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To undertake secondary analyses of the 1997 National Diet and Nutrition Survey of Young People aged 4–18 years in order to describe the contribution of school meals to daily food and nutrient intakes; and to compare the findings from 1997 with data collected in English primary and secondary schools in 2004–2005.
Cross-sectional analysis of 7-day weighed inventory food consumption data according to age, sex, household income, free school meals and breakfast consumption. Comparison of food consumption with the Balance of Good Health and of nutrient intake data with the Caroline Walker Trust (CWT) guidelines.
One thousand four hundred and fifty-six UK schoolchildren aged 4–18 years, 7058 English primary-school pupils and 5695 English secondary-school pupils.
Pupils' school meal choices in 1997 did not accord with the Balance of Good Health. Food choices in school were less healthy than choices outside school. School meals failed to make good the shortfalls in daily intakes of non-starch polysaccharides and zinc in primary-school pupils, and of calcium, iron, zinc, vitamin A and non-starch polysaccharides in secondary-school pupils, nor excess daily intakes of saturated fatty acids, non-milk extrinsic sugars and sodium at all ages. School meals typically failed to meet CWT guidelines. They were more likely to meet CWT guidelines when choice of foods was restricted.
School meals need substantial improvement to meet CWT guidelines for healthy eating. The introduction of food-based guidelines for school meals in England in 2001 did not improve the food choices in school meals.
A comparison of a parent-completed Willett food-frequency questionnaire (FFQ) and a self-completed Youth/Adolescent Questionnaire (YAQ) has not yet been conducted.
In the Diabetes Autoimmunity Study in the Young (DAISY), parents report their child's diet on the FFQ annually from birth until age 10 years, when the child begins to report their own diet using the YAQ.
To determine the comparability of these collection methods, 89 children aged 10–17 years and their parents completed the YAQ and FFQ, respectively, for the child's previous year's diet.
We compared reported intakes for energy, the macronutrients and a variety of micronutrients of interest to the DAISY study.
Bland–Altman plots of energy-adjusted differences between questionnaire responses against their means suggested that the two collection methods gave similar results. The average Spearman correlation coefficient of all energy-adjusted nutrient intakes was 0.50, and did not differ significantly by gender (males, r = 0.48; females, r = 0.46) or age (10–11 years, r = 0.49; 12–17 years, r = 0.51). While correlated, the nutrient values from the FFQ were higher than the nutrient values from the YAQ.
While reported nutrient intakes are correlated, an indicator variable defining which survey method a nutrient was collected with should be included in any longitudinal data analyses examining nutrient intakes collected with the YAQ and the FFQ as independent predictors of a disease outcome.
In 2001 the UK Department of Health funded pilot community-based interventions to improve fruit and vegetable intakes in five economically deprived areas of England. The effectiveness of the programme and the use of a brief tool for evaluating community interventions are reported here.
Data on intakes of and beliefs about fruit and vegetables were collected by a short postal questionnaire (FACET – Five-a-day Community Evaluation Tool) simultaneously from 810 individuals living in the pilot communities and 270 individuals who were participating in an unrelated observational study (controls). Data were collected before and after a 12-month intervention period. Quantitative dietary data derived from 7-day food diaries available for control subjects were used to assess the ability of the FACET questionnaire to estimate fruit and vegetable intakes.
Compared with controls, the intervention group significantly increased their knowledge of the 5-a-day optimum (P < 0.01) and reported increased access to fruits and vegetables (P < 0.001). Overall, the intervention had no demonstrable effect on total fruit and vegetable intakes as measured by FACET. However, smoking habit strongly predicted change in fruit and vegetable intakes (P < 0.01) in the intervention group. Opposite trends were observed in the two groups, with ‘smokers’ and ‘non-smokers’ in the intervention and control groups respectively reducing their fruit and vegetable intakes. The FACET questionnaire agreed with food diary estimates of fruit and vegetable intakes in 56% of cases.
Community-based interventions can produce important changes in knowledge of and access to fruit and vegetables. However, in this study change in fruit and vegetable intakes was strongly influenced by smoking habit. This bias needs to be considered in planning future intervention and evaluation programmes. The FACET questionnaire provides acceptable estimates of fruit and vegetable intakes which may be used for grading intake in large community-based projects.
