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The present study aimed to examine the temporal prevalence of overweight and obesity in Irish children through different methodologies and evaluate the change in rates between 1990 and 2019.
Anthropometric data from three Irish national food consumption surveys were used to examine the change in the prevalence of BMI and waist circumference-derived overweight and obesity levels.
Three cross-sectional food consumption surveys from the Republic of Ireland: the Irish National Nutrition Survey (1990), the National Children’s Food Survey (2005) and The Second National Children’s Food Survey (2019).
A demographically representative sample of Irish children aged 5–12 years: 1990 (n 148), 2005 (n 594) and 2019 (n 596).
Twelve percentage of children had overweight/obesity in 1990, which was significantly higher in 2005 at 25 % and significantly lower in 2019 at 16 % (P = 0·003). In 2019, more girls had overweight/obesity in comparison with boys (19 v. 14 %), whilst children from the lowest social class group had the highest levels of overweight/obesity (P = 0·019). Overall, the proportion of children with abdominal overweight/obesity was significantly lower in 2019 in comparison with 2005 (P ≤ 0·001).
Evidence from the most recent national survey suggests that overweight and obesity levels are plateauing and in some cases reducing in children in Ireland. Despite this, rates remain high, with the highest prevalence in 2019 observed in girls and in those from the lowest social class group. Thus, overweight/obesity prevention and intervention policies are necessary and should be continued.
Dietary patterns describe the combination of foods and beverages in a diet and the frequency of habitual consumption. Better understanding of childhood dietary patterns and antenatal influences could inform intervention strategies to prevent childhood obesity. We derived empirical dietary patterns in 1142 children (average age 6·0 (sd 0·2) years) in New Zealand, whose mothers had participated in the Screening for Pregnancy Endpoints (SCOPE) cohort study and explored associations with measures of body composition. Participants (Children of SCOPE) had their diet assessed by FFQ, and dietary patterns were extracted using factor analysis. Three distinct dietary patterns were identified: ‘Healthy’, ‘Traditional’ and ‘Junk’. Associations between dietary patterns and measures of childhood body composition (waist, hip, arm circumferences, BMI, bioelectrical impedance analysis-derived body fat % and sum of skinfold thicknesses (SST)) were assessed by linear regression, with adjustment for maternal influences. Children who had higher ‘Junk’ dietary pattern scores had 0·24 (sd 0·08; 95 % CI 0·04, 0·13) cm greater arm and 0·44 (sd 0·05; 95 % CI 0·01, 0·10) cm greater hip circumferences and 1·13 (sd 0·07; 95 % CI 0·03, 0·12) cm greater SST and were more likely to be obese (OR 1·74; 95 % CI 1·07, 2·82); those with higher ‘Healthy’ pattern scores were less likely to be obese (OR 0·62; 95 % CI 0·39, 1·00). In a large mother–child cohort, a dietary pattern characterised by high-sugar and -fat foods was associated with greater adiposity and obesity risk in children aged 6 years, while a ‘Healthy’ dietary pattern offered some protection against obesity. Targeting unhealthy dietary patterns could inform public health strategies to reduce the prevalence of childhood obesity.
Milk is widely recognised as a nutrient dense food, supporting the growth and development of children. Nevertheless some milk types such as whole milk can consist of high levels of saturated fat, which is recognised for its association with chronic disease risk in adults when intakes are elevated. In Ireland, current dietary guidelines recommend that children from two years onwards should consume low fat milk. Previous research has shown low levels of compliance with this guideline. Therefore the aim of this study is to review the current consumption of milk and non-dairy milk-based alternatives among Irish children and compare these with previous intakes.
Dietary intakes of ‘whole milk’ decreased over time from 232 ± 186g/d to current intakes of 131 ± 154g/d. In contrast, increases were noted in ‘reduced fat milks’ (26 ± 86g/d to 52 ± 110g/d) and ‘non-dairy alternatives’ (0.2 ± 4g/d to 3 ± 19g/d). A total of 68% of children were classified as consumers of whole milk (193 ± 151g/d) compared to 90% (257 ± 178g/d) previously. ‘Reduced fat milk’ consumers increased from 17% to 31% and ‘non-dairy alternatives’ consumers also increased from < 1% to 3%.
Our preliminary results indicate that the number of Irish children consuming whole milk have decreased over the last number of years. In contrast consumers of ‘reduced fat milks’ have significantly increased, indicating potential improvement to healthy eating guidelines adherence. Further analysis to examine current intakes and sources of saturated fat is warranted to establish additional changes in dietary patterns and compliance with recommendations within this age group.
