Search

OBJECTIVE To assess the median urine iodine concentration (UIC) of young adults in the Top End of Northern Territory, before and after fortification of bread with iodised salt became mandatory. DESIGN, SETTING Analysis of cross-sectional data from two longitudinal studies, the Aboriginal Birth Cohort and the non-Indigenous Top End Cohort, pre- (Indigenous participants: 2006-2007; non-Indigenous participants: 2007-2009) and post-fortification (2013-15). PARTICIPANTS Indigenous and non-Indigenous Australian young adults (mean age: pre-fortification, 17.9 years (standard deviation [SD], 1.20 years); post-fortification, 24.9 years (SD, 1.34 years). MAIN OUTCOME MEASURE Median UIC (spot urine samples analysed by a reference laboratory), by Indigenous status, remoteness of residence, and sex. RESULTS Among the 368 participants assessed both pre- and post-fortification, the median UIC increased from 58 μg/L (interquartile range [IQR], 35-83 μg/L) pre-fortification to 101 μg/L (IQR, 66-163 μg/L) post-fortification (P

Background The mean intake of vitamin A of Australians aged 2 y and older was 300 µg retinol equivalents lower in the 2011-2012 national nutrition survey than in 1995 and decreases preponderated in adults rather than young children. Objective This aim of this study was to identify the foods associated with this change and to examine how the method used to adjust for within-person variability affects the estimated prevalence of inadequate intakes in both surveys. Methods Foods contributing to vitamin A intake were calculated from the first day of data. The prevalence of inadequate intakes was calculated using a 2-d average, the Iowa State University method, and the National Cancer Institute (NCI) method and either taken from the published reports or calculated using Food Standards Australia New Zealand's in-house software. Results In adults, lower consumption of liver, yellow fat spreads, milk products, and carrots and similar root vegetables accounted for most of the change in intake. Vitamin A intake data were less right-skewed in 2011-2012 than in 1995. The prevalence of inadequate vitamin A intake depended on the adjustment method chosen: for example, in 2011-2012 it ranged between 3% and 55% in men aged 19-30 y. The NCI method prevalence (21% for this group) is taken as the preferred estimate of inadequacy because the method adjusts around the mean and accounts for several other sources of variance. However, the NCI method could not be used to analyze the 1995 survey. Conclusions The lower vitamin A intake in Australia was related to changes in retinol intake rather than carotenoid intake and to lower consumption of several different types of food. The estimated prevalence of inadequate intake depends on the statistical method chosen for analysis. A direct measure of vitamin A status is needed to allow conclusions about the implications of the decreasing intake of this vitamin.

OBJECTIVES: Many countries produce guides to healthy food choices for their populations. Healthy food choices are typically based on ensuring micronutrient adequacy while limiting components such as saturated fat, sugar and sodium. It has also been proposed that the degree of food processing can be used as the criterion for classification either for advice to the public or for making regulatory decisions around which food should be allowed to be voluntarily fortified or carry health claims. This study examined the concordance between two such systems. METHODS: The food database used to analyze intakes reported in the 2011–12 Australian National Nutrition and Physical Activity Survey has been classified by others to identify a) which foods are recommended or ‘discretionary’ in the Guide to Healthy Eating and b) by degree of processing according to the four levels in the NOVA system. The NOVA classifications were collapsed to compare ‘ultra-processed’ foods to the other categories. RESULTS: There were 5645 foods in the database after excluding codes used to generate recipes for fortified foods (e.g., vitamins and minerals) and foods added for the 2013 Indigenous wave of the survey. Of the 4014 recommended foods, 23.5% were classed as ultra-processed whereas 31.2% of the discretionary foods were classified as not ultra-processed. In this dataset, nearly one-quarter of the foods would be recommended to the public by one classification but not by the other. Some notable discrepancies were the classification of recommended foods such as margarine and mass produced bread and buns and breakfast cereals as ultra-processed whereas butter, cream, sugar, honey, and homemade cakes, biscuits and jams are not classed as ultra-processed. It should also be noted that the descriptions in classification systems are often imprecisely worded and so some decisions in the two dataset could be debated. CONCLUSIONS: The survey database serves as a useful starting point to screen possible tools even though it contains averages rather than brand-level information. These two specific classifications do not lead to equivalent advice about which foods to choose. FUNDING SOURCES: None.