To examine the association between fruit and vegetable (F&V) availability and consumption, the possible influences on this association, research gaps, and implications for developing strategies to increase F&V consumption.
Systematic review of studies that have examined associations between F&V availability and consumption.
Qualitative studies conducted among children and adults indicated that greater availability was associated with greater consumption. This finding was supported by cross-sectional studies among children. Availability was associated with dietary psychosocial variables such as preferences, and it appears that availability may moderate the relationship between these psychosocial variables and consumption. Intervention studies attempting to increase availability have resulted in increased consumption, and availability has predicted change in consumption over an 18-month period.
Availability appears to be a key proximal determinant of consumption, especially of F&V, and thereby provides a target for change. However, the mechanisms that relate these variables are unclear and there is a need to clarify the direction of causality. We suggest that the possible causal mechanisms may include: (1) availability simply facilitates increased consumption; (2) the visual cues of available food may stimulate consumption; and (3) available food exposure may increase preference, which leads to increased consumption. Each of these possibilities requires close examination, as do policy-level interventions.
F&V availability is associated with increased consumption. Research that elucidates the mechanisms between availability and intake, and tests policy-level interventions, is needed to advance increased availability as a public health procedure.
With obesity and nutrition-related diseases rising, public health authorities have recently insisted nutritional quality be included when advertising and labelling food. The concept of nutritional quality is, however, difficult to define. In this paper we present an innovative, science-based nutrient profiling system, Nutrimap®, which quantifies nutritional assets and weaknesses of foods.
The position of a food is defined according to its nutritional composition, food category, the consumer's nutritional needs, consumption data and major public health objectives for nutrition. Amounts of each of 15 relevant nutrients (in 100 kcal) are scored according to their ability to ‘rebalance’ or ‘unbalance’ the supply in the whole diet, compared with current recommendations and intakes. These scores are weighted differently in different food categories according to the measured relevance of the category to a nutrient's supply. Positive (assets) and negative (weaknesses) scores are totalled separately.
Nutrimap® provides an overall estimate of the nutritional quality of same-category foods, enabling easy comparisons as exemplified for cereals and fruit/vegetables. Results are consistent with major nutritional recommendations and match classifications provided by other systems. Simulations for breakfasts show that Nutrimap® can help design meals of controlled nutritional value.
Combining objective scientific bases with pragmatic concerns, Nutrimap® appears to be effective in comparing food items. Decision-makers can set their own limits within the Nutrimap®-defined assets and weaknesses of foods and reach categorisations consistent with their objectives – from regulatory purposes to consumer information or support for designing meals (catering) or new products (food industry).
To examine associations of various psychosocial factors with fruit and
vegetable intake in African-American adults.
A cross-sectional survey of a population-based sample of 658
African-Americans, aged 18–70 years, in North Carolina.
Information was collected on diet-related psychosocial (predisposing,
reinforcing and enabling) factors based on the PRECEDE (Predisposing,
Reinforcing, and Enabling Constructs in Educational Diagnosis and
Evaluation) planning framework; demographic, lifestyle and behavioural
characteristics, and fruit and vegetable intake.
The mean participant age was 43.9 years (standard deviation 11.6), 57% were
female and 76% were overweight/obese. Participants expressed healthy beliefs
regarding many of, but not all, the psychosocial factors. For example,
although half of the respondents believed it is important to eat a diet high
in fruits/vegetables, only 26% knew that ≥ 5 daily
servings are recommended. The strongest associations of the psychosocial
factors with fruit/vegetable intake were for predisposing factors (e.g.
belief in the importance of a high fruit/vegetable diet and knowledge of
fruit/vegetable recommendations) and one reinforcing factor (social
support), with differences between the healthiest and least healthy
responses of 0.5–1.0 servings per day. There was evidence of
effect modification by gender in associations between psychosocial factors
and fruit/vegetable consumption (e.g. self-efficacy was only significant in
women), with higher intakes and generally healthier responses to the
psychosocial variables in women than men.