Current dietary recommendations encourage increased fibre and reduced sugar consumption. In the UK, specific targets and benchmarks have been established for the sugar content of some foods but not for fibre. National Food Consumption Surveys provide comprehensive information of all foods consumed by representative population samples. The Irish national food surveys as completed by the Irish Universities Nutrition Alliance (IUNA) capture dietary data at brand level with all details as gathered on pack entered into a discrete but inter-linked database, the Irish National Food Ingredient Database (INFID). The aim of this study was to profile the carbohydrate quality of a convenience sub-sample of packaged foods as eaten by Irish children during the National Children's Food Survey II (2017/2018) as entered into INFID.
Materials and Methods:
All on-pack details from 385 available foods in the categories ‘white breads and rolls’; ‘brown breads and rolls’; ‘other breads and scones’; ‘ready to eat breakfast cereals (RTEBC)’; ‘biscuits’; and ‘cakes, buns and pastries’ were entered in to INFID and quality control completed. The carbohydrate profile of the products was assessed with respect to fibre labelling criteria and UK sugar guidelines and targets. SPSS Version 25 was used for all analyses.
Although 56% (n210) of all products entered were eligible to make a ‘source of’ or ‘high’ fibre claim, only 20% (n78) made such a claim. Of this, 46% stated ‘high fibre’ and 32% ‘source’, predominately in the ‘brown breads and rolls’ and ‘RTEBC’ groups. When compared to UK Department of Health guidance for ‘low’, ‘medium’ and ‘high’ sugar, 65% of all products examined (n250) were either ‘low’ or ‘medium’ sugar. Comparison of median sugar contents with Public Health England sugar reformulation targets revealed different responses in each category, with all categories other than foods deemed as “morning goods” yet to meet the 2020 target of 20% reduction in sugar content.
This small pilot study of a convenience sample of foods suggests that for the limited number of foods examined, for some there remains challenges to reduce sugar and increase fibre contents. Strategies such as reformulation, change in portion size, flexibility in labelling and/or a shift in sales portfolios could be considered but only alongside technological and safety considerations. Further research to broaden this analysis and to link nutrient levels as listed on pack with actual consumption patterns could help ensure all recent initiatives including reformulation are recognised.
Research suggests that food fussiness (FF) and food neophobia (FN) are two separate constructs. Food fussiness is the tendency to be selective about a large proportion of familiar and unfamiliar foods, while food neophobia is the refusal of novel foods. Therefore, the aim of this study is to explore the association between parental feeding practices and child's FF or FN.
Analysis was based on cross-sectional data from the nationally representative Irish National Children's Food Survey II (NCFSII; 2017–2018). The NCFSII collected detailed eating behaviour data from children aged 5–12 (n = 596) using the Children's Eating Behaviour Questionnaire (CEBQ). This questionnaire contained four items from the food fussiness subscale that represented FN and two items that represented FF. The Feeding Practices & Structure Questionnaire (FPSQ) assessed non-responsive and structure-related parental feeding practices. Spearman's correlation established the association between parental feeding practices and child's FF and FN. Moderation analyses was conducted to explore the extent to which child's age moderates the association.
Higher levels of child's FN was weakly to moderately associated with higher parental reports of reward for eating (RE) (r = .210, p < 0.001), persuasive feeding (PF) (r = .340, p < 0.001), overt restriction (OR) (r = .195, p < 0.001) and lower reports of structured meal settings (SMS) (r = -.085, p = 0.039) and family meals (FMS) (r = -.387, p < 0.001). Higher levels of child's FF had a slightly stronger association with the same parental feeding as FN, with additional associations with structured meal timings (SMT) (r = -.089, p = 0.031) and covert restriction (CR) (r = -.083, p = 0.045). Age moderated the association between both child's FF [b = .22, p < 0.001] and FN [b = .17, p = 0.002] and parental reports of PF, along with moderating the association between child's FF [b = .11, p = 0.04] and parental reports of SMT.
Overall, child's FN and FF were both associated with higher levels of non-responsive feeding practices and lower reports of structure-related feeding practices, with child's FF associated with more parental feeding practices than FN. These findings suggest that it is important to address FN and FF as separate constructs, with more structure-related feeding practices inversely associated with higher levels of FF only. In addition, as children get older findings suggest that less parental feeding practices are utilised, however, higher levels of child's FF/FN are associated with similar levels of PF and SMT (FF only) regardless of age.
Being physically active is associated with fundamental health benefits and assists with the maintenance of normal weight in children. The current World Health Organizations’ recommendation is for children to accumulate 60 minutes of physical activity (PA) per day to obtain such benefits. Conversely, time spent in sedentary behaviours including watching screens (ST) are positively associated with the risk of overweight and obesity in young people. The aim of this research was to estimate PA levels and ST usage of Irish children and to examine the relationship with body fat.