Aim: The review aims to describe how the use of dietary modelling to inform the development of food standards sits within a larger risk analysis framework and to show how the framework has wider applicability. Method: A narrative review is produced with reference to key published literature and authoritative sources related to the topic. Results: An essential feature of this framework is the separation in thinking between risk assessment and risk management. In risk assessment, dietary modelling assists in characterising the risk of the dietary component of exposure to a given food chemical or nutrient intake for a specific population. Risk management is the process of deciding what, if anything, should be done about the potential risk and analysing what option(s) are available. In risk management, the results of RISK Assessment, other information, such as behavioural science and health economic analysis, and policy considerations, inform the decision about which option should be selected. To illustrate how the framework can be used in public health, the steps in the framework are compared with the steps for developing food-based dietary guidelines, an educational tool aimed at the general public. Conclusion: The framework can help make sense of the various streams of information used in the wider public health nutrition arena. Depending on the purpose, different types of dietary modelling might be needed in risk assessment and to develop risk management options.

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

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.

Aims: The paper describes how a variety of different epidemiological study designs can be applied to data arising from a single prospective study. Methods: An overview of the data collection phases of the Aboriginal Birth Cohort Study is given. We illustrate how different research questions that require different analytical designs can be asked of the data collected in the present study. Results: With reference to five generic questions in health research, we showed how sixteen specific questions could be addressed in the Aboriginal Birth Cohort Study. These referred to a range of analytical designs. Conclusion: Readers need to take care not to confuse the overall design of a study with the design of a specific analysis. When conducting systematic literature reviews, studies should be classified according to the analytical design used in the specific report included in the review and not according to the design of the overall project.

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.

Aim: This paper describes the differences between the NUTTAB and AUSNUT food composition databases now available in Australia. Method: The NUTTAB and AUSNUT food composition databases are described in detail by officers of Food Standards Australia New Zealand directly involved in the database management and development. The positions of Food Standards Australia New Zealand in terms of revisions and policy directions are given from an authoritative perspective. Results: Food Standards Australia New Zealand develops two different sets of food composition databases, NUTTAB and AUSNUT. NUTTAB is a reference database that contains primarily analysed data for Australian foods. AUSNUT is a survey database that contains only data that are directly relevant to the particular national nutrition survey for which it was developed. These databases are available free of change from the Food Standards Australia New Zealand website. Conclusions: Food Standards Australia New Zealand develops two distinct series of food composition databases. Users will need to be aware of the similarities and differences of each database type to be able to determine which is the most suitable for their needs.

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.

OBJECTIVES To investigate dietary patterns and food intake as risk factors for surgically treated benign prostatic hyperplasia (BPH), as few risk factors have been established for BPH and recently there has been some interest in a role for diet in the development of BPH. PATIENTS, SUBJECTS AND METHODS A case-control study was conducted in Western Australia (WA) during 2001 and 2002. BPH cases were men with a diagnosis of BPH hospitalized for their first prostatectomy. Controls were frequency matched for age and sex from the WA electoral roll. A previously evaluated food-frequency questionnaire (FFQ) collected information on usual dietary intake 10 years earlier. Factor analysis identified dietary patterns in the FFQ data. Effects of dietary patterns and food intakes on the risk of BPH were examined using unconditional logistic regression, adjusting for various confounders. RESULTS In all, 406 cases and 462 controls (aged 40-75 years) provided data. Three dietary patterns were identified, i.e. 'Vegetable', 'Western' and 'Health Conscious'. BPH risk was not associated with the 'Health Conscious' or 'Western' patterns, but there was a lower risk with an increasing score for the 'Vegetable' pattern (odds ratio 0.78, 95% confidence interval 0.63-0.98). BPH risk was significantly and inversely related to the intake of total vegetables, dark yellow vegetables, other vegetables, tofu and red meat. There was a higher risk of BPH with increasing intake of high-fat dairy products. CONCLUSIONS These results indicate that vegetables, soy products, red meat and high-fat dairy foods might be important in the development of BPH.

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.

