 3205 to 3309) and 3272 g (CI 3211 to 3333) for the infants of traditional and nontraditional women respectively. Following humoral food habits does not appear to affect birth weight. Women who choose to follow these traditions should not be discouraged from doing so.

Purpose Dietary patterns offer an alternative method for analyzing dietary intakes that take into account the whole diet. We investigated empirical dietary patterns and prostate cancer risk in Western Australia (WA) using a population-based case-control study. Methods Incident prostate cancer cases were identified via the WA Cancer Registry. Controls were sourced from the WA electoral roll, frequency matched on age. A food frequency questionnaire (FFQ) estimated usual dietary intake from 10 years earlier. Factor analysis identified dietary patterns in FFQ data. Effects of independent dietary patterns on prostate cancer risk were examined using unconditional logistic regression, adjusting for potential confounders. Results A total of 546 cases and 447 controls provided data. Three distinct dietary patterns were identified, which we labeled vegetable, Western, and health-conscious. An increased risk for prostate cancer was observed with the Western pattern, which consisted of high intakes of red and processed meats, fried fish, hamburgers, chips, high-fat milk, and white bread. Men in the highest quartile for Western pattern score had an odds ratio of 1.82 (95% confidence interval 1.15–2.87, trend p = 0.02). Results were similar for aggressive cases and attenuated for non-aggressive cancers. Conclusions A western style diet may lead to increased risks for prostate cancer, especially aggressive prostate cancer.

To determine the prevalence of type 2 diabetes and its risk factors in a population of indigenous Australians.A cross-sectional study of 332 indigenous community residents aged 15 years and over with fasting blood samples and anthropometric measurements.Almost half of the study population (47.3%) was extremely lean (BMI22 kg/m(2)). Leanness was particularly pronounced in the youngest age group (1520 years), 78% of which had a BMI22 kg/m(2). The prevalence of diabetes was 12%. It was highest in those 45-54 years and declined in older aged people. No cases of diabetes were detected in those aged less than 30 years. Diabetes prevalence was strongly linked to BMI and age (age-adjusted odds ratio=24.1, 95% CI 6.0-96.5, p0.001) for BMIor=25 kg/m(2) versus BMI22 kg/m(2). Those with the lowest diabetes risk profile are lean (BMI22 kg/m(2)) and/or young (age 15-34 years).These results highlight that strategies to prevent or delay the onset of diabetes should focus on the maintenance of leanness from adolescence and throughout adult life whilst young people are still in the process of forming lifelong habits.

The objectives were to describe cross-sectional growth in 279 Australian Aboriginal children aged 8-14 years in order to test the hypothesis that birth size interacts with child size to predict glucose and insulin metabolism. Cross-sectional growth outcomes were described using standard deviation scores or z-scores for height for age (HAZ) and weight for age (WAZ) calculated from CDC 2000 reference values in Epi Info 2000. Interrelationships were examined using standard regression models with current height and weight and birth weight, ponderal index and birth weight below the 10th percentile for gestational age. All models were adjusted for gestational age, gender and chronological age. Growth outcomes were poor with negative mean z scores for height and weight. Children with a birth weight10th percentile for gestational age were significantly smaller and lighter than those with a birth/= 10th percentile for gestational age, indicating post-natal catch-up growth of small babies was unlikely. After adjustment for childhood size, there was no relationship between any birth measures and fasting glucose or insulin concentrations. Current child height and weight had positive relationships with both fasting insulin and glucose concentrations with a greater proportional change for insulin. For every increment of 1cm in height or 1 kg in weight, insulin concentrations rose 2% whereas glucose increased by only 0.2%. In this indigenous Australian cohort with poor post-natal growth, only current child size is related to measures of glucose and insulin metabolism.

In this article, we report the preva- lence of markers of growth, infection and chronic disease in a birth cohort of Aboriginal children living in the Darwin Health Region who were examined when aged 8-14 years (the Aboriginal Birth Cohort Study). We compared the prevalence of these markers between children living in the urban area of the region and those in remote Aboriginal communities. ABSTRACT Objectives: To describe the prevalence of markers of growth, chronic and infectious disease in peripubertal Aboriginal children living in the Darwin Health Region in the "Top End" of the Northern Territory, and to compare prevalence between children living in urban and remote areas. Design: Cross-sectional survey nested in a prospective birth cohort. Subjects: 482 children living in the region who were recruited at birth (Jan 1987 to Mar 1990) and were followed up between 1998 and 2001, when aged 8-14 years. Main outcome measures: Selected parameters of growth and nutrition, infectious disease and potential markers of chronic adult disease were compared between children living at follow-up in suburban situations in Darwin-Palmerston (urban) and those living in rural communities with an Aboriginal council (remote). Results: Remote children were shorter than urban children (mean height, 141.7 v 146.3 cm; P