This analysis was based on data collected from a nationally representative sample of Irish children aged 5–12-years (n = 591, 50% female) from The National Children's Food Consumption Survey II (www.iuna.net). The Child/Youth Physical Activity Questionnaires (C-PAQ/Y-PAQ) were used to measure PA and ST in 5–8 and 9–12-year-olds respectively. Both questionnaires were self-administered, recall instruments that assessed the frequency/duration of activities participated in over the previous 7-day period. The MET minutes (metabolic cost of the activity multiplied by the duration in minutes) of the PA's were calculated per child. Percentage body fat (%BF) was measured by a Tanita BC420MA device and participants were classified into categories based on their %BF, age and gender. Independent t-tests and ANOVA (post-hoc DunnettT-3) were used to assess differences between gender and %BF category.
Overall, children spent 93 mins/d being physically active with 69% meeting the > 1hr recommendation. There was a significant difference in the time spent undertaking PA between boys (99 mins/d) and girls (88 mins/d) p = 0.020. Children spent 107 mins/d watching screens with 68% meeting the < 2hr guidance. Girls spent significantly less time watching screens (89 mins/d) than boys (124 mins/d) p ≤ 0.001. Children who had a normal %BF accumulated more PA MET mins/day compared to those who were classified as obese, which was significant in the total population (p = 0.007), for boys (p ≤ 0.001), but not girls (p = 0.929).
This preliminary analysis indicates that a high proportion of Irish children are meeting the PA and ST recommendations, with boys being more physically active and spending more time watching screens compared to girls. However, results should be interpreted with caution as PA and ST usage were self-reported by participants. The association between PA MET minutes and %BF suggest that advice to encourage PA participation to combat excess adiposity in Irish children is justified. Future work should examine the role of other potential determinants of obesity in this cohort.
The Food Safety Authority of Ireland (FSAI) have set target maximum daily salt intakes for children (4–6y: 3 g, 7–10y: 5 g, 11–14y: 6g) while the European Food Safety Authority (EFSA) have set Adequate Intakes (AI) for potassium of 1100mg/d, 1800mg/d and 2700mg/d for children of the same respective age groups. An individual's sodium to potassium (Na:K) intake ratio is an important predictor of hypertension and the World Health Organization (WHO) recommend a Na:K intake ratio of ≤ 1.0mmol/mmol for both adults and children. Although the morbidities associated with hypertension may not be seen until adulthood, blood pressure in childhood has a significant association with blood pressure in adulthood. Therefore, estimation of Na:K intake ratios (best measured by urinary excretion) in children may predict their susceptibility to hypertension related diseases in later life. The aim of this study was to estimate sodium and potassium intake and mean molar Na:K intake ratio of Irish children and to assess compliance with dietary guidance.
Morning spot urine samples were collected for 572 children aged 5–12 years (95% of total sample) as part of the nationally representative Irish National Children's Food Survey II (2017–2018) (NCFSII; www.iuna.net). Samples were transported, processed and stored using best practice procedures. Urinary excretion of sodium and potassium were measured using a Randox RX Daytona and were corrected for gender and age-specific 24-hour urine volume estimations based on 24-hour urine volume estimates from Australian children. SPSS Version 25 was used for all analyses.
Mean 24-hour urinary sodium excretion was 2018mg/d, equivalent to an average salt excretion of 5.0g/d exceeding the FSAI maximum target intake for all age groups except 11–12 year olds. Mean 24-hour urinary potassium excretion was 1411mg/d with mean intakes below the AI from EFSA for all age groups with the exception of 5–6 year olds. The mean molar Na:K ratio of Irish children was 2.8 for boys and 3.4 for girls. Only 5% of Irish children met the WHO recommendation for a Na:K ratio of ≤ 1.0mmol/mmol.
High intakes of sodium and low intakes of potassium reported in this study result in a low compliance with the WHO recommendation of a Na:K ratio ≤ 1.0mmol/mmol. This may lead to a higher risk of hypertension and related morbidities in later life. Based on these findings, dietary interventions to combat hypertension related diseases (such as lowering sodium and increasing potassium intakes) should be implemented from childhood.
Under Regulation (EC) No 1924/2006 the usage of nutrition and health claims are permitted, however foods that are high in fat, sugars and salt are advised not to use such claims as foods promoted with these claims may influence consumer food choice. The use of nutrient profiles has been proposed as a means of avoiding the potential of such claims masking the overall nutritional status of a product. Ready to eat breakfast cereals (RTEBC) often display nutrition claims whilst also contributing significantly to total sugar and energy intake. The aim of this study was to profile a variety of RTEBC and compare nutrient composition and claim information between nutrient profile categories.
The Irish National Food Ingredient database (INFID) is a record of brand specific information from food labels collected during the Irish national food surveys. A convenience sub-sample of RTEBC as eaten by Irish children during the National Children's Food Survey 2 (2017/2018) were selected (n = 102). Nutrient profile (NP) scores were calculated using the UK Nutrient Profiling Model (FSA). NP scores were calculated based on a set of negative macronutrient indicators (energy, saturated fat, total sugars and sodium) minus positive indicators (protein, fibre, “fruit, vegetables and nuts”) present per 100 g. Foods scoring four points or more were classified as “less healthy”.