ObjectiveTo illustrate the effect of common mistakes when using 24-hour national dietary survey data to estimate the prevalence of inadequate nutrient intakes.DesignRaw data on nutrient intake from the Australian 1995 National Nutrition Survey were adjusted for within-person variance using standard techniques and corrected for underreporting using the criteria of Goldberg et al. The distributions for six nutrients were compared with current dietary reference values from the UK, USA and Australia.SettingA national sample of the Australian population with a 61.4% response rate.ResultsAdjusting for within-person variance reduced the range of nutrient intakes to 66–80% of the raw data range and the proportion with intakes below the estimated average requirement (EAR) by up to 20%. Excluding underreporters further reduced the proportion below the EAR by up to 10%. Using the dietary reference values from different countries also resulted in some markedly different estimates. For example, the prevalence of low folate intakes ranged from ConclusionsEstimates of the prevalence of low nutrient intakes based on raw 24-hour survey data are invariably misleading. However, even after adjustment for within-person variance and underreporting, estimates of the prevalence of low nutrient intakes may still be misleading unless interpreted in the light of the reference criteria used and supported by relevant biochemical and physiological measures of nutritional status.

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.

Objectives:To compare a widely used Australian food-frequency questionnaire (FFQ) with diet records and consider the results in relation to its use in nutrition surveillance.Design:Inter-method reliability study.Setting:A randomised trial in subjects with past asbestos exposure.Subjects:Seventy-two adults living in Western Australia.Methods:A semi-quantitative FFQ developed by the Commonwealth Scientific Industrial Research Organisation in South Australia was administered after the completion of four 7-day diet records (DRs).Results:Mean agreement between methods was not significantly different from 100% for many nutrients, but the limits of agreement indicated that, at the individual level, the FFQ over- or underestimated the DR by at least 50%. Mean agreement between methods decreased significantly with increasing intakes for the majority of nutrients. Pearson's correlation coefficients were less informative indicators of agreement compared with the limits of agreement.Conclusions:These results indicate poor agreement between the FFQ and DR when estimating absolute intakes. Therefore, comparing intakes collected using this FFQ with specific cut-off points such as Recommended Dietary Intakes for nutrition surveillance may lead to seriously flawed conclusions about population intakes.

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

ObjectiveThe effect on individual rankings and total intakes of nutrients of correcting total fruit and vegetable frequencies from a long food frequency questionnaire (FFQ) using the responses to two summary questions was examined in a group of women.MethodsThe performance of a self-administered FFQ in ranking individual levels of intake and estimating absolute levels of nutrient and energy intake was compared with the performance of the questionnaire when it was corrected for fruit and vegetable intake reported using the Block summary questions.SubjectsThe study population included 123 women, aged between 18 and 54 years, who were recruited from the Family Planning Association Colposcopy Clinic in Sydney.ResultsSubstantial and significant differences (PPConclusionThese results indicate that important differences in intakes are observed when two methods, which appear to yield the same results, are used. Further work is needed to determine which, if either, of the two methods yields intakes that can be compared quantitatively with national references for assessing the adequacy of population intakes.

ObjectiveTo compare intra- and inter-method reliability of a semi-quantitative food frequency questionnaire (FFQ) designed specifically to measure beta carotene (BC) and retinol intake, using two methods – the limits of agreement (LOA) and the correlation coefficient.DesignA cross-sectional study of dietary intake.SettingA randomized trial of vitamin A supplements in 2769 subjects with past asbestos exposure.SubjectsData from 57 men and 26 women, aged 28–72 years, living in Western Australia.MethodsThe FFQ was administered at baseline (FFQ1) and repeated 1 year later (FFQ2). Four 1-week diet records (DRs) were completed during the year.ResultsMean agreement between FFQ2 and FFQ1 was 120% for BC and 98% for retinol. LOA were 47–306% and 21–459%, respectively. Mean agreement between FFQ2 and the DR was 149% for BC and 63% for retinol; LOA were 50–447% and 11–349%, respectively. Mean agreement and LOA varied across energy intakes. Between the DR and FFQ2, correlation coefficients were 0.36 for BC and 0.51 for retinol. These varied considerably across age, gender and energy intakes and were not in accordance with limits of agreement findings.ConclusionAlthough correlation coefficients were positive and significant, there was less than ideal intra-method and inter-method reliability shown by the limits of agreement method. Bias was uneven across the range of intakes, the LOA were wide and, compared with the DR, the FFQ significantly over-estimated BC and under-estimated retinol. This shows the limitations of calculating correlation coefficients alone, for assessing reliability and validity.