Interventions to increase fruit/vegetable intake in African-Americans may be
more effective if they focus primarily on predisposing factors, such as
knowledge, self-efficacy and attitudes, but not to the exclusion of
reinforcing and enabling factors. The psychosocial factors that are targeted
may also need to be somewhat different for African-American men and
While adult populations have been well described in terms of nutritional status, such as the concentration of nutrient biomarkers, little work has been done in healthy paediatric populations.
The primary objective of this analysis was to explore the determinants of plasma micronutrients in a group of healthy infants and children.
The Diabetes Autoimmunity Study in the Young (DAISY) has enrolled 1433 newborns at increased risk for type 1 diabetes in Denver, Colorado. A representative random sample of 257 children from the DAISY cohort between the ages of 9 months and 8 years with a total of 815 clinic visits over time was used in this analysis. Annual dietary intake was assessed over time with Willett food-frequency questionnaires that were validated in this population. Environmental tobacco smoke (ETS) was assessed using a validated survey. Plasma samples were tested for vitamins, carotenoids and total lipids. Predictors of plasma micronutrients were evaluated using mixed models for longitudinal data, while adjusting for age, human leukocyte antigen genotype, type 1 diabetes family history and other potential confounders and covariates.
Increased micronutrient intake was associated with increased levels of their respective plasma nutrient, with the exception of γ-tocopherol. Independent of dietary intake, levels of α- and β-carotene and β-cryptoxanthin were significantly lower, and γ-tocopherol was significantly higher, in children who were exposed to ETS.
Dietary intake predicts plasma micronutrient levels. Exposure to ETS potentially could have negative health effects in this young population.
To evaluate compliance with the World Health Organization's International Code of Marketing of Breast-milk Substitutes in primary care, after the introduction of strict local infant feeding guidelines.
An audit form was sent to all community-based health professionals with an infant feeding remit. Walking tours were conducted in a random sample of community care facilities.
Greater Glasgow Primary Care Division.
(1) Primary-care staff with an infant feeding remit; (2) community health-care facilities.
Main outcome measures
Contact with manufacturers of breast-milk substitutes (BMS) and BMS company personnel, free samples or incentives, and advertising of BMS.
Contact with company personnel was minimal, usually unsolicited and was mainly to provide product information. Free samples of BMS or feeding equipment were rare but childcare or parenting literature was more prevalent. Staff voiced concerns about the lack of relevant information for bottle-feeding mothers and the need to support the mother's feeding choice. One-third of facilities were still displaying materials non-compliant with the Code, with the most common materials being weight conversion charts and posters.
Contact between personnel from primary care and BMS companies was minimal and generally unsolicited. The presence of materials from BMS companies in health-care premises was more common. Due to the high level of bottle-feeding in Glasgow, primary-care staff stated a need for information about BMS.
To appraise critically the relevance and value of the evidence base to promote and support the duration of breast-feeding, with a specific focus on disadvantaged groups.
A systematic review was conducted of intervention studies relevant to enhancing the duration of breast-feeding; topics included public health, public policy, clinical issues, and education, training and practice change. A systematic search was conducted. Eighty studies met the inclusion criteria. Data were systematically extracted and analysed. Full results and recommendations are reported elsewhere. Here a critique of the evidence base – topics, quality and gaps – is reported.
Many studies were substantially methodologically flawed, with problems including small sample sizes, inconsistent definitions of breast-feeding and lack of appropriate outcomes. Few were based on relevant theory. Only a small number of included studies (10%) were conducted in the UK. Very few targeted disadvantaged subgroups of women. No studies of policy initiatives or of community interventions were identified. There were virtually no robust studies of interventions to prevent and treat common clinical problems, or of strategies related to women's health issues. Studies of health professional education and practice change were limited. Cost-effectiveness studies were rare.
Policy goals both in the UK and internationally support exclusive breast-feeding until 6 months of age. The evidence base to enable women to continue to breast-feed needs to be strengthened to include robust evaluations of policies and practices related to breast-feeding; a step change is needed in the quality and quantity of research funded.
This study aimed to explore the associations between breast-feeding, dietary intakes and other related factors and subclinical vitamin A deficiency (SVAD) in children aged 0–5 years in an area in China where mild vitamin A deficiency (VAD) is found.
