Bridget Holmes

Meal and snacking patterns of school-aged children in Scotland

Background:Current lifestyles and the choice and availability of foods may influence the eating patterns of children. The aim of this study was to investigate the meal and snacking patterns of school-aged children in Scotland.Methods:A sub-sample of 156 children (5–17 years) from the national Survey of Sugar Intake among Children in Scotland completed a 4-day non-weighed diet diary. Meals and snacks were defined using a food-based classification system based on ‘core’ and ‘non-core’ foods. The first eating event containing a solid food item up to and including 0900 hours (1100 hours on weekend days) was defined as breakfast. Frequency of meal and snack consumption was compared between age, sex, body mass index (BMI) and socio-economic sub-groups, between term-time and school holidays and between weekdays and weekend days. Intakes of total fat, saturated fatty acids (SFA) and non-milk extrinsic sugars (NMES) on these days were also compared.Results:Children ate a median of 3.3 meals plus 2.0 snacks per day, which did not vary between age and BMI groups. In all, 83% of children ate breakfast on all 4 days. Boys ate more meals than girls but the number of snacks was similar. Children from lower socio-economic groups tended to eat more meals and fewer snacks. Snacks accounted for 21% of the total daily energy intake, 22% of total fat, 24% of SFA and 39% of NMES intake. Daily intake of energy, total fat, SFA and NMES did not differ between term-time and holidays or weekdays and weekend days.Conclusions:Children tended to follow a traditional pattern of three meals a day, which was consistent between age and BMI subgroups and between school term-time and holidays.

Food budget standards and dietary adequacy in low-income families

Supplementation has many potential advantages over fortification and dietary approaches for improving micronutrient intake. Pregnant and lactating women and infants are most likely to benefit from supplementation. Recent experience with vitamin A supplementation in young children has proved to be remarkably successful. Demonstrated efficacy of vitamin A supplements for improved child survival in many settings and a technical consensus on how to implement interventions were major factors in achieving this success. Bilateral and UN agencies worked together so that in 1999 80 % of children under 5 years of age in the least-developed countries received a vitamin A capsule in the last 6 months. At least one million child lives saved were associated with the increase in coverage in the last 2 years of the 1990s. Experience with Fe-folate supplements has not been as successful. Whilst a technical consensus has been reached on how to implement programmes to control Fe deficiency, the lack of convincing evidence of efficacy of Fe-folate supplements in terms of maternal and child survival outcomes has undoubtedly contributed to the limited pursuit of effective action. A new multiple micronutrient supplement for use amongst women of reproductive age in developing countries has been formulated. UNICEF is employing the supplement in programmes aimed at helping to prevent low birth weight. The new supplement is likely to be more efficacious than Fe-folate supplements for both maternal and child survival and development outcomes. Successful completion of rigorous efficacy trials will be critical for creating the political support needed to achieve universal coverage.

A comparison of four dietary assessment methods in materially deprived households in England

OBJECTIVES Low-income households in the UK concentrate factors associated with poor record-keeping such as lower literacy, numeracy and English language skills. The present study aimed to (1) compare the validity and acceptability of three dietary survey methods against appropriate reference measures and (2) identify a method which was both valid and acceptable in low-income households. DESIGN Cross-sectional design comparing three 4-day dietary survey methods (multiple-pass 24-hour recall, food checklist and semi-weighed method) against a 4-day weighed inventory and other reference measures within subjects. SETTING London, UK, 2001. SUBJECTS Low-income households were selected using a doorstep screening questionnaire in 18 of the 60 most deprived neighbourhoods in London. Results are based on 384 respondents (159 males, 225 females) aged 2-90 years in 240 households. Respondents were mainly White (48%), Black or Black British (31%) or Asian or Asian British (9%). RESULTS The dietary survey method preferred by interviewers was the 24-hour recall. Most respondents preferred the food checklist. Compared with the weighed inventory, repeat 24-hour recalls and the food checklist yielded higher estimates of energy and nutrient intakes. The semi-weighed method was least liked and yielded the lowest estimates of intake. CONCLUSIONS Based partly on evidence presented here and partly on evidence to be presented in later publications, four multiple-pass 24-hour recalls were recommended as the most appropriate method for a national study of diet and nutrition in low-income households in the UK.