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

The similarities and differences in four methods for adjusting nutrient intake for energy intake are discussed. The situation for macronutrients, as exemplified by fat intake, is compared to the situation for micronutrients such as vitamin C, with the conclusion that different methods are appropriate for the two situations. The categorization of data in analyses is identified as a source of potential misinterpretation of study results.

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.

OBJECTIVE To identify environmental factors involved in the etiology of insulin-dependent diabetes mellitus (IDDM). RESEARCH DESIGN AND METHODS An estimated 90% of all incident cases of IDDM in patients 0–14 years of age in New South Wales, Australia, were ascertained over 18 months. For each IDDM patient, two age- and sex-matched control subjects were randomly selected from the population. Past environmental exposures were determined with a questionnaire completed by the parents. Response rates were 92% for the IDDM patients (217 of 235) and 55% for the control subjects (258 of 470). The relative risk associated with each exposure was estimated with the odds ratio (OR) adjusted for confounding factors using multiple logistic regression. RESULTS The introduction of cow's milk-based infant formula into the diet before 3 months of age was associated with an increased risk (OR 1.52, 95% confidence interval [CI] 1.04–2.24). Exclusive breast-feeding for ≥3 months was associated with a protective effect (OR 0.66, 95% CI 0.45–0.97). High dietary intake of cow's milk protein in the 12 months before the onset of diabetic symptoms was also associated with an increased risk (OR 1.84, 95% CI 1.12–3.00). A recent infection (during the 3 months before onset of diabetic symptoms) was more common in the patients than the control subjects (OR 2.92, 95% CI 1.96–4.35), as was day care attendance before the age of 3 (OR 1.73, 95% CI 1.00–3.00). When two age-groups, defined by the median age at onset of diabetes, were compared, the associations with early infant-feeding were stronger among the younger group ( CONCLUSIONS These results indicate an increased risk of IDDM associated with early dietary exposure to cow's milk-containing formula, short duration of exclusive breast-feeding, high intake of cow's milk protein in the recent diet, recent infection, and early attendance at day care.

Publisher Summary Iodine is an essential component of the thyroid hormones thyroxine and triiodothyronine, which regulate metabolism throughout life and influence fetal and childhood physical and cognitive development. Australia and New Zealand have a common set of nutrient intake recommendations for iodine. Mandatory fortification of bread with iodine was introduced in Australia and New Zealand in 2009. All salt used in bread making is required to be iodized at 25–65 mg/kg salt with the exception of bread represented as organic. This chapter outlines the steps in the selection of bread as the food vehicle for iodine and the associated challenges. Bread was selected as the food vehicle because it is widely consumed by the population. Also, iodine fortification of bread is effective and safe, is technologically feasible, has minimal trade impacts, and is consistent with government polices and guidelines. In Australia and New Zealand, use of iodized salt in bread was projected to result in similar iodine intake improvements as those predicted for use of iodized salt in all salted processed foods, provided iodine concentrations were adjusted accordingly. Mandatory iodine fortification could not deliver sufficient amounts of iodine to fully accommodate the elevated requirements of pregnant and breast-feeding women without causing large numbers of young children to exceed their upper level of intake.

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.

Background In 1987, a prospective study of an Australian Aboriginal Birth Cohort was established focusing on the relationships of fetal and childhood growth with the risk of chronic adult disease. However as the study is being conducted in a highly marginalized population it is also an important resource for cross-sectional descriptive and analytical studies. The aim of this paper is to describe the processes of the third follow up which was conducted 20 years after recruitment at birth. Methods Progressive steps in a multiphase protocol were used for tracing, with modifications for the expected rural or urban location of the participants. Results Of the original 686 cohort participants recruited 68 were untraced and 27 were known to have died. Of the 591 available for examination 122 were not examined; 11 of these were refusals and the remainder were not seen for logistical reasons relating to inclement weather, mobility of participants and single participants living in very remote locations. Conclusion The high retention rate of this follow-up 20 years after birth recruitment is a testament to the development of successful multiphase protocols aimed at overcoming the challenges of tracing a cohort over a widespread remote area and also to the perseverance of the study personnel. We also interpret the high retention rate as a reflection of the good will of the wider Aboriginal community towards this study and that researchers interactions with the community were positive. The continued follow-up of this life course study now seems feasible and there are plans to trace and reexamine the cohort at age 25 years.