Data were from a population-based cross-sectional study with 1052 children aged 0–5 years. SVAD cases were identified by the indicator of serum retinol ≤ 20 μg dl− 1. Breast-feeding status, dietary intakes and other factors were collected through a pre-designed questionnaire.
The prevalence of SVAD in children aged 0–5 years was 6.9%. Logistic regression analysis showed that the odds ratio of SVAD for breastfeeding was 3.56 (95% confidence limits (95% CL) 2.17–5.82). After adjustment for sex, age in categories, residence, mother's education, mother's occupation, vitamin A preparation supplements, rank in siblings and diarrhoea, the odds ratio for breast-feeding fell to 2.38 (95% CL 1.13–4.95). The odds ratios for breast-feeding within children aged 1 year were 5.46 (95% CL 2.07–15.03) and 4.6 (95% CL 1.72–12.82) before and after adjustment of other confounders, respectively. The odds ratios for breast-feeding did not show statistical significance within children aged 0 or 2 years. The odds ratios decreased, but remained statically significant after further adjustments for individual dietary factor or all dietary factors.
Breast-feeding was a risk factor of SVAD for children, especially for those aged 1 year. The differences in dietary intakes and other established risk factors could not fully explain the increased risk. This finding implies that prolonged breast-feeding alone may not ensure protection of children from VAD in an area with mild SVAD.
To describe the food habits and physical (in)activity patterns and to investigate the relationship with sociodemographic factors among Palestinian adolescents.
Design and subjects
The Palestinian Health Behaviour in School-aged Children (HBSC) is a cross-sectional survey of grades 6, 8, 10 and 12. Students completed a modified version of the international HBSC questionnaire. A total of 8885 students were included in this analysis; 53% were from the West Bank and 47% from the Gaza Strip.
Adolescents in the West Bank consume more fruit, meat, chicken, sweets and soft drinks, but less vegetables than adolescents in Gaza (P < 0.01). Girls reported more daily consumption of fruit, vegetables and sweets than boys (P < 0.001), and less consumption of soft drinks, milk, meat and chicken (P < 0.01). Boys were physically more active than girls (P < 0.01), whereas girls reported doing more homework (P < 0.001). Both boys and girls reported less physical activity with increasing age (P < 0.001). Consumption of fruit and milk was positively associated with both parents' education, while consumption of meat, chicken and soft drinks was positively associated with mother's education only. Having breakfast on schooldays was positively associated with the father's education. Physical activity and television viewing were associated with the mother's education (P < 0.01). The parents' level of education had no effect on vegetable consumption and dieting status.
This study indicated that there are problems with Palestinian adolescents' eating, dieting and physical activity. Regional, gender and parental socio-economic status differences should be taken into account in developing interventions. More detailed studies are needed with more elaborate instruments about food habits and physical activity of adolescents.
The purpose of this study was to investigate the knowledge and health beliefs regarding osteoporosis risk factors of New Zealand women aged 20–49 years.
A descriptive, web-based survey.
An opportunistic sample of 622 women aged between 20 and 49 years living in Auckland, New Zealand was recruited by email.
There was a moderate level of knowledge about osteoporosis risk factors among the women surveyed, with a mean total score for all subjects of 16.4 (standard deviation (SD) 4.0) out of a possible 26 correct responses. Mean scores for osteoporosis knowledge were statistically different by age group, with women aged 40–49 years scoring higher than those aged 30–39 years and 20–29 years (17.3 (SD 4.0), 16.4 (SD 4.1) and 15.8 (SD 3.9), respectively, P < 0.001). Overall, about a third of the women perceived that they were likely to develop osteoporosis and 22% believed the disease to be potentially crippling. Most women were aware of the benefits of exercise and optimal calcium nutrition in preventing osteoporosis. Few women perceived barriers to exercise participation and eating calcium-rich foods. Older women (40–49 years) were more motivated to take care of their health than younger women (P < 0.001). A large percentage of subjects (77%) thought that calcium-rich foods contained too much cholesterol.
Despite reporting higher than average educational attainment and health consciousness, these women demonstrated average levels of knowledge about osteoporosis risk factors. They had low feelings of susceptibility towards development of osteoporosis, but most considered it to be a serious disease.