More than half of RTEBC were classed “less healthy” (53%) with a median NP score of 8.0 with “healthy” RTEBC scoring significantly lower at -0.0 (p < 0.001). “Healthy” RTEBC had a median sugar content of 13.4g/100 g compared to 24g/100 g in the “less healthy” (p < 0.001). “Healthy” RTEBC had a higher fibre content of 8.8g/100 g compared to 5.72g/100 g in the “less healthy” (p = 0.001), with 35% of healthy and 28% of less healthy RTEBC making a substantiated “high in fibre” claim. Micronutrient contents of all RTEBC were similar, with only iron significantly higher in “healthy” (13.3mg/100g) compared to “less healthy” (9.5mg/100g) (p = 0.02). The prevalence of substantiated micronutrient related claims was the same between “healthy” and “less healthy” RTEBC.
“Healthy” and “less healthy” RTEBC display similar micronutrient profiles, with most of the nutrition claims on both pertaining to the micronutrient and fibre content, potentially overshadowing the macronutrient contribution of the cereals. This analysis shows the ability of nutrient profiling to distinguish products by macronutrient profiles however it identifies the complexity of application with respect to micronutrient content. Further research is required to investigate the contribution of the profiled RTEBC to total nutrient intakes.
Coinfection with human immunodeficiency virus (HIV) and viral hepatitis is associated with high morbidity and mortality in the absence of clinical management, making identification of these cases crucial. We examined characteristics of HIV and viral hepatitis coinfections by using surveillance data from 15 US states and two cities. Each jurisdiction used an automated deterministic matching method to link surveillance data for persons with reported acute and chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections, to persons reported with HIV infection. Of the 504 398 persons living with diagnosed HIV infection at the end of 2014, 2.0% were coinfected with HBV and 6.7% were coinfected with HCV. Of the 269 884 persons ever reported with HBV, 5.2% were reported with HIV. Of the 1 093 050 persons ever reported with HCV, 4.3% were reported with HIV. A greater proportion of persons coinfected with HIV and HBV were males and blacks/African Americans, compared with those with HIV monoinfection. Persons who inject drugs represented a greater proportion of those coinfected with HIV and HCV, compared with those with HIV monoinfection. Matching HIV and viral hepatitis surveillance data highlights epidemiological characteristics of persons coinfected and can be used to routinely monitor health status and guide state and national public health interventions.
There is a lack of knowledge regarding the information and support needs of people with dementia with Lewy bodies (DLB) and their families around the time of diagnosis.
A volunteer sample of patients with DLB and their family members completed a web survey hosted by the UK based Lewy Body Society in May 2014. This focused on past experiences of information and support received and what information and support needs would have been beneficial at the time of diagnosis.
One hundred and twenty five adults responded to the survey. The majority were first degree relatives or spouses of people with DLB (n = 107, 86%). Approximately 50% (n = 61) reported they had not received any tangible support at diagnosis. Thirteen categories of information needs were identified.
People with DLB and their family members are currently inadequately supported at diagnosis. There is a need to address information needs related to symptomology, medication and prognosis, including provision of emotional and instrumental social support. Seeking the views of recipients of information and support is important in ensuring relevance and appropriateness prior to the development of interventions to improve the knowledge and coping skills of people with DLB and caregivers.
Objectives: There is a growing need for efficient procedures for identification of emerging technologies by horizon scanning systems. We demonstrate the value of best-worst scaling (BWS) in exploring clinicians’ views on emerging technologies that will impact outcomes in hepatocellular carcinoma (HCC) in the next 5 to 10 years.
Methods: Clinicians in Asia, Europe, and the United States were surveyed and their views about eleven emerging technologies relevant to HCC were explored using BWS (case 1). This involved systematically presenting respondents with subsets of five technologies and asking them to identify those that will have the most and least impact on HCC within 5 to 10 years. Statistical analysis was based on sequential best-worst and analyzed using conditional logistic regression.
Results: A total of 120 clinicians uniformly distributed across ten countries completed the survey (37 percent response rate). Respondents were predominately hepatologist (41 percent) who focused on HCC (65 percent) and had national influence in this field (39 percent). Respondents viewed molecular targeted therapy (p < .001) and early detection of HCC (p < .001) as having most potential, while improved surgical techniques (p < .001) and biopsy free HCC diagnostics (p < .001) were viewed upon negatively.
Conclusions: We demonstrate that BWS could be an important research tool to facilitate horizon scanning and HTA more broadly. Our research demonstrates the value of including clinicians’ preferences as a source of data in horizon scanning, but such methods could be used to incorporate the opinions of a broad array of stakeholders, including those in advocacy and public policy.