Understanding differences in dietary patterns by smoking status is important for nutritionists and health educators involved in helping individuals to make healthy dietary and lifestyle choices. Although smokers have a poor quality diet compared with nonsmokers, no study has examined nutritional adequacy and variability in the nutrient intake of smokers. The aim of this study was to compare dietary habits of smokers with nonsmokers in terms of nutrient intake, food groups contributing to nutrient intake, nutritional adequacy and day-to-day variation in nutrient intake. Noninstitutionalized adults aged 18--65 y (n = 1543) who participated in the Food Habits of Canadians Survey (1997--1998) were studied. Subjects, selected from across Canada using a multistage, random-sampling strategy, completed an in-home 24-h dietary recall. Repeat interviews were conducted in a subsample to estimate variability in nutrient intake. Smokers had higher intakes of total and saturated fat, and lower intakes of folate, vitamin C and fiber than nonsmokers. There were no significant differences in calcium, zinc and vitamin A intakes or day-to-day variation in nutrient intake by smoking status. Smokers consumed significantly fewer fruits and vegetables than nonsmokers, leading to lower intakes of folate and vitamin C. In conclusion, smokers have a less healthy diet than nonsmokers, placing them at higher risk for chronic disease as a result of both dietary and smoking habits. Diet may act as a confounder in smoking-disease relationships.

Day-to-day variability in dietary intake makes it difficult to measure accurately the "usual" intake of foods and nutrients. The objectives of the present study were to estimate within- and between-subject variability for foods and nutrients by adjusted and unadjusted models and to assess the number of days required to assess nutrient and food group intakes accurately by two different methods. Adult men and women aged 18-65 y (n = 1543) in the Food Habits of Canadians Study provided a 24-h recall. A repeat interview was conducted in a subsample to estimate components of variability. Within- and between-subject variability were determined by mixed model procedure (crude and adjusted for age, gender, education, smoking, family size and season). The number of days required to obtain various degrees of accuracy was ascertained by two methods, one that uses the variance ratio for groups and one that considers within-subject variability alone for individuals. Variance ratios were higher using the adjusted compared with the unadjusted method (e.g., for men, energy 1.07 vs. 0.49). More days were required to reflect usual intake with accuracy using the adjusted model (energy 5 vs. 2 d), indicating the need to control for confounders to obtain reliable estimates of intakes.

AbstractObjectiveTo determine the prevalence of vitamin A deficiency, infection and adequacy of vitamin A intakes among Zambian children, and the contribution of dietary vitamin A and infection to vitamin A status.DesignA cross-sectional survey of vitamin A intakes by the 24 h recall method, vitamin A status by plasma retinol and the modified relative dose-response test, and infection by acute-phase proteins.SettingRural communities in Central and Eastern Provinces of Zambia.SubjectsChildren 2–5 years of age.ResultsThe prevalence of vitamin A deficiency was 56 % by plasma retinol, 48 % with infection-adjusted plasma retinol and 22 % by the modified relative dose-response test. The majority of children (61 %) had a current infection. Vitamin A intakes were relatively high (331 to 585 μg retinol activity equivalents/d in the harvest/early post-harvest and late post-harvest seasons, respectively) and the prevalence of inadequate intakes was <1 % when compared with the Estimated Average Requirement (210 and 275 μg retinol activity equivalents/d for children aged 1–3 and 4–8 years, respectively). Elevated α-1-acid glycoprotein was negatively associated with plasma retinol (P< 0·0 0 1) and vitamin A intake was positively associated with plasma retinol (P< 0·05), but only when estimated assuming a 26:1 retinol equivalence for provitamin A from green and yellow vegetables.ConclusionsInfection and vitamin A intakes were significant determinants of plasma retinol. We cannot conclude which indicator more accurately represents the true vitamin A status of the population. Reasons for the persistent high prevalence of vitamin A deficiency in the presence of adequate vitamin A intakes are unclear, but the high rates of infection may play a role.

This study sought to elucidate the multi-level factors that influence behaviors underlying high childhood stunting and widespread micronutrient deficiencies in Kiribati. This two-phase formative research study had an emergent and iterative design using the socio-ecological model as the guiding theoretical framework. Phase 1 was exploratory while phase 2 was confirmatory. In phase 1, in-depth interviews, free lists, seasonal food availability calendar workshops, and household observations were conducted. In phase 2, focus group discussions, pile sorts, participatory workshops, and repeat observations of the same households were completed. Textual data were analyzed using NVivo software; ethnographic data were analyzed with Anthropac software for cultural domain analysis. We found a combination of interrelated structural, community, interpersonal, and individual-level factors contributing to the early child nutrition situation in Kiribati. Despite widespread knowledge of nutritious young child foods among community members, households make dietary decisions based not only on food availability and access, but also longstanding traditions and social norms. Diarrheal disease is the most salient young child illness, attributable to unsanitary environments and sub-optimal water, sanitation, and hygiene behaviors. This research underscores the importance of a multi-pronged approach to most effectively address the interrelated policy, community, interpersonal, and individual-level determinants of infant and young child nutrition in Kiribati.

This paper provides information on optimal breastfeeding practices in the People's Democratic Republic of Lao from data collected in the 2011 Lao Social Indicator Survey. Results: Early initiation of breastfeeding within the first hour of life occurred among 39.6% of Laotian infants. After controlling for the effects of wealth, early initiation of breastfeeding was found to be most prevalent among mothers with higher education, those who received antenatal services, and those who delivered in a health facility. Avoidance of prelacteal feeds within the first three days of life occurred among 65% of Laotian infants, and was highest among ethnic Hmong and Khmer infants, and among those born in public versus private health facilities. Avoidance of prelacteal feeds was lowest after deliveries in which a traditional birth attendant was present. Exclusive breastfeeding through the first 5 months of age was reported among 40.8% of infants nationally. Ethnicity again played a role with the highest levels of exclusive breastfeeding found to occur among ethnic Khmer infants (69.4%, OR 2.8, CI: 1.5-5.1). Discussion: These results highlight the role that health care workers can have on early breastfeeding practices at the point of both antenatal counseling and in the delivery setting. Strengthening the quality of counseling on infant feeding can have a significant impact on early initiation of breastfeeding. Ethnic differences significantly impact both early and exclusive breastfeeding practices. Conclusion: A complexity of factors at different levels of care impact breastfeeding practices. A synergy of strategic approaches are needed to target antenatal counseling as well as post-delivery practices, all which account for the unique social and cultural attitudes towards infant feeding. Stronger community-based interventions that account for cultural attitudes and practices are most likely to be successful in promoting exclusive and continued breastfeeding practices.