OBJECTIVE: Two recent papers examining low birthweight in Aboriginal infants came to different conclusions about the role of size for gestation and preterm delivery in influencing the low birthweight proportion. As the two studies used different methods to estimate the infants' gestational age and to analyse the data, the results cannot be compared directly. This analysis combines the methods of both earlier studies. METHOD: Data collected in 6 Top End communities were analysed to calculate the proportion of infants who were small for gestational age. RESULTS: Despite the high overall prevalence of preterm delivery from the midwives' estimates, 31.4% of infants fell below the 10th centile of weight for gestational age and sex. The majority of these infants were not low birthweight. CONCLUSIONS: The earlier report from the Top End of high proportions of small–for–gestational age infants cannot be dismissed as an artefact due to the method of estimating gestational age. IMPLICATIONS: Intervention programs to improve birth weights in Aboriginal infants need to address both conditions – small size for gestational age and preterm delivery – and need to target the whole population rather than high risk pregnancies.

A double-blind, placebo-controlled, randomized, factorial study using a daily oral administration of 30 mg beta-carotene and/or 500 mg vitamin C was conducted in 141 women with colposcopically and histologically confirmed minor squamous atypia or cervical intra-epithelial neoplasia (CIN) I. Over approximately 2 years of follow-up, 43 lesions regressed to normal and 13 progressed to CIN II. The regression rate was slightly higher, but not significantly so, in those randomized to beta-carotene compared to no beta-carotene (hazard ratio = 1.58, 95% CI: 0.86–2.93, P = 0.14) and slightly lower, but not statistically significant, for those randomized to vitamin C compared to no vitamin C (hazard ratio = 0.65, 95% CI: 0.35–1.21, P = 0.17). In a model with no interaction, the progression rate was slightly higher in those randomized to beta-carotene (hazard ratio = 1.75, 95% CI: 0.57–5.36, P = 0.32) and also in those randomized to vitamin C (hazard ratio = 2.40, 95% CI: 0.74–7.80, P = 0.13). Neither of these were statistically significant. However, there was some evidence of an interaction effect of the two compounds on the progression rate (P = 0.052), with seven of the progressed lesions occurring in those randomized to both vitamins compared to a total of six in the three other groups. The currently available evidence from this and other trials suggests that high doses of these compounds are unlikely to increase the regression or decrease the progression of minor atypia and CIN I. © 1999 Cancer Research Campaign

Objective Observational studies suggest that moderate intakes of retinol and increased circulating retinol levels may increase fracture risk. Easy access to supplements, combined with an aging population, makes this a potentially important association. The aim of this study was to investigate plasma retinol and total carotene concentrations in relation to fracture risk after long-term supplementation with retinol and/or beta-carotene in 998 adults between 1990 and 2007. Methods Participants were 663 men and 335 women in a cancer prevention program who were initially randomized to a retinol (7.5 mg RE/d) or beta-carotene (30 mg/d) supplement between 1990 and 1996. After 1996, all participants received the retinol supplement only. Plasma retinol and total carotene, medication use and various lifestyle factors were measured at annual clinic visits. Fractures were identified by self-report in 2007. The risk for any fracture or osteoporotic fracture was modeled using Cox proportional hazard models. Results Over a median follow-up of 7.8 y, 123 participants with plasma samples reported an incident fracture. Although plasma retinol concentrations were markedly higher than those reported in observational studies, no association was observed between plasma retinol and risk for any fracture (hazard ratio [HR], 0.86 μmol/L; 95% confidence interval [CI], 0.65–1.14) or osteoporotic fracture (HR, 0.97 μmol/L; 95% CI, 0.66–1.43). A lower risk for any fracture was suggested with increasing plasma total carotenes (HR, 0.85 μmol/L; 95% CI, 0.71–1.01). Conclusions This study does not support earlier reports of an increased fracture risk associated with increased plasma retinol concentration. The potential for carotenes to prevent fractures deserves further investigation.