Long-term poor growth outcomes are well documented for intrauterine growth-retarded babies (IUGR) in developed populations but there is a paucity of IUGR studies from disadvantaged populations where the greatest burden of IUGR occurs. Using a Northern Territory, Aboriginal cohort recruited at birth and followed up at a mean age of 11.4 years, comparisons of body size were made between children born at term who had been IUGR (n = 121) and those non-IUGR (n = 341), and between those IUGR babies who had an appropriate ponderal index at birth (n = 72) and those with a low ponderal index (n = 49). Compared with non-IUGR children, at follow-up the IUGR children were almost 2 cm shorter (P = 0.10), 4 kg lighter (P0.01) and their head circumferences were almost a 1 cm smaller (P0.01). For the 121 term IUGR children, there were no significant differences in growth outcomes according to ponderal index measures at birth. These findings from an Australian Aboriginal sample are consistent with other comparisons of IUGR and non-IUGR children in developed populations and suggest there may be no additional effects of IUGR on growth in childhood for disadvantaged populations similar to the Aboriginal population in the Northern Territory.

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:To consider the application of the store-turnover method as a guide to assess food intake in remote Aboriginal communities. Method:Food sources in a remote Aboriginal island community were documented. The contribution of quantifiable food sources to total community-level fresh fruit and vegetable availability was determined. Results:The store remains the single largest supplier of fruit and vegetables overall (54%), however its contribution varies depending on the subpopulation of interest. A store-turnover alone may significantly underestimate communitylevel dietary intake, depending on the contribution of other food sources. Conclusions:Changes in the food supply in remote communities, coupled with methodological complexities inherent in the store-turnover method, challenge its application in a contemporary context. Implications:A simplified version of the store-turnover method is needed that could be widely applied by community people and health practitioners seeking to initiate and monitor interventions to improve diet quality.

Remote dietary intakes may be more important than recent diet in the etiology of cancer because of the long latency in cancer development. We examined the reliability of remote dietary recall over 10 y. Subjects were 56 adults participating in a cancer prevention trial in Western Australia. All subjects completed a 28-d diet record (DR) in 1991. A food-frequency questionnaire (FFQ) modified to ask respondents about their diet 10 y earlier was sent to each subject for completion in 2001. Remote intakes recalled from 10 y earlier using the FFQ were compared with the DR using the limits of agreement (LOA) method and Pearson correlation coefficients. Mean intakes of most nutrients did not differ between dietary methods. The LOA indicated that the FFQ could under- or overestimate DR estimates by >/=50%. For many nutrients, agreement between methods depended on the magnitude of intake. Pearson's correlation coefficients ranged from 0.02 for retinol to 0.66 for alcohol. These findings are similar to those of other studies that examined the reliability of recent and remote dietary intakes. They also show that using this FFQ, remote diet recalled from 10 y earlier may be as reliable as recent dietary recall.

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.

Background It is thought that vitamin E may improve tolerance to intermittent claudication (i.e. pain caused by ischaemia in the muscles of the leg during exercise), thereby relieving the pain, through a variety of mechanisms. Objectives The objective of this review was to determine the effects of vitamin E on people with intermittent claudication. Search methods The authors searched the Cochrane Peripheral Vascular Diseases Group trials register, reference lists of relevant articles and a library specialising in literature on vitamins (most recent search performed in November 2000). Selection criteria Controlled trials comparing vitamin E with placebo, or other interventions, in patients with intermittent claudication. Data collection and analysis Both authors extracted data and assessed study quality independently. Main results Five eligible studies were found with a total of 265, predominantly male, participants. The average age was 57 years. The follow-up varied from 12 weeks to 18 months. The trials were small and generally of poor quality. The people studied were reasonably homogeneous but five different doses of vitamin E were used and four different physical outcomes were measured. No trials were identified that compared vitamin E with treatments other than placebo. All trials showed positive effects on one of their main outcomes. No serious adverse effects of vitamin E were reported. Two trials that lasted approximately eight months and used similar doses reported patients' subjective evaluation of the treatment. The relative risk for the combined results of these two trials using a random effects model was 0.57 with a 95% confidence interval of 0.28 to 1.15. Authors' conclusions While vitamin E - which is inexpensive and has had no serious side effects reported with its use - may have beneficial effects, there is insufficient evidence to determine whether it is an effective treatment for intermittent claudication.

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.