The contribution of breakfast cereals to the nutritional intake of the materially deprived UK population

Background/Objectives:Breakfast is an important source of micronutrients in the diet and its consumption has been linked to positive health outcomes. The present analysis investigated the contribution that breakfast cereals make to the nutrient intakes of the materially deprived (low income) UK population.Subjects/Methods:Data for 3728 respondents aged 2 years and over from the UK Low Income Diet and Nutrition Survey (2003–2005) were analysed. Nutrient intakes of consumers and non-consumers of breakfast cereal were compared.Results:Breakfast cereals were consumed by 49% of men, 58% of women, 80% of boys and 80% of girls, and median intakes were: 35, 25, 29 and 21 g/d, respectively. Consumers of breakfast cereals had higher intakes of thiamin, riboflavin, niacin, biotin, folate, vitamin B6, vitamin B12, iron and zinc than non-consumers. Breakfast cereal consumption was also related to higher intakes of calcium, attributable to higher milk consumption. The intake of wholegrain and high-fibre breakfast cereals was associated with a higher intake of non-starch polysaccharides. Intakes of niacin, biotin, calcium and zinc were higher but that of vitamin B6 was lower among consumers of exclusively wholegrain and high-fibre breakfast cereals compared with consumers of other breakfast cereals. There were no significant differences observed in intakes of non-milk extrinsic sugars according to type of breakfast cereal consumed.Conclusions:Breakfast cereals make a significant contribution to the micronutrient intake of the low-income UK population.

Sugar intake and dental decay: results from a national survey of children in Scotland.

The aim of this analysis was to investigate the strength of the association between sugar intake and treatment for dental decay in children in Scotland, and the impact of tooth brushing frequency on this association. The Survey of Sugar Intake among Children in Scotland was carried out in 2006 in those aged 3-17 years. Diet was assessed using the Scottish Collaborative Group FFQ, and interviews were carried out by trained fieldworkers who asked about dental health. A total of 1700 interviews were carried out, and 1512 FFQ were returned. Of the children, 56% had received treatment for decay (fillings or teeth removed due to decay). Intake of non-milk extrinsic sugars (NMES), but not total sugar, increased the risk of having had treatment for decay: adjusted OR 1.84 (95% CI 1.28, 2.64) for the highest ( ≥ 20.0% food energy) v. lowest ( ≤ 14.8% food energy) tertile of NMES intake. This raised risk remained in children who reported brushing their teeth at least twice a day. Compared with children who reported brushing their teeth at least twice a day and were in the lowest tertile of NMES intake, children who reported brushing their teeth once a day or less and were in the highest tertile of NMES intake were over three times more likely to have received treatment for decay (adjusted OR 3.39, 95% CI 1.97, 5.82). In order to improve dental health in children in Scotland, dental health strategies must continue to stress the importance of both reduced NMES intake and good oral hygiene.

The strengths and weaknesses of dietary survey methods in materially deprived households in England: a discussion paper

In 1998, a review for the Ministry of Agriculture Fisheries and Food (the predecessor of the Food Standards Agency) was published evaluating the relative merits of different dietary assessment methods against a series of factors likely to affect compliance or accuracy in low-income households. The review informed the design of a method comparison study carried out in London, UK, in 2001, in which the validity and acceptability of 4 d dietary assessment methods based on 24 h recalls, food checklists and a semi-weighed method were compared with 4 d weighed inventories and other reference measures. Results were based on observations in 384 respondents (159 males, 225 females) aged 2-90 years in 240 households. Outcomes of the comparison study included evaluations of each method made by respondents, interviewers and researchers. These findings were used in the present paper to update and extend the 1998 review. Additional factors not included in the 1998 review have been considered. This updated and extended review provides the basis for discussion of the relative merits of approaches to dietary assessment in low-income households in developed economies. The evidence presented here and elsewhere suggests that the 24 h recall is the method best suited for dietary assessment in low-income households, followed by the weighed inventory, food checklist and lastly the semi-weighed method.