Uncertainty remains over whether or not high intakes of retinol or vitamin A consumed through food or supplements may increase fracture risk. This intervention study found no increase in fracture risk among 2,322 adults who took a controlled, high-dose retinol supplement (25,000 IU retinyl palmitate/day) for as long as 16 years. There was some evidence that beta-carotene supplementation decreased fracture risk in men. There is conflicting epidemiological evidence regarding high intakes of dietary or supplemental retinol and an increased risk for bone fracture. We examined fracture risk in a study administering high doses of retinol and beta-carotene (BC) between 1990 and 2007. The Vitamin A Program was designed to test the efficacy of retinol and BC supplements in preventing malignancies in persons previously exposed to blue asbestos. Participants were initially randomised to 7.5 mg retinol equivalents (RE)/day as retinyl palmitate, 30 mg/day BC or 0.75 mg/day BC from 1990 to 1996; after which, all participants received 7.5 mg RE/day. Fractures were identified by questionnaire and hospital admission data up until 2006. Risk of any fracture or osteoporotic fracture according to cumulative dose of retinol and BC supplementation was examined using conditional logistic regression models adjusting for age, sex, smoking, body mass index, medication use and previous fracture. Supplementation periods ranged from 1 to 16 years. Of the 2,322 (664 females and 1,658 males) participants, 187 experienced 237 fractures. No associations were observed between cumulative dose of retinol and risk for any fracture (OR per 10 g RE = 0.83; 95 % CI, 0.63–1.08) or osteoporotic fracture (OR per 10 g RE = 0.95; 95 % CI 0.64–1.40). Among men, cumulative dose of BC was associated with a slightly reduced risk of any fracture (OR per 10 g = 0.89; 95 % CI 0.81–0.98) and osteoporotic fracture (OR per 10 g = 0.84; 95 % CI 0.72–0.97). This study observed no increases in fracture risk after long-term supplementation with high doses of retinol and/or beta-carotene.

Background Iodine deficiency has re-emerged in Australia. Pregnant and breastfeeding women need higher iodine intakes (estimated average requirements: 160 μg/day and 190 μg/day) than non-pregnant women (100 μg/day) because iodine is critical for early infant development. The impact of iodine fortification of bread on women9s iodine intake is evaluated by reproductive status using 2003 Australian Longitudinal Study on Women9s Health (ALSWH) food frequency data and projected onto 1995 National Nutrition Survey (NNS) daily food consumption data for women of child-bearing age. Methods Recent iodine analyses of Australian foods were combined with reported intakes of key foods to estimate iodine intake before and after fortification for 665 pregnant, 432 zero to 6 months postpartum, 467 seven to 12 months postpartum and 7324 non-pregnant women. Differences in mean iodine intake between these groups were projected onto NNS estimates of total iodine intake for women of child-bearing age. Results Pregnant and postpartum women reported eating more bread than did non-pregnant women. Mean iodine intakes (μg/day before; and after fortification) from key foods were higher in pregnant (78; 124), 0–6 months postpartum (75; 123) and 7–12 months postpartum (71; 117) than in non-pregnant women (65; 103). Projecting ALSWH results onto the NNS yields total mean iodine intakes of 167, 167, 160 and 146 for the same groups. Conclusion Current iodine intakes are well below dietary recommendations. The impact of iodine fortification of bread would be greater for pregnant and postpartum women than has been previously estimated using general population intakes, but additional strategies to increase intakes by these groups are still needed.

Prostate cancer risk was examined in relation to intakes of fruit, vegetables, beta-carotene and retinol. Subjects were a cohort of 1985 men previously to asbestos who participated in a cancer prevention programme of beta-carotene and retinol supplements that commenced in July 1990. Diet was assessed at entry to the programme. Ninety-seven cases of prostate cancer were identified during follow-up until the end of 2004. A decreased prostate cancer risk was observed with increasing intakes of vitamin C-rich vegetables, including bell peppers and broccoli. Fruit, other vegetables and vitamin A intakes did not appear to be strong factors in the development of prostate cancer in this study.

