Abstract Breastfeeding is promoted internationally as the preferred method of feeding for infants up to the age of four to six months. As a consequence there is much research interest in factors which may be predictors of breastfeeding. This paper presents a review of the recent literature identifying factors associated with the initiation and duration of breastfeeding among Western women. Attention was focused on studies which employed multivariate analysis of the data and breastfeeding initiation and duration were considered as two uniquely separate events. This review reveals that the associations between breastfeeding and many of the factors commonly investigated were not consistent. Many of the strong associations previously reported in univariate studies were not evident in more recent studies which employed multivariate analysis to control for covariates and potential confounders. While there was a strong and consistent association with demographic factors such as maternal age and level of education, there was a less consistent association with factors such as marital and socioeconomic status. Similarly, the previously reported univariate associations between breastfeeding and biomedical factors such as parity, method of delivery and infant health were less consistent in multivariate studies. However, a consistent negative association has been reported between maternal smoking habits and breastfeeding duration. More recent studies have investigated the association between breastfeeding and psychosocial factors. There is evidence to suggest that fathers play an important role in the breastfeeding decision and that intended duration is a strong predictor of actual duration. Despite the inconsistency of the reported associations, this review highlights the fact that breastfeeding is multifactorial in nature and future programs aimed at promoting breastfeeding must take this into consideration. (Aust J Nutr Diet 1998;55:51-61).

Do we agree on the interpretation of some commonly used indicators?

Dorothy Mackerras

Abstract A survey of health professionals (predominantly dietitians) and dietetics students was conducted to ascertain their views about words and phrases used in relation to definitions of indicators for measuring body weight, breastfeeding, and fruit and vegetable consumption. There were individual differences in how all the indicators were interpreted. Calculations were done to illustrate how the prevalence of different weight categories in the community differed when two common interpretations of the cutpoints were used; the prevalence of overweight and obesity varied by 4 to 6%. Further research is needed to determine how the public understands questions used in surveys before survey results can be compared to nutritional and health targets confidently. Targets and indicators based on a particular measuring method cannot be directly compared to the results of a survey that used a different method without calibration. (Aust J Nutr Diet 1998;55:63-67,73).

Fat, n-6 and n-3 fatty acid intake in rheumatoid arthritis and osteoarthritis patients

Dianne H. Volker, Gabor A. Major and Manohar L. Garg

Abstract The aim of this study is to determine the total fat intake and n-6 to n-3 polyunsaturated fatty acid (PUFA) ratio of rheumatic disease patients (considered candidates for n-3 PUFA supplementation) and to describe the likely influence of the background diet on supplementation efficacy. Consecutive patients with a diagnosis of rheumatoid arthritis and osteoarthritis volunteered to participate in a dietary survey. A previously validated semi-quantitative food frequency questionnaire was administered by a dietitian. One hundred and two patients (52 rheumatoid arthritis, 50 osteoarthritis) completed the survey. There were no significant dietary differences between the two groups. There was marked inter-subject variability in n-6 intake (2.5 to 43.4 g per day) and n-3 intake (0.6 to 4.7 g per day) and the n-6 to n-3 ratio varied between 2.3 and 12.7 with a mean n-6 to n-3 ratio of 7 to 1. Indication of significant change in dietary fat composition in recent years suggests that background dietary factors must be determined contemporaneously with any intervention. (Aust J Nutr Diet 1998;55:69-73).

The body size preferences of underweight young women from different cultural backgrounds

Jennifer A. O'Dea

Abstract This study investigated the body size preferences of underweight [body mass index (BMI) < 20] young women from different cultural backgrounds. Of the 276 underweight women in the study 12.6% had a BMI below 17, 37.5% below 18, and 57.5% below 19. The women perceived their current body size to be bigger than their ideal body and bigger than the ideal female body but smaller than the ideal male body. The mean (±SD) discrepancy score (current self minus ideal self) was 0.3 (±1.0) indicating a desired body size which was 10% slimmer than their current size. A total of 42% wanted to be slimmer, 43% were satisfied with their current size and 15% desired a bigger body. The women of Northern European background desired a body which was 12.5% slimmer than their current body size, women of Southern European and Asian background desired 7% and 10% slimmer bodies respectively. There were no cultural differences in age, BMI, body size perception, male and female body ideals or the discrepancy score between Northern European, Southern European or Asian women. Very underweight women (BMI < 18) and underweight women (BMI 18 to 19.9) did not differ in their body size perceptions, male and female body ideals, the discrepancy score or the number who wanted to be slimmer (42%), and there were no cultural differences. Dietitians and educators should be aware that underweight young women of various cultural backgrounds are likely to desire and pursue weight loss. The assessment of body image is appropriate prior to dietary counselling, treatment or education. (Aust J Nutr Diet 1998;55:75-80).

The calculation of the energy requirement of a critically ill child: a dietitians' survey

Melinda S. White

Abstract Optimal nutritional support is essential to the recovery of critically ill children. To supply optimal nutritional support, knowledge of energy requirements is needed. The aim of this study was to determine the methods by which dietitians in Australian hospitals calculated the energy requirement of a critically ill child in a given case scenario. A questionnaire containing a case study of a critically ill child was sent to the nutrition and dietetic departments of Australia's major hospitals. The dietitians were requested to calculate the energy requirement of the case study. There was variation in predicted energy requirements. A majority of the dietitians used the recommended energy intakes from the joint FAO/WHO/UNU expert consultation in 1985. There was also a large variation in injury factors used in the calculations. The amount of experience a dietitian had with critically ill children had no effect on the method used to calculate the energy requirement. The results indicate a need for guidelines on the use of predictive equations to estimate energy requirements in critically ill children. (Aust J Nutr Diet 1998;55:82-86).

Viewpoint

Health claims and functional foods: time for a regulatory change

Peter Williams

Abstract Food standards in Australia currently prohibit any health claims for foods to be used on labels or in advertising, even if they are true. Evaluation of the experience of health claims in the American market suggests that there may be public health benefits from allowing claims to be made, both in terms of improved purchasing patterns, greater consumer health knowledge and encouragement of the development of nutritionally improved products. Allowing health claims in Australia could assist the promotion of functional foods and help meet consumer demands for better information on labels, but the issues of substantiation and wording of claims need careful consideration. (Aust J Nutr Diet 1998;55:87-90).