A complex intervention to improve outcome in obese pregnancies; the upbeat study

Objectives To develop a lifestyle intervention to improve pregnancy outcome in obese pregnancies. Methods In accord with UK MRC guidelines a phased approach towards development of an randomised controlled trials (RCT) was adopted by a multidisciplinary team. This included Phase I literature review and protocol development; Phase II pilot RCT to assess behavioural change and practicality; Phase III (multicentre RCT; primary outcomes; maternal oral glucose tolerance test; neonatal, macrosomia, n=2700) will follow demonstration of behavioural change in the pilot. Results An intervention based on dietary advice (low glycaemic index, low saturated fat and reduced free sugars) and increased physical activity was developed. Advice is delivered by a health trainer in eight structured sessions between 19 and 28 weeks gestation and reinforced by a participant handbook, log book and physical activity DVD. Data are entered on an internet database. Recruitment to the pilot phase is complete. 136 obese pregnant women (body mass index; 36.7±6 kg/m2; 47 nullips,71 multips; age 30±5 years; 69 white; 42 black, 7 other) have been randomised to the intervention or standard antenatal care. Physical activity is monitored by accelerometry (1 week×3) and validated questionnaire, and diet by 24 h food recall (double- pass ×3). A lifestyle questionnaire in used to assess knowledge and attitudes. Behavioural changes will be analysed in Feb 2011 and presented at the meeting. Conclusion A pilot study of a complex intervention has been successfully implemented. This step wise approach has enabled detailed development, refinement and evaluation of each component, leading to an intervention acceptable to obese pregnant women.

Challenges in the assessment of total fluid intake in children and adolescents: a discussion paper

PurposeIn recent years, evidence has emerged about the importance of healthy fluid intake in children for physical and mental performance and health, and in the prevention of obesity. Accurate data on water intake are needed to inform researchers and policymakers and for setting dietary reference values. However, to date, there are few published data on fluid or water intakes in children. This is due partly to the fact that drinking water is not always reported in dietary surveys. The aim of this paper is to review the current status of the literature and highlight the challenges of assessing total fluid intake in children and adolescents.ResultsFrom the dietary assessment literature it is apparent that children present unique challenges to assessing intake due to ongoing cognitive capacity development, limited literacy skills, difficulties in estimating portion sizes and multiple caregivers during any 1 day making it difficult to track intakes. As such, many issues should be considered when assessing total fluid intakes in children or adolescents. Various methods to assess fluid intakes exist, each with its own strengths and weaknesses; the ultimate choice of method depends on the research question and resources available. Based on the literature review, it is apparent that if the research focus is to assess only fluid intake, a fluid-specific method, such as a diary or record, appears to be a feasible approach to provide an accurate estimate of intakes.

Evaluation of a nutrient-based diet quality index in UK young children and investigation into the diet quality of consumers of formula and infant foods.

OBJECTIVE To adapt and evaluate a nutrient-based diet quality index (PANDiet) for UK young children and to determine the nutritional adequacy of their diets according to consumption of young child formula (YCF) and commercial infant foods (CIF). DESIGN Content and construct validity of the PANDiet were assessed by studying associations between the PANDiet and its components, energy intake, food intakes, and child and maternal characteristics. Four groups of children were defined according to their intake of YCF and CIF: (i) no consumption; (ii) consumption of YCF; (iii) consumption of CIF; and (iv) consumption of YCF and CIF. Child and maternal characteristics, PANDiet scores and food intakes of these four groups were compared. SETTING Secondary analysis of data from the UK Diet and Nutrition Survey of Infants and Young Children (DNSIYC, 2011). SUBJECTS Young children (n 1152) aged 12-18 months. RESULTS The PANDiet was adapted to the UK based on twenty-five nutrients. A lower PANDiet score was linked to lower intakes of YCF, CIF, vegetables and fruits. Determinants of having a lower score were being older, having siblings and having a younger mother with a lower educational level. Compared with children consuming neither YCF nor CIF, PANDiet scores were higher in children consuming CIF (+1·4), children consuming YCF (+7·2) and children consuming YCF and CIF (+7·8; all P<0·001). CONCLUSIONS The PANDiet is a valid indicator of the nutrient adequacy of the diet of UK young children. Consuming CIF was not found to be associated with lower nutritional adequacy whereas consuming YCF was associated with higher nutritional adequacy.

Erratum to A complex intervention to improve pregnancy outcome in obese women; the UPBEAT randomised controlled trial [BMC Pregnancy and Childbirth., 15, (2015), 111], DOI: 10.1186/s12884-015-0540-1

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