The cutoffs defining anaemia based on haemoglobin and haematocrit recommended by the World Health Organization (WHO) and the United States (US) are different. We compared the prevalences resulting from these definitions and explored the reasons for the variation observed. A cross-sectional survey within a cohort study of children recruited at birth at Royal Darwin Hospital. Subjects were interviewed in their homes or other convenient location and had a blood sample drawn. Five hundred and seventeen Australian Aboriginal children aged 9–13 years inclusive. Depending on the criterion used, the prevalence of anaemia in the total group ranged between 6% (95% confidence interval: 4.1–8.4%) and 24.4% (20.7–28.3). Using the WHO criteria, girls aged 12–13 years were identified as a target group, having a two- to-six fold higher prevalence than the other groups. When compared to the US criteria, boys aged 12–13 years had the highest prevalence of anaemia, although this was not significant. Simulations show that the WHO cutoffs are based on inconsistent centiles of the age–sex haemoglobin and haematocrit distributions, and that this largely explains the discrepant results. This variability in definition could lead to inappropriate identification of target groups for intervention programmes. National Health and Medical Research Council of Australia, the Colonial Foundation and the Channel 7 Children's Research Foundation of South Australia Inc.

Objective: The Strong Women Strong Babies Strong Culture Program had specific goals to increase infant birthweights by earlier attendance for antenatal care and improved maternal weight status. Starting in August 1993, Aboriginal women in three pilot communities worked with pregnant women in a program that emphasised both traditional practices and Western medicine. Method: Two sources of data were used to examine different aspects of program effects. Results: Data from the NT Midwives Collection shows that the mean birthweight of infants of Aboriginal women increased by 171 g between 1990/91 and 1994/95 in the pilot communities and by 92 g in the surrounding three rural regions. Data extracted from clinic records in the pilot communities found that changes in maternal weight were associated with change in birthweight over time. Conclusion: Changes in birthweight coincide with the commencement of the program and are larger than the secular trend in surrounding communities. Implications: Ongoing evaluation of the expanded program will help to determine the extent to which the change in birthweight can be attributed to the program and whether the effects can be replicated.

Fortification of foodstuffs with folic acid is mandatory in many countries. Although the effect of folic acid in reducing neural tube defects in utero is well accepted, questions have been raised about possible adverse effects of higher intakes of folic acid on adult health. An increase in colorectal cancer and some other cancers has been postulated. As part of a larger fortification monitoring program in Australia, we conducted a systematic review of trials of folic acid for these outcomes. We found 26 trials using between 0.4- 20mg folic acid/day which reported all-cause mortality or the incidence of specified cancers or recurrence of colorectal adenoma. Using the in-trial follow-up data, the relative risks were 1.04 for total incident cancer (13 studies), 1.0 for colorectal and lung cancers, 0.82 for breast cancer, 1.16 for prostate cancer, 0.97 for the recurrence of colorectal adenoma and 1.11 for the recurrence of advanced colorectal adenoma. There was no association with all-cause mortality (relative risk=0.99, 23 studies). None of the relative risks were statistically significant at the customary alpha level. Our findings are similar to those of previous meta-analyses that have used different inclusion criteria to select studies.

To assess the utility of a new, rapid, economical procedure that may prove valuable in cervical screening, Fourier transform infrared (ir) spectroscopy was performed on 25 cervicovaginal lavage specimens from women referred for colposcopy on the basis of a cytological abnormality detected on their Pap smear and whose lavage specimen was positive for human papillomavirus. Of the 18 classed as CIN I or less by histopathology, 11 showed band frequencies that deviated only slightly from spectra that characterize normal cervical cells and 3 of 5 "atypia" specimens had spectra identical to normal. Two of 3 classed as CIN II had spectra only slightly more abnormal to these 11. In the case of 2 graded as CIN I, several bands were similarly altered in the direction of the pattern seen for 4 CIN III specimens. A further CIN I sample gave a spectrum that was even further shifted toward the latter and the remaining CIN I sample had a pattern that matched the 4 CIN IIIs. The most obvious change in each of the CIN IIIs was an additional peak at 972 cm-1 and this has been suggested as a key indicator for malignancy. One of the 3 CIN IIs had this peak. Other characteristic spectral changes were seen as well in the CIN III samples. High-risk HPV18 was present in 3 of the CIN III samples, as well as in one specimen classed as atypia, but having an abnormal ir spectrum. Low-risk HPV 6 or 11 was seen along in samples with a normal or slightly abnormal ir spectrum, but never in those that showed an ir pattern that was abnormal. The current study has therefore shown complete concordance between ir spectral findings and histopathology result in the case of CIN III specimens, but less precise matching for other grades of CIN. The spectral differences revealed by ir spectroscopy are likely to characterize molecular abnormalities in cervical cells during progression to cancer and may therefore have potential in assisting with clinical decision making. More studies will, however, be required to establish the place of this technique in cervical screening.